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PCOS and Thyroid – The Link Between The Two

Polycystic Ovarian Syndrome, or PCOS as we know it, can be quite complicated to diagnose. We know that and we’ve already discussed why in my previous article. But did you know that the lack of diagnostic criteria has led doctors to mistake it for a thyroid condition? And frankly, that’s not uncalled for because the two diseases are quite similar. In fact, many women who are diagnosed with PCOS also have an underlying thyroid condition.

PCOS and Thyroid


Studies show that depending on the type of PCOS you’ve got, there’s a 40 percent risk you also have a thyroid problem.

Now, we’ve had plenty of in-depth discussions about what is PCOS and how it happens, but we haven’t really got down to its counterpart disorder. So in this article we’ll be discussing what thyroid is and how it correlates with PCOS.

What is Thyroid?

Thyroid is one of the biggest endocrine secreting glands in the human body. It’s shaped like a butterfly and is situated in the neck. Its main function includes regulating the pace of metabolic activities and the rate at which your body consumes and makes energy. The thyroid gland also helps in making certain types of growth proteins and controls how sensitively the body will react to other hormonal secretions.

Now, there are two main types of thyroid conditions. One is where your thyroid gland is overly active. This will result in you having a higher than average heart rate, you’re most likely to be slimmer in weight, might experience trouble sleeping, anxiety issues and mood swings. However, if your thyroid is underactive, you’re likely to be overweight. Remember that being overweight/obese is also common symptom in women who suffer with PCOS.  (Polycystic ovaries- a Hormonal problem).

Women battling hypothyroidism generally feel more tired and sluggish and they’re the ones who are more at risk of developing PCOS. So let’s talk about hypothyroidism a bit more.

Hypothyroidism: Signs and Symptoms


What’s important to know about the thyroid gland is that it has a controller located in the brain. Yes, we’re talking about the pituitary gland. You may remember the name from our discussions on PCOS where I explained how the pituitary gland is responsible for the secretion of androgens, whose overstimulation can be a major cause of PCOS (androgen Overload).

We’ll talk about this gland more in a bit, but for now I want you to focus on what happens to your body when your thyroid gland doesn’t produce sufficient amounts of thyroid hormones.

Weight gain: We’ve covered this in PCOS as well. An underactive thyroid will not be able to regulate your body’s metabolic processes and will consume energy at slower rates. This means you’ll be left with plenty of intact glucose molecules in your blood that will be stored as fat.

Slow movements: The lack of energy is not only making you sluggish but you’re likely to speak and even think slowly!

Dry skin: Hormonal irregularities/imbalances increase the possibility of skin issues. With PCOS we were confronted with the acne dilemma. Here it’s dry skin, including dryness on the scalp and dandruff.

Irregular menstrual cycle: hypothyroidism is linked with delayed periods.

Other symptoms of an underactive thyroid include:

  • Breathlessness
  • Palpitations
  • Pins and needles
  • Dizziness
  • Dry eyes
  • Hirsutism
  • Hair loss (including eyebrows)
  • Hoarse voice
  • Difficulty swallowing food
  • Carpal tunnel syndrome
  • Pain in muscle and joints
  • Loss of appetite
  • Incontinence


Diagnosing Hypothyroidism

So hypothyroidism has plenty of signs and symptoms and many of them—as you may have noticed—overlap with PCOS. Some of the shared symptoms include disturbances in the menstrual cycle, problems in the ovulation cycle, skin issues, hair loss, depression, anxiety, brain fog and weight gain.

The good thing is that it’s easier to detect thyroid issues than it is to catch someone with PCOS. In fact, there is more medical research on thyroid symptoms and their causes than there is for PCOS.

To be able to tell if you or your loved one has an underactive thyroid, here are some specific symptoms you should look for:

  • Low body temperature
  • Hands and feet are cold
  • Dry skin and hair
  • The outer region of the eyebrows begin to thin or shed
  • weight gain despite diet and exercise

You can also book a consultation or a discovery session with me and if warranted, I can run some tests to help you get the correct diagnosis.

Many patients who come to me for hypothyroidism treatments are often frustrated that the tests to them by their previous doctor haven’t really helped them in any significant way.

I’m guessing the doctors tried to diagnose your condition with a single thyroid blood test? The most common way to test for hypothyroidism is to use the Thyroid Stimulating Hormone or TSH test. The sad reality is that it’s not highly accurate. The reason for this is that TSH is produced in your brain and its amount is regulated by the number of TSH already present in your system. If, for example, you’ve got an underactive thyroid and you’re not producing enough TSH, your brain will try to increase the levels of TSH to counter the effect. This creates much confusion during diagnosis because the amount of TSH present in your body never truly indicates the health or functioning capacity of the gland itself.

There’s also the issue of hypothyroidism or Hashimotos being present with the condition of PCOS. Since PCOS is an inflammatory condition, this inflammation can impact production and release of TSH from the pituitary. What this means is that even if you’ve got enough TSH in your system, it may not be producing enough thyroid hormones that your body requires. In such cases, it’s risky to base the health of your thyroid system on the amount of TSH present in a body. You need to run a full thyroid panel if you can identify with more than half of the typical low thyroid symptoms.

How are PCOS and Hypothyroidism related?

Studies show that over 22 percent of women with PCOS are also diagnosed for an underactive thyroid.

More specifically, a certain type of hypothyroidism, the Hashimoto’s Thyroiditis is often diagnosed in women that have PCOS, more so than it is diagnosed in the average population. Hashimoto’s is an autoimmune disease where the body counteracts against its own defense systems. You can read more about it here.

But even as we realize that the two disorders are connected with each other, there are seemingly more questions that need to be asked. For example, are the two disorders being caused by the same factors?

Understanding the Causes of Hypothyroidism

According to research, PCOS and thyroid disorders can both be triggered by environmental and genetic factors. In our last article, we learned that PCOS doesn’t have a singular cause but is usually the result of androgen excess and insulin resistance if family history doesn’t play a role. Now, let’s take a look at the risk factors of hypothyroidism:


  • The presence of an autoimmune disease: I just mentioned a study explaining the Hashimoto’s disease. This is an example of the immune system’s dysfunction. In the case of thyroid, the immune system mistakes the thyroid gland and its cells as infection and attacks them. This results in little to no thyroid hormones.


  • If you have ever had your thyroid gland surgically removed: In some serious medical conditions like thyroid cancer, people feel the need to have some part, if not all of their thyroid removed. This reduces the source of TSH and hence the thyroid hormones themselves.


  • Radiation therapy patients: Individuals who have undergone radiation treatment for cancerous thyroid glands can lose some part of their thyroid functioning.


  • Congenital hypothyroidism: This is a case where a baby is born with an underactive thyroid because it’s either partially formed or placed wrongly.


  • An inflamed thyroid gland: This happens when the gland is attacked by a viral infection or an autoimmune disease. The inflamed glands are known as the condition of Thyroiditis.


  • Medication triggers: Certain kinds of medicines can keep the thyroid gland from being able to produce normal levels of thyroid hormones. These medicines can further exacerbate the hypothyroidism condition among patients who possess a genetic tendency for the disease. Hold on to this point because we’ll come back to it when we discuss the treatments for hypothyroidism.


  • Pituitary gland damage: Also known as the master gland, the pituitary gland signals the thyroid on the number of hormones it needs to produce. However, if the pituitary is damaged, then it can stop signaling the thyroid gland on how much hormone it needs to secrete. Conditions like radiation, surgery and the presence of a tumor can all disrupt the master gland’s communication with the thyroid gland.


  • Iodine: Too little or too much iodine in the system can affect the production of thyroid hormones. This is because the thyroid gland needs some amount of iodine to perform its function. When you intake iodine through your food, it travels from the bloodstream straight to the thyroid. Be careful with any supplements containing Iodine if you have Hashimotos or a selenium deficiency.



So, is there a link?


Looking at these risk factors, we can tell that although hypothyroidism and PCOS are uniquely separate disorders, they do have some overlapping causes. Take for example the damage or insult to the pituitary gland caused by inflammation, environmental toxins etc.


For PCOS, any kind of insult to this master gland can cause an abnormally high secretion of male androgens. High testosterone levels bring about acne, hirsutism and ovarian dysfunction—all of which are also symptoms of an underactive thyroid.


One study reaffirms this link as it explains how hypothyroidism patients also exhibit high numbers of free testosterone in the body. Connected to this is the notion that a lack of thyroid hormones is also linked with worsening PCOS symptoms like insulin resistance. According to this study, insulin resistance is a natural consequence of hypothyroidism.

We also know that excess androgens, insulin resistance and Diabetes often seen in PCOS can cause problems with Thyroid over conversion where too much T4 is converted into T3. I talk about this in my free Ebook on Thyroid problems.

But if that isn’t enough of an overlap between these two disorders, juvenile primary hypothyroidism is also known to cause cystic ovaries—just like PCOS.

This happens because with the increase of testosterone levels, the sex hormone binding globulins, i.e. SHBG, reduce in number. So now we’ve got thyroid-related hormonal imbalance that mimics hormonal imbalance issues in PCOS.

Does that mean we can treat PCOS by treating hypothyroidism?

Sometimes… But, let me explain a bit further.  There are many common denominators that we see in both conditions. These common denominators include, Inflammation, Androgen overload, Insulin Resistance, Toxic liver, disturbances in cortisol levels and blood sugar problems. Also, both conditions seem to be intertwined when it comes to certain food sensitivities such as Gluten, Soy, Corn and Dairy. But there are many unique metabolic imbalances that make these conditions different as well.

The good thing about addressing the Root cause of PCOS is that if you opt for natural, functional medicine based options, improving one condition will often improve the other. This is what makes Functional Medicine so different than just treating or managing symptoms.

Treating Thyroid Disorders

As is my approach to functional medicine, our target is to eliminate the factors that are causing thyroid problems in the first place.

The first thing I’d recommend all my clients to do is to ensure a healthy, balanced diet. You’ll want to avoid foods that spike your insulin levels as well as foods that you have a food sensitivity to. Other considerations include things like hidden gut infections, SIBO, leaky gut or gut dysbiosis. Improving or supporting liver function is also key because the liver is the primary area where T4 is converted into T3. The liver also makes and stores glucose.  From a dietary standpoint, try to incorporate a low Glycemic diet, a paleo diet, or an AIP diet as I have explained here. For many woman with PCOS there is an autoimmune component very similar to that seen with thyroid disease and they will benefit most from the AIP diet.

With thyroid disorders, as a reminder, you must be very careful with any supplementation that contains iodine. While Iodine is necessary for thyroid function, in cases of autoimmunity, Iodine can be like gas on a fire. Please make sure that whoever you work with, testing for Hashimotos disease is done before attempting any supplementation that contains Iodine.

If you work with my office, you can rest assured that we will approach your PCOS or Thyroid problem addressing and identifying what your Root cause is. This means taking a BIG picture approach which often includes assessing nutritional deficiencies, food sensitivities, Complete thyroid and female hormone workup and investigating any potential problems related to gut health. We can then help customize your diet with my functional nutrition consultation program.

Another recommendation I would suggest is that you engage in regular exercise. Frequent cardiovascular activity and weight training can help with insulin levels, thyroid weight gain and keep your hormonal imbalances at bay. It’ll also help emotional stability by reducing your stress levels.

Thyroid or PCOS patients who wish to get in touch with me can do so by completing this health survey. This should give me a glimpse of your underlying health conditions, your goals and objectives and help me decide what will be the best approach in helping support your body.

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