PCOS And Your Thyroid: How Nutrition Plays A Role

Thyroid disorders and polycystic ovary syndrome (PCOS) are two of the most common (and perhaps overlooked) endocrine disorders in women. Although hypothyroidism and PCOS are very different, these two conditions share many similar features. Here’s what you need to know.

About the Thyroid

Located in the base of your throat with a butterfly shape, the thyroid gland regulates the rate at which your body converts food for energy, functioning as a thermostat to control the body’s metabolism and other systems. If working too fast (hyperthryroid) it tends to speed up your metabolism. If it works too slowly (hypothyroid) this tends to slow down your metabolism, resulting in weight gain or difficulties losing weight.

All cells in your body rely on the hormones secreted from your thyroid to function properly. In addition to controlling the rate at which your body converts carbohydrates, protein, and fats into fuel, thyroid hormones also control your heart rate and can affect your menstrual cycle, thus affecting fertility.

Statistics show one in eight women between the ages of 35 and 65 have some form of a thyroid disease (1). The most common form of thyroid disorders are autoimmune related and include conditions like Graves’ and Hashimotos, which occurs in the majority of patients.

Thyroid Hormones

The main thyroid hormones that the thyroid gland produces are triiodothyronine (T3) and thyroxine (T4). These hormones are synthesized from the amino acid tyrosine and the mineral iodine.

Signs and Symptoms of Hypothyroidism

According to the American Thyroid Association, hypothyroidism has a large variety of symptoms, many of them similar to PCOS (1). When your thyroid hormone levels are too low, your body’s cells cannot get enough thyroid hormone, slowing down your body’s systems. For example, the body makes less heat causing you to feel cold. Hypothyroidism doesn’t just cause symptoms; it can make other conditions worse. Symptoms of hypothyroidism usually appear slowly over several months or years. In general, the lower your thyroid hormone levels become and stay low, the more severe your symptoms will be.

Here’s some of the most common signs and symptoms:

 Common Signs and Symptoms of Thyroid Disorder

Diagnosing Hypothyroidism

To really diagnose hypothyroidism, your doctor should do the following:

  • Evaluate your symptoms, medical history, risk factors, and family history
  • Perform a physical exam
  • Check these blood tests:

TSH: measures how much T4 the thyroid is being asked to make. An abnormally high TSH test may mean you have hypothyroidism. Relying on TSH alone is not sufficient to make an accurate diagnosis and one reason why so many people with hypothyroid are misdiagnosed.

T4 tests (Free T4, free T4 index, total T4): assesses the amount of T4 your thyroid is producing.

Thyroid peroxidase antibody (anti-TPO) (TgAb): checks for thyroid antibodies and to detect autoimmune thyroid conditions like hashimoto’s.

T3 and Reverse T3 (rT3): assesses the amount of T3 your thyroid is producing and its ability to convert T4 to T3.

According to the American Thyroid Association, saliva tests for detecting thyroid disease are not accurate (1).

PCOS and Thyroid Disorders

It has been reported that hypothyroidism and autoimmune types of thyroid are more common in women with PCOS as compared to the normal population (2,3).

Sinha and colleagues found that 22.5% of women with PCOS had hypothyroidism compared to 8.75% in controls (3) and TPO antibodies have been shown to be present in 27% of patients with PCOS versus 8% in controls (4). More recently, a study published in Endocrine Research demonstrated a higher prevalence of Hashimoto’s thyroiditis (HT), elevated TSH, anti-TPO, and anti-Tg levels in PCOS patients (5). The researchers suggest an increased estrogen and estrogen/progesterone ratio seem to be directly involved in high anti-TPO levels in PCOS patients.

Both genetic and environmental factors are believed to be contributing to thyroid disorders in PCOS. Hypothyroidism is known to cause PCOS-like ovaries and overall worsening of PCOS and insulin resistance (1, 6).

Hypothyroidism can increase testosterone by decreasing the level of sex hormone binding globulin (SHBG), increasing the conversion of androstenedione to testosterone and estradiol, and reducing the metabolic clearance of androstenedione (1,5).

Medical Treatment for Hypothyroid

Hypothyroidism can’t be cured but it can be treated by replacing the missing thyroid hormone with synthetic thyroxine pills, which must be taken daily for life. Medications can treat hypothyroidism but not always its symptoms.

Nutrition and Thyroid

Functional medicine involves finding the underlying causes of the thyroid dysfunction or autoimmune response. For example, what is causing the body to attack itself, which is what happens with autoimmune conditions like hashimoto’s.

Soy
Soy is a phytoestrogen. This mean it can mimic estrogen although it does so very weakly and nowhere close to being as powerful as estrogen. Eating large amounts of soy can inhibit the activity of thyroid peroxidase (TPO) and cause the thyroid to be inflamed.

If you have a thyroid disorder, you may want to limit your intake of soy. Examples of soy foods include tofu, soy milk, and foods that are meat-alternatives. Be sure to read labels for hidden sources of soy. Watch out for the ingredient soy protein isolate which is found in many bars, protein powders, cereals, and processed food.

Gluten
Gliadin, the protein found in gluten is very similar to the hormone produced by the thyroid gland. The result is that the body thinks it has plenty of thyroid hormone and stops working as it should.

While there is a lack of scientific research to support it, gluten is linked with worsening (or causing) autoimmune disorders. Markers of autoimmunity, such as antihistone, have been reported to be elevated in PCOS women (7). If you have a thyroid disorder, especially an autoimmune one, it may benefit you to try a gluten-free diet to see how your symptoms respond.

Sugar
Hypothyroidism can worsen insulin resistance. A study published in Human Reproduction showed that women with the highest TSH levels (hypothyroidism), tended to have the most severe insulin resistance, regardless of weight status (6). Sugary foods and drinks raise insulin levels. Avoiding sugar as much as possible is important.

Iodine
The thyroid must have iodine to make thyroid hormone. The main food sources of iodine include dairy products, chicken, beef, pork, fish, and iodized salt. Pink Himalayan and sea salt are not rich sources or iodine. Keeping thyroid hormone production in balance requires the right amount of iodine. Too little or too much iodine can cause or worsen hypothyroidism. Discuss with your doctor before taking iodine supplements and use with caution and only under supervision of a health care provider.

In addition, it’s important to eat a healthy diet that includes a variety of fruits and vegetables to provide adequate amounts of vitamins and minerals such as selenium, zinc, chromium, and magnesium to keep your thyroid functioning properly.

Do you have PCOS and diagnosed with a thyroid disorder? Please share your experiences with us below:

 

Sources
1.HYPOTHYROIDISM: A BOOKLET FOR PATIENTS AND THEIR FAMILIES. A publication of the American Thyroid Association (ATA) www.thyroid.org accessed on July 14, 2015.
2.Rajiv Singla, Yashdeep Gupta, Manju Khemani, and Sameer Aggarwal. Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian J Endocrinol Metab. 2015 Jan-Feb; 19(1): 25–29.
3.Sinha U, Sinharay K, Saha S, Longkumer TA, Baul SN, Pal SK. Thyroid disorders in polycystic ovarian syndrome subjects: A tertiary hospital based cross-sectional study from Eastern India. Indian J Endocrinol Metab. 2013 Mar; 17(2):304-9.
4.Garelli S, Masiero S, Plebani M, Chen S, Furmaniak J, Armanini D, Betterle C. High prevalence of chronic thyroiditis in patients with polycystic ovary syndrome. Eur J Obstet Gynecol Reprod Biol. 2013 Jul; 169(2):248-51.
5.Arduc A, Dogan BA, Bilmez S, Imga Nasiroglu N, Tuna MM, Isik S, Berker D, Guler S. High prevalence of Hashimoto’s thyroiditis in patients with polycystic ovary syndrome: does the imbalance between estradiol and progesterone play a role? Endocr Res. 2015 Mar 30:1-7.
6.Mueller A, Schöfl C, Dittrich R, Cupisti S, Oppelt PG, Schild RL, Beckmann MW, Häberle L. Thyroid-stimulating hormone is associated with insulin resistance independently of body mass index and age in women with polycystic ovary syndrome. Hum Reprod. 2009 Nov;24(11):2924-30.
7.Hefler-Frischmuth K, Walch K, Huebl W, et al.Serologic markers of autoimmunity in women with polycystic ovary syndrome. Fertil Steril 2010;93:2291–4.

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Comments (14)
  • Danielle

    July 23, 2015 at 7:06 pm

    I’m 25 years old and when I was 12 I had my first menstrual cycle. When I was 13 it stopped completely. Found out that I had pcos and they put me on birth control pills to regulate things. I was on them until 2010. My fiance and I were trying to convince and could not. Later in 2010 I was sent to a endocrinologist and was diagnosed with hypothyroidism. They put me on synthroid and metformin ( which is for pcos). And it seemed to work well for the pcos until my cycle stopped again in a year. It’s off and on and it has taken a toll on me. I believe that I had both pcos and a thyroid disorder when I was 13, but being too young, the Dr decided to wait until I was older. With the thyroid problem, it is extremely hard for me to loose weight and once I do and get to a small goal amount, it all comes back and then some. Both disorders cause infertility and we have been trying for five years now and aren’t going to give up. If there is something extra to help with both disorders to help conceive, please let me know.

  • Aimee

    July 29, 2015 at 7:07 pm

    I have PCOS and now hypothyroid. I can honestly say this is the worst I’ve ever felt. Working to get pat the fatigue and weight gain. Started cleaning up my diet gluten free, dairy free, yeast free. Tough but hope to see results. Great article! Thank you.

  • Mary

    January 6, 2016 at 7:08 pm

    Hi I’m Mary I have PCOS and low thyroid.I recently had my thyroid test done its low causing me to be sluggish fatigue all the time much more in mornings my joints.its like I never get enough sleep.my sugar has been dropping lately.my periods are heavy unexpected no regular schedule I’m 49 the doc said I’m in perimenopause too.

  • An

    January 25, 2016 at 12:35 pm

    Interested in trying this. Unfortunately, I can’t stand any drink mix -ins. Is it available is pill form, or could it be put into a gel cap? Or possibly tasteless in something like yogurt, smoothie, etc? Looking for an alternative to metformin as my stomach can’t take it. Thanks! 🙂

  • Angela Grassi

    January 26, 2016 at 12:35 pm

    Thanks for your comment on the PCOS nutrition Center Blog. Ovasitol is a tasteless powder that should be taken with meals and should be dissolved in your favorite hot or cold beverage.

    Other forms of inositol are available but none that compare to the combination of myo and DCI in Ovasitol.

  • Gurpreet kaur

    March 30, 2016 at 2:47 am

    I have pcos and thyroid. I am a mother of 1year old daughter. Post delivery my weight has increased rapidly. My tsh levels have increased and pcos is worsening. Can u please help ?

  • Gina

    October 24, 2016 at 7:35 pm

    I am 35 and have both POCS and hypothyroidism. I have been unable to lose weight despite extremely clean eating and daily exercise. I have been prescribed birth control for the POCS but that made me gain a lot of weight. So I stopped taking the birth control. My thyroid medicine is armour and cytomel, and aside from high antibodies my thyroid is mostly under control. i am not sure what else to do and feel hopeless. I have had hypothyroidism since i was 25 and have been able to stay a healthy weight. For some reason, now that i have POCS nothing works. It has been 1 1/2 years of hard work with no effort.

  • Angela Grassi

    October 25, 2016 at 7:38 am

    Gina, a big reason a lot of women struggle to lose weight is due to insulin. Metformin can help but there are some other aggressive insulin sensitizing supplements like Ovasitol and NAC (both in our supplement store) that can help. As always, focus on getting labs into normal ranges with lifestyle changes rather than focusing on a number on a scale.

  • Jennifer Post

    March 2, 2017 at 4:48 pm

    I was recently diagnosed with Hashimoto’s. Is this different than hypothyroidism and is it curable? I was told it was curable with a clean diet, but I get conflicting information.

  • Angela Grassi

    March 2, 2017 at 5:38 pm

    Hi Jennifer!
    Sadly, Hashimoto’s is an autoimmune disorder and does not go away but can be managed.

  • Jennifer phanton

    March 10, 2017 at 6:05 am

    So I’m a 37-yr old female who had a thyroidectomy 15 months ago. I found out, when having my thryroid removed only made things worse, that I have PCOS and Hashimoto’s. I’ve always battled weight, depression, lethargy, no menstral cycle or irregular ones, acne, low blood sugar ironically combIned with high insulin, issues ovulating, and miscarriages (3 pregnancies and I’ve miscarried them all). I’ve read the article and my question is, what do I do now that I no longer have a thyroid but my PCOS remains and I feel worse now? I can’t be on Metformin as it causes my blood sugar to crash all the time. My allergist says I’m allergic to Gluten and I must admit I haven’t been able to cut Gluten from my diet. I also eat a lot of sugar so that doesn’t help. When I try to eat healthy I feel sick, it isn’t until a few days later when I finally break and eat junk food that I actually physically feel better. So I feel like I’m damned if I do and damned if I don’t. What do I do? I’ve considered HRT. But beyond that I’m at a loss. My allergist says nothing will get better until I cut Gluten out. But if I’m giving myself thyroid meds then how does Gluten even matter at this point? How do I still have PCOS when I’m regulating my own thyroid hormones?

  • Angela Grassi

    March 13, 2017 at 8:36 am

    If you have an allergy to gluten, eating it will cause more inflammation and make your PCOS symptoms worse. If you need support in making changes to your eating to reduce gluten and sugar, we can help. Many women get good results with Ovasitol helping to reduce cravings for sweets and carbs: http://www.pcosnutrition.com/product/ovasitol/

  • Arshiya

    May 24, 2017 at 6:03 am

    Hiiii …I’m Arshiya I’m 28 years old I have hypothyroid and pcos I have two kids after my second delivery my weight has increased a lot from 60 kg to 75 kg unable to loose weight my skin has become so dark and excess hair fall I am on metformin since 3 months but result , my periods are irregular if I periods once in 6 months bleeding is only for two days
    Please help me

  • Diana

    October 6, 2017 at 6:04 am

    Hi I’m 29 I have had a pacemaker since I was 18mons. I was diagnosed with PCOS when I was in highschool later had a daughter after graduation, after 7yrs had another daughter now I have had hives out of nowhere and feeling sick not knowing what was wrong went to have blood work done came back my thyroid was low the heart doctor says I have to go and have more blood work done for my thyroid today. I don’t know what to do, how is all this going to mean on my health? Pacemaker, PCOS, and thyroid smh…..

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