"It is probably just the menopause." I hear that sentence often from women who have been tired, cold and low for months. Sometimes it is true, sometimes an underactive or overactive thyroid sits behind the same complaints. The trouble is that thyroid symptoms are so general, fatigue, weight change, a flat mood, that they are easily put down to stress or a busy life. Three blood values, TSH, free T4 and anti-TPO, usually give a first answer within a single test.
This is the overview article of our thyroid series. My view: with persistent, unexplained fatigue the thyroid should come into the picture early, not only after every other cause has been ruled out. Below you will read what the thyroid does, which symptoms fit which type, which values to test, and when a test truly adds something.
Where is your thyroid and what does it do?
Your thyroid is a butterfly-shaped gland in your neck, just below your Adam's apple, in front of your windpipe. It produces the hormones T4 and T3, which regulate your metabolism: heart rate, body temperature, energy and digestion. Too little or too much thyroid hormone can throw that whole system off balance.
Control runs through your brain. The pituitary gland produces TSH (thyroid-stimulating hormone), which tells the thyroid how much hormone to make. That is why TSH is often the first value to shift, before you notice anything yourself. A TSH value is therefore the usual first step.
Recognising thyroid symptoms in women
Thyroid symptoms in women are often vague and develop slowly. An underactive thyroid slows your system (tired, cold, weight gain), an overactive thyroid speeds it up (palpitations, weight loss, restlessness). Many women only realise afterwards how long the complaints had been there.
Complaints that may fit an underactive thyroid (hypothyroidism):
- Persistent fatigue, even after enough sleep
- Weight gain without eating differently
- Feeling cold quickly, especially hands and feet
- Dry skin, brittle hair or hair loss
- A low or flat mood, slow thinking
- An irregular or heavier period
Complaints that may fit an overactive thyroid (hyperthyroidism):
- Palpitations or a fast heart rate at rest
- Unintentional weight loss while eating normally or more
- Sweating easily, feeling warm, trembling hands
- Restlessness, irritability or poor sleep
- More frequent toilet visits, looser stools
- A lighter or skipped period
The overlap with other causes is large. Fatigue and weight change fit iron deficiency, the menopause or a low period just as well. So a symptom alone says little, and a blood value gives direction. Read also which hormones you can test as a woman if you are unsure where your complaints come from.
Which thyroid value fits which symptom?
Not every symptom calls for the same value. The table below links common complaints to the blood value that usually says the most. Use it as a starting point for a conversation with your doctor, not as a diagnosis.
| What you notice | Value that gives insight | Why |
|---|---|---|
| Tired, cold, weight gain | TSH + free T4 | May point to an underactive thyroid |
| Palpitations, weight loss, restlessness | TSH + free T4 | May point to an overactive thyroid |
| Complaints plus thyroid disease in the family | Anti-TPO | Shows autoimmune involvement (Hashimoto) |
| Wish to conceive or pregnancy | TSH + anti-TPO | Thyroid may affect fertility and pregnancy |
| Borderline TSH, yet complaints | Free T4 + free T3 | Gives a fuller picture than TSH alone |
This table is an aid, not a substitute for medical advice. Which combination is useful for you depends on your complaints and history, and is best discussed with a doctor.
Underactive versus overactive thyroid: the difference
With an underactive thyroid the gland makes too little hormone. Your TSH then rises (your brain asks for more) and your free T4 falls. With an overactive thyroid it is the reverse: TSH falls and free T4 rises. That mirror image is the heart of the difference.
The most common cause of an underactive thyroid in the Netherlands is the autoimmune disease Hashimoto, in which the immune system slowly suppresses the thyroid. For an overactive thyroid, Graves' disease is the best-known cause. Both are far more common in women, often around hormonal transitions such as after childbirth or in the run-up to menopause. The NHG (Dutch College of General Practitioners) thyroid guideline describes these patterns and when each value is useful.
Want to go deeper into one type? Read our separate articles on the underactive thyroid (hypothyroidism) and the overactive thyroid (hyperthyroidism).
Why does the thyroid affect women so often?
Women have a higher risk of thyroid problems, partly through autoimmunity and partly through the interplay with their sex hormones. The risk rises around major hormonal moments: after pregnancy and during menopause.
Oestrogen affects how much thyroid hormone is freely available in your blood. During menopause that balance shifts, and thyroid complaints can easily be confused with menopausal ones. They look strikingly alike: fatigue, mood swings, weight change. So it can be useful to include your thyroid when menopausal complaints arise. Read more about the underactive thyroid and the menopause.
After childbirth a temporary inflammation of the thyroid can occur (postpartum thyroiditis). It first causes fast, then slow complaints and often recovers on its own, but deserves attention if the fatigue persists.
When is a thyroid test useful?
A test is most useful if you have complaints that do not pass, or if you belong to a higher-risk group. A one-off measurement of TSH and free T4 then gives quick direction: is your thyroid in balance or not? On Thuisarts.nl, the public information of the NHG, you can read that unexplained fatigue is a logical reason to consider blood testing.
Women with an autoimmune condition elsewhere in the body, such as rheumatoid arthritis or type 1 diabetes, have a higher risk of an autoimmune thyroid disease like Hashimoto's. The same applies to women with Down syndrome or Turner syndrome. If you have one of these conditions, discuss with your GP whether periodic monitoring of your thyroid values makes sense, even if you have no complaints yet.
- You have persistent fatigue, weight change or mood complaints
- You wish to conceive or are newly pregnant
- Thyroid or autoimmune diseases run in your family
- You recognise menopausal complaints and want to rule out the thyroid
- You previously had an abnormal value and want to follow it up
At Lunara you test your thyroid values without a referral. The Thyroid Complete measures TSH, free T4, free T3 and anti-TPO at once, so you get a fuller picture than with TSH alone. For a simple baseline, the Thyroid Function looks at TSH and free T4.
Which values are measured?
A thyroid test looks at a few core values. Together they show whether your thyroid works too hard or too softly, and whether an autoimmune cause is involved.
- TSH is the regulator from your brain and usually the first value to change. A high TSH fits an underactive thyroid, a low one an overactive thyroid.
- Free T4 is the active storage hormone. It shows how much hormone your thyroid actually releases.
- Free T3 is the active form your cells use. It refines the picture, especially with an overactive thyroid.
- Anti-TPO are antibodies that may point to an autoimmune process such as Hashimoto.
A result is always read alongside the reference range and your complaints. A value just outside the range does not automatically mean disease, and a normal value does not rule everything out. So discuss your result with a doctor. How to read the numbers is in thyroid values explained.
Testing your thyroid via Lunara: how it works
You do not need a referral for a thyroid test. You order online, book an appointment at a blood-draw location near you and have blood taken in the morning. You receive your result digitally, usually within a few working days. Nothing is shipped: you go to a location, give blood, and get your results online.
A practical tip: test preferably in the morning and, if you measure more often, around the same time each time. TSH has a natural daily rhythm, and by testing consistently you make your measurements more comparable. For TSH and free T4 you usually do not need to fast, but always mention your medication and any pregnancy, as these can affect how your values are interpreted.
Every result gets context from a BIG-registered doctor, per value. So you know not only what your TSH is, but also what that may mean in your situation and whether a next step is logical.
What does a borderline value mean?
Not every deviation is immediately a disease. A common grey area is subclinical hypothyroidism: your TSH is slightly raised, but your free T4 is still within range. Whether that causes complaints and whether something should be done about it depends on your age, your complaints, any wish to conceive and whether your anti-TPO is raised.
The NHG (Dutch College of General Practitioners) thyroid guideline often advises in such borderline cases to repeat the measurement after a few weeks to months, rather than over-interpreting a one-off number. A value just outside the range therefore does not automatically mean something is wrong, and a normal value does not rule everything out. The combination of values, your complaints and time together gives the most reliable picture.
The thyroid across different life stages
When a thyroid test is useful shifts with your life stage. It helps to know in which period your thyroid may deserve extra attention.
| Life stage | Why the thyroid may act up | When to consider testing |
|---|---|---|
| Wish to conceive | The thyroid can affect fertility and early pregnancy | Beforehand, certainly with earlier deviations or complaints |
| After childbirth | A temporary inflammation (postpartum thyroiditis) occurs | With persistent fatigue or palpitations after birth |
| Perimenopause and menopause | Shifting oestrogen levels and rising age-related risk | When menopausal and thyroid signals run together |
This table is an aid, not a prescription. Whether testing is useful in your situation is best discussed with a doctor. On Thuisarts.nl you find additional, reliable explanation per life stage.
Read on in this thyroid series
- Thyroid and fatigue, when your thyroid is the cause of tiredness.
- Testing your thyroid, the difference between a self-test, home test and blood test.
- Always tired?, which blood values give insight with persistent fatigue.
Frequently asked questions
Can I test my thyroid without a GP?
Yes. At Lunara you order a thyroid test without a referral and have blood taken near you. You then discuss an abnormal result with your GP, who refers to an internist or endocrinologist if needed.
Which thyroid value matters most?
TSH is usually the first and most sensitive value, because it reacts first. For a fuller picture, TSH, free T4 and, when in doubt, anti-TPO are read together. One value alone rarely gives the whole picture.
Are thyroid complaints the same as menopausal complaints?
They look very alike: fatigue, weight change and mood swings occur in both. So with menopausal complaints it can be useful to test the thyroid as well, so you know which cause is at play.
How often should I have my thyroid checked?
That depends on your complaints, history and earlier values. Discuss with your GP what suits your situation; a fixed frequency does not apply to everyone.
Sources
- NHG Guideline Thyroid Disorders (M31). Dutch College of General Practitioners. Available via nhg.org.
- Thuisarts.nl, I am tired / My thyroid works too slowly or too fast. Dutch College of General Practitioners. Available via thuisarts.nl.
Every blood test result via Lunara includes a professional review by a BIG-registered doctor. For treatment decisions, discuss your results with your GP.
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