When patients are referred to Dr Mary Ryan it is usually because they are burnt out.

“The majority of women would be referred with profound fatigue – they are never half tired, they are always crashed,” she says.

“Often it can occur after having a baby or during or after menopause but it can affect women of any age.”

Dr Ryan watches out for a few particular symptoms.

“If somebody came to me very tired, exhausted, with dry skin, dry hair and putting on loads of weight I’d be very suspicious of an underactive thyroid. If they said they’d lost weight and had palpitations and sweating and felt exhausted I’d be fairly sure that we were looking for an overactive thyroid.”

Dr Ryan always recommends that women– and men– who are experiencing fatigue have their thyroid levels tested via blood tests with their GP. That’s because, apart from the symptoms mentioned above, if left untreated, thyroid conditions can lead to more serious health problems down the line like a goitre, heart disease, depression, nerve damage and fertility problems.

Apart from an under or overactive thyroid, the problem could also be with the pituitary gland – the hormonal control centre.

“The pituitary gland – the control centre – may be overtired because they are overdoing it. That gland controls all the hormones to the muscles and if that has resulted in a hormone imbalance as well it becomes a vicious circle. If you have very heavy periods thrown into that or if you are peri-menopausal or menopausal that adds to the problem too.”

Hormones do so much

With more research being done into the role of hormones in overall health, endocrinology is starting to be valued as an important medical area, she believes.

“Like so much else in the world I believe it took women coming into medicine to focus on this,” she says.

Without hormones, our bodies can’t function as these chemicals control every muscle and organ in the body.

“They dictate our daily rhythms, stabilise our immune system, keep our brain fit and regulate our appetite and core body temperature,” she says. “They operate muscle and bone growth, the menstrual cycle, our feelings and moods.”

Women need to slow down

Because hormonal control “loops” are complex, the hormonal system is therefore very vulnerable to stress and sleep deprivation.

That’s where women not overdoing it comes in. It’s something that Dr Ryan is always keen to draw attention to.

“Women have to really look at their lives and slow down,” she says. “They have to give themselves time to rest and prioritise their wellbeing.”

It’s one of the reasons she wrote the book, It’s Probably Your Hormones, she says. Reared on a farm herself and aware of many rural women’s workloads, she is passionate about educating patients – and doctors – about hormone health.

“When we understand our bodies and what they need for good hormonal health, especially for women, we can advocate for ourselves, at home, at work and in the doctor’s office,” she says.

In relation to extreme fatigue, she gives an example of a classic patient situation and points out that she is not averse to ringing husbands to tell them that their wives need to rest.

“I remember one farming patient in her late 40s with four children who was exhausted, doing the milking before she got the children out to school,” she says.

“I told her she was going to have to rest. She said she couldn’t, that her ‘husband is a workaholic and he wouldn’t understand me sitting down.’ I said: ‘Has he ever asked you how tired you are?’ and she said: ‘No, he’s not that type of man.’

“In that situation I knew I had two choices: one was to bring her into hospital to rest her and the other was to ring the husband to explain how sick she was and that rest was compulsory.

“Once he realised, he was understanding, but in some situations women are their own worst enemies because they don’t rest, they let on they’re fine and keep going, going, going until they fall.”

Break the cycle

Dr Ryan is emphatic about change being needed; about women’s self-esteem needing to improve in order to stop this tendency to overdo it.

“We bring a lot of baggage with us,” she says. “We’ve seen our mother doing it all and we feel guilty if we don’t, but I always explain to them that men will do their own thing whereas women think they have to do it all. That’s something that I hope will change with women – that they’ll get to love themselves as much as men love themselves. We really have to do that and in doing that we will change the dysfunctional cycle, break the inter-generational problem of repeating the patterns of our mothers and grandmothers. That way, we’ll have a healthy hormonal balance. It’s something that’s so important.”

When all is working well

If the thyroid level in the blood is in the optimal range (15-20 or 21) you will have lots of energy and feel strong and your body will respond to behavioural changes such as increased exercise or a healthier diet.

“When your thyroid is working at its optimum you can also regulate your temperature to suit all types of weather,” she says, “your bowels work without grumbling, there are no problems with your libido, you have as much energy as you need and you are enjoying life.”

If your thyroid is out of sync, however, it’s a different story, leading to the symptoms mentioned above.

Treat tired pituitary gland

So, what are Dr Ryan’s solutions when it comes to treatment – firstly when one’s pituitary gland is tired and not working correctly?

“As well as fatigue you could experience restless leg syndrome and severe migraine – these would all be symptoms of a tired pituitary gland. There is a tablet to help get those hormones right,” she says, “but equally the person has to rest and eat a very healthy diet. The pituitary gland is controlling everything and particularly with thyroid patients, if they are overdoing it, the thyroid levels will go completely out of sync and it can be very hard to get them right.”

Overactive thyroid

“With an overactive thyroid [Grave’s Disease] the eyes protrude a little, the person loses weight, gets sweaty palpitations and become exhausted as a result. Those with overactive thyroid often have an irregular heart rate as well, which is the most common cause of stroke – a thing called atrial fibrillation.”

If the person has an overactive thyroid gland, what can be done?

“An overactive thyroid can be a little more difficult to treat and can need extra treatment in hospital. There is surgery but only if they’ve got a big goitre. The other is radiation, which we don’t tend to do as much now. We go more for the medication methimazole and we usually give it to reduce the excess T4 [one of the two main hormones produced by the thyroid gland]. The person usually has to take that medication for two to three years to get the thyroid back to normal.

“We’ve also found that patients with overactive thyroid do well on a gluten-free diet. Also the minerals zinc and selenium seem to help the whole hormone balance.”

Underactive thyroid

“This often happens after having a child because for two months prior the mothers weren’t sleeping well, they may have had a long labour and are doing all the nursing. They should share the nursing; use a breast pump to express milk so that their partner can take over every second night so that they get a night’s sleep. There is no point in two people being tired,” says Dr Ryan.

If the antibodies have destroyed a lot of the thyroid gland and caused underactive thyroid and Hashimoto’s Disease (the most common form of underactive thyroid) a lot of symptoms mentioned above will ensue including putting on weight, feeling very lethargic, and having dry hair and skin.

For underactive thyroid, treatment can be quite straightforward with the hormone simply replaced by medication (Eltroxin).

“If you have an underactive [thyroid], your blood tests will show that your thyroid –stimulating hormone (TSH) level is up so I know I’ve treated it if I’ve brought that TSH down, but the person will also have to do all the other things like eating healthily, resting and pacing themselves. I can’t emphasise that enough. One thing about Eltroxin is that once they go on it, they are on it for life, but it’s only a small tablet so it’s not a big deal.”

Dr Ryan’s advice

  • • Take medication as prescribed.
  • • Eat just three healthy meals a day and two healthy snacks and don’t eat after 7pm if possible. “With farmers in particular I would be telling them to milk cows early rather than late so that they are not eating late, at 8.30pm at night. Have the evening meal early,” says Dr Ryan.
  • • Get proper sleep
  • How long does recovery take?

    There should be an improvement within six weeks if the person takes all the advice on board.

    “It’s about treating the thyroid, treating the lifestyle, treating the diet and having self-worth enough to put yourself first as well,” she says.

    In relation to getting rest, Dr Ryan is very much into task-sharing and delegation in the home.

    “Women have to pull back from all the excess activities they are doing and set up a rota with the kids. Get them to make their own lunches and help out in the house,” she advises.

    She also tells women to stop pottering.

    “Women tend to potter right up to 10pm instead of delegating to the entire family. Remember the woman is working every bit as hard as everyone else all day and she shouldn’t be pottering until 10pm. She should be relaxing from 7.30pm if possible.”

    New book

    It’s Probably Your Hormones, RRP €18.99, published by Gill Books.
    The book, It’s Probably Your Hormones, RRP €18.99, published by Gill Books, is available in all good bookshops and on amazon.co.uk. Dr Ryan dedicates it to “mná na hÉireann and all the women who have been so unnecessarily misunderstood about their hormonal health”.

    It includes chapters about menstruation, menopause, fertility, stress, diet, sleep and hormones and also self-esteem.

    Read more

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