Dr. Lisa Maturo, Guest
Thyroid Nation
Dr. Maturo shares with us the importance of optimizing all hormones in thyroid disease.

I have Hashimoto’s thyroiditis and hypothyroidism myself, so I know as both patient and doctor how essential it is to get on the right thyroid hormone replacement and the right dose in order to feel better.  I think we have all heard a lot about the importance of the adrenals as well. And so I want to cover some of the other often overlooked hormonal issues that I see in practice on a regular basis with my thyroid patients. This article will focus on the hormones we don’t hear as much about and how I strive to balance those hormones in myself and my patients.

The Yin and Yang of Cortisol and Melatonin Hormones

Cortisol and melatonin are opposites, though they work together like yin and yang. Cortisol should peak in the morning for the “get up and go” when you awake, and melatonin should rise in the evening to help you get to sleep. Adrenal insufficiency (low cortisol hormone output) is rare as a diagnosis, however a lot of patients suffer from varying forms of what I call “stress burnout syndrome” or as you hear often the term “Adrenal Fatigue”. With testing, we might see cortisol low or low normal in the morning when it should be peaking, and higher in the evening when it should be lowering, so that melatonin can rise and do its job. This can be a sign that our natural hormonal rhythms have been disrupted by chronic stress effects. Usually, when I see that picture I first work to restore natural hormonal rhythms by addressing quality of sleep, and for that, I look to optimize melatonin levels. Sometimes I also add in adrenal support supplements too, every case is different. And don’t forget that DHEA (an adrenal hormone) does wonders to balance out cortisol so depending on the individual patient, we may look to optimizing DHEA for purposes of adrenal support as well. A lot of times patients will come in and say, “But I’ve tried melatonin for sleep and it didn’t work”. It is usually either an issue of the quality of the supplement they bought, or the dose being off. I find that once we get patients on a good quality melatonin (physician lines are usually the best) and the right dose titrating up slowly, it can work wonders for restoring circadian rhythms and helping to attain deep, restorative sleep which then results in better-balanced adrenal output and feeling better all day long. When you add in healthy diet, exercise, and other stress-reducing activities like meditation, yoga and breathing exercises– then you have all the right things in place to fully remedy the effects of chronic stress and keep your adrenal related hormones in a healthy balance.

Don’t Forget Sex Hormone Balancing

Hormone deficiencies or imbalances in the sex hormones can look an awful lot like thyroid disease and mimic or add to thyroid-like symptoms. Fatigue, depression, hot flashes, night sweats, mood swings, weight gain, bad cramping and heavy bleeding, insomnia and irritability (to name just a few) can come from being menopausal, perimenopausal (starts as early as 35 in some women!), PCOS (polycystic ovarian syndrome), or PMS. And in men, we can see the effects of low testosterone (andropause) or low DHEA causing problems with fatigue, low sex drive, and muscle atrophy. Many patients come in to see me who have never been told they should test the sex hormones by their previous thyroid doctor or endocrinologist. They didn’t think it was important or related to thyroid. This is usually because physicians are unfamiliar with how to assess and properly balance sex hormones. It is not commonly taught in medical school and so they have to develop an interest and seek out extra training and education to learn the art and science of effective, evidence-based hormone balancing. And so it can easily go unaddressed and overlooked in thyroid patients. Perimenopausal women often have sleep issues, and adding in progesterone at night can be so incredibly helpful (along with melatonin) to improve sleep, reduce night sweats and elevate mood. Testosterone is also very important as well and many times is overlooked because it is not considered as important since it is known more as a “male hormone”,  but in women it is incredibly important to maintain muscle and bone mass, and helps to maintain healthy libido in women too. It is one of the best feel-good hormones out there, and also the least understood and the least prescribed by physicians for women, sadly. It is one of the best hormones for increasing the elasticity and healthy appearance of skin as we age, and also is good for muscle, ligaments, joints, tendons, and bones. And great for supporting the metabolism and for fat loss! So much to love about optimizing testosterone. In perimenopause, the time frame when hormones are changing and declining more in the approach to menopause (starting as early as 35 in some women), the importance of optimizing progesterone and testosterone levels become hugely important, because it can help the transition toward menopause go so much smoother and women look and feel better as they age gracefully and healthfully. And many studies are showing we can also prevent age-related diseases when we keep our hormones optimized as we get older! So if hormones are replaced and optimized, we’re less likely to develop the most common age-related debilitating health problems like osteoporosis, cognitive decline, cardiovascular disease, and cancers. But wait…we’ve all heard “ all hormone replacement is bad and causes cancer”, right? Well, not exactly.  Where does that notion come from? The Women’s Health Initiative trial nearly 15 years ago found a link between breast cancer, stroke and heart disease with the use of Premarin and Provera, synthetic hormones.  The link was actually specifically related to using progestin (Provera), and found that Premarin, or synthetic estrogen, used alone had minimal complications. Once the medical media got a hold of and sensationalized the results, it was all over the news that “hormone replacement is bad and causes cancer”. But we cannot extrapolate the results of that one study to mean that all hormone replacement must be bad, and that natural bioidentical hormone replacement is bad too. Synthetically altered hormones are not the same as what our bodies produce, and are not the same as bioidenticals. Obviously, we don’t use Premarin or Provera, (synthetic hormones) because we know there are risks with those synthetically altered hormones that are nothing like what our bodies produce. They are completely different molecules that have very different effects on the body. I could write a very long article on just this topic alone, but for this piece, I’m trying to summarize. Bottom line is this:  don’t confuse the bad rap that synthetic hormones got with the use of bioidenticals. Many practitioners and patients simply do not understand the difference and feel afraid of hormones as a result, which is really a shame. Unsafe synthetic HRT gives bioidentical hormone replacement a bad reputation! The Danish Trial in 2012 actually looked at the use of bioidentical estradiol and found that there was no increased risk of heart disease, and actually showed a decrease in the risk, along with a decreased risk of stroke and breast cancer. It was opposite results of the WHI trial mentioned above which looked at the synthetics. Another interesting fact is that there is not one single negative study in all the literature on bioidentical progesterone. Again, bioidentical hormones should NOT be confused with the negative studies out there on synthetic hormones. They are entirely different in molecular structure and have entirely different and many times opposite effects. Progesterone does not equal medroxyprogesterone acetate (Provera) but even in some literature you will see them used interchangeably, and this is not accurate. A lot of people ask me WHY this information is not getting out there for everyone to better understand. I’ve had many patients say, “Why doesn’t my doctor know and understand this?” I can’t answer that other than to say that politics and economics likely have something to do with it. Most of medicine is deeply influenced by politics and economics, let’s face it. Our medical school curriculum is even influenced by the pharmaceutical industry in ways that affect what gets taught.

But my doctor told me if I don’t have a uterus, I don’t need progesterone…

There are progesterone receptors in the brain, uterus, heart, breast, vagina, bones and blood vessels. There is no reason NOT to give progesterone to all perimenopausal or menopausal women, uterus or no uterus. Another trial called the PEPI trial showed that bioidentical progesterone is safe, reduces cholesterol, and reduces coronary artery disease. What a great “drug” and it’s only a hormone! The EPIC trial it showed progesterone protects against breast cancer and that Provera (synthetic progestin) causes breast cancer.  Obviously, we know which one we want to use. Avoid the synthetic hormones.

Blood Sugar and the Hormone Insulin

I include blood sugar and insulin in my testing and consider it a very important hormonal area to consider when working with thyroid patients. Insulin is a hormone, let’s not forget, and blood sugar affects so many areas of hormonal balance in the body. Insulin resistance goes hand in hand with PCOS (polycystic ovarian syndrome) and is actually thought to be the cause of PCOS. That is why metformin, an insulin sensitizing medication, is often the treatment of choice for PCOS. You can have insulin resistance but not PCOS, so it gets complex and a savvy doctor can sort that out. But as you can see, one system (blood sugar and insulin) can easily affect and throw off balance the women’s hormones. If patients have insulin resistance at the same time as thyroid disease, they will many times suffer from more severe weight loss resistance as a result. This means no matter what diets they try, or how much they exercise, they can’t seem to lose weight because of this hormonal rut that happens in insulin resistance, which ultimately results in too much hormonal signaling of fat storage. Someone with a normal metabolism is going to metabolize their food much more efficiently than someone with insulin resistance. That is why it is also sometimes referred to as metabolic syndrome. So this issue can be an underlying reason why many hypothyroid patients have difficulty losing weight, and should not be overlooked or underestimated when it comes to feeling good and sustaining a healthy weight in thyroid disease.

Vitamin D Last but not Least

Vitamin D is thought to function in the body more like a hormone. So don’t forget or underestimate the importance of little old Vitamin D, because it impacts overall energy, healthy immune system, mood and well-being– and hugely mimics symptoms of low thyroid when deficient. Vitamin D deficiency and even low normal levels can result in fatigue, depression, moodiness, and generally feeling off. And deficiency is extremely common, in fact, it is getting to be epidemic to the point where I expect everyone I test to below and I’m surprised when it is not low. In fact, usually the only people I test who are not low are already supplementing it, and that’s the reason. Many times I have landscapers or other people who are out in the sun quite a bit come in and are shocked to find that they are low too. It doesn’t seem to matter how much sun we get, the levels are not optimal in most people.

In Conclusion…

I would encourage all thyroid patients to ask their doctors to test a full range of hormones, which minimally should include estrogen, progesterone, testosterone, DHEA, FSH, LH, Cortisol, Vitamin D, Blood Sugar, Insulin and HA1C. I know there are other hormones to test for too, but I’m trying to boil it down to what I feel are the most essential in a thyroid patient. These levels can help a savvy doctor determine if you have any hormonal deficiencies or imbalances, or features of PCOS, (polycystic ovarian syndrome) perimenopause, menopause, premenstrual syndrome, adrenal or stress imbalances, low Vitamin D, blood sugar problems or insulin resistance. And for men, of course, it can determine low testosterone or low DHEA and what we would refer to in men over 40 as andropause or “male menopause”. Most patients I see have more than just one hormonal deficiency or imbalance. So a typical 45 year old woman who comes to see me for thyroid disease will many times also be suffering from the effects of perimenopause, adrenal fatigue (or stress burnout effects), circadian rhythm problems (low melatonin or too high cortisol)  low vitamin D, and maybe some signs of insulin resistance as the cherry on top. That is A LOT of hormonal influences affecting overall energy and well-being! But it can be addressed and remedied if you find the right doctor who will put enough focus on the importance of looking at all of these hormones, and not just focus on thyroid hormone. I’m now very passionate in practicing what I feel is preventive medicine with the strong conviction that we can make the most positive impact on feeling our best in thyroid disease, (and in improving overall health and longevity), by combining hormone optimizing with healthy diet, good sleep, stress-reducing activities and regular exercise. What an amazing combination of remedies for good health that WE have full control over making happen! And don’t be afraid to find a new practitioner who will listen to your needs and address these hormonal issues if your current doctor won’t, keep looking and push for your health, because YOU are in full charge of it!

About the Author

Lisa-MaturoDr. Lisa Maturo is a naturopathic doctor who focuses her practice on preventive medicine and hormonal imbalances, with a strong emphasis on thyroid disease, bioidentical hormone replacement therapy, and medically supervised weight loss programs. She has been in practice for nearly 15 years in Arizona. She diagnosed herself with Hashimoto’s and hypothyroidism in her 3rd year of medical school, and over the years, has treated 1000’s of her patients who have come to her for help with thyroid disease. Dr Maturo is one of the few practitioners in Arizona certified in bio-identical hormone replacement therapy as taught by Dr Neal Rouzier, MD, a world-renown hormone balancing expert and author, who trains physicians in the art and science of hormone optimization, using evidence-based protocols. She is also a partner on Forever Health Network, a listing of hormone balancing experts selected and promoted by Suzanne Somers. Check out her website,, follow her on Facebook and Twitter.

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