How Thyroid Disease Is Different for Men

Symptoms of Hormonal Dysfunction Can Differ From Those in Women

thyroid in men
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When people think of thyroid disease, they typically considered it to be a disorder affecting women. And, while it's it true that women are between eight and 10 times more likely to be affected, as many as two million men in the United States are believed to be living with some form of the disease.

Of these, an estimated 60 percent will go undiagnosed, says the American Thyroid Association, in part because people do still regard it as a "woman’s disease."

But that is only part of the problem. While the causes and progression of thyroid disease are similar in men and women, there are symptoms unique to men that are frequently missed or misattributed, making the task of diagnosis all the more difficult.

Understanding Thyroid Disease

The thyroid gland is a small, butterfly-shaped organ located at the front of your neck just behind the Adam’s apple. Despite its relatively small size, the thyroid gland is responsible for many key bodily functions.

The primary task of the thyroid gland is to secrete hormones into the bloodstream which are then carried to the cells of the body. These hormones help the body metabolize energy, regulate body temperature, and ensure that the heart, brain, muscles, and other organs are working properly.

In fact, pretty much every biological function of the body relies upon thyroid hormones, from the growth of your hair and nails to your sex drive.

It stands to reason, therefore, that any imbalance can cause these systems to malfunction, either by putting the brakes on how they work or kicking them into overdrive.

The thyroid gland works by absorbing iodine from dietary nutrients and converting it into the building blocks for hormones. The two main thyroid hormones are known as triiodothyronine (T3) and thyroxine (T4).

The level by which these hormones are produced is largely determined by the pituitary gland. The role of the pituitary gland is to detect the amount of T3 and T4 circulating in the blood. If they are too low, the gland will secrete a hormone known as thyroid stimulating hormone (TSH) to signal the thyroid gland to produce more.

Any interference in this hormonal loop—either because of a tumor, autoimmune disorder, or other causes—can cause the thyroid gland to produce too many hormones (hyperthyroidism) or too little (hypothyroidism).

Hyperthyroidism in Men

Hyperthyroidism is a condition by which the thyroid gland produces too much T3, T4, or both. There can be many different causes for this. Chief among them is Graves disease, an autoimmune disorder in which the immune system produces an antibody that actively overstimulates the thyroid gland.

Graves disease runs strongly in families and is believed to affect one in every 200 people in the United States, typically adults over 40.

Other possible causes of hyperthyroidism in men include:

  • Thyroiditis (thyroid inflammation) which causes T3 and T4 to essentially "leak out" of the thyroid gland
  • A benign tumor of the thyroid or pituitary gland
  • A benign tumor of the testicles
  • Testicular cancer
  • Excessive iodine intake
  • Overuse of T4-containing supplements often used by bodybuilders to speed up the metabolic rate to get more of a "cut," lean muscle look

Men with hyperthyroidism will share many of the same symptoms of the disease as women. They may feel abnormally warm or sweaty at room temperature. Their increased metabolism may result in changes in appetite or a sudden, unexplained weight loss. Nervousness, jitteriness, fatigue, loss of concentration, and trembling of the hands is common. Oftentimes, the heart rate will be increased and perceived as a pounding or fluttering in the chest.

One of the telling symptoms is proptosis, or the bulging of the eyes mainly associated with Graves disease. Anywhere from 25 percent to 50 percent of women and men will experience this hyperthyroid symptom, triggered by the accumulation of immune cells in the eye socket.

Male Sexual Dysfunction in Hyperthyroid Disease

There are, however, several symptoms specific to men. These include gynecomastia, the abnormal enlargement of breast tissue that is commonly seen in older men but may appear earlier in men with hyperthyroidism.

Another tell-tale symptom is sexual dysfunction. In addition to low libido, erectile dysfunction is a common complaint in men with hyperthyroid disease. A 2012 review from Sexual Medicine and Andrology Unit at the University of Florence in Italy evaluated studies in which a total of 6,573 men were assessed. Men diagnosed as hyperthyroid (with low TSH and high T4 levels) were seen to be at an increased risk of severe erectile dysfunction.

Even after adjusting for factors such as age, smoking, obesity, and low testosterone levels, men with hyperthyroidism had more than a two-fold increase in risk compared to men with normal TSH/T4 levels. Why this occurs is still unclear.

Hypothyroid Disease in Men

Hypothyroidism occurs when your body doesn’t produce enough thyroid hormones. It is frequently associated with another type of autoimmune disorder known as Hashimoto’s disease, in which the body’s immune system directly attacks the thyroid gland.

Hashimoto’s disease causes thyroiditis (inflammation of the thyroid gland) which initially triggers an increase in thyroid hormones. Over time, however, the persistent inflammation damages the thyroid gland to where it is less able to produce T3 and T4.

Like Graves disease, Hashimoto's is largely an inherited disorder passed through families and is believed to affect around 14 million people in the United States, mostly between the ages of 40 and 60.

Other causes of hypothyroidism in men include:

  • Treatment of hyperthyroid disease (including radioiodine therapy) which can sometimes cause the thyroid gland to shut down completely
  • Thyroid surgery involving the removal of some or all of the gland
  • Beam radiation commonly used to treat cancers of the head and neck
  • Congenital defects of the thyroid gland
  • Certain medications such as lithium, amiodarone (used to treat irregular heartbeat), and interferon alpha (used to treat certain cancers)

Men with hypothyroidism will experience many of the same symptoms of the disease as women. They may be less tolerant to cold and feel chilly even in a warm room. Fatigue, constipation, depression, and hoarseness are all common. There may also be puffiness of the arms, legs, hands, feet, and face as well as the abnormal enlargement of the thyroid gland (known as a goiter).

Male Sexual Dysfunction in Hypothyroid Disease

In terms of symptoms related specifically to men, hypothyroidism is more commonly linked to the loss of muscle mass and strength rather than the weight gain typically seen in women.

Hypothyroidism can also increase the risk of male infertility. In fact, research how shown that men with low thyroid function tend to have poorer sperm quality, lower sperm production, and less sperm motility.

This is believed to be caused, at least in part, by a hormone known as prolactin which is secreted by the pituitary gland along with TSH. As the TSH output increases in hypothyroid men, so, too, does prolactin. This excess can trigger a steep decline in testosterone levels which, in turn, can affect sperm production, sex drive, and even lean muscle development.

The impact of hypothyroidism on androgens (male hormones) also appears strongly linked to erectile dysfunction, although the exact mechanism for this remains unclear. Unlike hyperthyroidism, in which a drop in TSH and rise in T4 is directly associated with erection difficulties, no clear linked has yet been established for men with hypothyroid disease.

With that being said, a 2008 study published in the Journal of Clinical Endocrinology and Metabolism suggested that men with low thyroid function had even higher rates of erectile dysfunction than hyperthyroid men (85 percent versus 71 percent, respectively) and more than three times the rate seen in men with normal thyroid function (25 percent).

The same study showed that, once thyroid function was restored through medication, the rate of erectile dysfunction was more or less the same as that of the general population.

Challenges in Diagnosis

While the diagnosis and treatment of thyroid disease are no different for men as they are for women, there remains a serious gap in reaching men affected by the disorder.

While women are commonly screened for thyroid problems when they present with symptoms, doctors will often overlook the thyroid when confronted with similar symptoms in men. Moreover, because many of the symptoms are generalized and occur primarily in men over 40, doctors will often attribute conditions like erectile dysfunction, weight problems, and loss of energy to age.

Even if thyroid disease is suspected, doctors will often fail to order a comprehensive panel of tests, including the TSH, free and total T3, free and total T4, and the battery of other important assays. Without all of these tests, a doctor will only have a narrow glimpse into what may or may not be going on. In fact, without the complete panel, a test can come back "normal" and completely miss thyroid disease even in men who are obviously sick.

In the same breath, men are often reluctant or embarrassed to share their full range of symptoms with their doctors, focusing instead on the ones that are the most apparent or problematic. Moreover, men will often entirely omit what they are going through emotionally, in part because they may be less aware of how hormones can affect moods, memory, and cognitive function.

Because of this, doctors will only get part of the picture and be unable to piece together the clues needed to direct a diagnosis.

What You Can Do

With few exceptions, there are few hard-and-fast signs of thyroid disease in men. While symptoms like goiter and proptosis may point you in the right direction, more often than not the signs and symptoms will be vague and non-specific.

The key feature of thyroid disease is that it is usually—but not always—progressive. Because thyroid dysfunction can affect multiple organs of the body, it’s important to take note of any and all symptoms you may be experiencing. While it is often easy to attribute these changes to age, most men can sense when a condition is abnormal, doesn’t make sense, or is getting worse.

If for any reason you suspect you have thyroid disease, be sure to relate all of your symptoms to your doctor and ask directly if thyroid disease might be the cause. If needed, you can request a referral to an endocrinologist specially trained in diseases of the thyroid gland.

In addition to a full thyroid panel, ask if it a highly specialized test called the TRH stimulation test may be included. It’s an expensive exam, similar in concept to a cardiac stress test, but is one of the most reliable forms of diagnosis today.

By getting diagnosed early, you can access treatment before any serious complications occur. Thyroid treatments today are far simpler than ever and may only involve medications, diet, and changes in lifestyle. If surgery or radioiodine therapy is needed, early diagnosis is almost always associated with greater treatment success.

The main point is not to suffer in silence. For a specialist referral or information about treatment resources in your area, use the online locator offered by the American Thyroid Association or contact the American Board of Medical Specialties toll-free at 866-275-2267.

Sources:

American Thyroid Disease. "Prevalence and Impact of Thyroid Disease." Fall Church, Virginia; updated October 2017.

Corona, G.; Wu, F.; Forti, G. et al. "Thyroid hormones and male sexual function." Int J Androl. 2012; 35(5):668-79. DOI: 10.1111/j.1365-2605.2012.01266.x.

Krajewska-Kulak, E. and Sengupta, P. "Thyroid Function in Male Infertility." Front Endocrinol. 2013; 4:174. DOI: 10.3389/fendo.2013.00174.

Krassas, G.; Tziomalos, K.; Papadopoulou, R. et al. " Erectile dysfunction in patients with hyper- and hypothyroidism: how common and should we treat?" J Clin Endocrinol Metab. 2008; 93(5):1815-9. DOI: 10.1210/jc.2007-2259.

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