Myths vs facts: TSH Schilddrüse and Wechseljahre

Menopause involves hormonal shifts that often affect thyroid function. A common myth is that an elevated TSH alone indicates hypothyroidism requiring treatment. Fact: In perimenopause, TSH can physiologically rise slightly without true hypothyroidism. Thyroid values must be interpreted together with fT3, fT4, and symptoms. Another myth: thyroid issues are the sole cause of menopausal symptoms like fatigue or weight gain. In reality, symptoms overlap but causes differ. Evidence is moderate: good observational studies exist, but no large RCTs recommend routine TSH screening during menopause. Many women receive unnecessary L-thyroxine because a mildly elevated TSH is misinterpreted as disease. A TSH above 4.0 mU/l with normal fT4 and no symptoms usually does not warrant therapy. If symptoms are present, individual workup including thyroid antibodies is needed. Consumer home lab tests can measure TSH, but interpretation is complex and should be done by a physician. Safety note: self-adjusting thyroid medication is dangerous.