New challenges for the multidisciplinary management of thyroid disease in menopause: a narrative review

ABSTRACT

Objective. Thyroid disorders pose a significant health concern in post-menopausal women, encompassing hypothyroidism, hyperthyroidism, and cancer. These conditions not only elevate cardiovascular risk but also contribute to increased general mortality. Despite the clinical importance, diagnosing thyroid dysfunction in this demographic remains challenging due to the prevalence of nonspecific symptoms and variations in thyroid function test interpretations.
Materials and Methods. We performed a narrative review using PRISMA methodology, in PubMed/Medline, SCOPUS, Scholar and Web of Science. Inclusion criteria were articles containing the keywords “menopause”, “thyroid”, and “disease” from the years 1990-2024 using MESH terminology in a broad-term search strategy.
Results. The search returned a total of 2034 articles. After removing duplicates and unavailable abstracts, we screened 1424 articles for abstracts. After excluding case reports, non-English articles, and articles without full text available, we used data from 57 articles. New evidence on the thyroid normal values in menopause are challenging the diagnosis of subclinical hypothyroidism and hyperthyroidism in the elderly. The challenges extend to thyroid cancer management in post-menopausal women, where outcomes and treatment efficacy may be inferior compared to younger cohorts. While overt thyroid dysfunction necessitates treatment, caution is advised for those concurrently using estrogen or SERMS.
Conclusions. In this paper, we assess a review of the current literature from a clinical point-of-view to give clinicians the “toolbox” to direct their diagnostics and treatment. A multidisciplinary team should be encouraged to manage thyroid disease in menopause while the gynaecologist could be the actual “case manager”, addressing the decisions to the patient’s needs and expectations.