In this eye-opening episode of PCOS Unfiltered: Nourish, Heal, Thrive, I sit down with Dr. Anya Szigeti to unravel the complex link between PCOS and Hashimoto’s thyroiditis. We dive deep into how insulin resistance acts as a central driver for both conditions, how hormonal imbalances and immune system dysregulation intertwine, and the subtle signs that may indicate an underlying thyroid issue. Dr. Anya shares actionable insights for women to recognize symptoms, advocate for their health, and implement small, sustainable lifestyle changes that support both PCOS and thyroid health.
🔹 In this episode we:
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*Website: www.backtohealthfunctionalmedicine.com
*Appointment Booking: https://backtohealthfunctionalmedicine.janeapp.com/
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*Holistic Hashimoto’s Healing Community on Skool
*IG https://www.instagram.com/dr.anyaszigeti/
*FB https://www.facebook.com/theszigetimethod
✨ Key Takeaways:
💡 Bonus: Share this episode with a friend who might be struggling with PCOS, thyroid issues, or overlapping symptoms—you never know who might feel empowered to take their next step toward healing.
(0:02 - 0:25) Welcome back to PCOS Unfiltered, Nourish, Heal, Thrive, the show where we cut through the noise and get real about reclaiming your health from the inside out. I'm your host, Lindsie, and today's episode is one you don't want to miss. We're diving deep into a powerful and often overlooked connection, the link between PCOS and Hashimoto's thyroiditis.
(0:26 - 0:55) My guest, Dr. Anya Szigeti, is back to break down the science, the symptoms, and the root causes that tie these two conditions together. We'll cover why they often coexist, the subtle signs you might be missing, what tests you should really be asking your doctor for, and how a functional medicine approach can help you feel like yourself again. If you've ever been told your labs are normal, but you know something is still off, this conversation will empower you to dig deeper and advocate for your health.
(0:55 - 1:15) As always, the content shared on PCOS Unfiltered is for informational and educational purposes only. The views and opinions expressed by the host and guests are not intended to serve as medical advice. Always consult with a qualified healthcare professional before making any changes to your diet, exercise, or treatment plan.
(1:16 - 1:33) The information shared is based on personal experience and expert interviews and is not a substitute for professional medical guidance. Now let's get started. Welcome back to Dr. Anya Szigeti.
(1:33 - 1:52) Super excited to have her back on. And today we are talking about the link between Hashimoto's and PCOS. So first question, for those who may not be familiar, can you briefly explain what Hashimoto's thyroiditis is and how it differs from other thyroid disorders? Yes, absolutely.
(1:53 - 2:12) So Hashimoto's thyroiditis is autoimmune. It's an autoimmune disease, and this is where your immune system mistakenly attacks your thyroid tissue. So what does this do? It leads to chronic inflammation and eventually under-functioning of the thyroid gland, which we call hypothyroidism.
(2:13 - 2:31) And the key to understand with Hashimoto's is it's not just a thyroid problem. It's an entire immune system issue, but it shows up or presents with thyroid imbalance. So that's what makes it different from other forms of hypothyroidism like iodine deficiency or post-surgical.
(2:32 - 2:57) And one thing to really understand with this is that with conventional medicine, most doctors only test TSH or thyroid stimulating hormone, which is actually made in your brain. And maybe they'll test T4, which is actually the inactive thyroid hormone. But with Hashimoto's, you can actually have normal TSH and thyroid hormone levels for years.
(2:57 - 3:41) I did for sure, while my immune system was slowly damaging my thyroid behind the scenes. And so unless you have the actual thyroid antibody tests run, which is specifically called TPO or thyroid peroxidase antibodies and TG antibody, thyroglobulin antibodies, you may not even know that that's happening behind the scenes. So this is where a lot of women get told your labs look normal while they're experiencing the common and unfortunately life disrupting symptoms of hypothyroidism Hashimoto's like exhaustion, struggling with weight gain, hair loss, brain fog, all those certain things.
(3:42 - 3:54) Now with holistic functional medicine, which is what I practice, I don't just treat the lab numbers. I look for root causes. And so with Hashimoto's, obviously we need to know that we have it.
(3:54 - 4:11) So I run a much more detailed panel than most doctors. And then we need to focus on different things like calming down the immune system, healing the gut, supporting the whole body, not just the thyroid or giving thyroid hormones. Yeah.
(4:11 - 4:36) I think that's even like, it relates to even my first few episodes about insulin resistance and how a lot of doctors just test for the fasting glucose, the A1C and disregard the insulin where all these things are happening. And so there's this, I feel like I say it every single time, there's this overarching theme where people, you know, if something is going on. But the doctor just keeps telling you, your labs are fine.
(4:36 - 4:42) Your labs are normal. You know, we'll just keep checking it or we'll wait till something else gets worse. And so, yeah.
(4:42 - 4:57) So that's huge. And whether it's conventional medicine or, you know, seeing a functional medicine doctor that you can advocate for yourself and ask for, ask for those tests. And if the doctor refuses, then it might be time to see somebody.
(5:01 - 5:32) So PCOS and Hashimoto's are both common in women. And how often do you see these two conditions coexisting in your practice? Honestly, more often than you would think. So I would say probably around 40 to 60% of women who come in with PCOS symptoms also show signs of Hashimoto's and many have already developed hypothyroidism and Hashimoto's is actually the most common form of hypothyroidism, but again, very underdiagnosed because of those tests that aren't being done.
(5:35 - 5:54) And so the two are often missed because, you know, I'm saying PCOS and Hashimoto's. If you have one, the other one is often missed because the symptoms of both overlap. So fatigue, irregular cycles, weight struggles, mood swings, fertility issues.
(5:55 - 6:18) So those are common with both. And if you just run basic labs and kind of have almost like the head in the sand mentality, then you could miss the big picture. So if I have a woman that comes to me with PCOS, especially if she has some of these common hypothyroidism Hashimoto's symptoms like cold intolerance, constipation, dry skin, brain fog.
(6:18 - 6:42) I actually screen all of my female patients for Hashimoto's because it's a relatively inexpensive test. And again, so underdiagnosed, but I also look at other factors like gut health and insulin sensitivity, like you were just mentioning with insulin resistance, of course, nutrition deficiencies, inflammation markers. So it's just really important to know that these systems aren't separate.
(6:43 - 7:18) Our hormones, our immune function, our metabolism, our gut health, they all interact and they're all going to affect each other. And with Hashimoto's specifically and PCOS specifically, they're often just different expressions of the same deeper imbalance. And so why do you think that is? Why is there such a strong overlap between these two? Well, the science is, it's kind of fascinating for me because I'm kind of a geek, but with PCOS and Hashimoto's, they're both rooted in systemic inflammation and hormone imbalances.
(7:19 - 7:35) And so when you have one, it creates the environment in the body where the other is more likely. So a couple of the keys there are insulin resistance, like you had mentioned, which is a driver with PCOS for sure. And then that triggers inflammation.
(7:36 - 8:00) Now, chronic inflammation is a known trigger for autoimmune conditions like Hashimoto's. And then when we have elevations in insulin, which as you mentioned, isn't very commonly tested for, that can also increase thyroid antibody production, which again is not commonly tested for. So all of this can be going on behind the scenes and people are getting normal blood work results because they're not testing for it.
(8:01 - 8:25) So a couple other correlations are the gut health and the microbiome, because the gut is where the majority of our immune system lives. And women with PCOS will often have dysbiosis or increased intestinal permeability, also known as leaky gut. And those are both very highly linked with autoimmune diseases, especially Hashimoto's.
(8:25 - 8:41) So there's a strong connection there as well. Then we look at estrogen dominance and hormone imbalances. So with PCOS, we often see estrogen dominance or androgen excess, and both of those can impair thyroid function.
(8:42 - 9:16) So if we want to dive and get really nerdy, estrogen actually raises levels of thyroid binding globulin, which reduces free T4, which is the active thyroid hormone, even if the total levels look normal. So this hormonal imbalance can actually stress the adrenal glands, which will disrupt cortisol, which can then affect thyroid hormone conversion, which is a whole other realm that's, again, very often overlooked. So it's this kind of domino effect of things happening.
(9:18 - 9:40) And then another piece is potentially shared genetic or environmental risk factors. So both conditions have some genetic predisposition. I'm not a big fan of relying on that because it's usually only about 5% to 10% of things actually have the genetic predisposition that we're finding, especially with different cancers and things.
(9:40 - 10:20) But they also have a high influence of being triggered by environmental things like nutrition deficiencies, which are unfortunately common, especially when we have the gut imbalances. So we're looking at things like selenium, zinc, vitamin D, our exposures to toxins, which is just, that's a whole nother session we could have on toxins and detoxification, chronic stress, which is a huge other area as well, even viral exposures. So these sort of epigenetic triggers can flip the switch for both PCOS and Hashimoto's, ironically enough.
(10:21 - 10:41) And how long can you, I mean, I've heard like 10 years that you could be, you could have normal labs, right? And still be feeling maybe somewhat okay. Like, I know for me, I've looked back and definitely there were indicators, but you could have normal labs and everything seems fine for years, right? I mean, before you actually, before something actually gets flagged. Right.
(10:41 - 11:13) And so you can, we can go back 10 to 15 years for most conditions, autoimmune cancers, all these types of things for the imbalances to start before the symptoms present enough for the person to pursue getting, you know, additional care and you say getting flagged, but for my particular story, so I was diagnosed with Hashimoto's over 10 years ago now and hypothyroidism maybe 15 years ago, but I had to fight. I had to do my own research. I had to advocate for myself.
(11:14 - 11:18) My doctor kept telling me everything was fine. I felt like absolute garbage. I was exhausted.
(11:19 - 11:24) My love, like different levels that they were tasked. Like vitamin D was terrible. It was so, so low.
(11:24 - 11:32) No one looked at my gut health. No one looked at my mental, emotional health, like all these different pieces of the puzzle. People weren't looking at that.
(11:32 - 11:43) Yeah. Unfortunately, the doctors that I was going to at the time. So I had to figure out which tests, you know, I put my symptoms in, this is the fourth, you know, AI and chat GPT and all that fun stuff.
(11:43 - 11:55) But I had to put my symptoms into Google. I think, I'm sure it's what I use probably back then. And it came up with, you know, just thyroid imbalance, thyroid imbalance, autoimmune, you know, get these labs tested.
(11:55 - 12:08) So I finally pursued, you know, convinced my doctor, persuaded her to test me for the antibodies and they came back elevated. And then she was like, well, your thyroid function is still fine. So we'll just wait until it gets worse.
(12:08 - 12:21) And then we'll just medicate you for life. Like no investigation as to why I have these antibodies or like, let's look at my full thyroid function, not just my TSH though. Yes.
(12:21 - 12:24) Yeah. Lots of. Yeah.
(12:24 - 12:39) I mean, it's unfortunate. It really is. So from a functional medicine perspective, what are the root causes that might link these two conditions? So with functional medicine, we're looking at the underlying systemic issues.
(12:39 - 13:07) And so one big one, as I mentioned, is chronic inflammation. So when we have conditions like insulin resistance, gut dysbiosis, this sets up the environment that is very conducive to autoimmune activation and hormonal disruptions, unfortunately. And so women with PCOS will likely have elevated inflammatory markers like CRP, TNF alpha.
(13:07 - 13:42) This indicates just low grade chronic inflammation, and that's going to present as ovarian dysfunction and metabolic issues as well. Now, the gut health and balance pieces, we're looking at dysbiosis and leaky gut primarily because when we have the altered gut microbiota, that increases the likelihood of that intestinal permeability or leaky gut. And this allows particles and toxins to go into our circulation, which triggers our immune system.
(13:43 - 14:14) And so this can also promote insulin resistance and autoimmune reactions. So the prevalence of PCOS related gut imbalances also unfortunately decreases beneficial guys like our short chain fatty acid producers, which then will increase again insulin resistance and inflammation. So that becomes this whole unfortunate pathway, and that immune stimulation and activation is a known trigger for autoimmunity and Hashimoto's as well.
(14:15 - 14:32) So again, similar things happening, triggering both of these conditions. We mentioned insulin resistance, of course, central driver for both. So high insulin is going to drive ovarian androgen production and negatively affect thyroid hormone metabolization.
(14:32 - 14:54) So we have issues on both ends for insulin resistance and then hormonal imbalances, hormonal dysregulation. So we have estrogens, progesterone, cortisol, thyroid hormone, they're all intertwined. And when there's an imbalance in one part of the system, it's going to affect all of the other levels.
(14:55 - 15:43) And then we have the immune system and the immune system dysregulation, which again, it's altered gut flora, which is where the majority of the immune system is in our gut and that chronic inflammation, it shifts the immune system into a pro autoimmune state, which is very challenging for Hashimoto's patients, of course. And then that leaves the PCOS patients at an increased risk due to already having the chronic systemic inflammation and that dysbiosis. So these two stem from, of course, the small piece of genetics, the environmental toxins, the chronic stress, the lifestyle, the dietary piece, and then likely existing with both conditions as well.
(15:43 - 15:54) Yeah. Wow. So since insulin resistance is a common thread between the two, as you've mentioned, how does it impact thyroid and ovarian function? Yeah.
(15:54 - 16:36) So with PCOS, it's approximately, I want to say around 65, 70% of women and maybe even higher with, if you have a higher BMI, we'll have that insulin resistance. And so what that's doing is that's escalating the androgen stimulation for the ovarian cells, unfortunately. And then they've also seen recently that PCOS women with insulin resistance have a significantly lower level of T3, which is the active thyroid hormone and T4, which inactive thyroid hormone and higher TSH, which is a thyroid stimulating hormone.
(16:36 - 17:03) That formula right there is your hypothyroidism diagnosis. And so that is indicating, you know, that science is indicating that there's definitely thyroid dysfunction linked to the insulin mediated changes with PCOS and the insulin resistance. And so they've also shown that insulin resistant PCOS patients have a larger thyroid volume.
(17:04 - 17:21) So that's saying that there's likely a larger strain on the thyroid itself. So it's actually working harder when someone has insulin resistance and PCOS as well. So that's driving, definitely driving both conditions.
(17:22 - 17:51) So if we look at like the ovary with insulin resistance, then we have hyperinsulinemia, which is a nice mouthful to say. We have excess androgens and then we have follicle arrest. And if we look at the thyroid, insulin resistance disrupts the HPT axis, which impairs the conversion of the inactive T4 to the active T3 and increases the risk for thyroid antibodies, which is Hashimoto's.
(17:52 - 18:11) Wow. So what are some of the subtle signs that a woman with PCOS might also be dealing with if they have an undiagnosed thyroid issue? Okay. So some of the most common that I see are cold intolerance.
(18:12 - 18:29) So that's even like chilly extremities. So hands and feet in like a non-cold environment or just being cold when everyone else is okay. So I will say for me personally, I've struggled with this for my entire life, always a thing for me.
(18:30 - 18:50) Everyone's like, oh, it's just because you're skinny. I'm like, no, because my thyroid was not happy for many years of my life. But I know that about myself and I know that I just, I can take some extra steps with that, but that is something that if that's you and you haven't had this work done to see what's going on, that might be like, Hey, something might be off with me.
(18:50 - 19:07) Um, constipation. And what is constipation? We're looking at not moving the bowels every day. So if you're not having at least one bowel move in a day, that in my definition is constipation, which is much different than most doctors.
(19:07 - 19:24) And I have a lot of patients that when they first come to me, they say my normal is two to three times a week. I wasn't pointing any fingers. But that's one of our major detoxifiers, especially for our estrogens.
(19:24 - 19:34) And we have three estrogens and with estrogen, you want to use it and lose it. You don't want it hanging around. And if you're constipated, it's hanging around and you're reabsorbing it.
(19:34 - 19:45) And then you're going to have an estrogen excess and you're going to have all those unpleasant symptoms. So that's a, that's a big one. Um, another common one is dry skin, thinning hair.
(19:46 - 20:01) And so there can be a hormonal piece with that as well. There can be so many other pieces and thyroid is one of them. And then, um, like brain fog and like depressive mood shifts.
(20:01 - 20:24) So, you know, tying back into what you mentioned in the beginning, you know, your body better than anybody else. You live in it 24 seven. And if you are experiencing shifts and mood swings and you're depressed or you're anxious or you're, you're not happy in a situation when you normally would be, that's not normal.
(20:24 - 20:39) Like something's going on. It could be as simple as being dehydrated, not getting a good night's sleep, but it could be your body telling you that something's off and it's asking for you to investigate it. Another piece of that too, that I see is energy.
(20:39 - 20:54) So that's another piece. And that was a big one for me is I was just exhausted and it was like crippling fatigue when I shouldn't be exhausted in like my early thirties. And I was very active.
(20:55 - 21:01) I was eating right. Did the best I did back in the day. Um, and I was just exhausted all day.
(21:01 - 21:11) I was drinking coffee all day and just like, could not, could not break it. So that was a big one for me. And that's another overlap that is very common with both conditions.
(21:11 - 21:47) But if you're having that, even though you've done the work and balanced out the PCOS side of it, we, you know, might be time to investigate the thyroid side too. Yeah. I mean, and that's where like, that's super powerful too, knowing that, because even, even for myself, like I've mentioned before, I've kind of like looked back and, you know, realized what was going on before I really kind of had that moment and said, I have to make some changes, but I probably had like all of those symptoms, you know? And yeah, I was never diagnosed with PCOS, but I was probably insulin resistant at some point and maybe headed down that road.
(21:48 - 22:00) So this is where it can be a wake up call. And if you're experiencing those, yeah, you don't necessarily have to run to the doctor. You can start taking control yourself and just making some of those small changes to help.
(22:00 - 22:21) Yeah. So do symptoms like fatigue, weight gain, or brain fog often get misattributed to one condition when both may be present? Yes. So this is super frustrating because like, for example, fatigue, weight gain, they're so common with both conditions.
(22:22 - 22:38) And so you could go to your doctor with a PCOS diagnosis and they would just be like, oh, well, you're always going to be a little more tired or you're always going to have difficulty losing weight. And then they're going to miss the underlying thyroid issue or vice versa. And then brain fog.
(22:38 - 23:00) That's another huge crossover symptom that cognitive imbalances and cognitive dysfunction can be due to high androgen stress, but also elevated TPO antibodies. So it could be either one. So that's why it's just, it's so important, one, to know your body and know when something's off and advocate for yourself.
(23:01 - 23:25) And two, to really partner with somebody that's going to do the deep work to get you, you know, identify which areas are imbalanced and get you on the path that you feel is the best for you to get those supported and balanced for a sustainable response. I was just talking with my last patient about this. He was like, I can't just jump and make an all or nothing.
(23:25 - 23:40) I need to do little teeny changes and then adopt that one. Then I can move on to the next one. And she's like, I finally have come to the realization that this is a lifestyle.
(23:41 - 23:49) This isn't like a diet. This isn't something I do for a few months and then go back to what I was doing before. Yeah.
(23:49 - 24:00) And that's huge. I mean, that's huge right there. When you start off by answering this question, saying how doctors say, well, you're just always going to have trouble losing weight or you're always going to be low on energy.
(24:01 - 24:14) No. And unfortunately, when they tell you that, because also when they hand you these diagnoses, a lot of the times it's like, yes, this is something you're going to have to deal with. This is a lifelong condition.
(24:15 - 24:23) You're going to have other issues. We'll wait till it gets worse, all this other stuff. And that's already putting these things in your head when you can be making changes.
(24:23 - 24:32) And even if it's the smallest thing, I mean, that's great. When you have a patient, I know I've had clients, the same thing. They start realizing that, yes, this is not a temporary thing.
(24:32 - 24:58) And one thing I definitely stress with a lot of my clients as well is the all or nothing mentality, because when you try to jump in, especially this happens with a lot of the fad diets, I feel like, and stuff, you jump all in and you fail and then you just throw your hands up and you're done. Instead of just trying to make those small little changes along the way, you can celebrate all of those wins and yeah. And otherwise you're just, you're setting yourself up for failure when you just think you can take it on.
(25:00 - 25:25) That's a wrap on today's deep dive into the PCOS Hashimoto's Connection. Huge thanks to Dr. Anya Sageti for showing her expertise, personal journey, and actionable steps we can all take to get to the root cause of these conditions. I hope you're walking away with a better understanding of how intertwined our hormones, immune system, gut health, and stress truly are, and how much power you have to support your own healing.
(25:26 - 25:58) If you'd like to connect with Dr. Anya, check the show notes for her social media links, her bestselling book, details on her holistic Hashimoto's healing community, and how to book a free consultation with her. And if this episode resonated with you, please share it with another woman who needs to hear that she can feel better, no matter her diagnosis. Until next time, remember, your body is talking to you, your symptoms are sending you messages, and all you need to do is listen and know that you have the power to take the next step toward balance and healing.