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Published: Monday, 7/4/2011

Treatable thyroid

Symptoms can be overcome for a normal life

BY CHERIE SPINO
SPECIAL TO THE BLADE

Eavesdrop on any conversation among women, and you’ll probably hear these common complaints: “I can’t seem to drop those extra pounds.”

Or “When I wake up in the morning, I just want to crawl back in bed.”

Heck, anyone who’s ever been a mother probably has uttered those words at some point. Cindy Steele, 48, a Toledo attorney, always chalked up her lethargy years ago to the fact that she had a little one running around.

“Sure, I was tired. But I had this little kid. I was in my mid-30s,” she says. “That’s the way it is.”

But for Ms. Steele, and millions of others, these common gripes are much more than mere whining: Weight gain, fatigue, sensitivity to cold, and dry hair.

They’re symptoms of a true medical problem: thyroid disease. About 20 million Americans have some form of diagnosed thyroid problem. Women are much more likely than men to get it; in fact, one out of eight women will get thyroid disease during their lifetime, according to the American Medical Women’s Association.

But perhaps more alarming is the fact that many, like Ms. Steele, think their fatigue and other symptoms are just “the way it is.” More than 8 million people are unaware that they’re suffering from thyroid disease, according to AMWA statistics. Some studies show that more than half of people treated for depression are actually suffering from low thyroid.

Sorting out the symptoms

SYMPTOMS OF THYROID DISEASE


The symptoms of hypothyroidism usually develop slowly over a number of years and include:

 

  • Fatigue
  • Numbness and tingling in hands
  • Constipation
  • Weight gain
  • Intolerance to cold
  • Dry, coarse skin and hair
  • Decreased sexual interest
  • Frequent, heavy menstrual periods
  • Forgetfulness
  • Puffy face
  • Goiter (enlargement of the thyroid gland)
  • Rapid heartbeat
  • Feeling shaky, nervous
  • Weight loss
  • Increased appetite
  • Diarrhea
  • Double vision
  • Thin skin
  • Menstrual changes
  • Intolerance to heat and excessive sweating
  • Swelling and enlargement of the neck from an enlarged thyroid gland (goiter)
  • Bulging of the eyes
  • Muscle weakness

Source: Cleveland Clinic

 

 

Why do so many go undiagnosed? Thyroid disease can be problematic because most of its symptoms are non-specific and can be caused by a variety of things like anemia or menopause, says Dr. Alan Farwell, an endocrinologist and director of patient education for the American Thyroid Association.

Often, women don’t want to be “whiners” so they don’t go to their doctors or confide their symptoms. They don’t even realize that they have a deeper problem. The symptoms are annoying, but they’re not life-threatening most of the time.

All most of us know about our thyroid is that we have one and that it has something to do with our metabolism. But this butterfly-shaped gland in the lower neck, just below the Adam’s apple, is crucial to all bodily processes.

The thyroid produces hormones, T3 and T4, that act as fuel for your cells. When your cells get just enough of the hormones, your body’s systems function at top form. But when they get too little or too much, your metabolism gets out of whack.

That’s when the pituitary gland steps in. Located in the middle of the skull, below the brain, it monitors the amount of thyroid hormone in the blood. When it senses that the thyroid isn’t doing its job properly, it will send out a hormone called TSH (thyroid stimulating hormone) to tell the thyroid to get back on track.

Immune disorder

The most common form of thyroid disease is low thyroid, or hypothyroidism, which is what Ms. Steele was diagnosed with. The thyroid doesn’t release enough hormone, and everything slows down. You might get constipated and lethargic. Your hair might fall out (see sidebar for a full list of symptoms).

If left untreated, mild cases of hypothyroidism can lead to higher cholesterol levels or heart disease. Only rarely, and in the most severe cases, will it lead to conditions such as fluid retention, congestive heart failure, and even death.

A small percentage of folks — fewer than 1 percent — suffer the opposite malady. Their bodies release too much hormone, and they might get jittery and have insomnia (see sidebar for more symptoms). This is called hyperthyroidism.

A lack of iodine in the diet can cause thyroid disease. But that’s not the problem in the United States. Most of us get plenty of iodine because it’s added to salt.

Most cases of thyroid disease are caused by the immune system attacking the thyroid gland, leading to Hashimoto’s thyroiditis (the most common form of hypothyroidism) or Graves’ disease (the most common form of hyperthyroidism).

No one’s sure exactly why Americans suffer so much from immune disorders like this, Mr. Farwell says. Those with a family history of thyroid disease, those over 60, and those with other autoimmune diseases like rheumatoid arthritis or diabetes are more at risk of thyroid disease.

Most family doctors can manage thyroid patients, but for more complicated cases, patients are referred to endocrinologists, who start with a battery of blood tests. The first is a TSH test, the most common thyroid test and one which is usually included now in a routine physical. If your TSH level is elevated, it means your thyroid gland isn’t producing enough thyroid hormone.

The TSH test isn’t the only gauge, though, and it varies from person to person and you could still be in the “normal” range and have symptom.

Mr. Farwell relies on a few other blood tests before he starts treating patients. “It’s always a good idea to get as much information as possible before going on a medicine for the rest of your life,” he says.

Some tests measure the presence of T3 and T4, the thyroid hormones. A low T3 or T4 result coupled with a high TSH level indicates hypothyroidism.

Another test measures the presence of antibodies in the blood that are used by the immune system to attack the thyroid. Farwell says that 10 to 12 percent of the population has thyroid antibodies, but only half of those develop problems and need to be treated.

Treatment

After diagnosis, most people with hypothyroidism take synthetic thyroid hormone medications like Synthroid or the generic levothyroxine, which they probably will take for the rest of their lives.

Overactive thyroid is a little more difficult to treat. Patients may take drugs to limit hormone production, radioactive iodine therapy to shut down the thyroid, or have surgery to remove part or all of the thyroid gland.

Once medication levels are adjusted, most patients find relief from symptoms.

Alison Mihaly, 46, a Toledo mother of four, finally finally feels like herself again after years of not feeling up to snuff. She was first diagnosed with hypothyroidism when she was pregnant with her first child in 1991.

She took Synthroid, but after having her fourth child eight years later, she stopped. “I didn’t really feel any better on it or any worse when I went off it,” she says.

Two years ago, she started waking in the middle of the night, drenched in sweat. A friend suggested she get her thyroid checked again.

After the full blood workup, she was diagnosed with Hashimoto’s thyroiditis. Her physician put her on a new med, and life changed. “I lost 10 pounds without thinking about it, and I stopped sweating all night long,” she says. “It made a huge difference.”

Looking back on it, Ms. Mihaly realizes it wasn’t the best idea to take herself off the medicine. “I felt like crap for 17 years,” she says. “I just didn’t know that much about it. I wish I had paid more attention instead of feeling half asleep for years.”

Patients have to educate and advocate for themselves. When you go to your doctor, “you have to emphasize what your symptoms are and be persistent in insisting on blood tests,” Ms. Steele says.

If there’s one thing she and Ms. Mihaly hope other women can learn from their stories, it’s this: You don’t have to “just live” with these symptoms. Thyroid disease is treatable, and you can feel good again.



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