Thyroid screenings uncover
the truth behind symptoms
By EVELYN D. HARRIS, For The Capital
About 12 million Americans have hypothyroidism (under-active thyroid) without knowing it, the Thyroid Foundation of America says.
Laura Atkins of Severna Park was one of them.
"I had been skinny as a rail and extremely energetic," said Mrs. Atkins. "When this hit, I was exhausted all the time, gained 40 pounds, had dry eyes and skin, brittle nails and just felt generally awful. My regular doctor tested my thyroid enzymes, but said nothing was wrong."
"I kept feeling worse until finally I went to Johns Hopkins and saw an endocrinologist. It turned out I was nearly in adrenal failure due to extreme hypothyroidism."
Mrs. Atkins, who has been taking thyroid medication since February, is beginning to lose weight and resume her former busy schedule of working and taking care of her home, her husband, her six sons and her animals (three horses, a poodle and a Chihuahua that just gave birth to eight pups).
According to Dr. Hazel Bowen-Wright, an endocrinologist who practices in Annapolis, an under-active thyroid can have a big impact on how you feel.
"Your thyroid controls your metabolism, which affects every organ in your body," she said. "With an under-active thyroid, everything slows down. You cannot tolerate cold, your heart rate is slower and you may suffer constipation, fatigue, depression, and lack of energy. Dry skin, brittle nails and hair loss are also common symptoms. . . . it is difficult to lose weight due to the slow metabolism. However, if you still can't lose weight after you begin taking the right dose of thyroid supplements, there is some other cause of the weight problem."
There are several different types of these thyroid medications. Dr. Bowen-Wright prefers Levothyroxine (synthetic T4 thyroid hormone) because it delivers a more constant, steady rate of thyroid hormone to the body. She said the animal thyroid dosage is not as steady, and it is harder to calibrate the correct dosage for the patient.
Getting the correct dosage is very important. If there's not enough thyroid hormone, the patient will continue to suffer symptoms. If there's too much hormone, the patient could develop symptoms of hyperthyroidism such as nervousness, heart palpitations and insomnia.
Dr. Bowen-Wright is an endocrinologist, which is the specialist of choice for more complex cases of both under- and over-active thyroid. She recommends that anyone at any age who has symptoms be screened for thyroid problems, and that women be tested at the age of 35 or when they are trying to become pregnant.
"Hypothyroidism causes fertility problems and also causes problems in pregnancy," she said. "More women than men have under-active thyroids and the condition becomes more common as you get older. As many as one in eight women over age 50 has some degree of hypothyroidism.
"Since 9 percent of men develop hypothyroidism by the age of 60, men should be screened at that time," she added.
Because calcium, iron and some other minerals may interfere with the body's ability to absorb thyroid hormone, Dr. Bowen-Wright said it is important not to take your thyroid supplement at the same time as your multivitamin.
"If you want to take your thyroid supplement before you go to bed, it is OK," she said. "It won't keep you awake because it does deliver a steady level of hormone."
To diagnose thyroid disease, the doctor will normally measure both T4 (the main thyroid hormone) and TSH (Thyroid Stimulating Hormone). In the typical patient with an under-active thyroid, T4 will be low and TSH will be high. That is because the pituitary gland in the brain recognizes that there is not enough T4, and is telling the body to make more. In more rare cases, levels of both T4 and TSH are low, because the pituitary is not functioning well.
Dr. Lawrence C. Wood, president and medical director of the Thyroid Foundation of America, would like to see doctors perform regular thyroid screening for all adult patients. The foundation is a nonprofit organization that provides education about thyroid disease.
Dr. Wood, who teaches at Harvard Medical School and at the Thyroid Unit at Massachusetts General Hospital, said performing regular TSH tests would prevent unnecessary suffering, and might even save money.
In a Kaiser Permanente study, doctors performed a TSH test on every adult patient presenting for treatment, Dr. Wood said. Researchers found that the tests were cost effective.
"Many individuals with thyroid dysfunction sought medical help but couldn't tell what specialist to see," Dr. Wood said. "Thus, they might see a family doctor for fatigue, a dermatologist for skin changes, a cardiologist for heart rhythm disturbances or a therapist for depression. Thyroid screening could have made the diagnosis and saved consultation costs."
Dr. Wood recommends that your doctor examine the front of your neck and feel your thyroid gland as you swallow in your annual check-up.
"In this exam, your doctor is looking for lumps and nodules, which could be signs of thyroid cancer, as well as for a goiter, which would indicate thyroid dysfunction," he said. The American Cancer Society estimates that about 23,600 new cases of thyroid cancer are diagnosed every year in this country. However, with treatment, thyroid cancer patients have an excellent prognosis and there are about 200,000 people living with the condition.
Dr. Wood said that if you think you have hypothyroidism, you should start with your primary care physician and get your TSH and T3 tested. Primary care physicians can treat most cases of simple hypothyroidism. However, for over-active thyroid (Graves' disease) and for more difficult cases of hypothyroidism, patients should see an endocrinologist. Dr. Wood also recommends starting with synthetic T4 medication, but if this does not relieve your symptoms he says you should tell your doctor so you can switch medications or change the dosage.
Dr. Wood said that in addition to multivitamins, soy and some medications such as Zoloft could affect absorption or the function of your thyroid hormones. He recommends taking your thyroid pill at night, and asking your physician about possible interactions whenever you start a new medication.
Dr. Bowen-Wright said Hashimoto's disease is the most common cause of under-active thyroid. Other causes are congenital defects and failure of the thyroid due to medical treatments such as surgical removal of part of the thyroid (normally done to treat over-active thyroid.)
Scientists do not know exactly what causes Hashimoto's disease. However, they do know that is in an autoimmune disease that is most common in people with a family history of thyroid disease.
Researchers say symptoms of autoimmune diseases often surface following physical or mental stress. Mrs. Atkins said that her thyroid symptoms closely followed her witnessing the death of a friend in a tragic riding accident. At about the same time, Mrs. Atkins also developed a condition called Meniere's disease, an inner-ear problem causing dizziness.
Other conditions that seem to be co-related with thyroid disease are insulin-dependent diabetes, immune diseases such as rheumatoid arthritis, colitis (inflammation of the colon), celiac disease (gluten intolerance), pernicious anemia and vitiligo (white spots on the skin.) Depression and bipolar disease (manic depression) are so strongly linked to thyroid problems that most psychiatrists do a TSH test for patients. Pre-mature gray hair also is linked to thyroid disease.
Dr. Wood said the painful wrist condition known as carpel tunnel syndrome is also linked to thyroid disease.
"In some cases, carpel tunnel syndrome actually disappears once patients get their thyroid hormone regulated," he said.
Some patients believe that certain foods such as soy, broccoli and cabbage actually damage the thyroid. According to Dr. Wood, normal amounts of these foods do not damage the thyroid. However, he said researchers have found thyroid damage in iodine deficient populations who rely heavily on foods such as cabbage, cassava and millet.
Dr. Wood does not advise taking supplements such as kelp that contain many times the body's requirement of iodine, because this could damage the thyroid.
"Iodine is used to suppress the thyroid in pregnant women who have hyperthyroidism (Grave's disease)," she said. "People should not try to self-treat for hypothyroidism with iodine such as in kelp supplements, because it could backfire."
Patients can call the Foundation at 1-800-832-8321 for information or go to the Web site at www.AllThyroid.com.
Evelyn D. Harris is a freelance writer living in Crofton.