Article about thyroid disease -- interesting

[Guest guest]

Interesting article from the Contra Costa Times yesterday.

--Diane

'Ups and downs of thyroid disease'

By Yadegaran -- Contra Costa Times

Posted: 01/11/2010 01:00:00 AM PST

DANIELLE GAYDEN of Oakland had to stick her face in front of a fan for almost an

hour to cool down. Second to her intolerance for heat was the anxiety, which

caused her heart to beat 200 times a minute and sent her to the emergency room a

dozen times in six months.

But Gayden, then 28 and newly married, had nothing to feel anxious about. Still,

doctors prescribed anxiety medication for what she described as an overwhelming

sense of terror. Had they noted her family history of thyroid disease, the ER

staffers may have called an endocrinologist to check Gayden's TSH, or thyroid

stimulating hormone, to see if it was too high.

The thyroid gland, located in the neck just below the larynx, is the body's

metabolism master. It converts iodine into hormones that influence every cell

and organ in the body, affecting our weight, mood, energy level and body

temperature, says Rick Dlott, a ez-based endocrinologist with Kaiser

Permanente. If hormones are too low, one is considered hypothyroid and may

suffer from fatigue, high cholesterol, weight gain, dry skin and depression. Too

high, or hyperthyroid, like Gayden, and one may experience anxiety, insomnia and

weight loss.

It seems we only hear about the butterfly-shaped thyroid gland in conjunction

with a celebrity's fluctuating weight. But the most common thyroid diseases are

autoimmune, and include Hashimoto's (hypothyroid) and Graves' disease

(hyperthyroid). An estimated

20 million Americans have some form of thyroid disease, and up to 60 percent

don't know it, according to the American Thyroid Association.

The reasons are complex. For starters, thyroid disease is hard to diagnose

because most standard blood tests don't pick up on this small but vital gland,

according to world-renowned endocrinologist Kent Holtorf of Torrance. Also,

symptoms are so common they are often attributed to other health problems.

Finally, even though hypothyroidism is particularly easy to catch, as it is more

common in women over 60, we interviewed dozens of women for this story who were

on cholesterol-reducing medications and antidepressants long before they or

their doctors realized the thyroid was to blame. Even after treatment with

natural or synthetic hormones, a lot of women still suffer with symptoms because

there is a discrepancy and debate among health care providers as to what is

normal TSH and if it is even the most accurate marker for hypothyroidism.

For instance, Kaiser Permanente's range is 0.1 and 5.5, while the labs at

Stanford University's School of Medicine use 0.4 to 4.0. The American

Association of Clinical Endocrinologists recommends treatment for patients who

test outside a TSH level of 0.3 to 3.0. Consequently, more research is proving

that other thyroid hormones such as T4 and especially T3 give us a better

picture of hypothyroidism, especially in patients who suffer from obesity,

diabetes, depression, inflammation or chronic fatigue syndrome, says Holtorf, an

expert in hypothyroidism. Holtorf and other experts, like Stanford's Haruko

Akatsu, say it is imperative to treat the patient and symptoms rather than a

number. After all, one person's comfortable 0.2 is another's hypo zone.

" Let's say I had a patient with a TSH of 0.4 and either their T4 or T3 is low.

That's abnormal to me, " says Akatsu, an endocrinologist and medical director of

the university's Thyroid Cancer Program. " No matter what is printing on the lab

paper, we need to assess the patient. I hardly ever use TSH alone, but I guess

it's a good place to start. "

Last summer, B.J. Thorsnes of El Cerrito became a victim of the thyroid numbers

game when she was hit with unexplained exhaustion, severe dry skin, joint pain,

swelling in her feet, and a " muddled brain. " " At 66, you don't know what's

happening with your body, " Thorsnes says. " But I knew it wasn't just that I was

getting older. "

The first doctor did blame her age. The second one prescribed Prozac and told

Thorsnes to see a psychologist. After reading about hypothyroidism and talking

with friends, many of whom were dealing with the same symptoms, Thorsnes asked

for a thyroid test. Turns out it was on the low end of her provider's range, but

because they considered her normal and would not treat her, Thorsnes switched to

an out-of-network physician. That doctor tested and confirmed that Thorsnes' low

T3 and T4 levels made her hypothyroid.

" I felt like a new person within days of receiving a slight amount of thyroid

hormone, " says Thorsnes, who has three sisters and two aunts — all with some

form of thyroid disease. " I can't tell you how excited I am to no longer be

dismissed as one of those 'older ladies' who doesn't know her own mind or body

and needs a shrink to navigate life's changes. "

" Old ladies " are hardly the only ones suffering from low thyroid problems. Andy

of South San Francisco was diagnosed with an underactive thyroid six

years ago when a new doctor was suspicious of 's symptoms, including

fatigue and weight gain despite an active lifestyle, elevated cholesterol,

coldness, dry skin and thin, brittle hair.

" In the morning, I'd comb it and it would be falling out on the counter, " says

, who is now 51 and has no family history of thyroid disease. " I was quite

surprised that I would have these issues, since I had always heard it was a

condition primarily impacting women. "

These days, the synthetic hormone medication takes generally works well

in mitigating symptoms, although it isn't perfect and he still has periodic

fatigue days, he says. A remedy from a San -based Chinese herbalist has also

helped relieve the coldness symptom, he says. has worked closely with his

doctor to find his thyroid's happy place, and has his levels checked at least

once a year.

" I tend to feel better when I'm at the lower numerical range, " he says. " You

just have to find a doctor who's willing to adjust you. "

Cheri Krueger of Concord found a doctor who practically saved her life. It was

January 1999, and Krueger was living on an Arkansas farm during a terrible

tornado spell. While running from a twister, Krueger slipped on her deck and

fractured her vertebrae. As a result, she was in a recliner for three months.

During that period of limited activity, she started noticing the hyperthyroid

symptoms.

" Heart palpitations so hard they'd wake me up, " Krueger recalls. " My hands would

shake all the time. I could not go an hour without eating. I'd be walking across

the pasture and my legs would buckle. And according to my husband, I was a huge

bitch. "

Around that time, Krueger read an article in a women's magazine about how to do

a thyroid self-test. She swallowed while looking in the mirror and noticed the

pronounced butterfly shape in her neck. Later, when she met with a doctor, he

told Krueger he could tell she was hyperthyroid by looking at her from across

the waiting room.

That fall, he gave her radioactive iodine, a treatment in which iodine collects

in the thyroid and over time, the radioactivity destroys overactive thyroid

cells. It caused her thyroid gland to shut down to the point of hypothyroidism,

a common response. All of a sudden, Krueger found herself on the opposite

metabolic spectrum. She was lethargic, felt cold, and gained weight.

Since, her doctor has stabilized her with synthetic hormones, which she takes

every day, as soon as she pries her eyes open in the morning, she says. The

entire experience has taught Krueger never to ignore symptoms, especially when

it comes to something as all-encompassing as a thyroid problem. " An undiagnosed

thyroid imbalance can cause serious long term-health problems, " she says. " It's

not just a weight thing. "

Resources

National Academy of Hypothyroidism. Headed by thyroid expert Kent Holtorf, this

nonprofit group of thyroidologists promotes the latest scientifically sound and

medically proven concepts and information about the diagnosis and treatment of

hypothyroidism. http://nahypothyroidism.org.

Shomon. This patient advocate and thyroid disease sufferer has penned many

best-selling books and educational materials about thyroid health, including

" The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss " (Harper,

2004). Read her blog at http://thyroid.about.com or follow her on Twitter

@Thyroid.

Light of Life Foundation. A Web site dedicated to the early detection, diagnosis

and treatment of thyroid cancer. www.checkyourneck.com.

American Thyroid Association. Founded in 1923, this organization is made up of

physicians and scientists who specialize in thyroid diseases. The group also

guides public policy about the prevention and management of thyroid diseases.

-- Yadegaran

Is tsh the most accurate marker for hypothyroidism?

With increasing knowledge of the complexities of thyroid function at the

cellular level, it is becoming clear that TSH and T4 levels are not the reliable

markers of tissue thyroid levels as once thought, especially in those suffering

from chronic physiological or emotional stress, illness, inflammation,

depression and aging.

In fact, it is common for an individual to complain of symptoms consistent with

hypothyroidism but have normal TSH and T4 levels. While there are limitations to

all testing, obtaining free triiodothyronine, reverse triiodothyronine and

triiodothyronine/reverse-triiodothyronine ratios can be helpful to get a more

accurate evaluation of tissue thyroid status and to predict those who may

respond favorably to thyroid supplementation.

-- National Academy of Hypothyroidism