NEWS: Thyroid screenings uncover the truth behind symptoms

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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.

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 s 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-, an endocrinologist who practices

in polis, 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- 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.

Getting screened

Dr. Bowen- 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- 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.

More testing

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.

Causes

Dr. Bowen- 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. "

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Patients can call the Foundation at 1-800-832-8321 for information or

go to the Web site at www.AllThyroid.com.

http://www.hometownannapolis.com/cgi-bin/read/2005/08_28-08/LIF