Thyroid Disease

Thyroid Disease

Resetting Your
Body's Thermostat

Nancy Lambrechts, a Boston travel agent, was having the time of her life: A successful career, active participation in her tennis league, romantic weekend visits to her fiance in Belgium.

But by early 1990, she was feeling "worse and worse and worse." Nancy, then in her late thirties, had a hard time walking the five minutes to the train, let alone picking up a tennis racquet. Her pulse raced. Her weight dropped. Blood tests confirmed what her doctor suspected: an overactive thyroid.

Like 3.7 million Americans--90 percent of them women--Nancy had hyperthyroidism, the most common form of thyroid disease. Her thyroid gland, a butterfly-shaped organ nestled at the base of the throat, was pumping out too much of the powerful hormones that regulate metabolism, heart rate and temperature. The gland was going haywire because it was under attack by her own immune system.

"You burn up so much energy it makes you tired. It's like the inside of you is exercising while you're sitting still," says Nancy, who tried anti-thyroid pills and finally radioactive iodine to control her condition. "Now I'm feeling pretty good."

From Rundown to Overwrought

Like the thermostat in your car, your thyroid gland is something you don't notice--unless it malfunctions. Then it can pour an overload of hormones into your bloodstream or cut production to almost zero. Thyroid hormones affect virtually every metabolic process. Too much or too little can wreak havoc, causing, respectively, nervousness or depression, weight loss or gain, insomnia or constipation, bursts of energy or episodes of exhaustion. Untreated, thyroid diseases can lead to menstrual problems, pregnancy complications, infertility and even coma and death.

"But it's so easy to treat," says James J. Figge, M.D., chief of the Division of Endocrinology at Albany Medical College in New York. "If you watch for symptoms and ask to be tested, the disease can be controlled. And the difference in someone's life can be like night and day."

For reasons researchers don't understand, women get thyroid disease ten times more often than men do. Of the 5 million adults who know they have thyroid trouble, 4.6 million are women. Of those, 3.2 million have hyperthyroidism and 1.4 million have its opposite, hypothyroidism, in which too little hormone is produced.

"People don't have a clue why women have more thyroid disease," says David S. Cooper, M.D., director of endocrinology at Sinai Hospital and associate professor of medicine at Johns Hopkins University School of Medicine, both in Baltimore. "We do know that most forms of thyroid disease are autoimmune diseases, where the body produces antibodies that attack tissues." And autoimmune diseases are more common in women.

Getting an Early Warning

Thyroid disease cannot be prevented. But because it's often inherited--Nancy Lambrechts, for instance, discovered that her aunt and cousin also had overactive thyroids--doctors recommend blood screenings for early detection in women over 40 who have a family history of thyroid or autoimmune disease.

Dr. Cooper also suggests that pregnant women have this test, because 1 in 20 has thyroid difficulties in the months after delivery. Sometimes it's a brief bout of hyperthyroidism that subsides on its own. But thyroid hormone levels can also plummet, leading to depression, memory loss and difficulty concentrating. The symptoms are often overlooked or wrongly attributed to postpartum depression.

"It turns out you can predict who's going to get the problem with a blood test," says Dr. Cooper. "If a woman has certain antibodies in her blood, there's a 50-50 chance she'll have this problem. It won't prevent it, but at least you'll be on the lookout for it and you can treat it."

Of course, screening is also vital if you have any warning signals of thyroid disease. Yet these red flags are often vague or misunderstood. A specialist may treat one symptom--like depression or constipation--without finding the underlying cause. In fact, hyperthyroidism often looks like something else. And hypothyroidism's symptoms--like fatigue and sluggishness--especially in postmenopausal women, are often dismissed as simple signs of aging.

"It can be very subtle, but the symptoms to look for are those that go on over a period of time, not something that happens one day and not again," says Dr. Figge. "The key is, if you're starting to develop a pattern of muscle cramps or loss of energy or gaining weight for no apparent reason, it's time to have it checked out."

There's also no cure for thyroid disease, but doctors have an arsenal of treatments ready to control it.

A "Grave" Problem

If it's hyperthyroidism--a common condition of another hormonal problem called Graves' disease--your metabolism roars into permanent high gear. You can see it and feel it: Typical symptoms include nervousness, sweating, heat intolerance and weight loss. When former president George Bush and his wife, Barbara, both developed Graves' disease, he was bothered by heart palpitations, while she had vision problems and bulging eyeballs.

"The metabolism just revs up," says Dr. Figge. "People with hyperthyroidism burn calories rapidly. Sometimes you can feel the heat radiating off their skin like a radiator."

Seventy-five percent of Americans are treated with radioactive iodine to damage some of the thyroid cells that produce too much hormone.

"Some people are uncomfortable about getting any form of radiation," Dr. Cooper says. "But there have been many studies following women for 15, 20 and even 40 years, and certainly there is no evidence it's harmful in any way. It does not affect fertility."

But almost everyone who takes radioactive iodine or undergoes a surgical procedure to remove all or part of the thyroid later develops an inactive thyroid and can expect to take synthetic thyroid hormones once a day for life.

Another option for hyperthyroidism is drugs that make it harder for the body to produce hormones. The drawbacks are that these drugs can cause allergies and lower resistance to infection.

Running on Empty

Before iodine was added to table salt in the 1920s, iodine deficiency was a prime cause of hypothyroidism in the United States. Today an autoimmune condition called Hashimoto's disease is the cause of most underactive thyroids. With Hashimoto's, a small goiter or thyroid enlargement develops, which often subsides with treatment.

Other factors that can slow down your thyroid include taking lithium, a drug used to treat manic-depressive illness, and receiving neck x-rays to treat cancer. Oddly, eating too much iodine-rich food--such as kelp--may also knock the gland out of commission. And many people with hypothyroidism started with an overactive thyroid that became underactive due to treatment.

Hormone levels drop with hypothyroidism. Your body responds by functioning more slowly. The results include fatigue, constipation, feeling chilly, gaining weight, mental sluggishness, hearing loss, dry skin, coarse hair and a puffy face and hands. Treatment is usually a daily tablet of levothyroxine (Levoid), a synthetic thyroid hormone that is identical to what your body produces. Levothyroxine can be taken during pregnancy.

Coping with Thyroid Disease

You can't prevent it or cure it, but doctors say there's plenty you can do to cope. Here are some suggestions.

Get checked. If you have a family history of thyroid disease or autoimmune disorders, or if you have any symptoms that lead you to believe that your thyroid might be out of whack, ask your doctor to do a blood test. The sooner the problem is identified and treated, the better, doctors say.

Ask about treatment. If you have hyperthyroidism, ask your doctor whether drugs or radioactive iodine is best for you. Discuss the effectiveness and side effects of each method. With your doctor, you should talk over the possibility that you'll need to take synthetic hormones later on, after you've taken the iodine or drugs. If tests reveal mild hypothyroidism, ask about hormone supplements, says Dr. Cooper.

Some doctors prefer to monitor patients with very low-level thyroid problems, however. "My bias is, patients should be treated," says Dr. Cooper. "Some of the mild symptoms may not even be recognized by the patient. But after treatment, the patient says, `Gee, I didn't even realize I felt tired. I feel better now.' And there's no downside to being treated. There is no harm to taking hormones to normalize your thyroid, if you're taking the proper dose."

Buy the brand name. If you take levothyroxine for hypothyroidism, ask your doctor or pharmacist for a brand-name form of the drug. "The generics aren't reliable," says Dr. Figge. "Absorption in the body is not as well-controlled, and so the dose that you really get may not be precise. And brand names aren't that expensive--about $10 a month. So there's really no excuse not to use them."

Be patient. Once treatment begins, those troubling symptoms won't fade overnight. Depending on the type of thyroid disease you have, you may feel sluggish--or on pins and needles--for several weeks, says Dr. Cooper. "It's important not to be impatient with how you're feeling. These things take time," he says. "With hypothyroidism, you might not feel back to normal for more than a month. And with hyperthyroidism, the blood tests could look normal, but you may still be feeling nervousness, anxiety or a rapid heartbeat."

Check the dose. Your doctor should give you a blood test annually to ensure that your hormone levels are on target. "Once a year is the minimum," says Lawrence C. Wood, M.D., president and medical director of the Thyroid Foundation of America and a thyroidologist at Massachusetts General Hospital in Boston. "You will also need it checked at menopause and if you suddenly go on a medication that contains a lot of iodine, like some vaginal douches do."

Women who take synthetic hormones for hypothyroidism may need up to 45 percent more when pregnant, so ask your doctor to check your thyroid levels every two months during pregnancy.

Mind the mix. If you take thyroid hormone pills and then decide to use birth control pills, your thyroid dose may need to be increased. "A woman should ask for a test about a month after starting the Pill," says Dr. Wood. "In some people, the estrogen in birth control pills seems to increase the need for the thyroid hormone."

Stop smoking. Researchers in the Netherlands say smoking may bring on Graves' disease in people predisposed to it. They don't know what it is about smoking that encourages the disease, but they say that kicking the habit could save you from it.