Treating and Understanding Thyroid Disease

When thyroid disease strikes, the body’s communications system goes awry.

Spend some time in the company of a teenager, and you might find yourself thinking about the power of hormones. But hormones do not typically come to mind when you experience weight loss, anxiety, palpitations, high blood pressure, brittle nails, constipation or a host of other symptoms that can be related to a hormone imbalance brought on by thyroid disease.

In fact, according to the American Thyroid Association, of the 20 million Americans who have thyroid disease, up to 60 percent go undiagnosed. A lack of awareness might be partly to blame; thyroid disease doesn’t tend to get the same amount of press as heart disease or Alzheimer’s, for instance. But perhaps more importantly, many of the symptoms of thyroid disease “are very non-specific,” says Elizabeth J. Spatola, MD, an endocrinologist and director of the Cardiovascular and Diabetes Center at St. Joseph Hospital in Nashua. “It’s dry skin. It’s weight gain. It’s fatigue. It’s ‘my hair is not as soft’ or ‘my hair feels coarse.’ If I have 10 patients coming in, nine of them are going to have those kinds of symptoms,” Spatola says. “I mean, who isn’t complaining about gaining weight and feeling tired?”

With its varied symptoms and poor showing on the general population’s awareness scale, thyroid disease is sometimes mistaken for depression, irritable bowel syndrome, some other ailment or simple aging, says Margarita Ochoa-Maya, MD, CDE, an endocrinologist and founder of Advanced Health and Wellbeing in Manchester. In fact, for the thyroid disease cases that are identified, it’s not uncommon for up to five years to elapse between the onset of the disease and its diagnosis, Maya says.

But the thyroid, a butterfly-shaped gland located front and center at the base of the neck, plays an important role in the communication system of the body, Maya says, and deserves to be noticed. It regulates metabolism, or energy-related functioning within cells, by secreting or withholding thyroid hormone, and in doing so, the thyroid gland influences just about everything in the human body, including the eyes, brain, heart, skin, hair, bones, bowels and mood.

The communication system is derailed when thyroid disease strikes and the thyroid gland produces too much or too little thyroid hormone. An overabundance of thyroid hormone, called hyperthyroidism, can cause irritability, a rapid or erratic heartbeat, weight loss, high blood pressure and diarrhea, among other things. It can weaken bones, sometimes leading to osteoporosis over time, Spatola says, and can leave patients feeling anxious and unable to focus, with racing thoughts.

Classic symptoms of hypothyroidism, or insufficient thyroid hormone, on the other hand, include depression, hair loss, weight gain, high cholesterol, extreme fatigue, constipation and stomachaches. Hypothyroid patients also often feel achy and sore.

The causes of a faulty thyroid are not fully understood — although your risk increases if you are female or if you have a family history of the disease — but autoimmune disorders lurk behind most instances of thyroid disease. Thyroid nodules, for instance, which can stem from an autoimmune disease called Hashimoto’s disease, can wreak havoc with the thyroid gland and in about three percent of cases will become cancerous, Maya says.

Also, an autoimmune disease called Graves’ disease leads to many cases of hyperthyroidism. Former first lady Barbara Bush is perhaps the most well-known sufferer of Graves’ disease, which causes the immune system to attack the thyroid gland, and triggers the thyroid to produce a surplus of thyroid hormone.

If a doctor suspects that a patient has thyroid disease, he or she will usually order a blood test that gauges the amount of thyroid stimulating hormone (TSH) in the blood. An elevated or suppressed level of TSH indicates possible thyroid trouble. A small percentage of people, however, will have normal lab results even though they have thyroid symptoms, Maya says, and will likely require additional testing.

The Fix

Treatment for hypothyroidism is usually straightforward: patients take prescription medicine to boost their supply of thyroid hormone.

Remedying hyperthyroidism tends to be more involved. In rare instances, patients with an overactive thyroid undergo surgery to remove part or all of their thyroid gland. More commonly, they take medication that inhibits thyroid hormone production, and are monitored over time to be sure that hormonal output remains on track, Spatola says.

Some hyperthyroid patients opt instead for radioactive iodine treatment, usually administered in capsule or liquid form. Swallowing radioactive iodine might sound scary, but it is considered a safe and effective treatment for thyroid disease. The thyroid, which feeds on iodine, absorbs the radioactive iodine and is destroyed, but surrounding tissue is left unharmed. Patients who receive radioactive iodine must maintain a lifelong regimen of thyroid medication to supply their body with the proper amount of hormone, but the overall course of treatment is usually more simple than it is when patients forgo radioactive iodine and only take medication for hyperthyroidism, Maya says.

Left untreated, the symptoms of thyroid disease often get worse. “Over time, it is usually — but not always — progressive,” Spatola says.

Weight Gain: My Thyroid Made Me Do It?

If you’re gaining weight, can you blame it on your thyroid? Probably not. Hypothyroidism, brought on by an underactive thyroid gland, can lead to weight gain, but it’s of a particular sort. “When you see someone who has severe hypothyroidism, you will never forget it. It’s a very specific type of weight gain. It’s a very doughy, fleshy kind of weight gain,” says Elizabeth J. Spatola, MD, an endocrinologist and director of the Cardiovascular and Diabetes Center at St. Joseph Hospital in Nashua. “In general, most people’s weight gain is not due to their thyroid. I know that nobody wants to hear that,” she says apologetically.

And, unlike the gradual weight gain that many inactive individuals experience over time, thyroid-related weight gain is not so subtle. If you suddenly and inexplicably gain, say, 15 pounds over three months, you might want to have it checked out, says Margarita Ochoa-Maya, MD, CDE, an endocrinologist and founder of Advanced Health and Wellbeing in Manchester. But most likely, if there’s a problem with your thyroid gland, you’ll experience other disease symptoms along with the weight gain. When in doubt, ask your doctor to arrange a screening test.