The Enid News and Eagle, Enid, OK

May 31, 2014

Never easy: Detecting problems with thyroid

By Judy Rupp, columnist
Oklahoma Watch

— Noting symptoms and reporting them to your doctor is a widely accepted way of detecting illness and getting treatment. With thyroid problems, this process does not always get the right results.

Suppose you told your doctor you are always tired, often irritablem are worried about thinning hair and skin and your inability to lose weight, despite frequent attempts at dieting. These are classic symptoms of hypothyroidism, a common disorder that is easily treated. They are also signs of other illnesses and non-illnesses too numerous to mention. So you’re having trouble losing weight? Join the crowd.

At any given time, 10 percent or more of Americans are depressed; it’s the most common condition confronting general practice physicians. And it’s the most common mental effect of a thyroid imbalance. As a result, about a third of the more than 30 million Americans with a thyroid disorder remain undiagnosed.

The thyroid is a gland, located in your neck. It produces hormones that travel through the blood to all parts of the body, controlling, among other things, how fast your heart is beating and how rapidly you burn calories — in other words, your metabolism. When something alters the production of these hormones, then problems can occur.

HYPOTHYROIDISM, the most common thyroid disorder, occurs when insufficient quantities of the two hormones, T3 and T4, are produced. The effects are a slowed metabolism, perhaps causing you to feel tired, sluggish and frequently cold. If you feel irritable or depressed, you are likely to relate it to stresses in your life. The aches and pains in your muscles and joints could mean simply that you’re exercising a bit too much to try to lose that extra weight.

All of these symptoms are common enough that they are unlikely to trigger an immediate suspicion of underactive thyroid. That diagnosis usually comes only after a blood test reveals an abnormally high level of thyroid-stimulating hormone (TSH). Increased levels of TSH are produced when the body detects declining levels of T3 and T4 and tries to compensate.

Undetected hypothyroidism can eventually lead to rather serious conditions such as heart failure. Treatment usually involves simply taking a thyroid pill that provides the missing hormones.

HYPERTHYROIDISM is the opposite — a speeded up metabolism that can cause a rapid or irregular heart beat, anxiety, nervousness, trouble sleeping, increased sweating and eating more than usual — but not gaining weight.

The latter makes an overactive thyroid seem almost desirable, but it’s not. It often leads to weak, brittle bones and other problems.

For women, an overactive thyroid usually causes heavy menstrual bleeding, whereas an underactive one produces a lighter flow. Both hyper- and hypothyroidism make it more difficult for a woman to become pregnant and can produce complications, sometimes serious, in the newborn child.

Any or all of these symptoms are likely to be attributed to reproductive issues or to menopause rather than thyroid imbalance.

For hyperthyroidism, doctors can prescribe antithyroid medications that limit the gland’s ability to produce new hormones. These medications do not permanently damage the thyroid as other treatments are designed to do. Radioiodine damages or destroys the cells that make thyroid hormones. Surgery removes all or most of the thyroid. The latter can be used because thyroid replacement medications are so effective.

THYROID NODULES do not cause symptoms, but you can probably see them yourself with a throat check. Stand in front of a mirror, stretch your neck back and then take a drink of water. Look for any enlargements.

Thyroid nodules are common, particularly in persons age 50 and over, and they usually do not represent any problem, although you should report them to your doctor.

Some nodules produce too much hormone, causing hyperthyroidism. They are known as “hot” nodules. Those that produce a normal amount are “warm” nodules. “Cold” nodules produce no hormone. Less than 10 percent — nearly all cold nodules — are cancerous.

THYROID CANCER usually develops in a nodule that is not causing any symptoms. A fine needle biopsy can be used to detect abnormal cells.

When a thyroid cancer is small, surgery alone — removing all or most of the gland — is usually curative. A large dose of radioiodine can also destroy cancer cells without significant damage to other parts of the body. The five-year survival rate for thyroid cancer is greater than 97 percent.

The consequences of a thyroid problem are numerous and can range from mild to life threatening.  Detecting an abnormality and correcting it is important.

Rupp is care coordinator for Long Term Care Authority of Enid Aging Services. Contact her at 237-2236.