Is your thyroid normal or is it time to get checked?
The incidence of thyroid disease seems to be rising dramatically. But we often dismiss the symptoms as simply the effects of a busy life. Is your thyroid normal or is it time to see your doctor?
Most women have no idea why they’re beginning to gain weight, to feel blue, to crave naps at the strangest times. They don’t understand why their periods are getting markedly lighter or suddenly heavier. They figure their hair is thinning or coarsening due to diet or age. They certainly aren’t aware that they’re experiencing symptoms of thyroid disease, which is now thought to be affecting as much as 10 percent of the North American population, with women at least four times as likely to suffer as men.
Symptoms of hypothyroidism
It was the autumn of 2007, in my case, when the butterfly-shaped gland at the base of my neck began to fail. I assumed that my deepening sense of depression was related to grief for having put down our beloved old dog at Thanksgiving. It made sense, as did my chronic yawning, which seemed typical for my experience of the winter sleepies.
The aches and pains I felt were likely muscle strain due to exercise, I decided. My skin felt dry because of the season. The disconcerting puffiness of my face surely had to be the result of my recent (typical 40-something?) weight gain.
It wasn’t until my appetite fell off so sharply that I could barely manage a cup of soup without choking that I began to wonder if something more serious was going on. Despite scarcely eating, I was nevertheless still gaining weight, and I was also losing my ability to concentrate. I felt as if, for no apparent reason, I’d developed ADD. Alarm bells finally rang and in January, I made a doctor’s appointment.
My family doctor, as luck would have it, is religious about checking thyroid hormone levels in her female patients. She knows that this unassuming little gland beneath our Adam’s apple governs the metabolic speed at which our body hums along, and is prone to malfunction. In some cases, the thyroid begins to vastly overproduce the hormone thyroxine, creating a condition known as hyperthyroidism. In other cases, like mine, it begins to sputter and conk out.
“You have hypothyroidism,” my doctor told me, after getting my blood test results and calling me in to see her. “Your thyroid can no longer produce thyroxine, and you’ll need to take a synthetic replacement hormone daily for the rest of your life.”
Oh! I sat back heavily in my chair in her office. I had never heard of thyroid disease. (I would later learn that my aunt, sister and grandmother all had thyroid trouble; family history is a factor.) It shocked me to think that what I was going through wasn’t temporary, but an actual chronic illness along the lines of diabetes.
Thyroid disease may be on the rise
Nobody is really sure whether thyroid disease is actually becoming more prevalent, but one thing is sure: The number of prescriptions in Canada for a common synthetic thyroid hormone replacement called Synthroid increased by 28 percent between 2005 and 2008. And if indeed “the incidence of thyroid disease is dramatically rising” in North America—as M. Sara Rosenthal, author of The Thyroid Sourcebook and director of the bioethics program at the University of Kentucky, argues—then for researchers the race is on to determine why this small gland in our neck is becoming so vulnerable. Could it simply be that more women are being screened now? One American study, testing people who were visiting a health fair in Colorado, suggests as much: “Thyroid dysfunction is common,” the researchers concluded, and “it may often go undetected.”
Living with thyroid disease
Leaving my doctor’s office that day, I remember thinking, Wow, I have thyroid disease—I have a disease! I began to take Synthroid, an inexpensive prescription that built my thyroxine levels back up so that in a matter of weeks I was feeling brighter, brisker and less weirdly arthritic. The puffiness ebbed, and I could concentrate again.
Novel as it was to suddenly be saddled with a chronic disease, I mentioned it to everyone I met and was startled at the number of other women who nodded in recognition. They, too, were taking Synthroid or, because they’d gone in the opposite direction —into thyroid overdrive—were taking another medication. One of them was my cousin’s partner, Michelle Kellner (who also happens to be a staffer at Best Health, heading up the advertising department). She was less fortunate in her initial encounter with doctors than I’d been. When she turned 30, she knew she was too young to be going through perimenopause, and yet her period had stopped for a year. Uncertain why, she consulted a number of specialists. “No one knew what was wrong with me.” No one, Kellner says, checked her thyroid hormone levels until she met a gynecologist who confirmed via a blood test that she was hyperthyroid.
He referred her to an endocrinologist, who noticed five little nodules on her neck (a symptom of hyperthyroidism that can indicate cancer). A biopsy found nothing cancerous, and he decided to simply “monitor” the condition, without appearing to realize that her original condition wasn’t being medicated.
For several years, she carried on with her life, unaware that her crushing exhaustion, an increasingly brittle irritability and yo-yo-ing weight were related to this untreated hyperthyroidism. “I assumed it was stress,” she says. “I thought it was a classic work-life balance problem and that I was pushing myself too hard.” But, she adds, “I didn’t feel like myself. I didn’t like myself. I thought: Something’s not right.”
Kellner switched doctors, and her new endocrinologist said: “‘This is crazy!’ Right away, she put me on medication.”
By that point, at the age of 36, Kellner had developed Graves’ disease, often the cause of hyperthyroidism. It can include a particularly devastating outcome known as thyroid eye disease, or TED, which features watery, bulging eyes and double vision.
She managed to escape that fate, but she was now at a point where the most efficient treatment was to surgically remove her thryoid, thereby letting her go into hypothyroidism. The operation took two hours, and required a three-day hospital stay. (A post-operative biopsy revealed a surprise: early-stage cancer. Kellner was told that this was coincidental.) Kellner is now on replacement thyroid hormone and, for the first time in years, feels “amazing.”
Reasons to get your thyroid checked regularily
So, how common is it to move through life with subtle symptoms like mine and Kellner’s with no diagnosis or appropriate treatment? “Women may suffer from a range of misdiagnoses,” notes Rosenthal, who has authored several peer-reviewed publications and consumer health books (and is herself a thyroid cancer survivor). She says symptoms of thyroid disease may mask or be mistaken for other problems, such as stress, anxiety, panic disorder, depression, fatigue and weight problems. Without treatment, the thyroid will eventually burn out completely.
Rosenthal recommends that all women have their thyroid function checked annually as a matter of course. And if you’ve been feeling out of sorts lately, don’t wait for your annual checkup to have your thyroid tested. While there are many remedies out there that promise a quick, pain-free cure for health and diet trouble, with thyroid medication the claim happens to be true. It’s often the diagnosis, rather than the treatment, that turns out to be painful.
This article was originally titled "Diagnosis: Thyroid disease," in the September 2009 issue of Best Health. Subscribe today to get the full Best Health experience—and never miss an issue!—and make sure to check out what's new in the latest issue of Best Health.