Thyroid Disorders

Thyroid Disorders

Keeping Your Regulator Fit

For most of our lives, the thyroid functions like a silent partner in a company, working behind the scenes to keep our bodies up and running. Small and butterfly-shaped, it rests unassumingly at the base of the throat, producing hormones that regulate the body's metabolism, temperature and heart rate. When it's functioning properly, we hardly know it's there.

But this unpretentious gland often makes its presence known in a big way. Like the ice maker in your freezer, it can go on the fritz, either pumping out hormones at a frantic pace or reducing its production to barely a trickle.

When this happens, the over- or underactive thyroid can dramatically rev up or slow down your body's metabolic activity. At the same time, these metabolic changes can produce a wide range of unpleasant symptoms that can take a devastating toll on the way you look and feel. Untreated, a malfunctioning thyroid can eventually trigger heart problems--and can even lead to coma or death.

As bad as all that sounds, it really isn't. "With early detection and proper treatment, almost all the problems of an abnormal thyroid can be corrected, and the symptoms, reversed," says Brian Tulloch, M.D., clinical associate professor at the University of Texas Medical School at Houston. "And most patients go on to live normal, functional, productive lives."

The Underactive Thyroid

As your thyroid loses steam and cuts back its hormone production, your body gradually shows all kinds of signs that it's running on empty: fatigue, chills, dry skin, coarse hair, heavy periods, swelling and puffiness around the face and eyes, to name a few. It can also affect your mental functioning, leading to poor concentration, forgetfulness and depression. Your sex drive and your fertility can sputter and stall. This condition is called hypothyroidism.

The problem with hypothyroidism is that many of the symptoms associated with it are so common that you might not even suspect your ailing gland is the culprit. "It's easy to overlook an underactive thyroid, because the symptoms are similar to those associated with other common illnesses and mimic many of the physical changes we associate with normal aging," says Lawrence Wood, M.D., president and medical director of the Thyroid Foundation of America and a thyroidologist at Massachusetts General Hospital in Boston. "Many patients--and even some doctors--just take these symptoms to mean that the body is getting older, so quite often, the problem goes unreported or is undiagnosed."

Generations ago, thyroid enlargement, or goiter, was common in America due to a lack of iodine in the diet. Today, however, iodine deficiency is not a problem in the typical American diet; the most common cause of hypothyroidism is Hashimoto's disease, a disorder of the body's autoimmune system.

Because hypothyroidism slows down the way the body burns calories, many overweight women wishfully try to blame their weight gains on a sluggish thyroid. But it's not to blame. "Obesity and major weight gains are rarely related to an underactive thyroid," says Dr. Tulloch. "Most thyroid-related weight gains amount to only a few pounds, and that's due mostly to water retention."

While doctors can't usually make an underactive thyroid active again, they can easily treat and control it. "All we have to do is restore the right balance of thyroid hormone in the system by replacing what isn't being produced," says Martin I. Surks, M.D., head of the Division of Endocrinology and Metabolism at the Montefiore Medical Center in New York City. Women with sluggish thyroids take little tablets containing a synthetic version of the hormone thyroxine. The drawback: They must take them every day for the rest of their lives.

The Overactive Thyroid

Now imagine the thyroid acting in reverse, pumping out too much hormone. These excess hormones push the body's metabolism into overdrive, producing a unique combination of hyper-symptoms that includes rapid heartbeat, weight loss, weakness, nervousness, irritability and tremors.

Not surprisingly, this is called hyperthyroidism. Its most common cause is Graves' disease, the autoimmune disorder that struck both former President George Bush and Barbara Bush. The former first lady, you may remember, was bothered by rapid weight loss, bulging eyeballs and vision problems--classic Graves' symptoms. Her husband became aware of his Graves' disease after a scare from an irregular heartbeat.

When treating an overactive thyroid, physicians have several options. The simplest and most prescribed is to use radioactive iodine to reduce the number of overproductive thyroid cells. Doctors can also prescribe drugs that block the production of thyroid hormone or that block the effects of the hormone on the body. And as a last resort, doctors may surgically remove all or part of an overactive thyroid. But since surgery and radioactive iodine can cause women to later develop hypothyroidism, a lifetime of thyroxine tablets is often necessary.

Who's at Risk

Several key factors can put a woman at risk for developing thyroid disorders. The most important is just being a woman. "Women are about five times more likely than men to develop problems with their thyroids," says Dr. Surks. "Many thyroid disorders also manifest themselves during or following pregnancy or after menopause."

Graves' disease and other causes of overactive thyroid are most common in the 20- to 40-year-old age group, but they can occur in older people, too. By age 50, at least one woman in ten has signs of an underactive thyroid. And 17 percent of women over 60 suffer from some form of hypothyroidism.

Genetics also plays a role. If your family has a history of thyroid disease or autoimmune diseases such as diabetes and rheumatoid arthritis, you're a candidate for thyroid problems as you get older. Another fact to consider: According to a Dutch study, cigarette smoking appears to be a significant factor that produces Graves' disease in predisposed people. These findings imply that kicking the habit may prevent the development of the disease if it runs in your family.

Other risk factors: having had radiation treatments around the head and neck as a child, the use of certain medications such as lithium or going through a particularly stressful experience such as losing a loved one.

What Women Should Do

With the exception of eating a balanced diet and not smoking, there's not much you can do to prevent thyroid disease. "It's important to detect thyroid disease early, before it fouls up your body, your emotions or your life," says Dr. Wood.

Have your doctor check out any symptoms or abnormalities that may suggest hypo- or hyperthyroidism. According to Dr. Wood, any woman over age 50, especially if she's in a risk group, should make a thyroid test part of her annual physical exam. "Regular exams become increasingly important as you get older, because many of the symptoms of thyroid disease become less obvious and harder to detect on your own," he says.

Checking for thyroid function usually requires only a blood test. If a lump or nodule is present, a doctor may take a sample of thyroid tissue for examination in a relatively painless procedure called a fine needle aspiration biopsy.

While treatments with thyroid hormone are almost always safe, studies have shown that too much replacement thyroid hormone may increase a woman's risk for osteoporosis, the bone-weakening disorder that can lead to fractures of the hip and vertebrae. That's why it's important to get an annual checkup that includes a thyroid-stimulating hormone test, take the dose of thyroid hormone that's right for you and maintain an appropriate program of nutrition and exercise.