Heeding Thyroid's Warnings
October 7, 2003
By Richard Perez-Pena
I'm not sure what wins the prize for my low point.
Was it falling asleep at my desk? Forgetting where to catch the bus I ride every day? Trailing off in midsentence in a meeting with my boss and just staring blankly at her?
In late August, I became dazed and profoundly fatigued. It came in waves, and in my worst moments I was unable to concentrate, and even focusing my eyes required effort. I felt as if I was moving in slow motion.
It was like a hangover without the headache or flu without the cough. I went to a doctor, who said it was probably depression. I said I was pretty sure there was something physically wrong. He asked about symptoms and ordered blood tests.
Two days later, we had a diagnosis. My thyroid gland, the butterfly-shaped gland at the base of the throat, no longer produced enough of the hormones that tell the body to get up and go, a condition known as hypothyroid. A daily hormone pill was all I needed, and after a few weeks, my body and brain had revved back up to their usual speed.
In that time, I learned that an underactive thyroid was far more common than I had suspected. Friends, colleagues and neighbors have it. Its prevalence is estimated at 1 to 10 percent of American adults. But in one respect, mine was an unusual case. I felt tired and stupid for just a few weeks. The norm is for sufferers to drag on for months or even years, not knowing that they have an easily treated disorder.
"We don't address the portion of the iceberg below the water," said Dr. Terry F. Davies, director of the division of endocrinology, diabetes and bone diseases at the Mount Sinai School of Medicine in Manhattan. "There's a terrible lack of awareness among primary doctors."
Some doctors test patients routinely for thyroid function at middle age, when problems become more common. But many do not. Pregnant women are rarely tested, though pregnancy can bring on a hypothyroid condition that can, in turn, harm the baby. Even after they develop hypothyroid symptoms, many people and their doctors chalk it up to aging, stress, depression, menopause or maladies like Lyme disease.
"I had been really dragging for about a year, but I never thought there was anything wrong with me," said Judith Enck, 43, who works for New York State. "I just attributed it to a very busy lifestyle and a new job and getting older."
Fit people who exercise regularly are quicker to notice a loss of energy and to think it may signal a physical problem, said Dr. Lawrence C. Wood, medical director of the Thyroid Foundation of America and a thyroid specialist at Massachusetts General Hospital in Boston. "We think there are 19.5 million people who have it and don't know it," he said.
Along with fatigue, the warning signs can include dry skin, constipation, hoarseness, hair loss, weight gain and feeling cold. In some cases, the gland swells, producing a noticeable lump in the neck, a goiter.
A blood test for thyroid-stimulating hormone, or T.S.H., is used to diagnose thyroid deficiency. The pituitary gland, deep in the brain, produces the hormone to tell the thyroid to work harder.
Traditionally, doctors have considered levels of it up to about 5 milliunits a liter as normal, but that is changing. Most healthy people have levels lower than 2, and many thyroid specialists say a reading above 2.5 or 3 should be treated.
My level was 9.6, a clear-cut case. But doctors frequently see patients with newly diagnosed cases at levels of 20, 30 or even 100, indicating that they may have suffered for years.
In poor countries, iodine deficiency often causes hypothyroid. In the developed world, it is usually brought on by Hashimoto's disease, an autoimmune disorder in which the body's disease-fighting systems attack the thyroid.
Hashimoto's is associated, through a group of underlying genes, with more serious autoimmune disorders, including juvenile diabetes, rheumatoid arthritis, lupus, multiple sclerosis and Graves' disease, which causes hyperthyroid, or overproduction of thyroid hormone. Those diseases tend to run together in families, and most, including Hashimoto's, are more common in women.
Dr. Wood said experts were at a loss to explain other stranger correlations like an increased risk of Hashimoto's in left-handed people or people who started to have a few gray hairs before age 30. (I'm right-handed, but I had strands of gray in my 20's.)
"There's a lot we still don't know," he said. "But we do know how to find this condition and how to treat it, and too often, we just don't."
Source: New York Times (October 7, 2003).