Thyroid disease common in U.S.

By MICHELLE ALEJANDRA BOOTH

VIEW ON HEALTH

Every year millions of people develop thyroid problems, with approximately 27 million Americans experiencing thyroid disorder. According to the American Association of Clinical Endocrinologists, this makes thyroid disease the leading endocrine disorder (problem that affects hormone glands) in the United States.

As common as thyroid disease is, the AACE estimates that about half of people with a thyroid disease remain undiagnosed.

The reason, perhaps because the symptoms are either very subtle or very similar to other health problems such as anemia, fatigue, depression, slow metabolism and a wide array of other diseases.

However, the test to diagnose is so simple and common that if the symptoms are mentioned to a doctor it's likely that they will test for thyroid disorder.

In fact, Dr. Hugh Burt, an internal medicine physician for Sunrise Hospitals, screens all his patients who are age 65 and older for thyroid disorder.

"For those patients of mine it is part of the routine and I try and screen for it annually," he said.

Thyroid disease is typically hereditary, affecting half of all children with at least one parent with thyroid disease by age 40, according to the AACE. It affects women in 80 percent of the cases affect women more than men.

Thyroid disease can come in many different forms with hypothyroid, hyperthyroid, goiter, thyroid nodules and thyroid cancer being the most common.

The thyroid is a small gland in the lower part of the neck in the trachea and it releases hormones that deliver energy to the cells of the body. The hormones the thyroid produces are, tri-iodothyronine (T3) and thyroxin (T4) and the pituitary gland and produces thyroid stimulating hormones that tell the thyroid how many hormones to produce.

Dr. Kenneth Izuora, an endocrinologist at the Nevada School of Medicine in Las Vegas and describes the thyroid as "the engine of the body."

"Most metabolic processes happen in the thyroid because it regulates the hormones in the body," Izuora said.

An overactive or underactive thyroid can lead to hormonal imbalances that affect the vision, heart, blood pressure, mood and even metabolism and proper organ function.

The body needs these hormones to function and these hormone levels determine how fast or slow the body's organ systems function. They also regulate the consumption of oxygen and production of heat. This process of collective organ function, oxygen consumption and heat production is commonly referred to as "metabolism."

In order to diagnose thyroid disease, a doctor can test for levels of thyroid-stimulating hormone in the blood, which is the most common screening measure for hyperthyroidism. A physician may also order a radioactive iodine uptake test, a biopsy, scan or ultrasound to look for any irregularities in the gland.

TYPES OF THYROID DISEASE

The most common form of thyroid disease is called hypothyroid, which is a slow release of thyroid hormones and accounts for roughly 80 percent of all thyroid cases and affects women five times more than men. Hypothyroid disease slows the metabolism in the body. The most common signs of hypothyroid are fatigue; feeling cold, dry skin and hair, hair loss, depression, stiffness in joints and muscles, irregular periods and depression. In some cases people with hypothyroidism can also develop high levels of cholesterol, which can increase the risk for heart disease.

If left untreated or if it becomes severe it can lead to dementia, irregular heart rhythms and in severe cases can cause coma.

According to Dr. Burt, hypothyroidism is the most common to diagnose because a lot of patients will commonly visit the doctor to complain about symptoms of fatigue and weight gain. Hypothyroid is also more common in older women around the age of 50.

"The symptoms of hypothyroid can mimic so many other things, which is why it's always good to check for hypothyroid as an option," said Dr. Burt.

Hypothyroid is commonly the result of inflammation caused by Hashimoto's disease, an autoimmune disease in which antibodies target the thyroid and impair its ability to produce hormones.

In order to treat hypothyroid, a patient will typically be prescribed an oral tablet or some form of hormones, typically a patient will feel better within two weeks and will be asked to take medication from 18 to 24 months. Sometimes the thyroid hormone levels will correct themselves with the use of medication and a patient can then be taken off medication, but if that does not happen a patient might have to take a prescription indefinitely. However, that is a small inconvenience compared to the pain of dealing with hypothyroidism, Dr. Burt says.

"My patients come to me and they tell me that they feel wonderful and they are so happy and it's just a matter of taking a little pill once a day for the rest of their lives, they no longer have headaches they have energy and they just feel so much better," said Dr. Burt.

However, if someone has hyperthyroid disease, the opposite is often true, because the thyroid releases too many hormones and causes the organs and tissues to overproduce. Patients who have hyperthyroid will typically present symptoms of rapid heartbeat, trembling hands, feeling hot a lot of the time, feeling hyperactive, having vision problems, diarrhea and irregular menstrual cycles. In many cases they will be hungry and eat a lot but still lose weight continually. It is more common in women between the ages of 20 to 40 but can also be diagnosed in men.

"Hyperthyroid is almost the exact opposite of everything about hypothyroid. Patients are less likely to complain about hyperthyroid than hypothyroid because...think they feel great and see that they are losing weight so they don't really complain about that," said Dr. Izuora.

In fact, because the symptoms in many cases are subtle, Dr. Izuora says a lot of people don't realize that there is anything wrong with them.

"A lot of patients think that they are just naturally hyper or that they have a fast metabolism and they think that is just how they are and so sometimes I get patients who have had those symptoms for up to five years and are barely being diagnosed," said Dr. Izuora.

However, if left untreated hyperthyroid can cause serious problems such as a cardiac arrest or complications due to an overactive heart or osteoporosis because the thyroid metabolizes the bones and vision problems that are attributed to bulging eyes.

"I tell my patients that, yes they are losing weight and that is great but they are losing weight at the expense of more serious problems," he said.

A lot of times hyperthyroid is caused by a disorder called Graves disease, which causes the immune system to produce antibodies that attack the thyroid gland and make it produce too much thyroid hormone creating an imbalance of hormones.

To treat hyperthyroid a patient might take oral hormone pills or beta-blockers, which control many of the symptoms of an overactive thyroid. The most common treatment is radioactive iodine, which causes the permanent destruction of the thyroid. This works because the thyroid gland collects iodine out of the bloodstream to make the thyroid hormone. In the case of hyperthyroid the body sucks up the iodine because it is overactive, the pill that is given then releases radiation, which destroys the thyroid gland, usually leaving the patient with a hypothyroid condition. A patient will then have to take medication or hormones for the rest of his or her life to regulate hormone function.

PREGNANCY

It is also common for younger women to develop postpartum thyroid, which causes a leakage of hormones from the thyroid, usually developing one to four months after giving birth, leading to a hyperthyroid condition. After that time, roughly four to eight months after giving birth, the woman might then develop hypothyroid because the thyroid may have lost most of its hormones.

However, in most women who develop postpartum thyroid the problem usually cures itself within the year. Risks for women who develop postpartum thyroid include having an autoimmune disease like diabetes, a personal or family history of thyroid disorders or having postpartum thyroiditis after a previous pregnancy.

However, if a woman has thyroid problems prior and during pregnancy they can have complications such as early labor and premature babies, smaller babies, fast heart rate of the developing baby, anemia, and problems with the brain development of the baby. If a woman is pregnant or thinking about getting pregnant, she may want to ask the doctor if a thyroid test is necessary. If any symptoms appear during her pregnancy she should tell her doctor immediately to avoid further complications.

THYROID CANCER

Hyperthyroid can also be caused by thyroid nodules, which are growths on the thyroid gland. Sometimes these growths don't cause any symptoms. Some of these growths are cysts and contain only fluid. Others are composed of thyroid tissue and can release hormones. Sometimes nodules will becomes so large that they cause problems with swallowing or breathing and in less than 10 percent of cases thyroid nodules are cancerous. To determine if a patient has nodules they may perform a scan and biopsy and perhaps surgery to remove the nodules. Even though cancerous nodules are uncommon, caution should still be exercised, especially if there is a family history of nodules.

Depending on the symptoms and the level of hormones, a person can live with thyroid problems. If left untreated, however, a malfunctioning thyroid can cause life-altering complications. Dr. Burt says patients with thyroid problems typically have a shorter life span, especially if left untreated. The problem does not lie with the thyroid but with the effect is has on the rest of the body, leading to vision problems, osteoporosis, possible cardiac problems or cardiac arrest, problems with the nervous system, dementia and in some cases, cancer.

That is why Dr. Burt is such an advocate for TSH exams.

"They are pretty affordable and so common that a doctor will typically recommend one. Treatment can then make all the difference in the world. I can tell by how happy my patients are later," he said.