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Dr. Alisa Hideg: Thyroid can wreak havoc

Tue., Jan. 7, 2014

Your thyroid gland is a small, butterfly-shaped lump on the front of your windpipe, just below where you can feel your Adam’s apple. It produces hormones affecting your entire body.

When the gland is healthy, you would not even know it is there. Unfortunately, when your thyroid does not function properly, the result can be quite miserable.

Hypothyroidism, when your thyroid does not produce enough hormone, can cause the following symptoms, which sometimes develop slowly over a period of years:

• Fatigue and muscle weakness;

• Increased cold sensitivity;

• Constipation;

• Dry skin and thin hair;

• Unexplained weight gain;

• Puffy face;

• High cholesterol or triglycerides;

• Muscle aches, tenderness and stiffness;

• Joint pain or swelling;

• Heavy or irregular periods;

• Slowed heart rate;

• Impaired memory and depression.

Hyperthyroidism, when the thyroid produces too much hormone, may result in these symptoms:

• Sudden weight loss without changes in diet;

• Rapid, irregular or pounding heartbeat;

• Nervousness, anxiety and irritability;

• Tremor – often in hands and fingers;

• Sweating and insomnia;

• Changes in your period;

• Increased sensitivity to heat;

• More frequent bowel movements;

• An enlarged thyroid gland (goiter);

• Fatigue, muscle weakness;

• Thin skin and fine, brittle hair.

Many of the symptoms of low and high thyroid hormone levels overlap and are similar to those associated with menopause, diabetes, autoimmune diseases, heart or lung disease and vitamin deficiency.

Thyroid hormone production may diminish or stop as a result of thyroid surgery, treatments used for hyperthyroidism, radiation therapy, some medications and pregnancy. Hypothyroidism also occurs with autoimmune diseases, pituitary disorders, iodine deficiency and as a congenital problem (being born with a defective or absent thyroid gland).

Hyperthyroidism can be caused by hyper functioning thyroid nodules (small lumps in your thyroid that produce thyroid hormone on their own), Grave’s disease, Hashimoto’s thyroiditis and other autoimmune diseases. Some health conditions may cause inflammation (thyroiditis) in the thyroid and a temporary leak of the thyroid hormone stored there.

An evaluation for thyroid problems starts with a medical history, physical exam, and often blood tests. If your thyroid is large or bumpy, an ultrasound or another imaging study can look more closely at your thyroid. Sometimes the cause of a malfunctioning thyroid can be discovered while taking a medical history, so it is important to answer questions as thoroughly as possible.

Both hyper- and hypothyroidism are treatable. Treatment choices depend on causes of your thyroid problem, your age and physical fitness, and the severity of your condition. Depending on the cause, you may need to see an endocrinologist, a physician specializing in diagnosis and treatment of gland and hormone problems.

Most people with hypothyroidism need to take a pill daily to replace thyroid hormone and the medication is managed by their primary care provider A blood test called TSH (thyroid stimulating hormone) is used to check hormone levels every one to three months at the beginning of treatment for dose adjustments. Over time, the test is repeated annually or as needed for symptoms.

Hyperthyroidism has four common treatments: radioactive iodine, anti-thyroid medication, beta blockers and surgery. Some of these destroy part or all of the thyroid function, resulting in hypothyroidism and need for a lifetime of thyroid hormone replacement.

You are at higher risk of thyroid problems if you have a family history of thyroid issues, you are female, have a personal history of radiation to the chest or neck, are more than 60 years old or if you already have an autoimmune disease. Talk with your health care provider about whether you should have routine evaluation of your thyroid function and keep in mind that there are many other health conditions that both affect and imitate thyroid disease.

Dr. Alisa Hideg is a family medicine physician at Group Health’s Riverfront Medical Center in Spokane. Her column appears every other Tuesday in the Today section.

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