Low Thyoid and Thyroid Dysfunction
Symptoms of a Malfunctioning Thyroid
Problems with estrogen and testosterone, the body’s main sex hormones, tend to attract widespread public interest. But we might all be better off paying more attention to a far more common endocrine disorder: abnormal levels of thyroid hormones. Thyroid disorders can affect a wide range of bodily functions and cause an array of confusing and often misleading symptoms.
Because the thyroid, a small gland in the neck behind the larynx, regulates energy production and metabolism throughout the body, including the heart, brain, skin, bowels and body temperature, too much or too little of its hormones can have a major impact on health and well-being.
Yet, in a significant number of people with thyroid deficiencies, routine blood tests fail to detect insufficient thyroid hormones, leaving patients without an accurate explanation for their symptoms. These can include excessive fatigue, depression, hair loss, unexplained weight gain, constipation, sleep problems, mental fogginess and anxiety. Women of child-bearing age may have difficulty getting pregnant or staying pregnant.
Symptoms of thyroid dysfunction vary widely from person to person and tend to develop gradually, so patients and doctors may not recognize them as a problem that needs exploration and treatment.
Hypothyroidism, low hormone levels, in particular is often misdiagnosed, its symptoms resembling those of other diseases or mistaken for “normal” effects of aging, Indeed the risk of hypothyroidism increases with age. Twenty per cent of people older than 75, most of them women, lack sufficient levels of thyroid hormones that, among other problems, can cause symptoms of confusion commonly taken for dementia.
Symptoms of an overactive thyroid, or hyperthyroidism, include weight loss, increased appetite, anxiety, insomnia and heart palpitations, including atrial fibrillation, a risk factor for stroke. Yet, as with too little thyroid hormone, older people may lack obvious symptoms and remain undiagnosed. Although many women are affected by an over-active thyroid, the majority of women suffer symptoms due to an underactive thyroid gland.
Overproduction or underproduction of thyroid hormones affects as many as 3 million Canadians, including a disproportionate number of women and the elderly. An estimated one women in five of ages 60 or older has some form of thyroid disease.
Although we know for a fact that 10 per cent of all Canadian women have a thyroid condition, it is felt that another 50 per cent of older women have this condition but are undiagnosed or misdiagnosed. This is because older adults experience fewer of the typical symptoms associated with thyroid disorder and that makes diagnosis very difficult.
Complete tests for thyroid function include three measurements: for the hormones thyroxine (T4) and triiodothyronine (T3) produced by the thyroid itself, and for thyroid-stimulating hormone (TSH also called thyrotropin) produced by the pituitary gland. Production of thyroid hormones requires iodine in the diet, found in high amounts in iodized salt, eggs, sea vegetables such as kelp, fish and shellfish from ocean waters and unpasteurized dairy products.
Even when blood levels of thyroid hormones are normal, if the level of thyroid-stimulating hormones is low (subclinical hyperthyroidism) serious problems can result. In a Swiss study of 70,298 men and women followed for a decade, among the 2,219 who had subclinical hyperthyroidism, the risk of fractures, especially hip fractures, was significantly elevated.
Likewise, subclinical hypothyroidism (normal levels of thyroid hormones but too much thyroid-stimulating hormone) may raise the risk of heart problems, especially in young and middle-age adults. The standard treatment for this condition is synthetic thyroid hormone known as levothyroxine.
Unfortunately, here in Canada we have rules and guidelines regarding what are normal and abnormal levels of thyroid hormones. The Canadian Society of Endocrinology believes these tests should be more exact and routinely done in older people. Right now when you do the test your physician tells you that you “are in the acceptable range.” The Society feels the ranges must be narrowed to properly diagnose all the people with undiagnosed thyroid disease. They also feel that screening adults for TSH should start at the age of 35 and be done every 5 years.
Experts believe that between 40 per cent and 60 per cent of people with thyroid disease do not know they have it. Yet, even for subclinical disorders, proper diagnosis and relatively simple treatment of abnormal levels can result in a much improved quality of life.
Low levels of thyroid hormones can be easily treated with a daily pill of synthetic hormone, levothyroxine (marketed as l-thyroxine or Synthroid) starting with a very low dose and gradually increasing or decreasing the amount as indicated by careful monitoring. These tablets come in strengths of 50mcg, 75mcg, 88mcg, 100mcg, 112 mcg and so on so they can be titrated to find the exact dose needed by the patient. These tablets are so effective that millions of people who have had their thyroid gland completely removed (usually for thyroid cancer) can lead a normal healthy long life with just one of these tablets every day.
However, diagnosing subclinical hypothyroidism can be tricky. Dr. Robin P. Peters of Erasmus Medical Centre in the Netherlands recently noted in the New England Journal of Medicine that about 75 per cent of patients with this condition have test results that suggest only mild thyroid failure, which physicians do not consider serious. That is why we must change the testing standards and start treating people who suffer low thyroid symptoms needlessly.
If you are taking either Synthroid or levothyroxine, you should be tested regularly and discuss all symptoms with your physician. You probably just need a dose adjustment. Your thyroid medication should always be taken on an empty stomach hours away from other meds or food. Antacids and calcium supplements should be taken far away from your medication as this will interfere with the body’s absorption of your drug. The same advice goes for those of you who take proton pump inhibitors like omeprazole or pantoprazole.
If the body is overproducing thyroid hormones, which may be caused by abnormal growths called thyroid nodules, an anti-thyroid medication such as methimazole (Tapazole) can block excess production. Or radioactive iodine, taken orally as a liquid or capsule, can be used to destroy thyroid cells. This treatment will cause the thyroid gland to cease functioning and then the patient takes one synthetic thyroid pill a day for the rest of his or her life
Some thyroid tests such as TSH or T3 may not be covered by OHIP. Pay the extra money and get your thyroid gland completely tested. If you are one of the undiagnosed sufferers, you will be treated and have a new greater quality of life.