Better Health & Living
Gaining Weight? Feeling Depressed? Tired All The Time?
Before you blame your age or couch potato ways, consider a simple blood test to rule out this disease
Published in health •living_well | 0 Comments, Talk about this article »
A few years ago, Mary Shomon, Kensington, Maryland, lived every woman’s nightmare. Even though she was eating a low-fat diet and exercising for 45 minutes every day, she gained 15 pounds in four months. “I felt terrible,” says Shomon, 45. “I was depressed and couldn’t think clearly, and the weight was inexplicably piling up.”
She started having trouble breathing. “I thought I had asthma,” she says. “Then my doctor did blood tests, and I learned I actually had hypothyroidism.”
You may know hypothyroidism as “underactive thyroid.” It occurs when your thyroid—a butterfly-shaped gland nestled at the base of your neck—doesn’t produce enough thyroid hormone, which is responsible for many vital functions, including bone growth, heart rate, mood, and your body’s ability to burn calories for energy.
About 25 million people have underactive thyroid—that’s 10 percent of all women and 3 percent of men. But experts think the condition is even more widespread and that about 13 million Americans are probably undiagnosed.
There are good reasons for that. For one thing, it’s easy to blame symptoms—weight gain, fatigue, and depression—on age or a busy life. Maybe you’re gaining weight because you’re not exercising enough, or your forgetfulness is a by-product of stress or depression. “Hypothyroidism looks like so many other medical problems that many doctors don’t think to look for it,” says Theodore C.
Friedman, MD, PhD, coauthor of The Everything Guide to Thyroid Disease and chief of the division of endocrinology, metabolism, and molecular medicine at the Charles R. Drew University of Medicine and Sciences in Los Angeles. “Those who do test for hypothyroidism don’t always know when thyroid hormone levels are abnormal.” (See “High End of Normal.”)
In addition, many women, especially at middle age, struggle with the most common symptoms—fatigue and difficulty losing weight—even if they don’t have underactive thyroid, says Farida Khan, MD, chief of endocrinology and vice chairman of the department of medicine at New York Methodist Hospital in Brooklyn.
Getting Diagnosed
If you’re having symptoms and are in one of several high-risk groups, it’s time to be tested. Your doctor will give you a blood test that measures your levels of thyroid-stimulating hormone (TSH), which is produced by the pituitary gland and signals the thyroid to produce thyroid hormone. Even a slight drop in thyroid hormone levels can trigger an increase in TSH.
Who’s at risk? Women are more likely than men to have underactive thyroid. Advancing age (by age 50, 1 in 12 women have it) and endocrine disorders such as diabetes and a family or personal history of thyroid problems also raise the odds. People with autoimmune illnesses such as lupus, scleroderma, and celiac disease are also at higher risk. Hypothyroidism is usually easily treated with thyroid hormone replacement medication, which you will take for the rest of your life. But give the medication about three months to affect how you feel. “Just because you start taking the medicine and the numbers start to get better doesn’t mean you’ll start to feel better right away,” Dr. Khan says. “It takes time for the tissues to respond.”
Untreated, the disease is more than just a collection of unpleasant symptoms. It can cause infertility, anemia, and high cholesterol, which can lead to heart disease. In extreme cases, it can result in coma or death.
Look for the Signs
Hypothyroidism is far from a silent disease. Talk to your doctor if you experience any of these symptoms.
You’re inexplicably gaining weight Like Mary Shomon, who has written several books on the disease, including Living Well with Hypothyroidism, you may put on weight even if you’re doing everything right in terms of diet and exercise.
You’re extremely fatigued People with underactive thyroid may sleep for long stretches and still awaken tired, or they may need midday naps to keep going. Even once-easy routine tasks may become exhausting.
You’re down Depression is a hallmark of hypothyroidism. It typically causes feelings of hopelessness, helplessness, and intense sadness. You may find you’re not interested in activities you once enjoyed.
You feel “foggy” You may have trouble concentrating or remembering things. Some people may have trouble doing their jobs.
You’re unusually cold Before Ann McDonough, 52, of Westwood, Massachusetts, was diagnosed four years ago, she started to feel that the air conditioning in her office bordered on arctic, though it had never bothered her before. She even had difficulty shopping in the frozen food section of her supermarket. “I thought it must be a symptom of old age,” McDonough says. “I never gave it a second thought.”
Of course, not everyone with hypothyroidism will have the same signs and symptoms, another factor that makes diagnosis challenging. Other signals include high cholesterol; dry skin, hair, and nails; hair loss (especially the eyebrows); constipation; and in women, irregular periods and difficulty getting pregnant.
But you won’t be diagnosed at all if you don’t see your doctor and ask to be tested. “If it’s affecting your quality of life, then you have to address it,” says Dr. Khan.
Freelance writer Winnie Yu is coauthor of The Everything Guide to Thyroid Disease
The High End of Normal
Diagnosing hypothyroidism isn’t a precise science. TSH levels can fluctuate wildly and may vary depending on what you eat, any drugs you take, and even the time of year that your blood is drawn.
The definition of “normal” also may vary from one lab to the next and from one doctor to another. In November 2002, the American College of Clinical Endocrinologists changed its definition of a normal TSH range from 0.5 to 5.0 mIU/dl (milliunits per deciliter) to 0.3 to 3.0 mIU/dl. Having levels above normal is considered hypothyroidism.
But for people on the high end of normal—say, 3.0 to 5.0 mIU/dl—getting treatment may be difficult. Experts call this mild or subclinical hypothyroidism. Some patients in this range are lucky enough to have no symptoms and can take a wait-and-see approach as their doctors monitor their TSH levels. Others, however, may experience bothersome symptoms and need to adopt a more aggressive approach.
The best way to deal with mild hypothyroidism is to get a TPO test, which tests for a condition called Hashimoto’s disease, says Theodore C. Friedman, MD, PhD, of Charles R. Drew University of Medicine and Sciences in Los Angeles. Hashimoto’s disease is an autoimmune condition in which antibodies mistakenly attack the thyroid gland; it’s at the root of nearly 95 percent of all cases of hypothyroidism. If your TPO test is positive, ask your doctor for treatment. If it’s negative, Dr. Friedman recommends just keeping an eye on your TSH levels.
But even a negative TPO test doesn’t mean you don’t have hypothyroidism. Underactive thyroid may also be brought on by certain medications, such as lithium and prednisone; viral infections of the thyroid; or other medical conditions, including hyperthyroidism that has been treated with radioactive iodine.
Sometimes a low dose of thyroid hormone helps improve the symptoms, and thyroid function becomes normal again after the treatment is discontinued, says Farida Khan, MD, of New York Methodist Hospital in Brooklyn. For many people, though, mild hypothyroidism does eventually become the full-blown disease.
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