Life Out of Balance: Disorders of the Thyroid

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Thyroid problems can sneak up on you. At first you may not associate the fatigue, muscle pain, temperature intolerance and moodiness with anything more than the effects of a stressful life or aging. But they keep getting worse, until you find that you can't function at all.

Alaynna Farrahi first started experiencing symptoms in late 2003, just months after the birth of her second son. She was feeling extremely tired and the weight she had gained during her pregnancy wasn't coming off as easily as she had hoped. Of course, these are the complaints of all new mothers, so Alaynna dismissed her concerns.

But then her muscles started cramping, she noticed she was always cold, her skin was dry and cracking to the point of bleeding, and she was starting to become depressed. From here, things would only get worse. During the next few months, her condition would deteriorate to the point where she could barely function at all, even on the most basic level.

"The fatigue and muscle cramps were debilitating," says the 34-year-old Mokena resident. "It became an effort to lift my arms, to get up out of a chair. I couldn't raise my hands to put on my shirt. I got to the point where I did what I had to do, and that was it. I even lost interest in eating."

Despite her lack of interest in food, Alaynna still wasn't losing the baby weight. In fact, she was gaining, and her face and the rest of her body seemed unnaturally puffy. She was so tired that she would fall asleep in the middle of the day while reading to the boys, and she even lost the hair along the bottom edge of her eyebrow.

Alaynna visited her doctor in the spring of 2004. He immediately suspected an endocrine problem and ordered a complete blood workup with thyroid panel. The results: Alaynna's thyroid stimulating hormone, or TSH, level was well over 300. It should have been less than 3.

Like nearly 27 million other Americans, Alaynna was struggling with a thyroid condition. Her thyroid gland wasn't functioning properly, and her hormone levels were off the charts. In a nutshell: If your thyroid doesn't work properly, neither do you. Left untreated, thyroid disease increases a person's risk for high cholesterol, osteoporosis, infertility, depression, anxiety, hair loss, sexual dysfunction, heart attack and, in extreme cases, coma or death.

Thyroid Function

The thyroid is a small, butterfly-shaped gland that sits in the front lower portion of the neck and is responsible for producing the hormones that regulate metabolism. This means that the thyroid controls how fast and efficiently the cells in your body convert nutrients into energy, which in turn affects the function of every tissue and organ.

"The thyroid is one of a group of glands that are part of the endocrine, or hormone, system,"explains Abdallah Altarshan, M.D., a Palos Heights endocrinologist. "Thyroid hormones regulate body metabolism and thereby affect brain development, breathing, heart and nervous system functions, body temperature, muscle strength, skin dryness, menstrual cycles, weight, cholesterol levels. They affect nearly every organ in the body."

The thyroid does all of this by working much like a central air conditioning system. If there are enough thyroid hormones, T3 and T4, in the blood stream to keep the body functioning at an optimal level, the gland stops producing them. When the body needs more, the thyroid releases more.

Much like a thermostat, the pituitary is central to this process. By secreting TSH, this small gland located at the base of the brain tells the thyroid when to stop and start making hormones. When thyroid levels in the body are good, the pituitary stops releasing TSH and the thyroid halts production.

Thus, thyroid diseases actually can be caused by either a malfunctioning thyroid or faulty pituitary gland. But since symptoms can be ambiguous and/or mild, according to the American Association of Clinical Endocrinologists (AACE), at least half of the 27 million people who have a thyroid condition are undiagnosed or misdiagnosed. Approximately 80 percent of those people are women.

Common Problems

By far, thyroid diseases are the most common endocrine disorders, affecting 40 percent more people than diabetes. While thyroid problems can be attributed to age, genetics, autoimmune disorders, medications, thyroid nodules and goiters, iodine deficiency, pregnancy, and in rare cases cancer, the symptoms are typically the same, associated with one of two conditions. More than 80 percent of all thyroid cases come in the form of hypothyroidism, and the remaining are hyperthyroidism.

"Hyperthyroidism refers to any condition in which there is too much thyroid hormone in the body," Dr. Altarshan says. "The thyroid gland is considered overactive."

When the thyroid gland is overactive, a person's metabolism is put into over-drive, which can cause feelings of extreme nervousness or anxiety. Hyperthyroidism commonly occurs in women between the ages of 20 and 50, and is often associated with an auto-immune disorder known as Grave's disease, a hereditary condition that can be triggered by periods of intense stress.

Symptoms of hyperthyroidism include:

• Rapid and erratic heart rate, often more than 100 beats per minute
• Becoming anxious, nervous and irritable
• Trembling hands
• Fatigue and muscle weakness
• Weight loss despite increased appetite and caloric intake
• Hair loss or change in hair texture
• Heat intolerance and excessive sweating
• Loose and frequent bowel movements
• Menstrual abnormalities.

At the other end of the spectrum is the more common condition known as hypothyroidism. When the thyroid gland is underactive, the result is the slowing down of many bodily functions. Hypothyroidism is most common among women and the elderly.

Symptoms of hypothyroidism include:

• Feeling slow or daytime fatigue
• Intolerance to cold
• Muscle weakness and cramps
• Weight gain
• Dry skin and hair, brittle nails
• Husky voice
• Facial puffiness
• Depression
• Elevated cholesterol levels
• Poor memory and difficulty concentrating.

Since symptoms can vary greatly, and they can be mild or develop gradually over many months or years, both hyper- and hypothyroidism can be difficult to diagnose. They also can be associated with many other conditions, including aging, menopause and stress. So don't jump to conclusions if you have one or two symptoms, but do consult your physician.

Restoring Function

Thyroid diseases typically can be diagnosed through a physical exam and simple blood test to measure TSH and thyroid hormone levels. When your thyroid level is too high, TSH is low, as the pituitary gland is attempting to stop hormone production. Conversely, if your hormone level is too low, the TSH is high. A normal TSH level is between .45 and 5. With a TSH level of 300 and symptoms to match, Alaynna Farrahi was diagnosed with hypothyroidism. More specifically, tests showed that she had the most common form of the disease, called Hashimoto's thyroiditis, in which the body's immune system actually attacks the thyroid and compromises hormone production.

"I had no idea what hypothyroidism was," says Alaynna. "It wasn't even on my radar screen." But with an extremely elevated TSH level, Alaynna's symptoms were not only affecting her quality of life, but they were putting her at risk for cardiac problems. Her physician immediately started her on medication to increase her thyroid levels.

Both types of thyroid disease can be treated successfully with medication. If the condition is mild enough or considered temporary, treatment may not even be necessary. However, since more severe cases like Alaynna's are often permanent and can be progressive, and since hormone levels can be difficult to regulate, some thyroid diseases require lifetime management.

"Hypothyroidism cannot be cured," Dr. Altarshan says. "But in almost every case, it can be completely controlled by replacing the amount of hormone that the patient's thyroid can no longer make. So even if your thyroid gland does not work right, T4 replacement can restore both the thyroid levels and the body's function."

While Alaynna felt a big improvement once she started treatment, it has taken three physicians, four different medications and several years to feel normal again. And even now, her condition requires regular monitoring and medication adjustments. "It's really like an experiment," says Alaynna. "And you're experimenting with your own body and emotions. You have to be very aware of how the disease is affecting you. I don't have the fatigue I used to have. My skin has gotten better. My mood and spirits are better, but I know I will be dealing with this for the rest of my life.

"The best advice I can give someone who believes he or she might have a thyroid problem is this: You are your own best advocate. Get diagnosed. Don't make excuses for your symptoms, and work with a physician who is willing to listen to your concerns. You are the one who has to live in your body every day; make sure you do so in the best mind, body and spirit possible."

If you believe you could be struggling with a thyroid disorder, the Palos Community Hospital Physician Referral Service can help find an endocrinologist in your area. Call (708) 226-2300 or visit us on the web at www.PalosCommunityHospital.org/doctor.

Top 10 Signs You May Have a Thyroid Condition

An estimated 27 million Americans experience thyroid problems, and yet more than half don't yet know it. That's because symptoms are often vague, and can develop slowly over many months or even years. Since a poorly functioning thyroid can increase your risk of obesity, depression, anxiety, hair loss, sexual dysfunction, infertility, heart disease and a host of other conditions, it's important that you don't ignore the signs.

You don't need to have each symptom to be diagnosed with a thyroid condition, but these are some of the most common:

1. Fatigue. Feeling exhausted when you wake up, feeling as if you need more than 8 or 10 hours of sleep a night, or being unable to function each day without a nap all can be signs of hypothyroidism. With hyperthyroidism, you also may experience nighttime insomnia.
2. Weight Changes. Gaining weight and difficulty losing weight are common in people with hypothyroidism, while losing weight without trying is often a sign of an overactive thyroid.
3. Depression and Anxiety. Depression may be a sign of an underactive thyroid, while anxiety or panic attacks are more commonly associated with hyperthyroidism. Depression and anxiety that does not respond to anti-depressants may also signify a thyroid problem.
4. Cholesterol Issues. High cholesterol, especially if it does not respond to diet, exercise or medication, can be a sign of hypothyroidism. Unusually low cholesterol is associated with hyperthyroidism.
5. Family History. If you have a family history of thyroid conditions, you are at greater risk of developing problems yourself.
6. Menstrual Irregularities and Fertility Problems. Heavier, more frequent and more painful periods may be associated with hypothyroidism, and shorter, lighter, infrequent menstruation can be a sign of hyperthyroidism. Infertility can be associated with both if left untreated.
7. Bowel Problems. Constipation is frequently associated with hypothyroidism, while diarrhea or irritable bowel syndrome (IBS) is associated with an overactive thyroid.
8. Hair and Skin Changes. Severe hair loss and thin, fragile skin may occur with hyperthyroidism. Coarse, brittle hair, along with dry and scaly skin and an unusual loss of hair at the outer edge of the eyebrow can be signs of hypothyroidism.
9. Neck Discomfort/Enlargement or Tightness in Throat. This can involve discomfort when wearing turtlenecks or ties, a hoarse voice or a visibly enlarged thyroid.
10. Muscle and Joint Pain. Muscle cramping and joint aches can be associated with thyroid problems, along with muscle weakness.