Do you have risk factors associated with thyroid disease?
You are at risk for an over or underactive thyroid if you or a close relative have:
- Hyperthyroidism including Graves’ disease
- Hypothyroidism including Hashimoto’s chronic thyroiditis
- An enlarged thyroid (goiter)
- Any autoimmune disease, including type I (juvenile) diabetes, rheumatoid arthritis, pernicious anemia due to a lack of vitamin B12, or the white skin spots of vitiligo
- Certain traits and other conditions associated with a thyroid risk including prematurely gray hair (one gray hair before 30), bipolar disease, and the heart condition of mitral valve prolapse
Approximately 25% of women are at risk for thyroid dysfunction, either under or overactive thyroid. Hypothyroidism is increasingly common after 50, when 10% of women can be shown to have hypothyroidism through screening tests. Hyperthyroidism is less common and tends to occur in women in their 20’s and 30’s. Because the symptoms may be subtle, the American Thyroid Association has recommended that every woman have thyroid function tests every five years beginning at age 35.
Thyroid Conditions:
If your thyroid becomes overactive, it is most likely due to a generalized overactivity of the entire thyroid gland known as diffuse toxic goiter or Graves’ disease. Symptoms may include nervousness, heart palpitations, weight loss, tremors, heat intolerance, lighter menstrual periods, increased sweating, and occasionally enlargement of your eyes. Because the symptoms tend to be dramatic and steadily increase, most individuals who develop hyperthyroidism realize they are sick sooner or later, and get appropriate help. The diagnosis is made by measuring the blood level of thyroid hormone and Thyroid Stimulating Hormone (TSH) made by your pituitary gland. Thyroid hormone levels will be high, and the TSH low, confirming the diagnosis.
If your thyroid fails or becomes underactive you will begin to feel tired, sluggish, cold, and you may develop muscle cramps and prolonged heavy periods. The symptoms are more subtle and therefore, many women don’t realize they have a medical problem and are slow to seek medical help.
If you are pregnant, it is particularly important to know whether your thyroid is even mildly underactive. If that is your situation, you are at increased risk for premature delivery, a low birth weight baby, miscarriage, and hypertension (toxemia at delivery). A blood test will show low thyroid hormone levels and an elevated TSH easily confirming the low thyroid state.
Your family is also at risk:
If there are thyroid and/or other autoimmune disorders in the family, other family members should be screened with thyroid hormone and TSH tests. The Thyroid Foundation of America recommends that family members also have an Antithyroid Peroxidase Antibody test (anti-TPO Ab). Since the antibody tests often become positive before thyroid hormone levels change, family members will learn whether they are at risk. This is especially important for women in the family who should have thyroid levels rechecked prior to pregnancy, especially if the TPO antibody test is positive.
Treatment:
If your thyroid function is low, the treatment is thyroid hormone tablets (usually thyroxine) given once a day. The dose is increased until the TSH is normal. Thereafter, a recheck every six to twelve months should be enough unless pregnancy is considered.
If your thyroid is overactive, your physician will first control your symptoms with a medication like inderal or propanalol which blocks the action of thyroid hormone on your body, slowing your heart and calming your nervousness and tremor. Next you will likely be given an antithyroid drug such as tapazole or propylthiouracil which slows production of thyroid hormone until levels drop into the normal range. After several months on one of these medications your thyroid may gradually return to normal function making it possible to stop this medication. In the United States, the commonest form of treatment is radioactive iodine which is given by mouth, travels through the bloodstream, and collects in your thyroid where it damages thyroid cells. In a few weeks, thyroid levels will usually drop into the normal range. Sooner or later you will likely become hypothyroid and need to start thyroid hormone supplements. Very rarely surgery may be performed to remove all or part of an overactive thyroid. This treatment might be chosen if there are possibly cancerous thyroid nodules present in your hyperthyroid gland.
Footnote: The Thyroid Foundation of America is a non-profit organization that was created in 1985 to provide free education and support to anyone with a thyroid problem and to increase public awareness about thyroid disorders. You can reach us by email at info@allthyroid.org, or by our toll-free telephone line at 1-800-832-8321. Reviews of common thyroid issues are also available on our website at http://www.allthyroid.org/.
Biographical: Dr. Lawrence Wood started the Thyroid Foundation while practicing as a thyroid specialist and internist at the Massachusetts General Hospital. He has devoted his career to helping identify patients with unrecognized thyroid problems and calling attention to thyroid issues that may affect the public health. He is particularly concerned about the recurrence of iodine deficiency in the United States and deeply distressed by our lack of ability to solve the worldwide problem of iodine deficiency, which is the largest single cause of preventable mental deficiency today.
