Thyroid Conditions: The Disease Your Doctor Might Miss
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Thyroid Conditions: The Disease Your Doctor Might Miss

More than 9 million Americans who have a thyroid condition don't know it. Could you be one of them?


Lenore Martin* could see her heart beating through her shirt-actually lifting the fabric-as she lay on the couch watching television. "I thought it was going to jump out of my chest," she says. For six months, the magazine assistant, then 26 years old, had felt so hot and sweaty she often wore just a tank top in the dead of winter. She had dropped two sizes and 15 pounds without dieting. Worst of all, she was constantly nervous and couldn't sleep. Usually laid-back, she had become so touchy that she got into fights with strangers on the street. "I literally thought my personality had changed," she recalls. When she went home for her brother's wedding, her father, a doctor, noticed not only the changes in behavior but also that she was always drenched in sweat. He saw, too, that her neck was swollen-a possible sign that her thyroid, a small, butterfly-shaped gland at the base of the throat, was enlarged and not functioning correctly.

*Name has been changed.

Soon after the wedding, she was tested and diagnosed with Graves' disease, a form of hyperthyroidism that occurs when the thyroid gland secretes too much hormone. Because these hormones regulate the metabolism of every organ and cell, they affect all bodily functions, from heart rate to how many calories you burn. The doctor discovered that Lenore's resting heartbeat was 140, nearly twice as fast as it should be normally. Like Lenore, many people don't recognize the symptoms of thyroid disease. And doctors don't regularly screen younger women unless they complain of symptoms, which are frequently attributed to stress, poor nutrition or lack of sleep. As a result, more than half of the nearly 15 million Americans who have either an underactive (hypo-) or overactive (hyper-) thyroid are unaware of their condition.

Silent Causes of Weight Gain

The more prevalent thyroid disorder is hypothyroidism, in which the thyroid gland secretes too little hormone. Almost nine million women suffer from this problem, including about 5 percent of women between the ages of 25 and 34. The usual age of onset is between 35 and 60. Though the best-known symptom is weight gain (others include sluggishness, enlarged thyroid, dry skin and hair, sensitivity to cold, heavy periods, muscle cramps and depression), it doesn't always accompany the condition. For example, Elizabeth Posoli, 29, hadn't been gaining weight when she was diagnosed six years ago. At a routine physical, the physician's assistant noticed that she had a slightly enlarged thyroid and looked pale. Elizabeth also had dry hair and a dry scalp and was unusually tired. Blood tests revealed that she had Hashimoto's thyroiditis (the most common cause of hypothyroidism), in which the immune system destroys thyroid cells, resulting in decreased hormone production.

Hypothyroidism can run in families but can also be caused by viruses, childbirth and some medications, including lithium and drugs taken to treat an irregular heartbeat. Severe cases of hypothyroidism can cause infertility, depression and cardiac problems. It is particularly important for women who are pregnant or are planning to get pregnant to be screened for this disorder; if left untreated, it can have serious consequences, including increased risk of miscarriage and a slightly lower IQ in babies carried to term. After giving birth, some women experience a period of hypothyroidism, though this usually corrects itself, says Geoffrey Redmond, M.D., a New York City endocrinologist specializing in female hormonal problems. But if psychological symptoms (such as depression) persist, a new mother should seek help, including getting tested for thyroid problems so she can receive appropriate treatment if necessary.

Low-Energy Culprit

Graves' disease, the most common form of hyperthyroidism, is an autoimmune disorder in which the body produces antibodies that overstimulate the thyroid. Graves' (which Lenore suffered from) is often characterized by an obviously enlarged thyroid gland and/or bulging eyes, weight loss, excessive sweating, anxiety, fatigue and decreased muscle strength as the body wears itself out with excess activity. Many women also find that their periods become irregular or stop altogether. Untreated hyperthyroidism can cause heart dysfunction, bone loss and fertility problems.

Getting the Right Treatment

There's no cure for an over- or underactive thyroid, and doctors don't know of any way to prevent the disorders. People who suffer from either one have to take hormone pills daily for life. Fortunately, they are highly effective. "Since I've been taking medication, I've had a lot more energy," says Elizabeth. Even after the condition is under control, patients need to get regular blood tests to monitor their thyroid-stimulating hormone (TSH) levels.

An overactive thyroid is typically controlled by shrinking the gland with radioactive iodine to halt hormone production. This results in an underactive thyroid, which doctors then treat using the hormone. Though radioactive iodine is very effective, it can take months to completely disable the gland and then find the right amount of replacement hormone.

For six months after radioactive iodine treatment, Lenore was lethargic and depressed, and suffered from severe muscle cramps. She also gained about 35 pounds. Her doctors finally found the right amount of thyroid replacement and she returned to her normal weight. These days Lenore gets her thyroid level checked every six months, though she's so attuned to her body that she generally knows when her medication needs to be adjusted. And she finally feels like her old self again. "I'm calm, confident and better than ever," she says.