By John Hastings
The thyroid has a big job: The hormones it secretes help regulate heart rate, maintain healthy skin, and play a crucial part in metabolism. When the gland is sluggish (hypothyroidism), it can rob you of energy, dry out your skin, make your joints ache, cause weight gain, and kick-start depression. When it becomes overworked—hyperthyroidism—and produces too much hormone, it can cause racing heart, sleep disturbances, and weight loss. That's a lot of grief for a gland the size and shape of a buckeye butterfly.
Given what can go wrong, you may be surprised to hear that about half of the estimated 27 million Americans with thyroid disease remain undiagnosed, according to the American Association of Clinical Endocrinologists. The seemingly unrelated symptoms are partly to blame. People can spend years going from internist to specialist trying to get a diagnosis. They're often prescribed skin creams and antidepressants when what they really require is thyroid medication.
Most people with thyroid disease, about 80 percent, have the hypo version. Should symptoms drive you to make a doctor's appointment, one of the first things your physician will ask is if you have a relative with the disease, since thyroid disease tends to run in families. Your risk also increases as you get older; in addition, being female (the disorder is as much as eight times more common in women), or having another autoimmune disorder such as type 1 diabetes or rheumatoid arthritis can worsen your odds.
Depending on your risk profile, your doctor may recommend a thyroid-stimulating hormone (TSH) blood test. TSH is released by the pituitary gland; when the thyroid bogs down, the pituitary releases more TSH. If you have normal levels of TSH, your test score will be from 0.4 to 2.5. A score between 0 and 0.4 is hyperthyroidism. Between 2.5 and 4 means you are at risk for hypothyroidism, and should be retested within a year. Above 4 means you have a mild case. Doctors used to resist treating patients in this category (clinical hypothyroidism starts at 10). But a 2007 British study in The Journal of Clinical Endocrinology & Metabolism suggests that treating such patients can help prevent cardiovascular disease by reducing bad, LDL cholesterol and the risk of hardened arteries while improving waist-to-hip ratio and increasing energy. So if your symptoms led to a TSH test and you scored higher than 4, you and your doctor should discuss treatment.
Women should have routine thyroid tests every five years beginning at age 35, according to Lewis Braverman, MD, chief of endocrinology at Boston University Medical Center. A TSH test runs anywhere from $20 to $80 and is covered by most health insurance plans. There's another, less common test called the TRH test that some doctors and alternative practitioners prefer, believing it offers a more accurate way to diagnose subtle thyroid dysfunction. It's expensive, though, and few doctors use it because they feel the TSH test is just as good. One or the other should be administered to the following:
- Women of all ages who have unexplained aches and pains, intolerance of cold, hair loss, sleep troubles, fatigue, dry skin, constipation, weight gain, forgetfulness, or heavy periods.
- Men with those symptoms (minus the heavy periods). Although women are up to ten times more likely to have thyroid troubles, men are not immune.
- Anyone with high cholesterol.
- Women who are depressed, even mildly.
- Women who have trouble conceiving or have suffered a miscarriage.
- Women who have recently had a baby or are entering menopause. Thyroid disease is often triggered during times of hormonal change.
- Women with a family history of thyroid disorders or other autoimmune diseases.
Published on December 18, 2012.