Kathryn “Kay” Elmore says she discovered she had thyroid issues after taking a blood test — and only after initially dismissing her chronic tiredness and dry hair to a normal result of working full-time and just having had her third child.
“You just think, ‘It’s kind of the way the world is,’” said Elmore, who grew up in Lombard with seven siblings. But Elmore’s primary doctor, during a routine exam, felt little lumps on Elmore’s thyroid. The thyroid gland is in the middle of the lower neck; it produces a hormone that influences every cell, tissue and organ in the body. The blood test showed her thyroid produced inadequate amounts of thyroid hormone – a condition known as hypothyroidism.
She has since taken the generic form of Synthroid called levothyroxine (also called T4), and a synthetic form of the thyroid hormone T3 called Cytomel. Elmore requires a blood test at least every six months to ensure that her thyroid is working well, and that her medication doses require no changes.
Hypothyroidism is the most common form of thyroid malfunctions, affecting up to 15 percent of Americans in cases ranging from mild to those requiring medication, according to the American Thyroid Association (ATA). The diagnoses have been climbing because technology has enabled lab tests to recognize milder conditions that weren’t recognized previously, says Dr. Elizabeth Pearce, associate professor of medicine at the Boston University School of Medicine and the president-elect of the ATA. January has been designated thyroid awareness month by the ATA.
Though hypothyroidism worldwide is due to iodine deficiency in people’s diets, that’s not the case for Americans.
“Here, it’s because a person’s immune system fails to recognize the thyroid and attacks – a situation in which antibodies directed against the thyroid gland lead to chronic inflammation – also known as Hashimoto’s thyroiditis,” Pearce said.
The problem frequently runs in families. Indeed, four of Elmore’s five sisters have some degree of thyroid problems.
The opposite situation – an overactive thyroid condition known as hyperthyroidism – is far less common and affects about .05 percent of the U.S. population, data show.
Both hypothyroidism and hyperthyroidism are five to 10 times more common in women than in men for unknown reasons, Pearce said. And though thyroid problems may crop up at any time, most start when women are 40 or older – again, for unknown reasons. One woman in eight will develop a thyroid disorder in her lifetime, the ATA says.
“Most nodules, or lumps within the thyroid, are found by accident when a person is having imaging done for some other condition,” Pearce said. “Over half of women over 50 have at least one nodule, but 95 percent turn out to be benign. Any nodules that look suspicious need to be biopsied to make sure they’re not thyroid cancer.”
Though thyroid cancer diagnoses have been climbing over the past 30 years, the treatments are usually effective and thyroid cancer deaths have remained stable over the years, Pearce said.
“There are new and evolving therapies,” she said. “In most cases, it is a very treatable cancer. The therapy story is a happy one.”
A concern remains, however, that pregnant women in the United States are ingesting inadequate amounts of iodine. That’s important because dietary iodine is needed to produce adequate thyroid hormone, which is important for the fetus’ brain development, Pearce said. Pregnant women with undiagnosed or inadequately treated hypothyroidism also have an increased risk of miscarriage and pre-term delivery. Pearce advises pregnant women to check their pre-natal multi-vitamins to make sure they include 150 mcg of iodine daily and to get more iodine by including seafood, milk, other dairy products and iodized salt in one’s diet. Many people don’t realize that commercially manufactured foods in the United States contain no iodized salt, she said.
If you are already taking big doses of iodine in medications for other ailments, such as heart rhythm problems (heart arrhythmias), that in itself can unmask an underlying thyroid disease. A three- to four-fold increase in diagnosing thyroid problems over the past 15 years has prompted caution from the ATA and other organizations that doctors start treatment cautiously.
“In the old days, most patients would have their thyroids removed after a lump was found that was thyroid cancer in their neck, and after surgery, they’d get treatments with radioactive iodine,” said Dr. John C. Morris, professor of medicine and endocrinology at Mayo Clinic and immediate past president of the ATA. Now, doctors recognize that many patients with so-called micropapillary thyroid cancers, which are a centimeter in diameter or smaller, may not require surgery and thyroid replacement, Morris said. As a result, in these very small tumors, doctors and patients steer clear of any risk of harm to the vocal cords or para-thyroid glands.
Doctors advise that patients get tested for thyroid problems, especially if they run in the family. The blood test measures the level of the thyroid stimulating hormone, known as TSH, that is produced in the pituitary gland, said Dr. Alaleh Mazhari, a doctor of osteopathic medicine at Loyola University Medical Center in Maywood. The hormone is sensitive to thyroid hormone fluctuations, and is usually the first test to become abnormal when a patient has thyroid dysfunction, Mazhari said.
A separate blood test assesses hormone function by interpreting the TSH alongside “free thyroxine (free T4)” – the hormone that hasn’t bonded to protein in the blood.
“If the TSH is elevated, the next question we ask is, ‘how elevated is the TSH and what is the free T4 level?’ Mazhari said. “If the TSH is greater than 10 or if the TSH is elevated and the free T4 is low, then treatment with thyroid hormone replacement is indicated.”
In patients with family history of thyroid disease, history of autoimmune disorders or abnormal thyroid labs, checking thyroid antibodies (anti-TPO ab, Anti thyroglobulin antibody) is helpful to check for autoimmune thyroid disease, Mazhari said.
For hypothyroid patients, weight management is a challenge, as Elmore attests.
“Weight gain is a constant struggle for me,” she said. Elmore said she eats lots of salad and refrains from eating red meat. She stays active by taking yoga a couple of times a week and walking five miles at least four days a week.
“I take one of my grandkids once a week to the park,” she said. “We blow bubbles and walk all over the place. I want to be a fun grandma.”
Sandra Guy is a local freelance writer.