Sunday, January 20, 2008

Thyroid disease: a silent epidemic!

The thyroid is small, butterfly shaped gland on the front of the neck. However, it serves the most important function of regulating the energy levels in the human body. The diseases of this gland can involve almost every living tissue, including the heart, brain, bone and the reproductive system. As these diseases present in various unusual and subtle ways, they are not usually detected early on . Thyroid diseases are more often detected in recent times. This is partly due to increased awareness of the disease.

To begin with, hypothyroidism, or a failure of the gland, is a very common thyroid disease. Hypothyroidism can present with tiredness, fatigue, decreased memory, weight gain and constipation. Women are more commonly affected than men. Infertility and menstrual irregularity are common features of hypothyroidism.

The diagnosis of hypothyroidism is very simple to make: a TSH (thyroid stimulating hormone) level that is high suggests hypothyroidism. A high TSH means that the thyroid gland has failed, and that the pituitary is making more TSH to stimulate the gland. In addition, the T4 level (T4 is a hormone produced by the thyroid gland) is often, but not always low in this setting. The TSH is the best test to make the diagnosis, and is easily available in most laboratories. A simple tablet (containing synthetic T4) called levothyroxine is usually needed lifelong to treat these patients.

Hypothyroidism in pregnancy could be particularly dangerous, as the developing fetus does not have a functioning thyroid gland in its initial 3 months. Hence, the fetus is dependant on the mothers thyroxine supply for the first 3 months, and this supply is critical for the baby’s brain development. Early, appropriate and precise levothyroxine therapy is needed in this situation to optimize pregnancy success and the baby’s IQ.

In addition to hypothyroidism, hyperthyroidism or overactivity of the thyroid gland can also occur. Hyperthyroidism presents with weight loss, severe anxiety, palpitations, trembling and a prominence of the eyes. Hyperthyroidism is diagnosed when the TSH level is very low. There are several anti-thyroid agents (like carbimazole) that can treat this disease. Some cases may require surgery or radioisotope (I-131) therapy.

Finally the thyroid may develop swellings, which may be benign or cancerous. An astute combination of blood tests, scans and needle biopsy of nodules can help in clinching the diagnosis. If malignant, the cancer needs to be removed surgically. Lifelong levothyroxine therapy is usually needed.

Of special concern is the emergence of a group of diseases called subclinical thyroid disorders, where the hormone abnormalities are only “mild”. Subclinical hypothyroidism is one such condition where there is “mild” thyroid failure. Patients with subclinical hypothyroidism need careful evaluation and therapy if they have any subtle complaints pertaining to hypothyroidism.

(I am an Endocrinologist at the Amrita Institute of Medical Sciences, Cochin . I am also the Editor of the Journal of Thyroid Research and Practice, and web editor of http://www.indianthyroid/society.com )

Also see

http://www.amrita.edu/accomplishments/media/The_Week.pdf

and

http://epaper.timesofindia.com/Repository/ml.asp?Ref=VE9JTS8yMDA3LzEyLzA2I0FyMDA3MDE=&Mode=HTML&Locale=english-skin-custom)

and

http://www.hindu.com/2008/01/18/stories/2008011852680600.htm

1 comment:

Russell Moris said...

During my youth I was overmedicated, with intolerance to medications, foods or chemicals. Around age 40 I decided to try a natural thyroid product to treat my hypothyroidism, so I decided to initiate treatment of desiccated bovine thyroid health supplements . It's the best decision I could make. Ever since I took it I feel much more energy and my weight is now lower than before.