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The Post Investigates: Thyroid Disease

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“In my mid-30s, I began experiencing fatigue, weight gain, difficulty concentrating, strange aches and pains, and erratic sleep patterns,” says Mark Rotherham. After consulting numerous specialists and undergoing a battery of tests, physicians told the Wisconsin businessman that nothing was physically wrong with him. Perhaps, some suggested, the problem was actually “in his head.” Exploring every avenue, Rotherham sought psychiatric help and began taking medications that “led to more side effects than I had with my original issues,” so he stopped. The problem persisted. And his life continued its downward spiral until, unable to work, he filed for disability.

“It ruined everything—career, social life, relationships, because I was tired all the time,” Rotherham recalls. With lab results in hand and determined to find an answer, he began researching the Internet for clues. “One thing that kept surfacing was hormone imbalance,” Rotherham found.

The search also introduced him to an Indianapolis physician, noted for success in treating “difficult” cases, who conducted more extensive lab tests that finally revealed a diagnosis—underactive thyroid. Immediately placed on thyroid supplements, Rotherham soon noticed a difference.

“Within a couple of weeks, I felt worlds better,” says Rotherham, now 49, who recently launched his own business. “I went from being literally flat on my back, achy and tired, to being highly functional.”

Rotherham is among the approximately 27 million Americans living with overactive or underactive thyroid, according to the American Academy of Clinical Endocrinologists (AACE). Unfortunately, like Mark Rotherham, many go undiagnosed until something goes terribly awry, at times wreaking havoc on one’s quality of life.

Think of the thyroid as your body’s thermostat. Functioning normally, this butterfly-shaped gland, which sits just below your voice box, releases just the right amount of hormones to regulate your body’s metabolism and keep things running smoothly. However, if the thermostat is turned up too high, the thyroid becomes overactive—a condition called hyperthyroidism. You may feel revved up, overheated, and anxious and notice unexplained weight loss. In contrast, if the thermostat is turned down too low, the thyroid becomes underactive—a disorder called hypothyroidism—and fails to provide enough hormones to meet the body’s demands. As a result, your body slows down, leading to a wide range of ubiquitous symptoms. Of the two, hypothyroidism is the more common—and the more insidious.

Dialing down

The reason hypothyroidism is missed so often is threefold: Doctors don’t always screen for thyroid dysfunction; patients may not know to ask about it; and the symptoms are common to many other conditions.

While some people with hypothyroidism note changes, others overlook symptoms, because they seldom develop overnight and are often subtle. Hypothyroidism is notorious for mimicking changes often associated with aging, such as fatigue and intolerance to cold.

Over time, people may discover that the gland swells (see Neck Check) and their eyebrows begin to disappear. Additionally, hypothyroidism decreases sweating and causes slowing of your most vital systems: the heart, the lungs, and the gastrointestinal tract. Patients may experience shortness of breath when exercising, and many develop sleep apnea. Worst of all, hypothyroidism can cause high blood pressure and raise blood levels of cholesterol, two of the biggest aging culprits in America. Identifying the thyroid disorder is crucial, because in rare cases, hypothyroidism can lead to coma or even death. For all of these reasons, I encourage both patients and their doctors to have a conversation about hypothyroidism. When left untreated, the complications can shave years off your life.

Gauging your risk

Women are especially vulnerable: According to the AACE, hypothyroidism is up to 8 times more common in women than men. But all of us need to pay attention to our thyroids as we age, because underactive thyroid becomes much more common in older adults. By age 60, as many as 17 percent of women and 9 percent of men have an underactive thyroid.

Smoking; exposure to secondhand smoke or large amounts of radiation during childhood or cancer treatments of the head, neck or chest; and some prescription medications (such as the heart drug amiodarone and long-term use of mood-stabilizing lithium) can cause hypothyroidism.

However, the most common culprit in the U.S. is autoimmune dysfunction, when the body’s immune cells start to attack thyroid tissue like it’s a foreign invader. As a result, the thyroid gland stops producing hormones the way it’s supposed to. Genetics likely play a role; we know that people with a personal or family history of autoimmune diseases such as rheumatoid arthritis, type 1 diabetes, and psoriasis, among others are at higher risk for hypothyroidism. Researchers are close to discovering which gene types might make us more susceptible to autoimmune thyroid problems. In those who are genetically susceptible, certain environmental factors, such as iodine in our diet, are thought to trigger the autoimmune attack on the thyroid.

Thyroid checkup

If you are worried about your thyroid hormone levels, a simple blood test can help you and your doctor reach a diagnosis. The American Thyroid Association recommends that all adults over the age of 35 undergo thyroid screening; however, there is no firm consensus on mass screening. It’s especially important for people with high cholesterol to ask about having their thyroid levels checked: Many people aren’t screened for thyroid levels and could potentially have hypothyroidism. The good news is that doctors now have a very sensitive “thyroid stimulating hormone” (TSH) test that allows us to diagnose thyroid disorders much earlier—even before symptoms appear. Higher than normal TSH levels can reveal whether your thyroid function is in danger, even if your actual thyroid hormone levels are normal.

If your thyroid blood tests come back sub-par or abnormal, the most common treatment option for hypothyroidism is synthetic thyroid hormone replacements. These oral medications help restore hormone levels that shift your internal thermostat and metabolism back to normal. Evidence suggests that people who take thyroid hormone replacements should do so on an empty stomach. Additionally, certain medications, supplements, and foods may affect your ability to absorb thyroid pills. Talk to your doctor about your present medication regimen to gauge if there is an interaction. For example, generally it’s best to wait about four hours after taking thyroid medication to consume soy and high-fiber products, iron and calcium supplements, antacids that contain aluminium or magnesium, and certain prescription medications such as cholestyramine (Questran). Ultimately, monitoring thyroid hormone levels will determine if there is an absorption problem.

The role of prevention

Even if you’re not a candidate for thyroid hormone medications, dietary changes may help you protect the health of your thyroid. Because both too much and too little iodine can cause hypothyroidism, it’s important to be aware of foods that contain iodine and how they may affect your thyroid. Iodine deficiency is rare in the U.S. because it is added to our table salt. Eating excessive amounts of certain raw vegetables such as brussels sprouts, cabbage, cauliflower, corn, and kale should be avoided because they contain enzymes that can drive down thyroid function. But don’t think I’m telling you not to eat your vegetables—cooking them for just a few minutes deactivates those enzymes and makes them nutritious for your whole body.

In general, to protect the cells in your thyroid and your entire body, I recommend foods rich in:

  • Antioxidants (blueberries, cherries, tomatoes, squash, bell peppers)
  • Omega-3 fatty acids (walnuts, salmon)
  • B vitamins (whole grains, fresh vegetables)

Vitamin D is another critical micronutrient that is getting a lot of attention for its role in autoimmune disease. We know that up to 70 percent of Americans aren’t getting enough vitamin D and that inadequate levels could put you at higher risk for autoimmune disorders, such as rheumatoid arthritis and multiple sclerosis. Vitamin D also plays a supportive role for the parathyroid glands, four smaller glands located on the larger thyroid, that closely monitor and regulate calcium levels in our blood and bones. One of the best ways to get your daily dose of D is just 10-20 minutes of sunshine each day. Sardines, dark leafy greens, and fortified dairy products are also important sources. I recommend at least 800 international units (IUs) daily for most adults and 1000 IUs for adults over 70.

In addition to warding off problems within the thyroid and autoimmune disease, keeping your vitamin D levels up will also help fight off flu and several forms of cancer.

The key to keeping the thyroid healthy is paying attention to your own body. All too often, we accept that certain changes, such as sluggishness and depression, are just a natural part of the aging process. But hypothyroidism is the secret culprit behind these unexplained symptoms for millions of Americans. When we simply accept weight gain, low exercise tolerance, and mental cloudiness without questioning the cause, we’re risking serious harm to our bodies.

After his hypothyroidism went undiagnosed for a decade, Mark Rotherham is back on his feet.

How to Take Your Thyroid Neck Check

1: Hold the mirror in your hand, focusing on the lower front area of your neck, above the collarbones and below the voice box (larynx). Your thyroid gland is located in this area of your neck.

2: While focusing on this area in the mirror, tilt your head back slightly.

3: Take a drink of water and swallow.

4: As you swallow, look at your neck. Check for any bulges or protrusions in this area when you swallow. You may want to repeat this process several times.
Reminder: Don’t confuse the Adam’s apple with the thyroid gland. They thyroid gland is located farther down on your neck, closer to the collarbone.

5: If you do see any bulges or protrusions in this area, see your physician. You may have an enlarged thyroid gland or a thyroid module that should be checked to determine whether further evaluation is needed.

Source: American Academy of Clinical Endocrinologists.

You can find more information on diagnosing and treating thyroid disease from our exclusive interview with Dr. Jeffrey R. Garber.

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  • Joyce Mann

    I will always be eternally grateful for Dr. Oz’s article in the July/August issue of the Saturday Evening Post. I had been feeling extreme fatigue for a number of years. In March 2009, I discussed it with my primary care physician. I asked if I might be suffering from hypothyroidism. He blew me off, said my thyroid was fine, and sent me for an expensive sleep apnea test. Of course I was diagnosed with sleep apnea and rented an expensive CPAP machine that I couldn’t use. I discovered later that I had never had a thyroid test.

    A year later, and still tired, I read Dr. Mehmet Oz’s article in the Saturday Evening Post. I had all but one of the symptoms that indicated hypothyroidism, plus there are thyroid problems, rheumatoid arthritis, and diabetes among close family members. I requested the routine thyroid tests, including the antibody tests. The results indicate hypothyroidism, and I’m now scheduled to see an endocrinologist. Hopefully I’m on the way to getting my life back. Thank you so much Dr. Oz and the Saturday Evening Post for this timely article.