Tired? Moody? Heavier? Might be your thyroid

How is the diagnosis made?
A simple blood test can check the level of TSH. (Remember an elevated TSH means that the pituitary is working harder to get the thyroid to produce hormones.)  Once an elevated TSH level is found, other tests may be done, including those for T4, T3, and a free thyroxin index or FTI (most thyroid hormone is bound up by protein as it circulates, and only the unbound portion enters the cells to “do its work.” This test measures the unbound portion). The latter tests help evaluate the actual working levels of thyroid hormones. 

Who should be tested?
Currently, most of the endocrine societies recommend that a woman have her TSH levels checked if she is symptomatic, has a family history of thyroid disorders, has an autoimmune disorder such as diabetes, or has high cholesterol. Testing is also recommended if a woman is in the early months of pregnancy and has a previous history of autoimmune conditions or obstetrical complications, such as recurrent miscarriage or early labor.

There is still some controversy as to whether there should be routine prenatal screening in women with no symptoms. There is a condition called pre-clinical hypothyroidism, where the TSH levels are somewhat elevated, but the FTI and T4 levels have not diminished below normal amounts. (In other words, the pituitary is working harder to get the thyroid to do its thing, and it’s still managing to do so.) Yet these women usually have no symptoms.

How do you treat hypothyroidism?
It’s not clear that those individuals with sub-clinical hypothyroidism should be treated. Many physicians believe that in the long term, if TSH is moderately elevated, even in the absence of currently low thyroid levels, a woman should be treated as soon as it’s diagnosed. Others believe, that a wait-and-see attitude should be taken, and that evidence-based medicine does not “bear witness” to an indication to start therapy before thyroid levels fall. However, if a woman has symptoms and/or her thyroid function is low, all physicians agree that therapy should begin.

What about hyperthyroidism?
This is most commonly seen with Graves' disease, an autoimmune disorder in which an immunoglobulin (an immune protein) acts on TSH to increase thyroid stimulation. This disorder affects about 2 percent of women during their lifetime and, again, is much more common in women than in men. 

Common symptoms:

• Heart palpitations
• Heat intolerance
• Nervousness
• Insomnia
• Breathlessness
• Increased bowel movements
• Light or absent menstrual periods
• Fatigue
• Trembling hands
• Weight loss (or weight gain because of nervousness and overeating)
• Muscle weakness
• Hair loss
• A staring gaze
• Bulging eyeballs

Hyperthyroidism usually begins between the ages of 20 and 40. It is diagnosed with a blood test for TSH, which will be abnormally low. Further tests should then be run to show that T3 and T4 also are elevated. An iodine thyroid scan should also be performed to see if the cause is a single nodule, or the entire thyroid. 

Does hyperthyroidism have other health effects?
The chief concern is cardiovascular. There is a much higher risk of developing irregular heart beats, especially arterial fibrillation which can lead to stroke and heart attack. Excess thyroid activity can also cause bone breakdown; even sub-clinical hyperthyroidism can lead to osteoporosis.

How is hyperthyroidism treated?
If your physician feels that your condition is due to a sudden inflammation of the thyroid (you may have pain in the neck where the thyroid is located or even have a mild fever), she may elect to simply calm down the tremor and nervousness with beta-blockers and add anti-inflammatory medications until the inflammation resolves (and the symptoms dissipate). However, if overproduction of thyroid continues, you will need specific drugs.

If the patient stops taking the medication, the thyroid will overproduce hormones once again. As a result, many physicians advise patients that their hyperthyroid condition be “taken care of for good” with radioactive iodine. Thyroid cells are the only cells in the body that can absorb iodine. When the iodine is radioactive, it destroys these cells and their ability to overproduce hormones.  The most common side effect is that the thyroid makes too little hormones, and the patient will need to take medication for hypothyroidism. Finally, if the patient has a goiter or nodule that is still overactive, surgery may be necessary. 

Dr. Reichman’s Bottom Line: Fatigue, weight gain, constipation, depression, memory problems, cycle changes, nervousness, and heart palpitations are each very common symptoms of thyroid problems. These symptoms may also be caused by psychological, social and other medical situations — however, none of these symptoms should be ignored.  Thyroid testing may give you the answer and the wherewithal for therapy that can change your life and health.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of HarperCollins.

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