Thyroid Disorders in Women

Thyroid disorders, which include underactive (hypo), overactive (hyper) thyroid, benign nodules, inflammation of the thyroid (thyroiditis) and malignant cancer are among the most common medical conditions. However, as their symptoms appear gradually, they are often misdiagnosed. Many patients and even doctors neglect the symptoms of thyroid disease and attribute them to old age. According to a new study published in the journal; Archives of Internal Medicine, in March 2000, an estimated 13 million Americans, a number twice as high as previous estimates, may have undiagnosed thyroid disease. In this study, the investigators measured indicators of thyroid dysfunction and cholesterol levels in 25,862 participants of Colorado health fair and also reviewed a questionnaire filled out by subjects on their symptoms. Approximately 9.5% of the participant had test results indicating hypothyroidism and 2.2% had hyperthyroidism. Both of these conditions can lead to serious health consequences, including coma and death. if not treated. The authors concluded that thyroid disease is fairly common and can easily go undetected.

Thyroid disorders affect five to eight times as many women as men. Unfortunately, there is a general lack of understanding about such diseases even among women who may experience three or more of its common symptoms. 'Left undetected and untreated, thyroid disorders can elevate cholesterol levels, cause long term complications and may lead to irregular cycles, infertility and worsening osteoporosis' says Dr. Debra R. Judelson, a Beverly Hills internist. As high as 15% of post-menopausal women may have hypothyroidism. Women with other autoimmune diseases such as type 1 diabetes, rheumatoid arthritis, etc; are at a higher risk of thyroid dysfunction as are elderly men. Thyroid disorders affect every phase of a women's life including puberty and menstruation, reproduction, pregnancy and post-partum (after delivery), and menopause. Thus, they may cause abnormally early or late onset of puberty, irregular or absent periods, irregular ovulation (production of egg for fertilization). Ovaries of hypothyroid women may have increased risk for cyst development; hypothyroidism during pregnancy may harm the fetus and may lead to postpartum thyroid problems such as post-partum thyroiditis,. Thyroid disorders may cause early onset of menopause and some symptoms of hyperthyroidism such as hot flushes, insomnia and mood swings may be mistaken for early onset of menopause. However, 'with early detection and proper treatment, almost all of the problems of an abnormal thyroid can be corrected and the symptoms reversed and most people can go to live normal functional productive lives'. The purpose of this column is to raise awareness of thyroid disorders especially among women so that a timely diagnosis can be made and treatment started.

The thyroid gland is located in the front of the neck below the Adam's apple. Its left and right lobes, which wrap around the trachea look like the wings of a butterfly. The thyroid takes up iodine from the body and produces hormones which affect almost all tissues of the body to control cellular activity and regulate the body's metabolism. There is interaction between the pituitary gland, which produces a hormone called 'Thyroid stimulating hormone' or TSH for short, and the thyroid gland which makes the thyroid hormones called T4 and (to a lesser extent) T3. The level of thyroid hormones is maintained within normal limits by a process called 'feedback control.' If the thyroid is producing abnormally low levels of thyroid hormones, the pituitary secretes more TSH to stimulate the thyroid gland and vice versa. Both hyperthyroid and hypothyroid patients can be easily diagnosed by a simple and inexpensive test which measures the amount of TSH in blood. In hypothyroidism the levels are elevated whereas in hyper state they are very low. Medical experts believe that performance of the sensitive TSH test as well as a careful examination of the neck for the presence of nodules or abnormal growth should be part of the annual physical examination, especially for women over the age of 50.

The most common cause of hypothyroidism is an autoimmune disease called 'Hashimoto's disease' in which antibodies to thyroid components start to destroy the thyroid tissue leading to underproduction of hormone.

In the early stages of hypothyroidism, the symptoms may be quite non-specific and vague such as fatigue, and generalized weakness or the patient may even be symptom less. This is especially true of elderly women. Later on other symptoms such as intolerance to cold, weight gain, very dry skin, dry coarse hair that falls off easily, aches and pains in joints and muscles, muscle cramps, constipation, mental sluggishness, increased sleepiness, forgetfulness, difficulty in concentration etc. may develop. Hypothyroidism seldom leads to obesity or huge weight gain.

Giving the patient synthetic thyroid hormone treats hypothyroidism. The TSH laboratory test discussed above is used to determine the appropriate therapeutic dose and to ascertain that hormone does not become abnormally high which may cause symptoms such as heart palpitations, heat intolerance, nervousness and irritability. Studies have shown that too much replacement thyroid hormone may increase a women's risk for osteoporosis.

Hyperthyroidism is most common in young adults and middle-aged persons, again women being more likely to have the disease than men. Symptoms of this disorder include weight loss, fatigue, tremors, intolerance of warm temperatures, increased thirst, hair loss, rapid heartbeat, shortness of breath, cessation pf menstrual periods, anxiety, depression, irritability, mood swings etc. In Grave's disease, the autoimmune disease that struck both former President Bush and Barbara Bush, rapid weight loss, bulging eyeballs and vision problems may be the classic symptoms. Hyperthyroidism is treated by use of radioactive iodine, antithyroid drugs or surgery.

In 'sub-acute thyroiditis', which is viral in origin and usually follows an upper respiratory tract infection.; various symptoms may smolder for months sometimes. Excess of thyroid hormones may be followed by a hypothyroid state that may require treatment but the patient eventually returns to a normally functioning thyroid.

In approximately, 5-10% of all pregnancies a condition called 'postpartum thyroiditis' may develop after the birth of the baby which is similar to 'sub-acute thyroiditis'but carries a higher risk of causing permanent hypothyroidism.

Nodular thyroid disease also is more common among women. The nodules may be solitary or multiple and are usually benign; however about 5% may be cancerous. Thyroid ultrasound is useful in evaluating thyroid nodules. A procedure called 'fine needle biopsy'is used to rule out the presence of a malignancy. Cancer of the thyroid gland is usually treated by surgical removal of the entire gland.

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