Published in Panorama
A sense of lethargy overtook Regina and she was often feeling fatigued. She attributed it to her age, 48 years, and believed she was reaching menopause. 37 year old Uzma was becoming very restless, irritable, often had mood swings and felt fatigued and lethargic these days. She felt she was going into some kind of depression but did not know why. (For more on Menopause, see my earlier bog on the subject)
“These women may in fact be suffering from hypothroidism rather than depression or menopause”, reveals Dr.Prakash Pania, Specialist Endocrinologist, Indian Specialist Medical Centre, Dubai.
“Anybody complaining of the above symptoms or any vague symptoms could be the victims of this thyroid disorder which results due to a deficiency of the thyroid hormone secreted by the gland. The butterfly shaped gland which lies below the Adam’s Apple in the neck produces hormones which increase oxygen use in the body cells. The hormones regulate the body’s metabolic rate and basically gets a person going. So when there is a deficiency of the hormone, the body slows down, and gets manifested in a variety of ways which could often overlap with symptoms of depression, ageing process, menopause, obesity and diseases of the muscles and joints.” (Refer to my earlier articles on Obesity, Childhood Obesity and Treatment for Obesity such as Gastric Banding and Bariatric Surgery)
Who and what ages of people are prone to hypothyroidism? Dr.Pania reveals, “While the elderly are most susceptible, hypothyroidism can affect people of all ages, including infants. Congenital hypothyroidism is believed to occur in about 0.04% of newborns and in 90% of them, it is life long. In 85% of these cases, the gland is either missing, underdeveloped or inappropriately positioned. Temporary hypothyroidism can also occur in premature infants for various reasons. In general, no matter the age, women are more prone to the disorder than men.” For this reason it makes sense screening babies for hypothyroidism.
What are the risk factors involved in hypothyroidism? A genetic predisposition is certainly observed, says Dr.Pania. “Usually thyroid disease will often skip generations. Insulin dependent diabetics, women with autoimmune diseases like systemic lupus (see What is Lupus), pernicious anemia and rheumatoid arthritis are at higher risk for hypothyroidism. Smoking triples the risk for the disorder. Women with breast cancer, those suffering from anorexia (see the post on Anorexia Nervosa) and bulimia are also at increased risk.”
A multitude of factors can cause hypothyroidism including autoimmune diseases of the thyroid gland, the commonest being Hashimoto’s thyroiditis, says Dr.Pania. “The causes range from this to congenital disorders as in infants, failure of the pituitary gland to secrete the thyroid stimulating hormone (TSH), surgical removal of the gland or a part of the gland, destruction of thyroid tissue, deficient or excessive intake of iodine, certain medications and inflammatory conditions.” (See my article on Treating Hypothyroidism)
Elaborating on these causes, Dr.Pania explains, “Thyroiditis, an inflammation of the thyroid gland can lower the amount of hormones produced. The most common form is Hashimoto’s Thyroiditis, a permanent condition requiring lifelong treatment. It occurs in roughly 0.3 – 5 per 1000 persons per year and women are 15-20 times more likely to develop the condition than men. The condition presents itself with goiter, among other symptoms.”
Very often, treating hyperthyroidism leads to hypothyroidism, says Dr.Pania. “For instance, Graves’ Disease is a form of hyperthyroidism wherein an excess of the thyroid hormone is secreted. The condition is treated with radioactive iodine which results in almost 50% of these patients developing hypothroidism at the end of one year, 65% of them becoming hypothyroidic at the end of five years. Other antithyroid drugs used to treat Graves’ may also result in hypothroidism.”
Similarly, those who undergo surgery for an overactive thyroid gland may face the same fate, ending up with hypothyroidism. Alternatively, says Dr.Pania, “Patients having thyroid cancer who have their gland removed also end up with hypothyroidism.”
Patients on drugs, particularly Lithium, for the treatment of psychiatric disorders and those taking anti-depressants, anti-seizure medication are likely to develop hypothyroidism, with or without symptoms, adds Dr.Pania. “Radiation in high dose or patients with cancers of the neck or head, can also result in hypothyroidism.”
Pregnancy (see my post on Psychological Problems associated with Pregnancy) is believed to affect the thyroid gland in several ways which in turn may lead to these mothers becoming hypothyroidic, explains Dr.Pania. “The iodine requirements increase during pregnancy, causing the reproductive hormones to bring about changes in the thyroid hormone levels. But it can so happen that women develop antibodies to their own thyroid during pregnancy. This leads to an inflammation of the gland following delivery. While this form of thyroiditis is chiefly temporary, it may go on to becoming permanent in some cases.”
As regards the role of iodine in causing hypothyroidism, Dr.Pania explains, “Both, too much and too little of it can cause the disorder. Individuals whose diet is deficient in iodine can develop the problem. Especially in the case of children who are affected with iron-deficiency anemia, commonly existing in iodine-deficient children, hypothyroidism can develop. On the other hand, too much iodine tends to suppress the production of thyroid hormones, leading to symptoms of hypothyroidism.
In addition to all these causes, in rare instances, secondary and tertiary hypothyroidism can develop in rare instances in patients with tumor, reveals Dr.Pania. “In these very rare instances, the pituitary gland fails to produce the thyroid stimulating hormone, hence causing hypothyroidism.”
With so many causative factors, how do the symptoms of the disorder manifest themselves? The symptoms are often vague and wide ranging, from psychological and emotional to the physical, agrees Dr.Pania. Short stature and obesity in children may indicate hypothroidism. The other symptoms include feelings of fatigue, lethargy, worthlessness, sadness, restlessness. There may be difficulty in concentrating, mood swings, menstrual irregularities, weight gain despite diminished appetite, goiter, constipation, dry, coarse skin, cold intolerance and lack of ambition.
Uncontrolled jaundice in a newborn is indicative of hypothyroidism, says Dr.Pania. “Such a child may be totally lethargic all the time; it will refuse to take feeds and its sucking capacity will be bad. This is known as failure to thrive and this form of hypothyroidism is typical of cretins. Undiagnosed and untreated, the situation may progress showing up sumptoms of protruding abdomen, delayed teething, physical and mental growth retardation.”
Diagnostic tests may include taking medical history of the patient, making a thorough physical examination, serum assays, blood tests for evaluating various thyroid hormones, thyroid stimulating hormone (TSH), and antithyroid antibodies in your blood and Thyroid scan for radioactive iodine uptake.
Once the diagnosis is made, routine treatment is with thyroid hormone pills, says Dr.Pania. “These pills have almost negligible side effect. The only problem is that if taken immediately before or after meals, high fibre food can interfere with the absorption of the drug, causing an under-dose of it. Hence, the pill is best taken early morning on an empty stomach, or at least half an hour before eating anything.”
A word of caution from Dr.Pania, for the elderly cardiac patients who may be taking these pills: “The potency of the pills should be suited to their underlying heart conditions and only gradually increased under medical supervision.” Untreated hypothyroidism is associated with unhealthy cholesterol levels, hypertension, heart failure in people with existing heart disease, iron deficiency anemia, respiratory problems, glaucoma, infertility and physical and mental retardation in children.