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Thyroid 101

How much do we know

Chances are we all know someone who has a thyroid condition. Or maybe we’re the person with a thyroid condition. We might remember those pre-diagnosis symptoms – extreme fatigue, gaining weight that we couldn’t lose. We were always cold, our hair was brittle, our skin dry and we had a difficult time concentrating on seemingly simple things. What in the world was going on, we wanted to know. And when the symptoms, combined with blood tests, pointed straight to hypothyroidism, we had to admit we didn’t really know much about the thyroid. 

Our thyroid, a small, butterfly-shaped gland sitting at the front of our neck, produces hormones, primarily T4 (thyroxin) and T3 (triiodothyronine), that are secreted into the blood. And as Susan Henley, MD, Endocrinologist with Colorado Springs Endocrine Clinic, explains, “Thyroid hormone affects the function of almost every organ system in the body; in particular, it is critical in metabolic activity in adults. It is also crucial for development of the brain and other organs in infants.”

If the thyroid gland isn’t producing enough hormone, we develop hypothyroidism, or underactive thyroid. “Hypothyroidism,” says Dr. Henley, “is 5-8 times more common in women than men. It is also more common in women with a small body size at birth and through childhood. Hypothyroidism is more common in both men and women as they age. There are certain patient populations that have a higher rate of hypothyroidism such as those with high cholesterol, certain types of anemia, low sodium or salt in the blood or family history of thyroid disease.”

As Paolo Bahr, DO, Family Medicine Physician with UCHealth Primary Care at Printers Park, explains, “In adults it can affect many aspects of the body’s metabolism, including heat and energy production, weight control, heart function, brain function, digestive functions, as well as maintenance of the nervous and musculoskeletal systems.”

Dr. Bahr says children can have congenital (present at birth) or acquired (developed after birth) thyroid disorders. “In fact, congenital hypothyroidism is one of the most common preventable causes of mental retardation, and therefore is a standard test in the Newborn Screen used throughout the United States.”

Assessing thyroid function includes a simple blood test. “TSH (thyroid stimulating hormone) is used to screen for thyroid disease,” says Dr. Henley. “TSH goes up if the thyroid gland is underactive and down if the gland is overactive.” If TSH is normal, explains Henley, T4 is tested and occasionally, T3 also needs to be tested. “There are rare disorders where the expected findings are not seen. These include a pituitary tumor secreting TSH and hypopituitarism. Some medications also affect thyroid testing.”

Once we’re diagnosed with hypothyroidism, we’re usually prescribed a synthetic hormone called levothyroxine. “Levothyroxine is chemically and structurally the same T4 that our body makes,” says Dr. Henley. “In other words the body is unable to distinguish between T4 in the pill and T4 made by the thyroid gland. Levothyroxine, a brand name, is one of the only medications that I insist my patients use. This is because there can be up to a 12% difference between each brand and each generic.” Dosage fluctuations, Dr. Henley explains, can make it very difficult to get a patient’s thyroid disease under control.

Thyroid malfunction can also lead to conditions such as hyperthyroid and Hashimoto’s disease. 

“Hyperthyroidism is when the body is receiving too much thyroid hormone,” says Dr. Bahr, “Common symptoms include heart palpitations, feeling flushed or hot, diarrhea, weight loss, menstrual irregularities, anxiety and fatigue. Long-term consequences can lead to dangerous irregular heart rhythms that can cause stroke or death, and bone-thinning that can lead to osteoporosis.

“Hashimoto’s is also known as ‘chronic autoimmune thyroiditis.’ It is a condition in which the body’s immune system produces antibodies and cells that start to damage the thyroid gland rather than protecting the body. It is one of the most common causes of hypothyroidism and is thought to be due to a combination of factors including genetic and environmental, e.g. exposure to infections, radiation, medications, etc.”

In Hashimoto’s, says Dr. Henley, “the antibodies are typically present for many years prior to the onset of decreased thyroid function. The thyroid gland gradually fails over time due to destruction of the thyroid gland. The patient may or may not have a goiter (enlarged thyroid gland) with or without thyroid nodules. The treatment of Hashimoto’s is the same as treatment of any other cause of hypothyroidism. The presence of Hashimoto’s does increase the risk of other autoimmune diseases in other members of the family.”