The Thy Life: The Importance of Thyroid Health At Every Stage of Life

By Mary Green

From a few short weeks following conception through infancy, into childhood and adolescence, during adulthood and throughout the golden years...it is the “engine” in our bodies that powers everything from body temperature, digestion, metabolism, muscle strength, skeletal growth and sexual development to the health of the heart, brain, kidneys and liver.

The Basics

To understand the role the thyroid gland fulfills when functioning properly, it’s best to start with the basics: The thyroid is a butterfly-shaped gland typically weighing less than an ounce that is located in the front of the neck just below the Adam’s apple. It is wrapped around the trachea (windpipe), and its purpose is to produce, store and release into the bloodstream hormones that regulate, or in some way participate in the process of, a wide range of crucial bodily functions.

For such a tiny gland, that’s a lot of responsibility. So how does the thyroid work its complex metabolic magic?

The process begins when the pituitary gland, the so-called “master gland” located at the base of the brain, produces thyroid-stimulating hormone (TSH), which acts upon the thyroid gland to produce two vital hormones, thyroxine [thigh-rahk-sun] (T4) and triiodothyronine [try-eye-oh-doe-THY-ruhneen] (T3), that influence virtually every cell in your body. Production of T3 and T4 occurs when iodine, introduced to the body via food, is synthesized. Although the thyroid produces much more T4 than T3, the T4 serves as the source of most T3, the form of thyroid hormone that actually enters the body’s cells to maintain metabolic function by converting food into energy and heat.

If the amount of thyroid hormone in the body is too low, the pituitary senses it and releases TSH, which signals the thyroid to produce more. Once the thyroid produces enough hormone for the body’s needs, the pituitary slows down its production of TSH back to normal.

The thyroid also produces calcitonin [kal-si-toe-nin], a substance which regulates the body’s calcium levels by promoting absorption of calcium into the bones. While the importance of calcium in providing strong bones and teeth is well known, it also plays an essential role in brain function. When a chemical signal arrives at a brain cell, it’s the job of calcium to deliver that signal from the outside of the cell to the inside.

In the Womb : The Thyroid and Fetal Development

Interestingly enough, the thyroid gland is the first of the body’s endocrine system glands to develop, which begins to take place approximately 24 days after conception. Human fetuses acquire the ability to synthesize thyroid hormones at roughly 12 weeks of gestation. However, the fetus remains dependent on the mother for the ingestion of iodine essential to make the thyroid hormones needed for normal brain development, as well as for many other aspects of a healthy pregnancy and fetal growth. In fact, research has shown that even mild hypothyroidism [hi-po-thigh-roy-dih-zum]—a deficiency of thyroid hormone—in a pregnant woman can result in decreased IQ or mental retardation in the child and can lead to a number of complications, including stunted growth in the baby, maternal hypertension, miscarriage and preterm delivery (see related articles on pages 12 and 16). Thus, it is extremely important for the mother-to-be to take in enough iodine to enable the thyroid gland to make enough hormone for both herself and the developing fetus.

Once a full-term baby is delivered, there is an abrupt rise in the baby’s TSH within 30 minutes of delivery, although the newborn continues to be protected by its mother’s thyroid hormone for a few weeks after birth. However, it is not unusual for some babies (1 out of 4,000) to suffer from what is known as congenital hypothyroidism, or an underfunctioning thyroid, which occurs because of the failure of the thyroid to develop, the inability to produce hormone normally, or iodine deficiency. If untreated for several months after birth, severe congenital hypothyroidism can lead to growth failure and permanent intellectual disability. Consequently, state-mandated programs that began in the 1970s now routinely test the blood of all newborns for evidence of thyroid dysfunction, as well as other metabolic diseases.

Thyroid Disease and Puberty

Thyroid disease can be damaging at any stage of life. At puberty, the thyroid starts to produce more thyroid hormone, which is needed for the rapid growth and sexual development that occurs during adolescence. Thus, a low-functioning thyroid at this stage of life can delay puberty, delay development of adult teeth and wreak havoc with a teen's reproductive function. For instance, girls with thyroid problems may have an abnormally early or late onset of puberty and menstruation, a decrease or increase in menstrual flow, or there may be a shorter or longer time between periods than usual.

Although thyroid complications among teenagers are unusual, they can cause marked physical and mental health complications when they do occur, and many signs of thyroid problems are not that dissimilar to common body changes experiences as a teen. So, if you suspect your child might have a thyroid problem, it’s wise to seek the services of a pediatric endocrinologist, a physician who specializes in diseases of endocrine organs such as the thyroid, pituitary, adrenal and pancreas.

Thyroid Disease in Older Adults

Although thyroid problems are common in those over 60, in this age group its features can be subtle and few in number. Symptoms are often attributed to aging, presumed to be medication side effects or caused by cardiovascular, gastrointestinal, or nervous system diseases. This can make it very difficult to suspect that a thyroid problem is present. Seniors especially should become familiar with the symptoms and body changes of thyroid disease. Doing so can lead to prompt diagnosis and treatment--the key to preventing the short- and long-term complications of thyroid disease and increasing the chances for having truly golden years.

What Causes Thyroid Problems?

Diseases of the thyroid can occur at any stage in life and are primarily classified into problems involving a.) the function of the thyroid gland (either overactive or underactive) or b.) the structure of the thyroid gland (changes in size or the development of nodules). Structural problems can include an enlarged thyroid gland (also known as a goiter [goy-ter]), a small thyroid gland (atrophic) or the development of either single nodules (solitary thyroid nodule) or multiple thyroid nodules (multinodular gland). Functional problems of the thyroid are initially evaluated with blood tests which are used to determine if the thyroid is functioning normally, or is overactive or underactive. The evaluation of structural problems of the thyroid is usually done with a thyroid ultrasound. Because a thyroid gland can often have both a structural problem and a functional problem simultaneously, the proper evaluation of a thyroid condition includes careful examination of both the structure and function of the thyroid gland.

Too Little Thyroid Hormone

Among the more common thyroid conditions is hypothyroidism (mentioned above), which can occur as a result of iodine deficiency; an autoimmune disorder, such as Hashimoto’s thyroiditis [hah-shemoe-toes thy-roy-dye-tiss], where the body attacks the thyroid gland as if it were foreign tissue; surgical removal of the thyroid to treat severe hyperthyroidism or thyroid cancer; and radiation therapy for treatment of cancers in the region of the head and neck.

Typical symptoms of hypothyroidism are abnormal weight gain, fatigue, hair loss, intolerance to cold, impaired memory (“brain fog”), constipation and a slow heart rate. Hypothyroidism is typically treated with a daily dosage of a synthetic hormone replacement drug, such as levothyroxine, which is usually required for the rest of the patient’s life.

Hypothyroidism affects women more than men and is especially common in females older than age 60.

However, infants, children, teens and adults of all ages can also develop the condition.

Too Much Thyroid Hormone

When your thyroid gland is overactive, the result is a condition called hyperthyroidism [hi-per-thigh-roydih- zum], which increases a person’s metabolic rate. Hyperthyroidism is the result of overproduction of T3 and T4 by the body and is most commonly caused by Graves’ disease, in which the body produces antibodies that stimulate the thyroid to secrete excessive quantities of thyroid hormones. It can also be caused by a toxic multinodular goiter, a condition that occurs when a hyperfunctioing nodule develops within a longstanding goiter (abnormal enlargementof the thyroid gland).

Symptoms of hyperthyroidism can include prominent eyes, heart palpitations, excessive sweating, weight loss, diarrhea, muscle weakness and a heightened sensitivity to heat. (NOTE: While Graves’ causes protruding eyes, hyperthyroidism of all types causes wide-open eyes, which create the illusion of protrusion). Approximately 15 percent of all patients diagnosed with hyperthyroidism are over the age of 60.

There are several options for treating hyperthyroidism. Anti-thyroid medications are often used to slow down the production of thyroid hormones. Alternatively, the gland may be partially or entirely removed surgically or radioactive iodine may be given. If the entire thyroid gland is removed, and usually after taking radioactive iodine, patients become hypothyroid and must remain on thyroid medication for life.

Thyroid Growths

Thyroid nodules—a collection of cells within the thyroid that grow and produce a lump—are relatively common and sometimes are discovered by physical examination of the thyroid gland, but often are detected incidentally during a radiology test such as an ultrasound or CT scan being performed for an unrelated reason. People can develop thyroid nodules at any age, but they occur most commonly in older adults. Thyroid nodules are more common in women than in men.

Fortunately, 90 to 95 percent of thyroid nodules are benign (not cancerous). Several features do make it more likely for a thyroid nodule to be cancerous: a rapid increase in the size of the nodule, difficulty swallowing, changes in the voice, difficulty breathing, a family history of thyroid cancer, or prior history of radiation exposure during childhood.

The type of cancer determines the treatment plan and the prognosis. With the less aggressive forms of thyroid cancer, treatment typically is surgery to remove the cancerous nodule (and any enlarged lymph nodes) from your neck. This is sometimes followed several weeks later by the administration of radioactive iodine to destroy any remaining thyroid tissue in the body. After surgical removal of the thyroid gland, patients must take synthetic thyroid hormone daily for the rest of their lives.

Until recently, patients had to temporarily stop their thyroid hormone therapy to receive radioactive iodine (RAI) treatment or undergo monitoring tests for possible cancer recurrence. This was to allow the patient's thyroid-stimulating hormone (TSH) level to rise and stimulate cancer cells to absorb iodine. Thanks to development of a synthetic product called recombinant human TSH, today’s thyroid cancer patients can undergo RAI and monitoring using recombinant human TSH without temporarily discontinuing their thyroid hormone therapy.

Patients whose thyroid nodule has been identified by a primary care physician are often referred to an endocrinologist for further evaluation or are referred directly to surgeons who specialize in thyroid surgery.

You can perform a simple Neck Check self-exam to help assist with finding nodules or enlargements in the neck that may point to a thyroid condition. A step-bystep guide is offered online at: http://thyroidawareness.com/neck-check.

Surprisingly, thyroid disease is more common than diabetes or heart disease and is a fact of life for as many as 30 million Americans. Women are at greater risk than men, and being 50 or older poses the highest risk of developing a thyroid condition. Also surprising are estimates suggesting that more than half of those with thyroid disease remain undiagnosed. For that reason, the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) are promoting thyroid awareness through The Thy Life educational campaign, with a mission to enlighten people at all stages of life about how maintaining good thyroid health is vital to a healthy life. For additional information about The Thy Life, visit www.thyroidawareness.com.

I Get By with a Little Support from My Friends

Imagine finding out that you have a thyroid nodule, when you thought that all you had was a “*swollen gland” and an upper respiratory infection. For Stacey Thureen, a visit to the doctor turned into the discovery of a nodule on the left side of her thyroid and not a “*swollen gland.” Fear, confusion, and disbelief are some of the immediate feelings that come to mind, right?

Stacey grew up in New Jersey and attended college in Iowa. She worked hard on her double major in English and Communication Studies and also swam competitively for the University of Iowa Hawkeyes. This hard work and dedication led Stacey to the communication and media industry where she currently works on projects for non-profit, print and production outlets. Stacey’s busy career and new diagnosis was daunting, but she knew that with good doctors and a strong support group she could get through this difficult situation.

After Stacey had further testing including a biopsy with a very small needle called a fine needle aspiration, doctors decided the best plan of action was to remove the left side of Stacey’s thyroid gland, also known as a partial thyroidectomy. “When I was told I needed surgery, I remember feeling that I trusted the doctors’ guidance,” Stacey reflects, “I had peace of mind knowing that they were doing everything they could to help me and my overall thyroid health.”

After her surgery on June 10, 2011, Stacey received more news. She had an autoimmune disease known as Hashimoto’s thyroiditis and hypothyroidism. Hashimoto’s thyroiditis is a condition where the body’s immune cells produce antibodies which can damage thyroid cells and cause hypothyroidism when not enough thyroid hormone is being made. This is the most common thyroid disease in the United States and is seven times more common in women than men. Stacey was immediately put on synthetic thyroid hormone medication to balance out her hormone levels.

This story line probably holds true for many patients whose thyroid glands are not working properly, but Stacey has an added obstacle. Stacey’s family suffered four losses prior to her diagnosis and one loss three days after her surgery.

“My faith and my husband’s support have given me strength through this process,” Stacey says.

She says that her support system of friends and family enabled her to talk about her feelings and fears while going through this difficult time. To anyone else going through similar experiences, whether it is a newly diagnosed disorder or losing a family member, Stacey urges people to talk about it with others. “By sharing your story you find a support system that you did not know existed,” she explains. Stacey discovered that many other women in her life were also affected by thyroid problems. It is comforting for Stacey to know that there are other people going through the same thing as her.

After sharing her story with friends and family, Stacey decided to use her communication and media talents to share her story with the public. She was featured on the show Better Living with Liz Walker, produced by The Walker Group, LLC. This story showed the journey from discovery to treatment to acceptance of Stacey’s thyroid problem.

Stacey’s advice to other people going through similar situations is simple: “Take it one day and one step at a time. Your support system will help you through anything.”

To learn more about Stacey and her story, or to watch the Better Living with Liz Walker segment, visit www.StaceyThureen.com. To learn more about the thyroid conditions and treatments, visit www.ThyroidAwareness.com.

(*Editor’s Note: A term that is commonly used by the public for enlarged lymph nodes due to upper respiratory infections.)

Thyroid and Weight Loss or Weight Gain

Many people fight a long battle against being overweight, from early adulthood, or pregnancy, or even starting in childhood. Sometimes people are surprised to see a pattern of weight gain begin to level off, or even reverse, such that weight control or weight loss may occur without any obvious additional effort on their part. If unexplained weight loss occurs, especially with a good appetite, it might be because of overactive thyroid, also called hyperthyroidism [hie-per-THIGHroid- is-m] or thyrotoxicosis [thigh-ro-tox-i-KO-sis]. With hyperthyroidism, the body burns up extra food without using it for anything but for producing heat. People who may have been gaining weight before the onset of hyperthyroidism eventually begin to experience symptoms or problems that are less welcome than the loss of weight.

If your doctor diagnoses you with overactive thyroid, the first step is to learn whether it might be a temporary case, and whether it is mild. The next step is to talk with your doctor about what treatment is best. Sometimes it is best to wait it out to see whether the thyroid will return to normal on its own. The thyroid may even become underactive, after having been overactive.

However, untreated hyperthyroidism often will fail to resolve on its own. Thinning of the bones may occur if it is severe and untreated for a long time. Irregular heart rhythm, heart failure, or even death can result from a severely overactive thyroid. Sometimes people are treated with pills, especially for types of hyperthyroidism that are severe but possibly capable of future self-correction.

At other times, the treatment consists of swallowing a pill of radioactive [ray-dee-o-AK-tiv] iodine. However, radioactive iodine for overactive thyroid is one of the most common causes of underactive thyroid. Another option may be surgery.

For people who once had overactive thyroid (hyperthyroidism) and who also have been overweight, one of the most frustrating outcomes is the weight gain that may occur once the overactive thyroid has been treated. Weight gain after treatment of hyperthyroidism is related, in part, to whether there was already a tendency toward becoming overweight. It is also related to how much weight loss had occurred before treatment. Some people will entirely regain the amount of weight lost during hyperthyroidism after they are treated for overactive thyroid, and they might gain more than before the hyperthyroidism started.

When a person is recovering from hyperthyroidism, one of the special skills of the endocrinologist [en-doh-cri-NAlo-jist] is to know when to start the patient on treatment for underactive thyroid (hypothyroidism [hie-po-THIGHroid-is-m]). When the thyroid’s condition is changing rapidly, testing is interpreted differently than when thyroid status is stable. The risk of treating hypothyroidism too soon is that thyroid hormone replacement therapy could result in too much thyroid hormone. However, once it is known that hypothyroidism has occurred, then the patient usually requires lifelong treatment with thyroid hormone (levothyroxine [le-vo-thigh-ROX-een; [T4]). The risk of delaying treatment is that a person may gain more weight than otherwise might have occurred. Sometimes the amount of weight gain may approach or exceed 10 or 20 lbs.

What about other causes of hypothyroidism? There are temporary situations in which hypothyroidism may be mild and not require treatment. The most common cause of spontaneous permanent hypothyroidism is the gradual destruction of thyroid function by Hashimoto’s thyroiditis (from cells of the immune system that develop in the body that destroy the thyroid gland’s ability to function).

Weight gain from spontaneous, longstanding hypothyroidism may be very small compared to the weight gain sometimes seen after treatment of hyperthyroidism. Weight gain from spontaneous hypothyroidism may be 5-10 lbs. Weight gain in advanced severe hypothyroidism may contribute to obstructive sleep apnea (an inability to breathe leading to frequent awakening during sleep and daytime sleepiness). Some of the weight gain in severe cases of hypothyroidism is due to myxedema [mix-uh-DEE-muh] (excess fluid under the skin), which goes away during treatment.

Small differences in dose of thyroid hormone can make a big difference in whether your health will be the best it can be. A blood test called TSH (thyroid stimulating hormone) helps find the best thyroid dose. TSH reacts to blood levels of thyroid hormone like a thermostat. If thyroid levels are low, this test will show higher than normal levels of TSH. This test gives the right answer assuming the pituitary is working as it should. The amount of weight loss one can achieve having their severely underactive thyroid treated is modest at best.

If hypothyroidism was not present in the first place, then treatment with thyroid pills creates no advantage over allowing your thyroid to produce the needed amount of thyroid hormone.

Where does this leave the person who is being treated for underactive thyroid and still is having trouble achieving or maintaining ideal body weight, or the overweight person who is considering thyroid treatment but has been found to have normal thyroid function? Thyroid hormone should not be offered for weight loss if a person does not have a thyroid problem. Lifestyle changes may be needed to address unwanted weight gain or inability to lose weight. In other words, fewer calories and more physical activity – don’t cut corners!

Dr. Susan S. Braithwaite serves as Staff Physician at St. Francis Hospital, Evanston, IL, and Visiting Clinical Professor at University of Illinois—Chicago. She completed undergraduate studies at Harvard and Radcliffe in 1965 and medical school at the University of Chicago in 1969, where she went on to complete medical residency training and a fellowship in Endocrinology and Metabolism. Dr. Braithwaite is a member of the AACE Board of Directors.

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