The human heart is deservedly the epicenter of our attentions spanning the spectrum from valentines to television drama. Over our average life span of some eighty years it will contract in the range of 3 BILLION Times, it’s drummer’s cadence a constant reminder of its central relevance to our survival. If, or when, it fails prematurely, it in all likelihood generates in the passing an abrupt, noisy and painful final closure. Your thyroid, as a counterpoint, those few grams of gland both sides of the front portion of the throat, is silent, rarely obvious in its failure and can be subtlety incapacitating over a period of years before being discovered. There are two explanations for this commonly undiagnosed condition. The first is the gamut of symptoms involving any and every other organ in the body including brain, heart, even bone marrow. The second is the inconsequential nuisance level of complaints that accompany thyroid conditions such as constipation, excess perspiration, dry skin and even hair loss in its early stages.
How often do patients complain to the family physician with fatigue, mood swings, sleepless nights, tremors, even frequent bathroom visits? All can be attributable to a text book of causes but often represent the early stages of thyroid disorder. Too often, the patient volunteers a self diagnosis of “it’s my age”. Thyroid glands can misbehave the way other tissues malfunction and become cancerous but for this discussion, I’m limiting the topic to overactivity and under activity of the thyroid. The underachiever gland causes the patient to be cold intolerant, likely showing some recent weight gain, probably constipated, lethargic, complaining of fatigue even depression. Often there is no specific cause other than a winding down prematurely in the glands function ahead of the process in other organs. Sometimes it’s an autoimmune process like lupus. Medications such as lithium and cordarone have been implicated as possible causes. Smoking is definitely a significant contributor because of the thiocyanate chemicals in tobacco. Low iodine in the diet used to be a factor but largely resolved by iodine addition to food. More recent investigation showed the thyroid is very sensitive to deficiencies in trace elements such as zinc and manganese, antioxidant vitamin E, A, D, and B complex groupings. The disease is SEVEN times more common in women for several reasons the most obvious being autoimmune disease in general is more prevalent in women. There is an inflammatory thyroiditis after pregnancy that seems to be a precursor to later failure. Recent exposure to radiation is a known predilection and for women with breast cancer treatment — another reason to be ever watchful.
Loss of the outer third of the eyebrows is often a clue to low hormone levels but a generalized hair loss especially scalp is more likely in hyper states. Overactivity is less subtle with the patient describing profuse sweating, unplanned weight loss, discomfort in warmer environs, increased thirst, increased heart rate and blood pressure, even palpitations and beat skips. In general, the overactivity, also 7 times more common in women, has more profound impact and begins earlier in the age 20-40 grouping. A family history can be relevant as can a recent term pregnancy and the condition may be masked by simultaneous endocrine gland disorders. There are four critical situations that bear extra consideration. The worst of these is the thyroid storm, potentially fatal because a massive amount of hormone is flushed into the cardiovascular system producing catastrophic overload. Goitre is not so prevalent with very few patients showing up with massive neck lesions; though a feeling of neck fullness and/or voice hoarseness is still a common complaint. Even when the gland is enlarged it does not always dictate the gland is overactive. Exophthalmos or bulging eye presentation is not as prevalent today with early diagnosis though flushing and diarrhea are usually well established sooner. Another serious occurrence is the myxedema swelling of the lower limbs Cosmetically disturbing to the patient for its puffy wax texture but more relevant medically because of its association with circulatory changes and skin breakdown from tissue pressure.
It’s always difficult to provide a synopsis of a common disorder whose presentations fill more than one textbook. For that reason, the parting suggestion– if you have any of the above symptom groupings, a simple blood test will provide an answer. Unlike cardiac screenings recommended for 40ish age groupings, thyroid pathology where suspected should be screened much earlier especially in women. Once found, it’s the easiest of treatments in the great majority of patients.
Written by Dr David Carll