FAQs: Answering your questions about thyroid disease
1/31/2019 by Dr. Rozalina McCoy
Thyroid hormone is vital for healthy metabolism and overall health, and levels that are either too low or too high are harmful for physical, emotional and psychological health.
An estimated 20 million Americans have some form of thyroid disease. Up to 60% are unaware of their condition. Women are five to eight times more likely than men to have thyroid problems. One woman in eight will develop a thyroid disorder during her lifetime.
If you suspect you're having a problem with your thyroid, these answers may clear up some of your questions:
Q: What is thyroid disease?
A: Basically, your body produces too little or too much of the hormone thyroxine. When thyroid hormone levels are too low, patients can develop conditions such as heart failure, high cholesterol, depression or weight gain. When thyroid hormone levels are too high, patient can develop atrial fibrillation, anxiety or osteoporosis.
Q: What are the symptoms?
A: The symptoms that indicate you might have thyroid problems include:
- People with hypothyroidism, or not enough of the thyroid hormone, commonly experience fatigue, intolerance to cold, weight gain, constipation, dry skin and irregular menstrual cycles.
- People with hyperthyroidism, or too much thyroid hormone, can experience anxiety, exaggerated emotions, weakness, tremors, heart palpitations, intolerance to heat, increased perspiration, irregular menstrual cycles and weight loss.
Q: How are thyroid problems diagnosed?
A: Because symptoms of thyroid hormone imbalance are so common and are often caused by health conditions unrelated to thyroid disease, the first step is to evaluate the function of your thyroid using a test for thyroid stimulating hormone (TSH). TSH is secreted by the pituitary gland in response to your body's levels of thyroid hormone. A normal TSH in adults is 0.3-4.2 mIU/L. Levels can be higher in older than younger people.
- If there isn't enough active thyroid hormone, TSH levels will rise as the pituitary gland tries to stimulate the thyroid to make more.
- If there's too much thyroid hormone, TSH levels fall.
People whose TSH is in the normal range are unlikely to have thyroid disease. If you're diagnosed with this condition, your provider will request that your TSH be checked periodically to monitor response to treatment.
Q: How are thyroid problems treated?
A: The treatment depends on whether your thyroid hormone levels are too high or too low.
- Hypothyroidism (hormone levels too low, TSH too high). This condition is more common and tends to affect women more than men. It can be caused by an autoimmune thyroid disease (Hashimoto's thyroiditis), radiation to the thyroid or pituitary gland, certain medications or other health conditions. Treatment is hormone replacement therapy; your dose will be adjusted on the basis of regular TSH tests.
- Hyperthyroidism (hormone levels too high, TSH too low). It can be caused by autoimmune thyroid disease (Grave's disease), certain medications, hyperactive nodules, infection or injury to the thyroid gland. The most common cause is taking too much thyroid hormone for hypothyroidism. Treating hyperthyroidism is more challenging than hypothyroidism and depends on the case for elevated thyroid hormone levels.
- Subclinical hypothyroidism/hyperthyroidism. Some patients have abnormal TSH levels but normal thyroid hormone levels. These conditions generally don't need to be treated. However, there are important exceptions, which you should discuss with your health care provider. But all patients with subclinical thyroid disease should have their TSH and thyroid hormone levels checked regularly to detect if the condition has progressed or if there is a need for treatment.
It's important for all patients taking levothyroxine to have their TSH monitored and dosages adjusted to maintain TSH in the normal range.
So keep in mind that symptoms suggestive of thyroid problems are very common and generally not caused by thyroid disease. It's important to discuss your symptoms and concerns with your health care provider, be screened for thyroid disease and treated, if necessary.
Dr. Rozalina McCoy is an endocrinologist and primary care physician in Employee and Community Health's (ECH) Division of Community Internal Medicine (CIM). She specializes in the management of type 1 and type 2 diabetes, osteoporosis and thyroid disorders. Dr. McCoy also is a health services researcher who is passionate about improving the care of patients with diabetes, reducing their burden of treatment and hypoglycemia, and working with community-based organizations to help everyone access evidence-based health-promotion programs.