Metabolic Mysteries: Undiagnosed Thyroid Disease and Women

A Look at Undiagnosed Thyroid Problems

Elizabeth Lee Vliet, M.D., is author of Screaming to Be Heard: Hormonal Connections Women Suspect...and Doctors Ignore. She does not tell her patients their thyroids are normal based only on TSH results. According to Vliet, "The normal range is relative. Many women have symptoms -- or are hypothyroid -- when TSH anywhere but the lower end of the range."

This broader interpretation of what constitutes 'normal' in terms of the thyroid is discussed in greater depth in HELP! My TSH Is "Normal" But I Think I'm Hypothyroid.

Dr. Vliet also tests for elevated thyroid [link url=http://thyroid.about.com/library/weekly/aa021698.htm]antibodies[/link], and low Free T3 and Free T4 levels. "Most women with elevated antibodies are in the process of developing autoimmune thyroid disease," says Vliet. "And even with normal TSH levels, I've found that majority of women with elevated antibodies, low Free T3 and low Free T4 require thyroid hormone replacement to feel well."

Doctors usually prescribe the synthetic T4 hormone levothyroxine to treat hypothyroidism. Popular brands include Levoxyl and Synthroid. Research reported in the New England Journal of Medicine in February of 1999 found that a majority of patients may feel better on a combination of hormones. On that basis of that study, more doctors are also adding synthetic T3 (liothyronine). Alternative physicians tend to prefer Thyrolar, Armour, or Naturethroid, drugs that include both hormones.

The thyroid can also become overactive -- hyperthyroid -- producing excess thyroid hormone. Olympic medal-winning athlete Gail Devers [link url=http://thyroid.about.com/library/weekly/aa012700a.htm]recently testified before Congress[/link] regarding her own case of Graves' disease, an autoimmune condition that can cause hyperthyroidism. In Devers' case, doctor after doctor failed to recognize the signs of severe Graves' disease, as the Olympic gold medal-winning athlete dropped from 125 to only 87 pounds, suffered debilitating fatigue, lost nearly all her hair, and suffered other symptoms including rapid heart rate, and dry skin. It was two years before Devers was finally diagnosed and treated.

Common symptoms of hyperthyroidism include rapid weight loss, insomnia, anxiety, irritability, palpitations, fast heartbeat, heat intolerance, sweating, tremors, diarrhea, depression, weakness, eye and vision changes, lighter or infrequent periods, and infertility. Your doctor will typically run a TSH blood test, and will look for low -- below .5 to nearly undetectable -- TSH levels to diagnose hyperthyroidism. Our [link url=http://thyroid.about.com/health/thyroid/blhyperthyroid-checklist.htm]Hyperthyroidism Symptoms Checklist[/link] features a comprehensive list of symptoms.

If you have a milder case of hyperthyroidism, your doctor may initially prescribe [link url=http://thyroid.about.com/msub9.htm]antithyroid drugs[/link] such as methimazole (Tapazole) or propylthiouracil (PTU), as these drugs offer some chance of remission. For more advanced hyperthyroidism, doctors prefer radioactive iodine treatment, known as RAI. By partially or fully disabling the thyroid, RAI eliminates hormone overproduction, but commonly results in life-long hypothyroidism. Surgery, known as thyroidectomy, is typically only done when you cannot tolerate antithyroid drugs, or are not a good candidate for RAI. A comprehensive overview of hyperthyroidism diagnosis, treatment and options is covered in our [link url=http://thyroid.about.com/library/weekly/aa022398.htm]Graves' Disease/Hyperthyroidism FAQ.[/link]

Occasionally, symptoms may accompany suspicious [link url=http://thyroid.about.com/msub13.htm]thyroid nodules[/link]. Nodules are typically evaluated by ultrasound scan and blood tests, and sometimes by an outpatient biopsy called fine needle aspiration (FNA). The vast majority of nodules are benign, and some are treated with levothyroxine. If cancer can't be ruled out, or your thyroid is obstructing breathing or swallowing, your doctor will likely recommend surgery.