I applaud the goal of thyroid awareness education and helping undiagnosed patients. After reviewing one of the campaign's web pages titled Top Ten Things You Should Know About Your Thyroid, I'd like to share some thoughts -- and in some cases, concerns -- about the information the endocrinology community is disseminating.
"1.) Up to 27 million Americans may be affected by thyroid disorders, although more than half remain undiagnosed."This number may actually be a substantial underestimate of the actual number of people affected.
According to Vahab Fatourechi, MD, of the Division of Endocrinology, Diabetes, Metabolism and Nutrition at Mayo Clinic in Rochester, if the upper limit of normal range of the TSH test were reduced from 5.0 to 3.0, as recommended by the American Association of Clinical Endocrinologists and the National Academy of Clinical Biochemistry, there would be a 3-fold increase in the diagnosis of hypothyroidism.
Dr. Fatourechi's estimates, which were reported in the Mayo Endocrinology Update, mean that an additional 22 million to 28 million people would be hypothyroid.
The actual number of people with thyroid disease, therefore, is likely far higher, falling somewhere in the range of 49 million to 55 million people.
"2.) Thyroid disorders are more common amongst women."This is true. Unfortunately, however, many doctors fail to consider thyroid disease in their female patients. Undiagnosed/untreated or improperly treated thyroid disease can be the cause of a weight gain, depression, high cholesterol, fertility problems, recurrent miscarriage, menstrual irregularities, low sex drive, or and perimenopausal and menopausal problems in some women. Still, many who complain to doctors about symptoms are not tested for thyroid disease, and remain undiagnosed.
"3.) Thyroid disorders tend to run in the family."It's a fact that having a family member with a thyroid condition raises the risk of thyroid disease for other family members. Many thyroid patients, however, have no family history of the condition, so this should not provide false security. Family history is only one of the many thyroid risk factors, which include smoking, toxic exposures, medications, and other factors. It's also important to note that many thyroid conditions develop as a result of autoimmune Hashimoto's disease or Graves' disease. Having a family history of any autoimmune disease -- including multiple sclerosis, rheumatoid arthritis, lupus, psoriasis, and others -- means that you are at risk of developing other autoimmune diseases.
4.) Fatigue is a common complaint for under and over active thyroid conditions."There is no doubt that fatigue is one of the primary complains. In addition to fatigue, for people with an underactive thyroid, other most common complaints include weight gain, depression, difficulty concentrating, and hair loss. For people with an overactive thyroid -- hyperthyroidism -- anxiety, insomnia, weight loss, tremor, and eye discomfort are also common.
"5.) TSH testing is the most useful test for thyroid screening."The TSH test is one test for thyroid screening, and conventional doctors believe that it detects the majority of thyroid dysfunction. But TSH screening does not detect some cases of thyroid disease that warrant treatment. For example, some people have symptomatic autoimmune thyroid disease but normal TSH levels. Only if antibody profiles are run will the autoimmune condition be revealed.
In my opinion, it's also misleading to say that the TSH test is most useful without explaining to patients that the thyroid community -- including the American Association of Clinical Endocrinologists themselves -- is unable to agree on the normal range for that TSH test. As of late 2002, one faction in the thyroid community recommended narrowing the normal range to 0.3 to 3.0, from its range of 0.5 to 5.0. More than four years later, however, many laboratories and doctors are still using the old range, and as noted under #1, lowering the normal range, as recommended, means that some 22 million to 28 million more people could be diagnosed as hypothyroid and receive treatment. Most screening, however, still uses the old 0.5 to 5.0 range, excluding 20 million or more Americans from diagnosis and life-changing treatment.
"6.) Regular check-ups are the key to successfully managing a malfunctioning thyroid gland."Regular check-ups are important, but they are only one part of successfully managing a malfunctioning thyroid gland. A check up is only as good as the physician performing it -- so physicians treating thyroid disease must be knowledgeable about how to properly diagnose, treat and manage thyroid patients. Given that the AACE admits that at minimum, 14 million people are undiagnosed, the medical community needs to do a better job of recognizing and diagnosing thyroid disease, to start.
Patients also must receive effective treatment, with thyroid drugs that safely relieve their symptoms. Unfortunately, many patients still complain of symptoms, even after treatment. Patients also need to know their options. In the case of hypothyroidism, for example, they need to know that there are various brands of levothyroxine, and despite the preference of some doctors for levothyroxine, there are other drugs -- including liothyronine (Cytomel), liotrix (Thyrolar), and desiccated natural thyroid (Armour Thyroid, Naturethroid, Biotech), that may work better at resolving their symptoms.