Is it My Thyroid?

Are you wondering why you feel tired and are gaining weight? Let’s look at whether your thyroid could be the problem.

Is it putting out the amount of hormone that it should be? Or if you are on thyroid medication, should the dose be changed? After all, the symptoms of fatigue, weight gain and hair loss did get much better when you had your thyroid checked back in college and were told that it was not working like it should. In fact, you probably remember that your dry skin, a tendency to constipation and heavy menstrual periods all disappeared after you started taking your thyroid supplement. The process of making the diagnosis of low thyroid hormone, or hypothyroidism [hi-po-thiroyd-izm], involved having blood tests that showed low levels of thyroid hormone. You took the advice to take a thyroid pill every day seriously, on an empty stomach, and not at the same time as your iron or calcium supplements. And you have rarely skipped your daily dose of thyroid medication since then. Now 40 years old, your life has changed…being married, working full-time as a legal assistant in a busy law firm, with three active children and a number of volunteer activities at your children’s schools.

Over the past year, you have seen your family doctor several times to discuss your concerns of tiredness and difficulty losing weight, symptoms that you know are linked to hypothyroidism. Your doctor sent you to a specialist in hormone disorders - an endocrinologist - to help determine if the way you feel is due to your thyroid. You were asked about your thyroid history, and your medication use was reviewed. Your physical exam confirmed that you are about 15 pounds overweight, but otherwise healthy. Your thyroid blood tests, including a TSH (thyroid stimulating hormone) and fT4 (free thyroxine) [thahy-rok-seen] were in the middle of the normal range.

Your endocrinologist explains that your weight problem and fatigue are not due to your well-treated hypothyroid condition. Neither a higher dose of thyroid hormone nor a change in brand would be likely to safely help you lose weight and decrease fatigue. Although this news is disappointing, additional discussion continues regarding your dayto-day habits: you learn that your daily calorie intake could be significantly decreased by eliminating the four cans of regular soda that you have developed a habit of drinking daily and by changing the fast food choices you have for lunch. You also are reminded of the benefits of increasing physical activity, such as taking a brief walk during lunch, parking a few blocks away from work or taking the stairs instead of the elevator. Maybe take a walk around the sports field during your child’s soccer practice rather than sitting in the bleachers. Perhaps even dropping weekly volunteer commitments to just twice a week, so you could try out the local Y. You begin to feel energized just thinking about making changes in your life!

The lesson here is that symptoms linked to hypothyroidism are not always due to hypothyroidism. Many factors can influence how you feel. Here are some insights regarding hypothyroidism occurrence, its causes and optimal treatment.

Thyroxine pills (a commercial form of the thyroid gland hormone) are formulated usually in 12 different doses, and the dose must be carefully regulated. It is useful to remain with a consistent brand. Thyroid hormone is best absorbed when taken on an empty stomach with a glass of water. One should then wait an hour before drinking other beverages such as coffee, eating and taking other medication. Some medications and supplements such as iron pills, calcium, vitamins, fiber and resins interfere with absorption of thyroid hormone so they should be taken later in the day. If a hypothyroid patient must take other medication on an empty stomach early in the morning, then the thyroid hormone pill can be taken later in the day, either one hour before or four hours after a meal.

You might also be curious as to whether there is benefit to a “natural” approach in the treatment of hypothyroidism – the internet shows many testimonials for diets and supplements to treat or cure thyroid conditions! Indeed, people who live in remote regions of the world and far away from the ocean can have an iodine-deficient diet. These people often develop a goiter [goy-ter] (enlarged thyroid) and hypothyroidism. In this unique situation, iodine replacement with iodized salt is the appropriate treatment. For most people living in the developed world, iodine deficiency is uncommon.

Endocrinologists typically advise patients to avoid dietary supplements which claim to benefit thyroid function. Dietary supplement quality is not controlled by any federal agency, so there is no guarantee that the supplements actually contain the product(s) they claim to contain. An example is extracts of animal glands for which there is no scientific evidence for effectiveness or purity.

Another frequently asked question is whether you would have more energy and lose weight more easily if you took another type of thyroid hormone replacement. After all, you have checked the internet for information on hypothyroidism and have read blogs about treatment options for hypothyroidism. Scientifically qualified, diligent medical researchers are interested in this question as well. Research by experts in the thyroid field have not shown any clear advantage for use of combination thyroid hormone preparations, either manufactured or derived from animal sources. Because there are compelling personal testimonials that can be read on internet blogs regarding a wide variety of treatments for hypothyroidism, it is important that questions regarding treatment be referred to your endocrinologist.

The most common causes of hypothyroidism are Hashimoto’s thyroiditis (antibodies formed to your own thyroid), prior treatment for hyperthyroidism (an overactive gland) and a history of thyroid surgery. Hashimoto’s thyroiditis is a commonly seen condition associated with the presence of antithyroid antibodies in the blood. Because the antibodies are directed against the thyroid cell, Hashimoto’s is considered an “autoimmune” condition. Endocrinologists often test for the antibodies through a blood test, as a marker suggesting the possibility of Hashimoto’s thyroiditis. The antibodies may also be present in relatives of patients with Hashimoto’s thyroiditis, but they themselves have no thyroid abnormality at all.

Once hypothyroidism is suspected, it can be readily diagnosed by measuring Thyroid Stimulating Hormone (TSH). With normal aging, the symptoms of hypothyroidism can be subtle and very slowly progressive. For that reason, many physicians will check a TSH level at the time of a physical exam in people over 40.

Because thyroid hormone is necessary for normal development of the neurological system, it is important to have normal thyroid hormone levels at the time of conception and during pregnancy. Very soon after conception, a pregnant woman’s blood volume expands, and many women with treated hypothyroidism require an increase in their thyroid hormone dose. The endocrinologist asks newly pregnant patients to have a TSH measured and followed during the pregnancy so that appropriate dose adjustments can be made.

Hypothyroidism may also occur after delivery, so it should be suspected when the new mother experiences severe fatigue. This form of hypothyroidism will frequently spontaneously go away in weeks or months, only to recur with future pregnancies. Although all types of thyroid disease occur more commonly in women, hypothyroidism can occur in men, who also may report increasing tiredness, constipation, weight gain and hair loss. In the event you are diagnosed with the condition, endocrinologists can provide you with the latest and best information regarding safe and effective thyroid hormone replacement therapy.

Dr. Anne Leddy is a graduate of the Johns Hopkins University School of Medicine where she also did her endocrinology fellowship. She has a long-standing interest in the management of thyroid disorders. Dr. Leddy practices endocrinology in southeastern Virginia where she is the managing physician for the Endocrine Division of the Tidewater Physicians Multispecialty Group. She is the immediate past president of the Mid-Atlantic chapter of the American Association of Clinical Endocrinologists (AACE) and presently serves as a member of the AACE Board of Directors.