Hypothyrodism, a common condition in which the thyroid gland doesn't produce enough thyroid hormone, doesn't always have clear cut symptoms. The condition can affect patients of all ages, backgrounds, and genders; but is more common in women and more common in whites and hispanics than in blacks. The likelihood of developing the condition also increases with age.
"Hypothyrodism mimics many other diseases, and the changes are subtle. The thyroid gland (a butterfly shaped gland in the middle of the neck) is like the furnace of our body. If you have hypothyroidism, you go into a low energy state," said Dr. Maya Dillas of Trinity Health in Minot.
Many individuals may worry that they have hypothyroidism, since the general symptoms of the condition can include fatigue, weight gain and intolerance of cold temperatures.
"Often what we see now, in the more westernized world, is that people don't eat appropriately or exercise, or they go to extremes, like never getting off the couch or going to the gym occasionally for four hours at a time. We often see women asking for a thyroid test, and they're disappointed if it's not positive," Dillas said.
"The causes of their symptoms could be a number of things - it could be that they're not getting enough sleep, it could be depression, or it could be another lifestyle factor. They hope it is hypothyroidism, because we all want a quick fix," she added.
More specific symptoms of hypothyroidism can include decreased sweating, brittle nails, constipation; and in women, menstrual cycle irregularities. In people with severe hypothyroidism, Myxedema coma, which causes a complete loss of consiousness and hypothermia, can occur.
Dillas explained that individuals should still ask their physicians for a test if they are concerned about symptoms and the American Medical Association recommends that women over age 50 should be screened. The American Endocinology Association suggests women over 35 should be screened, as well as pregnant women. In the United States, all newborns are screened for congenital hypothyroidism to prevent developmental delay.
"It's (hypothyroidism) under diagnosed, and often misdiagnosed unless tests are used for the diagnosis," Dillas said.
Individuals are screened for hypothyroidism through a blood test. The most common blood test used is TSH (thyroid stimulating hormone). If TSH levels are found to be abnormal, a test checking for T4 is then performed. T4 is Thyroxine, the main product of the thyroid gland. If T4 levels are abnormal, patients are prescribed synthetic thyroid hormones to replace the ones that their body is not making naturally.
"I see it many times, when TSH is borderline elevated, patients want me to prescribe medications, but I don't think it's a good idea. If you get too much medication, it could push you into a hyperthyroid state," Dillas said.
"If you're borderline and have pronounced symptoms, we can try a very low dose of medication. Under no circumstances should people force their physicians to prescribe thyroid hormones, take thyroid hormones on their own or increase the dosage on their own," she added.
Thyroid hormones are not a "miracle drug" Dillas warned.
"We treat the symptoms of hypothyroidism, and once it's corrected, you have to take other steps (to stablize the condition) such as seeing a psychologist for depression, exercising regularly and making other lifestyle changes. Patients can't expect that physicians can just keep increasing the amount of medication until they feel good. Continuing to up the dosages of thyroid hormone is like giving a diabetic more insulin so they can eat more," Dillas said.
Patients concerned about hypothyrodism should come to their doctor's appointment prepared with questions.
"Patients shouldn't just take what they are told by their relatives (about hypothyroidism). They should come to the doctor's office with a list of questions and get all the information they can about it. Unless physicians are asked a particular question, they don't know what patients want to know," Dillas said.
"It's good to ask to be tested if you have symptoms, but you have to trust your doctor and stay within the guidelines. Medicine has to be evidence based," she added.