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Often, the thyroid is the real culprit

Hypothyroidism, frequently undetected, can affect everything from mood to weight.

October 14, 2002|Dianne Partie Lange and Richard Flaste | Special to The Times

It is one of the stealthiest of human maladies: hypothyroidism. Resulting from an underactive thyroid gland, it can produce depression, weight gain, high cholesterol, fatigue and a wide range of other symptoms, each of which may look like a disorder all by itself. Even though it's the true culprit, the malfunctioning of the thyroid may never be detected, while the symptoms are being aggressively treated -- often ineffectively.

But that may be changing. These days the thyroid, like a schoolchild waving for attention, is finally getting a lot more notice. Recent research suggests that as many as one in 10 Americans may suffer from an underactive thyroid. That revelation has given added credibility to those who argue that the gland should be tested routinely, just as the heart is regularly examined.

The thyroid sits in the front of the throat, like a bow tie below the Adam's apple, quietly secreting hormones that circulate through the bloodstream to every cell of the body. When the gland goes awry, producing too little hormone (hypothyroidism) or too much hormone (hyperthyroidism, a much less common condition), body and mind are thrown out of sync. Too little of the thyroid hormone causes a body-wide slowdown.

For The Record
Los Angeles Times Monday November 18, 2002 Home Edition Health Part F Page 8 Features Desk 3 inches; 125 words Type of Material: Correction
Thyroid disease -- A graphic that accompanied a Health section story on Oct. 14 gave some incorrect information. The graphic stated that patients with hypothyroidism (underproduction of thyroid hormones in the body) should avoid products containing ephedra and caf- feine.
On the contrary, such advice is recommended for patients with hyperthyroidism (overproduction of thyroid hormones.)
Also, the graphic listed two "common treatments" for hypothyroidism -- a lifelong regimen of prescription hormone therapy and dietary changes. The graphic should have explained that hormone therapy is the recommended conventional medical treatment, and that health professionals recommend dietary changes as a supplemental treatment.

Testing and treatment

One current debate is whether people with slightly underactive glands should be treated.

The blood test for hypothyroidism is inexpensive and easy. So is the treatment. A daily dose of thyroid hormones replaces what a sluggish gland fails to make on its own.

As for diagnosis, there are several indications of hypothyroidism. One is an elevated level of a thyroid-stimulating hormone in the blood. Usually called TSH, it is the chemical signal that the pituitary gland sends to prompt the thyroid into action. Another test is a direct measurement of the amount of thyroid hormone in the blood.

But the amount of that hormone may be normal because the increasing amount of TSH is managing to keep the failing thyroid pumping adequately. That's why an elevated level of the stimulating hormone is so telling.

Some of the most obvious, but lesser, symptoms of hypothyroidism are thinning hair, dry skin and puffy eyes. These also come with age, of course, which is why they are deceptive symptoms. Other subtle signs are memory lapses, feeling chilled and trouble losing weight. Some of the indicators are so commonplace that one doctor, a hormone specialist in fact, sheepishly admits that he missed for far too long the signs that his own father, also a physician, was suffering from hypothyroidism and not just the frailty of his years.

The first of the major studies prompting the new vigilance was the Colorado Thyroid Disease Prevalence Study, published two years ago. More than 9% of the 25,000 Colorado residents tested had abnormally high TSH levels.

"That was a shocker," says Dr. Leonard Wartofsky, chairman of the department of medicine at the Washington Hospital Center in Washington, D.C.

That study was followed by a more diverse survey of 16,000 apparently healthy Americans published this year. It found that 4.6% had hypothyroidism, even though they seemed symptom-free. The abnormal test readings were most prevalent in women, the elderly, whites and Mexican Americans.

"There's a lot of this out there," says Wartofsky, "and studies are showing that there's a benefit to finding it and treating it."

There's no disagreement about treating anyone with clearly high levels of the stimulating hormone whether or not the patient has troubling symptoms. The most active controversy centers on people whose thyroid is just slightly underactive, a condition that has been called subclinical or mild hypothyroidism. In these people, there may be some symptoms or none at all. Nearly half of those with mild hypothyroidism, according to Wartofsky, will develop the full-blown disease in five to seven years.

On the testing issue, some kind of consensus among experts is expected to emerge soon. But for the time being, medical organizations have been offering a bewildering array of screening recommendations.

One says that men and women over 35 years old should have a blood test every five years. Another recommends annual screening for those over 60, especially women. A third puts the spotlight on just about anyone with a family history of thyroid problems.

Meantime, the federal group responsible for guidelines, the U.S. Preventive Services Task Force -- looking at costs as well as potential benefits -- is on the fence. It says, "There is insufficient evidence for or against screening."

"It's a hot debate," says Inder Chopra, a UCLA endocrinologist and member of a panel currently considering a recommendation for those who qualify for Medicare.

"You would be doing so many tests," he says, and it "wouldn't justify the expense."

Disease linked to aging

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