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After 30 plus years of
marriage, it is easy to overlook subtle changes in your spouse. But every
so often, enough clues pile up that something is not just right that suspicion
turns into concern.
Margaret had been complaining about getting
old, even though at 59 she had a satisfying and challenging career, |
was active in community events, and loved to
gather their adult children and grandchildren for elaborate family dinners
she took pride in preparing herself. She blamed her problems with dry skin
and occasional irregularity to the aging process, but she did have a flicker
of concern when an increasing amount of her hair accumulated in her hairbrush.
After her daughter began teasing her about gaining weight, Margaret began
to tally up all the little things that had changed. It wasn’t until her
husband began to comment on her growing forgetfulness, however, that her
health alarm signals finally went off and she scheduled an appointment
with her doctor for a check up.
Taken one at a time, Margaret’s "symptoms"
were more annoying than alarming. In her mind, they were simply the typical,
fussy complaints of someone just getting older. Who, after all, goes to
the doctor because of a lost handful of hair or a few extra pounds? There
has been enough coverage in the media about Alzheimer’s Disease however,
that increasing forgetfulness does trigger concern, especially as
people approach retirement age. In Margaret’s case, this concern allowed
early diagnosis of a very common -- and controllable -- health problem.
According to internist Thimos G. Paschalis,
M.D., "After age 40 or so, lots of people say they feel like they are slowing
down. They get sleepy after lunch, and often experience general fatigue.
As the years pass, even really healthy people notice the subtle ways their
bodies begin to change or, as some people put it, to ‘pay them back’ for
years of ‘abuse.’ Unless there is an overwhelming symptom that they recognize
as signaling a life-threatening condition like cancer or heart disease,
most people tend to dismiss these little early warning signs as being unimportant."
"In Margaret’s case, her family noticed
enough changes in her that she had perhaps not noticed or ignored in herself,"
the doctor explained. "Her detailed inventory of a handful of problems
and a some blood tests were sufficient to enable the diagnosis of hypothyroidism.
Like most folks, however, she had no idea what that was. Let’s face it,
unless something goes wrong, few people ever stop to think about their
thyroid, much less identify it as the cause of their symptoms."
A tiny gland with a
lot of responsibility...
The thyroid is a small, two sided gland
that snuggles around the windpipe at the base of the neck below the Adam’s
apple, and is part of the body’s endocrine system. Although it probably
weighs less than an ounce, this tiny gland has the major responsibility
of releasing hormones that regulate the body’s metabolism -- which controls
everything from how fast your heart beats to your mental health to your
body temperature to your overall energy level. When everything functions
properly, the thyroid produces two hormones -- thyroxine (T4) and
triiodothyronine(T3)
-- that maintain a delicate chemical balance in regulating the metabolism.
The thyroid takes its orders to release
these hormones from ‘quality control’ centers in the brain -- the hypothalamus
and the pituitary gland. When a drop in thyroid hormones in the
blood is detected, the pituitary sends out thyroid-stimulating hormone
(TSH) to prompt the thyroid into boosting hormone production. Alternatively,
if too much is detected, less TSH is released, which signals the thyroid
to reduce production.
There are at least two significant thyroid
conditions that warrant medical attention: hyperthyroidism
-- an over-active thyroid -- and hypothyroidism, an under-active
or non-performing thyroid which produces lower than normal levels of hormones.
An over-active thyroid sends out too many chemical messengers that accelerate
the body’s metabolism rate -- sometimes dangerously so -- producing symptoms
such as a sudden weight loss, heat intolerance, ‘bulging’ or protruding
eyes, and a rapid heartbeat. Both of these conditions -- which can mimic
other health problems and may, therefore, go undiagnosed and untreated
-- can claim a heavy toll on your well-being.
Women tend to be especially susceptible
to thyroid disease, and are much more likely than men to have an over-active
thyroid gland. They are also -- along with the elderly -- most commonly
affected by hypothyroidism. There is general agreement that all kinds of
thyroid disorders tend to run in families. There are no preventive measures
(lifestyle changes or immunizations) that can be taken to avoid thyroid
disease, and it can affect people of all ages.
About 8 million Americans are affected by
hypothyroidism. In the majority of cases (95 percent or more) hypothyroidism
is the result of a problem with the gland itself; where it just doesn’t
produce enough of the hormones to keep metabolism on track. The condition
can occur as the result of a viral infection or inflammation; it can result
from complications from thyroid surgery or treatment for hyperthyroidism;
or the body’s own immune system can "attack" the thyroid. There are also
congenital thyroid defects. Rarely, the cause of hypothyroidism can be
a medical problem that affects either the hypothalamus or the pituitary
gland. This "secondary" hypothyroidism results from insufficient TSH production,
even though there is no problem with the thyroid gland itself.
Diagnosing the problem...
Since an underactive thyroid slows the rate
the body burns calories for energy, one of the common symptoms is weight
gain. A slower metabolism can also translate into a slower heartbeat, a
lower body temperature, and a slower rate of muscle contraction. When these
symptoms develop and are reported to your physician, blood tests can measure
the levels of the thyroid hormones as well as the level of TSH produced
by the pituitary gland. Sometimes the thyroid gland itself is enlarged
to be felt during a physical examination -- which should also include an
assessment of other characteristic "fingerprints" of the disease in the
skin, hair and heart.
In some cases, additional blood tests for
cholesterol may be requested because this may also be abnormal in hypothyroid
patients. The doctor may also order cardiac tests and perhaps an electrocardiogram
for people with heart disease who have under-active thyroids to discover
any additional problems.
The blood tests can be performed relatively
inexpensively, and the results are generally available quickly. Once a
diagnosis is made, hypothyroidism can be treated by replacing the missing
hormones with a synthetic version taken orally. It may take a short period
to fine-tune the dosage (heart patients’ dosages may need to be increased
slowly), but improvement is usually noticed almost immediately. At first,
the doctor may order blood tests every three months or so, but once the
correct dosage is achieved, an annual blood test will probably be adequate
to monitor how well the thyroid is functioning.
"More sophisticated thyroid function tests
make it easier today to diagnose thyroid disease," said Dr. Paschalis,
"but we need to do more to educate people about the problem. Since the
initial symptoms are so elusive and indistinct that less than half of the
cases are diagnosed in early stages, some experts are recommending that
women over 60 be routinely screened for hypothyroidism. We certainly need
to stress that people who are feeling progressively more tired all the
time; who experience hoarseness, more than usual hair loss and dry skin,
water retention and weight gain; and have chronically cold hands and feet
should contact their physician. If the problem turns out to be hypothyroidism,
it can be easily and effectively treated with medication before more serious
symptoms develop." |
