Excerpt
The Thyroid Solution (Third Edition)
1
Thyroid Imbalance
A Hidden Epidemic
Could you have an overactive or underactive thyroid and not even know it? Millions of Americans—and a high percentage of women in menopause and perimenopause (the decade or so before menopause during which hormonal, emotional, and physical changes begin)—do. A thyroid imbalance is not always easy to recognize. Physicians continue to argue whether a minimal thyroid imbalance affects mental and physical health. But the truth is that it does—and big time.
Do you have any of the following symptoms?
•Always fatigued or exhausted
•Irritable and impatient
•Feeling too hot or too cold
•Depressed, anxious, or panicky
•Bothered by changes in your skin or hair
•At the mercy of your moods
•Inexplicably gaining or losing weight
•Losing your enthusiasm for life
•Sleeping poorly or insomniac
Are you feeling burned out from having acted on an excess of energy for several months? Are you listless, forgetful, and feeling disconnected from your friends and family? Are people telling you that you’ve changed? Are you taking Prozac or a similar drug for mild depression but still feeling that your mind and mood are subpar? Or have you been treated for a major depression in the past?
If you suffer from more than one of these symptoms or answered yes to one or more of these questions, you could be one of the many people with an undiagnosed thyroid condition. Although some of these symptoms may seem contradictory, all of them can be indications of a thyroid imbalance.
You could also be one of the many people who has been treated for a thyroid imbalance but still suffers from its often-overlooked, lingering effects—effects that may continue to haunt you even after treatments have presumably restored your thyroid levels to normal. If you’ve ever been treated for a thyroid imbalance, answer these questions:
•Do you still suffer from fatigue?
•Do you feel better but still not quite your old self?
•Do you have unusual flare-ups of anger?
•Are you less socially outgoing than you used to be?
•Are you less tolerant of the foibles of family and friends?
•Do you suffer from occasional bouts of mild depression?
•Do you have frequent lapses in memory?
•Are you often unable to concentrate on what you’re doing?
•Do you feel older than your real age?
If you’ve had a thyroid problem in the past but still answer yes to one or more of these questions, it is quite likely that your symptoms are thyroid-related. You don’t have to suffer any longer. The Thyroid Solution will show you how you can work with your physician to heal these lingering symptoms.
The Hidden Suffering
At any given time in the United States, more than 30 million people suffer from a thyroid disorder, more than 10 million women have low-grade thyroid imbalance, and nearly 10 million people with thyroid imbalance remain undiagnosed. Some 500,000 new cases of thyroid imbalance occur each year.1 All of these people are vulnerable to mental and emotional effects for a long time even after being diagnosed. Incorrect or inadequate treatment leads to unnecessary suffering for millions of these people. But these are numbers. Behind the numbers are the symptoms and ravaging mental effects experienced by real human beings.
For the past two decades, we have witnessed a major increase in the recognition and detection of thyroid diseases. This stems in part from improved medical technology, which has led to the development of sensitive methods of screening and diagnosing thyroid disorders. It also stems from the increased public awareness that thyroid disease may remain undiagnosed for a long time and that even mild thyroid dysfunction may affect your health.2 It is also likely that thyroid imbalance has become more common as a result of deleterious effects related to our environment. Medical associations such as the American Association of Clinical Endocrinologists have conducted public screenings for thyroid disease, much as cholesterol testing has become available in shopping malls and other public places. At any given time, more than half of patients with low-grade hypothyroidism remain undiagnosed. In a thyroid-screening program involving nearly two thousand people that I directed in the Houston area,3 8 percent of those tested had an underactive thyroid. Many people screened had never heard of the thyroid gland but rushed to be tested when they recognized that they were suffering many of the symptoms listed in the announcement of the screening. In a statewide health fair in Colorado conducted in 1995, 9.5 percent of the 25,862 participants who were screened for thyroid imbalance were found to have an underactive thyroid and 2.2 percent had thyroid hormone excess.4 The public’s awareness of thyroid disease was boosted by press reports about former president George H. W. Bush and his wife, Barbara, Russian president Boris Yeltsin, and Olympic track champion Gail Devers when they were diagnosed with thyroid disease. Thanks to these factors, people with unexplained symptoms are becoming increasingly likely to ask their physicians whether these symptoms might be related to an undiagnosed thyroid disorder.
As an endocrinologist who has focused his research, teaching, and patient care on thyroid conditions, I realized early on in my practice that taking care of thyroid patients was not as easy as I had expected. Treating and correcting a thyroid condition with medication may not always make the patient feel entirely better. I discovered that to care fully for my patients, to help them heal completely, I had to treat their feelings as well as their bodies. If they didn’t feel better even though their lab tests said they were cured, I learned to listen to them, believe them, and work with them to help them become wholly cured. In taking care of thyroid patients, the physician’s role is not merely to address physical discomfort, test the thyroid, and make sure blood test results are normal (indicating normal amounts of the various thyroid hormones in the bloodstream). Addressing the effects of thyroid disorders on the mind, addressing the health of the immune system (often the root of the thyroid condition), helping patients cope with their condition, and counseling them sympathetically are equally important.
Many physicians treat dysfunctioning thyroids, but few of them listen to the person attached to the gland. They concentrate on the blood tests, and once your lab results become normal, for these physicians your case is closed. Yet you may go on to suffer for years from a variety of physical and mental symptoms related to the thyroid condition. Research has shown that patients with thyroid imbalance continue to have symptoms even after their thyroid hormone blood levels have become normal with treatment.5 Physicians should be treating the still-suffering patients in a more comprehensive way for as long as it takes for the physical and mental effects to subside. The reality today, however, is that millions of patients suffer needlessly while their doctors continue to treat thyroid disease as a simple physical disorder rather than what it is: a complex blow to the body and brain.
In general, primary care physicians have not been adequately trained to detect and manage thyroid disease and may lack the expertise needed to diagnose and treat a wide range of thyroid disorders.6 They also receive little teaching on the effects of thyroid disease on mental health or on understanding the interplay between the mind, the thyroid, and the immune system.
The majority of practitioners of internal medicine and family medicine complete their residency without having had some form of training in endocrinology (the field of hormones). When they leave their training programs, they have inadequate knowledge of thyroid disorders and inadequate experience in diagnosing and treating these disorders. As a consequence, they seldom look for subtle indications of thyroid disease.
Often a primary care physician ignores the thyroid gland in a routine examination and fails to examine the gland by touch. Yet the simple touch examination, or palpation, of the thyroid gland is quite important in finding clues to the presence of thyroid disease. Often physicians are not taught how to palpate the thyroid gland during their training. Many physicians would admit that they were never taught the right way to examine the thyroid gland and do not do the exam routinely in their practice.
Because both the physical and mental symptoms of thyroid disease masquerade as signs of many other illnesses, getting the proper diagnosis can sometimes take a long time. Often symptoms are misdiagnosed and viewed as trivial. Until patients find the right doctor, they are left alone to deal with devastating effects, which may include depression or even upsetting changes in personal behavior. Thyroid imbalance can quickly escalate into a destructive brain chemistry disorder—as powerful and pervasive as major depression, an anxiety disorder, or manic-depression.
Once the brain has been denied thyroid hormone or oversupplied with it because of thyroid disease, it takes a long time to recover. If the symptoms are ignored, they can intensify. A vicious cycle occurs wherein the patient gets depressed, the thyroid disease worsens, physical and emotional effects multiply, and mental health suffers further. This cycle is not widely understood or recognized, and many physicians do not know how important it is to halt the cycle—or, indeed, how to halt it.
As we will see, thyroid disease is more often than not related to your immune system attacking your thyroid gland and causing inflammation in the gland. Beyond the effects on the gland itself, the inflammation chemicals put out by the immune system are dispersed throughout your body and can produce a wide range of both physical and mental effects. You end up having multiple symptoms related not only to thyroid imbalance but also to a quite reactive, inflammation-generating immune system.
The Thyroid and the Mind
The Swiss artist Arnold Böcklin (1827–1901) painted a portrait of a woman who appeared quite depressed. Her unsmiling face was sad and lifeless, and her eyes had a detached look. The most striking thing about her appearance, however, was that the front of her neck was swollen. The swelling was so evident that Böcklin drew attention to it with his use of color and lighting. As a layman, he recognized that she had a physical illness and that she was depressed, but it is doubtful that he made a connection between her thyroid and her depressive state. In fact, we did not begin to understand this connection until the late nineteenth century.
Even before the thyroid gland was shown to play a role in regulating metabolism, it was recognized as “the gland of the emotions.” In fact, the relationship between the thyroid gland and the mind was thought for years to have merely an anatomical basis: the thyroid is physically close to the brain. The thyroid was believed to protect the brain from overheating, which could result from increased blood flow to the brain when a person was upset. Dr. Robert Graves was the first to provide the classic description of what is now known as Graves’ disease. In his description of this “newly observed affection of the thyroid gland in females,”7 he highlighted symptoms of the nervous system and used the term globus hystericus because of the many psychiatric manifestations exhibited by his patients. Dr. Caleb Parry, who had recognized the condition before Graves but expired before his observations were published, wrote: “In more than one of these [patients], the affliction of the head has amounted almost to madness.”8
For decades, in fact, Graves’ disease was considered to be a mental illness rather than a true thyroid disorder. The early label “crystallized fright” illustrates that this condition was seen as some kind of mental illness that follows a psychological trauma. Among the first physicians to focus on the physical symptoms of the condition was Baron Carl Adolph von Basedow. In 1840, he described four patients with protruding eyes, goiter, and rapid heartbeat. He was also the first to describe pretibial myxedema, a brownish swelling over the legs that occurs in a small number of patients with Graves’ disease. Whereas the term Graves’ disease has prevailed in the English-speaking world, von Basedow’s disease is the term used in Germany and some other European and African countries.
Nearly half a century after Graves’ observations, the British physician Dr. William Gull9 described for the first time the physical and mental consequences of an underactive thyroid. His writings suggested that some of the effects of hypothyroidism were significant mental changes leading to a severe slowing of the mind. Since then it has become clear that the main function of the thyroid gland is to produce thyroid hormone, which regulates the functioning of our body and at the same time is a bona fide brain chemical that regulates mood, emotions, and many other brain functions. Doctors now have come to understand that the basis of the thyroid-mind connection, which was, for a long time, a mystery, is at least in part related to too little or too much thyroid hormone circulating in the body. A patient with a thyroid imbalance may experience physical effects such as skin problems, irregular heartbeat, congestive heart failure, high blood pressure, muscle dysfunction, and gastrointestinal disturbances. Thyroid hormones regulate the metabolic rate, a concept so well popularized that most people associate thyroid imbalance with metabolism and weight problems. And yet, for many people, the emotional and mood-related consequences of a thyroid imbalance are more drastic than the physical ones.
Paradoxically, whereas nineteenth-century physicians first described and demonstrated the significance of such mental symptoms, many modern-day physicians who treat thyroid patients tend to view thyroid disease only as a glandular disorder with physical symptoms only.
Why Thyroid Imbalances Are Frequently Unsuspected
Let’s take a look at the main reasons why doctors do not diagnose or misdiagnose thyroid imbalances.
Stress, depression, anxiety, tiredness, and other emotional or mental states can mask a thyroid imbalance. Your doctor may perceive symptoms caused by a thyroid imbalance as trivial, primarily because many of us complain of varying degrees of tiredness,10 lack of interest in life, and weight problems. Quite often, thyroid imbalance makes you suffer from symptoms of depression. Depression is the most common condition seen in general medical practice and also the most common mental effect of thyroid imbalance. Researchers estimate that, at any given time, 10 percent of the population suffers from depression; over a lifetime, the prevalence may be as high as 17 percent.11 Most patients with mental health problems seek help from primary care physicians rather than psychiatrists.12 Quite often these physicians have received no training or inadequate training in assessing, detecting, and managing subtle mental disorders. Doctors accurately diagnose fewer than 50 percent of patients with unequivocal depression.13 Even among those who are correctly diagnosed with depression, only a small portion receives adequate treatment for a sufficient time.14 The financial pressures placed on doctors and the bureaucracies of the current healthcare system have made doctors unable to spend additional time talking to patients who may be depressed. They do not have the time or they do not get reimbursed for that time. Getting into the emotional aspects of somebody’s life can be a drain on physicians’ energy, so many will actually avoid trying to understand the root of a patient’s anxiety or depression. Internists and family practitioners may feel uncomfortable dealing with mental anguish and may stick to the familiar territory of performing a physical examination, performing laboratory tests, and prescribing medications.
