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Ask The Doctor: How Do You Know if Your Thyroid is Out of Whack?

The American Thyroid Association reports more than 12% of the United States population will develop a thyroid condition during their lifetime. And women are five times more likely to have a thyroid condition than men.

Maintaining thyroid levels is an important part of heart health, weight management and preventing osteoporosis. We asked Nidhi Agarwal, MD, a Torrance Memorial Physician Network practitioner who specializes in endocrinology, to talk about symptoms, causes and treatment for thyroid disease.

What does a thyroid problem look like?

Dr. Nidhi Agarwal: Thyroid problems can be because of decreased or increased function of the gland. Low thyroid and high thyroid are at two ends of the spectrum. They share the common symptoms of fatigue, menstrual irregularities, mood changes, brittle hair/nails and sleep disturbance. For hypothyroid, which is low thyroid, someone would say, “I’m gaining weight even though I’m not eating as much, and I feel constipated. I am cold all the time, my skin is so dry, I’ve become so forgetful and I’m feeling depressed.” Less often we see complaints about a lump in the throat, causing difficulty with breathing, swallowing or speaking.

The other end of the spectrum, with high thyroid or hyperthyroidism, people usually rapidly lose weight despite having a good appetite. They feel anxious or irritable, hot and sweaty so their palms are almost moist. The heart rate is high, and they sometimes can feel it beating hard in their chest. Some also complain of loose stools and difficulty sleeping at night. Regardless of the type of disease, these are some of the common thyroid symptoms to look for.

What causes thyroid issues?

NA: The most common cause of hypothyroidism is autoimmunity, where the immune system makes antibodies that can attack the thyroid gland. It can run in the family but can happen suddenly as well. In other cases, surgical removal, iodine deficiency, radiation exposure or medications can affect the function of the thyroid. Hyperthyroidism can be caused by stimulating antibodies known as Graves’ disease, or nodules in the gland which cause increased hormone secretion or can happen transiently with a viral infection of the thyroid.

Does age affect the likelihood of developing a thyroid condition?

NA: As we age, normally our thyroid function tends to slow down and the normal reference ranges increase. However, thyroid disorders have no age limits. Hypothyroidism is more common in elderly than in young adults and is often underdiagnosed. Unlike younger people, older people may not have all the symptoms on the thyroid spectrum but can have significant change in their quality of life with just one or two symptoms. Regardless, we as physicians have to be very vigilant in making a diagnosis, as once diagnosed most patients require long-term follow-up. Thyroid function measurement is done with an easy blood test, and the results should be interpreted by an experienced physician keeping the patient’s symptoms in context.

What treatment is available for thyroid disease?

NA: Medication is the most common treatment for hypothyroidism. It does not cure the condition but only controls it. Usually we first try thyroxine (T4) therapy, since it has a good response, minimal side effects and the dose is easy to adjust. There are other preparations of synthetic liothyronine (T3) and combination therapy of T4+T3 available as Armour Thyroid and Nature-Throid, which are less commonly used. The treatment for high thyroid depends on the cause, but our options include medications, surgery and the use of radioactive iodine I-131 to destroy the thyroid gland.

What steps should someone take if they think they have a thyroid condition?

NA: Persons with a family history of thyroid disease, personal exposure to radiation/neck surgery and taking medications like amiodarone/lithium/interferons should be mindful of their symptoms. They should either see their primary care physician or an endocrinologist and discuss their symptoms in detail. If they have had any previous tests done on the thyroid, it would be helpful to bring those to the visit. Screening for thyroid problems is done with a thyroid stimulating hormone (TSH) level, which can be obtained at any time of the day with a blood draw and can help direct further need for testing.

Nidhi Agarwal, MD, is an endocrinologist with the Torrance Memorial Physician Network. Her office is located at 2841 Lomita Blvd., Suite 320, in Torrance. She can be reached at 310-517-8952.