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Tackling the thyroid

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					Tackling the thyroid
When pharmacist Heather Martle started feeling exhausted day after day she was suffering from the same disease as Oprah Winfrey, although she did not know it at the time. This common condition is called hypothyroidism, and typically affects more women than men. The butterfly–shaped thyroid gland in the neck regulates our physical and mental functioning. Too much thyroid hormone, known as thyroxin, and the metabolism revs up like a car engine out of control, leaving a typical sufferer anxious and unable to sleep, with the body using energy so fast that there is often considerable weight loss. This condition is known as hyperthyroidism. Hypothyroidism is when there is too little thyroxin and it’s as if a sufferer’s foot lifts off the body’s accelerator. Symptoms include sluggishness, forgetfulness, depression, constipation and weight gain. HYPOTHYROIDISM Heather Martle, now in her early 50s, was diagnosed with hypothyroidism 14 years ago. Despite having dispensed thyroxin many times as a pharmacist, she did not know her own exhaustion and irritability were thyroid–related. Her job at the time, as a supply–chain manager for a drug company, was extremely stressful and she worked very long hours and on most weekends. At first, her doctors put her exhaustion down to stress. For over a year, her hypothyroidism was not diagnosed. As soon as it was, she started taking thyroxin tablets. The first dose ‘felt a little over the top – I got heart palpitations,’ she says. ‘But the only problem with the treatment is getting the dosage right; this condition is such an easy thing to fix, and people really need to know that. The treatment is a cheap little tablet and it changes your life. You get the boost you need and you feel totally normal. It’s wonderful.’ Between 2 percent and 20 percent of the population suffers from thyroid disease at some stage. Although it is believed many cases go undiagnosed, especially of hypothyroidism, it’s easy for doctors to miss the correct diagnosis because the illness develops slowly and the symptoms could be caused by a wide variety of ailments. Four of the five members in Heather’s immediate family have thyroid disease, as do most of the women on her mother’s side of the family. ‘I take my tablet every morning and so does my mom, who lives with me,’ she says. General practitioner, Dr Vera Scott, advises people to be aware of the symptoms of thyroid disease as doctors don’t always consider it as a diagnosis and there’s no routine screening for it. ‘My advice is to be aware of the symptoms and ask your doctor if you’re concerned about your thyroid,’ she says. Nor can thyroid disease be avoided or regulated by following any particular diet, she says. General practitioner, Dr John Cornell, diagnoses several new underactive thyroid cases every year. The caricature hypothyroid patient has a swollen face, hair loss and a coarsening of the skin, and is sluggish and forgetful. ‘If you hadn’t seen your aunt for five years, and she’d developed an underactive thyroid in that time, when you saw her you might say, “Hey, what’s happened?”’ says Dr Cornell. ‘Somebody living with her would possibly not notice, because there’s a very slow onset.’ However, many patients simply feel depressed or tired, as did Heather. ‘You’ve got to be fairly far gone before you develop many of the physical concomitants of hypothyroidism,’ says Dr Cornell. ‘Treating the
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disease is extremely easy – and gratifying, because most patients say that it’s like waking up.’ The most common cause of hypothyroidism is Hashimoto’s disease, a disorder in which the immune system inappropriately attacks the thyroid gland. The resulting inflammation often leads to an underactive thyroid gland. Too little iodine in the diet can also cause hypothyroidism, although this is not the case in South Africa as all our salt is iodised. When GPs suspect a patient has a thyroid problem they perform blood tests to determine the quantity of hormones the thyroid and pituitary glands are producing. If the thyroid is underactive the tests show there is too little of the thyroid hormone and too much of the pituitary’s hormone, because the pituitary is having to work extremely hard to stimulate the thyroid. Every child born in a public or private hospital in South Africa is screened for a congenital form of hypothyroidism called cretinism. If not treated, this leaves the child stunted both physically and mentally. Risk factors for hypothyroidism
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Family history of thyroid disease Personal history of a thyroid problem Family history of autoimmune disease (such as alopecia, lupus, multiple sclerosis, rheumatoid arthritis, psoriasis, Raynaud’s syndrome, endometriosis, etc) Previous radiation treatment to the neck, tonsil, head, chest area Female, over 60 years of age Menopausal or perimenopausal Smoker, or previously a heavy smoker

HYPERTHYROIDISM Hyperthyroidism is easier to diagnose than hypothyroidism as it starts much more rapidly, says Dr Scott. One of the most common causes is Grave’s disease, in which the immune system attacks the thyroid gland, causing overproduction of the thyroid hormone. This typically affects women aged 30 to 50 and it may cause the thyroid gland to enlarge into a goitre. Another cause of hyperthyroidism is a carcinoma, multiple tumours, or a benign tumour, called an adenoma, in the pituitary gland. Hyperthyroidism can be treated by simply treating the symptoms if they are mild, or by surgically removing a tumour or, more commonly, with radioactive iodine. Hyperthyroidism made 33–year–old Verona Mathews’ life hell for years. A lecturer in public health at the University of the Western Cape, she assumed her voice tremors were due to nervousness. She had always been small but her weight dropped to 32kg ‘and my heart felt like it was jumping out of my chest,’ she says. ‘I could eat two plates of food and feel I’d had nothing. In my wedding photos I’m very thin and my eyes are popping out of my face.’ She was only diagnosed when the manager of a community health centre she was visiting for work suggested she had a thyroid problem. She was given two sets of hyperthyroidism treatment before she started taking radioactive iodine, which normalised her condition but partially killed her thyroid. She must now take a synthetic thyroid hormone for life, to balance out her thyroid functioning. Verona says, ‘I used to think it was only old people who have chronic diseases. It took me a while to get there, but now I’ve made my peace with it. What helped was that my husband found many articles on the topic and I realised there’s nothing I could have done to prevent it. So the only thing left to do was to accept it. After I was diagnosed I found out that lots of people I know have thyroid disease. It really helps to
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know you’re not alone. My advice to people who have the disease is to find out all you can, because knowledge is power. The more you understand something, the more you are able to accept it.’ Risk factors for hyperthyroidism
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Family history of thyroid disease Diagnosed with a goitre – in the past or present Diagnosed with thyroid nodules – in the past or present Previous treatment for hypo– or hyperthyroidism Previous temporary thyroid complaints Had a thyroid problem in a previous pregnancy Diagnosed with an autoimmune disease – in the past or present

Written by Jo–Anne Smetherham Bankmed, Spring 2008

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