Gendill 1 Ninnah Gendill ENG 122-502 Jennifer Demack 24 April 2008 “Doctor, We Need to Talk” Approximately 20 million Americans have been diagnosed with either hypo or hyperthyroidism (“Statistics About Thyroid Disorders”). To make an already outrageous number even more astounding, an additional 13 million people have no idea that one of these two thyroid conditions could be causing their pain and suffering. These latter undiagnosed patients need to be informed about the types, causes, diagnosis, and treatment of thyroid conditions in order to engage in their legal right of informed consent with their doctor to receive proper care. Thyroid conditions are sorted into two primary types: hypothyroidism and hyperthyroidism. Hypothyroidism is the result of the thyroid slowing down, and not producing enough of the essential hormones T3 and T4, whereas hyperthyroidism is exactly the opposite (“Do You Have a Thyroid Problem?”). With hyperthyroidism, the thyroid not only produces enough hormone, but it produces more than it should. Why does this happen? There are several causes for both of these conditions. Hypothyroidism’s number one cause is the autoimmune disease Hashimoto’s thyroiditis (Mayo Clinic, “Hashimoto’s Disease” 1). Also known as chronic lymphocytic thyroiditis, this disease causes your immune system to create antibodies that damage the thyroid on a microscopic level, resulting in a goitrous enlargement in the neck. The slow, continual inflammation brought about in these situations explains why a person may be afflicted with Gendill 2 Hashimoto’s for years before any symptoms of hypothyroidism shows up (“Chronic Lymphocytic Thyroiditis,”). Although Hashimoto’s is believed to be genetic, other factors such as gender, age, and immune system affect the development of this disease. Secondary Hypothyroidism is a less common cause of hypothyroidism than Hashimoto’s Thyroiditis. Although a thyroid condition, Secondary Hypothyroidism is actually caused by the pituitary gland rather than the thyroid. In these cases, the pituitary no longer produces the thyroid stimulating hormone known as TSH (Basaria). TSH notifies the thyroid when hormones T3 and T4 need to be created; thus, when no TSH is produced, neither is T3 or T4. It is interesting to note scientific studies have found “[…] symptoms of hypothyroidism and absence of a goiter are important clues to the diagnosis” of secondary hypothyroidism (3). Both hypo and hyperthyroidism are brought on by postpartum thyroiditis, a painless inflammation of the thyroid resulting from pregnancy. Undetected in 5 to 10% of pregnancies, this is often disguised by the typical changes that show up in pregnancy such as fatigue, aches and pains, and emotional problems (Drucker, “Postpartum Thyroiditis”). When hypothyroidism appears, symptoms are not always evident even if the condition is present; however, permanent hypothyroidism can emerge even as long as 3 or 4 years afterwards. In contrasting cases of postpartum thyroiditis where hyperthyroidism develops after pregnancy (rather than during), symptoms usually appear within the first three months of pregnancy, but often vanish over time without causing significant damage. Hyperthyroidism, the less widespread thyroid condition, is primarily caused by Graves’ disease, a condition believed to affect between 1 and 2 % of the population (Thyroid Foundation of America, “The Overactive Thyroid”). Graves’ is also known as diffuse toxic goiter, “diffuse because the entire gland is involved in the disease process, toxic because the Gendill 3 patient appears hot and flushed, as if he or she were "toxic" due to an infection, and goiter because the overactivity enlarges the gland (par. 1).” As an autoimmune disease similar to Hashimoto’s thyroiditis, the excessive hormone that results from Graves’ hyperthyroidism attacks not only the thyroid but the eyes and skin as well (Mayo Clinic, “Graves’ Disease”). The destruction causes symptoms such as a goiter, reddish skin on shins and feet, and the protruding eyes characteristic of Graves’ Ophthalmology. Toxic hot nodules also cause hyperthyroidism. Named for the hot spots revealed during thyroid scans, these nodules are sections of the thyroid gland that absorb incredible amounts of the radioactive iodine administered for scanning (Drucker, “Hot Nodule”). Unresponsive to the pituitary hormone TSH, these hot nodules automatically produce enough hormones that the rest of the thyroid shuts down in compensation. If this unbridled behavior isn’t alarming enough, five percent of hot nodules can become cancerous. Blunt Trauma is an extremely uncommon cause of hyperthyroidism. Stylianos Delikoukos and Fotios Mantzos performed a research study on this cause and explain blunt trauma to be an excessive amount of force to the neck (Delikoukos 1). For example, one instance in this study involves being thrown against the front seat of a car in an accident (1). As a result of such blows, the thyroid releases hormones into the blood stream in exceedingly high amounts, inducing a life threatening hyperthyroid stage known as thyroid storm (3). The two situations discovered by Delikoukos and Mantzos illustrate the severity of this -- both patients discussed were hospitalized for fevers, vomiting, and tremors within hours of their accidents. Diagnosis is the first step to treating these potentially serious conditions. Before visiting a doctor, an individual can perform some observations of their own to check for Gendill 4 symptoms of a thyroid problem. These indications are important to communicate to a doctor to insure a correct diagnosis. Symptoms afflicting both hypo and hyperthyroid patients are often written off as other illnesses. These include the sleep disorders and fatigue that can be diagnosed as just that: sleep disorders and fatigue. Additionally, menstrual irregularities and hair loss appear in thyroid conditions. Various symptoms unique to hypothyroidism that often attributed to signs of aging in women include weight gain, dry skin, muscle cramps, feeling cold, and puffiness (“Do you have a thyroid condition?” par. 11). Furthermore, the mental problems associated with hypothyroidism such as “ [the] inability to concentrate, forgetfulness and depression […] have led to tragic cases [where hypothyroidism was] misdiagnosed as senility, madness or psychosis (par. 15).” Anxiety, muscle weakness or twitching, acne, and diarrhea are symptoms of hyperthyroidism that can be misdiagnosed as a less serious condition. Sweating, also a hyperthyroid symptom, could be misdiagnosed as a condition called Hyperhidrosis. Yet, “If sweating is accompanied by fever, weight loss, chest pain, shortness of breath, or a rapid, pounding heartbeat. These symptoms may indicate an underlying problem such as hyperthyroidism (Van Voorhees).“ After looking for these symptoms, there is a second observation. This involves checking your neck for any unusual lumps or nodules, since most thyroid conditions will result in a goiter or other enlargement. In a program set up by the American Association of Clinical Endocrinologists (AACE), individuals are taught to perform the following steps when checking for nodules: Gendill 5 “Step 1: Focus the mirror on your neck just beneath the Adam’s apple and right above the collar bone, where your thyroid gland is located. Step 2: Tilt your head back. Step 3: Swallow some water. Step 4: While swallowing, observe your neck for bulges or protrusions (Langer 189).” If any unusual enlargement of the thyroid is detected in this step, then it is indeed time to consult with a doctor who will be able to give a definite diagnosis. The doctor will not only check for symptoms and nodules, but also conduct tests to check the hormone levels in the blood stream. Blood tests are not only important to confirm diagnosis of thyroid conditions, but they are also important for monitoring the body’s response to treatment (Costa). These tests check the levels of thyroid hormones T3 and T4 as well as the regulating hormones produced by other endocrine glands. In the occurrence of hypothyroidism, results of these tests will usually show reduced levels of thyroid hormone and higher levels of pituitary hormone TSH. As one might guess, test results for patients with hyperthyroidism are the opposite: higher T3 and T4 levels with reduced TSH. When the results of these blood tests come back, there are several treatment options that the doctor will mention depending on which condition has been diagnosed. In treatment of hypothyroidism, a drug by the name of Levothyroxine, a synthetic form of the thyroid hormone T4, will be used to supplement the thyroid and reestablish normal hormone levels (Mayo Clinic, “Hypothyroidism”). With the correct dosage, this has few side effects, however when taking levothyroxine, there are foods that should be avoided because they reduce the absorption. These include soy products, iron supplements, and some antacids. Alternatives to this lifelong treatment of levothyroxine are natural thyroid hormone and iodine supplementation. Gendill 6 Natural thyroid hormone is extracted from pig thyroid and contains both thyroid hormones T3 and T4 in contrast to the synthetic hormone that contains only the hormone T4 (Mayo Clinic, “Hashimoto’s Disease”). Although this may sound like a better solution than levothyroxine, doctors have several concerns about the use of natural thyroid extract. Their reasons include the levels of T3 and T4 being different in animals than in humans, and the amounts of T3 and T4 in each batch varying depending on what the animal ate and when they were butchered. Furthermore, “there is no scientific evidence that natural extracts of thyroid hormone offer any advantage over synthetic versions (“Hashimoto’s Disease”).” A natural remedies encyclopedia believes that supplementing kelp, sea salt and other forms of iodine into the diet is a safer form of treatment than both natural and synthetic thyroid hormones (“Part 3:Thyroid”). This is because of the belief that thyroid medication will weaken bones and cause breast cancer. When choosing iodized or seas salts as an iodine supplement, check the labels, because these salts can contain an anti-caking agent that is believed to cause Alzheimer’s. There are a variety of treatment methods available for hyperthyroidism in contrast to the hormone replacement and supplement methods available for hypothyroidism. Hyperthyroid methods include radioactive iodine, anti-thyroid drugs, beta-blockers, and surgery, as well as alternative treatment (“Treating Hyperthyroidism”). The best treatment for hyperthyroidism will vary between individuals. The patient and doctor should thoroughly discuss options in order to choose the right treatment for each unique situation. Radioactive Iodine is the most common treatment option for hyperthyroidism. Even though this treatment is safe and effective, you must be cautious: if too much iodine is administered, hypothyroidism can develop. Taken by mouth, it is important not to use Gendill 7 radioactive iodine if breastfeeding, pregnant, or planning on getting pregnant in the next six months. Also, washing hands and avoiding contact with young children and pregnant women, as well as double flushing the toilet, is imperative for at least three days following treatment. “This will stop [the] radiation in your body from affecting others (“Treating Hyperthyroidism”).” For those who do not choose to take radioactive iodine, there are the antithyroid drugs Methimazole and Propylthiouracil (“Treating Hyperthyroidism”). These are effective for most people and there is a lower risk of developing hypothyroidism than with radioactive iodine. Methimazole is the most common of these two drugs because it is easier to take and has fewer side effects. At the same time, Propylthiouracil is best for pregnant and breastfeeding women. Remember, if medication is stopped, hyperthyroidism can reoccur. Beta-blockers are a less common treatment option, but effectively improve the tremors and fast heartbeat of hyperthyroidism (“Treating Hyperthyroidism”). If afflicted with thyroiditis, this might be the only treatment needed to stop symptoms, yet not everyone can take beta-blockers. Heart or lung problems can affect the eligibility for this method. Surgical removal of either part or the entire thyroid, also known as a thyroidectomy, should be considered the last resort of treatment options. It is typically an option if your thyroid is so enlarged that it affects other parts of your neck, or if you are pregnant and unable to take antithyroid drugs; but a thyroidectomy incurs more risk of developing hypothyroidism depending on how much of the thyroid is removed (“Treating Hyperthyroidism”). Additionally, it costs more than other treatment methods. Various alternative medicine sources recommend eating foods called goitrogens as a treatment for hyperthyroidism. Goitrogens are foods such as broccoli, cabbage, turnips, soy Gendill 8 products, peanuts, kale, peaches, and pears that inhibit thyroid function (“Part 3: Thyroid”). Even though this works, it is not effective for long-term treatment. It backfires “when iodine is then re-introduced to the diet or accidentally ingested, [for] the now larger thyroid has the capacity for great thyroid hormone production (Johnson).” In contrast, a better alternative form of treatment would be to increase the amount of copper in your diet. Found in legumes, nuts, and dark chocolate. Copper aids the body’s metabolism in tolerating excess iodine without increasing thyroid hormone production. Knowledge of these treatment options is important when talking to a doctor. A patient’s right to informed consent requires doctors to tell their patients about every available treatment option, the risks, and the benefits as well as the alternative methods. There is more to thyroid conditions than simply types, causes, diagnosis, and treatment options. The relationships between thyroid conditions and depression, ADHD, and fetal development are all still being researched. Still another aspect of thyroid conditions that is not fully understood is the occurrence in animals. However, this basic knowledge of both hypo and hyperthyroidism that is known will aid in protecting you, your loved ones, and even your pets from the myriad of “other health problems” caused by undetected thyroid conditions (“Treating Hyperthyroidism”).” Gendill 9 Works Cited Basaria, Shehzad, and Milena Braga. "A Rare Form of Hypothyroidism." Southern Medical Journal 95.5 (May 2002): 549. Academic Search Premier. EBSCO. Fort Collins Public Library, Ft. Collins, CO. 31 Mar. 2008 <http://0- search.ebscohost.com.dalva.fcgov.com:80/login.aspx?direct=true&db=aph&AN=6566568 &site=ehost-live>. Costa, Anthony J. "Interpreting thyroid tests." American Family Physician 52.8 (01 Dec. 1995): 2325. Academic Search Premier. EBSCO. Fort Collins Public Library, Ft. Collins, CO. 31 Mar. 2008 <http://0- search.ebscohost.com.dalva.fcgov.com:80/login.aspx?direct=true&db=aph&AN=96012645 50&site=ehost-live>. Delikoukos, Stylianos, and Fotios Mantzos.. "Thyroid Storm Induced by Blunt Thyroid Gland Trauma." American Surgeon 73.12 (Dec. 2007): 1247-1249. Academic Search Premier. EBSCO. Fort Collins Public Library, Ft. Collins, CO. 14 Apr. 2008 <http://0- search.ebscohost.com.dalva.fcgov.com:80/login.aspx?direct=true&db=aph&AN=28026242 &site=ehost-live>. "Do you have a thyroid problem?." Prevention 42.7 (July 1990): 46-53. Academic Search Premier. EBSCO. Fort Collins Public Library, Ft. Collins, CO. 31 Mar. 2008 <http://0- search.ebscohost.com.dalva.fcgov.com:80/login.aspx?direct=true&db=aph&AN=90081321 81&site=ehost-live>. Drucker, Dr. Daniel J. “Postpartum Thyroiditis.” Mythyroid.com. 31 May 2005. 14 April 2008. <http://www.mythyroid.com/postpartum.html>. Gendill 10 ---. “Hot Nodule.” Mythyroid.com. 31 May 2005. 14 April 2008. <http://www.mythyroid.com/hotnodule.html>. Johnson, John. “Goitrogens.” IThyroid. 2005. 8 April 2008. <http://www.ithyroid.com/goitrogens.htm>. Langer, Stephen E. and James F. Scheer. “Menopause or Low Thyroid function?.” Solved: The Riddle of Illness. 3rd ed. Los Angeles: Keats, 2000. 187-189. Mayo Clinic. “Hashimoto’s Disease.” MayoClinic.com. 1 February 2007. 14 April 2008. <http://www.mayoclinic.com/health/hashimotos-disease/DS00567>. ---. “Graves’ Disease.” MayoClinic.com. 6 July 2007. 14 April 2008. <http://www.mayoclinic.com/health/graves-disease/DS00181>. “Part 3: Thyroid.” Pathlights Natural Remedy Encyclopedia. 2006. 8 April 2008. <http://www.pathlights.com/nr_encyclopedia/11endo03.htm>. “Statistics About Thyroid Disorders.” CureResearch. 7 September 2007. 14 April 2008. <http://www.cureresearch.com/t/thyroid/stats.htm>. Thyroid Foundation of America. “The Overactive Thyroid: Hyperthyroidism Caused by Graves Disease.” Allthyroid.org. 2004. 14 April 2008. <http://www.allthyroid.org/disorders/hyperthyroidism/overactive.html>. ---. “Chronic Lymphocytic thyroiditis.” Allthyroid.org. 2004. 14 April 2008. <http://www.allthyroid.org/disorders/thyroiditis/chronic_lymphocytic_thyroiditis.html>. “Treating Hyperthyroidism." American Family Physician 72.4 (15 Aug. 2005): 635-636. Academic Search Premier. EBSCO. Fort Collins Public Library, Ft. Collins, CO. 31 Mar. 2008 <http://0- Gendill 11 search.ebscohost.com.dalva.fcgov.com:80/login.aspx?direct=true&db=aph&AN=18020440 &site=ehost-live>. Van Voorhees, Benjamin. “Hyperhidrosis.” Medline Plus Medical Encyclopedia. 18 May 2007. 15 April 2008. <http://www.nlm.nih.gov/medlineplus/ency/article/007259.htm>.