Deficient thyroid function can have far-reaching health consequences-from hair
Loss to infertility.
Report
BY GUNJAN SHARMAI am gaining weight. Do I have hypothyroidism?"
This is an association urban women today are increasingly drawing between their tilting scales and that butterfly-shaped endocrine gland located around the voice box and the wind pipe iQ the neck. This association and the subsequent dash for the path lab for a self-prescribed thyroid function test could be a reflection of the growing awareness about the gland, its functions and their importance. Going by what many doctors say, it is also an indication of the high incidence of hypothyroidism
in women.
What is not clear yet, however, is the reason for this higher incidence in women and what triggers the problem. An auto-immune disorder (where the immune system turns against the body), hypothyroidism is the underproduction of the thyroid hormones-
essentially triiodothyronine (T3), thyroxine (T 4 )-by an underactive thyroid.
Many doctors say they see, on an average, five new patients with hypothyroidism every day. And
yet they believe that the condition is under-reported. If hypothyroidism is under-reported, then it is because it goes unnoticed thanks to its largely vague symptoms-tiredness, hair loss, hoarse voice, forgetfulness and puffy face and eyes-that are easily mistaken for stress and weakness. If left untreated, failure of the thyroid gland can lead to serious complications: from reproductive problems to cardiovascular conditions.
Her unnoticed and therefore untreated hypothyroidism made Delhi-based Shweta Singh, 35, go through two painful miscarriages. A subsequent detailed examination ascertained the underlying
cause to be hypothyroidism. Thyroid failure can also cause depression. Doctors say that about
14 per cent of all cases of depression are because of hypothyroidism.
Psychiatrists refer many cases to endocrinologists when patients don't respond to standard psychiatric
treatment for depression. Shiv Prakash ]ha, 54, consulted a psychiatrist as his persistent insomnia
and depression were getting on his nerves. When psychotherapy failed to improve his condition,
he underwent a detailed hormone profile, which showed that the levels of thyroid stimulating hormone (TSH) was above 100. Incidentally, the production of T3 and T4 is regulated by TSH, which is produced by the pituitary gland.
IN CONTROL: Shruti (centrel with her children. Her hypothyroidism was diagnosed when she became pregnant 23 years ago TSH levels are in the normal range (0.5-5) when thyroid is producing
adequate T4. Inadequate levels of thyroid hormones prompt the system to stimulate the thyroid, raising TSH levels in the blood. Less common causes of hypothyroidism are the failure of the pituitary to secrete TSH and the failure of the hypothalamus to secrete the thyrotropin regulating hormone that regulates pituitary's TSH production.
Drug induced cases are also there.
"People with hypothyroidism can show severe depression, detachment feeling of worthlessness,
mood swings and may even develop suicidal thoughts,"
says DrAmbrish Mithal, senior consultant
endocrinologist at Medanta Medicity, Gurgaon. In women, hypothyroidism can also cause infertility. The upside is that once diagnosed, thyroid failure can be corrected with medicines. Hence, infertility as a result of thyroid failure is often reversible. Low thyroid hormone levels can impair ovulation either directly or by causing prolactin levels to go up. Prolactin is high during pregnancy and breastfeeding. High levels of this hormone stops ovulation and thus disrupts the menstrual cycle.
Manmeet Kaur, 31, had planned to have a baby a year after marriage in 2006. But when she
couldn't conceive for four years, she consulted a gynaecologist. She was referred to an endocrinologist after her TSH levels were found to be high. As soon as her thyroid function was restored, she conceived and gave birth to a healthy male baby.
Hypothyroidism can also manifest in women as irregular menstrual cycle, Polycystic Ovarian
Syndrome and obesity. While those affected generally gain up to a couple of kilos extra with hypothyroidism, in some women the weight gain can be as high as 15- 20 kilos.' In such cases, medicine might have to be supplemented with exercise and diet. Weight gain was the symptom
that sent Vani Khurana of Chennai rushing for the doctor's clinic. Khurana's work schedule as an
executive didn't leave her much time to exercise or eat at home. A gradual weight gain-which could
easily be linked to her lifestyle-of about 13 kilos over a year forced her to go on a diet which helped
lose only a few kilos.
The diagnosis of hypothyroidism, in a way, changed everything for the better.
"Medication helped lose weight faster. And, eating healthy has become a way of ·life for me," says
Khurana.
As women with severe hypothyroidism rarely conceive, the manifestation of this condition during pregnancy is not very common. But if it does occur, insufficient thyroid hormone production
in the mother can cause serious defects in the baby and can even prove fatal. The thyroid hormone
thyroxine plays an important role in the cognitive development of the foetus, and in turn, the intelligence quotient of the child. Women with hypothyroidism who are planning to start a family are therefore advised to watch their thyroid function.
"During the first trimester, the foetus is totally dependent on the mother's hormone. Thyroid
helps the normal development of brain, and deficiency of it, especially during first trimester, can
lead to mental retardation of the child," says Dr Hrishikesh Pai, senior consultant gynaecologist and
obstetrician at Lilavati Hospital, Mumbai, and Fortis La Femme Hospital, Delhi. According to a US study, womenwith thyroid dysfunction are at a higher risk of having infants with defects in their heart, kidney or brain. Birth defects like cleft lip and cleft palate may also have an association with the mother's hypothyroidism, says the study.
"Though there is no concrete study to prove this association, there is none to refute their claim, too,".
says Dr Anoop Misra, head of the department of metabolic disorders at Fortis Hospital, Delhi.Hypothyroidism is also associated with high cholesterol and lipid
levels. In fact, there are instances of people visiting cardiologists with suspected heart problems
ending up with a diagnosis of hypothyroidism. Shalini Devi's hypothyroidism was diagnosed
15 years ago by Dr H.S. Rissam, interventional cardiologist at Max Hospital in Delhi. Shalini
had been referred to Rissam for an intervention. On seeing Shalini, Rissam observed that her skin was thick and dry and she was plump, symptoms usually associated with high TSH level. Before proceeding for the intervention, Rissam got her thyroid profile test, which confirmed Rissam's suspicion. Shalini's TSH level was 100, very high compared with the normal range of 0.5-5. Rissam cancelled the intervention and put her on thyroid medication. Shalini is now hale and hearty at 65, her cholesterol and lipid levels absolutely unper control. "She is still not a heart patient," says Rissam. But severe hypothyroidism, if left untreated, can lyad to many cardiovascular problems, says Rissam. "These patients can be easily identified by a doctor as they look unnaturally plump with thick facial skin," he says. "In fact, every patient should be tested for his thyroid profile before any surgiis cal treatment. General anaesthesia can cause extreme hypo-tension in tht:;se patients and the patient in some cases can slip into coma." Some symptoms such as fluid collection around the heart and lungs can be misleading. "This generally happens in tuberculosis. I get patients who were previously treated for tuberculosis. They visit us only when the TB medication doesn't work," says Dr Sujeet ]ha, consultant endocrinologist and director of Institute of Endocrinology,
Diabetes and Obesity at Max Healthcare, Delhi. Doctors have found a link between metabolic disorders and hypothyroidism. As in the case of Gauri Gupta, 23, a bank employee in Delhi. The homeopath she consulted for hair loss prescribed a TSH test, which showed high levels of the hormone. When the levels did not come down even with medication-thyroxine hormone-further probe detected celiac disease, where the body fails to absorb gluten protein and becomes
allergic to wheat and related substances. "Gauri was asked to make changes in her eating habits
to manage celiac disease and given medication for her hypothyroidism. Both the problems were controlled in a month," says Jha. Though doctors have discerned links between hypothyroidism and
many conditions such as celiac dis-ease and diabetes, what triggers hypothyroidism is still not very clear. Some studies point to the impact of lifestyle changes, stress and environmental pollutants. "Though women are more prone to hypothyroidism than men, what triggers it still is a mystery," says Jha. Though hypothyroidism can ruin one's life, the consolation is that it is easily controllable by administering thyroxine hormone, and the medication doesn't have any sideeffects. "It is still not considered a 'disease', unlike its hyper counterpart, which may pose much more severe health risks," says Dr S.K. Wangnoo, senior consultant at the Apollo Centre for Obesity, Diabetes and Endocrinology at Indraprastha Apollo Hospitals, Delhi. To avoid the complications, screening of thyroid function is important. Those with a fam-ily history or persistent symptoms (see box) should get a thyroid pro@e done. Indian studies show that 68.2 per cent women with thyroid failure show menstrual irregularities. And hypothyroidism affects 1 in every 2,500 newborns. Says Wangnoo, "More awareness can help people report their hypothyroidism on time." An informed step in time can save a life from going haywire .
What is thyroid:
An endocrine gland, fairly large and ductless
Location:
On the front part of the neck below the thyroid cartilage (Adam's apple)
Function:
Secretes hormones that influence growth and development by regulating the rate of
metabolism.
Hormone pathway:
Thyroid hormone synthesis starts from a part of the brain called the hypothalamus that releases thyrotropinreleasing hormone (TRH), which travels from the pituitary stalk to the pituitary gland. The pituitary gland then releases thyroid-stimulating hormone (TSH) into the blood. The TSH stimulates the thyroid to produce the two thyroid hormones, L-thyroxine (T4) and triiodothyronine (T3). Another hormone Calcitonin involved in the regulation of
calcium is produced by specific cells in the gland.
Regulation:
The pituitary gland senses how much hormone is in the blood and adjusts its production accordingly. If there is too much thyroid hormone in the blood, TRH and TSH production are both reduced.
Diseases of this gland can also alter the levels of the hormones.
Disorders
HYPERTHYROIDISM
(overactive thyroid activity)
Causes:
Toxic nodule, excessive intake of iodine, ingesting thyroid hormone, Graves'disease
Symptoms:
Insomnia, nervousness, hand tremors, excessive sweating, feeling excessively hot in normal or cold
temperatures, frequent bowel movements, losing weight despite normal or increased appetite, scanty or nil menstruation, joint pains, difficulty concentrating
HYPOTHYROIDISM
(underactive thyroid activity)
Causes:
Postpartum thyroiditis (inflammation), acute thyroiditis, silent thyroiditis, thyroid hormone resistance, medications that affect thyroid function
Symptoms:
Early symptoms include easy fatigue, exhaustion, inability to sustain cold temperatures. Later symptoms are poor appetite, weight gain, dry skin, hoarse voice, puffiness around eyes
THYROID NODULES
Are generally benign thyroid neoplasms (new abnormal tissue growth), but may be malignant, too
GOITRE: The enlargement of the
thyroid gland that can occur with
hyperthyroidism or hypothyroidism
and also with benign and malignant
cancerous nodules
Causes: Mostly iodine deficiency
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