By Megan Williams, The Free Lance-Star, Fredericksburg, Va.
Jul. 27–When Anita Kaissi found herself feeling constantly sluggish, she thought it was because she had just had a baby.
It took doctors three months to determine that her fatigue, hair loss and dry skin weren’t postpartum depression, but postpartum thyroiditis, an inflammation of the thyroid that makes it overactive.
“They told me it was all in my head,” Kaissi said.
As it turns out, it was all in her neck. The thyroid, located in the neck, is one of the largest endocrine glands in the body. It controls hormones that determine how quickly the body burns energy.
Kaissi is one of an estimated 27 million Americans who suffer from a thyroid disorder. Half of those people remain undiagnosed, according to the American Association of Endocrinologists.
Dr. Neil Green, the physician director of Nuclear Medicine at Mary Washington Hospital, is often called in to differentiate between the different types of thyroid disorders and to suggest treatment.
Though thyroid disorders don’t find the spotlight as often as other conditions do, Green sees people with thyroid problems everyday.
“People don’t talk about it because it’s manageable,” Green said. “It’s the diseases that people die from, or become very sick from, that you hear about.”
With the exception of thyroid cancer, the different types of thyroid disorders are rarely life-threatening and are effectively managed when diagnosed and treated.
But the road to recovery, beginning with the first symptoms, can be a long one.
WHAT THE SYMPTOMS SAY
Hair loss, fatigue, body temperature changes, brittle nails and dry skin. These are “checklist” symptoms of a thyroid disorder. However, they are not always all present in patients. Other less-common symptoms might also exist, making a thyroid disorder difficult to diagnose.
“I didn’t have any symptoms at first,” said Fredericksburg resident, Monica McFadden, 37. “I always struggled with my weight as a teen, but they don’t check for thyroid problems in regular checkups.”
McFadden discovered she had hypothyroidism — underactive thyroid activity– when she went for a physical for a job she applied for.
“My hair had been falling out before I went, but I didn’t recognize it for what it was,” she said.
For Kaissi, of Spotsylvania County, her fatigue, hair loss and depression were written off as postpartum problems by her doctors.
Another diagnostic challenge, Green said, is that some symptoms — such as loss of bone mass and heart arrhythmias — are silent, affecting a patient internally.
PINPOINTING THE PROBLEM
If a doctor examining Sharon Sampsell, of Colonial Beach, hadn’t noticed the nodules — tissue growths on her thyroid — she may never have realized she had a thyroid condition. She had experienced some weight gain, but she didn’t know it was related to her thyroid.
Patients usually realize something is wrong, but pinpointing the problem is harder.
Blood work can reveal abnormal hormone levels, suggesting a thyroid problem. The next step is determining what kind of problem it is. There are many types of thyroid disorders.
Many people are diagnosed with hypothyroidism, the underactive kind. However, hyperthyroidism — an overactive thyroid — is also common, and its cause must be narrowed down further.
An overactive thyroid is usually the result of one of two things: a type of thyroiditis or Graves Disease.
Enter Dr. Green. To determine which it is, he will give the patient a small dose of radiation to determine how “hungry” the thyroid is.
“If the thyroid is not that hungry it’s a marker of thyroiditis. If it has a whopping appetite, it is a sign of Graves,” Green said.
The “hunger” is due to the thyroid getting what it wants. (The radioactive iodine shrinks the gland and lessens symptoms).
That test, along with blood tests, thyroid function tests and scans, helps Green diagnose a condition so treatment can begin.
TREATING THE PROBLEM
Despite the many varied types of thyroid disorders, treatment is generally standard for all: medicine.
An overactive thyroid is treated with a radiation pill, with a dosage 10 times that of the diagnostic pill.
“It’s very safe. People are familiar with X-rays and that is beaming radiation throughout the body,” Green said. “There is no increased risk of cancer, or genetic defects in offspring.”
People with an underactive thyroid are usually prescribed Synthroid, a brand name of the drug Levothyroxine, the fifth most frequently prescribed drug in the U.S. in 2007.
The tricky part is getting the dosage correct.
“They changed my dosage from 25 micrograms to 125 micrograms over a few years,” McFadden said. “Until they get the right dosage, symptoms can get worse.”
LIVING WITH IT
The symptoms that accompany hypothyroidism may never completely go away, even if the right dosage of Synthroid is administered.
“After a while, you get used to it,” Kaissi said. “It becomes a part of your life.”
She still has dry skin and is tired a lot of the time. She has growths on the sides of her thyroid that have to be monitored closely to make sure they don’t get bigger.
McFadden has struggled with depression since being diagnosed and is living with her weight gain because she can’t seem to work it off.
“There are still days when I don’t want to go to work because I’m so tired,” she said.
Sampsell’s thyroid levels are within normal limits these days. However, she still has similar problems to Kaissi and McFadden.
Thyroid disorders are manageable though, and rarely life-threatening.
“Of all the things I could have had, there are many that are a lot worse,” Kaissi said.
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