Thyroid Problems, Misdiagnosis and Medication: A Guide for Women
A look at the symptoms, causes, diagnosis and treatment of thyroid disorders in women
Many women suffer from thyroid problems. This is a well known fact, but did you know that many, many women suffer from thyroid problems which go undiagnosed and untreated or, even worse, mistreated with inappropriate medication?
According to the Thyroid Foundation of America over half of thyroid disorders are misdiagnosed or missed completely.
What Is Your Thyroid?
Your thyroid sits at the bottom of your neck and is the shape of butterfly wings. Feel right at the bottom of your neck at each side of your windpipe.... there you go; that is your thyroid.
Your thyroid may be small but it has many functions including manufacturing and storing Thyroid Hormone.
Thyroid Hormone:
- Stimulates enzymes that combine oxygen and glucose. This increases your basal metabolic rate (BMR) and regulates your body heat.
- Helps maintain blood pressure.
- Regulates tissue growth and development.
- Is essential for healthy skeletal and nervous system development.
- Plays an important role in the development of the reproductive system.
What is Most Likely to go Wrong With My Thyroid?
With Thyroid Hormone impacting so many body systems and functions, it is no surprise that many things can go wrong if your thyroid stops working properly. As you may be able to guess from the fact that the main function of the thyroid is to produce Thyroid Hormone-- the most common problems relate to too much or too little hormone being produced.
The release of too little of the hormone is called hypothyroidism or under-active thyroid and the release of too much is called hyperthyroidism or over-active thyroid.
The third common problem is a thyroid nodule i.e. a small lump of tissue on your thyroid gland. The American Thyroid Association estimates that 10% of these growths are cancerous but 90% are harmless.
Could I Have A Thyroid Problem?
It can be quite difficult to diagnose a thyroid problem due to the range of symptoms but look for the most common symptoms. Do you have several or all of the below?
Do you have several or all of the below?
Outward signs:
- Weight gain
- Dry or itchy skin
- Thin, dry hair or hair loss
- Puffy face, hands and feet
- Enlarged thyroid gland (goiter)
- Husky voice
Inward signs:
- Fatigue
- Depression
- Low body temperature
- Decreased taste and smell
- Slow heart rate
- Constipation
- Poor memory or concentration problems
- Irregular or heavy menstruation
- Muscle aches
- Infertility
- High cholesterol
If so then you may have hypothyroidism also known as an under-active thyroid.
Do you have several or all of these symptoms?
Outward signs:
- Bulging eyes
- Enlarged thyroid gland
Inward signs:
- Nervousness
- Irritability
- A faster heartbeat than usual or irregular heartbeat
- Sleep problems
- Lack of appetite
- Muscle weakness
- Trembling hands
- Increased bowel movements
- Shorter or lighter menstrual periods
If so then you may have hyperthyroidism also known as an over-active thyroid.
Thyroid nodules can grow up to a few inches. Unless cancerous they rarely cause problems but they can sometimes grow large enough to press on the windpipe and affect your ability to swallow. This can sometimes trigger hyperthyroidism.
Diagnosis of Thyroid Disorders
The first stage of diagnosis is the questions of your medical practitioner about your medical history and any symptoms you are experiencing. He or she will also feel your thyroid gland to see if it is enlarged and look for physical signs such as a puffy face, nail and hair condition and bulging eyes.
Further tests will include:
- Blood tests
- Checking your weight
- Checking your blood pressure and heart rate
- Measuring your body temperature
- A fine needle biopsy if a nodule is found
Treatment of Thyroid Disorders
The treatment of both an ove-ractive and an under-active thyroid is based on the same aim-- to get your thyroid functioning at a normally again.
Treatment can take the form of medication or surgery, but if you have no nodules or goiter, then the most common approach will be medication only.
Misdiagnosis of Thyroid Disorders: What Is the Controversy?
There are several reasons why thyroid problems go undiagnosed. The main problem is that the cluster of symptoms can point to a number of potential problems and, unless you ask about possible thyroid problems, a doctor may jump to a different diagnosis based more on your gender and age than on your cluster of symptoms.
So what do I mean by that? Well, in men these symptoms may seem more unusual, but in women many of these symptoms are often part and parcel of being a woman. Let’s look at two examples.
Example 1
A 50-year-old woman goes to her medical practitioner and complains of irregular periods, problems sleeping and problems concentrating. What would you diagnose? Well the automatic assumption would be that she is starting menopause. With a male patient (without the menstruation problems!) the automatic assumption will likely be different and lead to testing which later reveals hyperthyroidism.
Example 2
A 30-year-old woman with a 6-month-old baby visits her medical practitioner and complains of fatigue, constipation, thinning hair, irritability and weight gain. What springs to your mind? Well to mine the thought comes, “Yes, you have a baby who doesn’t sleep much which leaves you tired and irritable. Also thinning hair, constipation and weight gain are common in the first few post partum months”. Even if the woman added in the symptom of depression, the automatic assumption would be that she had post natal depression.
A man with the same symptoms? No assumptions but testing and possible diagnosis with hyperthyroidism.
So let’s be clear. This isn’t a case of sexism or men receiving better treatment. This is a case of jumping to conclusions based on the symptoms that we expect to see in women at certain stages of their lives.
Thyroid Medication Controversy: T3 and T4
The thyroid gland takes iodine from the foods you eat and converts it into thyroid hormones: thyroxine (T4) and triiodothyronine (T3). The thyroid gland produces around 80% T4 and 20% T3. Most medication to treat thyroid problems is based on these two hormones.
Most medical practitioners prescribe T4-only thyroxine-based medication but there is a growing school of thought that believes that this just masks the problems and does not help the thyroid gland to begin functioning properly again. These advocates feel that there needs to be some T3 presence in the medication to make it truly effective and many medical studies seem to support this theory.
T4 medication is meant to convert and produce some T3 once it is inside the body-- but some think that in the vast majority of cases not enough T3 is produced, if any. This results in treatment of only part of the symptoms.
Many patients report that their symptoms are only mildly improved by a T4 medication and some symptoms are not improved at all. It is thought by groups who do not believe in T4-only medication, that medical practitioners often add medication to deal with each additional separate symptom. So, instead of taking one cure all drug, a patient may end up taking a medley of drugs and so treat the symptoms but not the cause.
Thyroid Misdiagnosis or Mistreatment: How Can I Avoid It?
There are two main ways to avoid becoming a casualty of the thyroid debates and they are both easy to do.
- Be conscious of your symptoms and of the symptoms of hypothyroidism and hyperthyroidism. Don’t allow yourself to be brushed off if you think that you have a thyroid problem. Ask to be tested.
- If diagnosed with a thyroid problem, research all your surgical and medication options. Research the arguments on either side of the T4 fence and come to your own conclusions. Then, visit your medical practitioner with your decision. Most studies come to the conclusion that the best medications have an element of T3 added. You should feel empowered to read all of the research with an open mind and decide on the way you want to proceed with no pressure from anyone else.
Thyroid Problems and Issues: Credible Sources of Information
1. A WebMD video describing thyroid tests.
2. A WebMD guide to understanding thyroid problems, symptoms and treatments
Feeling all revved up, even at bedtime? Or maybe your throttle's on idle with symptoms of depression, fatigue, and weight gain. In both cases, the root cause may be your thyroid.
3. A WebMD primer on understanding the basics of thyroid probems.
4. The website of The American Thyroid Association.
5. Take a Personal Hormone Evaluation at Platt Medical Center.
6. The Miracle of Bio-Identical Hormones, a book by Michael E. Platt, M.D.
7. Stop the Thyroid Madness -- a patient-to-patient informational and advocacy web site