Tricky to diagnose, treat
Diagnosing and treating an underactive thyroid can be challenging, he says, especially when a patient's thyroid hormone levels test in the borderline-normal range. In most cases, a hormone level between 4 and 10 is the accepted range for treatment. When patients experience symptoms with a hormone level of 3, doctors are faced with the question of whether or not to treat. And it's a tricky question, because treatment is not just a matter of taking a little pill that immediately cures all your symptoms. Finding just the right amount of hormone replacement medication to keep levels stable can be a difficult balancing act.
In Kruger's case, it took her nearly 20 years to finally feel like "I got my life back." During that time, despite being on medication, her thyroid levels were still problematic. She continued to feel tired and to gain weight, her cholesterol levels shot up and she began developing heart disease, a consequence of insufficient thyroid.
Finally, about six months ago, one of her doctors heard about a new type of thyroid drug and sent Kruger to Mark Lupo, M.D., a thyroid specialist in Sarasota. He prescribed Tirosint, a liquid gel cap form of levothyroxine sodium, the thyroid hormone replacement pill commonly used to treat hypothyroidism. (Tirosint was approved for the U.S. market in 2010.)
Although drugs can work differently in each individual, Tirosint's liquid form seemed to do the trick for Kruger: She dropped 20 pounds in six months. "And when I get up in the morning, I don't feel like someone has beat me with a stick," she says. More importantly, her heart problems have improved.
Sometimes, thyroid isn't to blame
But, Lupo warns, women shouldn't be too quick to blame their weight gain on thyroid problems rather than on unhealthy eating habits or lack of physical activity.
"I see this every day, people who tell me, 'I'm overweight , I must have a thyroid problem,' " Lupo says. But people with thyroid problems may gain up to 10 to 20 pounds, he says. "Someone who comes to me weighing 300 pounds has other problems."
Lupo agrees with Kruger, however, that there does need to be more awareness of thyroid problems on the part of both patients and doctors. He's also convinced that older women particularly should be screened for thyroid function, which can be done with a simple blood test.
"I usually say that women should be screened before their first pregnancy and at age 35 and every five years after that, and every one to two years at age 50 and above," Lupo says. Because thyroid conditions are less common in men, but can develop with age, he suggests "men get screened at age 65 or if they have symptoms or risk factors."
- Do a neck check. The first sign of a problem can be a lump or enlargement of the small gland in the lower front area of your neck. The AACE's thyroidawareness.com website offers a simple way to check by watching your neck as you swallow water.
- Get your thyroid tested. If you suspect a thyroid problem, ask your doctor to do a blood test for thyroid stimulating hormone (TSH) as well as for thyroid antibodies, which can indicate Hashimoto's thyroiditis, the most common form of hypothyroidism.
- Monitor your cholesterol. High cholesterol that is unresponsive to diet, exercise or medication can be a sign of an underactive thyroid; unusually low cholesterol may be a sign of an overactive gland.
- Consider cognitive changes in older adults. The American Thyroid Association estimates that one in four nursing home residents has undiagnosed hypothyroidism that can contribute to memory loss and cognitive decline. It's important to note, though, that overtreatment with thyroid hormone can also cause mood changes.
- Remember: Same/same/same. For those diagnosed with hypothyroidism, it's critical to take the same dosage of the same medication at the same time every day. Caffeine, as well as calcium, antacids and iron supplements, can affect your body's absorption of medication. The Mayo Clinic recommends waiting four hours between taking your thyroid pill and eating anything with calcium; an Italian study published in 2008 found that coffee can reduce absorption of the drug by half.
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