The Silent Disease
Tired? Bloated? Weight gain? It could be your thyroid.
A 21-year-old college student feels like she’s having a heart attack. She calls 911, is rushed to the ER and has blood work done. The doctor discovers a thyroid problem and her world changes.
Now married and a mother of two, Sara Allred, 29, has her thyroid disorder under control with daily medication. “My official diagnosis was hypothyroidism, or an underactive thyroid,” explains the special education teacher who lives in suburban Channahon. “At the time, I didn’t even know what a thyroid was or what its function was. Weird things were happening to my body…and fast! Mood swings, exhaustion, hair loss, acne and weight gain…and I hardly had an appetite.”
Jose Dutra, MD, director of the Thyroid Surgical Clinic at Northwestern Memorial Hospital, isn’t at all surprised by Ms. Allred’s story. “The problem with thyroid disease is that many other diseases produce the same symptoms, like fatigue and weight gain,” he explains. But what, exactly, does the thyroid do?
“The thyroid gland – located in the base of the neck, just above the clavicle bone and below the voice box or larynx – controls many [internal] activities concerning metabolism, such as heart rate and body temperature,” explains Dr. Dutra.
In Ms. Allred’s case, her thyroid lacks the hormone controlling her metabolism, resulting in hypothyroidism. To keep her levels in check, she takes one Synthroid pill a day. “It provides my body with the hormone it needs since the thyroid is unable to produce it on its own,” she explains. “I haven’t had any major side effects from the medication and my levels stayed normal throughout both pregnancies. I consider myself lucky.” And she is, according to Dr. Dutra. “If thyroid disease goes undiagnosed, it can cause premature birth, low weight for the fetus and many other problems,” he says. “Usually, patients with hypothyroidism need to have their medication adjusted when they become pregnant.”
Dr. Jose Dutra
And while a simple blood test can detect some thyroid diseases, there is no specific screening for thyroid cancer. “Most of the time, thyroid cancer is incidentally discovered by a CT scan or an MRI,” comments Dr. Dutra. “Say a patient was involved in a car accident and is brought into the emergency room for an MRI of the neck. Suddenly, the doctor discovers a thyroid nodule (a localized lump in the thyroid gland).”
While there may be cause for worry, most nodules turn out to be non-cancerous. “If a thyroid nodule biopsy is negative (no cancer cells found), patients are then followed clinically, usually through yearly ultrasonography,” explains Dr. Dutra. “Most patients with thyroid nodules have normal thyroid function, except for the presence of the nodule. They have no thyroid dysfunction or symptoms related to the thyroid gland itself.”
Yet, with the amount of women experiencing thyroid issues on the rise, one wonders if there’s any way to get more people talking about the silent diseases of the thyroid. Many only think about it if there’s a family history of thyroid disorders. “If there’s a history of medullary thyroid cancer, one of the more rare thyroid cancers, we start screening for tumors when a child is born,” explains Dr. Dutra. “Sometimes we remove the thyroid completely when the child may be five years old or younger, because we know, based on the screening, that he or she will eventually develop medullary thyroid cancer. Unfortunately the most common of the four main types of thyroid cancer, especially among females, is papillary thyroid cancer. And most cases are not familial.”
Dr. Dutra continues, saying that instances of thyroid cancer have tripled since 1975. “There were about 4.9 cases per 100,000 people then. Now there are about 14.3 cases per 100,000. And in most cases, the diagnosis was made based on nodules discovered incidentally. A nodule appeared on a CT or an MRI being done for another reason, and it had to be investigated.”
But Dr. Dutra points out that more and more people are talking about thyroid disorders today because of the common appearance of nodules. “Some think thyroid cancer is being over diagnosed,” admits the head/neck surgeon. “Some nodules are less than one centimeter, but the problem is that once the patient has a diagnosis of thyroid cancer, it’s very difficult in our environment to not treat it.”
Some patients take precaution to remove the thyroid completely, as removal generally ensures a 95 percent cure rate. “But a lot of doctors are discussing treatments without operations,” shares Dr. Dutra. “Some studies in Japan follow patients for many years because the cancerous nodules are less than one centimeter. Most did very well with a little progression over 10 years, but some progressed to have local metastasis [or spreading]. And you wouldn’t believe how many women I see…especially young females between 18 and 35…whose tumors tend to present in a more aggressive way. They have multiple metastases already when the tumor is diagnosed. So, at this point, we don’t have a good marker that can tell us which patients will do well without surgery. Until we have a clear-cut marker, the only treatment effective for thyroid cancer is surgery…complete, or in some cases partial, removal of the thyroid gland. Other conditions such as Hashimoto’s thyroiditis, the most common cause of hypothyroidism in the U.S., are most often permanent and require lifelong thyroid replacement therapy. If the thyroid has been surgically removed or irradiated, as in cases of Graves’ disease, lifelong thyroid hormonal replacement is also required.”
However, for those women simply suffering from diseases like post-partum thyroiditis, silent thyroiditis and sub-acute thyroiditis, there’s light at the end of the ‘treatment tunnel.’ “Some thyroid conditions or dysfunctions are temporary,” observes Dr. Dutra. “After several months, the thyroid ‘heals’ itself and its function returns to baseline.”