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Thyroid disease may create a life of ups and downs

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National Academy of Hypothyroidism: Headed by thyroid expert Dr. Kent Holtorf, this nonprofit group of thyroidologists promotes the latest scientifically sound and medically proven concepts and information about the diagnosis and treatment of hypothyroidism. Go to http://nahypothyroidism.org .

Holtorf Medical Group: Dr. Kent Holtorf and his group of doctors specialize in the treatment of thyroid disorders, as well as chronic fatigue syndrome, infectious diseases, neurological Illnesses, age management medicine and a host of other conditions in offices in Torrance and Foster City. For information, call 310-375-2705 or go to www.holtorfmed.com .

American Thyroid Association: Made up of physicians and scientists who specialize in thyroid diseases, the group guides public policy on the prevention and management of the diseases. Go to www.thyroid.org .

Author Mary Shomon: A patient advocate and thyroid disease sufferer, Shomon has written books and educational materials about thyroid health, including "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss" (Harper, 2004). Read her blog at http://thyroid.about.com or follow her on Twitter @ThyroidMary.

Light of Life Foundation: This Web site is dedicated to the early detection, diagnosis and treatment of thyroid cancer. Go to www.checkyourneck.com .

Danielle Gayden of Oakland had to stick her face in front of a fan for almost an hour to cool down.

Second to her intolerance for heat was the anxiety, which caused her heart to beat 200 times a minute and sent her to the emergency room a dozen times in six months.

Gayden, then 28 and newly married, had little to feel anxious about. Still, doctors prescribed anxiety medication for what she described as an overwhelming sense of terror.

Had they noted her family history of thyroid disease, ER staffers may have called an endocrinologist to check Gayden's TSH, or thyroid stimulating hormone, to see if it was too high.

The thyroid gland, located in the neck just below the larynx, is the body's metabolism master. It converts iodine into hormones that influence every cell and organ in the body, affecting weight, mood, energy level and body temperature, says Rick Dlott, a Martinez-based endocrinologist with Kaiser Permanente.

If hormones are too low, one is considered hypothyroid and may suffer from fatigue, high cholesterol, weight gain, dry skin and depression. Too high, or hyperthyroid, as in Gayden's case, and one may experience anxiety, insomnia and weight loss.

It seems we only hear about the butterfly-shaped thyroid gland in conjunction with a celebrity's fluctuating weight. But the most common thyroid diseases are autoimmune, and include Hashimoto's (hypothyroid) and Graves' (hyperthyroid) .

An estimated 20 million Americans have some form of thyroid disease, and up to 60 percent don't know it, according to the American Thyroid Association. The reason so many are unaware is because of the complexity of thyroid disease.

For starters, thyroid disease is hard to diagnose, because most standard blood tests don't pick up on the small but vital gland, according to world-renowned endocrinologist Kent Holtorf of the Torrance-based Holtorf Medical Group. Also, symptoms are so common they are often attributed to other health problems.

In addition, even though hypothyroidism is easy to catch, as it is more common in women over 60, dozens of women interviewed for this article were given cholesterol-reducing medications and antidepressants long before they or their doctors realized the thyroid was to blame.

Even after treatment with natural or synthetic hormones, many women still suffer with symptoms because of a lack of standard testing. There is debate among health care providers as to what is normal TSH and if it is even the most accurate marker for hypothyroidism.

For instance, Kaiser Permanente considers a healthy TSH range to be 0.1 to 5.5, while the labs at Stanford University's School of Medicine use 0.4 to 4.0. The American Association of Clinical Endocrinologists recommends treatment for patients who test outside a TSH level of 0.3 to 3.0.

Also, more and more research is proving that levels of other thyroid hormones such as T4 (thyroxine hormone) and especially T3 (triiodothyronine hormone) provide a better picture of hypothyroidism. That's especially true in patients who suffer from obesity, diabetes, depression, inflammation or chronic fatigue syndrome, says Holtorf, an expert in hypothyroidism.

"The problem is that most doctors learn thyroid is very easy to diagnosis - if TSH is high, you know the thyroid is low," Holtorf says. "But a high TSH is missing in up to 80 percent of people with low thyroid."

Standard thyroid tests, Holtorf says, don't account for situations when TSH is in a normal range, but thyroid is still low, or underactive.

"Doctors are missing too many people with low thyroid if they're just doing the simple test," he says.

Holtorf and other experts, including Stanford's Haruko Akatsu, say it is imperative to treat the patient and symptoms rather than a number. After all, one person's comfortable 0.2 is another's hypothyroid zone.

"Let's say I had a patient with a TSH of 0.4 and either their T4 or T3 is low. That's abnormal to me," says Akatsu, an endocrinologist and medical director of Stanford's Thyroid Cancer Program. "No matter what is printing on the lab paper, we need to assess the patient. I hardly ever use TSH alone, but I guess it's a good place to start."

Last summer, B.J. Thorsnes became a victim of the thyroid numbers game when she was hit with unexplained exhaustion, severe dry skin, joint pain, swelling in her feet and a "muddled brain."

"At 66, you don't know what's happening with your body," Thorsnes says. "But I knew it wasn't just that I was getting older."

The first doctor she saw did blame her age. The second prescribed Prozac and told Thorsnes to see a psychologist. But after reading about hypothyroidism and talking with friends, many of whom were dealing with the same symptoms, Thorsnes asked for a thyroid test.

It turns out her TSH was on the low end of her provider's range, but because they considered her normal and would not treat her, Thorsnes switched to an out-of-network physician. That doctor tested and confirmed that Thorsnes' low T3 and T4 levels made her hypothyroid.

"I felt like a new person within days of receiving a slight amount of thyroid hormone," says Thorsnes, who has three sisters and two aunts, all with some form of thyroid disease. "I can't tell you how excited I am to no longer be dismissed as one of those `older ladies' who doesn't know her own mind or body and needs a shrink to navigate life's changes."

"Old ladies" are hardly the only ones suffering from low-thyroid problems. Andy Bryant was diagnosed with an underactive thyroid six years ago when a doctor was suspicious of Bryant's symptoms - fatigue and weight gain despite an active lifestyle, elevated cholesterol, coldness, dry skin and thin, brittle hair   Read Full Article...