Inside the Beltway, Under the Radar is a doorway into D.C.'s best kept secret, the Wednesday Morning Group, a speaker series that has stimulated and educated Washingtonians for over four decades. The speakers are an endless stream of the known and unknown telling their tales and capturing our imaginations. In this blog I bring you the speakers and make their presentations endless.

The Taming of the Thyroid

March 20, 2011

My first order of business after hearing Thyroid-patient advocate, Mary Shomon, speak was to call my general physician so I could find out the specific results of my THS test, the most general test used to test for Thyroid Disease. I had asked my doctor to run the test just about a year ago at the age of 44 because I had suddenly gained weight despite an unchanged diet and six-day a week exercise routine, I was fatigued, not sleeping, depressed, constipated and walking around in a bit of a fog.

My doctor’s office was happy to offer up the test results on the telephone and I found out that I fell well within the “normal” number range (1 to 2) that leads doctors to tell countless millions of women, “you’re fine, consider Prozac for your depression, diet harder for the weight gain and take a sleeping pill for the insomnia,” or the classic, “you just need a vacation.”
According to Shomon, though, I should not cross “Thryroid Problems” off my list. Shomon says results from the THS should never be considered the final answer in the mystery so many women find themselves trying to solve, namely, “what’s wrong with me?”

While Thyroid Disease is known to afflict 25-million Americans, Shomon, who has written nearly 10-books on the tiny, butterfly-shaped gland, says nearly 60-million people, mostly women, suffer from Thyroid problems, most of them without even realizing it. That’s one-in-five women.

September is Thyroid Awareness month -- a pretty big deal for a little gland that used to be called the least important gland in the body. Biologically speaking, a person cannot live without their Thyroid.

As part of her outreach, Shomon, who writes a newsletter called Sticking Out Our Necks has created a list of counter-points to three typical reasons people check “A Thyroid Problem” off their list when trying to sleuth out their medical mystery.

I’m not symptomatic: In other words, I do not have a goiter and I am not overweight therefore I must not have a Thyroid problem. According to Shomon, the overweight woman with bulging eyes no longer represents the Thyroid patient. In fact, underweight women who exercise too much can put themselves at risk for Thyroid issues.

As women try to solve the mystery (statistically speaking women are 10 times more likely to suffer from Thryoid problems than men), Shomon suggests they ask themselves the following questions:
1) Are you losing more hair than seems normal for you at your age? And further, are you losing hair from the outer edge of your eyebrows?
2) Do you ever feel like you are really suffering from brain fog?
3) Do you suffer from low sex drive?
4) Are you experiencing sleep disruptions, i.e. waking up in the middle of the night and having trouble falling back to sleep?
5) Are you gaining weight without any change in diet or exercise? Or, despite a new, stricter diet and exercise regime are you not losing weight?
6) Are you suffering any depression or anxiety?
7) Do you have high cholesterol?
8) Are you fatigued even though you sleep eight or more hours a night?
9) Do you have erratic periods? Heavy periods?
10) Do you have a history of fertility problems (including miscarriage) and/or are you being told you’re you have peri-menopausal or menopausal symptoms?
12) Are you constipated?

Genetics plays a role here too. If Aunt Matilda had a “goiter” or “a glandular problem,” the reality is she had Thyroid issues. If there’s a history of auto-immune disease in the family, that can be a red flag as well. Smoking, too, increases the risk of developing Thryoid problems as do estrogenic substances, pesticides used to kill West Niles Virus, Floride in our water and toothpaste, chemicals used in plastics, and radiation – when getting x-rays, always ask for a lead collar to cover your neck.
According to Shomon, too many raw foods and too much soy, chronic physical and mental stress and not knowing how to de-stress as well as too little sleep can put us at risk for Thyroid problems.

I’ve had a physical the doctor didn’t tell me I have a Thyroid problem. In the typical, general physical, a check of the Thyroid is not mandated. So, says Shomon. Unless your doctor stood behind you and felt your neck for an enlargement of the gland, you have not been checked for a Thyroid problem. In addition, when looking for a clinical signs of Thyroid issues, doctors will test a patient’s reflexes. Finally, general blood tests run as part of a physical do not test the Thyroid. “Unless you ask, the Thyroid is not being tested,” says Shomon.

I had the Thyroid test and the doctor said I was normal: Have you personally seen the results of the test? Shomon says that every patient who ever gets any kind of test done should always ask for a copy of the written report. “There is a 25-percent rate of error in transmission of information from a doctor to a patient,” says Shomon. “If they won’t fax it or scan it, leave them a stack of self addressed stamp envelopes and have them use the envelopes to send you your test results every time a test is run. When you receive them put them in a file. You don’t even need to be organized.”

So the doctor said you were in the “normal range,” and you actually saw the results of the test with your own eyes, it’s still not enough to cross “A Thyroid problem” off your list. “While the THS is the gold standard for Thyroid testing, the normal range is controversial.” The old school of thought suggested that results above “5” suggested a Thyroid problem. The new school of thought suggests that the bar should be lowered to “3”. “There are millions of Americans in the 3 to 5 range and they are stuck in limbo, stuck in a range where if their doctor uses the old scale they may not be treated. They may end up being put on Prozac for depression instead of being put on a Thyroid medicine. The depression medicine could actually complicate the Thyroid problem,” says Shomon.

Another problem with the THS test is that some doctors will only use the test to determine a diagnosis. “They will, in fact, ignore other telling signs such as genetics, a visible goiter, or history of a Thyroid problem,” says Shomon.

And finally, as with any test, the THS test is not immune to error. “The THS can be affected by environmental factors. Perhaps the blood sits for too long in 100-degree weather waiting to be picked up by a lab. Then it sits in the back of a hot truck for another few hours before it arrives at a lab to be tested. By then, a THS of “8” could have fallen to a “2” and a patient will appear in the normal range,” warns Shomon. 
So, if the THS is not enough, what should you -- as a patient – demand? Shomon says that “besides making sure that your doctor considers your symptoms as well as your genetic and personal history, you must request a complete thyroid panel which includes: Thyroid/TSH, Free T4, Free T3, Thyroid Peroxidase Antibody/TPO, Thyroid Antibody/Anti-thyroid AB.”
The most common forms of Thyroid Disease are Graves Disease and Hashimoto Disease. In Graves, a person’s Thyroid is working over-time and therefore the person is hyper-thyroid. In Hashimoto, the most common form of Thyroid problem, a person’s Thyroid is “underworking,” or hypo-thyroid. While there are a number of other different Thyroid afflictions, hyper- or hypo-, the road will always lead to hypo-Thyroidism because they way hyper-Thyroidism is treated is to get the Thyroid to stop working too hard and make it under-work, which leads to hypo-Thyroidism.

As for medicines and treatments, Shomon doesn’t advocate for one particular medicine. “The most important message is there are many treatments and there is not only one medicine despite what your doctor might say. What is the best medicine? The one that is the best specifically can help you get rid of your symptoms.”