When Renuka, a fitness instructor in her 40s, found her energy levels dipping, she attributed it to the inevitable signs of ageing. But when she developed intense muscle pain and cramps in her legs she decided to see her doctor, who diagnosed it to be the result of a thyroid dysfunction.
The thyroid, a small butterfly-shaped gland, produces two hormones - thyroxineT4 and triiodothyronineT3. These hormones control the amount of energy used by the body to maintain vital processes such as breathing, circulation and digestion. In a study conducted in early 2006 by the Department of Endocrinology, Amrita Institute, Kochi, women were found to be nine times more prone to suffer from thyroid dysfunction.
Thyroid dysfunction occurs when the gland either fails to produce enough hormones or produces them in excess. Too little production denotes hypothyroidism, due to which activities of the body slow down. Under-activity of the thyroid gland can be caused by an auto-immune reaction called Hashimoto's disease, overdosing of medications for hyperthyroidism, iodine deficiency, certain drugs used in the treatment of depression, heart problems, radiation therapy for tumors of neck, head etc.
Over-activity of the gland causes hyperthyroidism, which makes body processes gallop at a faster pace than is necessary. Hyperthyroidism is commonly triggered by autoimmune disorders though it can also result from overdosing for a hypothyroid problem. If untreated, it may result in heart failure.
Dr Hiramalini Seshadri, Senior Consultant, Holistic Internal Medicine & Rheumatology, Apollo Hospitals, Chennai, lists the common symptoms of hypothyroidism: weight gain, swelling of feet, puffy face, sluggishness, constipation, excessive menstrual bleeding, dry skin, hair loss, depression, poor memory and intolerance to cold.
Hyperthyroidism, on the other hand, can cause weight loss, palpitations, diarrhea, anxiety, scanty periods and hot flushes. Patients with hyperthyroidism may also develop eye problems in the form of itching, redness and swelling.
Treatment involves taking some tablets but it is crucial to ensure the right dosage, says Dr. T.K Sabeer, Endocrinologist, Diacare Centre for Diabetes and Endocrinology, Kannur, Kerala. "Too much may cause bone loss, osteoporosis, cardiac arrhythmias, while too little can lead to higher cholesterol levels and increase in blood pressure."
According to Dr. Kamala Selvaraj, Obstetrician and Gynecologist, G.G Hospital, Chennai, patients may be asymptomatic till a close examination reveals mental sluggishness, slow speech, a low pitched voice, delayed reflexes, low body temperature and decreased heart rate.
A simple blood test can determine malfunctions of the thyroid gland. The most sensitive test involves checking the value of Thyroid Stimulating Hormone (TSH) secreted by the pituitary gland. Screening for autoimmune causes of thyroid dysfunction involves checking for the presence of specific antibodies. Cancerous conditions may cause a distinct nodule or lump on the gland. As far as cancer of the thyroid is concerned, Dr. Arpandev Bhattacharyya, Consultant Endocrinologist at Manipal Hospital in Bangalore, is confident that a diagnosis at the correct time has a high rate of success.
After diabetes, thyroid problems are the most common glandular disorder the world over. In fact, it has been found that diabetics have higher prevalence of thyroid problems and this is also one of the causative factors for difficult diabetes, informs Dr. Sabeer.
"Hypothyroidism is more common in women and is accompanied by menstrual irregularities and bleeding problems. This can lead to an ovulation and cause infertility," says Dr. Selvaraj. Of the 2,882 patients treated for infertility in 2004-05 at G G Hospital, 153 were thyroid patients. Out of these, hypothyroidism accounted for 110 infertile cases. "But adequate clinical or surgical therapy can help control the disease and also aid fertility," she says.
Untreated thyroid problems can push up the rate of miscarriages and premature deliveries, says Dr. Sabeer. Dr. Selvaraj agrees that patients with hypothyroidism have a higher incidence of abortions, pre-eclampsia and intrauterine growth retardation. Similarly, post-partum thyroiditis can occur after delivery, a molar pregnancy and also after miscarriages. "This may subside after delivery or after termination. However, though the condition is normally self limiting, a significant proportion of women may acquire a life-long dysfunction," she says.
It is vital to check for hyperthyroidism during pregnancy, especially when there is excessive vomiting, weight loss, high blood pressure and persistently fast heart beat, since the same maternal and fetal complications triggered off by hypothyroidism can happen in this case too.
Treatment for hyperthyroidism involves radioactive iodine, medications or surgery in extreme cases. Patients are given radioactive iodine only if they are not pregnant or lactating since this can affect the baby.
An imbalance of thyroid hormones during pregnancy can also result in babies acquiring thyroid problems at birth. Dr. Selvaraj cautions: "Those mothers who are on anti-thyroid medication are also at risk of producing babies who are hypothyroid. Treatment of fetal hypothyroidism is important because it may affect the physical skills of the baby."
Thyroid hormones are said to play an important part in the maturation of the brain and the physical growth of both the fetus and the newborn. Thyroid disorders occur one in 3000 to 4000 babies and are more common in girls than boys. Usual symptoms are poor appetite, sleepiness and prolonged jaundice after birth. If not diagnosed early, the infant's physical and mental development could be delayed.
Thyroid dysfunction can manifest in growing children too in the form of mental and physical retardation. Symptoms include unusual weight loss/gain, deteriorating school performance, irritability, hyperactivity and prominent eyes. "Only a few children develop obvious symptoms like goiter," says Dr. Bhattacharyya.
"The early symptoms of thyroid disorder are most often mistaken for depression, stress, menopause or ageing, and patients remain under-diagnosed until a vigilant health care professional detects the problem," rues Dr. Bhattacharyya - and indication of the low awareness levels regarding this disorder. "There is much cause for concern here, since the problem is completely curable."