Durban - During her pregnancy with her first son, a friend asked Lisa Crouch, 51, if she’d looked at her eyes in the mirror. “I wasn’t aware of it, but my eyes were bulging slightly,” she recalls.
Crouch consulted her doctor, who referred her to an endocrinologist. “I had Graves’ disease,” she says.
Graves’ disease causes an overactive thyroid, or “hyperthyroidism”, a condition in which too much thyroid hormone is produced. Thyroid hormone is produced by the thyroid gland, a butterfly-shaped endocrine gland in the front of the neck, and it plays a significant role in metabolism. If there is too much thyroid hormone, functions of the body tend to speed up.
“I was full of energy, so I didn’t think there was anything wrong with me at the time, but after my baby was born I lost a lot of weight. I got thinner and thinner. I thought it was due to breast-feeding,” Crouch says.
She had to go on an anti-thyroid drug, NeoMercazole, and was told she should not fall pregnant while on the medication, as it could be dangerous to a growing foetus.
Nonetheless, Crouch did fall pregnant, and with careful administration of her medication, her pregnancy was uneventful. Afterwards her doctor advised that she should have her thyroid removed or take a radioactive iodine tablet, which destroys the thyroid.
“I decided to swallow the tablet because it was the least invasive. It was pretty painless, though I couldn’t sleep in the same bed as my husband or be close to my children for three days because I was about as radioactive as a microwave,” she says.
Crouch now takes the thyroid hormone replacement supplement Eltroxin because her thyroid gland became underactive after she took the radioactive iodine.
She has not looked back.
“I have to take it for life, and I go for blood tests every six months, but I feel healthy and fine,” she says.
Graves’ disease, the most common form of hyperthyroidism, is caused by the overproduction of thyroid hormone by the thyroid gland. This is triggered by antibodies in the blood that turn on the thyroid and cause it to secrete too much thyroid hormone.
“Little is known about why this autoimmune response happens. Studies show it can run in families and is most common in women aged between 20 and 40,” says Dr Joel Dave, an endocrinologist in Cape Town.
Early signs may be red or inflamed eyes, or a bulging of the eyes.
Emotional stress
According to the American Thyroid Association, physicians have long suspected that severe emotional stress, such as the death of a loved one, can set off Graves’ disease in some patients, but this has not been proved. Hyperthyroidism may also be caused by nodules or lumps in the thyroid that increase the output of thyroid hormone. This condition is known as toxic nodular or multinodular goitre (swelling of the thyroid gland).
Johannesburg social entrepreneur Kelli Givens, 53, was first alerted to her multinodular goitre when she “started feeling a tightness” in her throat.
“My neck was getting bigger and I was losing a lot of weight, about a kilo every few days. I had hair loss on my eyebrows and my nails wouldn’t grow. The goitre also started to affect my breathing and even my voice changed,” she recalls.
A fine-needle biopsy, a procedure removing thyroid cells for examination, confirmed her thyroid gland was toxic and growing. She had the gland surgically removed.
Like many people who have had their thyroid removed, Givens took a while to gauge how much Eltroxin was right for her.
“It took about six months to stabilise the dose. If I miss taking it or take too little, I become very tired. If I take too much, I become overenergised.”
Weight gain and fatigue are the most common symptoms in people with an underactive thyroid (hypothyroidism), which is mostly caused by a deficiency in iodine, although in many countries the prevalence of iodine deficiency is low because governments ensure their populations receive adequate iodine by iodising foodstuffs.
Hypothyroidism, like hyperthyroidism, is often also caused by an attack on the thyroid gland by the immune system.
“The body makes antibodies to the thyroid gland, which then attack it. The thyroid gland becomes inflamed and damaged, and as a result it produces less and less thyroid hormone,” says Dave.
Talk show host Oprah Winfrey had hypothyroidism for years.
“It slowed down my metabolism and made me want to sleep all the time. Most people gain weight. I did. Twenty pounds (9kg),” she said in 2007.
Apart from fatigue and weight gain, other symptoms of an underactive thyroid are dry skin, constipation, depression, heavy periods, poor memory and hair loss, although Dave warns that these complaints are often mistakenly blamed on the thyroid gland.
Supplementation
“The diagnosis of a thyroid problem cannot be made on symptoms alone. It must be backed by blood tests for TSH (thyroid stimulating hormone), T4 (thyroxine) or T3 (triiodothyronine), two hormones made by the thyroid gland,” he says.
For an underactive thyroid, which is 10 times more prevalent in women, the cornerstone of treatment is thyroid hormone supplementation, namely Euthyrox, Eltroxin or Synthroid.
Neomercazole is the only drug registered in South Africa for treating an overactive thyroid.
Radioactive iodine and surgery are the other treatment options.
While it certainly does sound alarming, radioactive iodine has proved to be safe, and there is no convincing scientific evidence that it can cause cancer, so many patients with an overactive thyroid are treated this way, says Dave.
The thyroid gland needs iodine to make thyroid hormone, so it will take up any form of iodine in your bloodstream.
“Over a period of several weeks, the radioactive iodine destroys the cells that have taken it up,” Dave explains.
The result is that the thyroid or thyroid nodules shrink, and the level of thyroid hormone in the blood returns to normal, although a common complication of the radioactive iodine is that the thyroid gland becomes underactive.
Physicians also prescribe what’s known as beta-blockers for hyperthyroidism, drugs that reduce symptoms like tremors, rapid heartbeat, and nervousness, but which do not stop thyroid hormone production.
As for alternative medicines, Dave cautions that there is no scientific evidence these are effective in the treatment of hypothyroidism or hyperthyroidism.
“Patients with a thyroid problem should use products that have been specifically approved by the Medicines Control Council in South Africa for use in patients with thyroid disease,” he says.
The good news is that hyperthyroidism and hypothyroidism are, in general, easily controlled and safely treated.
The choice of treatment will be influenced by your age, the type of thyroid problem you have, its severity and other medical conditions that may be affecting your health. For Crouch and Givens, the result was a better quality of life.
“The only niggle is having to take the Eltroxin for life, but that’s no big deal,” says Givens. - Daily News
l To find an endocrinologist near you, visit www.samedicalspecialists.co.za