Understanding and diagnosing thyroid problems

I feel like crap all the time and I want to know why! 

Considering that there are anywhere from 20 to 27 million people with thyroid disorders in the US alone, you might wonder, Do I have this? I used to think it was mostly something that old people got - before really talking to people about it, my elderly grandma was the only one I knew who had this condition. I didn't know anything about it: where the thyroid was, what it looked like, or why we even had one. What is it good for, anyway?

The answer: just about everything! It's amazing to think that such a small part of the body could be responsible for so much - basically every system in the body is regulated by the thyroid gland, a butterfly-shaped organ located at the base of the throat. We'd like to think that when something goes wonky with a part of our bodies that we'd know about it, but that's not always the case.

For an organ so small, it does have a major job to do: it affects all the other glands of the body, which in turn regulate our other body systems. So if something is off with the thyroid gland, you can bet other things will follow sooner or later.

Since I'm no endocrinologist, and the study of the thyroid can get rather complicated, I'll try and simplify it as much as possible. In fact, even some doctors don't really have a full understanding of how it works, which can be extremely frustrating for patients. While my primary doctor is okay, at least he is open to trying other forms of medication and ordering regular blood tests. Some people complain that their doctor won't even let them order a simple blood test to check things out. Seriously?! I think it's because they're afraid of what they'll find, and even more, they won't know what to do with the information they receive.

I found one such article that sums that up pretty well:

What the heck does the thyroid gland do? Most physicians will tell you “it controls metabolism,” which is what we all learned in medical school. That statement is basically the same as saying “it’s really complicated and I don’t understand it.” - Dr. Rob Lamberts 

If you don't know much about your condition, and your doctor doesn't really know, either, then that can mean months, years, even - of feeling like crap when you don't have to.

The thyroid is responsible for our metabolism, which, by definition is "The chemical processes that occur within a living organism in order to maintain life." Sounds pretty important! In a nutshell, it affects every cell in the body and how it uses energy. It does this by absorbing iodine from our food supply to produce essential thyroid hormones.

The thyroid is controlled by the pituitary gland, which is really why when you have a TSH test (Thyroid stimulating hormone) done, it's more a determinant of how the pituitary is functioning. You can have a completely normal TSH result and yet still have symptoms, which is why some people go undiagnosed for years - but more on that later. The thyroid converts this iodine into important thyroid hormones - thyroxine (T4) and triiodothyronine (T3). In a normally functioning thyroid, the body converts the T4 (storage hormone) into T3 for energy. As a result, the body produces much less of the "business" hormone T3, because otherwise you would be hyperthyroid - when the thyroid is "sped up." This can happen either on its own or if you are being improperly treated with medications.

When thyroid levels become too low, the pituitary produces more TSH, which in turn makes the thyroid produce more hormones. As a result, someone with hypothyroidism would often - but not always - have a high TSH.

If you've felt like crap for years or are wondering if you're hypo, there is quite an extensive list of symptoms, depending on who you consult. Unfortunately, many of the lists can say completely different things, which I always found confusing and frustrating. Don't ever underestimate the power of your thyroid gland to screw things up; if in doubt, google it and see for yourself.

Symptoms can include:
• feeling cold all the time
• low energy and fatigue, wanting to sleep all the time
• hair loss, loss of outer eyebrow hair
• depression or feeling extremely unmotivated
• low sex drive (more on that later!)
• dry skin
• constipation
• swelling, especially in the face
• pain and stiffness in your joints
• heavier (or sometimes lighter) than usual periods
• infertility or repeated miscarriages
• brain fog and/or memory loss
• muscle cramps and aches
• irritability
• weight gain, even with diet and exercise
• increased cholesterol
• consistently low body temperature
• shortness of breath
• dry, brittle nails
• dizziness and headaches
• migraines
• easily upset or emotional, scares easily
• choking easily
• feeling lumps or sensations in your throat

It's important to note that in some people, symptoms creep up very gradually, and are often dismissed as something else - we often contribute many of these things to "just getting old." Well, I call BS!

I went to several websites to come up with somewhat of a comprehensive list of symptoms for this list, because many times they are very inadequate. I have also consulted my father-in-law's Physicians Desk Reference and noticed, almost amused, that according to their list you'd practically have to be dead before they'd stand up and take note. There's a difference, to them, between symptoms and "signs" - symptoms are things you complain about and only you notice going on inside you, and signs are those outward things (like near heart failure, she says sarcastically) that a doctor can see going on. For example, goiter, or enlarged neck, would be a "sign." (But who really wants to have to wait until their neck swells up like a balloon? Oh wait... been there, done that...)

Granted, everyone is different, and not everyone will experience a full range of symptoms, or even close. Some can have relatively high TSH numbers and feel great; others, like myself, can be in the "normal range" and still feel like crap. I had to laugh when I consulted the almost pathetic list at Wikipedia - which lists a set of common and uncommon symptoms. Some were indeed abnormal and rare, and others on that uncommon list were actually quite common! What the heck?

Even more annoying is when patients give the run down of complaints to physicians who don't  know what all the comprehensive symptoms even are. Apparently, yes - shortness of breath can be a symptom of hypo and not just hyperthyroidism; and yet often I was feeling like I literally needed to gasp for breath. My doctor assumed it was anxiety; I told him I was not anxious. I explained how I would literally have to stop for breath just while reading a bedtime story to my kids. How is that anxiety?

Considering how prevalent hypothyroidism is, I don't know why more doctors don't do regular panels on their patients just to prevent them from falling through the cracks. Some don't know what the full range of symptoms are and just think it's normal for them. Some don't know their family history, some don't understand how it can affect them and what it means for their diagnosis. While it can affect men as well, it is more commonly inherited from mother to daughter.

It's important to not only understand the basics of how your thyroid works and what it should be doing, but take a proactive role in finding a physician who will take your complaints seriously. If possible, it's very helpful to know your family history, know your treatment options and know your rights as a patient so you can feel your best.