... about thyroid disorders

By Julia Cyboran

She was at her wit's end and decided to consult her doctor. She was told that the symptoms she was feeling might be due to an under-active thyroid. A simple blood test would determine if the diagnosis was correct.

Thyroid disorders are so widespread that most physicians are used to seeing patients who present with these kinds of symptoms. "Thyroid disease is common and even more so in women," says Dr Heather Lochnan, associate professor at the University of Ottawa and an endocrinologist at the Ottawa hospital. In Canada thyroid disorders are estimated to affect one in 20 — and it's five to seven times more common in women. Here are a few tips on how to prepare your patients to deal with thyroid disorders.

HYPO vs HYPER
• Go hormonal Reassure your patients that all it takes is a simple blood test to pinpoint a thyroid problem. The thyroid stimulation hormone (TSH) level in the blood will let you know if patients are suffering from hypo- or hyperthyroidism. "It's a very frequently ordered test," adds Dr Lochnan.

• No pain in the neck Thyroid nodules tend to be small and painless. In most cases, patients won't even notice them. You'll usually find them incidentally during a routine checkup. "Thyroid nodules are very common and they need to be investigated," explains Dr Lochnan. She adds that a biopsy can determine if the nodule is cancerous or not. Nodules often turn out to be benign, in which case you should tell your patients that you'll be keeping an eye on the lumps to see if they grow. In some cases, adds Dr Lochnan, you might advise patients to go on medication designed to deliver synthetic hormones to the body. If the nodule is cancerous, the only treatment option is a thyroidectomy. Once a portion or the entire thyroid is removed, patients will have to take medication for the rest of their lives.

• Can you spare some hormone? A TSH test can easily determine if a patient is suffering from hypo- or hyperthyroidism — but some other symptoms can also clue you in. If your patient is feeling weak, fatigued or constipated, and has coarse, dry hair and dry, rough pale skin, it might mean that their thyroid isn't pumping enough hormones through their body. A small amount of weight gain could also be a symptom. "I think there is some misconception about weight gain," says Dr Lochnan. "Untreated hypothyroidism rarely leads to obesity but may cause some weight gain or make it difficult to lose weight. However it's still reasonable to screen people with unexplained weight gain or weight loss for that matter for thyroid disorders." You can tell your patients that hypothyroidism is easily treated. "Treatment with a thyroid hormone is daily and lifelong," she adds. She advises that you let your patients know that hypothyroidism is common and does require treatment.

• Going into overdrive Patients who experience palpitations, restlessness and weight loss in spite of increased appetite are more likely to suffer from hyperthyroidism. According to Dr Lochnan, most people opt to go on antithyroid drugs to manage their hyperthyroidism but radioactive iodine is often an excellent alternative. Basically radioactive iodine is given in the form of a capsule. The pills give off a poisonous type of radiation that the thyroid cells absorb. But this won't harm your patients' health and it's important that they be made aware of the benefits of this therapy. It may take a few treatments for the iodine to take full effect and antithyroid tablets are sometimes given in the interim. One drawback is that treatment with radioactive iodine can cause hypothyroidism, which means patients will have to be on thyroid hormones for the rest of their life. Dr Lochnan adds, "It's important to reassure patients that thyroid disorder is common and manageable and that treatment is required. If left untreated they may develop more serious health problems." These include heart problems and bone loss.