FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

MODERN TESTS DIAGNOSE THYROID DISORDERS EARLIER

Question: I have several friends who have thyroid problems. Is this condition becoming more common, because I rarely heard of anyone with it until the last few years?

Answer: While it's possible that thyroid disorders are becoming more common, I suspect that there's another reason for your observation about the rate of diagnosis for this condition. Before I explain, I need to give you a short anatomy lesson.

The thyroid is an "H" shaped gland located in the neck below the Adam's apple. The sides of the "H" lie along either side of the "windpipe," or trachea. The contour of the gland is not normally visible, and the upper lobes (the top of each side of the "H") can typically only be felt just above the collar bone next to the "windpipe." When enlarged, however, the lobes of the thyroid gland can form a distinctive bulging in the lower front surface of the neck.

Thyroid hormone, the product of the this gland, is responsible for regulating metabolism. High levels speed up metabolism while low levels slow it down. Thyroid hormone affects all organs, but the liver, heart, brain and kidneys are at least 10 times more sensitive to it than others. Therefore, just as you would suspect, abnormal levels of thyroid hormone most frequently cause symptoms of malfunction in one or more of these organs.

When the thyroid produces too little hormone, the condition is called "hypothyroidism." Whereas, too much hormone results in "hyperthyroidism."

The underactive condition is more common than is the overactive one. In the population as a whole, about 2 percent have obvious symptoms of this disorder, and 12 percent have a more subtle "subclinical" presentation. This means that their disease is detectable with blood tests but does not produce any specific symptoms. The incidence is even higher in the elderly population. About 6 percent of those over 60 have symptom-producing hypothyroidism, and another 20 percent have the subclinical form. Certainly, there are many people of all ages with thyroid problems!

It is difficult to truly tell if thyroid problems, both hyperthyroidism and hypothyroidism, are more common now than they were in the past. You see, the tests that were previously used to measure thyroid disease were crude by our present standards. Most individuals with hypothyroidism had symptoms of low energy, weight gain, hair loss, depression and other subtle symptoms of hypothyroidism for 7 years before the condition worsened to the extent that it could be identified. This resulted in statistics that significantly underreported the actual frequency of the condition in the population.

Today we can diagnose thyroid disease much earlier than in the past and implement treatment in time to prevent serious complications. This certainly does result in a greater percentage of the population being diagnosed with thyroid problems, but this increased frequency may only be a consequence of today's better tests.

So the important "take home" information is that with these better tests it makes sense to screen more widely for possible thyroid disease. To find out if you should be screened look at these questions: Are you older than 60? Do you have heart trouble? Depression? High cholesterol? Dry skin? Heat intolerance? Fatigue? Mental disturbance? A lump in your thyroid? Menstrual irregularity? Other symptoms you can't explain? If so, talk to your doctor about your symptoms, and remind him or her that you are concerned about your thyroid.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.