FAMILY MEDICINE® COLUMN

By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

THYROID DISEASE CAN'T BE CURED, BUT READER CAN LIVE NORMAL LIFE

Question: About six years ago, at age 28, I was diagnosed with Hashimoto's disease. I understand this disease causes the body to attack its own thyroid, which results in lack of production of normal hormones. Can early detection stop or reverse the effects of this disease? Is it hereditary?

Answer: Hashimoto’s thyroiditis is the number one cause of low thyroid hormone levels, a condition called hypothyroidism. It is very common in women between the ages of 25 and 50. You are correct in stating that the body attacks its own thyroid gland in Hashimoto’s thyroiditis. Let me explain what happens. First the body develops antibodies to the thyroid gland. Then, the immune system reacts to the thyroid tissue as though it were a foreign invader such as a bacteria or virus. No one knows why this happens. Recognizing and developing antibodies to foreign substances is a normal defense mechanisms. This same defense mechanism helps the body overcome colds and minor infections. But, because the immune system is attacking its own body, this type of ailment is called an “autoimmune disorder.”

Hashimoto’s thyroiditis is not curable, but is easily treatable with thyroid hormone replacement. It does appear to be hereditary, so screening of family members is recommended. Regulating thyroid hormone is a complex process. The thyroid gland -- located in the front of the neck -- produces thyroid hormone (thyroxin) that regulates our metabolism. However, it’s the pituitary gland in the brain that polices this process by sending thyroid stimulating hormone (TSH) to the thyroid gland. The amount of TSH secreted into the blood determines the amount of thyroxin the thyroid gland produces.

As the thyroid is destroyed by the immune system, the gland produces less hormone. This sends a message back to the brain to send more TSH to the gland. The resultant elevation in TSH level is detectable by a simple blood test. A high TSH level indicates that the thyroid is not responding to the “signals” sent by the pituitary. This is one of the first signs of hypothyroidism. Other studies that might be done include a thyroid profile and a thyroid antibody test.

A TSH level should be part of routine screening in people with a family history of hypothyroidism, during and after pregnancy, and when the very first symptoms of pending menopause appear. Hypothyroidism should also be considered as a possible underlying disease process when symptoms such as unexplained fatigue, coarse, dry hair, hair loss, cold intolerance, depression, memory loss, and abnormal menstrual cycles occur. Some people will have only one symptom, but others will have several, in different combinations. In the earliest stages of hypothyroidism, there may be no recognizable symptoms at all.

Treatment of hypothyroidism is generally straightforward. A thyroid hormone pill taken once a day usually does the trick. Most people respond readily to treatment and live a long, normal life. Hypothyroidism is not currently “curable” and will require treatment for the rest of your life. You should never stop your medication unless directed to by your physician. If left untreated, hypothyroidism can progress to severe depression, heart failure or coma.

So here it is in a nutshell: Know your family medical history. Promptly and properly report your symptoms. If hypothyroidism is diagnosed, learn about the disease. TAKE YOUR MEDICATION as prescribed. Once your condition stabilizes, make sure to have your TSH levels checked at least once a year.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Past columns are available online at http://www.FamilyMedicineNews.org.