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

BLOOD TESTS DETECT HYPOTHYROIDISM, MEDICATION RELIEVES SYMPTOMS

Question: I am 52 and postmenopausal by a couple of years. Lately I just haven’t had any energy, and I can’t seem to remember things. My husband thinks I am depressed because our youngest left for college in the fall, but I don’t feel sad. In addition to feeling tired, I’ve also noticed some other recent changes. My skin is dry this winter, worse than last year. When I brush my hair, a lot of hair comes out. I am cold all the time -- even during a recent warm spell when it was in the mid-70s. Are all these things related? Do you think I am depressed, or could there be something else going on?

Answer: While it is difficult and inappropriate to make a diagnosis without seeing a patient, what you describe is a fairly classic presentation of hypothyroidism. This condition is relatively common in postmenopausal women. The most common symptoms are fatigue, cold intolerance and mild weight gain. Depression can be a symptom of hypothyroidism as well.

Hypothyroidism usually comes on gradually, so many people don’t notice several of these symptoms as being meaningful or related to one another. You are to be commended for at least asking the question about the relationship of various symptoms you’ve noticed.

Before I talk specifically about hypothyroidism and how it is treated, I need to give you a short anatomy lesson about the thyroid gland itself. The thyroid is an "H" shaped structure that is attached to the trachea -- sometimes called the windpipe. The gland is located low in the neck at about the level of the collarbones. It straddles the trachea, with the main parts of the gland lying on either side and the cross-bar of the "H" shape crossing over the front of the trachea.

The tests to determine if the thyroid gland is working properly are simple blood tests. These tests measure the concentration of the two main thyroid hormones, T3 and T4, as well as the level of a pituitary gland hormone called thyroid stimulating hormone, or TSH. As the name implies, TSH regulates the amount of hormone the thyroid produces. In the vast majority of cases, hypothyroidism will produce low levels of T4, also known as thyroxin, and high levels of TSH in the blood.

Hypothyroidism is more common in women, and the likelihood of developing this increases with age. It does not seem to run in families. If left untreated, it can produce severe consequences. These can include heart problems that are life threatening, increased susceptibility to infections and acute psychosis.

If the tests I mentioned find too much TSH circulating in your blood, your doctor will probably recommend that you start taking thyroid hormone replacement medication. Many people find a prompt resolution in their symptoms once the missing thyroid hormone is adequately replaced. You will still need to have periodic blood tests to monitor the functioning of your thyroid gland. This will help keep things in balance.

Generally, this is one of those conditions that will require treatment for life. While there is no cure, adequate treatment with thyroid hormone will almost certainly make it possible for you to function as if you did not have a problem.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.