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Medical Conditions Doctors Miss

So you're sleepy a lot and maybe a little blue, and your blood pressure is on the high side. It could be stress, or these and other common symptoms could be signs of serious medical conditions that doctors sometimes overlook.

Hypothyroidism continued...

The prevalence of hypothyroidism is controversial because there is a debate in the medical community about what qualifies as a disorder. Some experts believe illness should be diagnosed when there are mild thyroid abnormalities, called subclinical hypothyroidism. Others think illness should only be diagnosed at later stages, when there is more thyroid dysfunction.

Subclinical cases are prevalent and are probably the most underdiagnosed in the United States, says Leonard Wartofsky, MD, MPH, a prominent thyroid expert and chairman of the department of medicine at the Washington Medical Center in Washington, D.C.

The prevalence of subclinical hypothyroidism depends on age. Wartofsky estimates the range at 4%-5% for people in their 20s to 15%-20% for people in their 70s and 80s. The disorder affects up to 4%-10% of the population and is estimated to affect up to 20% of women older than 60.

Subclinical hypothyroidism is already a serious condition, asserts Wartofsky, pointing to symptoms of fatigue, high cholesterol levels, menstrual irregularities for women, failure to conceive, and possible reduced IQ for children of women with subclinical hypothyroidism during pregnancy.

Yet there is uncertainty over how to manage subclinical cases. "There's a question over whether there's really a benefit to treating patients with subclinical hypothyroidism," says Monica C. Skarulis, MD, senior clinical investigator for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

Scientific research has not shown a benefit for treatment, says Skarulis. In fact, in at least one study of older adults, people who did not get treatment appeared to fare better than those who did receive treatment.

The study brings up issues such as whether or not experts are on track in their definition of thyroid abnormalities. "Is subclinical hypothyroidism really a disease? Or is this something that we should rethink? I think a lot of us are rethinking it," says Skarulis.

The debate over what defines hypothyroidism makes it unclear how many people are actually missing out on proper treatment. Wartofsky believes only about half or less of people with hypothyroidism are diagnosed with the disorder.

Experts do agree that hypothyroidism can be missed by doctors and patients because the symptoms can be commonplace.

According to the Mayo Clinic, symptoms include:

  • Increased sensitivity to cold
  • Constipation
  • Pale, dry skin
  • A puffy face
  • Hoarse voice
  • An elevated blood cholesterol level
  • Unexplained weight gain
  • Muscle aches, tenderness, and stiffness,
  • Pain and stiffness in the joints
  • Carpal tunnel syndrome
  • Heavier-than-normal menstrual periods
  • Depression

Tell your doctor if you have been feeling tired and have other symptoms of hypothyroidism. If left untreated, hypothyroidism can contribute to complications such as increased risk of heart disease, diabetes, sleep apnea, and forgetfulness. An extreme form of the disease, called myxedema, is a potentially life-threatening condition in which tissues swell up, fluid accumulates around the heart and lungs, muscle reflexes decrease, and mental abilities diminish.

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