What Feels Like Stress May Call for a Thyroid Test
April 21, 2000 -- Feeling tired or forgetful? Is your skin and hair drier
than normal? Are you retaining water, gaining weight, constipated, or hoarse?
These are just a few of the symptoms of a disease called hypothyroidism, which
occurs when the thyroid -- a bow tie-shaped gland in the front of the neck --
does not produce enough thyroid hormones.
Low levels of thyroid hormones can cause many problems because the hormones
affect nearly every part of the body, such as breaking down fat, regulating
menstrual periods, and controlling body temperature.
But you may have low levels of thyroid hormone and not even know it. A
recent study in the Archives of Internal Medicine found that nearly 10%
of reportedly healthy people whose thyroid function was tested during statewide
health fairs in Colorado had low thyroid levels.
"The symptoms of mild hypothyroidism are nonspecific, change gradually,
and are easy for a person to write off as the effects of stress or
overwork," says study author Gay J. Canaris, MD, MSPH. Canaris is assistant
professor of internal medicine at the University of Nebraska Medical Center in
The study's results suggest that people are not screened frequently enough
for hypothyroidism, and researchers recommend that doctors screen more people
for the disease and better educate them about its symptoms.
Other symptoms of hypothyroidism include the following: fatigue, lethargy,
mood swings, depression, decreased appetite, cold intolerance, slow wound
healing, menstrual irregularities, and joint pain.
The basic test to screen for thyroid disease measures the level of
thyroid-stimulating hormone (TSH) in the blood. This hormone is extremely
sensitive to the body's need for thyroid hormone. When the thyroid is making
too little hormone, TSH levels shoot up to try to spur it into action.
Therefore, a high TSH level is a sign that all is not well with the thyroid
Thomas C. Rosenthal, MD, says his experience as a family physician has shown
him that hypothyroidism can be difficult to recognize.
"[When] I used TSH as part of my routine screening panel, I was
surprised to find that many patients had unsuspected hypothyroidism," he
says. "These were typically patients who might present with depression ...
aches and pains, or concerned about their memory problems." Rosenthal is
professor and chair of the department of family medicine at the State
University of New York at Buffalo.
Even mild hypothyroidism can cause problems. The Colorado Thyroid Disease
Prevalence Study found that people with mild thyroid problems tended to have
higher cholesterol and low-density lipoprotein (LDL) levels than those with
normal thyroid levels.
The association between low thyroid levels and increased cholesterol and LDL
levels worries researchers, because it suggests that hypothyroidism might add
to one's risk of heart disease. Both you and your physician should be more
aware of the early warning signs so the disease can be diagnosed and treated
Canaris recommends regular TSH tests for older patients -- particularly
older women -- and for those with a family history of hypothyroidism; those
with high cholesterol levels or hypertension; and those with possible symptoms
that have changed recently, such as constipation or intolerance to cold. The
American Thyroid Association, the American College of Pathology, and the
American College of Physicians all recommend regular TSH tests for women over