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Women's Health

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Thyroid at Root of Many Symptoms

Symptoms continued...

In the case of an overabundance of thyroxin flooding through the system and supercharging every cell to an unhealthy degree, the result can be another autoimmune disorder called Grave's disease. Although late in the progression you may lose weight, Vliet says, at first you will be gaining just as with hypothyroidism. Other symptoms apart from the dry hair and skin and hair loss include a restlessness, inner tension, tossing and turning, and an agitated sort of depression. Despite the misdirected energy, fatigue is a symptom of an overactive thyroid, too. Having hyperthyroidism, Vliet says, is like sitting in park with your foot on the accelerator. Sometimes Grave's disease causes the eyes to bulge slightly. (Graves, Vliet says, is also related to postpartum psychosis in which the ovarian hormones join with the thyroid hormones to produce psychiatric symptoms.)

Art of Testing

Shomon urges women not to drag (or rev) around feeling bad but to consult a doctor. Probably the first test that will be done is a TSH test for thyroid stimulating hormone, a substance produced by the pituitary gland that regulates the thyroid gland. If the TSH is greater than the upper level of normal (4.5 to 5 mU/L), many doctors will check the "free" T4 level (thyroxin), which costs less than a T4 index, which tests both T3 and T4. A TSH above 2 can mean fertility is impaired, Vliet says.

Kenneth R. Blanchard, MD, an endocrinologist in Newton, Mass., says what he learned in medical school -- to test only TSH -- was flat wrong. He always tests for T3 and T4. "I have seen people living in misery with 100% T4," he emphasizes. Vliet also tests for T3 and T4, as well as antibodies that can cause autoimmune problems. "You can have shortages of T3 and T4 before the TSH goes up or down," she says. "Women with significantly elevated antibodies may need medication before the TSH reaches 4 or 5."

"We're patients, not lab values" is Shomon's motto. She says the range of "bad" test results is too small and that doctors will dismiss the same set of symptoms in one woman as hypochondria if the test readings are a few tenths of a point lower than in another woman with the same complaints. Vliet and Blanchard specialize in nailing down and treating thyroid dysfunction at varying levels for each woman.

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