In this article:
Can you name the health condition that is rapidly on the rise and affects tens of millions of Americans but is rarely in the news?
Can you name the health condition often used by comedians and advertisers as the cruel punchline in jokes about being overweight?
If you said “thyroid disease,” you’d be right.
January is Thyroid Awareness Month, but you’d never know it by looking at most news programs, magazines, or websites. Sure, there will be a smattering of information here and there about the signs and symptoms of an undiagnosed thyroid disorder, or how to do a thyroid neck check. Pharmaceutical companies or medical societies sometimes pay to put an impossibly thin, fit, and coiffed celebrity spokesperson out on the interview circuit during Thyroid Awareness Month.
But let’s face it. Thyroid disease simply doesn’t get the high-profile awareness campaigns we see for breast cancer or heart disease. And when thyroid disease is discussed, it’s usually downplayed. The medical world even refers to thyroid cancer as the “good cancer”— as if any cancer is good!
More than 10 million Americans are estimated to live with undiagnosed thyroid conditions! And among millions who have already been diagnosed, many struggle with debilitating symptoms and related health problems! Why is such a common chronic disease rarely receiving the attention it rightfully deserves?
Thyroid conditions can be debilitating, and with so many people struggling with the challenges of diagnosis and treatment, one thing is clear: we need more thyroid awareness! In fact, a month isn’t nearly long enough. Ahead, a look at the reasons why we need thyroid awareness all year long!
It’s estimated that, at minimum, 20 million Americans have a thyroid condition; the majority have hypothyroidism, an underactive thyroid. Thyroid function is essential for the function of cells, tissues, glands, and organs. A lack of thyroid hormone negatively affects the brain, the heart, and the reproductive, nervous, and gastrointestinal systems – essentially all the body’s functions. Given the prevalence of thyroid disease and the obvious importance of a functioning thyroid, why do so many people go undiagnosed? There are several possible reasons.
Vague Symptoms. First, the signs and symptoms of a thyroid condition are common to many other conditions. For example, common thyroid symptoms such as fatigue, weight gain or difficulty losing weight, mood changes, and brain fog can be due to depression, PMS, perimenopause and menopause, and pregnancy/childbirth. Thyroid symptoms such as low sex drive and hair loss are also often attributed to aging in both women and men. And high cholesterol levels, insulin resistance, and difficulty losing weight – all common thyroid symptoms – are also commonplace in an increasingly overweight population. As a result, many people with thyroid symptoms are never tested and are misdiagnosed and treated for the wrong conditions. These patients often end up taking antidepressants, blood pressure and cholesterol drugs, and type 2 diabetes medications that don’t work because the undiagnosed thyroid condition isn’t treated.
No Routine Screening. Second, apart from a heel stick test for congenital hypothyroidism in newborns, there is no routine screening done for thyroid disease. You might be surprised to learn that the standard blood test panels typically done as part of your annual physical do not include thyroid tests. When a possible thyroid condition is suspected, a doctor has to specifically order – or you need to explicitly request – a thyroid lab test or panel.
Reliance on the TSH Test. Third, many healthcare providers rely on only one test, Thyroid Stimulating Hormone (TSH), to diagnose your thyroid condition. The TSH test measures a pituitary hormone, not your circulating thyroid hormone levels. You can have a TSH level that’s in the reference range. Still, your free levels of thyroid hormone – including T4 (thyroxine) and the active thyroid hormone, T3 (triiodothyronine) – can be abnormal, indicating that you have an underlying thyroid condition.
Failure to Test for Antibodies. Finally, most thyroid problems in the U.S. are caused by an autoimmune thyroid disease called Hashimoto’s thyroiditis. Many doctors, however, fail to order the test that best identifies Hashimoto’s – Thyroid Peroxidase Antibodies (TPOAb) – when conducting a thyroid evaluation. This leaves many patients without an accurate diagnosis.
A Stigma. Because thyroid disease affects women eight to ten times more often than men, it’s become stigmatized. Some doctors view thyroid disease as a condition that middle-aged women use as an excuse for being overweight, tired, or having a low sex drive. As a result, some women are reluctant to raise the issue with doctors, and some doctors are quick to dismiss women’s concerns and fail to test for thyroid problems.
Even after diagnosis and treatment of a thyroid condition, you may be one of the many thyroid patients who continue to have unresolved symptoms of thyroid disease. All too frequently, patients are told by their healthcare providers that lingering problems like – fatigue, difficulty losing weight, brain fog, mood problems, constipation, and other known thyroid symptoms – have nothing to do with their thyroid condition. There are several reasons for this situation.
Differing Target Levels. Many healthcare providers focus on getting your TSH level into the reference range, often called the “normal range.” Beyond normalizing the TSH level, symptoms may not be considered. This focus on the TSH test can leave you undermedicated, symptomatic, and functionally hypothyroid, with borderline low or low-normal Free T4 and Free T3 levels.
Use of Only T4 Medications. Thyroid hormone replacement drugs are used to treat hypothyroidism. The most commonly used medication is a synthetic form of the T4 thyroxine hormone, known as levothyroxine (i.e., Synthroid, Levoxyl). Studies have shown, however, that some thyroid patients feel best – and have thyroid levels close to optimal – when their treatment includes both T4 and the second T3 hormone, triiodothyronine. This can be accomplished by prescribing levothyroxine plus the synthetic T3 drug liothyronine (Cytomel) or treatment with a natural desiccated thyroid (NDT) drug. (NDT drugs include natural forms of both T4 and T3, derived from dried porcine thyroid.) However, some practitioners do not test for T3 levels nor prescribe synthetic or natural T4/T3 combination treatment.
Malabsorption. For it to work, thyroid hormone replacement medications must be properly absorbed. If you have digestive issues or conditions that cause absorption problems – Crohn’s disease, gastrointestinal reflux disease (GERD), an ulcer, or irritable bowel disease (IBD) – you may not effectively absorb your medication. In this case, you may need a higher-than-normal dose of medication – or a switch to a liquid or gelcap form of levothyroxine like Tirosint – to absorb your thyroid medication and resolve symptoms.
Some patients are also unaware they need to take thyroid medications apart from food, coffee, milk, and medications or supplements containing iron or calcium. Failure to follow dosing instructions can result in poor medication absorption and continuing symptoms.
If you have undiagnosed or poorly treated thyroid disease, you face a number of risks, including:
- An increased risk of heart disease and type 2 diabetes
- An increased risk of obesity
- An increased risk of infertility and recurrent miscarriage
- An increased risk of premature delivery
- An increased risk of liver disease
- An increased risk of depression
- An increased risk of neurological and memory problems
Some thyroid problems, when untreated, can increase the risk of developing thyroid cancer.
Eventually, long-term, untreated hypothyroidism can, in some cases, lead to a condition known as myxedema coma and even death.
Thyroid awareness starts with YOU! The first thing you can do is to become knowledgeable about the full range of potential thyroid symptoms.
You should also be aware that there are factors that put you at a higher risk of developing a thyroid condition. For example:
- A family history of thyroid or autoimmune disease
- A personal history of autoimmune disease, especially type 1 diabetes, celiac disease, rheumatoid arthritis, Lyme disease, or Sjögren’s syndrome
- Pregnancy or recent childbirth
- Infection with COVID-19
- Iodine deficiency or excess
- Being a current or former cigarette smoker
- Exposure to radiation from a nuclear accident (i.e., Chornobyl or Fukushima)
Get tested as often as needed. Paloma has a helpful article – How Often Should You Get Your Thyroid Tested? — that reviews the critical points when you should have complete thyroid screening and tests.
It’s also important to advocate for yourself. Whether you’re diagnosed or undiagnosed, if you have any symptoms associated with thyroid conditions, always insist on a complete thyroid panel – TSH, Free T4, Free T3, and TPOAb – not just a TSH test.
Consider seeking a thyroid-savvy healthcare provider for the best possible thyroid diagnosis and treatment. Experienced practitioners understand how to diagnose thyroid conditions properly. They also know that you’ll have the best possible quality of life not when your thyroid levels are “normal,” but when your treatment is optimal.
Finally, whether it’s January – or any day of the year – please do your part to help spread thyroid awareness with friends and family. If you have a thyroid condition, it’s especially important to let family members know because they are at a higher risk of thyroid problems themselves.
Effective thyroid diagnosis and management depend in part on complete and accurate blood tests. Paloma Health’s Complete Thyroid Home Test kit makes thyroid testing easy and nearly painless. The test panel includes Thyroid Stimulating Hormone (TSH), Free Thyroxine (Free T4), Free Triiodothyronine (Free T3), and Thyroid Peroxidase Antibodies (TPOAb). You can order your affordable kit online, follow the easy instructions to take your samples, and send your test kit back to Paloma’s certified lab in the prepaid mailer. Your results come back quickly to your secure online portal.
For diagnosis and treatment of hypothyroidism, Paloma offers a network of experienced thyroid specialists who provide virtual care in most areas of the U.S. Paloma’s doctors understand the diagnosis process and are committed to making you aware of all your treatment options. They believe that the best thyroid treatment for you is the one that safely and best resolves your symptoms. Reach out if you would like to discuss the opportunity to work with a Paloma practitioner for your thyroid care.