Living with an underactive or overactive thyroid

The activity level of a tiny gland in your neck can be behind a host of health problems.

26 February 2018
By Glynis Horning

The thyroid is a small, butterfly-shaped gland in the front of your neck with a disproportionately large role in your wellbeing. It secretes hormones that control the way your body converts food into energy, affecting your body temperature and your heart, muscles, bones and cholesterol.

There are no accurate statistics in South Africa, says Cape Town endocrinologist Dr Wayne May, but it’s thought that about 2% of the population have malfunctioning thyroids, with women outnumbering men three to one. This can put you at risk of anything from an enlarged thyroid gland (goiter) to cancer, and produce a range of unpleasant symptoms along the way.

Hyperthyroidism (overactive thyroid)

If you have an overactive thyroid gland, it produces too much of a hormone, revving up the activity of your body’s organs. This is most common in people below age 40, but can occur at any age, says May. Signs are feeling hot all the time, sweating, rapid heartbeat, weight loss, muscle weakness and fatigue, trembling hands, eye problems (watering or red eyes and swollen lids), menstrual disturbances and infertility.

Causes of hyperthyroidism can range from Graves’ disease (an autoimmune disorder) to toxic adenomas (growths in the thyroid gland), pituitary gland problems (though this is rare) and pregnancy (normally in the first trimester).

Left untreated, hyperthyroidism can lead to serious heart and bone problems and what’s called a “thyroid storm” – a medical emergency where you have palpitations, a high temperature, chest pain, weakness and disorientation, and go into heart failure. “This would usually occur with a secondary hit, like an infection or when undergoing surgery,” May says.

Hypothyroidism (underactive thyroid)

If your thyroid is underactive, on the other hand, it produces too few hormones, lowering your energy levels. You feel tired and weak, and have cold hands and feet, muscle pains, elevated blood cholesterol, depression, disturbed sleep, forgetfulness and trouble thinking clearly. This affects up to eight times more women than men.

Causes of hypothyroidism can be anything from autoimmune disease to pituitary problems or low iodine intake, or it can set in after pregnancy or thyroid surgery or radioactive iodine treatment.
The incidence of hypothyroidism increases as you grow older, with up to 17% of women over 60 estimated to be affected. Yet many go undiagnosed, as they tend to attribute their problems to menopause and ageing, says May. This is dangerous, as left untreated, hypothyroidism can put you at risk of heart attack or stroke. Fortunately, it’s easily diagnosed and treated.

The diagnosis

This is done by a simple blood test – ask your healthcare practitioner. You should get tested if you notice the symptoms above, or have risk factors like a family history of thyroid disease or autoimmune disease. But even if you don’t, have a test done routinely after age 60. If you can manage it, have it done every five years after age 35. What’s called a ‘TSH test’ (for thyroid-stimulating hormone) is inexpensive and covered by most medical aids.

The treatement

Your doctor or a specialist endocrinologist will prescribe medications such as T4 (Eltroxin, Euthyrox), at doses appropriate for your specific condition.  Most patients feel better in weeks, with improved mood, mental function, cholesterol level and weight, but you will likely need to stay on the medication for life, May says.

You may also be advised to make dietary changes, as thyroid hormone production can be affected by deficiencies of micronutrients such as iron, zinc and vitamin, which play a part in your body’s incorporation of iodine into the thyroid hormones. In the past, iodine supplements (such as kelp) were sometimes prescribed, but in South Africa table salt has long been iodated to prevent this. 

Ask your Clicks clinic for advice and information, and visit the website for the Society for Endocrinology, Metabolism and Diabetes of SA.

Image credit: Getty Images