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Thyroid Imbalance Impacts Women's Health

Menorah Medical Center April 28, 2014

Dr. Michael Sokol

by Linda Cruse, Special sections contributing writer | Reprinted courtesy of Kansas City Star Magazine

Robin Huber has had thyroid disease since she was 18. Amissa Long learned she had it in her 30s and Kerri Melson in her 40s.

All three women have hypothyroidism, or an underactive thyroid. Their thyroid gland, situated in the neck, is supplying lower-thanrequired levels of essential hormones needed for the body to function efficiently.

Hypothyroidism is a common syndrome, particularly among women, said Dr. Richard Hellman, an endocrinologist with Hellman and Rosen Endocrine Associates, on the North Kansas City Hospital campus.

“Women are eight times more likely than men to have hypothyroidism,” he said, adding that in the United States the condition is caused primarily by autoimmune disease. Symptoms include weight gain, hair loss, fatigue, constipation, dry skin and depression.

“The condition can be confirmed by lab tests,” he said. “It’s important not to neglect it because severe hypothyroidism can result in serious problems.” In addition, women suffering from both depression and hypothyroidism must address their thyroid issue to overcome their depression, he said.

Three women’s stories

When Melson was in her late 40s, she began taking hormone replacement therapy for menopause symptoms.

Within a month Melson began experiencing physical problems, including hair loss, fatigue and weight gain.

Concerned, she stopped taking the hormone replacement, but her symptoms continued. “I cried and cried and cried about losing my hair,” said Melson, of Greenwood, Mo. “It was so bad you could see my bald scalp.”

Uncertain where to turn for help, Melson spent several miserable months before she ran into a friend who was able to help. After listening to Melson describe her symptoms, she said, “I think you have what I have. You need to see Dr. Sokol.”

Dr. Michael Sokol is an endocrinologist and psychiatrist with Statland Medical Group, which is part of Midwest Physicians. He is on staff at Menorah Medical Center, part of HCA Midwest Health System.

He suspected that Melson was suffering from an underactive thyroid, or hypothyroid. Lab tests proved he was right.

“The thyroid impacts how efficiently the body works,” Sokol said. “It’s like putting oil in a motor – too much or too little impacts the motor’s operating efficiency. It is the same with the body.”

He put Melson on thyroid medication, and she immediately began to feel better. “It’s a miracle,” said Melson, now 52. “You don’t even realize you have a thyroid and how much it does until you go through something like this.”

Long’s first concerns surfaced several years ago when she started gaining weight despite exercising regularly and lowering her calorie intake. Working out exhausted her instead of energizing her as it had in the past.

“My primary care physician said my thyroid blood test was normal, but I knew something was going on,” said Long, 33, of Kansas City.

Long, who works in a doctor’s office, asked to be referred to an endocrinologist. She saw Dr. Ahmad Al-Mubaslat, an endocrinologist with Midwest Endocrinology Associates, which is part of Midwest Physicians. He is on staff at Research Medical Center, Menorah Medical Center and Lee’s Summit Medical Center, all part of HCA Midwest Health System.

He determined that she had hypothyroid disease. She has been taking thyroid medication for three years and is amazed at the improvement in her skin, hair and ability to sleep. Additionally, the medication has helped stabilize her weight.

Al-Mubaslat said women often wait too long before seeking help. “Unfortunately many women live with symptoms for years, putting off what is often highly treatable,” he said.

In Huber’s case, she learned at age 18 that she had thyroid disease after having her thyroid checked at the recommendation of her orthodontist. Huber, who had no symptoms, said both her mother and grandmother have hypothyroidism. Now 51, Huber’s 17-year-old son also has thyroid disease.

Huber has had her thyroid medication adjusted throughout the years. “In my late 20s I began getting anxious, so they lowered the level of my medication,” she said. “About 10 years later I began getting depressed, so they increased the level. It needs regular monitoring.”

Most hypothyroidism cases are treated by taking synthetic thyroxine, a medication that is identical to the hormone T4. Levels of TSH (thyroid stimulating hormone) are monitored, and doses of thyroid hormone replacement are adjusted as needed. Free T4 is measured in certain circumstances.

Facts about thyroid disease

According to the American Thyroid Association, one in eight women will develop thyroid disease in her lifetime. Women are more likely to develop hypothyroidism as they age, said Hellman, and being age 50 or older increases the risk of thyroid disease for both men and women.

Other risk factors include autoimmune disease, a family history of thyroid disease and thyroid surgery. Surgical removal of all or part of the thyroid usually results in hypothyroidism

While cases of thyroid disease are increasing, both Sokol and Al- Mubaslat said that is due, in part, to the fact that physicians are becoming better at diagnosing thyroid disease.

“More people are being screened, so we’re catching cases earlier,” Sokol said. “Also, tests are more sensitive than they used to be.”

The TSH test is the best screening test, Sokol said. The TSH test assesses the amount of thyroid stimulating hormone in the blood. Other tests include the free T4 test, which measures the actual amount of circulating thyroid hormone in the blood. In hypothyroidism, the level of T4 in the blood maybe normal or may be lower than normal. Another test looks for the presence of thyroid autoantibodies.

Even women without signs or symptoms of an underactive thyroid need to be followed by a physician at certain thyroid levels, Hellman said.

“Women without symptoms can have subclinical hypothyroidism,” Hellman said. “That means the process has begun but it’s very mild. When a physician chooses to treat this varies, but they need to be followed.”

Hellman said it was extremely important for pregnant women with a predisposition or family history of thyroid disease to be screened in pregnancy. Hypothyroidism increases the chance of miscarriage, preterm delivery and preeclampsia. It can also affect the baby’s growth and brain development. Thyroid medications are safe to take during pregnancy.

Additionally, thyroid disease has been linked to infertility, so women having difficulty conceiving should be screened, Hellman said.

The American Thyroid Association recommends measuring thyroid function in all adults beginning at age 35 and every five years after. Sokol said people with a family history of thyroid disease should be screened annually.

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