Feeling tired is perfectly normal when you’ve been having one too many late nights.
But let’s say you’ve had a good night’s rest and fatigue still hits you. And you can’t quite explain the bouts of blues you’ve been experiencing, just as you mull over why the extra weight you put on recently has been going nowhere despite the hour-long workouts.
If you’ve been struggling with a cluster of these symptoms on a regular basis, it could be time to introduce that thyroid gland of yours to the family doctor as you could be suffering from undiagnosed hypothyroidism.
Locating your thyroid is easy: the butterfly-shaped gland sits at the base of your neck, just below the Adam’s apple. This tiny organ produces thyroid hormones that affect all aspects of your metabolism, from maintaining the rate at which your body uses fats and carbohydrates, and helping to control your body temperature, to influencing your heart rate and regulating the production of proteins.
When the thyroid gland fails to produce enough hormones, hypothyroidism happens. It could be due to a number of reasons, including a hereditary autoimmune disease, or as a side effect of radiation therapy for the head and neck as treatment for cancer.
Hypothyroidism affects more women than men — if you’re a woman over 35, your chances of having hypothyroidism are high, simply because of a derangement in your immune system, the likelihood of which increases with age.
According to senior consultant endocrinologist Prof Dr Nor Azmi Kamaruddin, this is when the immune cells go “haywire” and start attacking the thyroid instead of protecting it.
“This happens more often in elderly women, where instead of recognising only viruses, bacteria and fungi as being foreign, the immune system starts seeing its own thyroid cells as being foreign as well, and begins attacking them. The result is an inactive thyroid gland, which leads to hypothyroidism,” he says.
Along with fatigue, weight gain and depression, other common symptoms of hypothyroidism can range from goitre, muscle aches, constipation, low sexual drive and high cholesterol, to high blood pressure, brittle hair and nails, and dry, flaky skin.
Some signs can also sound awfully like the usual womanly woes. Older women with an undiagnosed condition may easily mistake their thyroid problems for menopause symptoms. And if you’ve been having irregular periods or difficulty getting pregnant, your thyroid could be to blame.
Because many of its symptoms are often attributed to other medical conditions, hypothyroidism is often under-diagnosed. This can be dangerous, especially for pregnant women.
“It has been said that if a mother has severe hypothyroidism when she is pregnant, the baby that she is carrying is at risk of losing five IQ points every month. This means that when the baby is born, he or she will only have an IQ of 65 to 75, as compared to 120 for normal babies,” says Prof Nor Azmi, who is also the president of the Malaysian Endocrine and Metabolic Society.
Infants born with hypothyroidism may sometimes be blind or deaf, or go on to have severe intellectual impairment, he adds.
Thankfully, the incidence of newborns with congenital hypothyroidism in the country is rare — based on statistics by the Health Ministry, the occurrence is about one in every 2,500 live births.
While Malaysia has yet to develop a full-fledged national screening programme for this condition, up to 98% of newborns are currently being screened in over 240 Government facilities to rule out congenital hypothyroidism within the first week of birth. Up to 95% of private facilities also offer this early detection method, which, when combined with prompt treatment, can mitigate serious mental retardation in children.
Seeking early treatment
Getting tested for hypothyroidism is relatively simple: just walk into any clinic or diagnostic lab and request for a thyroid stimulating hormone (TSH) test.
If your results are indeed positive, treatment will be just as easy: you will be prescribed thyroid replacement hormones, in the form of oral thyroxine pills. The only drawback is that you will have to take the medication for life.
Hypothyroidism should not be confused with hyperthyroidism, which is when you have an overactive thyroid gland.
Hyperthyroidism is generally picked up more easily by doctors due to its specific symptoms: unexplained weight loss, hyperactivity, rapid heart rate, hand tremors and insomnia.
“Hypothyroidism often goes under the radar because you may blame your weight gain on all the nasi lemak you’ve been consuming; you might blame your depression on your spouse or children or boss at work.
“Patients with hyperthyroidism, on the other hand, tend to seek treatment earlier because of the peculiar symptoms, and the doctors too will be able to recognise the symptoms easily,” says Prof Nor Azmi.
An overactive thyroid is commonly treated with radioiodine, to be ingested as a drink or capsule. The dose of radioactivity in the radioiodine is harmless, but will shrink or render the thyroid gland incapable of further producing thyroid hormones.
Patients with hyperthyroidism will often transition into hypothyroidism, and will need the support of life-long thyroxine medication.
Both hypothyroidism and hyperthyroidism are easily treatable — the biggest challenge then comes in the form of “silent” sufferers who may not be aware that they have the condition.
Prolonged untreated hypothyroidism can lead to a number of serious complications. There’s goitre, epitomised by the swelling of the neck resulting from the enlargement of the thyroid gland. Although goitres are usually painless, an unusually large one can cause a cough and interfere with your swallowing and breathing.
Hypothyroidism is often linked with high cholesterol — leaving it untreated for too long can lead to an increased risk of heart disease.
In pregnancies, thyroid dysfunction gives rise to miscarriage, stillbirth and low birth weight.
Women who are on thyroid hormone replacement before pregnancy are advised to increase their daily dosage by up to 50% when pregnant, says Prof Nor Azmi.
The bottom line is: if someone in your family has thyroid issues, it is wise to get yours checked out as soon as possible.
“A female sibling of someone with hypothyroidism has a one in three risk of sharing the same condition. If you’re planning to conceive, or the moment you find out that you are pregnant, you should do a thyroid function test,” Prof Nor Azmi advises.
Elderly females with non-specific symptoms should also have their thyroids screened, he adds.
“Hypothyroidism is actually one of the easiest to treat among all the hormonal diseases. In fact, the biggest challenge in treating the condition is compliance from the patients, as it requires life-long therapy,” says Prof Nor Azmi.