Is my thyroid the problem?
Dear Dr Mitchell,
How can I know if I have a thyroid problem, and how is testing done? I am tired all the time and I can’t seem to keep the weight on, though I am not complaining. I Googled my symptoms and saw hyperthyroidism. But could this be what I have? The tiredness continues even though I take multivitamins and even if I have 10 hours of sleep each night. It’s just a weary feeling, and I seem to burn fat faster than everyone I know, even though I’m sedentary 99 per cent of the time.
An overactive thyroid gland can present with weight loss and feelings of exhaustion despite adequate rest. It can also present with palpitations (high pulse rate), changes in the eyes (bulging, prominent eyes and lagging of the eyelids). In some instances it can be also be associated with enlarged heart, high blood pressure and heart failure. Thinning of the hair and hair loss can also be a feature. In some individuals there is an obvious enlargement of the thyroid gland (goitre) which presents as a swelling in the front of the neck. In some cases the swelling goes down into the chest wall and is not very obvious (retrosternal goitre).
An overactive thyroid gland may be due to Graves’ disease. In this case there might not be any obvious swelling of the gland but the bulging eyes, lid lag, palpitations, and fine tremors of the hands usually cause the patient to present to the physician.
High levels of thyroid hormone speed up the body’s metabolism and cause weight loss despite adequate diet. Other causes of lethargy and weight loss should be explored and investigated. These include uncontrolled diabetes mellitus, malignancy in the lymphatic system, bowel malignancy, connective tissue disorder such as Systemic Lupus Erythematosis (SLE) or a compromised immune system as occurs in Human Immunodeficiency Virus (HIV) infection or Acquired Immunodeficiency Disease Syndrome (AIDS).
A complete physical examination should be done. Blood tests can be done to investigate whether you have a thyroid problem. A thyroid stimulating hormone (TSH) level can be done initially to avoid overinvestigation. If the TSH level is low, then this suggests that the gland is overproducing thyroid hormones (Hyperthyroidism), and a high TSH suggests that the thyroid gland is underproducing thyroid hormones (Hypothyroidism). If the TSH is abnormal, then a repeat blood test for a complete thyroid function test should be done. An ultrasound or CT scan of the neck can help to further evaluate the thyroid gland and detect a retrosternal goitre if this is present. Any suspicious nodule within the thyroid gland may also be detected, and a subsequent biopsy should be done to rule out a malignancy in the thyroid gland.
A complete blood count, blood glucose, and HIV test should also be done as a part of your investigation.
“If you, in fact, have a hyperthyroid, then this can be controlled with appropriate medication. In some cases radioactive iodine has to be used to control the symptoms. Removal of the thyroid gland partially or completely is done in some cases to control the symptoms. In this case replacement therapy with thyroxine is given. Consult your doctor who will advise you further.
Best wishes
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver. com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax 968-2025. Dr Mitchell cannot provide personal responses.
DISCLAIMER: The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
