Why You Could Have Thyroid Disease and Not Know It

You May Be Overlooking the Subtle Signs of Thyroid Disease

By Parveen Verma, DO, Virtua Endocrinologist
Virtua Endocrinology – Cherry Hill

Despite how common it is, thyroid disease isn’t a health topic that often makes headlines. However, the American Thyroid Association estimates that 20 million Americans have hormonal imbalances from thyroid disorders, and up to 60 percent of those people will go undiagnosed. The bad news for women is that 1 in 8 will develop a thyroid disorder at some point in life.

While there are many effective treatments for thyroid problems, getting to a diagnosis is sometimes a challenge. The most common thyroid issues are hypo- or hyperthyroidism, and some of their symptoms can appear like signs of normal aging, including:

  • Constipation
  • Fatigue
  • Irritability
  • Memory lapses
  • Sleep problems
  • Thinning hair
  • Weight gain 

If you have these symptoms, your primary care provider (PCP) can order a simple blood test to measure your thyroid levels.

What does the thyroid do?

The thyroid is a tiny neck gland that plays a significant role in the body. This is how it works:

  • The thyroid gland takes iodine found in many foods and converts it into thyroid hormones, called T3 and T4.
  • Every human cell depends on thyroid hormones to regulate metabolism (converting oxygen and calories to energy).
  • Two other glands, the pituitary and the hypothalamus, use hormones called TSH and TRH to continually communicate with the thyroid—measuring and stimulating the release or decrease of T3 and T4 hormones, depending on the body’s needs.

Symptoms and causes of hypo- and hyperthyroid disease

Hypothyroidism, or an underactive thyroid gland, is the most common thyroid condition. When you have hypothyroid, your normal body function will slow down. In its early stages, hypothyroid symptoms may not be obvious. However, more symptoms can appear over time, including:

  • Constipation
  • Depression
  • Dry hair, skin, or nails
  • Extreme fatigue or drowsiness
  • Sore muscles  
  • Weight gain or fluid retention

Determining the exact cause of hypothyroidism can be tricky, but the most common causes include:

  • Autoimmune disease
  • Congenital hypothyroidism (hypothyroid present at birth)
  • Damage to the pituitary gland
  • Inflammation of the thyroid (thyroiditis)
  • Medicines that prevent the thyroid from making normal amounts of hormones
  • Radiation treatment
  • Rare disorders that can impair thyroid function
  • Surgical removal of the thyroid
  • Too much or too little iodine in your diet

Hyperthyroidism, or an overactive thyroid gland, develops when the body produces high levels of thyroid hormone. This disorder affects women 5 to 10 times more often than men. As with hypothyroid, the symptoms may not initially appear to be thyroid-related.

Hyperthyroid symptoms include:

  • Anxiety or irritability
  • Diarrhea
  • Fast heart rate (palpitations or heart racing)
  • Frequent perspiration
  • Hair loss
  • Trembling hands
  • Unexplained weight loss

Some causes of hyperthyroidism include:

  • Graves’ disease (a disease that causes the thyroid to secrete too much thyroid hormone)
  • One or more nodules in the thyroid
  • A viral infection that affects the normal function of the thyroid gland
  • Overmedication with a thyroid hormone

Having a family history of thyroid disorders raises your risk, as well as having a family history of autoimmune diseases such as Graves's disease, Hashimoto's disease, lupus, or rheumatoid arthritis.

What to know about testing  

Your PCP can order blood tests during your annual physical to check your TSH and other thyroid hormone levels. Your PCP may refer you to an endocrinologist if your symptoms are difficult to diagnose or hard to manage. Endocrinologists specialize in managing thyroid disease and other metabolic disorders like diabetes, pituitary or adrenal gland disorders, and reproductive disorders.

Acceptable levels or “reference ranges” of TSH can vary from lab to lab. Currently, the “normal” reference range for TSH levels is .4 to 4.5 in U.S. labs. However, TSH is a screening test, meaning further testing may be needed to make a definitive diagnosis.

Thyroid ultrasound and imaging scans look at gland size and nodules. And radioactive nuclear imaging shows hot or cold spots in the glands and increased or decreased activity.

Don’t wait to seek a diagnosis

If you’re feeling symptoms, schedule an appointment with your primary care doctor for testing. Treatment depends on the type of thyroid disorder you have. The good news is that you can get back to feeling better soon after starting treatment.

If you need specialty care, find a Virtua endocrinologist near you and schedule an appointment online today.

Updated October 11, 2021

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