The hidden culprit
Feature published in Shifa News, January 2017 Translated by: Samana Syed
50 year old Musarrat Altaf was suffering from various health problems since the past 10 years. She sometimes experienced palpitations, other times her blood pressure would rise or breathing became difficult. The resident of Islamabad consulted many specialists at different times but only got temporary relief. None of them could identify the root cause. “The primetime of my life was spent combating various diseases,” says the patient. Doctors considered excess weight to be the culprit although it was a thyroid disorder.
According to a study published in PubMed, a health journal, thyroid disorders are the second most common endocrine disease after diabetes in the world. There is no specific data available in Pakistan however, news reports say around 15 percent people have thyroid problems around the world, more commonly among women. “Women tend to seek doctor’s help when it comes to menstrual irregularity or infertility and get diagnosed for the disorder,” says Dr Saeed Mahar, an endocrinologist at Liaquat National Hospital Karachi.
What thyroid is
Thyroid is a butterfly-shaped gland in front part of the neck usually where the tie is worn. It regulates major functions of the body. For instance, gastrointestinal, cardiovascular, and nervous system and maintains hormonal balance. Therefore, its derangement affects many critical functions.
According to Dr Osama Ishtiaq, an endocrinologist at Shifa International Hospital, Islamabad, “body cells need energy to carry out daily activities. This energy production process is controlled by the thyroid.” hypothyroidism is a condition that occurs when hormone production slows down resulting in reduced supply of energy. Similarly, when the metabolic activity increases with increase of hormone excretion, it is known as hyperthyroidism. Deficiency or excess of hormones can both be harmful for an individual.
Thyroid problems can occur at any age; even in newborns. However, hypothyroid is more common in those above 60 while hyperthyroid is mostly seen among 20 to 35 year olds. Though medical advancement and awareness has made diagnosing easy yet thyroid disorders remain under diagnosed. “Moreover, the symptoms are usually linked to other health problems. For instance, rapid heartbeat is usually associated to tension or high blood pressure. The actual problem is not identified until the symptoms become severe,” says Dr A H Aamir, president of Pakistan Endocrine Society. When left untreated, complications of thyroid problems become life threatening.
Deficiency of this hormone can particularly be harmful for women. So, “they must undergo a screening test if they experience menstrual irregularity or problems conceiving,” recommends Dr Saeed.
Delay in pregnancy, infertility, abortion, mental disability in babies may also be caused by thyroid malfunctioning,” warns Dr Osama.
Thyroid stimulating hormone (TSH) is the initial test to screen out thyroid disorder. “Many patients suffer from thyroid issues without being aware of it,” says Dr Osama. Some even get diagnosed for cancer in this way.
“We now pick a lot of thyroid cancers which were previously missed by GPs and internists,” adds Dr Saeed Mahar. However, detailed test is recommended in case of classic or serious symptoms.
Causes and prevention
Thyroid imbalance is mostly an autoimmune disorder. A patient’s body produces antibodies against the gland which further causes problems. Iodine deficiency and use of certain medicines are also some other causes. In 2013, a UNICEF report reveals that more than 35 million infants are at risk of disability and brain damage associated with iodine deficiency.
Regular intake of iodized salt enables the gland to start producing thyroxine hormone hence prevent major thyroid disorders. However, some associate iodized salt to family planning as well.
Dr Javeria Ahmad Noor, a gynecologist based in Islamabad says this is a misconception. “It has nothing to do with family planning, impotence or infertility. Iodine salt should be used in diets regularly as it helps prevent goiter and hypothyroidism.”
She further adds, “excessive iodine gets excreted out of the body. So there is nothing to worry about.”
Major diseases caused by thyroid malfunctioning are hypothyroidism, hyperthyroidism and goiter.
“Hypo” means beneath, below or low. Thyroid gland starts producing low number of hormones in this condition. As a result, less energy is provided to the body cells affecting their development and activity. Iodine deficiency or inflammation can cause this problem. However, it can also be a reaction to hyperthyroidism. Reduction in hormones can also cause anger, anxiety, restlessness and even psychosis (mental commotion) and depression,” says Dr Saniya Akhtar, a psychiatrist at KRL hospital, Islamabad.
Hypothyroidism lowers the chances of conceiving. However, it can also occur after pregnancy. Other than disturbing the menstrual cycle, it can cause weakness, laziness, excess weight and sleep, body swelling, fatigue, slow heartbeat, skin dryness, low appetite, cold, dizziness and constipation. “It may affect the unborn baby’s mental development causing mental disability or reduction in IQ level,” says Javeria.
The disorder is treated using thyroxine hormone. Its tablets however, must be taken only after doctor’s consultation as their overuse may cause hyperthyroidism.
“Hyper” means excessive or something which is more than the normal level. This condition occurs when the thyroid gland begins secreting more hormones than normal. Weight loss, hypertension, excessive sweating, rapid heartbeat, increased appetite, shaky hands, anxiety and hot flashes are some of its main symptoms.
According to Dr Javeria, the condition is harmful for pregnant women. “Globally, one pregnant woman in 1500 gets hyperthyroidism. It tends to increase her blood pressure, putting her placenta at risk of separating at anytime.” This complication occurs if a blood clot is produced behind the placenta, forcing an immediate childbirth. It may even cause excessive blood loss after delivery.
The disorder is treated using tablets, radioactive iodine capsules/injection or surgery. Tablets help stop the over activity and over flow of hormones. But their excess usage can also cause hypothyroidism. Therefore, must be taken with a doctor’s consultation only. Radioactive iodine capsule or injection is the second treatment method. And surgery is the last option in which the gland is removed.
“Excess of hormones is much more harmful than its deficiency. In such case, patients are given these hormones externally,” says Dr Osama.
The swollen form of thyroid is called goiter. The neck seems to swell from the area of the gland. According to Dr Osama, it is the most common disease in the northern areas of Pakistan and is usually caused due to iodine deficiency. The gland is removed immediately after surgery in case it increases in size. “It is a dangerous condition that puts pressure on the windpipe causing breathing issues.”
Thyroid malfunctioning in any form is painful. And unfortunately, there is nothing much that can be done to prevent them, except overcoming iodine deficiency. Therefore, check with a doctor if you have unexplained tiredness, weight loss or gain, diabetes, family history, or stress. Know your hidden culprit before it is too late.