Thyroid Problems

Kelly Anne Spratt, D.O., Director of Women's Cardiovascular Health at the University of Pennsylvania Presbyterian Medical Center, answers your questions.

Q. What are the symptoms of thyroid problems? Can they be found in a regular blood test? Is there a cure?

A. There are different kinds of thyroid problems. A person can have an underactive thyroid (hypothyroidism), where the gland produces too little hormone. Common symptoms include feeling tired, weight gain, constipation, dry skin, and brittle nails. Hyperthyroidism is an over-production of hormone, and can result in symptoms of weight loss, irritability, and irregular heartbeats. Either situation can be corrected and the diagnosis is made by a simple blood test measuring the thyroid stimulating hormone (TSH).

Hyperthyroidism can be treated surgically by removing the thyroid, burning it away with radioactive iodine, or using medications that enable the thyroid gland to ignore the stimulating signal. Hypothyroidism is treated with supplemental hormone, which, once begun, is usually continued indefinitely. By age 60, 17 percent of women and 9 percent of men have an underactive thyroid. Once the diagnosis is made, treatment is easy with a once-a-day medication, and patients feel much better once their amount of thyroid hormone is normal.

Thyroid cancer is a relatively rare condition. Diagnosis is done by a needle aspiration biopsy. Treatment is surgical removal and has a high success rate.

Q. My cholesterol is up to 260 and I have just been diagnosed with a sluggish thyroid. The doctor has prescribed a very low dosage of synthroid. He said to wait four to six weeks and he will repeat the blood work. If the synthroid dosage has to be increased to get the thyroid into a normal range, will that in any way cause or contribute to osteoporosis?

A. Hypothyroidism -- that is, too little thyroid activity -- affects 1 percent of the U.S. population and about 10 percent of those over 65. It can cause high cholesterol, high blood pressure, anemia, and nervous system problems. Treatment is absolutely necessary.

Your doctor is correct to adjust your blood level of medication to prevent "overshoot" of thyroid replacement. Excessive thyroid hormone can cause heart problems and bone loss. Fortunately, the vast majority of studies on this subject have shown that with careful monitoring, there is no decrease in bone density in women. Additionally, in elderly women, there was no increase in hip fracture among women who have osteoporosis and are taking thyroid hormone.

If your doctor feels you are at risk for osteoporosis, it is important to build up your bone mass with calcium (1500 mg a day) and weight bearing exercise. If you have gone through menopause, you should also consider hormone replacement therapy or other medicine like alendronate (Fosamax) which has been shown to prevent osteoporosis.


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