Understanding the complexities of treating the thyroid

As a person ages, it’s common to experience weight gain and fatigue, but sometimes these changes can be a sign that the body isn’t working the way it should. Such was the case with Christine Ciletti of Boca Raton.

Cilleti, 68, was diagnosed with thyroid cancer in 2002.

Cilleti, 68, often felt tired, very tired.

“I would fall asleep in the middle of my own sentence,” she said. “I was being checked for narcolepsy, but of course I didn’t have narcolepsy.”

With a negative diagnosis for narcolepsy behind her, Cilleti approached her physician in search of the underlying cause of her exhaustion.

“He found that I had a lump in my neck. He had no idea what it was. He ordered an ultrasound and biopsy and I found out [I had cancer] right there while I was on the biopsy table,” said Cilleti, who was diagnosed with thyroid cancer in 2002.

Thyroid disease is far more common in women than in men. Conditions that particularly affect women are hyperthyroidism (overactive thyroid), hypothyroidism (underactive thyroid), thyroid nodules, thyroid cancer and goiters, an abnormally enlarged thyroid gland.

“Women are more likely to have thyroid disease, depending on the study, five to eight times more than men,” said Dr. Sabina Casula, assistant professor of medicine in the Division of Endocrinology, Diabetes and Metabolism at the University of Miami Miller School of Medicine. “The reason this occurs is not well understood, but it’s more common also in the same family, so there is definitely a genetic disposition to thyroid disease.”

One shouldn’t immediately assume they have thyroid cancer, as it’s not a very common outcome. According to Casula, only 5 percent of patients who have nodules will end up being diagnosed with thyroid cancer.

The thyroid is a gland found at the base of the neck, just below the Adam’s apple. It produces hormones that regulate the body’s metabolism. The two most common thyroid problems are over-secretion of thyroid hormones (hyperthyroidism) and under secretion (hypothyroidism).

According to the U.S. Department of Health and Human Services, symptoms of hypothyroidism tend to develop slowly, often over several years. At the onset of hypothyroidism, a patient may just feel tired, but as the disease progresses, the person may begin to feel other symptoms of a slowed-down metabolism, including weight gain (even though the person may not be eating more food), constipation, muscle or joint pain, muscle weakness and depression.

Hashimoto’s Disease, the most common cause of hypothyroidism, is an autoimmune disease in which the immune system mistakenly attacks the thyroid and causes it to underproduce hormones.

When a patient is experiencing symptoms of a poorly functioning thyroid gland, doctors should perform both a physical exam as well as an ultrasound to check the area, because palpating with the fingers alone isn’t accurate enough and a lab test may not reveal the cancer, Casula said.

When Cilleti was diagnosed with cancer, the treatment was relatively simple and she quickly felt better. But Cilleti did have to have her thyroid gland removed.

“My thyroid was replaced with thyroid hormones, and I never felt so good,” she said.

The doctor who treated Cilletti, Dr. Richard Mack Harrell, an endocrinologist with Memorial Regional Hospital, said thyroid under-function is a very common problem, and it’s essential the doctor prescribe the patient with the correct dosage of thyroid hormones.

Occasionally, however, a doctor may overtreat the thyroid gland, he said. This stems from a doctor overestimating how much thyroid hormone a patient needs because he doesn’t believe the results of a Thyroid Stimulation Hormone (TSH) test, the lab test used by endocrinologists to see if the thyroid is working properly.

The test results should fall between 0.5 and 5.0 “If the TSH test is less than 0.4, it’s a pretty good sign that the brain thinks you’re getting too much hormone,” Harrell said.

Dr. Maryanne Samuel, an internist with Baptist Health Medical Group, agrees with Harrell’s treatment indications.

“We have a saying that says, ‘Start low and go slow,’ because every medication has side effects,” she said. “So for example, we’ll start with a low dose [of thyroid hormones] because we don’t want them to feel palpitations.”

In addition, Samuel suggested that patients continue to see their endocrinologist every six to eight weeks until a stable pattern emerges.

Patients should check in with their doctors if they are pregnant, planning to get pregnant, or if they’ve recently experienced significant weight change because the prescribed hormone levels are based on a person’s weight.

A person with an overactive thyroid gland, or hyperthyroidism, will feel like they’ve had “one too many cups of coffee,” said Harrell. In the long term, the condition can lead to atrial fibrillation and osteoporosis.

Harrell said that most endocrinologists like to give the T4 [hormone] because the body then decides how much T3 to make. “When you start giving T3, you’re making the assumption that you know more than the body,” Harrell said. T3 is the hormone that, when given too much, causes a person to feel sweaty, nervous and lose weight.

“The best doctor doesn’t just look at a number on a test, he also listens to the patient,’’ Harrell said.

Harrell said patients should be weary of doctors who claim to take a “more natural approach” to thyroid hormone imbalances. In addition to synthetic hormones, some doctors offer Armour Thyroid, or thyroid hormones that come from a pig.

“It’s only natural if you happen to think that hogs are similar to people,” Harrell said. “The same people who make your hotdogs, take the thyroid out of the hogs and mash them up and sell them to the industry.”

While Harrell himself will occasionally prescribe Armour Thyroid, he warned to be careful of doctors who only treat with Armour Thyroid because, “Armour Thyroid has both T4 and T3 in it, so you get a little bit of a jolt from it, and some people like that,” he said.