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When butterfly-shaped gland flutters, something's amiss

Air Force Airman 1st Class Julia Maldonado, a medical laboratory technician, tests a blood sample at Joint Base Langley-Eustis, Virginia. Thyroid disease is diagnosed by a test that checks the amount of thyroid-stimulating hormone, or TSH, in a patient’s blood. (U.S. Air Force photo by Staff Sgt. Teresa J. Cleveland) Air Force Airman 1st Class Julia Maldonado, a medical laboratory technician, tests a blood sample at Joint Base Langley-Eustis, Virginia. Thyroid disease is diagnosed by a test that checks the amount of thyroid-stimulating hormone, or TSH, in a patient’s blood. (U.S. Air Force photo by Staff Sgt. Teresa J. Cleveland)

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Conditions and Treatments

FALLS CHURCH, Va. — Mood changes, unexplained weight gain or loss, and frequently feeling too hot or too cold can be signs of any number of health issues. But as many women are discovering, these also are signs of thyroid disease.

Thyroid disease is more common in women than men, according to the Centers for Disease Control and Prevention, and it’s also more prevalent in older people. As many as 30 million Americans have thyroid disease, according to the American Association of Clinical Endocrinologists, and half of these cases may go undiagnosed.

Because of enhanced awareness, “More and more Military Health System providers are ordering thyroid testing when assessing patients, and more and more patients are asking providers if their symptoms are related to the thyroid,” said Army Maj. Kate Kinnaird, an endocrinologist at Fort Belvoir Community Hospital in Virginia.

“So we’re screening more for thyroid disorder than we used to,” she said, “and we’re detecting more and more cases of thyroid dysfunction.”

The thyroid is a butterfly-shaped gland at the base of the throat. The pituitary gland sparks it by releasing thyroid-stimulating hormones, or TSH. The thyroid then sends its own hormones into the bloodstream to regulate physical energy, body temperature, weight, and mood.

“When a patient presents with depression or anxiety, one of the first things we do is a thyroid test,” said Army Reserve Lt. Col. Amanda Cuda, a family medicine physician who’s serving as an assistant professor at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.

“We want to make sure the thyroid isn’t a component, especially if someone hasn’t had depression or anxiety previously,” she said.

A simple blood test diagnoses thyroid disease. If a patient’s TSH level is high, the pituitary gland is trying to stimulate an underactive thyroid, or hypothyroid. Symptoms include dry skin, hair loss, difficulty concentrating, and weight gain.

If the TSH level is low, the pituitary gland is trying to slow down an overactive thyroid, or hyperthyroid. Symptoms include rapid heartbeat, weight loss, nervousness, and irritability.

A study published in the October 2012 issue of Medical Surveillance Monthly Report found increased rates of thyroid disorders among U.S. military members during a 10-year period ending in 2011. The study’s authors note the  higher rates may be linked to increased testing of service members with symptoms including depression, sleep disorders, and menstrual and fertility problems, all of which have been linked to thyroid disease.

“We don’t fully understand why more women than men have thyroid disease,” Kinnaird said. One possible reason is that most thyroid disorders are autoimmune-based, and autoimmune diseases are more common in women than in men.

“Think of an autoimmune disease as the body fighting against itself,” Cuda said. Autoimmune hyperthyroidism is also known as Graves disease. Autoimmune hypothyroidism is called Hashimoto’s disease.

“There’s also been an increase in autoimmune disorders in society in general,” Cuda said. “Just about everything you can think of might trigger a thyroid disorder in someone who has a family history, including dietary changes, smoking, stress, a viral infection, or environmental exposures.”

Other causes of thyroid disorders include iodine deficiency, which is uncommon in the United States, and having had head and neck radiation.

For patients with an underactive thyroid, physicians prescribe replacement thyroid hormone medication. An overactive thyroid is less common. In those cases, treatment options vary, depending on what’s causing it. “Some forms of hyperthyroidism resolve on their own,” Kinnaird said, “and some require treatment with medication, radioactive iodine, or thyroid surgery.”

Untreated, thyroid disease can lead to a number of serious health issues, including elevated cholesterol levels and high blood pressure. Pregnant women, and women up to a year after childbirth, also can develop thyroid issues, Kinnaird said. The thyroid can become overactive or underactive, or sometimes a hyperthyroid phase is followed by a hypothyroid phase. Usually, these dysfunctions resolve on their own, she said.

Also, all newborns are screened for congenital hypothyroidism, Cuda said. Untreated, it can cause growth and developmental delays.

Thyroid cancer is three times more common in women than in men, according to the CDC. But the death rate is very low compared to other cancers.

“The good news is that most thyroid problems can be detected and treated,” Cuda said.

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