A Misbehaving Thyroid Can Bring Plenty of Problems

Fatigued or Full Throttle: Is Your Thyroid to Blame?
Understanding Thyroid Problems -- Symptoms and Treatments

By Debra Fulghum Bruce,MD

FeatureReviewed by Brunilda Nazario, MD

Feeling all revved up, even at bedtime? Or maybe your throttle's on idle with symptoms of depression, fatigue, and weight gain. In both cases, the root cause may be your thyroid.

The thyroid -- a butterfly-shaped gland in the front of your neck -- makes hormones that control the way your body uses energy. Your thyroid controls your metabolism, which is how your body turns food into energy, and also affects your heart, muscles, bones, and cholesterol.

While thyroid disorders can range from a small, harmless goiter (enlarged gland) to life-threatening cancer, the most common thyroid problems involve an abnormal production of thyroid hormones. Too much of these vital body chemicals results in a condition known as hyperthyroidism. Too little hormone production leads to hypothyroidism.

Although the effects of thyroid problems are unpleasant or uncomfortable, most thyroid conditions can be managed well if properly diagnosed and treated.

What is an overactive thyroid?
Hyperthyroidism happens when the thyroid becomes overactive and produces too much of its hormones. Hyperthyroidism affects women five times to 10 times more often than men, and is most common in people younger than 40. People with hyperthyroidism have problems that reflect overactivity of the organs of the body, resulting in symptoms such as sweating, feeling hot, rapid heartbeats, weight loss, and sometimes eye problems.

Hyperthyroidism can occur in several ways:

Graves' disease : The release of excess hormones is triggered by an autoimmune disorder. For some unknown reason, the body attacks the thyroid, causing it to spill out too much hormone.

Toxic adenomas: Nodules (abnormal growths or lumps) develop in the thyroid gland and begin to secrete thyroid hormones, upsetting the body's chemical balance; some goiters may contain several of these nodules.

Subacute thyroiditis: Painful inflammation of the thyroid causes the gland to enlarge and "leak" excess hormones, resulting in temporary hyperthyroidism, which resolves spontaneously. Subacute thyroiditis generally lasts a few weeks but may persist for months.

Pituitary gland malfunctions or cancerous growths in the thyroid gland: Although rare, hyperthyroidism can also develop from these causes.

Silent thyroiditis: Usually a temporary state of excess thyroid hormone release causing mild hyperthyroidism. In some cases it can result in permanent damage to the thyroid and low thyroid hormone production by the gland.

Postpartum thyroiditis: A type of hyperthyroidism that occurs in a small percentage of women within months of delivery. It last only a few months, followed by a several months of reduced amounts of thyroid hormone production by the gland. Typically these women fully recover normal thyroid function.

Ingestion of excess thyroid hormone can result in hyperthyroidism.

What is an underactive thyroid?
Hypothyroidism, by contrast, stems from an underproduction of thyroid hormones. Since your body's energy production requires certain amounts of thyroid hormones, a drop in hormone production leads to lower energy levels, causing you to feel weak and tired.

What is an underactive thyroid?
Approximately 25 million people suffer with hypothyroidism and about half are undiagnosed. Older adults -- particularly women -- are more likely to develop hypothyroidism than younger adults. Hypothyroidism also tends to run in families.

If hypothyroidism is not treated, it can raise your cholesterol levels and make you more likely to have a heart attack or stroke. During pregnancy, untreated hypothyroidism can harm your baby. Luckily, hypothyroidism is easy to treat.

Causes of hypothyroidism may include:

Hashimoto's thyroiditis: In this autoimmune disorder, the body attacks thyroid tissue. The tissue eventually dies and stops producing hormones. Other autoimmune disorders occur with this condition and other family members may also be affected by this condition.

Removal of the thyroid gland: The thyroid may be surgically removed or chemically destroyed as treatment for hyperthyroidism.

Exposure to excessive amounts of iodide: The heart medicine amiodarone may expose you to too much iodine. Radioactive iodine treatment for hyperthyroidism can also result in hypothyroidism. You may be at greater risk for developing hypothyroidism, especially if you have had thyroid problems in the past.

Lithium: This drug has also been linked as a cause of hypothyroidism.

If left untreated for a long period of time, hypothyroidism can bring on a myxedema coma, a rare but potentially fatal condition that requires immediate hormone injections.

How is hyperthyroidism diagnosed?
Your doctor will ask you about your symptoms and do a physical exam. Then he or she will order blood tests to see how much thyroid hormone your body is making. In addition, your doctor may discover that you have hyperthyroidism while doing a test for another reason.

Signs and Symptoms:

-You may feel nervous, moody, weak, or tired.
-Your hands may shake, your heart may beat fast, or you may have problems breathing.
-You may be sweaty or have warm, red, itchy skin.
-You may have more bowel movements than usual.
-You may have fine, soft hair that is falling out.
-You may lose weight even though you eat the same or more than usual.

How is hypothyroidism diagnosed?
Your doctor will ask questions about your symptoms. You will also have a physical exam. If your doctor thinks you have hypothyroidism, a simple blood test can show if your thyroid hormone level is too low.

Signs and Symptoms

-You may feel tired, weak, and/or depressed.
-You may have dry skin and brittle nails.
-You may have difficulty standing cold temperatures.
-You may have constipation.
-You may experience memory problems or trouble thinking clearly.
-You may have heavy or irregular menstrual periods.

Symptoms of hypothyroidism occur slowly over time. At first you might not notice these symptoms. Or you might mistake them for normal aging. This is not normal aging. See your doctor if you have symptoms like these that get worse or won't go away.

Pregnancy, which requires an increased production of thyroid hormone, can cause hypothyroidism. About 2% of pregnant women in the United States get hypothyroidism.

How is hyperthyroidism treated?
Hyperthyroidism is easily treated. With treatment, you can lead a healthy life. Without treatment, hyperthyroidism can lead to serious heart problems, bone problems, and a dangerous condition called thyroid storm.

If your symptoms bother you, your doctor may give you pills called beta-blockers. These can help you feel better while you and your doctor decide what your treatment should be. Even if your symptoms do not bother you, you still need treatment, because hyperthyroidism can lead to more serious problems.

Radioactive iodine and anti-thyroid medicine are the treatments doctors use most often. The best treatment for you will depend on a number of things, including your age. Some people need more than one kind of treatment.

After treatment, you will need regular blood tests. These tests check to see if your hyperthyroidism has come back. They also check to see if you are making enough thyroid hormone. Sometimes treatment cures hyperthyroidism but causes the opposite problem-too little thyroid hormone. If this happens, you may need to take thyroid hormone pills for the rest of your life.

How is hypothyroidism treated?
Doctors usually prescribe thyroid hormone pills to treat hypothyroidism. Most people start to feel better within a week or two. Your symptoms will probably go away within a few months. But you will likely need to keep taking the pills for the rest of your life.

In most cases, thyroid hormone medication works quickly to correct symptoms. People with hypothyroidism who take thyroid hormone medication usually notice:

Improved energy level.
Gradual weight loss (in people with severe hypothyroidism at the time of diagnosis).
Improved mood and mental function (thinking, memory).
Improved pumping action of the heart and improved digestive tract function.
Reduction in the size of an enlarged thyroid gland (goiter), if you have one.
Lower cholesterol and triglyceride levels.
It's important to take your medicine just the way your doctor tells you to. You will also need to see your doctor for follow-up visits to make sure you have the right dose. Getting too much or too little thyroid hormone can cause problems.

If you have mild (subclinical) hypothyroidism, you may not need treatment now. But you'll want to watch closely for signs that it is getting worse.

Thyroid disease or menopause?
According to the American Association of Clinical Endocrinologists (AACE), millions of women with unresolved menopausal-like symptoms, even those taking estrogen, may be suffering from undiagnosed thyroid disease. While symptoms such as fatigue, depression, mood swings, and sleep disturbances are frequently associated with menopause, they may also be signs of hypothyroidism.

A survey done by the AACE showed that only one in four women who have discussed menopause and its symptoms with a physician was also tested for thyroid disease. The thyroid plays a role in regulating overall body metabolism and influences the heart, brain, kidney, and reproductive system, along with muscle strength and appetite.

If you are experiencing symptoms of menopause and the symptoms persist despite appropriate therapy, ask your doctor to do a thyroid screen (TSH). A blood sample is all that is needed to make the initial diagnosis of hypothyroidism and treatment is easily achieved with thyroid replacement therapy.

What about thyroid cancer?
Cancer of the thyroid gland is quite rare and occurs in less than 10% of thyroid nodules. You might have one or more thyroid nodules for several years before they are determined to be cancerous. People who have received radiation treatment to the head and neck earlier in life, possibly as a remedy for acne, tend to have a higher-than-normal propensity for thyroid cancer.

Signs and Symptoms:

-You may get a lump or swelling in your neck. This is the most common symptom.
-You may have pain in your neck and sometimes in your ears.
-You may have trouble swallowing.
-You may have trouble breathing or have constant wheezing.
-Your voice may be hoarse.
-You may have a frequent cough that is not related to a cold.
-Some people may not have any symptoms. Their doctors may find a lump or nodule in the neck during a routine physical exam.

Most people who have treatment for thyroid cancer do very well, because the cancer is usually found early and the treatments, including surgery, work well. Once treated, thyroid cancer rarely returns.

Wheezing With Colds Raises Risk of Asthma

Wheezing With Colds Raises Risk of Asthma
Rhinovirus-Related Wheeze Big Risk Factor in Kids

WebMD Health NewsReviewed by Louise Chang, MD Oct. 1, 2008 -- Infants and toddlers who wheeze when they are sick with colds have a big risk of developing asthma later in childhood, a new study shows.

Wheezing with rhinovirus infection during the first three years of life was associated with a tenfold increase in asthma risk by age 6, researchers from the University of Wisconsin report.

Nearly 90% of the children in the study who wheezed with rhinovirus infection during their third year of life had a diagnosis of asthma three years later.

There are more than 100 identified rhinoviruses that are known to cause colds, but until now, these viruses have not been strongly associated with asthma risk, the study's principal investigator tells WebMD.

Instead, much attention has been focused on another common infectious agent, known as respiratory syncytial virus (RSV). Young children who are hospitalized with RSV infections have a high risk of developing asthma later in childhood.

"When we started this study we fully expected to find that RSV was the big culprit, but that is not what we found," says Robert F. Lemanske Jr., MD.

Colds, Wheezing, and Asthma
Wheezing occurs as a result of airway narrowing, and it is characterized by a whistling sound in the lungs during breathing.

As many as half of children will wheeze with respiratory illness at some point during their first three years of life, but many of them will not go on to develop asthma.

Early respiratory illness is a well-recognized risk factor for childhood asthma, but the impact of specific respiratory viruses on the airway disorder is not well understood.

In an effort to better understand the relationship between virus illness and childhood asthma, Lemanske and colleagues closely followed 259 children from birth through their sixth birthdays.

The children were considered at high risk for developing asthma because one or both parents had asthma or respiratory allergy.

By age 6, 28% of the children had been diagnosed with asthma.

Children who wheezed while sick with colds during the first year of life were three times more likely than children who did not wheeze while sick to develop the respiratory disease.

Wheezing with rhinovirus infection during the second year of life was associated with a sixfold increase in asthma risk, and wheezing with infection during the third year of life increased asthma risk about 30-fold.

By comparison, wheezing with RSV infection during the first three years of life was associated with a threefold increase in asthma risk, and RSV-associated wheezing during the third year increased asthma risk tenfold.

Wheezing with rhinovirus infection was identified as the most significant predictor of asthma in these high-risk children.

Wheezing With Colds Should Raise Suspicion
The next step, Lemanske says, is to examine specific rhinoviruses to see if some are more closely linked to asthma risk than others.

"Not everybody who gets a cold develops asthma," he says. "Are there certain strains that are more pathologic? We don't know."

He adds that the message to parents and pediatricians is that any wheezing associated with respiratory illness should raise suspicions about asthma.

"We would argue that kids who wheeze with rhinovirus need to be followed closely," Lemanske says.

American Thoracic Society past president John Heffner, MD, agrees.

"We have known that respiratory infections that lead to hospitalization are associated with increased asthma risk in children," he tells WebMD. "But now we know that the risk extends to common infections that don't often lead to hospitalization."

View Article Sources
SOURCES:

Jackson, D.J. American Journal of Respiratory and Critical Care Medicine, Oct. 1, 2008; vol 178: pp 667-672.

Robert F. Lemanske Jr., head of the division of pediatric allergy, immunology and rheumatology; professor of pediatrics and medicine, University of Wisconsin School of Medicine and Public Health, Madison.

John Heffner, MD, chair of medicine, Providence Portland Medical Center, Portland, Ore.; past president, American Thoracic Society.

15 Foods to Help You Lose

15 Foods To Help You Lose

By Denise Foley

Want To Curb Your Appetite And Stop Sugar Cravings? Then Put These On Your Grocery List.

Thirty billion a year -- that's about how much Americans spend on slim-down products, many of which don't even work. A better way to get real weight-loss results? Go grocery shopping. New research points to more than a dozen foods, from beans to beef, that can help you fight hunger, kick your candy addiction, boost your metabolism-and ultimately shed pounds. And some of these superfoods deliver health bonuses too.

1. Eggs. Skip the bagel this morning. Eggs, which are full of protein, will help you feel fuller longer-a lot longer. A multicenter study of 30 overweight or obese women found that those who ate two scrambled eggs (with two slices of toast and a reduced-calorie fruit spread) consumed less for the next 36 hours than women who had a bagel breakfast of equal calories. Other research has shown that protein may also prevent spikes in blood sugar, which can lead to food cravings.

2. Beans. You've probably never heard of cholecystokinin, but it's one of your best weight-loss pals. This digestive hormone is a natural appetite suppressant. So how do you get more cholecystokinin? One way, report researchers at the University of California at Davis, is by eating beans: A study of eight men found that their levels of the hormone (which may work by keeping food in your stomach longer) were twice as high after a meal containing beans than after a low-fiber meal containing rice and dry milk. There's also some evidence that beans keep blood sugar on an even keel, so you can stave off hunger longer. Heart-health bonus: High-fiber beans can lower your cholesterol.

3. Salad. Do you tend to stuff yourself at meals? Control that calorie intake by starting with a large salad (but hold the creamy dressing). In a study of 42 women at Penn State University, those who ate a big, low-cal salad consumed 12 percent less pasta afterward-even though they were offered as much as they wanted. The secret, say researchers, is the sheer volume of a salad, which makes you feel too full to pig out. Health bonus: A study published in the Journal of the American Dietetic Association found that people who ate one salad a day with dressing had higher levels of vitamins C and E, folic acid, lycopene, and carotenoids-all disease fighters-than those who didn't add salad to their daily menu.

4. Green tea. The slimming ingredient isn't caffeine. Antioxidants called catechins are what help speed metabolism and fat burning. In a recent Japanese study, 35 men who drank a bottle of oolong tea mixed with green tea catechins lost weight, boosted their metabolism, and had a significant drop in their body mass index. Health bonus: The participants also lowered their (bad) LDL cholesterol.

5. Pears. They're now recognized as having more fiber, thanks to a corrected calculation by the U.S. Food and Drug Administration. At six grams (formerly four grams) per medium-size pear, they're great at filling you up. Apples come in second, with about three grams per medium-size fruit. Both contain pectin fiber, which decreases blood-sugar levels, helping you avoid between-meal snacking. This may explain why, in a Brazilian study that lasted 12 weeks, overweight women who ate three small pears or apples a day lost more weight than women on the same diet who ate three oat cookies daily instead of the fruit.

6. Soup. A cup of chicken soup is as appetite blunting as a piece of chicken: That was the finding of a Purdue University study with 18 women and 13 men. Why? Researchers speculate that even the simplest soup satisfies hunger because your brain perceives it as filling.

7. Lean beef. It's what's for dinner-or should be, if you're trying to shed pounds. The amino acid leucine, which is abundant in proteins like meat and fish as well as in dairy products, can help you pare down while maintaining calorie-burning muscle. That's what it did for 24 overweight middle-aged women in a study at the University of Illinois at Urbana-Champaign. Eating anywhere from nine to 10 ounces of beef a day on a roughly 1,700-calorie diet helped the women lose more weight, more fat, and less muscle mass than a control group consuming the same number of calories, but less protein. The beef eaters also had fewer hunger pangs.

8. Olive oil. Fight off middle-age pounds with extra virgin olive oil. A monounsaturated fat, it'll help you burn calories. In an Australian study, 12 postmenopausal women (ages 57 to 73) were given a breakfast cereal dressed either with a mixture of cream and skim milk or half an ounce of olive oil and skim milk. The women who ate the oil-laced muesli boosted their metabolism. Don't want to add olive oil to your oatmeal? That's OK-it works just as well in salad dressings, as a bread dip, or for sautéing.

9. Grapefruit. It's back! A 2006 study of 91 obese people conducted at the Nutrition and Metabolic Research Center at Scripps Clinic found that eating half a grapefruit before each meal or drinking a serving of the juice three times a day helped people drop more than three pounds over 12 weeks. The fruit's phytochemicals reduce insulin levels, a process that may force your body to convert calories into energy rather than flab.

10. Cinnamon. Sprinkle it on microwave oatmeal or whole-grain toast to help cure those mid-afternoon sugar slumps. Research from the U.S.
Department of Agriculture found that a little cinnamon can help control post-meal insulin spikes, which make you feel hungry. Health bonus: One USDA study showed that just a quarter teaspoon of cinnamon a day lowered the blood sugar, cholesterol, and triglyceride levels in people with type 2 diabetes.

11. Vinegar. It's a great filler-upper. In a Swedish study, researchers found that people who ate bread dipped in vinegar felt fuller than those who had their slices plain. The probable reason: Acetic acid in the vinegar may slow the passage of food from the stomach into the small intestine, so your tummy stays full longer. Vinegar can also short-circuit the swift blood-sugar rise that occurs after you eat refined carbs such as white bread, cookies, and crackers.

12. Tofu. It seems too light to be filling, but a study at Louisiana State University showed that tofu does the job. Researchers tested it against chicken as a pre-meal appetizer for 42 overweight women-and the participants who had tofu ate less food during the meal. The secret: Tofu is an appetite-quashing protein.

13. Nuts. Yes, they are fattening: A handful of peanuts is about 165 calories. But research shows that people who snack on nuts tend to be slimmer than those who don't. A study from Purdue University found that when a group of 15 normal-weight people added about 500 calories worth of peanuts to their regular diet, they consumed less at subsequent meals. The participants also revved up their resting metabolism by 11 percent, which means they burned more calories even when relaxing. Health bonus: Walnuts contain omega-3 fatty acids. And researchers at Loma Linda University recently found that eating 10 to 20 whole pecans daily can reduce heart disease risks.

14. High-fiber cereal. Studies show that you can curb your appetite by eating a bowl for breakfast. But how well does it really work? Researchers at the VA Medical Center and the University of Minnesota in Minneapolis tested the theory against the ultimate diet challenge: the buffet table. They gave 14 volunteers one of five cereals before sending them out to the smorgasbord. Those who'd had the highest-fiber cereal ate less than those who didn't have as much fiber in the morning. Try General Mills Fiber One (14 grams per serving) or Kellogg's All Bran With Extra Fiber (13 grams per serving).

15. Hot red pepper. Eating a bowl of spicy chili regularly can help you lose weight. In a Japanese study, 13 women who ate breakfast foods with red pepper (think southwestern omelet) ate less than they normally did at lunch. The magic ingredient may be capsaicin, which helps suppress appetite