by Jennifer Wider, MD
of the Society for Women's Health Research
First, it was Oprah's book club. Then it was a campaign to build new schools to educate impoverished women and children around the globe. It seemed everywhere media mogul and American talk-show host Oprah Winfrey led, people would follow. Now, she's shifting her attention to thyroid disease, after she decided to go public about her own recent diagnosis.
Oprah's thyroid disease diagnose may be the best thing that ever happened to the efforts to raise awareness of thyroid conditions, which often go undiagnosed or misdiagnosed. Millions of people in the United States have a thyroid condition and the vast majority are women. The American Association of Clinical Endocrinologists estimates that more than eight out of 10 patients with thyroid disease are women.
Winfrey describes her battle with fatigue and weight gain in the October issue of O Magazine: "First hyperthyroidism, which sped up my metabolism and left me unable to sleep for days. (Most people lose weight. I didn't.) Then hypothyroidism, which slowed down my metabolism and made me want to sleep all the time."
"Although she has not officially revealed her exact diagnosis, it sounds like chronic autoimmune thyroiditis or Hashimoto's disease," explains Samara Ginzburg, M.D., assistant professor of medicine and endocrinology at the Albert Einstein College of Medicine in New York. "Hashimoto's can start with a hyperthyroid phase, due to release of stored hormone from an inflamed gland, followed by a hypothyroid phase."
The thyroid is a butterfly-shaped endocrine gland in the neck which produces hormones and helps regulate the body's metabolism. If the gland is underactive or does not produce enough hormone, referred to as hypothyroidism, a person may feel sluggish, fatigued and gain weight. If the gland is overactive or produces too much hormone, known as hyperthyroidism, a person may experience heart palpitations, tremors, irritability and weight loss.
"As with other autoimmune diseases (in which the body's immune system mistakenly attacks healthy tissues), it's believed that female hormones play some role in thyroid diseases. Just how big a role is not known. Puberty, pregnancy, and menopause, all seem to affect the onset of thyroid diseases," said Rita Baron Faust, a health educator and author of "The Autoimmune Connection."
Despite the large number of people suffering from thyroid conditions, millions walk around without a proper diagnosis. "Many of the symptoms of thyroid disease as with other autoimmune diseases are non-specific," Baron Faust said. "It's a laundry list of so-called 'female' complaints: fatigue, depression, weight gain, dry skin (underactive thyroid), anxiety, palpitations, brittle or thin hair, and difficulty concentrating (overactive thyroid). Any of these symptoms could be attributed and often are to other conditions."
"The key is for women to know about these symptoms and to report them fully to their doctors or other health care providers, because when viewed individually doctors often dismiss them as isolated problems or examples of normal aging," said Martha Nolan, vice president of public policy for the Society for Women's Health Research, and a thyroid disease patient, who had the condition for five years before it was properly diagnosed. "Patients need to put the symptoms together, speak up and doctors need to pay attention."
Thyroid disease can be easily diagnosed with a simple blood test and treatment is usually successful. It may require lifelong thyroid hormone replacement therapy or radiation and surgery, depending on the type of condition.
"Hashimoto's disease is diagnosed with blood testing for TSH (thyroid function) and thyroid autoantibodies," explains Dr. Ginzburg. "It is treated with daily thyroid replacement in the form of levothyroxine."
The trick in managing thyroid disease is getting a proper diagnosis. Too many women neglect their symptoms, attributing them to other causes. "Women who are gaining or losing weight without trying, experiencing depression or anxiety without some external trigger, and have symptoms such as palpitations, hair loss or joint pain, should not blame them on pregnancy or menopause," says Baron Faust. "It's true that mood swings, palpitations, and difficulty concentrating are symptoms of menopause, but they are also red flags for thyroid disease."