Not feeling good some days, and don’t know why? Dr Vivien Lim, an endocrinologist (a specialist in hormones and glands) from gleneagles hospital, talks about hyperthyroidism and hypothyroidism – hormonal conditions women face.
Not feeling good some days, and don’t know why? Dr Vivien Lim, an endocrinologist (a specialist in hormones and glands) from gleneagles hospital, talks about hyperthyroidism and hypothyroidism – hormonal conditions women face.
A female patient in her mid-30s first consulted me after she noticed a swelling of her neck. She told me her hands shook a lot, she often felt restless as well as anxious, and that she couldn’t tolerate the heat as much as before. She was also losing weight.
On examination, her pulse was high at 100 beats per minute (the average is about 72 beats per minute). Based on all the above signs, I suspected high thyroid hormones in the blood, and that she was likely suffering from a condition called Graves’ disease. This occurs when the body produces auto-antibodies, or antibodies that attack one’s own immune system instead of neutralising foreign matter that enters the body.
In Graves’ disease, the auto-antibodies target the thyroid, causing it to behave as if there was a shortage of thyroid hormones, and produce more. This ultimately leads to an excess of thyroid hormones in the body.
WHAT IS HYPERTHYROIDISM?
Hyperthyroidism is a condition in which your thyroid gland produces too much of the hormone thyroxine. It can accelerate your body’s metabolism significantly, resulting in sudden weight loss, restlessness, palpitations, fatigue, and even hair loss. The auto-antibodies that cause hyperthyroidism may also target the eyes, leading to swelling in the softtissues behind or surrounding the eyes, causing them to bulge. In rare cases, they can affect the tissues in the lower legs and cause skin plaques.
To confirm my diagnosis, I tested the patient’s blood for thyroid receptor antibodies (TRAb), the auto-antibodies that cause hyperthyroidism. The TRAb levels came back as very high. Her treatment options included medication, radioactive iodine or surgery.
Drugs are usually prescribed to target the overproduction of thyroid hormones, and patients are usually treated for about 18 months or so. Most of those who stop medication usually experience a recurrence. In fact, the higher the level of antibodies, the greater the chance of a thyroid disorder recurring when medication is stopped.
WHAT IS HYPOTHYROIDISM?
Interestingly enough, the patient’s older sister also came in for a consultation and complained of weight gain despite regular exercise. A busy marketing executive, she found it hard to concentrate and constantly felt tired. Her menstrual cycle was also off, with occasional heavy periods.
Her thyroid hormone level turned out to be low, while the antibody level was high. However, these antibodies are different from those related to Graves’ disease. These cause the destruction of thyroid cells, leading to hypothyroidism, a condition where the thyroid hormone levels are low. The reduced levels of thyroid hormones have varied manifestations, such as constipation, tiredness, dry skin, and brittle hair. In severe instances, symptoms also include a low heart rate, lowered body temperature, and even coma.
SEEK TREATMENT EARLY
Both thyroid conditions are more common than you think. Hyperthyroidism is present in about one to two per cent of the population while hypothyroidism is present in up to about five per cent of the population. These disorders are more prevalent among women, and may run in the family. The risk of hypothyroidism also increases with age.
My first patient was treated with an antithyroid medication and her symptoms were controlled with a beta blocker that helped manage her fast heart rate.
In fact, a few months into treatment, her thyroid hormones improved dramatically. Her period became normal again and she stopped losing more hair than usual. After her sister started her medication, she stopped gaining weight. Now, she brims with energy and newfound confidence.
Both learnt that it was important not to ignore early signs and symptoms, which are usually indicators that something may not be right. So, if you feel out of sorts or unwell, seek medical help. Be honest with your doctor and do the recommended tests so you can begin treatment early. Early detection and treatment can prevent the condition from deteriorating and possibly leading to worse consequences to your health.
Hyperthyroidism is present in about one to two per cent of the population while hypothyroidism is present in up to about five per cent of the population. These disorders are more prevalent among women, and may run in the family.
MEET THE DOCTOR
Dr Vivien Lim is a specialist in endocrinology with a varied sub-specialty focus, which includes diabetes, thyroid, osteoporosis, and obesity and weight management. She was awarded the Health Manpower Development Plan Scholarship, and received training in endocrinology at the Mayo Clinic in the US. She was the clinical lead for osteoporosis in Khoo Teck Puat Hospital, as well as programme director of the endocrine training programme. She was a senior lecturer at Yong Loo Lin School of Medicine at NUS, and is currently the vice president of the Endocrine Metabolic Society of Singapore, and a member of the executive committee of the Osteoporosis Society of Singapore.
To make an appointment, call the Gleneagles Patient Assistance Centre at their 24-hour hotline at 6575-7575 or e-mail gpac@parkway.sg. For more information, Visit Gleneagles Website.
