Kristin Angelov was 26 when the exhaustion hit. Getting up in the morning was a superhuman effort, a struggle compounded by her suddenly dismal mood.
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"I would be in meetings at work and feel so tired and dizzy, like I was going to pass out," she says. And though the once-energetic writer stuck to a healthy diet, she packed on five pounds in two weeks. What's more, whenever she stepped out into the cold, her fingernails and toes turned a faint shade of blue. She dragged herself to her primary-care doctor, who ran a series of tests. Kristin's big problems, her M.D. told her, stemmed from a small place--the thyroid gland in her neck.
Cancer on the rise
While incidences of some cancers, including breast and cervical, have been steadily dropping (hooray!), thyroid cancer is on the rise: An estimated 45,000 new cases were diagnosed last year, and 75 percent of those were in women, according to the American Cancer Society. What's more, the majority of sufferers are much younger than the typical cancer patient.
"Twenty-one percent of women who undergo surgery for thyroid cancer at our center are under the age of 35," says endocrine surgeon Keith Heller, M.D., of New York University Langone Medical Center. The encouraging news? If you are diagnosed and treated early, the cure rate is close to 99 percent.
Experts theorize that doctors might be discovering more cases by accident during imaging procedures such as CT scans for problems like severe migraines. Or the culprit could be the CT scans themselves--frequent radiation exposure near the neck, especially in childhood, is a thyroid-cancer risk factor (routine dental X-rays and mammograms, however, are not). The best defense is a good offense:
As a general rule, see your doctor if you have a sore throat, hoarse voice, persistent cough, or trouble swallowing for more than two weeks, or if you find a lump in your neck.
If it is cancer, surgery to remove the thyroid is the norm. "I know that sounds scary, but the operation takes just two hours, and patients are often back at work within a few days," says Heller. Believe it or not, it's relatively painless to live without a thyroid:
After your doctor figured out the right dosage, you'd take a daily synthetic thyroid hormone (also prescribed for hypothyroidism) that works to mimic the real thing.
Lodged between the voice box and the collarbone, and wrapped around the windpipe, the thyroid helps control your body's energy supply. The butterfly-shaped gland pumps out thyroid hormone, a powerful chemical that regulates metabolism and body temperature, says endocrinologist Jeffrey Powell, M.D., of Northern Westchester Hospital in New York. It also works with just about every system in your body to keep your brain sharp, your bowels moving, your periods regular, and your skin, nails, and hair healthy. Think of the thyroid like a car's gas and brake pedals rolled into one: It can speed up or slow down the rate at which your body burns through its fuel supply.
Of course, when one part of a car malfunctions, the whole system can stall. And of the 25 million Americans with thyroid disorders, the majority are female. It's estimated that women are as much as 12 times more likely to develop a problem than men are, possibly because they are also more prone to developing autoimmune diseases (such as lupus and rheumatoid arthritis), which can mess with the thyroid, says Armand Krikorian, M.D., associate director of endocrinology at University Hospitals Case Medical Center in Cleveland.
Thyroid disorders--which are often genetic and typically involve the production of too little thyroid hormone (hypothyroidism) or too much (hyperthyroidism)--can also temporarily or permanently spring up after pregnancy. And new research shows that a chemical used to make nonstick cookware and water-resistant coatings for carpets and couches can also heighten the risk for thyroid complications.
Signs of trouble
Hypo-and hyperthyroidism can often have opposing suites of symptoms. The former, more prevalent ailment is what hit Kristin. In many cases, though, hypothyroidism signs are subtler and increase in intensity over time. Unexpected or sudden weight gain may occur, but since that can be due to a variety of factors, it's not enough to indicate hypothyroidism.
Some experts also look for the following symptoms: dry skin, hair loss, forgetfulness, fatigue, frequent chills, constipation, and irregular periods. Another red flag for hypothyroidism is feeling very weak during a workout you used to have no problem getting through.
"Thyroid hormone regulates how much energy reaches all cells, including muscle cells," notes endocrinologist Jeffrey R. Garber, M.D., an associate professor of medicine at Harvard Medical School.
Much easier to identify is hyperthyroidism (Graves' disease is a common type), in which the thyroid unleashes a flood of excess hormone. This can shock your body into sudden weight loss, rapid heartbeat, insomnia, or bouts of diarrhea. Sufferers can feel constantly wired, warm, and shaky, as if they're hooked up to an IV filled with espresso. Similar to the warning signs of hypothyroidism, the symptoms of hyperthyroidism can become worse or more persistent over time--but both conditions are highly treatable with prescription meds.
The best way to safeguard your energy center is to catch a problem early. If you suspect an issue, ask your M.D. about a simple blood screen called a thyroid stimulating hormone (TSH) test that can detect a gland gone haywire. Just know that while the test itself is safe, there's controversy around who should be given one: As awareness of thyroid disease rises, young women are flocking to their physicians for TSH tests, even if they have no symptoms (in other words, just in case). As a result, some doctors simply check every female patient; others believe that's overkill. "The problem with routine screening is that a lot of women may be borderline hypothyroid, and though they have no symptoms, their doctors put them on unnecessary medicine that could eventually result in hyperthyroidism," says Garber. On the other hand, untreated thyroid disorders can lead to infertility, chronic depression, cardiac ills, or high cholesterol. The bottom line: If you're showing warning signs and your doctor blows off your test request, get a second opinion or see an endocrinologist.
If you have hypothyroidism, your physician will likely prescribe a daily dose of a synthetic thyroid hormone called levothyroxine and do follow-up tests every six weeks for the first six months to make sure the dosage is right, says endocrinologist Eric Epstein, M.D., of Montefiore Medical Specialists in Scarsdale, New York. For hyperthyroidism, treatment may involve a daily drug (such as tapazole) that slows down your overactive gland. In most cases, thyroid meds are very effective, though the ideal, of course, is to ward off the issue in the first place.
You can't do much about the genetic and autoimmune risk factors, but you can protect your neck by making sure you get enough iodine, which has been closely linked to thyroid hormone production. The element is typically added to salt and some breads, but as many women move toward gluten-free, low-sodium diets, they may end up iodine deficient, says Garber. He recommends taking a daily multivitamin that contains 150 micrograms of iodine (220 micrograms if you're pregnant; 290 micrograms if you're breastfeeding). Oh, and quit the cigarettes: Chemicals in the smoke may increase the risk of the Graves' disease form of hyperthyroidism.
If you're diagnosed with a thyroid disorder, know that you can soon get your life back on track. Just ask Kristin, now 37. After working out the right daily dose of levothyroxine, she's been symptom-free for more than a decade. "I no longer walk around feeling zonked out all the time," she says. "My weight is under control, and I was able to get pregnant twice. Life is good!"
Check your neck
Every time you look in the mirror, a key to your well-being stares back at you. An enlarged thyroid may mean your gland is producing too much or too little hormone. The key is knowing what to watch for. Perform this simple self-check once every two months.
1 Hold a mirror in front of you and focus your gaze on the lower front area of your neck, right above your collarbone.
2 Tilt your head back, moving the mirror along with you.
3 Take a medium-size sip of water.
4 As you swallow, watch your thyroid area, checking for any unusual bulges or protrusions. (Note: Don't confuse your thyroid with your Adam's apple, which is farther up.)
5 If you see anything suspicious, go to your doc.
Source: American College of Endocrinology
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