IF SYMPTOMS PERSIST Dr. Jose Pujalte, Jr. “How soon, unaccountable, I became tired and sick;” –  Walt Whitman (1819-1892), American poet,    When I Heard the Learn’d Astronomer (1865) We are all familiar with the ubiquitous remote control device. It’s that little thing with so much power in controlling your TV and who gets to watch Netflix, the aircon and now. Well the body has a remote too. Very few understand the thyroid gland, which like a remote, holds the key in controlling many functions (of the body). For example, it can regulate how fast the heart beats or how efficient calories are burned, or to what energy levels are possible and even to what extent the body can tolerate cold. What Thyroid?  Weighing less than an ounce, this butterfly-shaped gland is located just below your Adam’s apple. It secretes the hormones that control metabolism. T3 or triiodothyronine and T4 are these hormones. The thyroid has a complex interaction with the hypothalamus of the brain and the pituitary gland, a pea-sized structure known as the “master gland.” Thyroid-wise, the pituitary produces TSH or thyroid stimulating hormone. TSH is the primary controller of thyroid hormone secretion. The hypothalamus in turn controls pituitary secretion. Just like in government, “withdrawal of support” of any of these structures spells chaos. Hypothyroidism. This brings us to underactivity of thyroid hormones, or for purists, undersecretion. Known as hypothyroidism, this puts the state of the body in slowdown – a sort of slow motion of bodily processes that all have the net effect of mental and physical sluggishness. (Hyperthyroidism or overactivity of the thyroid is another article.) Causes and Risk Factors.  Known risk factors are being female and over 50, obesity, previous thyroid surgery, exposure of the neck to xrays or radiation treatment. Causes include Hashimoto’s thyroiditis which is autoimmune (that means that the body’s immune system turns on its own thyroid), disturbances with the pituitary gland in which it fails to secrete THS. There may be congenital defects contributing to thyroid dysfunction. Finally, there are some patients who were previously hyperthyroid but were treated. An effect of destroying the thyroid by surgery or irradiation is hypothyroidism. One then needs a lifetime supply of thyroid hormone replacements. Signs and Symptoms.  Many frustrated dieters may want to blame their thyroid for weight that just won’t budge. Indeed it’s a convenient excuse to point to the thyroid and say : “Well, I’ve got a sluggish metabolism. I just can’t seem to lose weight! (sigh)”. However, true hypothyroids exhibit the following signs and symptoms:

• Fatigue and weakness
• Intolerance to cold
• Unexplained weight gain
• Constipation
• Depression
• Joint pain/muscle pain
• Brittle or thin hair
• Cracked or brittle nails
• A puffy face (not from overeating!)
• Hoarse voice
• For women, heavier than normal menstruation.

Diagnosis and Treatment. When in doubt, see a doctor. The specialist in this condition is the endocrinologist. However, for screening, it won’t hurt to see your favorite doctor or family medicine practitioner.  The physical exam may reveal lower temperature, low blood pressure, and decreased heart rate. Reflexes may be abnormally delayed. Blood tests will show a low T4 level and the serum TSH may be high (primary hypothyroidism) or low to low normal (in secondary hypothyroidism). Once hypothyroidism is documented, treatment is begun posthaste. Usually, the good doctor will replace the deficient thyroid hormone with the lowest dose of levothyroxine. The patient is monitored to make sure that thyroid function normalizes and more importantly, that hyperthyroidism – the opposite condition does not occur. Hypothyroids may be slow moving but the visit to the doctor should be the one exception. Dr. Pujalte is an orthopedic surgeon. email [email protected]