Living with Hypothyroidism

Every morning, around six a.m., I take a 50-mcg dose of synthroid. I then go into my fifteen year old son's room and rouse him from sleep to give him his 100-mcg dose of Levothyroxine. Both medications are synthetic hormones. We each need to take our pill an hour before eating any breakfast.

We both have hypothyroidism, but in each of us the disease has taken a different form.

My son, who is now fifteen, stopped growing around seven years of age. We were referred to an endocrinologist. A blood test confirmed that my son's thyroid was not producing a sufficient amount of thyroxin (T4) and triiodothyronine (T3), the two hormones necessary for growth, for development, and for cellular processes.

My son was, and still is, short. After several years though on the synthetic growth hormones now available, he is no longer the shortest kid in the class; he's just shorter than most others.

Because the workings of the thyroid, the pituitary gland, and the hypothalamus are not completely understood, an explanation as to why my son's thyroid ceased to function properly has yet to be found.

What the medical community can tell us is that the thyroid is controlled by the pituitary gland, located in the brain. In a feedback system, the thyroid controls the pituitary, but the pituitary is also controlled by the hypothalamus, which is also located in the brain. The hypothalamus releases the hormone Thyrotropin Releasing Hormone (TRH), which tells the pituitary to release the Thyroid Stimulating Hormone (TSH). This hormone tells the thyroid to release its hormones, which primarily consist of T4 and T3; these thyroid hormones affect the functioning of the pituitary gland, hence the feedback system.

A breakdown in communication between these three components results in various conditions, one of which is hypothyroidism.

While my son was affected at an early age by this condition, I wasn't diagnosed until I was fifty years old. I wouldn't have known that the fatigue, the forgetfulness, the weight gain, and depression were due to hypothyroidism if my son's endocrinologist hadn't looked at me on one particular visit and said, "You have a goiter."

I had thought the bump in my neck was my adam's apple, heading south, along with various other body parts.

What followed next were an ultra sound, a thyroid scan, and blood testing. The bump was a cluster of nodules, growths on my thyroid. At that point, I was hearing words like biopsy and surgery.

But before any invasive procedures, I was put on Levothyroxine, a 25-mcg dose. Fortunately, the medications had a fast effect on the nodules, and within a couple of months, they had shrunk. No biopsy, no surgery.

Recently, my doctor had to adjust my meds; the T3 and T4 levels were still low. This is how it will be for the rest of my life: blood tests, ultra sounds, and dosage adjustments.

My son may or may not need treatment for the rest of his life. At some point, like all of us, he will stop growing, having reached his full height. What that height will be is still an unknown factor. It is likely, though, that he will suffer from adult hypothyroidism, and will, like his mother, be on medication for the rest of his life.

Living with this disease is different for each of us. For my son, it is growth charts and weigh-ins. Not only is he shorter, he's thin, so it's important his weight keeps up with his growth. Though unexplained weight gain is a common symptom of hypothyroidism in adults, in children with this condition a lack of weight gain can be part and parcel with short stature. For other children, though, the slowed metabolism caused by the malfunctioning thyroid causes sluggishness, and so calories are not burned off. These kids can't lose excess weight.

Imagine a child who eats little but still gains weight, and is too tired to play. This is yet another form of childhood hypothyroidism. This disease has many guises, varying symptoms, and there is no cure, only treatment.

A study published in 2000, called the Colorado Thyroid Disease Prevalence Study, claimed that as many as 10% of the U.S. population is affected by thyroid disease.(1) Now, in 2007, that is thought to be a conservative number. The reason it is so difficult to pin down a more realistic statistic is because many cases go undiagnosed or are misdiagnosed.

If my own condition hadn't manifested in a goiter, it is unlikely I would have been diagnosed. My fatigue and forgetfulness would have been attributed to menopause, my depression treated with Prozac, and my weight gain dismissed as a part of getting older.

The medication has lessened these symptoms, and some days are better than others. Some days, I don't need to nap for forty minutes on the couch in the middle of the day. I'm less forgetful and I've lost three pounds. The depression hasn't completely vanished, but episodes are fewer and less severe.

There are times when my son is easily agitated, has a difficult time concentrating, and wants to do nothing but stare at the television. This will go on for a few days, and then he is back to his normal, active, happy self. Soon after he 'returns' he experiences a growth spurt, and suddenly his shoes are too tight and his jeans are too short.

The symptoms of hypothyroidism are broad and vary from case to case. Some people become susceptible to cold, some suffer from hair loss. Almost all, though, experience fatigue, unexplained weight fluctuation and/or constipation, forgetfulness and moodiness or depression. When taken separately, each of these symptoms is easily attributed to other causes. Fortunately, awareness of the grouping of these symptoms has brought about a rise in diagnosis of thyroid related diseases, and in particular, hypothyroidism.

Living with hypothyroidism isn't always simple. It's a lifelong condition, and can be much like riding a roller coaster with its dips and peaks and twists and turns. I can be going through my day, attending to the business at hand, and quite suddenly be overwhelmed with the desire to sleep. Of course, this isn't always possible, and I must push myself to get past the urge. The urge will pass, but what follows are muscle aches and an inability to concentrate. Most days, though, I feel fine. Some days, I feel wonderful. Ah, the peaks!

Though it's unlikely my son or I will ever be completely symptom free, the disease is manageable. We avoid certain foods such as raw broccoli and cabbage (which is fine with my son) because they inhibit processing of iodine. I have to be sure to take my calcium supplements at least four hours after I take my synthroid because calcium inhibits the absorption of the medicine.(2) We both need to be aware of any sudden and persistent changes in our weight, our moods, in our general health, because an adjustment in our meds may be needed.

If left untreated, hypothyroidism can result in heart disease because it causes high levels of cholesterol. It also affects the heart muscle, and so can cause high blood pressure, increasing risk for stroke and hypertension. Depression can also worsen, and over time, be debilitating.(3) Fortunately, treatment is simple, and negative side affects are rare.

Living with hypothyroidism means taking daily medication. It means being aware of diet and the intake of dietary supplements. It means regular blood tests and regular visits to the endocrinologist. But this regimen is far easier to live with than the symptoms of adult hypothyroidism, or the frustration of this condition for children. Better a pill at six a.m., than depression, fatigue, and forgetfulness.

(1)Melanie Haiken. Feeling lethargic, moody, tired, fat? It could be your thyroid. http://www.cnn.com/2007/HEALTH/conditions/05/10/healthmag.thyroid/index.html

(2)Todd Nippoldt M.D. Ask an Endocrinologist http://www.mayoclinic.com/health/hypothyroidism/AN01181

(3)University of Maryland Medical Center. http://www.umm.edu/patiented/articles/how_serious_hypothyroidism_000038_6.htm