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endocrine

Tired of Feeling Tired?
Tired because of thyroid issues The lows and highs of thyroid

Are you sick and tired of feeling sick and tired? On the other hand, sick and tired of feeling tired and wired? Are you nevertheless reluctant to see your doctor because:
  • As a working mother of three kids who have ADHD, you cannot imagine why you wouldn’t feel constantly tired?
  • As a recently laid off Silicone Valley techy with a $2 million mortgage or a recently hired young firefighter who weighs 130 pounds fully loaded, you can’t imagine not being on the edge of your seat most of the time?
  • You are afraid your doctor will roll her eyes and sigh when you complain that you are tired all the time, or ask if you are bragging or complaining when you tell about your weight loss and excessive energy?
While you may be suffering from what I call “lifestyle fallout fatigue” or “postmodern tension syndrome,” you could have a thyroid problem. A simple blood test called TSH or (Thyroid Stimulating Hormone) can tell if a misbehaving thyroid gland may be causing or contributing to your problem. If your TSH is lower than normal, it suggests your thyroid function is too high. Conversely, if your TSH is higher than normal, it suggests your thyroid function is too low.

Hormones are not just a female thing.
Often when we hear the word “hormones.” We think of the female sex hormones that coordinate women’s menstrual cycles and prepare their bodies for pregnancy, lactation, and PMS. Most women might agree that they, can live comfortably without female hormones, but most other hormones are vital to life. These complex chemical messengers regulate and orchestrate virtually all of your body functions. Hormones are produced by small organs called “endocrine glands” which synthesize and release precise amounts of specific hormones into the blood stream in response to changing conditions in other parts of your body. For example, if your blood sugar level is running a bit high after a healthy snack of Twinkies and a super-sized soda, endocrine cells in the pancreas release insulin, which drives that extra sugar into your body cells to fuel their microprocessors. If your blood glucose level starts running low, say during your first week on the Adkins’ diet, another hormone, glucagon, kicks in, telling your liver and muscles to break down and release just enough of their stored sugar into your blood stream to bring your blood glucose back up to normal. Without properly functioning endocrine glands to keep everything in balance (the scientific term for this balance is “homeostasis”) you would be a little more than a big bowl of kidney, liver and intestinal stew.

What is so special about the thyroid gland?
The thyroid gland produces thyroid hormone, which in turn regulates how efficiently we can turn the oxygen we breathe and the food we eat into useful energy. Day in and day out, your body is incorporating, producing and using energy for everything it does, from breathing, pumping blood and regulating your body temperature to talking, digesting food and analyzing data. Although your spouse may disagree, scientifically, you are producing useful energy even while you are lying on the couch eating Buffalo Wings and watching “Survivor” or “Monday Night Football”. The absolute minimum rate of energy production needed to sustain life (which is essentially the energy a person in a coma uses) is called the basal metabolic rate. Although very few of us have been truly comatose, most of us have felt that way from time to time. Its called “being dead tired.”

Whether you are training for the Big Sur Marathon or the Guinness Book of World Records for tree sitting, a healthy thyroid gland keeps the daily work output of your muscles, heart, lungs, and brain in balance with your calorie and oxygen intake. A word to the wise: If you are training for the Guinness World’s Record for tree sitting, you will store any unused energy as abdominal adiposity (more commonly known as a beer gut). I am not sure what gland you can blame that on, but it is NOT your thyroid.

Why is high, low and low, high?
Your thyroid gland can suffer many problems, I will focus on the two most common: An underactive thyroid (primary hypothyroidism) and an overactive thyroid (hyperthyroidism or Grave’s disease). The thyroid gland may be our body’s efficiency expert, but ironically, it is by nature a slacker. Charged with cracking the whip on this indolent organ is the pituitary gland. Located at the base of the brain, the pituitary gland, also called the “master gland,” (I hate to be sexist but “mistress gland” doesn’t sound quite right) sends out chemical messages to all of its subordinates, including the thyroid. This gland prods, nudges, inspires, and cajoles them into making just the right amount of hormone at just the right time. One of those chemical messengers is TSH (thyroid stimulating hormone). When the thyroid gland is being diligent, the pituitary will send regular TSH memos telling it to “keep up the good work.” When the thyroid is being sluggish, the pituitary will send it a few extra TSH memos advising it to get in gear. If the thyroid becomes a serious slacker and begins to jeopardize your health, the pituitary gland will release a flurry of TSH memoranda. Thus, when the TSH level is too high, it usually means your thyroid hormone level is too low.

Unfortunately, there is no such thing as “thyroid squelching hormone,” so, if the thyroid gland goes ballistic and starts inciting riot amongst your bodily organs, the best the pituitary gland can do is absolutely nothing. Even when the TSH level drops to 0.00, left untreated the thyroid storm may continue unabated. None-the-less, when the TSH level is too low, it usually means that the thyroid hormone level is too high.

The Mystery of Myxedema Madness: how low can you go?
I’m going to take the easy way here by quoting The Merck Manual (the “bible of medicine”) because I cannot possibly match this arcane piece of Edgar Allen Poetry:
“The symptoms and signs of primary hypothyroidism...may be insidious in onset. The facial expression is dull: the voice is hoarse and speech is slow: facial puffiness and periorbital (eye area) swelling occur….”
So far this sounds like an apt description of Dr. Anne first thing in the morning, but there’s more:
“Patients are forgetful and show other evidence of intellectual impairment, with a gradual change in personality. Some appear depressed. There may be frank psychosis (myxedema madness). Cold intolerance may be prominent; eyelids droop….”
Now that is Dr. Anne after a busy night on call. However, there is still more:
Hair is sparse, coarse, and dry; and the skin is coarse dry, scaly and thick. Weight gain is modest and is largely the result of decreased metabolism of food and of fluid retention, and women often develop menorrhagia (heavy menstrual periods). Patients generally note constipation, which may be severe.”
I don’t claim any resemblance there, but my point is this: the symptoms of hypothyroidism often come on gradually, and, even when relatively advanced, are common enough in otherwise healthy people to be written off as normal (for example, who among us doesn’t get “corked up” every once in a while?) Unfortunately, long-term, severe hypothyroidism is incompatible, not just with a normal life, but with any life at all. Eventually severe hypothyroidism may cause “myxedema,” a syndrome of heart and lung congestion, generalized swelling, confusion, disorientation and ultimately coma. “Myxedema madness” refers to mental deterioration. If not properly and promptly diagnosed and treated, this profoundly slow metabolism rate is soon followed by no metabolism at all: a condition commonly reffered to as ”being dead”. Fortunately thanks in part to the humble TSH test and thyroid replacement hormone, it the modern world, hypothyroidism seldom reaches that endpoint.

Tired because of thyroid issues The Best UPS Driver in the World
A couple of weeks before Christmas of 1996, a 25-year-old UPS driver came to me complaining of anxiety. As usual during the holiday season, he was working twelve hour days, six days a week, eating on the go, showing up to work early to get a jump start on his day and driving his unwieldy brown UPS truck like a Ferrari. The time pressure was always immense at this time of year, and a certain amount of anxiety was understandable. However, this year, something was different. He was not only driving, he was driven. In addition, he was running out of gas. He had lost about twenty pounds in the past month in spite of constantly eating; he couldn’t sleep more than about four fitful hours a night, and his heart was racing faster than a greyhound after a wild hare. His “resting” heart rate was 140 beats per minute, about twice normal. His shoulder blades stuck out like naked, truncated wings, and the imprint of his spine showed through his belly when he took a deep breath. He was literally consuming himself, and without intervention, would soon be a self-cannibalized carcass. No surprise to me, his TSH was 0.00 and his thyroid hormone levels were through the roof. His thyroid scan confirmed that his entire thyroid gland was metaphorically on fire.

I brought him back to my office a couple days later to explain the problem: “You have Grave’s disease; an immune system problem that’s over stimulating your thyroid gland. That is why both your metabolism and your career are in hyperdrive. It is a good thing you came in when you did. You were about to crash and burn.” He looked surprised and concerned, so I reassured him. “You’re basically a healthy young guy, and we can start your treatment now. With one medication to slow down your heart rate and another to slow down your thyroid gland, after a few days of rest, you’ll feel like your old self again.” I pulled out my prescription pad and a work excuse and started writing. He looked curiously disappointed. “Is something wrong?” I inquired with polite puzzlement. He shifted in his chair, looked at the ceiling, took a deep breath, and in a sheepish tone of voice said, “At the rate I’ve been going, I’ll break the all-time UPS record for monthly productivity. Could we start this treatment AFTER Christmas?”

It does not make sense to wait until you descend into myxedema madness or receive a posthumous award for “Best UPS Driver in the World” to begin proper treatment when a simple screening test of thyroid function is out there. Just remember that, when it comes to interpreting your TSH level, in general, high means low and low means high. You just might need to explain that to your doctor!

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"Tired of Feeling Tired?"
   authored by:
FAMILY MEDICINE
Dr. Anne Phelan-Adams is a board-certified family physician with experience in a variety of practice settings ranging from occupational health and urgent care to traditional family medicine. When not busy working or caring for her four children, thr...



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