Hypothyroidism: Symptoms and Treatments

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Hypothyroidism: Symptoms and Treatments




Guest:  Dr. Kathie Hermayer - Endocrinology, Diabetes & Medical Genetics, MUSC

Host:  Dr. Linda Austin – Psychiatry, MUSC


Dr. Linda Austin:  I’m Dr. Linda Austin.  Today, I’m interviewing Dr. Kathie Hermayer, Professor of Medicine and an endocrinologist here at MUSC.  Dr. Hermayer, let’s talk about hypothyroidism.  That’s a very common illness, isn’t it?


Dr. Kathie Hermayer:  Yes, it is. 


Dr. Linda Austin:  How common?


Dr. Kathie Hermayer:  It occurs in about one in eight women, overall.  Generally, at age 40, there are about ten percent of women with the disease.  And, at age 60, about 15 to 20 percent of women have the disease.  Thyroid disease is four times more common in women than men.


Dr. Linda Austin:  Boy!  That is really common.  Is it standard, then, as part of an annual physical to get a blood test for thyroid disease?


Dr. Kathie Hermayer:  Yes.  It’s actually recommended to check a TSH about every other year in someone under the age of 40.  And then, once you’re over 40, you should probably consider checking it yearly.


Dr. Linda Austin:  And, I’m sure, if you have symptoms, that leads to even greater scrutiny.  What are some of the symptoms of hypothyroidism?  


Dr. Kathie Hermayer:  As I tell my patients, thyroid disease, really, affects about every organ system of the body.  So, the symptoms people can present with for hypothyroidism can be fatigue; weight gain; feeling cold; constipation; wanting to sleep a lot; slow heart rate; brittle nails; coarse hair; hair can be falling out.  And, in the menstruating population of women, they can actually have more frequent and heavier periods.


Dr. Linda Austin:  So, clearly, the thyroid gland is a very important gland.  And we should have said earlier, hypothyroidism means low thyroid.  So, in other words, the thyroid hormone is not cranking the body up metabolically in the way it should, and every organ system is involved.


Dr. Kathie Hermayer:  Correct.


Dr. Linda Austin:  You know, as a psychiatrist, we routinely test for hypothyroidism, not only because it’s so common but, also, because it can be associated with depression.  Do you see that as a presenting symptom often?


Dr. Kathie Hermayer:  Yes.  People come to me with some of their major complaints being fatigue, depression, and weight gain.  Those three can be a tip-off that it’s probably time to check somebody’s thyroid panel and see where their numbers are. 


Dr. Linda Austin:  Let’s assume those numbers come back abnormal.  What is your next step, as an endocrinologist, to help the patient?


Dr. Kathie Hermayer:  If the numbers are abnormal, and they’re consistent with their symptoms, then we usually will begin thyroid hormone therapy.  Now, you need to be careful when you give somebody thyroid hormone therapy; that you don’t give them too much.  If you give somebody too much thyroid hormone, it can lead to problems with the heart, and having a rapid heart rate or an irregular heart rate, as well as early development of osteoporosis.


Dr. Linda Austin:  How do you, as a doctor, know if you’re giving too much or too little?


Dr. Kathie Hermayer:  Usually, after we start thyroid hormone, we’ll recheck a Free T4 and a TSH about six to eight weeks after we’ve started therapy.


Dr. Linda Austin:  So, you routinely do that?  Is that right?


Dr. Kathie Hermayer:  Correct.


Dr. Linda Austin:  And, you look for those numbers, those lab values, to be within a given range?


Dr. Kathie Hermayer:  Correct.


Dr. Linda Austin:  Now, let’s say somebody comes in with that triad of symptoms that you mentioned; the fatigue, and the depression, and the weight gain, you start them on thyroid hormone.  Let’s say, pretty quickly, your first guess as to the dose is about right.  How long will it take before they’ll start to have more energy, before the depression lifts, before they start losing some weight?


Dr. Kathie Hermayer:  What I normally tell people, if they’re very symptomatic, they should start feeling better in a matter of a few days; three or four days, after starting thyroid hormone therapy.  However, to really see a proper adjustment based on dose and where their levels should be, it takes about six to eight weeks.  But, in terms of, clinically, how somebody is feeling, they should see an improvement in their overall well-being in a matter of days. 


Dr. Linda Austin:  Now, I’ve heard that some weight loss doctors out in the community often prescribe thyroid hormone even when the patient does not have abnormal lab values.  They do it as kind of a weight loss adjunct, or augmenting treatment.  Is that safe to do?


Dr. Kathie Hermayer:  That is not a practice that I endorse.  I think it can be dangerous.  You have to be careful not to give somebody, again, too much thyroid hormone.  The other thing you don’t want to do is suppress somebody’s natural production of their own hormone.  And, when we give somebody a substance they don’t need, it, possibly, could shut off the body making its own cortical hormone.


Dr. Linda Austin:  But, now, we, as psychiatrists, for years, to some degree, in cases of very severe treatment-resistant depression, will add on thyroid hormone, really, to boost the action of the antidepressant.  And that’s regardless of what the thyroid levels show.  Is that potentially dangerous, then?

Dr. Kathie Hermayer:  My discussions with my psychiatric colleagues is that it’s done in a very carefully monitored situation, and it’s done for a particular clinical reason, such as depression.  In those cases, it’s monitored closely by a psychiatrist, sometimes in coordination with an endocrinologist, so it’s done safely.  What I’ve noticed, sometimes, in the community when thyroid is administered for weight loss, there can be a misperception that thyroid may actually help somebody lose a great deal of weight, whereas, perhaps, they will not.  And it can actually be harmful to somebody for the reasons I mentioned earlier, such as on the heart structure or the bones of the body.  So, that’s why I think, overall, as an endocrinologist, if somebody’s being placed on thyroid hormone because of depression, that’s a different issue than if they’re being placed on thyroid hormone because of weight gain.


Dr. Linda Austin:  Because, with a weight gain issue, it may not help anyway.


Dr. Kathie Hermayer:  Correct. 


Dr. Linda Austin:  What is the medication for hypothyroidism?


Dr. Kathie Hermayer:  The general medication we use to treat hypothyroidism is Levothyroxine Sodium.  Usually, we start at a relatively low dose, and we gradually work the dose up, checking blood hormone levels about every six to eight weeks.  And I inform my patients that it can, sometimes, take several months to get them to a stable dose, and to sort of bear with their practitioner as we make these dose adjustments. 


The other thing I inform patients about is if they gain or lose more than ten pounds during the course of thyroid hormone therapy, they need to alert their physician.  Their dose may change and, say, if they lose ten pounds, they may be at risk for hyperthyroidism; which is medication-induced, and then we need to back off on the medication.  Likewise, if somebody gains weight, we may need to increase the dose of thyroid hormone.


Dr. Linda Austin:  Dr. Hermayer, thank you so much.


Dr. Kathie Hermayer:  You’re welcome.


If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at:  (843) 792-1414.

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