Wednesday, April 14, 2010
Imagine playing baseball in front of thousands of cheering people, ready for the next pitch, heart pounding, mouth dry, the adrenalin rush of competition. Now imagine sitting in the locker room after the game or at home having dinner with family and friends and still experiencing those same symptoms. Imagine missing work because the heart pounding, dry mouth, sweaty palms was due to an overactive thyroid. Imagine the life of the New York Mets all star shortstop Jose Reyes who has just returned to play after being diagnosed with his thyroid issues in spring training.
The thyroid gland, located in the front of the neck can be thought of as the thermostat of the body, releasing hormones that help regulate heart rate, temperature and other body functions. Too much and the body speeds up with fast heart rate, sweating, diarrhea, irritability and weight loss. Too little thyroid hormone leads to symptoms like feeling cold, lethargy, constipation, weight gain and thinning hair. The thyroid doesn’t act alone with feedback loops to the pituitary gland in the brain telling it what to do, but sometimes things go wrong with the pituitary, the thyroid or both.
Usually, symptoms arise very slowly over time and the patient ignores or doesn’t realize that a problem exists. It may take significant thyroid enlargement (goiter) and a swelling in the throat to be the first sign that the thyroid may need some attention. Or it may be a relative or friend who notices that something isn’t quite right.
Diagnosis begins with talking to the patient, learning about the symptoms and examining the patient. Graves disease, where the thyroid enlarges can cause exophthalmos, a bulging of the eyes. Add a swollen thyroid gland in the neck and the diagnositic clues are easy to find. Too often, the diagnosis is thyroid problems is harder to make, but blood tests that can measure thyroid hormone levels in the body can help confirm that a thyroid problem exists. X-ray scans may be done to look at the thyroid gland in the neck, sometimes using radioactive dye to measure function and look for lumps or nodules.. If a thyroid nodule is found, tissue samples obtained by using a fine needle placed into the area are used to check for abnormal cells or cancer. Once the diagnosis is made, it’s on to treatment and control.
Low thyroid levels can be supplemented by thyroid replacement medications taken once a day as a pill. Too much is a different story. Beta blockers, medications that decrease the adrenalin response in the body, can be used to control the hyperthyroidism symptoms of increased metabolism. In addition, medications can be used to ablate or stop part, or all of the thyroid gland from functioning. On occasion, surgery is required to remove some or all of the gland.
Once thyroid function in the body is back to normal, regular blood tests are recommended to check thyroid hormone levels in the body, but often the patient knows when things are out of whack. Too jittery, too sleepy, fast or slow heart rate, feeling cold or hot all can point to the need for adjustment of the thyroid levels in the body. Thyroid disease often becomes a lifelong issue of monitoring and hormone control.
As with most things in medicine, the body functions well in a narrow range of normal. Get outside that range and symptoms happen. The excitement that is normal when an athlete steps on the field is special but loses its luster if it happens every moment of the day. Hopefully, Mr. Reyes can enjoy his excitement at the appropriate time.