Disorders of this small gland are common, especially in older women.
Catherine Horvath, 51, was feeling no symptoms five years ago when her doctor ordered a routine blood test to check, among other things, how her thyroid was doing. Your thyroid is the butterfly-shaped gland low in your neck that influences metabolism, growth and development and body temperature.
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The results showed astoundingly low levels of thyroid hormone — a sign her thyroid function was, as she puts it, “pretty close to being nonexistent.” If left untreated, she was at risk not only for bothersome symptoms but for other serious diseases as well.
The fix was simple, one pill a day to replace the thyroid hormone her body wasn’t making. Within a year, Horvath’s levels w31ere back to normal. “It doesn’t really affect my life,” says Horvath, who lives in Santa Cruz, California. “I manage it by taking a pill every day.”
Thyroid Disease is Common
Horvath is one of the estimated 24 to 28 million Americans who likely have some form of thyroid disease, many of whom develop the disorder later in life. Yet, according to American Association of Clinical Endocrinologists, nearly half of those with thyroid disease don’t know they have it or are misdiagnosed.
That’s because thyroid disease—particularly among older adults when the disorders can become more common—often masquerades as other ailments.
Hypothyroidism is one of the most common thyroid diseases. Your thyroid does not produce enough hormones and can be overlooked by older people who dismiss the following symptoms as the “price” of getting older:
- Fatigue
- Constipation
- Dizziness
- Weight gain
On the other hand, hyperthyroidism, or an overactive thyroid, can be mistaken for:
- Heart rhythm problems
- Muscle weakness
- Anxiety
- Age-related osteoporosis
Thyroid lumps (or nodules) are much more common among older people, yet often can’t be detected without a neck exam. While most lumps are benign, some are cancerous and require treatment.
As many as 10 percent of Americans older than 60 have some form of thyroid disorder, says Dr. Hossein Gharib, an endocrinologist with the Mayo Clinic College of Medicine, who has most recently served as president of the American Thyroid Association. “People do not always recognize thyroid disease because they might think it is just a normal part of aging,” Gharib says. “That’s why it’s important to ask for thyroid screening.”
Get Your Thyroid Regularly Tested
“Thyroid disease can happen at any stage in life, but the risk for hypothyroidism increases as we age,” says Dr. Mack Harrell, a thyroid specialist in Hollywood, Florida and president of the American Association of Clinical Endocrinologists. Doctors say many thyroid disorders start early in life as smoldering autoimmune disorders, when the body’s natural defenses turn against the thyroid and attack it. Over decades, those attacks begin to damage the thyroid’s cells enough to start lowering thyroid hormone levels.
A simple blood test will reveal whether your thyroid is functioning properly. The thyroid’s hormones, known as T3 and T4, are released in response to the ebb and flow of TSH, or thyroid stimulating hormone, which is produced by the pituitary gland. If a thyroid is working normally, the pituitary gland gets the message to keep the TSH within a fairly tight range.
But, if a blood test shows TSH levels are too high or too low, that might mean the thyroid is having trouble. For older adults, this often means hypothyroidism.
Women Have a Higher Risk of Thyroid Disease
Women, it seems, are particularly vulnerable to thyroid disease. “Women get more thyroid disease of every variety than men,” Harrell says. “They outdo men 3- or 4-to-1 for everything.”
The reason why women are more susceptible isn’t clear. Hormonal fluctuations during a woman’s reproductive years may stress the thyroid, taking a toll over decades.
Women are also more prone than men to all autoimmune disorders. About five years after her hypothyroidism diagnosis, Horvath developed scleroderma, another autoimmune disease that causes the buildup of collagen that painfully stiffens and swells her hands, feet and arms. The condition has disabled her significantly, she says.
“Autoimmune diseases do tend to run in clusters,” Harrell explains, “and thyroid disease is the most common autoimmune disease.”
Get Your Thyroid Checked for Lumps
Hyperthyroidism is less common among older adults, but Harrell and others say that it’s a particularly dangerous condition because it targets key vulnerabilities in aging bodies.
When your thyroid produces more hormones than the body needs, your metabolism goes into overdrive. Symptoms can include hand tremors and rapid or irregular heartbeat, leading to serious cardiac problems. Too much thyroid hormone can also leech away calcium in bones, leading to osteoporosis.
At younger ages, a revved-up thyroid often develops when the immune system stimulates parts of the thyroid to overproduce. In older ages, hyperthyroidism often stems from lumps that form on the gland, some of which can grow so large they simply pump out too much hormone.
And older people, particularly women, are far more likely to have lumpy thyroids than those at younger ages. “If you’re over the age of 50 and you’re female in this country, you have a 1 in 2 chance of having a lumpy thyroid,” Harrell says.
To treat an enlarging nodular thyroid, as it is called, doctors can surgically remove the thyroid, which presents some risk but is sometimes a better option for healthy patients with many years ahead. Other treatments include anti-thyroid medications or radioactive iodine, although those can damage the liver or may not always be successful.
A Lumpy Thyroid Increases the Possibility of Cancer
Lumpy thyroids carry an increased risk of cancer. While the vast majority of lumps are benign, about 6 percent are not, which is significant considering half of all women over 50 and an estimated 90 percent of women over age 70 have lumps.
Within the past 15 years, the number of patients diagnosed yearly with thyroid cancer has increased dramatically, from 18,000 to 65,000. The reason isn’t entirely clear, although many experts believe it’s largely due to better diagnostic methods. The good news is that once detected, the vast majority of thyroid cancers are very treatable with surgery, yielding a high survival rate.
A simple neck examination led to Jeani Adams’ diagnosis of thyroid cancer at age 40. Now, 17 years later, the Richland, Washington resident says she shows no signs except a scar from surgery. But considering the alternative, she says, that’s just fine.
Boosting Your Thyroid Health
Wondering how to boost your thyroid health? Here are some tips about the best ways to stay aware:
- Don’t dismiss symptoms as just aging: If you’re more tired or anxious, if you are constipated or are having trouble sleeping, ask your doctor about your thyroid.
- Be sure your doctor checks for thyroid health via a neck exam and regular blood screens: If he or she doesn’t, that could be a red flag and a sign that you should take your business elsewhere.
- Ask questions about your care: Be sure your doctor knows, for example, that the TSH levels at age 70 won’t be the same as those for a 30-year-old. Ask your doctors to explain the risks of various treatments. Get a second opinion when possible.
- Do your own “neck check” exam: Stand in front of a mirror and take a drink from a glass of water. As you swallow, keep your eye low on the neck just below the Adam’s apple. If you see lumps move up and down, tell your doctor.
- Stay consistent with your medications: “We just tell people who take thyroid hormone: same, same, same,” Harrell says. “Take the same thyroid hormone preparation every time, take it at the same time of day, take it in the same fashion.”
- Don’t panic: If diagnosed with thyroid disease, realize it’s quite treatable in all its forms. The important thing is to take action.
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