According to the American
Thyroid Association, women are five to
eight times more likely than men to be
diagnosed with thyroid disease. Since two
of the most common thyroid conditions
are autoimmune in nature, their symptoms
may often be confused with other health
problems, which can make reaching a
diagnosis for some a long and puzzling
process. Today the diagnostic
journey of autoimmune thyroid disease, the
symptoms, the risks, and how-- due to
advances in testing-- one result just might
provide the missing piece you've been
looking for. I'm Ereka Vetrini, Access
Health starts now. [Music]
The thyroid, a butterfly-shaped gland in
the front of our neck, produces hormones
that are responsible for keeping our
body's metabolism, heartbeat, temperature,
mood, and more, in check. Despite its small
size, the thyroid gland plays a huge role
in determining how our body functions
and ultimately how we feel. Too
much or too little of its hormones can
have a major impact on our health and
well-being. The most common causes of
thyroid malfunctions are autoimmune
disorders, which means instead of your
immune cells protecting your thyroid tissue,
they attack it and interfere with
hormone production. Access Health caught
up with Dr. Mark Lupo, director of the
Thyroid and Endocrine Center of Florida,
to learn more about these often under
diagnosed conditions. Because the thyroid
has an impact on every part of our
body, sometimes the symptoms can be
vague and difficult to make a diagnosis. So often
patients are being treated specifically
for individual symptoms, such as depression or sleeping problems,
heart problems, such as palpitations,
so they go in this path of being on
antidepressants or being referred for sleep
studies, or being told they need to just
exercise more and eat less, and the
thyroid is really not thought of as the
unifying cause of these symptoms. It can
be quite a diagnostic journey for people. [Music]
My name is Kaylan, I'm 33 years old,
I live in San Diego, California with my
fiance Baxter, and I also have a little
dog named Eddie. I work as an
organizational psychologist during the
day, and I teach night classes for our local
university. I grew up in upstate
New York, I'm from a family of four, I
have an older brother-- as a family we
were very healthy, very active, we always
skied together, every weekend it was a
family event-- my brother and I loved
skiing and it turned into a sport for us as
well but I got a scholarship to go to
school out in California. Since there
isn't much skiing, I actually ended up
playing soccer for the University that I
got the scholarship to. Towards the end
of my doctoral program I started
experiencing things like feeling a little bit
shaky, I had my hands would tremble, I
didn't sleep very well. I was feeling
physically anxious, it wasn't anything
mental or emotional, it was just the
physical feeling of always feeling
anxious, and I, and I honestly I didn't think
that there's anything wrong with me. I thought
that everything that I was experiencing
was due to my own behaviors. That's what
affected me the most out of everything
that I was feeling because I really
thought, okay if I'm a little shaky, or
I'm not sleeping well it's because I'm
not on a good you know, pattern of sleep
or maybe I'm just drinking too much
caffeine and staying up late to study
but, but, the physical feeling of being so
anxious all the time that was what
really made me think maybe something's
going on here. I did go to my
doctor about it and he
didn't think that I had any kind of
anxiety disorder, he asked me ‘can you
control it through exercise’ and I said
yes when I work out really hard I feel
better, and he said well if you can
control it physically then I wouldn't
suggest putting you on medication
but he never asked me any other questions. I was feeling all of
these symptoms and combinations that I
really couldn't explain, I really
couldn't even analyze it and describe it
myself. Autoimmune thyroid disease can
take years to develop
often leaving patients with a shopping
list of vague, variable, and nonspecific
symptoms. For patients the
obvious can sometimes be the invisible. My
name is Liz, I live on Siesta Key on the
west coast of Florida, I'm 51 years
old and I'm a clinical psychologist. I
work mainly in criminal forensic
settings all over Florida and Texas. I have a
daughter who's 16, her name is Grace, and
she's in the tenth grade and we take a
lot of trips together-- We do a lot of
hiking, snowboarding, basically just
going on adventures-- and we've done that
ever since she was very young. When
my daughter was around four I
started having symptoms that I hadn't
had before, such as feelings that my heart
was, was, racing, feeling like it was
pitter-pattering and almost a feeling of anxiety
but there's nothing to be anxious
about it. So alternately I would feel very
like cranked up like that sort of
nervous like, racy feeling and then I
would sometimes just feel exhausted,
so I thought I had a heart problem. So I
went to a cardiologist and they, the
cardiologist, put me on beta blockers. It
did help the, the, racy heart but I felt
so tired and I talked to her about it
and I said you know there's, there's got
to be something else I can do because I really feel bad. So I,
I told her you know something is wrong
and she said that I was just getting
older. Many
patients are seeking care and answers
from specialists for individual symptoms
that arise early in the disease process
or being dismissed without help, due to
vague symptoms and are likely walking
around undiagnosed. Autoimmune
thyroid disease is the most common
thyroid problem we see-- Graves disease is the
most common reason people have an overactive
thyroid and that's when the immune
system attacks the thyroid and tricks
it into making too much thyroid hormone. Whereas
Hashimoto's is the most common cause of
an underactive or hypothyroidism, so the
immune system attacks the thyroid and
destroys the normal thyroid gland and
patients then have underactive thyroid. When the thyroid’s under active
or slow, people have brain fog, they have
depression sometimes, fatigue, exercise
intolerance, feelings of shortness of
breath, they'll retain some fluid and
gain a little bit of weight, become
constipated, and get cold easily, have dry
skin, and sometimes hair thinning. On the
other end of the spectrum the immune
system tricks the thyroid or stimulates
it into making too much thyroid hormone--
everything is sped up so people have
anxiety, insomnia, they get fidgety,
they're shaky, they have heart palpitations, again exercise
intolerance, feelings of inefficient
breathing, or shortness of breath, muscle
weakness, sweating, and weight loss. Because the
metabolism is revved up. So
patients individually, can have both
attacks at the same time, so that's why
we think of it as a spectrum and not an
either/or, but all those symptoms are not
specific to thyroid-- so in diagnosing a
thyroid problem we have to look at the
whole picture; family history, physical
exam, the patient's symptoms, other
medications they might be on, because at
times it's not as straightforward as it
would seem and it needs a very thorough
investigative look. Coming up,
what standard thyroid tests may not
be telling you
[Music] [commercial]
[Music] Welcome back-- diagnosing
thyroid disease is a process that incorporates
numerous factors including a clinical
evaluation, and imaging tests, however,
blood tests for thyroid function provide
some of the most crucial evidence for
doctors. What are they testing for, and
what are the results telling us? So when
first seeing a patient with suspected
thyroid problems, we order a test called
TSH or thyroid stimulating hormone--
that's a hormone that comes from the
pituitary which is the master gland in the
brain that communicates with hormone
producing glands, such as the thyroid-- So
that TSH gives us great insight into the
thyroid balance status of the body. So
if a TSH is normal then generally that
patient has normal thyroid function. If
the TSH is abnormal, then we look at the
actual thyroid hormones that the
thyroid is producing, so that's T4, which
is the predominant hormone that's
produced by the thyroid that gets converted
into T3, which is the more active thyroid
hormone. So those are your options for
what else can I test hormone wise to see
how severe either the over activity,
or the under activity might be. There's
been some debate on what the
reference range should be, so on a lab report
you'll have a result and then there'll be a
range that your doctor looks at but
sometimes that individual result might be
at the lower end of a range or the
higher end of the range-- even though it
may not be flagged as abnormal, I begin to
ask more questions; do you have a family
history of thyroid problems, do you have
any thyroid symptoms, do you have
any thyroid enlargement, have you had a
miscarriage, are you trying for pregnancy,
all of these things that trigger the
need to explore more. The problem is the
underlying autoimmune disease and that
can exist even if the TSH is normal, so
we need to look deeper into options for
testing and identifying those patients
who may be at risk for autoimmune
thyroid disease and not know it. We were on our annual ski trip
over Christmas and New Year's and we
had bought tickets to this really
nice mountain and I was really excited to ski,
and as we went up the chairlift the
first run went pretty tough. My lower legs
were really stiff, they were really
hurting and I just assumed it was
because it was really cold outside. I went to
the rental shop and I tried three different
pairs of boots and it didn't matter what
I was wearing, I was in so much pain I
couldn't ski at all that day but I still
explained it away as being the boots. One
of the things that I decided that I was
going to do was create a running goal-- so
I was gonna run a half marathon and I
just remember my legs would get so stiff
that I couldn't even run because I
couldn't feel them anymore and when I'd reached down to
feel them they would be as hard as a rock. I’d
assume that it was because I really didn't
stretch much before I would go running,
so I started doing yoga, and thinking
that that's what was wrong. I
flew back to New York for an interview in
April, my mother met me in the city and we
got a hotel the night before my
interview and, and she took one look at me and
she said you need to go to the doctor the
day you get home. She could tell by the way
that I looked and I think the way that
I was behaving also, that there was
something wrong. You could tell that I was
feeling very physically anxious, it was
hard for me to catch a breath, but I was
so exhausted that we couldn't
really walk around the city like we normally
would. She wanted to take me shopping
and I was just too tired, it hurt to walk,
and at that time she could see the lump
in my throat and my eyes were also
protruding-- I explained away every single
symptom that I felt until somebody else
could see it and tell me there's
something wrong with you. I had a girlfriend who is a
professional kite surfer, so I learned to
kite surf and we would go kite surfing in
various different places. So one year we
were out in the gorge to kite surf for a
week, by the time we get to the gorge my
eyes were hurting really, really bad. After
this maybe five hour flight, I think
that's the first time that I figured out
something was really weird with my eyes
because they had never done that before
they had never gotten so inflamed that I
was having to actually treat them for an
entire week. We'd go out and
we'd kite surf for hours and then we come
back and I would literally like go to the
car and just drop and she'd come to the
car, eat an apple, and go back out for
four hours and I couldn't do that, so I
sort of attributed that to I was maybe
like, getting older and a little bit
out of shape, so my solution was to
come home and get more built up. So I came
home and I started with a personal
trainer to actually you know build up my
stamina. I
think that it did make me feel stronger
and make, and give me some more endurance,
but I still had problems of feeling
tired. So I would see my
gynecologist every year, and every year she
would tell me that she thought that there
was something wrong with my thyroid
and she wanted to do specific thyroid
testing, and every year she did and every
year she would tell me that it would
come back within normal limits. One
day though it became really bad-- my
daughter and I went to Space Camp, and my
daughter and I had gone to Space Camp every
year from when she was seven on, it was
one of her favorite things to do. I woke up
and my eyes were bulging and so
bloodshot I thought that I wasn't sleeping
well because I'm in Space Camp. I'm
sleeping on this horrible mattress and I
flown here, which irritates my eyes,
but I really felt terrible. I got a
primary care doctor and I told him that
what was wrong with me now was that I had
developed an allergy to cats. He looked at me and he said I'm
gonna run some blood tests, not just
the typical thyroid panel which my
gynecologist had been running for years
but he said that there was a test that
he wanted to run, and he called me back in and
he told me that I had Graves disease. Patients like Liz and Kaylin are
not alone in their struggle, in a
sizable number of people with autoimmune
thyroid conditions, routine blood tests
can fail to detect the antibodies
allowing the disease to progress. So because
autoimmune thyroid disease is what is
causing the thyroid function problem, we
have to look at what the immune system
is doing so we have to look beyond those
basic tests. Up next technology
takes a leap towards early diagnosis
[Music] [commercial]
[Music] Welcome back the diagnosis of
autoimmune thyroid disease can be elusive,
leaving patients questioning their
symptoms even after they leave the doctor. According to
the guidelines published by the American
Thyroid Association, measurement of
thyroid antibodies for confirmatory
diagnosis of autoimmune thyroid disease
is recommended. Dr. Lupo
explains that there are antibodies in the
blood that through innovations and testing,
can be detected to confirm Hashimoto's
and Graves disease before it may
even be reflected in a patient's TSH. There are
different types of thyroid antibodies in
the blood some of them will stimulate the
thyroid to make excess thyroid hormone--
and we see that in Graves disease--
some of them will block the thyroid and
decrease the thyroid hormone production
causing hypothyroidism, some of them will
destroy or damage the thyroid, and those
are the thyroid peroxidase and thyroglobulin antibodies that we
see typically in Hashimoto's. There
are times where the TSH test is normal but
the thyroid is already under attack
by the immune system, so the times we
think about that would be if there's a
strong family history, if there's some
symptoms suggestive of thyroid or
previous history of thyroid TSH results
that fluctuate a little bit, very
importantly if there's a young woman who has
had trouble becoming pregnant, or
who has had miscarriages, screening with a
TSH is not enough, looking at thyroid
antibodies is very important to explain those
reproductive problems and, which, are
quite treatable with thyroid medication. Other times we see patients with
thyroid eye disease, so the eyes become
bulging, the vision becomes impaired the
eyes can ache, or be irritated,
seemingly-- maybe eye allergies or something else--
but that can be Graves disease, where those
antibodies that attack the thyroid, the TSH
receptor antibodies also attack the fat
and muscle behind the eye and caused
the bulging and that can occur with
a normal TSH. So my test results were
saying that I was normal but I wasn't, I
wasn't feeling normal and I wasn't
feeling right. Fortunately, finally,
someone said let's figure out why,
and then they ran that one extra test
that was able to give the answer. Remembering that Graves disease
is the immune system attack, where the
thyroid is tripped and stimulated into
making excess thyroid hormone, if we
can measure something that's very specific
as a stimulating immune system
attack, that would give us a definite
diagnosis of Graves disease, but there are
different types of tests. So the older
tests looked at these TSH receptor
antibodies, but didn't tell us exactly if it was
stimulating or blocking, and now we have
a test that's a bioassay, meaning we're
measuring the exact cause of Graves
disease, so that's the TSI or TSH
stimulating immunoglobulin that we can
measure directly to confirm a diagnosis
of Graves disease, and at that same time
determine how active the immune system
is against the thyroid. So if we
know why the thyroid is misbehaving then
we can guide treatment better and we
can make predictions on outcomes and
prognosis. I
called my general practitioner and it
was going to take him a month to see me,
he suggested that I go to Urgent Care
and as soon as I got there both the LPN
who took my blood pressure and the
urgent care doctor asked me do you have
a family history of thyroid disease, and
I said my mother does, and they said well
we think you do too we're gonna get all your blood
work done. And they did and it came back
within a couple of hours and he said yep,
you have Graves disease. My levels were
so far off that my doctor had asked me
about my symptoms and how long I had been
experiencing those symptoms and he said
that considering how far along I was and
how bad my levels were, that I had
probably had the disease for a year
before I was diagnosed. [Music]
[commercial] [Music]
In my experience with the treatment and
management of thyroid disease, patients
do very well in large part due to these
new innovative tools we have to recognize the autoimmune
etiology of thyroid disease, and manage
these patients better. Since being
diagnosed and finding a great doctor
accepting that there really is something
wrong and I need to take some downtime and
take care of myself and stay on a, a
regular regiment with my medication-- I
am back to enjoying life in San Diego and
being active on a regular basis. So my
advice to people who think they might
have a thyroid problem is simply talk
to your doctor. Call the office, make an
appointment, explain what symptoms you're
having, and ask whether or not thyroid
testing would be appropriate. I'm very
lucky that my primary care doctor
actually listened to my symptoms and ran
some tests so that I didn't get very
sick and I am actually able to continue
to do all the things that I want to do. If you're struggling for answers
and aren't feeling quite like
yourself, it's important to talk to your doctor
and ask about testing your thyroid. For
more information on the antibody
tests discussed here today, visit
quidel.com or thyretain.com-- if you're a
patient already suffering with thyroid
disease you can also reach out to the
Graves Disease and Thyroid foundation
for support, and as always you can
find a guide to thyroid symptoms and
helpful links on our website, access
health dot TV and don't forget to follow us on
Facebook and Twitter. See you
next time! [Music]
