Unbalancing act - keeping the thyroid gland in working order

Vibrant Life, March-April, 1995 by Judith E. Angerman

Treatment for hypothyroidism is easy to handle: a thyroid hormone tablet once a day (usually a lifetime prescription) should produce a fairly rapid recovery. In addition, some patients may notice an unexpected bonus: weight loss.

"Thyroid hormone was given years ago by doctors to overweight patients," explains Jerome M. Hershman, former president of the American Thyroid Association and a professor at the University of California School of Medicine in Los Angeles. "But excessive amounts were found to cause not only nervousness but also numerous deleterious effects on the heart and bones." Now, he says, it's regarded as "inappropriate and even quackery" to give thyroid-hormone therapy to induce weight loss. "I always caution patients to take the exact amount of hormone prescribed," he adds, "and not to take any extra to try to lose weight."

An overactive thyroid is a little more complicated to treat. In his book Your Thyroid.- A Home Reference, cowritten with Drs. David Cooper and E. Chester Ridgway, Massachusetts General's Lawrence Wood describes three ways to lower the overproduction of thyroid hormone.

First, a patient can take antithyroid pills to block hormone production, but allergies to the drug are common, and only 15 percent of those who use antithyroid pills find them effective in the long run. Most adults who develop hyperthyroidism are treated instead with radioactive iodine.

Swallowing radioactive iodine in capsule or liquid form, the second choice, destroys some of the thyroid tissue, thus reducing the amount of hormone produced. This is not an option for pregnant women because the iodine can cross the placenta and affect the baby's thyroid as well. Surgery, the third alternative, removes most of the thyroid gland. Sooner or later, says Wood, virtually everyone treated either with radioactive iodine or with surgery ends up with a hypothyroid condition; in fact, Wood believes that thyroid dysfunction progresses naturally over time from overactive to underactive. Fortunately, a daily supplement of thyroid hormone brings the level back to normal.

Periodic checkups to monitor, adjust, and fine-tune the thyroid hormone level are essential. An excess of thyroid hormone may upset the body's digestive, nervous, and reproductive systems, and can also induce heart problems. In addition to these concerns, Jerome Hershman says, some studies indicate that excessive doses of thyroid-replacement hormone over a long period of time can increase the risk of osteoporosis, although, he cautions, there's still some controversy surrounding this subject.

"If you suspect a thyroid problem or if you have a family history of thyroid disease, be a detective and ask your doctor to perform a TSH test," suggests Cedars Sinai's David Aftergood. "If thyroid's the problem, treatment is easy and recovery is possible in a matter of months."

For more information, contact the Thyroid Foundation of America, Inc., Massachusetts General Hospital, Ruth Sleeper Hall, Room 350, Boston, Massachusetts 02114; 800-832-8321.