Thyroid problems, when undiagnosed and untreated, can cause a variety of uncomfortable symptoms, including weight gain or inability to lose weight, depression, anxiety, fatigue and infertility.

Because symptoms can sometimes be broad, thyroid disease is often misdiagnosed as a mental-health issue, and symptoms can be seen as attributed to other factors such as lifestyle, lack of sleep, overeating or stress.

Thyroid problems are mostly genetic, and thyroid problems do run in the family. They are more common in young women but can happen at any age including in the elderly, depending on the specific type of thyroid problem. Iodine deficiency, exposure to goitrogens (foods or other substances that can cause goiter) and other environmental factors may also play a part.

The thyroid gland is a small, butterfly-shaped gland in the neck. when the thyroid is its normal size, you can’t feel it. This gland controls how quickly the body uses energy, makes proteins, and controls how sensitive the body is to other hormones. it does this by producing thyroid hormones called T4 and T3. These hormones act throughout the body to influence metabolism, growth and development as well as body temperature.

During infancy and childhood, adequate thyroid hormone is crucial for brain development. Thyroid health also is especially important especially for women of childbearing age, as this affects fetal development and pregnancy outcome.

When the thyroid works normally, it produces and secretes the amount of T4 and T3 hormones necessary to keep things moving at their proper pace.

The most common problems of the thyroid consist of an overactive thyroid gland, known as hyperthyroidism, and an underactive thyroid gland, known as hypothyroidism. Of the two, hypothyroidism is more common.

In the United States, the most common cause of hypothyroidism is an autoimmune disease called Hashimoto’s thyroiditis, in which your own body makes antibodies that attack the thyroid cells. it cannot be prevented but is easily treated with replacement thyroid hormone pills. Iodine deficiency as a cause for hypothyroidism is more common outside the United States; it can be prevented by adequate intake of iodine in the diet.

This is why the U.S. government puts iodine in salt and other food products.

Common symptoms of hyperthyroidism include anxiety, insomnia, rapid weight loss, diarrhea, high heart rate, high blood pressure, eye sensitivity or bulging, and vision disturbances. Common symptoms of hypothyroidism include feeling cold all the time, fatigue, weight gain, constipation, difficulty concentrating, fluid retention, depression, body pain and slow reflexes.

While there is no consensus from either the U.S. Preventive Service Task Force or the Endocrine Society on whether to check for thyroid issues during annual or regular physical exams, if a patient suspects thyroid dysfunction based on any of the symptoms discussed, it can be diagnosed by simple blood tests.

Zinnia T. San Juan, M.D., is an assistant professor and a specialist in endocrinology with the Division of Endocrinology, Department of Internal Medicine, Texas Tech University Health Sciences Center Paul L. Foster School of Medicine.

By Paul G. Donohue M.D. February 01, 2011 12:00 AM

DEAR DR. DONOHUE: Six years ago, my sister, 67 years old, was diagnosed with Graves’ disease, and it has affected her eyes. has there been any advancement in research with it? Where is the best medical facility for it?

Chalk up another illness to an immune system that turns against its own body. in this case, it’s the thyroid gland and the eyes. Graves’ disease is an enlarged thyroid gland (a goiter) that’s putting out too much thyroid hormone. The stimulation that causes the overproduction comes from antibodies made by the immune system. not only do they lead to excess thyroid hormone, they also lead to deposition in the orbit (the bone socket for the eyes) of material that pushes the eye outward and infiltrates the eye muscles. That, in turn, often produces double vision. The name given to eye involvement is Graves’ ophthalmopathy or orbitopathy.

Your sister has to protect her eyes by using eyedrops or eye lubricants. When outside, she should wear large sunglasses with side extensions that keep wind out of the eyes.

In the early stages, if eyesight is threatened from the pressure of the infiltrating material on the optic nerve, large doses of cortisone are given to shrink the infiltration. Often, time permits the swelling in the orbit to regress.

Six years from the start of her illness, your sister’s eyes are still a problem. she should be under the care of an ophthalmologist and an endocrinologist (a thyroid specialist). A number of surgical procedures can be done to enlarge the bony socket. If she suffers from double vision, eye-muscle surgery can correct that, or she can wear glasses with prisms that compensate for eye misalignment.

DEAR DR. DONOHUE: will you please explain a rectocele? Is surgery advised? I am 82 years old and concerned about surgery.

A rectocele (RECK-toe-seal) is a downward bulging of the rectum into the vagina. A similar bulge of the urinary bladder is a cystocele, and of the uterus, a uterine prolapse. all three are referred to as pelvic organ prolapse — “prolapse” meaning “falling downward.” The ligaments and muscles supporting these structures give way with aging and childbearing.

Surgery for a rectocele is advised if it causes symptoms like straining to evacuate, or is painful or causes loss of bowel control.

If you don’t want surgery, then try a pessary, a device that comes in many shapes and that’s inserted into the vagina to prop up the fallen organ. your doctor can suggest one best suited to your problem.

DEAR DR. DONOHUE: Recently, a testing service provided ultrasound tests for a reasonable fee. my arteries appear very good for a woman of 67. However, my gallbladder displayed many large stones, and my left kidney has a cyst. what can I expect to happen from my gallbladder and kidney? my doctor tells me not to worry. would you agree?

A single kidney cyst is a fairly common finding on an ultrasound scan. Often, it’s discovered exactly as yours was: A scan is taken for some unrelated reason, and the cyst is seen. A cyst is a round structure filled with fluid. It’s innocent. unless it’s pressing on the kidney and interfering with kidney function or causing pain, you don’t have to do a thing about it. If you’d never had the scan, you’d never know about it. Now that you know, you still can ignore it.

Silent gallstones — gallstones not stirring up any trouble — also can be ignored. in five years, one in 100 people with such stones will have a gallbladder attack; in 10 years, 1.5 people will have an attack; in 15 years, 1.8 will suffer an attack. The odds are greatly in your favor that nothing will happen.

Readers may write to Dr. Donohue or request an order form of available health newsletters at P.O. Box 536475, Orlando FL 32853-6475.

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