How to Thwart a Thyroid Problem
An Untreated Condition of the Butterfly-Shaped Thyroid Gland Can Have a Significant Impact on Your Body and Daily Life. Find Out How to Spot the Signs and What You Can Do About It.
Who Gets Thyroid Disease
Anybody can develop a thyroid problem, but women are much more likely than men and older adults are more likely than young people to develop one. People with HIV may also have somewhat higher rates of thyroid abnormalities than the general population, due to changes to the immune system caused by HIV or due to certain infections and cancers. Antiretrovirals and medications used to treat certain illnesses that are more common among people living with HIV, such as hepatitis C and tuberculosis, can also affect a person's thyroid function (see "Medications that Can Affect the Thyroid" for a list of some meds to watch for).
Infectious diseases specialist Dr. Stephen Shafran, from Edmonton's University of Alberta Hospital, says, "Overall, thyroid disease is not very common in people living with HIV, perhaps because thyroid disease is much more common in women than men, and in Canada the ratio of HIV infection for males to females is approximately 3:1." He also notes that in his HIV practice, he sees more hypothyroidism than hyperthyroidism.
Cause and Effect
The most common cause of hypothyroidism is called Hashimoto's thyroiditis, an autoimmune disease that involves the body's own immune cells damaging the thyroid. Iodine deficiency, thyroid surgery, radiation therapy to treat cancers of the head and neck, and other endocrine disorders are usually considered in the diagnosis of hypothyroidism. For people who have more advanced HIV, doctors might also check for infections or cancers that can invade the thyroid.
Although uncommon, people with HIV can develop a form of hyperthyroidism called Graves' disease one to three years after starting ART due to a strong immune response. As a result of starting HIV treatment, Patrick's immune system improved, but because his response to the medication was so strong, he also produced antibodies that caused his thyroid to become overactive and produce too much thyroid hormone.
A number of medications can also affect the thyroid, which is yet one more reason for people to talk to their doctors and pharmacists about all the drugs they're taking.
Pinpointing the Problem
Diagnosing a thyroid problem is key to feeling better and preventing other problems from ensuing. Had Selena's hypothyroidism gone undiagnosed, her lack of energy and weight gain would have likely continued to take a toll on her quality of life and sense of well-being. As for Patrick, if his Graves' disease had gone undiagnosed and untreated, he could have developed more serious complications, such as heart disease and bone loss, down the road.
Luckily for both of them, the diagnosis of thyroid disease is generally based simply on symptoms, a physical exam and blood tests. Blood tests that reveal a low level of thyroxine and a high level of TSH indicate hypothyroidism. And blood tests that reveal high levels of thyroxine and low levels of TSH indicate an overactive thyroid. (To sort out more complex cases, other tests such as a thyroid scan or a thyroid biopsy may be ordered.)
Offsetting the Imbalance
Dr. Shafran notes that treating an underactive thyroid tends to be more straightforward than treating an overactive one: "Hypothyroidism is easy to manage with the drug levothyroxine [Synthroid, Eltroxin], which is available in many strengths." On the other hand, he says, "managing hyperthyroidism tends to be more complex and patients should be treated by an endocrinologist -- a doctor who specializes in treating hormone problems." In cases of hyperthyroidism, two types of medicine are usually prescribed: an anti-thyroid drug and a heart drug called a beta-blocker, to control uncomfortable symptoms like a rapid or irregular heartbeat and shakiness. Sometimes, radioactive iodine is prescribed to destroy the overactive thyroid gland. Most patients who receive radioactive iodine subsequently become hypothyroid and then require levothyroxine therapy.
To treat hypothyroidism, levothyroxine is the most commonly prescribed medication (see "Tips for Levothyroxine Users"). To ensure that your treatment is working well, your healthcare team will monitor its effects to make sure your symptoms improve and your hormone levels return to normal. A person's TSH level will usually normalize after several weeks of treatment. If it remains elevated, this indicates that the dose of levothyroxine is too low. The dose may then need to be increased gradually until the TSH normalizes. Patience is needed as it can take several weeks or months to get you on the right dose and for your symptoms to resolve. After your treatment is stabilized, your doctor will probably recommend that you continue taking this dose and that your levels be monitored regularly.
The good news is that thyroid disease is a manageable condition that is fairly simple to diagnose and treat. In terms of prevention, the best thing a person can do to stay healthy is report any unusual symptoms to their healthcare team. For people on ART, there is only a small chance that the thyroid will be affected -- most people do just fine. If you have suspicious symptoms or several risk factors, your doctor may screen you for thyroid disease to detect it early.
This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
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