Verbal Diarrhoea #15

"For years, Santos, a book lover, could not concentrate enough to finish one book. Last month, she read four."

Claims a newspaper article about Maria Santos, (name changed for patient confidentiality reasons), 44, a project manager at a bank who moved to Hong Kong four years ago from the United States, where she was diagnosed with hypothyroidism (an underactive thyroid).





Question: Are these completely new books, or the books that she never finished over the years? Pray tell.

About Verbal Diarhhoea




Reference

The silent scourge of thyroid disorders (SCMP; paywall)

 WORLD THYROID DAY
Nadine Bateman (healthpost@scmp.com)
May 29, 2012    

For more than a decade, Maria Santos suffered symptoms of a thyroid disorder that left her struggling at work and unable to enjoy life.

"I felt tired all the time and found it really hard to get out of bed in the mornings," says Santos (name changed for patient confidentiality reasons), 44, a project manager at a bank. She moved to Hong Kong four years ago from the United States, where she was diagnosed with hypothyroidism (an underactive thyroid).

"I couldn't concentrate properly; my brain felt 'foggy' and slow. I was moody and irritable. My skin, hair and nails were terrible - really dry and dull - and I gained weight easily … My husband used to say 'Come on, let's go to the gym, you can get out of this lethargy', but I just couldn't."

Hongkonger Milia Chan, 40, has experienced the other extreme of thyroid disorder - hyperthyroidism, or an overactive thyroid - since being diagnosed in 1995. The service business manager with an information technology company has symptoms that include "an extremely fast heartbeat, shaking hands, shortness of breath and bad temper".

Both forms of thyroid disorder are surprisingly common (an underactive thyroid being more common) but they often go undiagnosed because many of the symptoms are similar to those of other conditions. The symptoms can also be attributed to "lifestyle factors", such as stress, poor nutrition, and a lack of exercise or sleep.

The thyroid, a butterfly-shaped gland in the neck, controls metabolism. It produces hormones called T3 and T4, which tell cells how much energy to use. Hyperthyroidism occurs when the thyroid overproduces the hormones and the body uses energy faster than it should. Hypothyroidism is the opposite: the thyroid doesn't produce enough hormones and the body uses energy slower.

People of all ages can get the disease, but women have it more often than men. It is estimated that one in five people worldwide have a thyroid disorder. Hence World Thyroid Day, last Friday, to promote understanding of the condition.

Dr Lauren Bramley, a family doctor who has a clinic in Central, suspects the figure is higher because many cases go undiagnosed. She recently completed a master's in endocrinology, diabetes and metabolism at the Chinese University and is treating a number of patients with thyroid conditions.

"Hypothyroidism is now rampant," says Bramley. "Hyperthyroidism, although increasing in prevalence, is not nearly as common as hypothyroidism. Furthermore, many hyperthyroid patients can become hypothyroid."

She says the list of hypothyroid symptoms is exhaustive, which is why it can be difficult for doctors to diagnose. "For example, fatigue - a major symptom of hypothyroidism - is also present in many other conditions or the result of lifestyle factors. But thyroid disorder has more symptoms than any other disorder in the body. This is because the thyroid gland is important in so many functions of every organ."

Other key symptoms of hypothyroidism include low body temperature, sensitivity to heat or cold, difficulty waking up in the mornings, severe fatigue at around 3pm, difficulty concentrating, low mood, enlargement of the thyroid gland in the neck and thinning of the outer areas of the eyebrows. Weight gain and hair loss are common complaints but are not always present. Bramley also believes pollution may negatively impact the function of the thyroid gland.

Hypothyroidism can be caused by many factors, such as autoimmune thyroid disease, hereditary conditions, inflammation (thyroiditis) and tumours. Worldwide, the most common cause is believed to be iodine deficiency.

Dr Teofilo San Luis of the Asia & Oceania Thyroid Association says: "Iodine is available through eating marine foods such as fish, shrimps, squid, oysters, crabs and seaweeds; processed foods which have been iodised; milk; and iodised salt."

He says people affected with thyroid disorders will have goitre (thyroid enlargement) as evidence of poor iodine nutrition. However, he says that goitre is "only the tip of the iceberg" as there are "more insidious manifestations" of iodine deficiency not commonly recognised, such as reproductive failures.

"Women are very vulnerable because of increased demands for iodine during pregnancy and lactation, and if their iodine nutrition is overlooked this could result in their babies having significantly lower IQ levels."

Patients are typically diagnosed through a physical examination, analysis of medical history and laboratory tests such as blood tests. Bramley notes lab test results can sometimes be unreliable.

If the condition is hypothyroidism due to iodine deficiency, San Luis says the treatment is to increase intake of iodine through iodised salt or, in extreme cases, iodised oil capsules. (Bramley, however, suggests refined, iodised salt is "not the ideal source". She advises taking unrefined sea salt which is not iodised, and supplements such as Iodoral tablets or Lugol's Solution.)

In general, Bramley advises first correcting underlying deficiencies of iron, vitamin D3, selenium and iodine, and suggests a review of heavy metal toxicity such as mercury, arsenic and fluoride.

Medications such as oral contraceptives and psychiatric drugs should also be considered. Identifying and balancing other hormones such as cortisol, progesterone and DHEA are important, says Bramley.

Chan had an operation to remove her thyroid gland last April. Her doctor, Laurence Shek, prescribed thyroxine, which she will take every day for the rest of her life. "It took my body a while to adjust, but my heart is better now and I can do more exercise," Chan says.

Last September, Santos was prescribed T3, vitamin D, DHEA and iodine supplements - she had previously taken T4 medication for years without benefit. "I'm so much happier. I've more energy - I go to the gym three times a week. I feel good when I wake up in the mornings; I'm enjoying socialising again; and I'm losing weight."

For years, Santos, a book lover, could not concentrate enough to finish one book. Last month, she read four.