The Cost of Missing an Underactive Thyroid

The Tragic and Invisible Epidemic of Thyroid Disease

For over a decade, research by Jacob Teitelbaum M.D., author of the best-selling book "From Fatigued to Fantastic!"¹ has shown that hypothyroidism, like most other illnesses that affect predominantly women, has been dramatically under diagnosed.^2,3 The American Academy of Clinical Endocrinologists (AACE), the nation's largest organization of thyroid specialists, has now confirmed this. After a 2002 meeting, the normal range for thyroid tests was dramatically narrowed. As noted in the AACE press release:

"Until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and help patients with a thyroid disorder who tested outside the boundaries of that range. Now AACE encourages doctors to consider therapy for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.0. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone unaddressed until now.

"The prevalence of undiagnosed thyroid disease in the United States is shockingly high—particularly since it is a condition that is easy to diagnose and treat," said Hossein Gharib, M.D., FACE, and president of AACE. "The new TSH range from the AACE guidelines gives physicians the information they need to diagnose mild thyroid disease before it can lead to more serious effects on a patient's health—such as elevated cholesterol, heart disease, osteoporosis, infertility, and depression."⁴

Now, 6 months after the new directives have been given, doctors are still largely unaware of these new lab guidelines for diagnosis and therapy. Even the major labs doing thyroid testing have not bothered to change the now incorrect normal ranges for both diagnosis and therapy of thyroid disorders.

The normal range for thyroid hormone levels in the past have been based on statistical norms (called 2 standard deviations). This means that out of every 100 people, those with the 2 highest and lowest scores are considered abnormal and everyone else is defined as normal. That means if a problem affects over 2% of the population (and as many as 24% of women over 60 are hypothyroid⁵ and 12% of the population have abnormal antibodies attacking their thyroid⁶), then our testing system will still miss most of them. In addition, our testing system does not take biological individuality into account. To translate how poorly this "2%" system works, consider this. If we applied it to getting you a pair of shoes, any size between a 4 and 13 would be "medically normal". If a man got a size 5 shoe or a woman a size 12, the doctor would say the shoe size they were given is "normal" and there is nothing wrong with it!

This increased the number of Americans with Thyroid illness from 13 million to approximately 27 million. Unfortunately, over 13 million Americans with thyroid disease remains undiagnosed⁴, and the majority of those receiving therapy are not being dosed appropriately^5,6. Doctors do not know that they have not been adequately trained in the proper diagnosis or therapy of hypothyroidism, and the cost in human life and devastating illness is enormous. What makes this especially tragic is how easy therapy is if doctors were given the correct information. Even the major laboratories continue to give erroneous normal ranges for the tests, simply because they're not aware of the guidelines of the AACE or the information put out by their National Association of Clinical Biochemistry.

What Is the Cost of Missing Hypothyroidism?

1. Over 30,000 preventable deaths/year from heart attacks. Women with unaddressed hypothyroidism are more than twice as likely to have a heart attack. A study in the prestigious Annals of Internal Medicine noted that hypothyroidism "contributed to 60 percent of cases of myocardial infarction [heart attacks] among women affected by subclinical [even mild] hypothyroidism." It contributed more to causing heart attacks in these patients than smoking, elevated cholesterol, high blood pressure, or diabetes!⁷. Another new study supports this showing that subclinical hypothyroidism was associated with a 2.6-fold increased prevalence of ischemic heart disease.^7a
2. Over 4600 miscarriages per year after 15 weeks of pregnancy—countless more before. Six percent of miscarriages are associated with hypothyroidism. Undiagnosed hypothyroidism is also associated with infertility. In moderate to severely hypothyroid mothers, the baby was also over 6 times as likely to die soon after being born.⁸
3. Learning disabilities—Children born to hypothyroid mothers have a lower IQ (average of 7 points). They are almost 4 times as likely to have an IQ under 85 and over twice as likely to have learning difficulties resulting in their having to repeat a grade.⁹
4. Hypothyroidism contributes to millions being unnecessarily disabled. Over 6 million Americans have Fibromyalgia and tens of millions more have chronic muscle pain. Undiagnosed or inadequately addressed thyroid disorders contribute to these unnecessarily disabling conditions.^1,2,3 Our initial understanding of this was elucidated by Dr. Janet Travell, who was the white house physician for President Kennedy-who suffered from excruciating back pain¹⁰. Dr. Teitelbaum's recently published research shows that 91% of these patients can improve with proper therapy—especially including thyroid hormone.²
5. Hypothyroidism is a major cause of gaining and being unable to lose weight. It causes fatigue, dry hair, coarse skin, depression, and "brain fog" as well. Americans are currently addressing hypothyroidism, which is often confused as being depression, with Prozac! This is an even bigger problem in the elderly who are being misdiagnosed with depression or Alzheimer's/senility when what they have is hypothyroidism.

What makes this situation especially tragic is that, given the proper information, hypothyroidism is incredibly easy and inexpensive to diagnose and address. Instead, because of lack of awareness on the part of physicians, Americans unnecessarily suffer with a major public health disaster.

References

1. From Fatigued to Fantastic! (Avery/Penguin Putnam 2001;1st edition 1995). Jacob Teitelbaum M.D.

2. Teitelbaum JE, Bird B, Greenfield RM ,Weiss A., Muenz L, Gould L. Effective Treatment of CFS and Fibromyalgia—A Randomized, Double-Blind, Placebo-Controlled, Intent to Treat Study. The Journal of Chronic Fatigue Syndrome. Volume 8(2), 2001, pg3-28.

3. Teitelbaum J, Bird B. Effective Treatment of Severe Chronic Fatigue: A Report of a Series of 64 Patients. J Musculoskeletal Pain 1995; 3 (4):91-110.

4. Press release on AACE website (accessed in 2002—this is no longer at this web address, so I have placed the press release below).

5. Canaris GJ, et al. The Colorado Thyroid Disease Prevalence Study: Archives of Internal Medicine, Feb 28,2000 p526-534.

6. National Assn of Clinical Biochemistry website.

7. HAK AS, Subclinical Hypothyroidism is an independent Risk Factor for Atherosclerosis and MI in Elderly Women. Annals of Internal Medicine 2000; 132: p270-278.

7a. J Clin Endocrinol Metab 2004;89:3365-3370.

8. Allan WC, et al. Maternal Thyroid Deficiency and Pregnancy Complications; Implications for population Screening. J Medical Screening. 2000. Pg127-130.

9. Haddow JE, et al. Maternal Thyroid Deficiency During Pregnancy and Subsequent Neuropsychological Development of the Child. New England Journal Of Medicine 1999: P549-555.

10. Travell J, Simons DG, Simons L: Perpetuating Factors. Chapter 4. In: Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams and Wilkins, Baltimore M.D.

Press release on AACE website

OVER 13 MILLION AMERICANS WITH THYROID DISEASE REMAIN UNDIAGNOSED

~January is Thyroid Awareness Month~
2003 Campaign Encourages Awareness of Mild Thyroid Failure, Importance of Routine Testing

NEW YORK - January 2003 - Did you know that 1 in 10 Americans—more than the number of Americans with diabetes and cancer combined^1,2—suffer from thyroid disease, yet half remain undiagnosed1? In order to counteract this lack of awareness and educate the public about the prevalence of thyroid disease, diagnosis, and therapy, the American Association of Clinical Endocrinologists (AACE) continues its annual thyroid awareness campaign. The 2003 campaign, Hiding in Plain Sight: Thyroid Undercover, launched today in conjunction with AACE's annual sponsorship of Thyroid Awareness Month.

New clinical guidelines published by AACE in November 2002³ not only enable doctors to more easily identify patients with thyroid disease, but also provide therapy standards. Using a simple blood test called the thyroid stimulating hormone (TSH) test, any physician can determine whether someone is suffering from an overactive or underactive thyroid—in many cases, even before patients begin to experience symptoms⁴.

Until November 2002, doctors had relied on a normal TSH level ranging from 0.5 to 5.0 to diagnose and address patients with a thyroid disorder who tested outside the boundaries of that range⁵. Now AACE encourages doctors to consider therapy for patients who test outside the boundaries of a narrower margin based on a target TSH level of 0.3 to 3.0⁴. AACE believes the new range will result in proper diagnosis for millions of Americans who suffer from a mild thyroid disorder, but have gone unaddressed until now.

"The prevalence of undiagnosed thyroid disease in the United States is shockingly high—particularly since it is a condition that is easy to diagnose and treat," said Hossein Gharib, MD, FACE, and president of AACE. "The new TSH range from the AACE guidelines gives physicians the information they need to diagnose mild thyroid disease before it can lead to more serious effects on a patient's health—such as elevated cholesterol, heart disease, osteoporosis, infertility, and depression."

If the thyroid gland doesn't work properly, neither do you. The thyroid gland, a butterfly-shaped gland located in the neck just below the Adam's apple and above the collarbone, produces hormones that influence essentially every organ, tissue and cell in the body⁶. If thyroid disease is left unaddressed, it can lead to such complications as elevated cholesterol levels and subsequent heart disease, infertility, muscle weakness, osteoporosis and, in extreme cases, coma or death⁷.

Thyroid disease is of particular concern to women, since they are five to eight times more likely than men to be diagnosed with the condition⁸. The elderly are also at increased risk for the disease—by age 60, as many as 17 percent of women and nine percent of men have an underactive thyroid⁹. Thyroid disease is also linked to other autoimmune diseases, including certain types of diabetes, arthritis, and anemia¹⁰. For example, 15 to 20 percent of people with Type 1 diabetes, as well as their siblings or parents, are at a greater risk of testing positive for a thyroid disorder¹¹.

Eighty percent of patients diagnosed with thyroid disease have hypothyroidism (underactive thyroid)¹². Common symptoms of hypothyroidism include: fatigue, forgetfulness, depression, constipation, and changes in weight and appetite⁴. The good news is that this serious condition is easily addressable by taking a levothyroxine sodium pill once a day to restore thyroid hormone to its normal level⁴. Once a patient is stabilized on medication, switching brands or dosage is not recommended unless otherwise directed by their physician⁴.

"Because the symptoms of thyroid disease are somewhat vague or subtle, patients often don't know they should be asking their doctor for a TSH test," said Gharib. "In fact, many patients have said they didn't realize they were ill until they began treatment and started feeling more energetic and healthy."

Although mild hypothyroidism can often be addressed by a primary care physician, AACE recommends that certain types of hypothyroidism patients see an endocrinologist:

• Patients of age 18 years or less
• Patients unresponsive to therapy
• Pregnant patients
• Cardiac patients
• Presence of goiter, nodule, or other structural changes in the thyroid gland
• Presence of other endocrine disease

While the TSH blood test is the most sensitive and accurate diagnostic tool for thyroid disease, AACE also recommends that patients perform a simple self-examination called the Neck Check™. This easy, quick self-exam, unveiled by AACE in 1997, helps Americans detect if they have an enlarged thyroid gland and should speak with their doctor about further testing.

For step-by-step instructions on how to perform the Neck Check™, or to view the new AACE clinical guidelines for hypothyroidism and hyperthyroidism, visit the AACE web site at www.aace.com.

The American Association of Clinical Endocrinologists (AACE) was established in 1991 and is the country's largest professional organization of clinical endocrinologists. Its membership consists of more than 4,200 clinical endocrinologists devoted to providing care for patients with endocrine disorders. The association strives to improve the public's understanding and awareness of endocrine diseases and the added value of the clinical endocrinologist in the diagnosis and therapy of these diseases.

Thyroid Awareness Month is supported through an unrestricted grant from Abbott Laboratories.

References

1. National Diabetes Fact Sheet: National estimates and general information on diabetes in the United States. National Institutes of Health, et al, 1997.

2. Johns Hopkins Urban Health Institute, Special Projects, Johns Hopkins University, 2001.

3. AACE Medical Guidelines for Clinical Practice for the Evaluation and Treatment of Hyperthyroidism and Hypothyroidism, Endocrine Practice, Vol. 8, No. 6, Nov/Dec 2002.

4. Rosenthal, M. Sara The Thyroid Sourcebook, Lowell House, Los Angeles, 1996 (pp. 37-38).

5. Wood, L.C. Your Thyroid: A Home Reference, Ballantine Books, New York, 1995 (p. 229).

6. Wood L.C. Your Thyroid: A Home Reference, Ballantine Books, New York, 1995 (pp. 1-3).

7. Singer P.A. Treatment Guidelines for Patients With Hyperthyroidism and Hypothyroidism, JAMA 1995: 273: 808-812.

8. Wood L.C. Your Thyroid: A Home Reference, Ballantine Books, New York, 1995 (pp. 216-217).

9. Wood L.C. Your Thyroid: A Home Reference Ballantine Books, New York, 1995 (pp. 179).

10. Wood L.C. Your Thyroid: A Home Reference Ballantine Books, New York, 1995 (pp. ?).

11. Adams A, Walston J, Silver K. Autoimmune Disease Risk in Families with Type 1 Diabetes, www.genetichealth.com 10/27/01.

12. Hollowell study.