Lewisburg resident Angela Strickler was only 25 years old, a young wife and mother of two little girls, when she received a shocking diagnosis of thyroid cancer.
“It was just devastating,” she said.
It was also surprising, since she had no symptoms and no family history of thyroid issues. A nodule on her thyroid was discovered during a regular gynecological exam in November 1993, shortly after her youngest daughter had just turned a year old. The discovery was followed by two biopsies — the first with inconclusive results, and the second confirming the presence of cancer.
Surgery followed in January. Though hoping to take just the right lobe of the thyroid, the surgeon was forced to remove the left lobe as well, when he discovered cancer in both. As a result of this thyroidectomy, Strickler’s body naturally developed hypothyroidism, a condition caused by the lack of the thyroid hormone that regulates metabolism. She was put on a prescription, Synthroid, which replaces the hormones normally produced and distributed by the thyroid gland.
“The worst part of this whole scenario,” she said, “is that it takes years for your body to adjust to Synthroid.”
She developed “ill side effects that are lifechanging,” she said, such as depression, severe weight loss, sleeplessness, and mood alterations.
“It straightened itself out,” she said, “but it took a long time.”
Now at 52 years old, she continues to take Synthroid and must continue to monitor her hormone levels. If she starts to not feel well, she knows it’s time for some new bloodwork and possible dosage changes.
What it is
January is Thyroid Awareness Month — a good time to consider the importance if this little organ that regulates many of our bodies’ critical functions.
According to Dr. Madiha Alvi, an endocrinologist at Geisinger Medical Center in Danville, the word “thyroid” comes from a Greek word meaning “shield”, as the organ is shaped like one. More commonly, it is referred to as butterfly- or “H”-shaped.
The thyroid is a gland that consists of a right and left side, joined together by a tiny fiber band in the center, Alvi explained, and is located at the front part of the base of the neck.
It’s a small organ that does a lot of work.
“It is commonly referred to as a gland that controls our metabolism,” Alvi said. Though the most popular association with thyroid malfunction is weight-related problems, she said the thyroid also regulates body temperature; nail, skin and hair health; and women’s menstrual cycles.
The thyroid “helps regulate most of the organs in our body,” said Michael Adler, MD, FACE, an endocrinologist with Endocrinology of Evangelical Community Hospital. For example, it is crucial for a healthy heart rate, reproduction, and brain, bowel and kidney function.
In fact, “There are very few things that aren’t affected by it,” he said.
How it works
The thyroid’s main job is to make what is called the T3 and T4 hormones. It does this by using iodine from the foods we eat, which is absorbed through the intestine and then travels through the blood stream and finally to the thyroid (Hormone Health Network).
According to the American Thyroid Association, these hormones are then secreted into the blood and carried to every tissue in the body, helping the body to use energy, stay warm and keep our organs in proper working condition.
The Hormone Health Network explains that the thyroid is governed by the pea-sized pituitary gland at the base of the brain.
This tiny gland checks the amount of thyroid hormone in the blood and tells the thyroid to make more or less of it, in order to keep the levels balanced.
When something happens in this process and the hormone levels become unbalanced, a variety of health issues could result.
When the normal process of producing and distributing the thyroid hormone is not working correctly, a person will develop either hyperthyroidism — too much hormone production, or hypothyroidism — not enough hormone production.
According to Adler, hyperthyroidism could be caused by several conditions – the most common being Graves disease, an immune disease that stimulates the thyroid to overproduce the hormone. Hyperthyroidism can also be caused by nodules on the thyroid that can cause it to overproduce, or an inflammation of the thyroid that passively leaks out the hormone.
Symptoms of hyperthyroidism include feelings of anxiousness, a faster heart rate, sweating, and trouble sleeping. “Everything in the body speeds up,” Adler said.
“It will make your body run at 165 miles per hour when it’s supposed to run at 65 miles per hour,” agreed Alvi, who said other symptoms may include heart palpitations, unintentional weight loss, diarrhea, and tremors or shaking of the hands.
On the opposite spectrum, hypothyroidism causes the body to slow down. This is what happens following surgery, for example, when a suspicious nodule was removed, or an entire thyroidectomy was necessary. Occasionally, a person will discover an underactive thyroid that is congenital, or as is a common cause in other parts of the world — due to an iodine deficiency. Adler said the most common cause of hypothyroidism is an autoimmune disease called Hashimoto’s disease, named after a Japanese surgeon. This disease attacks the thyroid, and over time it becomes scarred and non-functional.
Common symptoms of an underactive thyroid include fatigue, weight gain, fluid retention, slow heart rate, constipation, dry skin, and hair loss.
Alvi said these are often common symptoms for a variety of other conditions, and “the only way to know if it is related to the thyroid is by running the thyroid test.”
Women and those with a family history of thyroid disease are at the highest risk for developing thyroid issues. Often, there are specific indications in pregnant women, or based on someone’s age or body mass index or weight, that would lead to the standard practice of checking the thyroid through a simple bloodwork panel. Some physical or structural changes that might encourage getting tested is difficulty swallowing or noticing a physical lump or swelling in the neck.
If someone has concern, it’s important to discuss symptoms with a healthcare provider and to undergo proper screening, Adler said. The general recommendation for screening begins at age 35, and then every five years after that. A family history may trigger an earlier or more frequent screening.
Since thyroid disease is an autoimmune disease, Adler said, a blood test “can detect it attacking the thyroid before clinical disease starts.”
Megan Eger, 33, of New Columbia, was diagnosed with hypothyroidism last August, after a difficult summer experiencing symptoms such as fatigue, weight gain, muscle and joint pain, trouble concentrating, memory loss, and hair loss.
“It impacted everything,” she said. “At work, I had a lot of fatigue and trouble concentrating.”
At home, she said, she found it difficult to care for her two children. “I was so exhausted and not feeling well. I wasn’t able to do as much with them. It made things very difficult.”
There is a family history of hypothyroidism on both sides of her family, she said, so she was not completely surprised when she saw her doctor, got bloodwork, and received the same diagnosis.
Her doctor prescribed her a prescription medication that replaces the hormones that her thyroid does not make, thus normalizing the levels.
“I still have some issues,” Eger said, “but I can definitely tell there’s some improvement in my symptoms. I don’t have as much trouble concentrating. The weight gain leveled out, and there’s no more hair loss.”
A month ago, her lab work came back normal. She will have a follow-up appointment next month. She still hopes for the possibility that she may be able to one day stop taking the medicine. But for now, she is happy to be back to her normal activities.
Alvi said the most common prescription medications for thyroid disease work inside the gland at a cellular level. This treatment requires a regular checking of blood work and adjusting the dose of medication “to find that normal healthy balance,” of hormone production, she said.
While the priority is to help the patient feel better as soon as possible, she said, it’s also necessary to monitor regularly for complications and also to treat a patient for underlying causes.
“We have to make sure we’re not just putting a Band-Aid on,” Alvi said, explaining that thyroid issues could result from temporary inflammation or nodule activities.
Aside from prescription hormone replacement pills, Alvi said another option could be an active iodine treatment that fools the thyroid into making the normal hormone ingredient.
While conditions such as thyroid cancer may require surgery, Alvi said, “we must make sure we pick the right kind of candidate for the right kind of treatment very carefully.”
Though 27 years ago Strickler received that dreaded cancer diagnosis, she said she was grateful that it was thyroid cancer. This type of cancer is more isolated than other forms, and is highly treatable.
She is also thankful that her condition was caught as early as it was — when her thyroid was still functioning normally.
Today, she still gets bloodwork done a few times a year, but if that’s all she has to deal with, she’s ok with that.
“I feel like I’m at a good point,” she said. “I’m very thankful for the health I have today. I’m able to spend time with my family — and that’s what matters most.”