Hypothyroidism in women is a common hormonal disorder which affects many Indian women. Some health tips for women to handle thyroid problems.
When Rajini Balan* started gaining weight in spite of yoga and a reasonably healthy diet, she was not really worried. She put it all down to midlife crisis and her desk job and reacted very positively by adding a brisk morning walk to her routine. But a couple of months later she found herself feeling perpetually tired and sleep-deprived. She was missing her morning walk often and never seemed to have energy for anything.
As she gained more weight, she could not bear to look at herself in the mirror. She made the mistake of attributing her lack of energy and depression to her weight gain. “I just need to lose a couple of kilos,” she kept telling herself. While well-meaning friends and family suggested that she sign up for a gym, it didn’t occur to anyone that she might be ill.
It was only when her periods started becoming irregular that she sought a doctor’s help, thinking it might be early menopause or something related. Instead, she was diagnosed with hypothyroidism.
The thyroid is a gland located in the neck and is part of the endocrine system, the system that produces all the hormones in the body. This gland synthesizes a hormone called thyroxine that has far-reaching effects on nearly every other system in the body. Although present in micrograms, this hormone plays a role in such important functions as regulation of the body’s metabolism rate and is essential for proper growth of mind and body.
Hypothyroidism, a condition where the thyroid hormones fall below normal levels, occurs when there is gland failure or dysfunction, for many reasons.
Iodine is an important requirement in the thyroid hormone production process and its deficiency causes goiter (which really means ‘thyroid swelling’). A deficiency of this micronutrient occurs due to its absence in soil, water and food and can affect people of all socioeconomic groups. In India, iodine deficiency is a major health problem in spite of government initiatives like provision of iodized salt. According to a 2004 UN report (PDF) on the world’s nutrition status, about a third of India’s population is at risk of developing iodine deficiency disorders, while the number of children born mentally impaired due to iodine deficiency is also very high.
Most of the conditions leading to hypothyroidism cause the thyroid gland to swell up giving rise to a swelling in the front of the neck. In the case of Sheetal Jain*, a 38-year-old teacher, the condition was readily detected. She developed a neck swelling before any of the other symptoms kicked in and was quickly diagnosed with colloid goiter.
The other common symptoms of hypothyroidism include weight gain, fatigue, malaise, dryness of skin and hair, hair loss, depression and apathy, intolerance to cold, loss of appetite, constipation and menstrual disturbances. The risk increases with age and is especially greater in post-menopausal women.
Women have a greater requirement of thyroid hormones, particularly during puberty, pregnancy and lactation. This is one of the reasons for thyroid swellings to occur during these stages in life – the gland steps up activity to meet the greater demand with a resulting increase in size. This is a physiological process. But for reasons not clearly known, all types of thyroid disorders are far more common in women than in men. It is one of the more common among women’s health problems.
Another remarkable feature about the thyroid is its effect on reproductive health. From its location in the neck, the gland appears to remotely control the entire reproductive system. Excessive or subnormal production of the hormone causes menstrual disturbances – irregular periods, heavy flow or even complete cessation. Hypothyroidism is also a well-documented cause for infertility and miscarriages.
Take the case of Vinutha Kumar*, 31, a computer engineer. When she had not conceived five years after her marriage, she very reluctantly went to see a doctor. “I was petrified about having to undergo all sorts of tests and finding out there was something horribly wrong with me”, she says. But fortunately for her, all she had was subclinical hypothyroidism that was corrected and she is now the happy mother of a two-year-old girl. This is another problem with hypothyroidism. It is often present in a subclinical form where symptoms do not overtly manifest themselves. This is why women with the condition frequently suffer from vague complaints and go in and out of consultations without the diagnosis being made.
…infertility and menstrual disturbances are often thought of as ‘gynaecological’ problems; not many are aware of the influence the thyroid gland has on reproductive health.
Also, infertility and menstrual disturbances are often thought of as ‘gynaecological’ problems; not many are aware of the influence the thyroid gland has on reproductive health. The challenge with detecting hypothyroidism during pregnancy is that many of the symptoms can be mistaken for those of the pregnancy itself, while slightly older women like Rajini often attribute their symptoms to menopause. Thyroid function tests are now often part of the antenatal check-up in pregnant women. A deficiency during pregnancy can also adversely impact the growth of the foetus, even causing the baby to be born mentally impaired.
Once the suspicion arises, the diagnosis itself is fairly simple. A blood test to estimate the hormone levels is all that is usually required. Of course, some conditions will additionally need ultrasound and nuclear scans. The treatment is, by and large, hormone replacement which actually boils down to swallowing a pill; sometimes for the rest of your life. But as Rajini, now undergoing treatment and well on her way to being her old self, says, “Hey, at least there’s a cure!”
So if you know anyone struggling with any of the symptoms mentioned above and if they fall into the risk category, get them to see a doctor. They may just be a blood test away from help.
*Names changed to protect privacy
Dr. Lakshmi Ananth is a doctor and a writer who wields both scalpel and pen
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