Why your thyroid diagnosis may have been missed

By Njeri Maina
Monday, June 7th, 2021 00:00 | 6 mins read
Thyroid diagnosis.

Njeri Maina @njerimainar

The thyroid gland is a butterfly shaped organ located at the base of the neck, which produces hormones that control the body’s metabolism.

At times the thyroid may over or under function, thereby leading to thyroid disorders, such as hyperthyroidism and hypothyroidism. 

Dr Eric Mugambi, a public health specialist, consultant physician and leading endocrinologist says that the conditions maybe prevalent,  but underreported due to the knowledge gap that exists among patients.

“Hyperthyroidism manifests in different ways. Grave’s disease is a form of hyperthyroidism.

The typical patient with hyperthyroidism would be energetic and jittery.

They may appear anxious and restless and be easily startled. The eyes may appear protuberant and ‘staring’.

Their breathing might be fast and they might complain that they feel hot. They often have sweaty palms and a fine tremor of the hands.

Usually their pulse and sometimes their blood pressure is increasing. Their weight is often reduced – despite increased appetite and dietary intake.

Increased bowel motions are consistent with hyperthyroidism. Women may present with reduced periods, in terms of amount and frequency.

Rarely, patients with Grave’s disease might have skin changes resembling an orange peel on the front of their legs,” Dr Eric explains.

Allan Maimbu, a businessman and financial consultant vividly remembers ailing from all these symptoms last year.

He recalls always feeling tired, despite having rested and having enough sleep. He had also lost a lot of weight inexplicably.

“I am a father of two daughters. At times I would come home and they want to play, but I would only play for a short while as my heart would be beating too fast and I would feel really tired.

I would then go lock myself in the bedroom, sweating profusely and out of breath, trying to recover.

Allan Maimbu and his wife Lilian Kakuvi.

I was always bloated regardless of what I ate. At some point, one of my legs had turned black from excess hormone deposits,” Allan explains.

He is grateful to his wife, Lydia Kakuvi, for pushing him to get tested. In December 2020, after a battery of tests, he was diagnosed with Grave’s disease.

He remembers his wife crying, and the doctor reassuring them that the disease is treatable.

Allan visits the doctor every six weeks for checkups, and he has seen considerable improvement in his weight and quality of life since he started treatment.

Dr Eric explains that the type of treatment and whether the disease is curable or not depends on the type of thyroid disease leading to hyper or hypothyroidism and when it is diagnosed.

“At the very extreme, you have early cancer, which can be cured through surgery and radioactive iodine therapy.

However, even in this case, thyroid hormone replacement is required for life.

At the other extreme, you have self-limiting thyroid diseases, such as sub-acute thyroiditis following a viral infection or following child birth (post-partum thyroiditis).

However, the latter at times recurs. Thyroid disorders caused by auto-antibodies can be treated and the patient restored to normal thyroid function,” he elaborates.

Triggered by pregnancy

Sarah Katulle, founder of Thyroid Disease Awareness Kenya Foundation (TDAK), is one of the people whose thyroid disease was triggered by pregnancy. She was diagnosed with hyperthyroidism post-partum.

She recalls feeling fine pre-pregnancy and feeling tired and sluggish with a swollen neck and experiencing fast heart beats post-pregnancy.

It would take quite some time and several practitioners later, for her to get a correct diagnosis.

She recalls finding very little information on the condition and how she had to do her own research to empower herself.

As a result, she decided to set up an organisation that would help fill in the knowledge gap and empower patients by forming TDAK in 2017.

Sarah also knew firsthand the cost of lack of information as she had lost a close friend to hyperthyroidism due to a late diagnosis in 2014.

“I also wanted to advocate for policies that would alleviate the cost burden, as thyroid tests, consultation fees and hormone replacement drugs are too expensive,” she offers.

While it is clear as in Sarah’s case that pregnancy can be a trigger for thyroid diseases, what other triggers and risk factors are there?

Other risk factors

“Risk factors can be broadly categorised as genetic and environmental,” Dr Eric explains.

Genes with information critical to a functional immune system may be altered, leading to the so called auto immune-mediated thyroid disorders, including Grave’s disease and Hashimoto’s thyroiditis.

This means that family history plays a role in thyroid diseases. A number of genetic syndromes involve multiple endocrine organs in addition to the thyroid gland and it is not unusual to find the combination of type One diabetes and thyroid dysfunction in affected patients. 

The doctor says women are at a higher risk of thyroid disease. Also race appears important as studies in the west suggest that autoimmune thyroid disease occurs at a lower rate in black Americans compared to Caucasians, Hispanics and Asians.

Age modulates the type of thyroid disease, with hypothyroidism being more common in older persons.

The most important environmental factor relates to iodine intake, too little or too much could cause problems.

Surgery and radiotherapy around the neck area, and ingestion of medicines that contain too much iodine are some notable examples. 

While a hyperthyroid patient is unenergetic and has a heart that beats a tad too fast, in situations where the thyroid gland does not produce enough hormone, it presents the opposite picture. They appear dull, lethargic and somnolent.

Their skin is cold and dry and they might experience hair loss. Facial features may roughen over time, a change likely to be first recognised by family and friends.

It is useful sometimes to study facial photos of the patient before and after diagnosis.

Their pulse rate will be reduced and they will report weight gain despite low appetite.

They might be constipated and women may have increased period quantity or frequency. 

While the symptoms for hyper and hypothyroidism are different, they are similar in that they affect one’s mental state and emotions.

Patients with hypothyroidism often appear depressed while those with hyperthyroidism might have anxiety and depressive symptoms as well. 

“In general, for one to make a diagnosis of a primary psychiatric disorder, such as major depression, secondary medical causes for the symptoms need to be excluded; and if present managed satisfactorily. Thyroid disease can still coexist with mental illness.

It is, therefore, imperative that health specialists rule out thyroid disease before a primary diagnosis of a psychiatric condition is made,” Dr Eric further explains.

Lifestyle change

Allan was given drugs and a few lifestyle changes to stick to during treatment. His doctor asked him to stop eating certain animal products, including milk and to not take any salt, but seasalt.

He also eats natural meals, such as traditional vegetables, whole cereals, and wholemeal flour.

He does not exercise until the doctor advises him to, because of the associated heart palpitations that occur with exertion. He also drinks a lot of water to clear toxicity off his body.

“Established Hypothyroidism is treated with life-long hormone replacement.

Locally, and in Europe, hyperthyroidism is often treated medically, that is through the use of anti-thyroid drugs, which most patients take for 18 to 24 months.

Surgery is an option for patients with obstructive symptoms or those with large goiters and desirous of a cosmetic result.

In the United States, the first line therapy is often radio-active iodine,” Dr Eric explains.

Since the disease is triggered by different environmental factors in a person who is genetically predisposed to the disease, positive lifestyle changes are recommended.

“Pregnancy is a well-established trigger for auto-immune thyroid disease. Other triggers are iodine, infections, inflammatory agents and chemicals found in pesticides and environmental pollutants,” Dr Eric explains.

As to why it takes too long to correctly diagnose the disease, Dr Eric recommends an awareness campaign in the form of continuous medical education and self-directed learning. 

“A high index of suspicion is warranted as the presentation of thyroid disease is remarkably diverse,” he says. 

Sarah is determined to do this through TDAK. She wants patients to be empowered. She holds regular webinars and disseminates useful tidbits on thyroid diseases through her foundation.

Allan’s advice to anyone ailing from any thyroid disease is for them to take heart and get support from family, friends and those who have triumphed over similar conditions.

“Do not downplay any symptoms that you have. I downplayed mine for quite a while before seeking medical advice.

If you feel off, listen to your body and seek help. An early diagnosis could be the difference between life and death,” he says in conclusion.