DEAR MAYO CLINIC: I recently read that thyroid issues affect women more often than men. Can you explain what the thyroid is and how it affects my body? Can I do anything to prevent having issues with my thyroid as I age?

ANSWER: The thyroid is a small butterfly-shaped gland at the neck's base. The thyroid has a significant effect on the body in that it produces hormones that help regulate many of your body’s functions.

The thyroid gland produces two main hormones: thyroxine (T-4) and triiodothyronine (T-3). These hormones keep your body's metabolism consistent, aid in maintaining your body's temperature, have an impact on how well your nervous system functions and can affect your heart rate as well as blood pressure. A third hormone, known as calcitonin, which aids in controlling the level of calcium in your blood, also is produced by your thyroid gland.

Unfortunately, there are numerous disorders that can affect the thyroid, and women are at higher risk for thyroid issues than men. According to the American Thyroid Association, about one in every eight women will suffer from thyroid illness during their lifetime.

Although it is believed that the development of thyroid illness is connected to a person’s autoimmune system, it is unknown why women are more susceptible to thyroid disease. Genetics may play a role. Women of any age can experience thyroid issues, although women who have just given birth or are going through menopause are more likely to experience thyroid concerns.

The most commonly known thyroid conditions include:

• Thyroid nodules.
  About half the population in the U.S. are estimated to have a nodule by the time they are 60. Although some thyroid nodules may grow to a size where they are visible, frequently these nodules will go undetected until discovered either by a healthcare professional during a physical examination or incidentally during imaging of the neck for another reason. Fortunately, most thyroid nodules are benign, but a workup is necessary to determine whether thyroid cancer may be present. Evaluation of a suspected nodule may include a blood test and an ultrasound.
• Hyperthyroidism.
  When the thyroid gland makes too much thyroid hormone, a condition known as hyperthyroidism, or overactive thyroid, can occur. While the whole thyroid often is involved in a hyperthyroid state, sometimes benign nodules can cause an increase in hormones. Hyperthyroidism accelerates the body's metabolism, causing a variety of symptoms, including unexpected weight loss; increased hunger; a rapid or irregular pulse; sweating; mood issues, such as increased anxiety or irritation; and changes in the menstrual cycle. Depending on a person’s age and health history, treatment options include medication to reduce hormone levels, or radioiodine, which destroys the thyroid and its ability to make thyroid hormone. Also, some patients may be eligible for surgery to remove all or part of the thyroid. With thyroid surgery or radioactive iodine, patients are expected to require thyroid hormone replacement therapy.
• Hypothyroidism.
  Hypothyroidism can occur when the thyroid gland does not make enough thyroid hormone. There may not be noticeable symptoms in the early stages of this condition as symptoms often develop slowly or are attributed to other ailments. For instance, many patients report fatigue and weight gain, although it must be acknowledged that these are nonspecific symptoms that could be from a host of reasons other than thyroid dysfunction. As the metabolism continues to slow, other symptoms may occur, including constipation, raspy voice, muscle weakness and sensitivity to cold. A blood test is necessary to diagnose this condition. Treatment for hypothyroidism usually involves taking a thyroid medication known as levothyroxine to return hormone levels to normal.
• Hashimoto’s disease.
  Hashimoto's disease is an autoimmune disorder that occurs when immune-system cells lead to the death of the thyroid's hormone-producing cells, resulting in hypothyroidism. Although anyone can develop Hashimoto's disease, which is also known as chronic autoimmune thyroiditis, it is most common among middle-aged women. The primary treatment is thyroid hormone replacement.

There is no way to prevent thyroid disease. The best course of action is to establish a routine to get annual health physicals and be aware of any unusual symptoms you experience. Speak with your healthcare team about concerns, including tests for thyroid hormone if you are concerned. If you are suspected of having thyroid issues, an evaluation by a thyroid expert or a thyroid disorders clinic may be warranted. Overall, most people with thyroid disease can go on to live a normal quality of life. — Dr. Victor Bernet, Endocrinology, Mayo Clinic, Jacksonville, Florida

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Related Articles 

• Consumer Health: What happens if your thyroid is too active or not active enough? published 1/13/23
• Mayo Clinic Q and A: Thyroid nodules, cancer and treatment published 1/17/23
• Consumer Health: What is Hashimoto’s disease? published 1/7/22

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DEAR MAYO CLINIC: I recently read that thyroid issues affect women more often than men. Can you explain what the thyroid is and how it affects my body? Can I do anything to prevent having issues with my thyroid as I age?

ANSWER: The thyroid is a small butterfly-shaped gland located at the base of the neck. The thyroid has a significant impact on the body because it produces hormones that help regulate many of your body’s functions.

The thyroid gland produces two main hormones: thyroxine, or T4, and triiodothyronine, or T3. These hormones keep your body's metabolism of fats and carbohydrates consistent, aid in maintaining your body's temperature, have an impact on how well your nervous system functions, and can affect your heart rate. A third hormone, known as calcitonin, which aids in controlling the level of calcium in your blood, also is produced by your thyroid gland.

Unfortunately, there are numerous disorders that can affect the thyroid, and women are at higher risk for thyroid issues than men. About 1 in every 8 women will suffer from thyroid illness during her lifetime, according to the American Thyroid Association.

Although it is believed that the development of thyroid illness is connected to a person’s autoimmune system, it is not known why women are more susceptible than men to thyroid disease. Genetics may play a role. Women of any age can experience thyroid issues, although women who have just given birth or are going through menopause are more likely to experience thyroid concerns.

Here is information about four of the most common thyroid conditions:

• Thyroid nodules
  It’s estimated that about half the population in the U.S. will have a thyroid nodule by the time they are 60. Although some may grow to a size where they are visible, frequently these nodules will go undetected until a routine medical examination. Fortunately, most thyroid nodules are benign, but a workup is necessary to determine whether thyroid cancer may be present. Evaluation of a suspected nodule may include a blood test and an ultrasound.

• Hyperthyroidism
  When the thyroid gland makes too much thyroid hormone, a condition known as hyperthyroidism, or overactive thyroid, can occur. Sometimes benign nodules can cause an increase in hormones. Hyperthyroidism accelerates the body's metabolism, causing a variety of symptoms. These may include unexpected weight loss; increased hunger; a rapid or irregular pulse; sweating; mood issues, such as increased anxiety or irritation; and changes in menstrual cycle. Depending on a person’s age and health history, treatment options may include medication to reduce hormone levels or shrink the thyroid gland. Additionally, some patients may be eligible for surgery to remove all or part of the thyroid.

• Hypothyroidism
  When the thyroid gland does not make enough thyroid hormone, hypothyroidism, or underactive thyroid, can occur. There may not be noticeable symptoms of this condition in the early stages, as symptoms often develop slowly or are attributed to other ailments. For instance, many patients report fatigue and weight gain. As the metabolism continues to slow, however, other symptoms may occur, including constipation, raspy voice, muscular weakness and sensitivity to cold. Treatment for hypothyroidism usually involves taking a thyroid medication known as levothyroxine to return hormone levels to a normal level.

• Hashimoto’s disease
  Hashimoto's disease, or chronic autoimmune thyroiditis, is an autoimmune disorder that occurs when immune system cells lead to the death of the thyroid's hormone-producing cells, resulting in hypothyroidism. Although anyone can develop Hashimoto's disease, it is most common among middle-aged women. The primary treatment is thyroid hormone replacement.

There is no way to prevent thyroid disease. The best course of action is to establish a routine to get annual health physicals and be aware of any symptoms you experience that are unusual. Speak with your health care team about your thyroid health, including the need for tests for thyroid hormone if you are concerned. If you are suspected to have thyroid issues, an evaluation by a thyroid expert or thyroid disorders clinic may be warranted. Overall, most people with thyroid disease can go on to live a normal life. — Compiled by Mayo Clinic staff

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Related Articles 

• Mayo Clinic Q and A: Thyroid nodules, cancer and treatment published 1/17/23
• Consumer Health: What happens if your thyroid is too active or not active enough? published 1/13/23
• Consumer Health: What do you know about the types of thyroid cancer? published 9/30/22
• What you should know about thyroid cancer in adolescents, young adults published 9/20/22
• Consumer Health: What is Hashimoto’s disease? published 1/7/22

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Stiff-person syndrome is an autoimmune disorder of the nervous system, often resulting in progressive, severe muscle stiffness and spasms of the lower extremities and back. It also can affect other body regions.

"This neurological disorder can affect anyone at any age," says Dr. Andrew McKeon, a Mayo Clinic neurologist and expert in autoimmune neurology and movement disorders. "More commonly, it affects women, usually starting in the 40s or 50s. More than 50% of patients have a coexisting non-neurological autoimmune disease, such as Type 1 diabetes or autoimmune thyroid disease."

Symptoms may include:

• Stiffness
• Spasms
• Exaggerated startle responses sometimes resulting in falls

Dr. McKeon says it is a rare, often misdiagnosed disorder.

"Stiff-person syndrome can be underdiagnosed and be mistaken as generic back pain or a psychiatric diagnosis, or overdiagnosed," says Dr. McKeon.

He says patients with fibromyalgia or other primary pain disorders, spinal cord diseases or variants of amyotrophic lateral sclerosis (ALS) are sometimes initially diagnosed with stiff-person syndrome.

Patients may need to have testing for autoimmune movement disorders. A movement disorder may be caused by the body's immune system, which is meant to fight off infection, suddenly attacking the brain. Once diagnosed, an autoimmune movement disorder can often be treated.

It's important to work with your health care team to get tested and properly diagnosed for the disorder.

Testing for stiff-person syndrome is done only at Mayo Clinic Laboratories.

"Electrophysiology testing and antibody testing in serum or cerebrospinal fluid assist in making the correct diagnosis," says Dr. McKeon.

Mayo Clinic Laboratories, based in Rochester, Minnesota, offers the only commercially available test designed specifically to evaluate all relevant biomarkers for stiff-person spectrum disorders.

Patients with relevant symptoms for the disorder may be tested with the Stiff-Person Spectrum Disorders Evaluation or the Glycine Receptor stand-alone test, which is another biomarker often found in patients with stiff-person spectrum disorders. Additionally, health care professionals may use the Movement Disorder evaluation to evaluate additional biomarkers for patients with other immune-mediated movement disorders.

Related posts:

• Sharing Mayo Clinic: Diagnosed with stiff-person syndrome
• Sharing Mayo Clinic: Finding joy after rare neurologic diagnosis.

Connect with others talking about stiff-person syndrome on Mayo Clinic Connect.

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The thyroid gland creates and produces hormones that play a role in many systems throughout the body. When your thyroid makes too much or too little of these important hormones, it’s called thyroid disease.

And thyroid disease is common.

"We know that about 10% of people have some degree of thyroid dysfunction," says Dr. Juan Brito Campana, a Mayo Clinic endocrinologist.

There are several different types of thyroid disease, including hyperthyroidism, or overactive thyroid; hypothyroidism or underactive thyroid; and Hashimoto’s disease, where the immune system attacks the thyroid gland. Hypothyroidism is the most common thyroid disease. Treatment for hypothyroidism involves daily use of levothyroxine, a synthetic thyroid hormone that restores adequate hormone levels.

Levothyroxine is one of the most common prescription drugs in the U.S., but a new study by Mayo Clinic researchers suggests it is significantly overused in people with mild hypothyroidism or no apparent thyroid dysfunction. These results were published in JAMA Internal Medicine.

On the Mayo Clinic Q&A podcast, Dr. Brito Campana discusses diagnosis and treatment for thyroid disease, and what the research on the overuse of levothyroxine means for patients.

Watch: Dr. Brito discuss treatment of thyroid disease:

Read the full transcript.

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For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was recorded prior to COVID-19 or recorded in an area not designated for patient care, where social distancing and other safety protocols were followed.

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DEAR MAYO CLINIC: I'm five months pregnant and was just diagnosed with hypothyroidism. I've never had thyroid problems before. Could this diagnosis be connected to my pregnancy? Will the hypothyroidism go away after I have my baby?

ANSWER: It's likely that the hypothyroidism was triggered by your pregnancy, but the underlying cause of the condition probably isn't the pregnancy itself. Some women have a thyroid disorder that doesn't show any symptoms until they become pregnant. Once symptoms appear, it's important to receive treatment and continue to receive follow-up care for six to nine months after the baby is born. You'll also need periodic checkups after that to monitor your thyroid function, especially if you become pregnant again.

Your thyroid is a small, butterfly-shaped gland at the base of the front of your neck. The hormones that the thyroid gland makes — triiodothyronine, or T3, and thyroxine, or T4 — affect all aspects of your metabolism. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate, and help regulate the production of proteins.

Research has shown that about 10% of young women have a thyroid disorder that, although it doesn't cause any problems before pregnancy, flares up and produces symptoms during pregnancy. Women who have a thyroid disorder often are found to have high concentrations of anti-thyroid antibodies in their bodies, a condition known as chronic thyroiditis, Hashimoto's disease or autoimmune thyroid disease. After childbirth, the antibody level usually increases and may lead to temporary altered thyroid function. This also may occur during pregnancy.

As in your case, this thyroid disorder often leads to hypothyroidism — a condition caused by low levels of thyroid hormones in the body. Some common symptoms of hypothyroidism can be hard to spot during pregnancy because they mimic signs of pregnancy, such as weight gain, fatigue and constipation. Other symptoms of hypothyroidism that may be more obvious during pregnancy include increased sensitivity to cold, dry skin, a puffy face, muscle weakness, hoarseness, joint pain or stiffness, and difficulty with concentration or memory.

For someone in your situation, treatment for hypothyroidism with thyroid hormone (levothyroxine) is crucial because untreated hypothyroidism can affect fetal development and maternal health during pregnancy. You'll need to be monitored carefully throughout your pregnancy, including blood tests to check your thyroid function every four to eight weeks.

In some women, this condition also results in a disorder known as postpartum thyroiditis after pregnancy. This disorder can lead to hypothyroidism or hyperthyroidism, which is a condition caused by high levels of thyroid hormones in the body. Hyperthyroidism after pregnancy often resolves on its own without treatment. If hypothyroidism develops after childbirth, however, treatment typically is needed for about six to 12 months. It usually can be discontinued after that.

Keep in mind, though, that even when treatment successfully eliminates hypothyroidism in a case like yours, the underlying thyroid disorder remains. That means if you get pregnant again, the likelihood is high that you will develop hypothyroidism again — no matter how much time elapses between your pregnancies. Knowing that ahead of time enables you and your health care provider to work together to decide on a treatment plan. When treatment begins early in pregnancy, it often can prevent symptoms of hypothyroidism from appearing.

You also should work with your health care provider to establish a timeline for follow-up care to check your thyroid function over time, even if you don't have any additional pregnancies. Some research has found that women who have a thyroid disorder that triggers symptoms during and after pregnancy also are at risk for developing other thyroid problems later in life. Regularly scheduled checkups can catch any additional thyroid dysfunction when it's still in the early stages and more easily treated. — Dr. Robert Smallridge, Endocrinology, Mayo Clinic, Jacksonville, Florida

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Related Articles

• Mayo Clinic Q and A: Mild hypothyroidism may not need treatment published 9/17/19
• Mayo Clinic Minute: How the thyroid affects the heart published 9/11/19
• Women’s Wellness: Pregnancy and thyroid disorders published 7/18/19
• Study finds similar cardiovascular outcomes for generic, brand-name drugs for hypothyroidism published 6/19/19
• Consumer Health: Understanding hypothyroidism published 1/26/18
• Should hypothyroidism in pregnancy be treated? published 1/26/17

The post Mayo Clinic Q and A: Thyroid disorder may not show symptoms until pregnancy appeared first on Mayo Clinic News Network.

JACKSONVILLE, Fla. — A new study by Mayo Clinic researchers may have broad implications for treatment of patients with predominantly benign thyroid disease and newly treated hypothyroidism.

The study, to be published in Mayo Clinic Proceedings in July, looked at whether generic and brand-name levothyroxine therapy affected hospitalization for cardiovascular events for those patients who are more at risk of coronary heart disease and heart failure. Levothyroxine is the most prescribed medication in the U.S., with more than 23 million prescriptions written annually.

The retrospective analysis, using deidentified claims data from a large private U.S. health plan, found that cardiovascular event rates were similar for generic and brand-name levothyroxine therapy, with lower pharmacy costs for the generic drug. The findings, if confirmed with research into longer-term event rates, suggest that generic or brand-name levothyroxine may be used to treat hypothyroidism due to benign thyroid disorders. The average 30-day cost of the generic drug was about half the cost of brand-name medication for patients and insurers.

"More than 90% of thyroid prescriptions are for levothyroxine, and there has been disagreement as to whether generic levothyroxine and branded thyroxine preparations are equivalent," says Robert Smallridge, M.D., a Mayo Clinic endocrinologist and the study's principal investigator. "These findings suggest that generic and brand levothyroxine therapy are similar as related to cardiovascular events risk."

Dr. Smallridge says the findings require confirmation with longer-term follow-up and study of subsets of patients, such as those with a history of thyroid cancer, who frequently receive higher doses of levothyroxine.

Hypothyroidism, or underactivity of the thyroid gland, affects the function of many organs in the body, elevating blood cholesterol levels and increasing the risk of heart attacks, heart failure and stroke. Levothyroxine is used to reduce elevated cholesterol and reverse symptoms of hypothyroidism. U.S. brand names for levothyroxine include Levothroid, Levoxyl, Synthroid, Tirosint and Unithroid.

The analysis was unusual in that it used information from an administrative claims database provided by OptumLabs Data Warehouse. OptumLabs was co-founded by Optum Inc. and Mayo Clinic in 2012. This data warehouse contains deidentified administrative claims data, as well as deidentified electronic health record data from a nationwide network of provider groups.

The study reviewed records for 87,902 patients followed for a mean period of one year, focusing on hospitalization for heart attacks, congestive heart failure, atrial fibrillation or strokes. The analysis found no difference in event rates for the four types of cardiovascular events.

Dr. Smallridge is the Alfred D. and Audrey M. Petersen Professor of Cancer Research and deputy director of the Mayo Clinic Cancer Center in Jacksonville. The study was funded by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, with an additional gift from Alfred D. and Audrey M. Petersen.

Watch: Dr. Smallridge shares more about hypothyroidism, the study and the results. Sound bites available for download.

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About Mayo Clinic Proceedings
Mayo Clinic Proceedings is a monthly peer-reviewed medical journal that publishes original articles and reviews dealing with clinical and laboratory medicine, clinical research, basic science research, and clinical epidemiology. Proceedings is sponsored by the Mayo Foundation for Medical Education and Research as part of its commitment to physician education. It publishes submissions from authors worldwide. The journal has been published for more than 80 years and has a circulation of 130,000. Visit the Mayo Clinic Proceedings website to view articles.

About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, comprehensive care to everyone who needs healing. Learn more about Mayo Clinic. Visit the Mayo Clinic News Network. 

Media contact:

• Tia Ford, Mayo Clinic Public Affairs, 904-953-0746, newsbureau@mayo.edu

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Mayo Clinic endocrinologist Dr. Juan Brito says, while some people genuinely need the hormone replacement to regulate metabolism and ward off health risks, most people taking it do not. Dr. Brito says each prescription should be accompanied by thorough follow-up care. "What is important is to engage the patient and the doctor, and make sure they have a reason to [take] it and a plan – what to do if symptoms don't get better and what to do if the symptoms do get better."   Dennis Douda has more in this Mayo Clinic Radio Health Minute.

To listen, click the link below.  

Over-prescribed levothyroxine

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The thyroid is a butterfly-shaped endocrine gland in your neck, just above your collarbone. The thyroid makes hormones to help control the rate of many activities in your body, including how fast you burn calories and how fast your heart beats. But, sometimes, problems develop with the thyroid gland, and it doesn’t secrete the right level of hormones. January is Thyroid Disease Awareness Month. On the Mayo Clinic Radio podcast, endocrinologist Dr. John C. Morris III discusses diagnosis and treatment of thyroid conditions, such as hypothyroidism, hyperthyroidism, Graves' disease and thyroid cancer. Also on the program, ophthalmologist Dr. Arthur Sit  explains the importance of regular eye exams to prevent glaucoma. And high-risk pregnancy certified nurse practitioner Deb Miller shares steps women can take to help prevent birth defects.

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Here's your Mayo Clinic Radio Podcast.

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