Thyroid disorders: Too much or too little, but highly treatable

SINGAPORE — After undergoing surgery to remove an overactive thyroid in 2014, games designer and publisher Xeo Lye had jokingly asked his doctor how long he could survive without thyroid hormone replacement pills “in the event of a zombie apocalypse”. He was given one year.

“I was told that my body functions will gradually shut down if I did not take my hormone pills. I will eventually slip into a coma and die. Well, it sounds like I’d still have some time to butcher a few zombies along the way,” said the 38-year-old games with a laugh.

A decade-long struggle with Graves’ disease, an autoimmune disorder that causes his own antibodies to attack the thyroid, has not dampened his outlook.

Mr Lye removed the entire gland as his condition was so severe that it could not be effectively controlled with regular treatment. A checkup had also detected a nodule in his thyroid which was potentially cancerous.

In conjunction with Thyroid Awareness Month, Mr Lye shared his experience to raise awareness of thyroid disorders.

Diagnosed in 2004, he had initially attributed early signs of the disease – difficulties falling asleep and hand tremors - to the stress of trading in the US Options market. But the hand tremors became too obvious to dismiss. Sleep eluded him and his immune system went haywire. Common mild illnesses like stomach flu became difficult to manage. Once, he took six months to recover from a viral fever.

Mr Lye’s “super strong” thyroid also almost killed him in 2011 when it went unto an overdrive after radioactive iodine (RAI) treatment that was intended to slow down his thyroid activity. The episode affected his potassium levels, which caused muscle paralysis.

“Initially, I thought I had overworked my muscles after trying on skinny jeans on a shopping trip, which I considered a real workout,” he quipped. “The cramps got worse and by the time I got to the (hospital’s) emergency department, I could no longer feel my limbs. I didn’t realise how serious the episode was until I learnt from the doctor that I was well on my way to a cardiac arrest.”

UP TO ONE IN 10 MAY HAVE A THYROID ISSUE

The thyroid is a butterfly-shaped gland in the neck that influences metabolic processes. If it malfunctions, it will wreak havoc on a host of body functions including regulation of heart rate and rhythm, weight, brain activity and energy production.

Experts estimate that up to 5 to 10 per cent of the population suffers from a thyroid disorder.

It is currently unclear why some individual’s thyroids or immune systems malfunction.

Research shows genetic factors may be involved. A study published in Hormone and Metabolic Research in 2011 found that children and siblings of autoimmune thyroid diseases sufferers have a 16-fold and 15-fold- increased risk of developing the conditions, respectively. Studies have also shown that if an identical twin contracts Graves’, the other twin has a higher chance of getting it too.

Thyroid conditions, which can occur at any age, are also more common in women. They are about five times more common in women than in men, said Dr Goh Su-Yen, head and senior consultant of Singapore General Hospital’s department of endocrinology.

A similar trend is observed for thyroid cancer, which is three times more common in women than in men, said Dr Goh. Thyroid cancers are the eighth-most common cancer in women but are not among the top 10 cancers for men, based on the 2010 to 2014 National Disease Registry report, she said.

“However, this does not mean that (thyroid disorders) are rare in men. Both men and women can be afflicted by the same type of thyroid disorders,” said Dr Vivien Lim, president of the Endocrine Metabolic Society of Singapore and endocrinologist at Gleneagles Hospital.

Common thyroid disorders range from an enlarged gland (known as a goiter) to the life-threatening cancer. They also include Graves’ disease (which causes the thyroid produces too much thyroid hormones), Hashimoto’s thyroiditis (which causes the thyroid to produce too little hormones) and thyroid containing nodules, said Dr Lim.

SYMPTOMS MAY TAKE YEARS TO BECOME NOTICEABLE

Early signs of a thyroid disorder may not be obvious. For instance, signs of an underactive thyroid may develop slowly over several years, depending on the severity of the hormone deficiency, said Dr Goh.

“You may barely notice symptoms such as fatigue and sluggishness, which may initially seem to be just part and parcel of getting older. The signs become more obvious as your metabolism continues to slow,” said Dr Goh.

While both genders experience similar symptoms, certain signs are more commonly seen in men.

If the thyroid condition is severe, it may cause erectile dysfunction, said Dr Lim. Periodic paralysis – attacks of muscle weakness – is more common in men with Graves’ disease, said Dr Goh. The condition may be fatal if the breathing muscles or heart are affected.

Men and smokers with Graves’ also tend to experience a more severe form of eye symptom, known as Graves’ orbitopathy, she added. This occurs in the form of inflamed eye muscle and tissue, which can cause the eyeballs to appear to protrude from their sockets.

Besides muscle paralysis and eye symptoms, Mr Lye also developed a rare skin condition called pretibial myxedema, which caused swelling and scaling on his ankle. “The doctor was so shocked and excited by it because it was so uncommon in Singapore it only existed in medical literature,” he said.

HIGHLY TREATABLE

According to Dr Lim, most thyroid disorders are highly treatable. In hyperthyroidism for example, oral medications are able to control the symptoms and reduce thyroid hormone production. When oral medications do not work, there are other options such as radioactive iodine, she said.

Those with a sluggish thyroid are usually treated with hormone replacement therapy. This involves the use of synthetic thyroid hormone pills that regulate the patient’s thyroid hormone levels and normalises metabolism, said Dr Goh.

Outcomes for early-stage thyroid cancers appear positive too.

“It depends on the patient’s age and how advanced the cancer is but I always tell patients that if I were to choose one cancer to have, it would be (thyroid cancer), given that it is rather slow-growing and the 10-year survival rates are high, when detected early,” said Dr Lim.

Some thyroid patients seek complementary or alternative therapies, such as supplements, Traditional Chinese Medicine, together with treatments prescribed by their doctors.

While such alternative therapies are generally safe, there is little evidence to show they are effective, said Dr Nitish Mishra, a specialist in endocrinology and consultant at Raffles Diabetes and Endocrine Centre. He cautioned against replacing conventional medical treatment with such therapies.

“The danger is that their thyroid condition will worsen, and they may require emergency admission beyond a certain threshold. In the case of thyroid cancer, there is a potential for the disease to spread if conventional medical treatment is delayed,” he said.

Patients who wish to use alternative therapies should also check with their doctors before starting any alternative therapy.

Although Mr Lye requires hormone replacement therapy for life, he has no regrets getting rid of his “mutant” thyroid.

“My sister, who has a much milder form of Graves’ disease, said I was stupid to (remove my thyroid). But for me, it feels as if a curse has finally been lifted,” he said.