Published on June 27, 2013

The Tale of the Broken Thyroid

By Stephanie Marsau

When I was younger I was pretty good with biology type stuff and really enjoyed learning about the human body in school. When it came time to learn about the systems of the body though, there was one I always seemed to forget—the endocrine system.

To me, with all the other systems—respiratory, muscular, skeletal, etc.—you more or less knew what they were referring to by their name, such was not the case with the endocrine system.

So how ironic is it that 15 years later, it’s my endocrine system I have an issue with? A few years ago at a routine checkup, I told my doctor about how tired I’d been. So on a hunch, he decided to check my thyroid stimulating hormone (TSH) levels and they came back extremely high, nearly double what they should have been.

Now here’s where it gets tricky. One would think that if levels come back high, that would indicate your thyroid is in overdrive. However, it actually means the opposite—let me explain.

thyroid_disorders_clip_image001The thyroid gland is a butterfly-shaped gland located in your neck that produces thyroid hormone. When it functions properly, the thyroid is part of a feedback loop with your pituitary gland. First, the pituitary senses the level of thyroid hormone that the thyroid has released into the bloodstream. The pituitary then releases TSH, which stimulates the thyroid to release more thyroid hormone.

When the thyroid, for whatever reason, does not produce enough thyroid hormone, the pituitary detects this reduction in thyroid hormone, and it moves into action. The pituitary then makes more TSH, to help trigger the thyroid to produce more thyroid hormone. Therefore, if you have high TSH levels, you actually have an underactive thyroid, or hypothyroidism.

So why was my underactive thyroid presenting itself as extreme fatigue? The thyroid has the only cells in the body capable of absorbing iodine. It then converts iodine into two hormones, T3 and T4. Once those are released, they travel through the bloodstream and help cells convert oxygen and calories into energy. So when your thyroid isn’t working right, and T3 and T4 aren’t being released, you feel abnormally tired.

Almokayyad_RI was curious about a couple other things so I asked McFarland Clinic Endocrinologist Rami Almokayyad for some help. I asked why sometimes our glands get out of whack and create too much of a hormone in some people and not enough in others—I basically wanted to know how I ended up with this.

He said that the cause isn’t always known, but an underactive thyroid can sometimes be caused by an autoimmune disease called Hashimoto’s disease. An autoimmune disease is one where your body attacks healthy cells by mistake—so in the case of Hashimoto’s disease, the thyroid is being attacked, leading to underactive thyroid. There’s still a little bit of mystery behind this though, because while doctors know this autoimmunity can cause an underactive thyroid, they don’t know what causes the autoimmunity itself. Genetic and environmental factors can also play a role in having an underactive thyroid.

I currently take a drug called Levothyroxine to normalize my levels and I asked Dr. Almokayyad if that was something I’d need to do forever, or if there were changes outside of medication that could help. He said that when an autoimmune disease strikes the thyroid, that leads to the normal thyroid tissue being replaced with fibrous tissue, which will reduce the amount of thyroid hormone it’s producing and eventually it will quit working completely.

He went on to say it’s a progressive disease and once a person is on thyroid hormone replacement, rarely will they be able to come off.

It all sounds like a lot, doesn’t it? Here’s the good news though. All you have to do to make this better is take one tiny pill a day. You may have to have blood drawn every three to six months or so to make sure your medication doesn’t need adjusting, but otherwise—that’s it.

Fatigue can be a symptom of almost everything, but if it’s something that’s been going on for awhile and your doctor has yet to test your thyroid levels, consider mentioning it at your next visit. To learn more about hypothyroidism visit Mary Greeley Medical Center’s Multimedia Health Library.

About the Author

Stephanie MarsauStephanie is the Marketing Communications Coordinator at Mary Greeley Medical Center. A blogger for several years, Stephanie's goal is to present health information in an entertaining, but helpful way.

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