Constant aches and pains led Salma Ghaffar, school teacher and mother of four to reach out to a doctor who got some lab tests done. “I remember experiencing fatigue, forgetfulness and brain fogs,” she says. “I would think about something, and then it would slip from my mind.”

The test results confirmed that Ghaffar had hypothyroidism. “It’s been over two decades now and I am on thyroid medication for life.”

Thyroid disorders impact multiple aspects of a person’s health, and are some of the most common endocrine disorders, particularly in women. According to a medical study titled “Subclinical Hypothyroidism: Frequency, clinical presentations and treatment indications,” published in the Pakistan Journal of Medical Sciences, a whopping 93.8 percent of the patients in the study with Subclinical Hypothyroidism were females, whereas only 6.2 percent were male, making thyroid disorders predominantly female-centric.

The American Thyroid Association (ATA) states that women are five to eight times more likely than men to have thyroid problems, and one woman in eight will develop a thyroid disorder during her lifetime.

Although easily treatable, awareness about thyroid disorders is limited. Up to 60 percent of those with thyroid disease in the US are unaware of their condition, as per ATA. The number of those cognisant of thyroid disorders in Pakistan is understandably fewer, and there is no data available to indicate the percentage of the population’s awareness in this regard.

Often patients keep going round in circles and get treated for symptoms but not the cause. More recently, medical practitioners have begun testing thyroid levels more than before, and these disorders are now coming to the fore as the core reason for common conditions such as weight issues, infertility, depression and anxiety, chronic fatigue, or even developmental and growth issues.

Thyroid disorders are among the most undiagnosed and misdiagnosed of health problems, impacting more women than men. But early diagnosis and treatment can fix many of the issues caused by them

The butterfly-shaped thyroid gland at the base of the neck is small in size, but it impacts one’s overall well-being. Aches, pains, hair loss, constant fatigue, fluctuations in weight, a fuzzy brain feeling, insomnia, feeling excessively hot or abnormally cold, depression, anxiety, and disturbances in the menstrual cycle are among the effects of thyroid disorders.

“The thyroid gland can be seen relatively easily if enlarged, especially if you extend your neck or swallow,” Professor Emerita Tasnim Ahsan, an endocrinologist, explains.

Thyroid disorders, especially hypothyroidism, are the commonest of all endocrine disorders all over the world, barring diabetes. “About 25 to 30 percent of our patients have a thyroid issue,” says Dr Asma Ahmed, consultant endocrinologist at the Aga Khan University Hospital.” There is also a high prevalence of goiter in the female population, attributed to estrogen’s proliferative effect on the thyroid, according to Ahmed.

“Thyroid dysfunction can be of two types: hyperthyroidism — an excess of thyroxine, a hormone that the thyroid gland produces — or hyporthyroidism, a deficiency of thyroxine,” says Ahsan.

Symptoms of an underactive thyroid, according to Ahmed, include constipation, fatigue, hoarse voice, puffy face, and dry skin. As hypothyroidism slows down metabolism, the mind and physical activity also slow down.

“It’s so distressing when one doesn’t know what is wrong with them,” says Sameera*, project manager at a multinational company. “You could be the only odd one wearing a shawl while everyone else is feeling hot. My hypothyroidism was diagnosed after years of suffering. I used to wonder of it’s all in my head.” Once she started correct medication, her life slid back to normalcy.

Hyperthyroidism, the opposite of hypothyroidism speeds up everything, according to Ahsan, and the patient becomes anxious or fidgety. Other symptoms include fine tremors of the hand or tongue, a staring look in the eyes, palpitations and cardiac rhythm problems or heart failure in elderly patients.

Ahmed explains that symptoms of hyperthyroidism in the body are usually dramatic and abrupt. “Classic symptoms may include increased frequency of bowel movements, weight loss despite a normal or increased appetite,” she says. “There can be a thyroid swelling at the base of the neck. In case of autoimmune Graves’ diseases, it can result in a protruding of the eyes.”

​Whether there is a rise in thyroid disorders because of rising prevalence of autoimmune diseases, or simply increased awareness, early diagnosis and treatment remain the cornerstone of management of thyroid disorders. “It’s not a bad idea to get your thyroid tested if you’re feeling tired all the time,” concludes Ahmed.

Thyroid hormone levels, if managed well, can help thousands of unaware patients, with debilitating manifestations of thyroid disorders, to lead optimal lives. “Mental health can be affected by both hyperthyroidism — mainly anxiety — and hypothyroidism, mainly depression,” says Ahsan. “The body doesn’t like too much or too little thyroxine, so there is an intricate mechanism of keeping this hormone stable.” When the body is unable to maintain this balance naturally, that is where medication for thyroid disorders steps in.

“My weight gain was so rapid within three months that I couldn’t fit into my clothes comfortably,” says Rushna Shamsi, a teacher and mother of four. “Body shaming and not knowing why this was happening depressed me. I tried weight loss injections, yet there was no change, just more depression and anxiety.”

Research on the internet, visiting doctors, and several blood tests followed. Shamsi was finally diagnosed with hypothyroidism. “The invisible reason for all my health issues now had a name, and could be treated. My thyroid hormone levels keep fluctuating, so I get tested every quarter,” she adds.

For most patients, regularly monitoring thyroid hormone levels is imperative. “As my thyroid hormone levels fluctuate, I have to adjust my medicine dosage accordingly,” says Ghaffar. “I have been advised to get my levels checked every three months.”

For Tahira*, a homemaker, her disorder was more than just an under or over-active thyroid. “I was 35 when I saw a slight swelling in front of my neck,” she says. “There were no other symptoms. Surgery was advised to remove nodules as the first step, but the biopsy showed malignancy. The second surgery was a thyroidectomy,” says Tahira who went through radioactive iodine therapy.

“More than the cancer, it’s the therapies that leave you weak, especially the bones, resulting in lifelong aches and pains,” she says. The ordeal was not easy and acceptance took time but, with faith and family support, she has pulled through. “Even the smallest thyroid problems should be taken seriously to nip the issue in the bud.”

Thyroid disorders are straightforward to diagnose, not expensive to treat, and even cancers in the thyroid have a good prognosis, yet many patients remain undiagnosed. Untreated thyroidal disorders, Ahmed believes, can manifest serious consequences, especially heart disease and endocrine emergencies, such as coma. “It can also cause infertility and recurrent miscarriages,” she says.

Thyroid disorders can affect a person of any age. “In children and teens, it results in poor growth, resulting in short stature, delayed puberty and poor mental development,” says Ahsan. “Babies may be born with decreased thyroid hormones production ability, which can lead to slow mental and physical development. Hence it’s important to screen every child born for TSH levels.”

When asked about the reasons for thyroid disorders, medical experts are unanimous in the answers. “Iodine seems to play an important role in thyroid disorders, as it is an important trace element required for the synthesis of thyroid hormones,” says Ahmed.

Both doctors agree that the most common cause for thyroid dysfunction is autoimmunity which may have a familial or genetic propensity. “The genetic cause is most often linked to autoimmune disorders such as Hashimoto’s disease, a hypothyroidism in which the immune system attacks one’s own thyroid and results in over or underproduction of thyroid hormones,” explains Ahmed.

“Graves’ disease is also an autoimmune disorder, a type of hyperthyroidism that speeds up metabolism,” adds Ahsan.

Whether there is a rise in thyroid disorders because of rising prevalence of autoimmune diseases, or simply increased awareness, early diagnosis and treatment remain the cornerstone of management of thyroid disorders. “It’s not a bad idea to get your thyroid tested if you’re feeling tired all the time,” concludes Ahmed.

(names changed for privacy) The writer is a freelance journalist with a focus on human-centric stories. She tweets @FarahnazZahidi*

Published in Dawn, EOS, April 25th, 2021