Thyroid Is Small Gland With Big Responsibilities by Gina Shaw Itís a small gland at the base of your throat, right above your collarbone, shaped a lot like a butterfly or a bow tie. You donít hear much about your thyroid, and if itís working properly, you probably donít think much about it either. But if your thyroid isnít functioning well, neither are you. Why is the thyroid so important? Think of it as a sort of thermostat for your bodyís metabolism. It produces the hormones that regulate metabolism throughout your system, and when itís set too high, or too low, there can be consequences everywhere in the body. Thyroid disease affects about one out of every 10 Americansómore than diabetes and cancer combined. And like diabetes and cancer, thyroid disease is often genetically linked: If your mother had it, you may be at an increased risk as well. Hyperthyroidism (a thyroid in overdrive) can lead to nervousness, increased sweating, weight loss, confusion and vision problems. Famous people with hyperthyroidism, also known as Gravesí disease, include runner Gail Devers and former First Lady Barbara Bush. Hypothyroidism (an under-active thyroid, which is far more common) slows down y our heart rate and blood pressure, and can produce weight gain, dry skin, forgetfulness, muscle aches, loss of sex drive and decreased appetite. Those symptoms are unpleasant, but an uncontrolled thyroid can lead to much more serious health problems down the road, such as heart disease, osteoporosis, infertility and depression. And thyroid disease is particularly dangerous during pregnancy, when even a mildly under-active thyroid can cause complications. Women are five to eight times more likely to develop thyroid conditions than men, and about one in 50 U.S. women is diagnosed with hypothyroidism during pregnancy. In a 1999 study, women with untreated hypothyroidism were found to have an increased risk of giving birth to babies with lower IQs, even if they showed no thyroid symptoms during pregnancy. A 2002 Johns Hopkins study found that women with thyroid disease were more likely to give birth to babies with heart, brain and kidney defects. And last year, a study done at the University of Texas Southwestern Medical Center found that women with asymptomatic, untreated thyroid disease were almost twice as likely to give birth prematurely. So how do you know if thereís something wrong with your thyroid? Often, itís not immediately apparent. Many people with thyroid disease report that it took them years and many wrong turns before getting an accurate diagnosis. "Because the symptoms of thyroid disease are somewhat vague or subtle, patients often donít know they should be asking their doctor for a TSH test," said Dr. Donald A. Bergman, president of the American Association of Clinical Endocrinologists (AACE), referring to the thyroid-stimulating hormone (TSH) test, a blood sample that measures your thyroid function. "In fact, since hypothyroidism can develop quite slowly, many patients have said they didnít realize they were ill until they began treatment and started feeling more energetic and healthy." The AACE recommends periodic screening for thyroid disease, using the TSH test, once you reach 35, or if you have unexplained symptoms such as mood swings, forgetfulness, weight gain, depression, and dry, coarse skin and hair. Thatís the most accurate assessment, but thereís also an easy test you can do at home to see if your thyroid is enlarged. The AACE calls it the "neck check." Stand in front of a mirror, with your chin tilted up slightly, swallow a glass of water, and watch your neck as the water goes down, focusing on the area just above the collarbone and just below the Adamís apple. If you see any bulges or protrusions as you drink, you should check with your doctor about a thyroid evaluation. (Donít confuse the Adamís apple with the thyroid. The thyroid is lower and closer to the collarbone.) "Neck check" cards are available online at www.aace.com/pub/tam2002/NeckCheckCard.pdf. Thyroid disease is usually treated with a daily dose of a drug called levothyroxine sodium (LT4), which is marketed under brand names such as Synthroid and Levoxyl. But controlling thyroid function can be challenging, because even small differences in absorption of the drug can have a marked effect on how well it works. A survey of nearly 1,000 people with thyroid disease, released in 2003 by author and advocate Mary Shomon ("Living Well With Hypothyroidism"), found that only about 43 percent of respondents were happy with the treatment they were getting. Many were still suffering symptomsóespecially fatigueódespite their treatment. Of those still struggling with thyroid-related symptoms (particularly weight gain, which is troublesome for most women with hypothyroidism), 80 percent of those in the survey reported that regular exercise helped. Shomonís new book, "The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss," has also earned praise, ranking fourth on Amazonís "customer favorites" list of paperback nonfiction for 2004. You can learn more on Shomonís Web site at www.thyroid-info.com. Gina Shaw is the medical writer for The Washington Diplomat.