It’s Think Thyroid month and all the awareness generation campaigns seem to be focused around women. Around 4-6% of India’s population is said to have hypothyroidism (a state caused by insufficient production of the thyroid hormone). In fact, 88% of thyroid problems are a form of hypothyroidism.
It is eight times more prevalent among women than men. But that doesn’t mean men can take it easy. The thyroid gland has a role to play in literally every organ and, therefore, hypothyroid manifests itself in several niggling little ways (puffy eyes, hoarse voice, irregular sleep, fatigue, low sexual drive, elevated cholesterol, weight gain, muscle cramps, depression, etc.). And, according to Manoj Chadha, consultant endocrinologist, Hinduja Hospital, Mumbai, when men come to him for diagnosis, their condition is usually far more advanced than that of women.
In men, it escapes notice
“This could be because the index of suspicion among men is far lower than for women,” says A.K. Ajmani, consultant endocrinologist, Ram Manohar Lohia Hospital, New Delhi. As Ambrish Mithal, chairman, department of endocrinology at Medanta Medicity, Gurgaon, and consultant endocrinologist, Indraprastha Apollo Hospital, New Delhi, says, “Usually among women, hypothyroidism is caught early through the gynae route.” Irregular menstrual periods and other gynaecological problems are among the symptoms of the disease. Other symptoms include lethargy, disturbed sleep, weight gain and depression. “When a woman visits a doctor with these problems, she is usually immediately advised a thyroid test, but when a man complains of this, it is usually blamed on overwork, stress, diet, faulty lifestyle,” says Dr Chadha.
Chin up: Hypothyroidism is eminently treatable.
It takes alertness on the doctor’s part to zero in on the problem, even when the signs are clear. Dr Mithal gives the example of a patient, a CEO of a company. “He started complaining of fatigue through the day and a lot of snoring at night. He was found to have sleep apnoea and, in fact, was getting treatment for that,” he says. A chance encounter socially with Dr Mithal led to a TSH (thyroid stimulating hormone) blood test. The cause of his woes was found to be hypothyroidism.
Often, among men, the diagnosis is made quite by chance—in one remarkable instance, Dr Chadha describes how at a clinic where he visits, he happened to hear the voice of a male patient who was talking to a colleague. “I didn’t even see him, but just heard his voice, which was hoarse, and advised him to get a test done,” says Dr Chadha. Sure enough, he was found to have hypothyroidism. “Very often patients come to me, saying that friends or relatives who had heard their voice on the phone had advised them to get a thyroid test done,” he says.
In many hospitals, TSH tests are already part of the annual health check-up routine for women. But is there a case for TSH tests to be made compulsory for men as well? While Dr Chadha says it depends on the economics (the test costs Rs200-400), Dr Mithal believes it could help. As he points out, in the case of hypothyroidism, lifestyle is rarely the cause.
After iodine, what else?
The cause of hypothyroidism in India is no longer iodine deficiency. “When I was a student that was the biggest factor. But today it is predominantly auto-immune related,” says Dr Mithal. Other causes are thyroid surgery, radiation therapy, side effects of certain drugs (amiodarone, for instance), viral and bacterial infections.
So, if the iodine deficiency issue has been sorted out thanks to the success of the Union government’s Universal Salt Iodization (USI) Programme, then why are we seeing such a spike in hypothyroidism cases? One reason is more investigation—hence, more cases are being picked up. “Environmental factors and diet factors” have also contributed, says Dr Chadha, though he is reluctant to pinpoint exactly what these factors could be.
All three doctors, however, dismiss arguments that eating so-called goitrogenic foods (thought to suppress thyroid function) such as cabbages and cauliflower could actually increase the risk. “Soy, perhaps yes, but none of the other food substances,” says Dr Mithal.
Good news, at last
Hypothyroidism is eminently treatable and inexpensive to treat—thyroxine taken early in the morning on an empty stomach, with a gap thereafter of 30 minutes before eating anything, does the trick. The bad news is that the medication is usually lifelong (there are only certain situations where doctors say they can stop the medication). “This is one case where I discourage people from finding a cure in yoga, homeopathy, and so on,” says Dr Mithal.
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