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Thyroid disorder may cause high cholesterol

January 18, 2000

NEW YORK (Reuters Health) -- A high blood cholesterol level may be an
indication that the thyroid gland in the neck is underactive, rather than
the result of poor dietary habits. In order to increase awareness of the
link between the two, endocrinologists are urging Americans to learn about
the link between high cholesterol and the thyroid in a program called "Take
Cholesterol by the Neck."

The program, sponsored by the American Association of Clinical
Endocrinologists (AACE), notes that after diet, "thyroid disease is the most
common secondary cause of high cholesterol."

"Somewhere between one-quarter and one-half of patients with underactive
thyroids will have high cholesterol levels," AACE President Dr. Richard A.
Dickey told Reuters Health. "The cholesterol level responds just by
diagnosing and treating the thyroid disease." Conversely, about 10% of
persons with high cholesterol have underactive thyroids, AACE past-president
Dr. Stanley Feld explains.

A survey released by the AACE shows that "fewer than half of the adults who
had been diagnosed with high cholesterol knew if they had ever been tested
for thyroid disease."

Everyone with a high cholesterol level should be screened for thyroid
disease, Dickey explains. "We want to avoid patients being treated for high
cholesterol when the cause is really thyroid disease," he added. This is
also the recommendation of the Food and Drug Administration and the National
Cholesterol Education Program. The cholesterol-lowering statin drugs carry a
warning that all persons with high cholesterol levels should have their
thyroid function checked.

The thyroid is a butterfly-shaped gland that is located just below the
Adam's apple. It produces hormones that regulate metabolism, including the
ability to metabolize cholesterol. In addition to high cholesterol, an
underactive thyroid (hypothyroidism) can cause fatigue, weight gain, dry
skin, and depression or mood swings. Thyroid hormone replacement therapy can
restore thyroid hormone levels to normal.

Thyroid disease affects as many as 13 million Americans, though more than
half of these patients are not diagnosed, AACE officials believe. Diagnosis
is done with a simple blood test. Individuals can perform a preliminary
self-check by standing in front of the mirror and drinking a glass of water
while watching for signs of an enlarged or irregular thyroid.


Thyroid dysfunction more common than estimated

March 01, 2000

NEW YORK (Reuters Health) -- Based on new study findings, researchers
estimate that there may as many as 13 million Americans with undiagnosed
thyroid problems, double previous estimates.

"Thyroid dysfunction is common, may often go undetected, and may be
associated with adverse health outcomes that can be avoided," lead author
Dr. Gay J. Canaris of the Nebraska Medical Center in Omaha and colleagues
write in the Archives of Internal Medicine.

"Surprisingly, the prevalence of (underactive thyroid) was higher than
expected," co-author of the study, Dr. E. Chester Ridgway, said in a press

The investigators note that of those with no known thyroid problems, testing
revealed that nearly 10% had a dysfunctional thyroid gland. Canaris noted in
the press release that "thyroid symptoms... are often mistaken for signs of
aging, menopause, depression or stress," and added, "we, as physicians,
should be conducting more thyroid testing."

Canaris and colleagues measured indicators of thyroid dysfunction and
cholesterol levels in the blood of 25,862 participants of the Colorado
Health Fair. The study participants also filled out a questionnaire that was
designed to reveal symptoms of hypothyroidism.

About 9.5% of the subjects exhibited evidence of an underactive thyroid and
2.2% showed signs of an overactive thyroid. Both conditions can lead to
serious health problems if not treated.

Of the patients who already knew they had a thyroid problem and were on
thyroid medications, 40% had abnormal levels of thyroid stimulating hormone,
indicating that they were not taking the proper dosage of medication.
"Clinicians may therefore consider monitoring patients on thyroid
replacement more frequently," the researchers advise.

In addition, subjects with elevated thyroid stimulating hormone levels, an
indication of an underactive thyroid, had higher total cholesterol and LDL
("bad") cholesterol levels than subjects with normal thyroid function. High
LDL and total cholesterol are risk factors for heart disease. Ridgway noted
in the press release that underactive thyroid is linked to cardiovascular
problems and said that this "points to the need for more widespread thyroid
stimulating hormone testing and more aggressive treatment."

SOURCE: Archives of Internal Medicine 2000;160:526-534.


Thyroid disease often undiagnosed

October 17, 1997

More than one in ten Americans may suffer from thyroid disease, according to
a new study. And despite the long-term health risks associated with the
condition, most of those cases go undiagnosed.

Dr. E. Chester Ridgway, senior author of the study and division head of
endocrinology at the University of Colorado, says new research "shows that
there is a clear need to educate people about the importance of routine
thyroid screening."

Results of the study were presented at the annual meeting of the American
Thyroid Association held this week in Colorado Springs.

The thyroid is a butterfly-shaped gland located under the Adam's apple at
the front of the neck which helps regulate metabolism and organ function.
Over- or under-production of thyroid hormones can lead to hyper- or
hypothyroidism, respectively. Weakness, fatigue, and anxiety are some early
signs of thyroid dysfunction. Left untreated, thyroid disease can contribute
to cardiovascular disease and interfere with the proper function of major

Ridgway and his colleagues tested for levels of thyroid-stimulating hormone
(TSH) in blood samples drawn from nearly 26,000 visitors to a 1995 'Health
Fair.' TSH is secreted by the pituitary gland, and helps regulate thyroid
activity. Although TSH is not produced by the thyroid, levels of the hormone
are thought to be a good marker for overall thyroid function.

"The presence of an elevated TSH in this screening population was 9.5%," the
researchers discovered. Another 2.2% of those tested had low TSH levels.
Overall, 11.7% (2,456) of those tested were found to suffer from some form
of thyroid disease. Upon questioning, nearly 90% admitted they were not
receiving treatment for their condition.

Ridgway stressed that, beyond getting tested, "those who have been diagnosed
(as having thyroid disease) need to be managed properly." The disease can be
effectively controlled, usually with medication. "Because thyroid hormone
levels fluctuate greatly," Ridgway said, "patients should follow their
physicians' prescribing instructions closely and have their level of TSH
monitored regularly using a simple TSH test."

The Colorado scientists also discovered a strong relationship "between an
underactive thyroid and high cholesterol (levels)," said study lead author
Dr. Gay Canaris of the University of Nebraska Medical Center. He said those
with hypothyroidism displayed higher levels of total cholesterol and LDL
'bad' cholesterol, compared with patients with normal thyroid activity.

Raised cholesterol has long been linked to increased risk for heart attack
and stroke. "The better we can help people control their thyroid condition,
the better we can help them manage or even bring down their cholesterol
levels," Canaris said.

The study was funded by Knoll Pharmaceutical Co. of Mount Olive, New Jersey.


A simple blood test measuring the levels of a pituitary hormone that helps
regulate the thyroid, called TSH, can usually indicate thyroid dysfunction.
This test can be followed up with a blood test measuring levels of
thyroxine, a hormone secreted by the thyroid gland itself.

While overt hyper- or hypothyroidism are easily diagnosed by physicians, the
illness can be less apparent in its early or "subclinical" stages.


Alternative names:
thyroxine test

Normal values:
4.5 to 12.5 mcg/dl


Thyroid Disease Often Confused With Depression

January 13, 1998

By Kathleen Spiessbach

Thyroid disease is often misdiagnosed as depression or goes completely
undetected, endocrinologists say. They urge those experiencing depressive
symptoms to perform a self-examination for thyroid disease at home as an
initial step in screening for the disease, and to consult their doctor.

At a press conference in New York on Tuesday, the American Association of
Clinical Endocrinologists (AACE) estimated that 1 in 20 Americans, or 13
million people, are afflicted with thyroid disorder, yet as many as 8
million go undiagnosed.

"Many people get the 'blues,' and they think it is just part of getting
older, or to be expected after having a baby, or the result of a stressful
lifestyle," said Dr. Stanley Feld, chief of endocrinology at Presbyterian
Hospital in Dallas, Texas, at the conference. In fact, a hormonal imbalance
due to an over- or under-active thyroid gland (located just below the Adam's
apple at the base of the throat) may be the cause, he said. Thyroid
disorders affect women more often than men, and tend to flair up during
middle- and late middle age.

To help people experiencing symptoms that suggest depression to discern
whether they may be suffering from thyroid disease, AACE President Dr. H.
Jack Baskin described the "Thyroid Neck Check," a simple, five-step test
that can be performed at home:

-- First, hold a mirror in front of you so that you can see the front of
your neck.

-- Next, tip your head back while focusing on the area just below the Adam's

-- Third, take a drink of water and swallow.

-- As you swallow, check your neck area for any bulge or protrusion.

-- If you see any bulge or protrusion, you may have an enlarged thyroid
gland. Consult your doctor to determine whether treatment for thyroid
disease is needed.

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