The butterfly effect

CHENNAI: In the hierarchy of lifestyle diseases, having a ‘thyroid problem’ is often dismissed as a non-serious medical condition that can be managed with taking a pill everyday on an empty stomach.

No wonder there are a lot of younger women these days with thyroid-related issues, which is worrisome since these can lead to complications in their reproductive health.

“Approximately 10% of Indian families had at least one member with a thyroid condition, according to the National Family Health Survey-4. A study in Lancet revealed that hypothyroidism is the most common form of thyroid that affects 11% of the Indian population,” explained Amol Naikawadi, joint managing director and Preventive Healthcare Specialist, Indus Health Plus.

What’s a thyroid?

The thyroid is a butterfly-shaped endocrine gland, around 2 inches long located near the base of your neck right above your collarbone. It’s part of the endocrine system, which is made up of organs that produce, store, and release hormones into the bloodstream.

Your thyroid’s main job is to control the speed of your metabolism (metabolic rate), which is the process of transforming the food you consume into energy. All the cells in your body need energy to function. When your thyroid isn’t working properly, it can impact the functioning of your entire body.

Thyroid disorders can range from just a harmless enlarged gland that needs no treatment to a life-threatening cancer. The most common problem is abnormal production of thyroid hormones.

Too much thyroid hormone results in a condition known as hyperthyroidism, while inadequate hormone production leads to hypothyroidism. Both can be managed well if properly diagnosed and treated.

Hypothyroidism

A common condition where the thyroid doesn’t create and release enough hormone into your bloodstream. This slows down your metabolism, and can make you feel tired, gain weight and be unable to tolerate cold temperatures. Hypothyroidism is a treatable condition, and can be managed with regular medications and follow-ups.

Hyperthyroidism

An over-active thyroid is a condition where your thyroid gland makes and releases high levels of hormone. This speeds up your metabolism. Hyperthyroidism can be treated with antithyroid drugs, radioactive iodine, beta blockers and surgery. If left untreated or under-treated, hyperthyroidism can lead to atrial fibrillation, stroke, congestive heart failure, and/or osteoporosis.

Menstrual cycle

Women are more commonly affected than men, making it imperative to address thyroid-related issues across all age groups – from new-borns to the elderly.

Among adolescent girls, irregular periods may be an indicator of thyroid disease. However, not many are aware that this could be a symptom. Girls experiencing delayed or prolonged periods could have hypothyroidism.

“Since I was already diagnosed with PCOD (poly cystic ovary syndrome) in my early 20s, I was not aware that thyroid can impact my menstrual cycle. After running the basic tests, my thyroid levels were found to be low. Thyroid and PCOS are so common these days but we don’t know enough about it to link the two and understand the cause and effect,” says 26-year-old Sujitha.

Thyroid impacts the health of women right from their teenage years to old age. Young girls who experience symptoms of sudden weight gain, tiredness, lethargy, heavy flow during periods and others, can present these symptoms as thyroid later in life.

Dr Nithya Abraham, clinical assistant professor of endocrinology and diabetes, Amrita Hospital, explains that hypothyroidism prevents ovulation and produces multiple cyst formations in the ovary if left untreated.

“Hypothyroidism can also manifest as mood swings, depression, decreased interest in studies, poor memory, and gastrointestinal issues like constipation. Also, hyperthyroidism can cause irritability, fatigue, and menstrual disturbances,” she explained.

Conception, pregnancy

Sanjana (31) had been planning her pregnancy for the last four years without knowing that her thyroid levels would pose a challenge.

“Since I started working from home during the lockdown, I had gained a lot of weight, and experienced changes in my menstrual cycle. I had attributed it to lifestyle changes but around two years ago, when I met a doctor, I found out I had hypothyroidism. And that, it was the reason I was unable to conceive,” she recalled.

Imbalance in thyroid levels can impact the quality of eggs, ovulation cycle and fertility. “Even if a woman gets pregnant, if the thyroid levels are not normal, it can impact the health of the baby. This can lead to miscarriage, or the brain development of the child and his growth can be affected,” opined Dr J Krithika Devi, fertility consultant, Nova IVF Fertility.

Doctors also pointed out that hypothyroidism or hyperthyroidism cannot prevent a pregnancy, but it can lead to difficulties in conception, leading to lower pregnancy rates. It can also lead to foetal and maternal complications.

“This includes low-birth weight, mental retardation in the foetus, foetal tachycardia, pre-term delivery, placental insufficiency, abortion, pre-eclampsia, post-partum haemorrhage, and post-partum thyroiditis in the mother,” elaborated Dr Nithya.

Hence, women planning to conceive should ensure that thyroid levels are normal before attempting to become pregnant. “Also, after getting pregnant, regular monitoring through blood tests is crucial to prevent foetal and maternal complications,” she added.

The symptoms of fatigue, constipation, dry skin, bloating and weight gain or loss are associated with everything but very seldom with thyroid, especially for women in their 20s. However, imbalance in the thyroid levels is a major challenge to pregnancy.

“Always check your thyroid levels if you’re trying to get pregnant. If a woman who is started on thyroid hormone gets pregnant, their dosage needs to be raised based on their hormone levels as recommended by the physician. Pregnant women with hypothyroidism have to get their thyroid tablet dose adjusted every 4-6 weeks until they deliver,” stated Dr Ghurulakshmi Moorthy, consultant endocrinologist, Gleneagles Health City. “Many women with hypothyroidism have healthy pregnancies. In the case of hyperthyroidism, symptoms of palpitations, diarrhoea, weight loss and excessive sweating are common.”

Medication, management

Timely testing, lifestyle changes and medical interventions are crucial to maintaining a balanced thyroid level for the well-being of both mother and her unborn child.

Internal medicine physician Dr Spoorthi Arun of Promed Hospital averred that it was important to create awareness on preventive measures and effective management strategies for maintaining optimal thyroid health.

“Thyroid gland also plays a role in controlling your heart, muscle, and digestive function, brain development, and bone maintenance. So, when there is a thyroid imbalance, it can impact your entire body. Therefore, an appropriate management plan is important to keep thyroid disorders away,” she explained.

Lifestyle changes like a balanced diet rich in iodine and selenium, regular exercise, stress management and emotional wellness are the cornerstones for maintaining thyroid balance, considering the link between body and mind.