A thyroid gland with an evil-looking emoji face inside an illustrated neck
Illustration: Giovanni Spera 
Health

Feeling Fatigued, Anxious or Depressed? It Might Be Your Thyroid

Thyroid disorders are invisible, debilitating and way more common than you think.
09 August 2020, 4:00am

This article originally appeared on VICE Italy.

"After seeing my results, the doctor was surprised I hadn’t arrived on my hands and knees," said Alice, who’s spent the past five years in treatment for hypothyroidism. The thyroid gland is a key organ regulating all kinds of functions in the body – meaning a defective thyroid can have a huge impact on your quality of life.

About 6 million people have thyroid disorders here in Italy and it’s estimated about 3.8 percent of the population of Europe is affected by some kind of thyroid dysfunction. But they often go unnoticed.

"The thyroid gland is an endocrine gland, which produces and secretes hormones," explained Professor Laura Fugazzola, head of the Thyroid Centre at the Endocrinology and Metabolic Disorders department of the Italian Auxology Institute. Found at the bottom of the neck, the gland produces two hormones called T4 and T3, which are in turn controlled by another hormone called TSH, made by the pituitary gland. These hormones manage our body’s energy levels by regulating our metabolism, internal temperature, heart rate, muscle strength and much more.

Hypothyroidism, or an under-functioning thyroid, can cause fatigue, depression, swelling, drowsiness, hair loss and oversensitivity to cold. Hyperthyroidism, on the other hand, happens when the thyroid produces too many hormones, causing insomnia, fast heartbeat, hyperactivity, anxiety and nervousness, weight loss and sweating. If left untreated, thyroid disorders can lead to infertility.

Diagnosing thyroid problems is often difficult because symptoms can be as subtle and generic as feeling really tired. "I don't know if the fact that I 'collapse' right after dinner or my ability to sleep anywhere are caused by my disorder," said Alice, who didn’t know she was sick until she got tested. Her mum had been recently diagnosed, so she went in for a check. The tests revealed her hormonal levels and metabolism were completely off.

Thyroid disorders disproportionately impact women, especially after menopause, and our understanding of them is still limited. This is often the case for predominantly female diseases like endometriosis or polycystic ovary syndrome. "A woman in her 20s feeling tired, unmotivated and with bad hair isn't exactly news,” Alice said. “But a society that belittles these symptoms does nothing to help.”

One of the main causes of thyroid problems is iodine deficiency. Iodine is a chemical element necessary for the production of thyroid hormones that’s not made by our body and needs to be consumed. In some countries, like Italy, the element is scarce in the soil, so Professor Fugazzola says it’s important to integrate it, for instance with iodised salt.

Sometimes, hypothyroidism can be caused by previous medical treatments. When test results show enlarged nodules or abnormal cells in the thyroid gland, doctors often prescribe removing part of the organ as a precautionary measure. But a partial thyroid often produces fewer hormones, leading to other health problems.

Giuditta, 34, had the right side of her thyroid gland operated on when she was 13 and she developed a goitre, or an enlarged thyroid. “My mother saw a small lump going up and down my neck while I was eating my salad,” she said. “I hadn't even finished chewing by the time we were in the car on our way to the doctor."

Giada, 27, also underwent surgery as a precautionary measure when she was 21 and since then, she's been in treatment for hypothyroidism. She said her hormones levels were tested by pure chance. "It was some kind of thyroid disorders awareness day,” she said, so the hospital was offering free check-ups. “My mother, who is a borderline hypochondriac, insisted we both do them."

The specialists she consulted after receiving the bad news had different opinions on surgery, but eventually she did go under the knife. Professor Fugazzola said non-invasive techniques – like thermal ablation, which uses heat to burn off abnormal cells – are more common today in non-severe cases.

Valerio, 33, was also operated on to remove a lump. Goitres can result from thyroid tumours, which are usually benign, but can be cancerous. During his recovery after the operation, he couldn’t move his neck properly, or talk. For Giada, the worst part was signing the consent form acknowledging her vocal cords might be damaged. “It scared the hell out of me,” she said.

There is no cure for thyroid disorders. Patients have to take medication their entire lives, which is periodically adjusted based on test results. Valeria, 36, discovered she had Hashimoto's disease – one of the most common causes of an under-active thyroid – at 19 while being tested for gluten intolerance. Hashimoto's (also known as Hashimoto’s thyroiditis) is an autoimmune disease where the immune system targets the thyroid gland instead of bad cells. Although thyroid problems aren’t necessarily hereditary, Valeria's mum also has a thyroid disorder, as does Alice’s.

The hormones used to treat thyroid disorders have a huge impact on your metabolism, so they’re often used (and abused) to lose weight. Unfortunately, as Fugazzola explained, this can put a strain on the heart – resulting in a fast or irregular heartbeat – and the bones, leading to osteoporosis.

Valeria said getting your dose exactly right is important. "If you take too many hormones you get tachycardia [fast heartbeat],” she explained. “If you take too few, you feel really sluggish.” Since Giada is at risk of developing enlarged nodules again in the future, she currently takes a high hormone dosage which causes slight hyperthyroid effects. She says she often has a hard time sleeping, her heartbeat is fast and her hands sweat a lot. "I resent being a slave to drugs at 20," she said.