THE HEART OF THE MATTER
a special program of the National Emergency Medicine Association (NEMA) 

Week: 617.6

Guest:  Dr. Jack Baskin, President, American Association of Clinical Endocrinologists Orlando, FL

Topic: Thyroid problems and depression

Host/Producer: Steve Girard

NEMA: It's a small gland...but it does so much to help our bodies run correctly and efficiently...the thyroid gland...and we should know about its role in depression. It could help us avoid the use of anti-depressants. we're happy to have Dr. H. Jack Baskin of Orlando, Florida with us today...he's the president of the American Association of Clinical Endocrinologists...to talk about the thyroid, it's duties, and how is may cause the blues...

BASKIN: Well, it's one of the glands, so called endocrine glands of the body, that produces hormones that circulate in the blood. The thyroid is located in the front part of the neck, right along the sides of the trachea, or windpipe...and its function is to take iodine from foods we eat and convert that to thyroid hormone, and then put that hormone back into the bloodstream, where it circulates through literally every cell of the body. Thyroid hormone then controls the metabolism of each cell. It tells each cell how much calories and oxygen to use up to produce energy. And different cells respond differently. Fingernails will grow faster if they get more thyroid. Hair will grow faster or slower, depending upon how much thyroid there is. The heart will beat faster if it's given extra thyroid, so each cell in the body responds differently, depending on what each cell does, to thyroid hormone.

NEMA: I've heard some names associated with thyroid abnormalities, like Graves disease and Hashimoto's disease...do these problems run in families?

BASKIN: These are different types of thyroid conditions...high and low thyroid...that you do see in families, and we're realizing more and more that it is highly hereditary...and that many people, if they check back, will find their other relatives in their family that have thyroid problems that often seems to skip a generation...so they may find that a cousin, or second cousin has a thyroid problem that they didn't know about until they went back to check on it. Also, the strange thing is you do see people that are hyperthyroid and hypothyroid in the same family, suggesting that there is a common denominator that starts the thyroid into malfunctioning...and in some people it becomes overactive and in others it becomes overactive.

NEMA: Are there environmental causes for thyroid conditions?

BASKIN: Today we do see people who get exposed to radiation, who develop thyroid problems. This has occurred in children who were given radium treatments for acne 30 or 40 years ago...half of those people have now developed thyroid problems in adult life. We see thyroid problems in people who get certain types of medication, that have high amounts of iodine in them. One of them is a heart medication known amioterone, and there's a very high incidence of thyroid problems in people who take that medication. So, there are environmental things that still cause thyroid problems, but the great majority seem to have no cause, or else be hereditary.

NEMA: Let's talk about the relationship between thyroid problems and bouts with the blues or depression....

BASKIN: Well, it's a connection we've realized for years ...and there's been a lot recently about depression in the media...and various...lots of talk about it, and one of the things our organization, the American Association of Clinical Endocrinologists wants to emphasize is that thyroid problems frequently present as depression. Depression is a symptom, just like fever is a symptom, and there are various causes for depression. Now, some of these causes should be treated with antidepressants. Others might be better to try to find a cause for the depression, and treat that. And because people who are low thyroid frequently have depression....oftentimes it's their primary complaint....it's something that needs to be thought about, and easily ruled out with a simple blood test...perhaps before putting patients on long term anti-depressant medications. It would be much easier to correct a patient's thyroid condition than it would be to put a person on a chemical that would change them. Thyroid hormone does have an effect on the central nervous system, just like it does on the heart or any other organ of the body. And if there is not enough thyroid, oftentimes this causes what appears to be depression.

NEMA: Are certain groups or ages more susceptible?

BASKIN: Thyroid problems occur at all ages. It doesn't seem to be specific to any age group - it occurs among pediatrics...all the way up to octogenarians. We have, in our campaign, emphasized certain times when you do see an awful lot of thyroid problems develop, such as pregnancy...and immediately following pregnancy, really. We refer to that as post partum depression. We refer to older people who are also getting depression, because a lot of times it's thought to be premenstrual syndrome or something else, or premenstrual problems, when really it's again...it's a common age for the thyroid to fail. At about age 40 in females, there becomes a very high incidence of low thyroidism. Some studies report over 10 % incidence of thyroid problems in women over the age of 40, so we refer to that one as a type of depression that we also see. The postpartum depression that you see immediately after delivery...again, that's a common time for the thyroid gland to fail. But actually, it can occur at any time, and it can present as depression.

NEMA: Does the onset of thyroid problems increase with age?

BASKIN: Yes, you see an increase as time passes...to the point where we've recommended that women over the age of 40 should have a TSH test as part of their annual physical examination, because this test will pick it up before any symptoms occur...and because it's such an easily treatable disease when it's picked up early like that...that we've suggested to family practice, primary care doctors, that this be part of the annual physical examination., before it produces any long term effects.

NEMA: What happens if a thyroid condition goes undetected and untreated?

BASKIN: Generally, with hyper....it produces its effects rather quickly...maybe not in days, but over a period of weeks or months. The patient becomes very obviously ill, starts losing weight, has heart problems, heart failure...and can, if not treated, can result in death. Hypothyroidism is much more subtle. Patients can oftentimes go along for years with slightly low thyroid function, and just blame it on getting older, stress, overwork...and not realize that they have a problem, and it's due to their thyroid. So, it's a much more chronic problem when it's hypothyroid...in most patients, whereas hyperthyroidism usually manifests itself one way or the other within a period of a few months.

NEMA: Is there something we can do at home to check for an enlarged thyroid?

BASKIN: The checking of the thyroid is what we call a "neck-check". And what one does is hold a mirror in front of the neck...and take a glass of water...put water in the mouth, tilt up and swallow....and watch the neck as they swallow. Now, usually you don't see any lumps there, other than just the Adam's apple, which is part of the windpipe, move up and down. If one sees a lump, either to one side or the other, that is the thyroid...and you should not be able to see the thyroid. So, if one can see or feel the thyroid gland, it is enlarged, there's something wrong...and they should go to their physician and point it out to them, and find out why it's enlarged. So, an enlarged thyroid always indicates something is wrong with the thyroid.

NEMA: I've heard the treatment for thyroid problems is fairly straightforward...

 

BASKIN: Well, if the thyroid is not functioning enough, and It's only function is to make thyroid hormone, we just give the added thyroid hormone. We have synthetic human thyroid, which is identical to the thyroid the body makes. It's absorbed well from the stomach, so simply taking a pill a day corrects the patient who is hypothyroid. If the thyroid is over producing, there are several ways that have been used to treat it. In the past, surgery to remove part of the thyroid was the treatment. Today, we give a dose of iodine that has been made radioactive, and this radioactive iodine goes into the thyroid just like any other iodine, but it dissolves part of the thyroid. So, It's kind of like having surgery in pill form...and it slows down the thyroid, it makes it quit overproducing the thyroid hormone. So, either an under active or an overactive can be treated today with medicine.

NEMA: Is the thyroid something that physicians overlook during exams....?

BASKIN: It varies tremendously from one physician to another. In my experience, there are some physicians that apparently never think of the thyroid, there are others who are very diligent about examining the thyroid each year when the patient comes for a physical. I think the patient is better off bringing it to the physician's attention, and ask them to feel their neck when they go for a physical....and especially among women, ask for a TSH test to be done.

NEMA: It's pretty important for people to know that depression can be rooted in thyroid problems...and easier to treat than a constant regimen of anti-depressants...

BASKIN: We got concerned about is a survey done in October on people who had gone to the physician complaining of depression, and even those who were taking Prozac....a long term anti-depressant, about one in five of the people who complained about depression had their thyroid checked ...and even among those who were taking anti-depressants, only on in three had their thyroid checked...and we became very concerned about this, because we think that people really are not looking for it...or not thinking of the diagnosis enough and this is the reason we emphasized thyroid blues this year in our thyroid awareness campaign.

NEMA: If you have depression, or just feeling the blues, and you can't put your finger on the reason why...ask your doctor to check your thyroid function.

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