Keeping it Real with Dr. David Capuzzi

Q: Welcome to Keeping It Real. Who are you and what is your background?

A: You have a couple of hours? [Laughs.] My specialties are endocrinology, diabetes and lipid disorders. I head the Cardiovascular Disease Prevention Center at Thomas Jefferson University Hospital. My practice includes patients with high cholesterol and related abnormalities. The treatment goal is to arrest the formation of fat deposits in arteries that lead to heart attack and stroke. I also treat patients with diabetes and with abnormalities of the adrenal, thyroid and parathyroid glands. My coworker Dr. John Morgan and I conduct clinical research studies using nutritional agents and medications to prevent first or recurring episodes of coronary disease and stroke.

Q: What is thyroid disease?

A: Thyroid disease refers to abnormal function of the thyroid gland, a gland in the neck above the collarbone that forms hormones that influence nearly all cells and tissues of the body.

Q: Who gets the disease?

A: Anyone can get this disease ranging from the unborn fetus to elderly people. However, most thyroid conditions are five to 10 times more common in women than in men.

Q: What are its symptoms?

A: Early in the disease process, there may be no symptoms. As thyroid disease progresses, there commonly are changes in memory, mood, strength, energy level, sleep pattern, appetite, weight, bowel habit, hair, or skin texture. Women often have changes in menstrual flow. Individuals may have any combination of these symptoms.

Q: Does thyroid disease affect other body functions such as fertility or brain function? If so, how?

A: Thyroid disease can cause malfunction of the ovaries, testes, and other parts of the reproductive tract, thereby interfering with fertility in women or men. Thyroid hormones are present in the brain and are essential for its normal development and function. Thyroid hormones may also be involved in the transfer of messages among various cells in that organ.

Q: Is thyroid disease hereditary?

A: There is a strong hereditary component to most thyroid conditions.

Q: What is the difference between an overactive and an underactive thyroid?

A: An overactive thyroid gland produces an excess of thyroid hormones. An underactive gland produces an inadequate amount of these hormones. Hyperthyroid individuals can experience nervousness, irritability, palpitations, increased heart rate, weight loss despite an increased appetite, weight gain, frequent bowel movements, fatigue, weakness, lack of energy, increased perspiration, intolerance to heat, decreased menstrual flow, shortness of breath on exertion, changes in vision, bulging and irritation of the eyes, thyroid gland enlargement, and a tendency to squirm. Most individuals have a combination of these symptoms. Hypothyroid individuals usually have opposite symptoms, but they also share weakness, tiredness, and lack of energy. These symptoms include depression, forgetfulness, unexplained weight gain with decreased appetite, dry skin and hair, intolerance to cold, constipation, heavy menstrual flow, vague aches and pains especially of the joints, and sometimes swelling of the arms, legs and abdomen. On rare occasions, hypothyroid individuals have minimal or no symptoms.

Q: How many people suffer from the disease?

A: About 27 million, or 1 in 10, Americans suffer from thyroid disease. Half remain unidentified and undiagnosed. Over 8 out of 10 patients with thyroid disease are women.

Q: How does the disease affect fitness?

A: Because normal thyroid function is essential for normal function of virtually all organs, muscles, and structures of the body, a diseased thyroid gland interferes with a person’s capacity to exercise, be fit, to carry out everyday activities, and to enjoy life. Variable food intake also interferes with adherence to a healthy diet.

Q: What advice can you give on ways to help thyroid patients manage the disease, stay fit and feel good?

A: It is important that patients with thyroid disease follow their specific recommended medical regimens. They should also adhere to sound lifestyle habits with exercise, healthy diets, and stress reduction as needed. Smoking cessation is very important for everyone. Tobacco use often aggravates the various eye symptoms that afflict some patients with thyroid disease.

Q: Do children suffer from this disease? Do we have numbers on children touched by the disease each year?

A: Since thyroid abnormalities can occur at any age, these conditions can afflict both children and teenagers. One out of every 5,000 babies are born with existing hypothyroidism. Untreated hypothyroid children will experience a slowing of growth and development, as well as several of the same symptoms that cause suffering in hypothyroid adults. Children and teenagers can also develop hyperthyroidism with similar symptoms to those of afflicted adults.

Q: What signs should we look for if we suspect that a child may suffer from the disease?

A: Signs to look for in children suspected of having thyroid disease include growth slowing, dry and itchy skin, sluggishness, increased sensitivity to cold, constipation, fatigue, slowed development, and unexpected poor performance in school. Signs in hyperthyroid children are similar to those in adults as well as slowed growth and development.

Q: How is the disease treated?

A: Individuals who are identified and diagnosed as having hypothyroidism should be treated with daily morning doses of purified thyroid hormone, mainly levothyroxine. It is important to use a high quality brand of this thyroid hormone and to tailor the dose to the individual patient. Three types of therapy are available to treat individuals diagnosed to have the most common form of hyperthyroidism, which is termed Graves' disease. These options include the use of antithyroid medications, radioactive iodine, and surgical removal of the gland. There are potential risks and benefits to each form of therapy, which must be carefully weighed and discussed with the patient who then understands these and then actively participates in the choice of therapy. There are situations where a particular option is contraindicated, such as the use of radioactive iodine in the pregnant patient. Surgery is not commonly performed unless coexisting thyroid cancer is suspected.

Q: Are there new or alternative methods of treatment?

A: New methods of treatment are under active investigation. However, since the underlying causation of the most common thyroid conditions remains unclear, the standard options for therapy have thus far remained unchanged.

Q: How do patients go about finding a good specialist to treat them in the Philadelphia area?

A: Consulting your family physician or another of your physicians is probably the most reliable way to find a good specialist. Other potential sources of information include satisfied patients under the care of an excellent physician, the county medical societies, medical and endocrine societies, major medical centers, and perhaps Web sites.