Thyroid Alert

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Section: healthy woman "I was told I'm borderline thyroid. What does that mean?"

It means that your thyroid test--a blood test called TSH, or thyroid-stimulating hormone-was slightly abnormal, indicating possible mild thyroid disease. The key question is, however, was your TSH slightly on the high side or on the low side of normal? That will tell you which of the two main thyroid diseases you may have, each of which is treated differently.

New guidelines were issued last year to catch more people with mild or subclinical thyroid disease. The new normal range is more narrow--0.3 mU/L to 3.0 mU/L--and doubles the number of people who have early thyroid disease, a condition that goes vastly undiagnosed and untreated. (The previous range was 0.5 mU/L to 5.0 mU/L.)

If your TSH is above normal, the thyroid is underactive (hypothyroidism), which is most commonly found in women past the age of 50. The pituitary gland sends more TSH into the bloodstream when it senses that levels of the thyroid hormone thyroxine are low. If the condition is severe enough and left untreated, hypothyroidism can raise your cholesterol and blood pressure, and increase your risk of heart disease.

If your TSH is below normal, it means there's too much thyroid hormone, and production slows down to compensate for the excess. This is called hyperthyroidism and is most commonly diagnosed in women in their 20s and 30s. Women over 50 with hyperthyroidism are at greater risk for osteoporosis because the body breaks down bone faster than it can make it.

Being slightly above or below normal doesn't necessarily mean that you need treatment. That's because it's not clear whether or not lesser degrees of thyroid dysfunction are harmful. So the best course of action may be to just have your TSH level checked regularly for any change.

Treatment for an underactive thyroid is a synthetic form of thyroxine. But overmedicating can cause bone loss, so it's important to take the lowest dose you need.

For hyperthyroidism, or overactive thyroid, the treatment of choice is usually a one-time radioiodine pill, which is very safe.

Everyone should get a TSH test starting at age 50 and then every 5 years after or sooner if you're having symptoms.

LOOK FOR THIS

Signs of an underactive thyroid, which include

• mild depression or mood swings
• fatigue
• inability to concentrate
• muscle soreness
• weight gain from fluid retention
• dry skin and cold intolerance
• constipation
• heavier and more frequent menstrual flow

Signs of an overactive thyroid, which include

• nervousness or irritability
• weight loss
• heat intolerance or increased sweating
• insomnia
• fatigue
• decreased menstrual flow
• heart palpitations

PHOTO (COLOR): Find out when to worry.

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By Mary Jane Minkin, MD

with Toby Hanlon, EdD

Mary Jane Minkin, MD, is a board-certified obstetrician-gynecologist in New Haven, CT, clinical professor at Yale University School of Medicine, and co-author of The Yale Guide to Women's Reproductive Health (Yale University Press, 2003).

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