Health Checks and Hyperthyroidism

I am now closer to 50 than I am to 40. Very soon, I might have to change this blog title to Fifty Fit and Fed. FMR has also been reminding me to get my yearly bloodwork done to make sure I haven’t developed any “old people” problems, like high blood pressure, high cholesterol, or diabetes. I say “yearly” but really, my last blood test was in 2021 – 3 years ago. You could say I’ve been lazy. In my defense, I haven’t been able to tolerate going hungry in the mornings while I wait to get my blood drawn. Some people get hangry but I guess nauseous. There really should be a term for people who get hunger nausea. I realised this when my son complained he had hunger nausea. So yes, it is a thing.

I digress… so I finally got around to getting tested. I picked the clinic with the earliest opening hours so I wouldn’t have to wait so long. Except, they did the most basic of blood tests – they only checked for diabetes, lipid profile, liver and renal function. I had no diabetes and my lipid profile was excellent (so they told me). Strangely though, a few markers were out of the norm:

• Liver function:
  • total protein 62g/L (low)
  • ALT 43U/L (high)
  • AST 37U/L (high)
  • GGT 42U/L (high)
• Renal profile:
  • Creatine 39umol/L (low)
  • Corrected Calcium 2mmol/L (low)

Liver function shows fatty liver despite the fact that I hardly drink these days. The recommendation was to get re-tested. I was going to wait a couple of months before re-testing but a friend urged me not to wait. She said, sometimes there are no obvious symptoms so it’s best to be sure. I took her advice and got another test – this time, I included thyroid function, Vit D and cancer markers.

• Haematology:
  • Neutrophils – 37.6% (low)
  • Lymphocytes – 50.8% (high)
• Liver function:
  • AST – 48U/L (high)
  • Fibrosis score – 1.44 (intermediate risk)
• Renal function:
  • Urea nitrogen – 7.1mmol/L (high)
  • Creatine – 37umol/L (low)
• Endocrine:
  • TSH – <0.008mIU/L (very low)
  • Free T4 – 72.9pmol/L (very high)
• Urine:
  • White blood cell – 64/uL (high)
  • Squamous Epithelial cells – 3+
  • Non-squamous Epithelial cells – 1+
  • Bacteria – 1+
  • Mucus – seen

The diagnosis was hyperthyroidism. The cause of hyperthyroidism is most commonly Graves’ disease. Hyperthyroidism is also commonly inherited – which is most likely why I got it since my mother had it. Apparently, so did two of my aunts (on my mother’s side). The good news is that they were all successfully treated and no longer require medication so I think I can hope for the best.

Graves’ disease is an autoimmune disorder that involves overactivity of the thyroid (hyperthyroidism). Hallmarks of the condition are bulging eyes (exophthalmos), heat intolerance, increased energy, difficulty sleeping, diarrhea and anxiety.

What causes Graves’ disease? Researchers aren’t sure why some people develop autoimmune disorders such as Graves’ disease. These disorders probably develop from a combination of genes and an outside trigger, such as a virus.

With Graves’ disease, your immune system makes an antibody called thyroid-stimulating immunoglobulin (TSI) that attaches to your thyroid cells. TSI acts like thyroid-stimulating hormone (TSH), a hormone made in your pituitary gland that tells your thyroid how much thyroid hormone to make. TSI causes your thyroid to make too much thyroid hormone.

How did I not know I had hyperthyroidism? In retrospect, now that I know I have it, I can see the symptoms that are linked to it. Unfortunately, a lot of the symptoms overlap with other conditions I could be experiencing. It’s a little like having a runny nose and fever – it’s the hallmark of many illnesses. Coupled with the fact that I am perimenopausal, so many symptoms linked to hyperthyroidism are also perimenopausal symptoms.

• Nervousness or irritability – not sure about the nervousness but any irritability was easily explained away by menstrual/perimenopausal hormones.
• Fatigue – name one mother who isn’t fatigued.
• Muscle weakness – okay, so I did wonder why my strength training was not making much progress. Although I did get sick from time to time and had to stop training. I attributed any inconsistency to those intermittent breaks.
• Trouble tolerating heat – the weather has been hot lately and everyone has been complaining about it.
• Trouble sleeping – another symptom linked with perimenopause.
• Tremor, usually in your hands – I never noticed this until the doctor asked me to hold out my hands. That was when I noticed a fine tremor in my left hand which I doubt anyone would have noticed if they weren’t looking out for it.
• Rapid and irregular heartbeat – my heartbeat has always been a bit fast. I did notice it was higher than usual despite all my exercise. My resting heart rate crept up to 90+ quite frequently. Again, I didn’t think too much of it because I had a mini-stroke a few years ago and caught Covid twice.
• Frequent bowel movements or diarrhoea – I didn’t have the usual presentation of diarrhoea but I did need to go to the toilet a lot! After every meal, in fact. According to the doctor, this is considered diarrhoea. Well, now I know.
• Weight loss – I eat a lot and I was hungry a lot. Perhaps that’s why I didn’t notice any weight loss?
• Mood swings – this didn’t happen a lot. When it did, it didn’t last long, and then I chalked it down to perimenopause which also causes mood swings.
• Goiter – an enlarged thyroid that may cause your neck to look swollen. Sometimes it can cause trouble with breathing or swallowing. I can’t say I noticed any neck swelling. No one else did either. Only the doctors seem to be able to see it. I did wonder if they could see it because they knew to look out for it. Swallowing did feel a little more difficult, but this is not uncommon with age. Breathing also felt a little more difficult when I was lying down but only if my neck was compressed by my pillow.

Swallowing problems, or dysphagia, are very common as people age…

The other symptom, which is related to Grave’s Disease, is exophthalmos (protruding eyes because of swelling in the eye sockets). I can’t say I noticed this one either but the doctor observed it during my examination. When I went home and looked carefully in the mirror, I could also see it was more pronounced in my left eye where more whites were visible.

Another symptom which I have been having lately is hives. From time to time, I would break out in a rash that itches terribly. It happens anywhere on my body and at any time of the day. When it happens at night, I can’t sleep so that was another reason why I didn’t link poor sleep to anything else. What I did find odd was that sometimes the antihistamines would work and sometimes it wouldn’t. I thought it was linked to perimenopause since it causes dry skin. Several friends also complained about it so I was convinced it was a common symptom.

I did get tested for allergies as well and the test revealed an allergy to dust mites. I’m guessing it’s not a new allergy since I’ve always been sensitive to it since I was a child. I thought it was odd that it would suddenly present this way after years of suffering from it. But it appears that these hives could also be related to hyperthyroidism so maybe it wasn’t a change in the way I responded to dust mites.

Hyperthyroidism may present with an itchy rash, hives, or changes in skin pigmentation. Medications that treat hyperthyroidism may also cause a rash. Hyperthyroidism, also known as overactive thyroid, is a condition in which your thyroid gland makes too many hormones.

So I guess the symptoms were there but not serious enough to cause alarm. They weren’t even bothering me much so I would never have sought out treatment for them on my own.

How serious is Hyperthyroidism? If it isn’t treated, it can cause some serious health problems, including:

• An irregular heartbeat that can lead to blood clots, stroke, heart failure, and other heart problems.
• An eye disease called Graves’ ophthalmopathy. It can cause double vision, light sensitivity, and eye pain. In rare cases, it can lead to vision loss.
• Thinning bones and osteoporosis.
• Fertility problems in women.
• Complications in pregnancy, such as premature birth, low birth weight, high blood pressure in pregnancy, and miscarriage.

Blood clots and stroke… could this have been the cause of my TIA (or at least have been a contributing factor)? How long have I had hyperthyroidism? Could I have had it for years without noticing it? Possible. Regardless of whether it had anything to do with my stroke or not, at least I have discovered it and am getting treated for it now so I won’t experience other complications. While I’ll miss being able to indulge in excess, I won’t be missing these health problems.

Sometimes the symptoms are so subtle that they go unnoticed for a long time. In other cases they come on suddenly over a period of a few days or weeks and are severe.

What’s the message after all this? Get your blood test and get it regularly – especially when you’re getting older but not only then. Although hyperthyroidism tends to occur more frequently in older women, it can affect men and it can affect younger women, too. Even if we aren’t worried about hyperthyroidism, we should get health checks to detect any medical condition early. Sometimes, the symptoms don’t appear until the condition has progressed to a more serious stage. Kinda like tooth decay – when it hurts, it’s already pretty advanced and harder to treat.