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HEALTH MATTERS: What you should know about a thyroid crisis

It’s not surprising that CareerCast.com’s 2017 analysis of stress-inducing industries included a “non-combat” occupation — public relations executives. CareerCast measures occupations based on 11 stress factors. If you don’t know, the world of public relations is a continuous cycle of several stress factors including deadlines, constant travel, working in the public eye and competitiveness.

Dominic Friesen is a 20-year public relations veteran. He is the owner of Bridge and Tunnel Communications in the Los Angeles area.

“Honestly, for years, I felt something was out of whack with my health but I attributed it to the workload and stress that comes with my profession,” Friesen said.

For several years, Friesen experienced persistent bouts of sweating profusely, fatigue, rapid muscle mass and weight loss, and an erratic appetite.

“Weird things were going on with my body, including what seemed to be what women describe as ‘hot flashes’ even when weather temperatures were mild or cold,” he said. “I would just start dripping with sweat for no reason.”

He begin to lose weight rapidly even though he had stopped working out.

“I used to work out six days a week but had to stop because of extreme fatigue,” he said.

During his annual physical examination, Friesen complained to his primary doctor about his unexplained ongoing symptoms. He was not diagnosed based on his symptoms.

“Basically, I was told that I was just stressed out and burning a candle at both ends,” he said.

It wasn’t until he had blood work that the culprit was discovered.

“I received a letter in the mail with my blood work results,” Friesen said. “When I read the word ‘thyrotoxicosis,’ I had no idea what that meant. My primary doctor did not call me to explain the diagnosis. I was scheduled to see a specialist in a few weeks.”

The Society for Endocrinology states that thyrotoxicosis is the name given to the clinical effects experienced due to an excess of thyroid hormones in the bloodstream. The main cause of thyrotoxicosis is hyperthyroidism, which is an overactivity of the thyroid gland resulting in it producing excessive levels of thyroid hormones

While waiting for his appointment to see the specialist in December, Friesen’s symptoms worsened.

“I was very sick and called urgent care and informed them of my initial results,” he said. “I was told to immediately get admitted to ER.”

It was at that moment that he realized his condition was severe. According to medical studies, thyrotoxicosis has been associated with dilated cardiomyopathy, right heart failure with pulmonary hypertension, and diastolic dysfunction and atrial fibrillation.

January is Thyroid Awareness Month designed to educate people about how the thyroid gland works, recognize when there is an issue and what to do. Thyroid disease can affect anyone, but women are five times more likely than men to suffer, and a person’s risk increases with age.

“The thyroid is a small, butterfly-shaped gland located in the middle of your lower neck,” explains Dr. Robin Miller, who is board certified in internal medicine and the medical director of Triune Integrative Medicine in Medford, Oregon. “The two essential thyroid hormones produced by the thyroid are triiodothyronine (T3) and thyroxine (T4). These control the rate at which every cell in your body works (your metabolism).”

“Thyrotoxicosis, also known as a thyroid storm, is associated with untreated or undertreated hyperthyroidism and constitutes a life-threatening emergency,” Dr. Miller said. “A delay in treatment would most likely result in death.”

Thyroid storm is rare. It develops in people who have hyperthyroidism but aren’t receiving appropriate treatment. When left untreated, thyroid storm can cause congestive heart failure or fluid-filled lungs.

People with hyperthyroidism may develop thyroid storm after experiencing trauma; surgery; severe emotional distress; stroke; diabetic ketoacidosis; congestive heart failure; or pulmonary embolism.

Friesen suffered two traumas involving car accidents.

“Patients with thyrotoxicosis present with a rapid heartbeat that is usually greater than 140 beats per minute and may have low blood pressure, abnormal heart rhythms, and congestive heart failure,” Dr. Miller said. “In addition, patients develop high temperatures as high as 104 to 106 degrees. They often suffer from anxiety, delirium, psychosis and can fall into a stupor or coma.”

Patients can also experience nausea, vomiting, diarrhea, and abdominal pain. The mental symptoms, along with the physical symptoms, distinguish thyroid storm from severe hyperthyroidism.

“Hyperthyroidism is when your body is producing excessive amounts of the thyroid hormones T3 and T4,” Dr. Miller said. “Since these hormones regulate your metabolism (how your body processes and uses energy), having too high a level will cause symptoms related to a high metabolism. In essence, hyperthyroidism speeds up some of your body’s processes.”

Dr. Miller states that the patient may experience several symptoms: appetite change (decrease or increase), difficulty sleeping (insomnia), fatigue, frequent bowel movements (perhaps diarrhea), heart palpitations, heat intolerance, increased sweating, irritability, light menstrual periods (or even missed periods), mental disturbances, muscle weakness, nervousness, problems with fertility, shortness of breath, sudden paralysis, tremor/shakiness, vision changes, weight loss (or perhaps weight gain), dizziness, thinning of hair, itching and hives, and a possible increase in blood sugar.

When a thyroid storm is suspected, treatment should begin immediately — even before lab results are ready. Antithyroid medication like propylthiouracil or methimazole would be prescribed to reduce the production of these hormones by the thyroid. Pregnant women who have hyperthyroidism can’t be treated with radioactive iodine. Surgical removal of the thyroid gland is also a treatment option; however, the patient would need to take thyroid hormone replacement pills for life. (Source: Medindia.net)

“If you have hyperthyroidism, your thyroid is producing too much of these two hormones,” Dr. Miller said. “This causes all of your cells to work too quickly.

“For example, your respiration rate and heart rate will be higher than they normally would be. You may even speak far more quickly than you usually do.”

Dr. Miller says that a thyroid storm develops abruptly and affects all the systems of your body.

“Treatment will begin as soon as thyroid storm is suspected — usually before lab results are ready. Antithyroid medication like propylthiouracil (also called PTU) or methimazole (Tapazole) will be given to reduce the production of these hormones by the thyroid,” she said.

“Hyperthyroidism requires ongoing care. People with hyperthyroidism may be treated with radioactive iodine, which destroys the thyroid, or a course of drugs to suppress thyroid function temporarily,” Dr. Miller said. “Pregnant women who have hyperthyroidism can’t be treated with radioactive iodine because it would harm the unborn child. In those cases, the woman’s thyroid would be removed surgically.”

Dr. Miller also warns that people experiencing thyroid storm should avoid taking iodine in lieu of medical treatment, as this can worsen the condition.

“If your thyroid is destroyed by radioactive iodine treatment or removed surgically, you will need to take synthetic thyroid hormone for the rest of your life.”

The mortality rate for people with untreated thyroid storm is estimated to be 75 percent. The chances of surviving thyroid storm increase if you quickly seek medical care. Related complications may be lessened once your thyroid hormone levels are returned to the normal range (known as euthyroid).

“When I feel sick, I just have to stop and rest no matter what is going on in my life,” Friesen said. “This is still very new for me.”

Resources:

American Association of Endocrine Surgeons – www.endocrinesurgery.org

CareerCast.com – www.CareerCast.com

Graves Disease & Thyroid Foundation – www.gdatf.org

International Thyroid Federation – www.thyroid-fed.org/tfi-wp

Light of Life Foundation – www.checkyourneck.com

Medscape – www.medscape.com

National Institute of Health/Medline Plus – www.nlm.nih.gov/medlineplus/thyroiddiseases.html

Society for Endocrinology – www.endocrinology.org

The Thyroid Foundation of America- www.thyroid-info.com

ThyCa: Thyroid Cancer Survivors’ Association – www.thyca.org

US National Library of Medicine National Institutes of Health – www.nih.gov

Marie Y. Lemelle, MBA, a public relations consultant, is the owner of Platinum Star PR and can be reached on Twitter @PlatinumStar or Instagram @PlatinumStarPR. Send “Health Matters” related questions to healthmatters@wavepublication.com and look for her column in The Wave.