Friends and patients have asked me many questions during the last few weeks about Oprah Winfrey's recent revelation that she had thyroid disease.
How could she successfully stop all of her thyroid medications? Does she really have thyroid disease? Does her medical history as she reports it make sense? Why can't I stop my thyroid medication too?
So I thought I would respond to these questions in my "first of the new year" newsletter.
First and foremost, as I do not know the specifics of Winfrey's medical history, my comments reflect the general concerns and questions her article raised for me, a doctor with 25 years of private practice in internal medicine treating many women (and some men) with thyroid disease. I feel better referring to Winfrey as "the patient" so there is no concern that I am directly responding to her personal history -- which I couldn't possibly know. Our patient is a fictitious and nameless patient, therefore.
The patient is a 53-year-old perimenopausal female who seems to work pretty much 24/7 with a history of fluctuating weight problems but has otherwise been in what she describes to be good health. In February 2007 her medical problems began -- with symptoms of difficulty sleeping, lethargy and irritability, gradual weight gain and fluid retention, exercise-induced palpitations and high blood pressure. She admitted that she "couldn't sleep for days."
She went to many doctors and finally one of them diagnosed an overactive thyroid condition, "which gradually converted to an underactive thyroid condition." She was treated with a number of medications -- presumably to treat her overactive thyroid at first (tapazole or PTU) and later medications when she apparently developed an underactive thyroid (synthetic or natural thyroid hormones). She also was on medications for her palpitations and high blood pressure.
Her weight continued to climb despite treatment and a healthier lifestyle of good eating, exercise and rest along with medication. She believed her medications made her feel like she was in a fog, slowed down and viewing life through a veil. At this point she again switched doctors and eventually stopped all of her medication except for daily aspirin. Although she doesn't say this in her medical history, her description of how she felt suggests she was somewhat better after stopping the medication.
What was the patient's thyroid diagnosis and what were the results of her thyroid function studies? Did she really have an autoimmune disease of her thyroid, and why then could she stop her thyroid medication without any ill effect? Is she the infrequent patient who has transient thyroiditis and is now better -- for the time being at least?
It is unusual and often dangerous for a patient with an underactive thyroid from autoimmune destruction (or surgical removal for that matter) to stop their thyroid medication for more than a few days to weeks. Once the diagnosis of low thyroid is correctly made, lifelong thyroid replacement is usually necessary and life-saving. It can however be very difficult to find the correct thyroid replacement medication and dose. But what is not questioned is the continued lifelong need for treatment.