A year ago, Takesh Mathur, 47, suddenly found himself struggling to stay awake. "I was overcome with extreme lethargy and despite eight hour of sleep at night, found myself nodding off during the day," he recalls. He lost his appetite but despite eating a fraction of what he did three months earlier, he watched in horror as his weight crept up. "I hit the gym harder but still put on 5 kg in two months," says Mathur.
A friend suggested he get levels of his thyroid-stimulating hormone (TSH) checked. The normal range of TSH concentration falls between 0.45 and 4.5 mU/L. People with mildly under-active (subclinical) thyroid have TSH levels of 4.5-10mU/L. Mathur's serum TSH was an unbelievable 125mU/L. He was diagnosed with hypothyroidism, a condition in which the body cannot produce enough thyroid hormone that helps regulate metabolism. The causes could be one of many -- autoimmune, iodine deficiency, viral or other respiratory infections, or use of certain medication -- Mathur still doesn't know.
"What I do know is popping one tablet a day brought my TSH down to 15 within a month and two months later, I was within the healthy range. That was in February last year, and I've been within the healthy range ever since," he says. With his body getting its daily dose of the hormone, he lost his extra weight and life were soon back on track.
Mathur's experience busts several myths about hypothyroidism which, along with subclinical hypothyroidism, affects 11% of India's population, compared to 2% in the UK and 4.6% in the US, reported The Lancet in October last year. Among the most common misconceptions are:
Hypothyroidism causes weight gain
True, but only if it is untreated. Most people like to blame their extra weight on a sluggish thyroid but even when it's untreated, the weight gain is usually 2-3 kg, and almost never more than 5 kg. And once TSH levels fall, so does the reading on the weighing scale.
Bad lifestyles fuel hypothyroidism
Wrong, there is no lifestyle link. Stress, inactivity, obesity or the type of food you eat do not cause hypothyroidism. And since there is no connection between the disorder and how you live your life, you can pretty much go back to living the way you did once treatment starts.
Depression causes hypothyroidism
Wrong. It's the other way around, persistent sadness is an early symptom of hypothyroidism and everyone with depression should be screened for an under-functioning thyroid gland.
It's a woman's disorder
Wrong again. Though like most autoimmune diseases, it affects far more women than men, but it's not unusual for men to be diagnosed with hypothyroidism. If you're healthy, get your TSH levels checked every five years, but if you have diagnosed hypothyroidism, start with once every two to three months for the first year till the hormone levels stabilise, after which an annual check will suffice unless you develop symptoms.
Treatment is critical during pregnancy and at childbirth because the hormone is critical for the baby's brain development. TSH tests of the mother during pregnancy and the newborn become a must.
You can stop medicines when you feel better
Wrong. Follow the prescription and do not stop having medicines. Thyroid medicine works best on an empty stomach and should be taken an hour before eating. Wait at least six hours after taking thyroid medicines before you supplements such as calcium, iron, multivitamins or antacids. You can eat anything you want. The grey area is soya, which should not be had close to a thyroid tablet as it interferes with absorption.
A major cause for the high prevalence in India is the longstanding iodine-deficiency in its population, which has been partly corrected with the iodisation of salt two decades ago. Yet, while consumption increased from 51% in 2005 to 71% in 2009, just a little over a third of the salt produced is adequately iodised. And a tenth of the population continues to eat salt with no iodine, which needs to change to bring down prevalence of this very treatable disorder.
"It's easier to treat hypothyroidism than high blood pressure or diabetes because the replacement is so near nature that the risks are zero," says Dr Ambrish Mithal, chair of endocrinology and diabetes, Medanta. "People treated optimally lead a normal life, with no restrictions."