Understanding Normal and Abnormal Thyroid Function in Patients with Eating Disorders

Monday, January 9, 2017

300300p27278EDNmainMedical Monday Drabkin 114Eating Disorders are complex psychological illnesses that, in the most severe form, can have devastating physical effects on the entire body system. Thyroid gland function is frequently evaluated in patients with eating disorders and understanding what the results mean can be extremely important. The thyroid is one of my favorite glands. It’s called the “shield gland” in German because it sits on the neck in the shape of a shield and literally has a protective function for virtually all organ systems in the body. It belongs to the endocrine, or hormone, system of the body. The thyroid gland produces hormones (triiodothyronine and thyroxine, T3 and T4, respectively) that act like the gas pedal or brakes of the body’s metabolism and organ function by making them work faster or slower. Thyroid hormones have such a crucial effect on the body that levels that are too high or low can qualify as medical emergencies and sometime require a stay in the intensive care unit.

In babies, thyroid hormones play an important role in brain development and low levels can lead to mental retardation or cerebral palsy. In adults, altered thyroid hormones can cause a myriad of problems affecting the heart, brain, bones, body temperature, intestines, GI tract and lungs. Elevated thyroid hormones can cause heart palpitations and heart failure, rapid bone turnover and osteoporosis, fever and sweating, diarrhea, hair loss, anxiety and coma. Low thyroid hormones can cause a slow heart rate, swelling of the hands and face, confusion, low sodium, low body temperature, respiratory depression, lethargy and coma. The death rate for both extremes of thyroid hormone expression is around 30-40%. Yikes!

Patients with very low body weight and insufficient nutrition, such as people with eating disorders, almost always have a down-regulation of normal body function to conserve energy. Their heart beats slower, bone production slows, gut motility slows, menstrual periods stop in women and testosterone production drops in men. Thyroid hormone production in malnutrition, however, remains normal and matches the physiologic needs of the body in order to keep it alive. An excess amount of thyroid hormones in a state of starvation would cause organ systems to exhaust and fail, which could lead to serious illness or death. This is why people should ALWAYS avoid taking thyroid supplements unless specifically prescribed by a physician. Weight loss or energy supplements containing thyroid hormones bought in stores or online can be unsafe for anybody and especially dangerous for people with eating disorders.

Interpreting the results of your thyroid tests can be tricky because the release of thyroid hormones into the body is regulated by another hormone called TSH (thyroid stimulating hormone). Generally speaking, if the body is underproducing thyroid hormones, TSH will be elevated to induce more thyroid hormones (T3 and T4) for the body. Inversely, if there is too much thyroid hormone in the body, the TSH will be low to slow down the production of T3 and T4. In most cases, hypothyroidism (low thyroid hormones) is characterized by a high TSH and low T3/T4. Hyperthyroidism (high thyroid hormones)usually has a low TSH and high T3/T4. Most patients on the ACUTE ward have either normal thyroid studies or a distribution that we define as a “sick euthyroid” indicating the thyroid’s normal reaction to a body in a state of stress. Fortunately, a “sick euthyroid” will correct with weight restoration.

I hope this helps you understand a little bit more about one of the most important hormonal systems in your body! I wish you all health and happiness in the new year ahead!

Anne Drabkin, MD

If you or a loved one is suffering from an eating disorder, do not delay seeking treatment. We at the ACUTE Center for Eating Disorders are here to help. For more information or to take a confidential assessment, please contact our admissions team at acuteinfo@dhha.org or by calling our admissions line at 1-877-ACUTE-4-U.