Health
Issues 2005, Number 83, pp. 31-32.
Peter
Greenberg is a Consultant Physician at the Royal Melbourne Hospital’s
Departments of General Medicine and Diabetes and Endocrinology.
Christine
Walker is the Chief Executive Officer of the Chronic Illness Alliance.
Running
on Empty: Hypothyroidism–An Introduction to an Underactive Thyroid
Gland
Reviewed
by Peter Greenberg and Christine Walker
All
health consumers require information that is well-researched and easily accessible so
they can contribute, as much as they choose, to decisions about the kind of health care they
think best suits their needs. Possibly the greatest need for such information occurs when a
person is first diagnosed with a serious life-threatening or chronic illness. However, with
many illnesses the need for information continues, providing the person with the ability to
engage in discussions with health providers, make informed decisions, and generally have a
good background understanding of what is happening to their bodies, and the treatments
that are on offer.
Running
on Empty: Hypothyroidism fills much of these criteria for someone with an
underactive thyroid. This book attempts to fill the information needs of the many people
who have, or suspect they have, underactive thyroid glands. Clearly, the author’s
experience over several years is a strong motivating factor. “The importance of the thyroid
gland to human health has been known by western doctors for many years, and yet it is
probably the most overlooked factor in a great many health problems that plague the 20th
century” (p. 21). Rather than railing at the health system, she has decided to participate in
it
by contributing to the understanding of this particular condition.
The
value of the book is that it does not assume that people are generally aware of the role
of the endocrine system in their bodies. The author, Robyn Koumourou, explains the
endocrine system and the interrelationship between the various glands. With this
background, she outlines the place of the thyroid and how it works (chapters 4 and 5) and
then moves on to discuss hypothyroidism. This in itself is an achievement, as the endocrine
system and the thyroid itself are highly complex.
It
is only from this point that Koumourou begins to speak of clinical evaluation, signs and
symptoms (chapters 8, 9 and 10). Recognising the complexity of her subject — where
every clinical presentation is different — Koumourou argues that diagnosis is sometimes
difficult. This part of the book will be of great value to people who wish to learn more, so
they can engage in dialogue with their health professionals. One problem she could have
emphasised even more is the non-specific nature of many of the symptoms of an
underactive thyroid. For example, how many people who do not have thyroid problems
would tick one or more of the boxes against the various symptoms of hypothyroidism in the
introduction? Importantly, she reminds us that the possibility of thyroid malfunction should
always be considered when “fatigue and exhaustion” are major symptoms.
Chapter
12 explains the tests used to confirm a diagnosis, showing people the principles of
how to understand the purpose and meaning of thyroid tests. This both informs people and
empowers them to engage in dialogue with their health professionals. This chapter also
provides some background to the current debate about what constitutes normal thyroid
hormone levels. She indicates that most people with normal thyroid function have TSH
(thyroid-stimulating hormone) levels that are actually in the lower portion of the normal
range, rather than the levels being spread in a normal distribution across this range.
Although some people do indeed seem to benefit from treatment for hypothyroidism when
their TSH level is not higher than the upper limit of the normal range, such additional clinical
benefit is quite uncommon. Furthermore, other benefits of increasing the dose of thyroxine
in this way, so as to achieve more normal TSH levels are not clear at present. This chapter
is followed by a useful outline of current treatments and their side effects.
Additional
strengths of the book are the list of contact organisations, and the text and web
references provided. However, there are also some disappointments. The chapter on
complementary therapies and alternative treatments is a mere page and half long. It does
not recognise that Australians, along with the rest of the world, are consumers of alternative
and complementary therapies — with some 621 million Australian dollars being spent on
alternative therapies in 1992–1993 (MacLennan et al. 1996). Like others, people with
underactive thyroids will look for alternatives in both diagnosis and treatments. Guidance
and information is necessary in this area, especially as iodine supplements may affect
thyroid function and tests. Additionally, Australia is a multicultural society and the use of
non-western medicine in some cultures is not ‘alternative’ but the norm. People from
diverse cultures also require guidance and information regarding the relative value of
different treatments.
Another
disappointment lies in the author’s advice to seek a doctor who is “sensitive”,
“compassionate” and who will work closely with those affected by hypothyroidism. These
qualities may not always be easy to find or to put into practice, so strategies for better
communication would be helpful. Chapter 21 on “stress and the thyroid gland” implies that
there is an established cause-effect relationship between stress and “auto- immune”
conditions, without evidence to support this claim. There are also some inaccuracies. Figure
10, for example, seems to disregard micro-organisms other than “parasites” as of relevance
to “cause”.
Limitations
aside, this book will be a useful introduction to anyone concerned about the
thyroid. It is easy to read, and provides people who have (or suspect they have)
hypothyroidism with a great deal of useful information to which they can return when
necessary. It also shows how to access further information.
Peter
Greenberg is a Consultant Physician at the Royal Melbourne Hospital’s Departments
of General Medicine and Diabetes and Endocrinology.
Christine
Walker is the Chief Executive Officer of the Chronic Illness Alliance.
Running
on Empty: Hypothyroidism – An Introduction to an Underactive Thyroid Gland is
written by Robyn Koumourou and published by Cocoon Books, PO Box 7429, Upper
Ferntree Gully, Victoria, 3156 or go to: www.cocoonbooks.com Cost: $38.50.
Reference
MacLennan,
A., Wilson, D. & Taylor, A. 1996, ‘Prevalence and cost of alternative
medicine in Australia’, Lancet, Vol. 347, pp. 569-573.
Health
Issues 2005, Number 83, pp. 31-32.
Ordering the Book
