Larry Batiste wondered why he was losing weight. But he really knew something was wrong when he could stay awake for 27 hours without a sip of coffee.

When his resting heart rate soared above 132 beats per minute, Batiste stopped wondering about his symptoms and went straight to urgent care.

“My hands would tremble, and I would lay there awake at night, and it felt like my heart was pounding right out of my chest,” said Batiste, a Houston Fire Department captain and paramedic for more than 30 years. “I had heart palpitations. In my years as an EMS supervisor, I knew it wasn’t a heart attack, but I knew it wasn’t normal.”

Batiste’s symptoms were alarming, but not uncommon. Diagnosed with hyperthyroidism, or an overactive thyroid, he is among the estimated 20 million Americans who have a thyroid imbalance, according to the American Thyroid Association.

Thyroid is a busy gland

The thyroid is a butterfly-shaped gland in the base of the neck. About 2 inches long, and weighing less than an ounce, the thyroid is small, but mighty. This troublesome gland packs a powerful punch to your metabolism and nearly every system in the body. Hormones produced by the thyroid regulate growth, heart rate, body temperature, muscle strength and appetite. They also affect the health of your heart, brain, kidneys and the digestive and reproductive systems.

Too much or too little of that hormone can throw your body off track with a host of contradictory symptoms: feeling too hot or too cold, nervous or depressed, wired or tired and gaining or losing weight unexpectedly.

Dr. Tom Thomas, an endocrinologist for Kelsey-Seybold in Houston, said he frequently treats city employees for thyroid disease, but he sees more cases of hypothyroidism than hyperthyroidism.

The underactive thyroid

Hypothyroidism, caused by an underactive thyroid, tends to run in the family and has a female predominance with a 3 to 1 ratio of female over male patients, Thomas said.

“Many of my thyroid patients are women who complain of generally feeling lousy, fatigued, with irregular or heavy periods, constipation, hair loss, weight gain and muscle aches. The majority of these patients ignored their symptoms, chalking it up to lifestyle or aging, but they ended up having a thyroid imbalance,” Thomas said.

Devaki Radhakrishnan, who works for Houston Emergency Center, said she has been living with hypothyroidism for 15 years.

“I went to the doctor when I was feeling sluggish and started gaining weight despite no changes in my diet and exercising several times a week,” Radhakrishnan said. “My sister and daughter also have hypothyroid disease, and we are all on levothryroxin. I would prefer to use a natural remedy, but generally my symptoms are being managed with the drug, and I have only had to increase the dose slightly over the years.”

Medication makes a difference

Vanessa Branch-Welks said she first suspected she had a thyroid imbalance after attending a thyroid seminar at the United Way.

“I had been losing my hair, gaining weight and had pretty dramatic hot and cold flashes, but I knew it wasn’t menopause,” said Branch-Welks, who works at the Houston Health Department.

“Since I got on Synthroid, my hair has grown back, but it’s not what it used to be, and now I’m cold all the time. If you think you might have a problem with your thyroid, I definitely recommend seeing your doctor. It’s not an easy fix. You won’t be cured, and you may have to stay on medication, but you’ll feel better and your overall quality of life improves.”

Hypothyroidism can’t be entirely reversed with medication, and many patients take thyroid replacement medication the rest of their lives, Thomas said. Progression is gradual over time. The risks of allowing hypothyroidism to remain untreated outweigh the inconvenience of taking a daily medication.

“In most cases, a simple blood test and a prescription of Synthroid will help patients feel much better. Significant hypothyroidism, when the blood test reveals a thyroid stimulation hormone level over 10, can be linked to higher cholesterol and higher blood pressure,” Thomas said. “If the TSH level rises above 20, blood pressure goes even higher, which tends to make the heart weaker. LDL and total cholesterol would tend to rise, and patients can gain quite a bit of weight and feel badly. All of these factors can affect your mental status, making you feel confused or disoriented, causing trouble breathing and even heart failure.

“We have to monitor hypothyroidism in pregnant women very closely,” Thomas said. “If you let the TSH level get over 2.5, rates increase for fetal deformities, spinal deformities and significant complications including miscarriage.”

The overactive thyroid

Conversely, hyperthyroidism can be more challenging to treat, Thomas said. Thyroid-blocking drugs can manage the imbalance, but they don’t provide a lasting cure. Another option is radioactive iodine treatment, where patients take a one-time iodine capsule that dissolves the thyroid gland. Once the thyroid is dissolved, patients are prescribed Synthroid for thyroid replacement therapy, Thomas said.

Before she sought treatment for hyperthyroidism, Meryl Bote’s symptoms were visibly noticeable.

“I had no idea that I had a problem until my neck got really swollen and my eyes started bulging,” said Bote, who works for the Houston Public Library Department. “It turned out that I had a goiter and Grave’s disease, or severe hyperthyroidism. I started taking medication to control it, but eventually my doctor recommended radioactive iodine treatment.

“I went from having hyperthyroidism to hypothyroidism, gaining considerable weight and being on medication for the rest of my life. I don’t mind taking a pill daily, but I wish I had held out and investigated other natural options before dissolving my thyroid altogether.”

 “Hyperthyroidism is sort of a different animal in itself. It can become very severe,” Thomas said.  “Radioactive iodine treatment is reserved for severe hyperthyroidism when the patient’s heart rate is running fast or irregular. If the blood pressure gets too high, there’s shortness of breath, an abnormal amount of weight loss, and it can’t be managed in a more conservative way.

“I personally don’t choose radioactive iodine treatment as an option unless those patients have failed to improve using more conservative measures, or if they cannot tolerate the prescribed medications.”

Stay on top of it

Since his hyperthyroidism diagnosis in 2011, Baptiste has seen his symptoms improve and relapse. He’s currently assessing his treatment options.

“I have started feeling the heart palpitations again, and my doctor mentioned Graves disease. I’m not ready to commit to radioactive iodine treatment or surgery just yet, but am keeping a close eye on my thyroid levels,” Batiste said. “My advice to anyone who suspects they might have a thyroid imbalance is to stay on top of it. Don’t wait; don’t brush it off. Go for your annual physical and ask your doctor to run a blood test to see where you stand.”