When Your Coworker, Employee or Boss Has Thyroid Disease

An Open Letter to the Colleagues of Thyroid Patients

This letter can help colleagues understand the challenges faced by those in their workplaces who have thyroid conditions. istockphoto

A few years ago, a thyroid patient posted on my Facebook wall, asking a simple but important question: "How do you explain to your family what you are going through?"

It's difficult to fully explain what's going on with a chronic disease that is, in many ways, "invisible" to everyone but the sufferer. But I wrote the following article: When Your Family Member or Friend Has Thyroid Disease: An Open Letter to the Family and Friends of Thyroid Patients to be conversation-starter, or help in some way to help those who care about thyroid patients to understand just a little bit better what it is like to have thyroid disease.

Recently on Twitter, someone saw a Tweet about the above letter, and asked: "Is there a similar letter for the workplace?" That valid question prompted me to reformat and rewrite the following letter, which is intended to be shared with the colleagues of thyroid patients.


Dear Colleague: 

Someone you work with has thyroid disease. You may not know much about thyroid problems, but I imagine, like many of us, you've heard things here and there. If anything, you may associate the thyroid with symptoms like weight problems, or think it's an excuse people use for being overweight. Or, you may have someone among your family or friends who is taking thyroid medication -- usually Synthroid -- and they seem to be doing fine, and don't have what you think are signs of thyroid disease, so you assume thyroid disease is similar for most patients.

There are many dimensions to thyroid disease, and while the whole picture is far greater than I can cover in a letter, I'll do my best to give you a brief overview of what your colleague is facing.

The thyroid is our master gland of metabolism and energy. Every single bodily function that requires oxygen and energy -- basically, everything that goes on in the body -- requires thyroid hormone in proper amounts. That means we need the proper balance of thyroid hormone in order think clearly, to remember things, to maintain a good mood, to have the basic energy to get through the day, to see well, and much more.

Think about thyroid hormone as the gasoline that makes the car go. If there's no gas, there's no way to move forward.

Thyroid problems commonly show up in one of several forms. Your colleague may be hyperthyroid...which means that his or her thyroid gland is overactive, and producing too much thyroid hormone. When the thyroid becomes overactive, it's a bit like the gas pedal on the car is stuck, and the engine is flooding.

Hyperthyroidism can cause extreme anxiety, nervousness, rapid heart rate, high blood pressure, and even heart palpitations. They may be hungry and thirsty all the time, anxious, suffering from diarrhea, and losing weight. Others may even be wondering or gossiping, wrongly, that the colleague's rapid weight loss is due to an eating disorder or some sort of illness like cancer or AIDS.

His or her eyes may be sore, sensitive, gritty and irritated, and vision can even become blurry. Sleep may be difficult or impossible, and lack of sleep combined with the body zooming along at 100 miles an hour can cause extreme exhaustion and muscle weakness.

Frankly, people who are in the throes of hyperthyroidism have told me that they feel and look like someone who is strung out on drugs, or who has had 20 cups of coffee after not sleeping for a week.

With heart pounding, and all body systems going full tilt, your jittery, stressed-out hyperthyroid colleague may even feel like -- and look like -- he or she is losing it, ready to fall apart at any moment.

If your colleague is hypothyroid, they are dealing with different challenges. Hypothyroidism means the thyroid is underactive, isn't producing enough of the energy and oxygen-delivering thyroid hormone. This is like trying to get somewhere with barely enough gas and feet that can't reach the gas pedal.

If your colleague is hypothyroid, he or she may be feeling sluggish and tired, and exhausted all the time.

Think about the worst flu you've ever had, and how tired, and achy and exhausted you felt. Now imagine waking up every day feeling like that, but having to get up, and drag yourself into work feeling that way.

Depression -- or feeling blue -- is common in hypothyroidism, as are memory problems and being fuzzy-brained -- we patients call it "brain fog." Your colleague may also look different; some common thyroid signs include the loss of the outer half of the eyebrows, thin/dry/coarse hair, hair loss, puffy face and eyelids, and weight gain.

Your colleague may be the healthiest eater at the office, or the one who eats the least and works out the most, and yet be unable to lose weight. He or she might even be gaining weight on that program.

If your colleague has thyroid cancer, they have an entirely different challenge. Cancer as a concept is frightening and raises fears and concerns. Still, the majority of thyroid cancers are considered highly treatable and survivable, so doctors and others often cavalierly refer to thyroid cancer as "good cancer." But the reality is, no cancer is "good," and someone who has thyroid cancer has cancer, "the big C."

Someone with thyroid cancer initially may have few, if any, symptoms. In some cases, however, they may have symptoms of hypothyroidism, hyperthyroidism, or a combination of symptoms.

Most thyroid cancer patients require surgery to remove the thyroid -- and this can be daunting, including the idea of a several-inch incision in the neck and resulting scar. After surgery, many thyroid cancer patients will need to have followup radioactive iodine treatment to ensure that all the cancerous tissue was removed, and it can be many weeks after surgery before a thyroid cancer patient -- who by that point is typically quite hypothyroid -- can start thyroid medication to again get lifesaving thyroid hormone they need.

The thyroid cancer patient in your workplace will require a lifetime of medical treatment for the resulting hypothyroidism, along with periodic -- and sometimes physically challenging -- follow-ups and scans to monitor for a recurrence of cancer. In some cases, during those scans, they may be required to stay away from other people due to radioactive exposure, or may be so profoundly hypothyroid -- and as a result, it's unsafe for them to drive, or make business decisions -- that they need to take a week or more off from work.

These are just a few of the conditions that can affect thyroid patients. There are autoimmune diseases -- Graves' disease and Hashimoto's -- that can be at the root of hyperthyroidism and hypothyroidism. Sometimes people develop a goiter -- an enlarged thyroid -- or benign nodules that cause symptoms. Sometimes a temporary infection causes thyroiditis. And again, these problems can be difficult to pinpoint, misdiagnosed as everything under the sign, and even when diagnosed, poorly treated.

So what many thyroid patients have in common is living in a world that overlooks, downplays, poorly treats -- and sometimes even makes fun of -- their condition. Magazine articles, books by doctors, patients brochures in doctors offices -- and doctors themselves -- insist simplistically that thyroid disease is "easy to diagnose, easy to treat" -- even though patients know that this is far from the truth.

As for "easy to diagnose," your colleague may have even struggled for years to get diagnosed -- to get taken seriously -- in the first place. Doctors regularly misdiagnose hyperthyroid patients as having an eating or anxiety disorder, and hypothyroid patients as having stress, depression, PMS, menopause, or "laziness." Worse yet are the truly unsympathetic physicians that we all too frequently encounter in thyroid care. Like the marathon runner with hypothyroidism who was in training, on a strict diet, and still gaining weight and was told by her doctor that she had "fork in mouth disease." Or the endocrinologist who discourages patients from speaking up, and instead tells them they must do what he says, because, "I'm the doctor, you're the patient." Or the doctor who diagnosed a woman with hyperthyroidism by clapping his hands together loudly behind her head, chortling: "Oh, I can always tell you hypers, because you practically jump off the examining table when I do that!"

There are advertisements and comedians who use the words "thyroid problem" as the not-so-secret code to describe someone who is fat. And there's a whole realm of scam artists out there trying to sell us cockamamie Thyro-this and Thyro-that "cures" for thyroid disease that in many cases can make things a whole lot worse -- or at best, not help at all.

Even Oprah admitted she had a thyroid problem, then claimed it went away, then said she had it but it wasn't an excuse for her weight gain, then decided not to get treatment, and continues to struggle with her health issues. And perhaps saddest of all, there are friends, relatives and coworkers who say "I don't buy this thyroid disease thing, it's just an excuse for not losing weight" or "Thyroid? Hah! She's just lazy!" Or, "Why can't he just get OVER it and get back to normal?" Husbands criticize their wives for gaining weight. Teenagers whisper behind a friend's back about anorexia. Coworkers complain that their colleague is "lazy."

Once we're diagnosed, treatment is not an easy fix for many thyroid patients. Doctors try to rush hyperthyroid patients into permanently disabling the thyroid with a radioactive treatment that will make them hypothyroid for life. Even then, many doctors believe there is only one medication to treat hypothyroidism -- a medication that does not resolve symptoms for all patients. When patients learn about other available options, doctors may stonewall, refuse additional treatments, or push antidepressants, cholesterol medications, weight loss pills and more, instead of addressing the thyroid issues.

In the end, the conventional medical establishment believes that treatment for thyroid problems is, for the most part, one-size-fits-all. This cavalier attitude means that many thyroid patients struggle for years to live and feel well, despite being diagnosed and "treated."

Not every job can accommodate it, but when you are in a position to do so, some of the things you can do to help the thyroid patient in your workplace include:

  • Allowing for part-time or full-time telework or telecommuting / work-from-home
  • More flexible working hours in general
  • Half-day Fridays
  • Access to workout facilities onsite
  • A nap room
  • On-site daycare
  • Healthier foods in the workplace (cafeteria, vending, healthy catered lunches, healthy snack cart, etc.)
  • More comprehensive health coverage (especially plans that cover some or all holistic and complementary medical care)
  • Flexible spending accounts / medical savings accounts - so patients can use money on supplements, vitamins, and holistic health services

In a world where thyroid patients are disregarded, overlooked, misdiagnosed, abused, exploited, mocked, and ignored -- it's important to be a colleague who truly "gets it" for the thyroid patients in your workplace. As a colleague, you can be the person who understands that while thyroid disease may not be visible, it is causing your colleague(s) to suffer.

You can be the person who understands that even though celebrities aren't constantly talking about thyroid disease, and sports figures aren't wearing bracelets to promote thyroid awareness, that this is a genuine, difficult, and life-changing diagnosis. You can be the colleague who listens and learns about the struggles and challenges. You can be the colleague who empowers the thyroid patients in your workplace.

Live well,

Mary Shomon
Thyroid Patient Advocate

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