When Your Coworker, Employee or Boss Has Thyroid Disease

An Open Letter to the Colleagues of Thyroid Patients

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

When you have a chronic disease, such as thyroid disease, it's hard to fully explain what you are coping with. This can be particularly challenging in the workplace, as you consider what to tell your coworker, your boss, or employee about your condition.

We have shared an open letter to the family and friends of thyroid patients in the past, but the information you share with your loved ones will differ from what you will want to share on the job.

You probably don't want to share any personal information which would make your colleagues become suspicious of your performance, but at the same time, saying nothing could also be an issue.

Helping your colleagues understand some of the symptoms you are living with, may prevent them from questioning and drawing their own inaccurate conclusions. For example, if you are sluggish in the morning due to hypothyroidism, you don't want your boss to wonder whether you have a late night drinking problem. Likewise, if you are shaky and jittery due to hyperthyroidism, it's better if your employees don't simply think you are totally stressed out (and overly caffeinated).

Let's look at what you may wish to include in your letter, broken down into subheadings for your convenience. Certainly, everyone's job situation and colleagues are different, so you will need to make changes that fit your own personal situation.

(Both men and women can develop thyroid disease, so any references to "his" or "her" could be either gender).

Letter to Colleagues Explaining Your Thyroid Disease

Dear Colleague: 

Someone you work with has thyroid disease. Most people have heard of thyroid disease to some extent, as it's very common. But what is less understood is that there are many different types of thyroid disease, and even with one condition, the symptoms may vary tremendously between different people.

You may associate the thyroid with symptoms of weight problems, or even think it's an excuse for people being overweight. Or, you may have someone among your family and friends who is taking thyroid medication (such as Synthroid) and seems to be doing fine, without any symptoms.

Too often, the public assumes that thyroid disease is similar for most people, but that's not true, and often frustrating for people living with the disease. There are many dimensions to the thyroid disease, and it's impossible in a letter to cover them all, but we will share a brief overview of what your colleague may be facing.

Function of the Thyroid Gland

The thyroid is our master gland of metabolism and energy. This gland is considered an "endocrine" gland, or a gland which secretes hormones that control bodily functions. 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. You can think about thyroid hormone as the gasoline that allows you to drive a car.

If there's no gas, there's no way to move forward.

Types of Thyroid Problems

Thyroid problems are generally broken down into either hyperthyroidism or hypothyroidism. Often the symptoms of these two conditions are the opposite, but that's not always the case. In addition, the symptoms of either condition, such as hyperthyroidism, can vary depending on the cause, severity, and many other factors.

Hyperthyroidism

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 having the gas pedal pushed to the floor and stuck, and the engine is flooding.

Hyperthyroidism can cause extreme anxiety, nervousness, rapid heart rate, high blood pressure, and even heart palpitations. A person with hyperthyroidism 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.

Your colleague's eyes may be affected by her thyroid. This may include visible bulging, while the person is coping with eyes that may be sore, gritty, and irritated. Her 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 in the throes of hyperthyroidism may 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—and look like—he is losing it, ready to fall apart at any moment.

Hypothyroidism

If your colleague is hypothyroid, he may be dealing with different challenges. Hypothyroidism means the thyroid gland 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 may be feeling sluggish and tired, or 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 with hypothyroidism, as are memory problems and being fuzzy-brained. People living with hypothyroidism call it "brain fog." Your colleague may also look different; some common thyroid signs include hair loss, including the loss of the outer half of the eyebrows, a puffy face, and swollen eyelids.  He may also gain weight. 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.

Thyroid Cancer

If your colleague has thyroid cancer she has 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 the "good cancer." But the reality is that no cancer is "good," and someone who has thyroid cancer has cancer, "the big C." In fact, studies show that people who are diagnosed with cancer go through similar emotions, whether it is an early, very curable cancer, or an advanced, untreatable cancer.

Someone with thyroid cancer may initially have few, if any, symptoms. Sometimes, however, a person may have symptoms of hypothyroidism, hyperthyroidism, or a combination of both.

Most people with thyroid cancer will require surgery to remove the thyroid, and this can be daunting. Not just that it is cancer, but the idea of a several-inch-long incision in the neck is frightening.

After surgery, many people with thyroid cancer will need to have follow-up radioactive iodine treatment to ensure that all cancerous tissue is gone. This period after surgery can also be very challenging. Doctors often wait several weeks after thyroid surgery to begin thyroid medication. During this time, people can be very uncomfortably hypothyroid.

If your colleague has had thyroid cancer, it's helpful to know what to expect after treatment. Someone who had had their thyroid removed will require lifelong medical treatment for the resultant hypothyroidism. Periodic follow-up exams will also be needed to monitor for a recurrence of the cancer. In particular, some of the scans that are done as a part of this monitoring, require a person to stay away from others for a period of time, due to the exposure to radioactivity. Sometimes sick leave will be necessary until hypothyroidism is treated to the point where it is possible for a person to drive and make wise decisions on the job.

Conditions That Affect People with Thyroid Disease

There are different conditions that can be at the root of thyroid disease.

There are autoimmune diseases, including Graves' disease and Hashimoto's disease, that can be at the root of hyperthyroidism or hypothyroidism. In these conditions, the body makes antibodies (such as we make against bacteria and viruses), but the antibodies are directed against a person's own thyroid tissue.

Other people may have a thyroid goiter (enlarged thyroid) or benign nodules which are causing symptoms.

Acute infectious thyroiditis is a temporary condition related to an infection, often with the bacterial species Staph and Strep.  Postpartum thyroiditis is a very common condition, usually found in the year following childbirth.

Many of these problems can be difficult to pinpoint, may be misdiagnosed as just about anything, and even when diagnosed, may not be properly treated.

Thyroid Disease Often Results in a Misdiagnosis

While simple blood tests can often help make the diagnosis of thyroid disease, it is not as "easy to diagnose" as some have suggested. Your colleague may have struggled for years to get diagnosed, or even to be 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 health care providers, such as one who told a marathon runner she was gaining weight because she had "fork in mouth disease." Many of the symptoms of thyroid disease are subtle or vague—at least early on—and many people complain of seeing too many providers before finding one who truly listened.

The Thyroid Disease Stigma

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 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."

It's heartbreaking to hear of the stigma many have faced with their thyroid issues. Which again, is why it's important to share this information.

Treatment of Thyroid Disease Can Be Challenging

Once a diagnosis is made, which again, can be challenging, the treatment is not usually an easy fix. The common thought in medicine that "thyroid disease is easy to diagnose and easy to treat" is a myth.

There are different medications for hypothyroidism, and the best medication for one person may not resolve the symptoms for another. And that's just among the most commonly prescribed medications. Some treatments, such as  Armour thyroid (natural desiccated thyroid), bring added confusion.

Often times, physicians will treat the symptoms of thyroid disease too quickly. This may include prescribing antidepressants, cholesterol medications, weight loss pills, and more, rather than waiting to see if the symptoms clear up with the replacement of the deficient thyroid hormone.

At the same time, our "instant fix" society sometimes rushes to treat the thyroid condition too aggressively, rather than giving it some time. For example, disabling the thyroid with radioactive iodine may be recommended for people with hyperthyroidism, when the condition would have resolved itself in time. This commits a person to permanently require thyroid replacement therapy.

In the end, the conventional medical establishment often uses a one-size-fits-all approach to treating people with thyroid disease. When the differences between people are not recognized and addressed, people may struggle for years to live and feel as good as they can.

Workplace Accommodations That May Help Those With Thyroid Disease

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 people with thyroid disease 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

A Call To Understand Invisible Disease

In a world where people with thyroid disease are sometimes disregarded, overlooked, misdiagnosed, mocked, and ignored, it's important to be a colleague who truly "gets it" for the people with thyroid disease 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 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 people with thyroid disease in your workplace.

Live well.

Bottom Line on Talking to Colleagues About Your Thyroid Disease

It can be challenging knowing what to say to your colleagues at work when you are coping with thyroid disease. For the most part, you don't want to share the details of your diagnosis and symptoms as you would with a family member or friend. Yet, if you don't say something, your colleagues may attribute any symptoms they observe to something else. Something such as being lazy or on drugs.

This sample letter gives a general overview of what you may wish to share, but you will need to make modifications, additions, or subtractions, based on both your own condition, and the impact you are intending to make with the letter.

Overall, the public is becoming more aware of the diversity of symptoms related to thyroid disease, and how treatment is not always so simple. 

Source:

Kasper, Dennis L.., Anthony S. Fauci, and Stephen L.. Hauser. Harrison's Principles of Internal Medicine. New York: Mc Graw Hill education, 2015. Print.