It is 11 in the morning and it finds you in a busy matatu stage where rowdy conductors are calling out for passengers.
Your baby is safely swaddled on your back. Amid all the chaos, you finally get a matatu. But, as you raise your foot to board the vehicle, you feel drained of your strength, your feet collapse and you and your baby find yourself under the bus. Seconds later, the bus starts moving.
Your life flashes before your eyes. You are scared. Just as the matatu is about to run you over, it screeches to a halt. The screams from the onlookers have given you a second chance to live.
This is the story of Sarah Katulle, a 41-year-old mother, who until the bus episode, did not know she had thyroid disease.
On that day, she was on her way to a gynaecologist for a postnatal check-up. It had been a month since she delivered her baby girl.
After the near-death experience, she proceeded to her gynaecologist, whom she told about her symptoms. “I got tired quickly, had a fast heartbeat and I lost so much weight. I could not even climb the staircase with ease,” she tells HealthyNation .
At this stage, she had not seen a specialist for the thyroid disease yet. When her physician noticed her protruding left eye and a swelling on the neck, she suspected Sarah had thyroid disease. She was then asked to take the thyroid hormone test, one which turned out positive.
It was then that she was referred to Dr Bernard Gituma, a physician specialising in endocrinology.
Sarah was diagnosed with hyperthyroidism, one of the most prevalent types of the thyroid disease which manifests when the thyroid glands produces excessive hormones.
The other type, hypothyroidism, is not as common.
In hindsight, she thinks she started experiencing the symptoms of thyroid disease in 2011.
But, it was not until two years ago that she found a specialist. “I started seeing him in 2018, and it took about four months to stabilise my hormones. The swelling on my neck then shrank,” she says. “After a few other tests, the doctor advised that I needed to have a surgery to have part of my thyroid glands removed.”
Had she removed her thyroid glands as a whole, she would have been on a thyroid hormone pill ingestion for the rest of her life.
This diagnosis made her realise a gap in the sensitisation and awareness of the disease. It is then that she founded a page on Facebook - Thyroid Diseases Awareness Kenya Foundation, so as to reach many people.
Supposing Sarah stayed longer without getting a proper diagnosis, she may have had a thyroid storm if the disease had not been detected in time.
A thyroid storm occurs when there is an excessive release of the thyroid hormones, which could lead to cardiovascular complications.
“It is like the waves of the ocean when there is a storm, which is usually chaotic, a patient may be confused, and they may not able to give you their history and the symptoms (confusion, palpitations, dehydration, excessive sweat, extreme high blood pressure, and water in the brain) manifesting at the same time,” he says.
Since the presentation of the disease is varied and could be assumed to be something else, it needs expertise for diagnosis.
The symptoms of the hyperthyroidism include excessive metabolism rate, nervousness, anxiety, loss of weight despite eating a lot, poor sleep patterns, lacking concentration, palpitations of the heart, exophthalmos (bulging eyes), which is caused by the inflammation of the structures below the eye, tremor of the body, and for the women, periods may disappear.
Its converse, hypothyroidism, presents itself through fatigue, effortless weight gain, symptoms of depression, coarse hair and skin, rough face, swelling of the legs and low heart rate. “Primary care doctors ought to be sensitised about thyroid disease to avoid misdiagnosis,” advises Dr Gituma.
Thyroid tests are very sensitive and are produced in very minor quantities in the body (in nanograms), which may not be screened in most of the public hospitals.
The main cause of hyperthyroidism, which Dr Gituma says accounts for about 80 per cent, is the Graves’ disease - an autoimmune disorder that occurs when the immune system attacks the thyroid cells resulting in over-production of the thyroid gland and it has gained a form of autonomy.
“In the endocrine system there is something like a messenger sent to the glands to produce hormones. In autoimmune diseases, the messages are overruled and the feedback is lost, therefore, losing the negative feedback, which asks the gland to stop producing the hormone,” says Dr Gituma.
Hypothyroidism is mainly caused by thyroiditis. “In thyroiditis, the body attacks the thyroid gland and instead of producing the thyroid hormone, the cells that produce the hormones are damaged,” says Dr Gituma.
Other causes could be iodine deficiency, and damage of the gland from medical interventions such as total thyroidectomy (removal of the thyroid glands).
The risk of misdiagnosis is likely to occur since the symptoms of the disease are not specific to thyroid disease, and could be assumed to be other diseases such as pneumonia or hypertension.
“Health workers need to be trained on this disease,” insists Dr Gituma. “If misdiagnosis and wrong treatment persist, the biological effect of the primary problem (thyroid in this case) will exert pressure and is likely to eventually cause the thyroid storm.”
The good news is that, if detected early, treatment for thyroid related disease is 90 per cent successful. In as much as Sarah presented quite late, her condition was managed through surgery and follow-up medication.
The treatment of hyperthyroidism disease varies and should be adjusted every four weeks, and that could take about three of four months to adjust the level of the thyroid hormone, says the specialist.
Hypothyroidism, on the other hand, is treated by giving the patient medicine meant to replace the hormone and is re-accessed after a month to check if the level is okay. “It is easier to treat hypothyroidism than hyperthyroidism,” he says.
Notably, Dr Gituma says not everyone with a neck swelling has the disease and that a clinician has to test before giving any form of treatment related to thyroid disease.
The entire thyroid hormone test costs about Sh4,000 to Sh7,000 and can only be easily interpreted by a specialist.
