How the Thyroid Gland Mystifies Doctors and Patients

By Oona Tempest and Andy Miller November 27, 2023

About 25 years ago, Andy Miller learned he had hypothyroidism, a condition that afflicts millions of other Americans. Curious about how this condition was affecting others, the KFF Health News journalist interviewed endocrinologists who treat hypothyroidism and several patients who live with it. Their stories revealed how mystifying thyroid and autoimmune conditions can be.

The first page of an eight-page comic about hypothyroidism. At the top of the page, a cartoon version of the reporter, Andy Miller, is introduced. He is the narrator for this series. The next panel reads “about 25 years ago, I was overcome by constant fatigue,” and shows him exhausted, lying in bed with the words “constant fatigue” weighing him down. The following panel reads, “even though I slept 10 to 12 hours a night, I would still wake up tired!” and shows him holding an alarm clock with spinning hands. The final and bottom panel reads, “my voice dropped to Darth Vader-like depths … and my kids were worried about me, which added to my alarm,” and shows, on the left, Miller as Darth Vader. On the right, his children look spooked as they observe and listen to their “dad.” — (Oona Tempest/KFF Health News)

This second page reads, “my doctor was initially stumped, too. Then a friend suggested it could be a…” at the top of the page, and leads into a large arc of text that says, “thyroid problem” above a drawing of Miller’s neck and head. The thyroid, a butterfly-shaped gland in the neck, is highlighted with radiating shades of pink and yellow. Beside Miller, text reads, “the thyroid gland releases hormones that regulate metabolism. When not enough thyroid hormone is produced, it causes hypothyroidism.” The final panel below shows a doctor saying, “Some typical symptoms are fatigue, weight gain, hair loss, and changes to menstrual cycle.” — (Oona Tempest/KFF Health News)

The next page opens with Miller holding a doctor’s prescription in one hand and a bottle of thyroid hormone medication in the other. The prescription reads, “after running a test, my doctor prescribed a thyroid hormone medication.” Below, Miller is drawn with raised arms and a smile; butterfly wings on his back lift him as he jumps for joy and says, “It was like a switch turned back on! The pill restored my energy! My voice returned to normal!” Beneath him reads, “and so… I joined millions of Americans taking daily medication to keep my body functioning well.” The text has a border of pills with butterfly wings. — (Oona Tempest/KFF Health News)

Page 4 begins with text that reads, “Levothyroxine, a synthetic thyroid hormone, is among the most prescribed drugs in the U.S.” Beneath the text is a dizzying pattern of pill bottles. On top of the bottles is an image of the United States, with text that reads “That’s about… 100 million prescriptions annually! But why??” The following text addresses the question with, “hypothyroidism is most commonly caused by an autoimmune condition in the U.S. It’s called Hashimoto’s disease.” An image of a wilted thyroid gland covered in butterflies is centered below. The final line of text reads, “this occurs when the immune system mistakenly attacks and damages healthy thyroid cells.” — (Oona Tempest/KFF Health News)

The top panel of this page shows Miller from the back as he looks at two other people he interviewed for this series: a doctor and a patient with hypothyroidism. The accompanying text reads, “I talked with doctors and patients and found out I was one of the lucky ones. While generic levothyroxine works for me, it doesn’t work for everyone.” In the bottom panel, another interviewee is introduced, named Beth VanOrden, a teacher. She is lying on a couch and says, “I would crash for 3 hours on the couch after school.” Below her, additional text says, “her condition brought years of frustration. It took an alternative drug regimen for positive results.” — (Oona Tempest/KFF Health News)

Page 6 continues to introduce people Miller spoke with. The first panel shows a rendering of Misty, of South Carolina, digging out from beneath a pile of medical bills as she reaches for a set of pill bottles. She says, “I have about $6,000 in unpaid hospital and medical bills over the past two years.” In the panel below, Jennifer Silvestri, of New York, is introduced. She’s pictured having blood drawn while saying, “managing pregnancy with hypothyroidism can be difficult. I hope to have a baby.” Additional text reads, “hypothyroidism decreases fertility, and there’s a higher risk of miscarriage. During pregnancy, medication often needs to be adjusted.” — (Oona Tempest/KFF Health News)

The next pages introduce the illustrator of the comic, Oona Tempest, as an interviewee with hypothyroidism. The intro text reads, “even our illustrator has faced challenges. Her symptoms began at 22, far below the average age of onset. Doctors didn’t initially pick up on the cause.” This is accompanied by a drawing of her sitting in a doctor’s office. The doctor beside her says, “Hmmm … you’re fine,” while scratching his chin. In reply, she says, “but I am soOoOo tired.” The following text reads, “by the time they did, her thyroid was beyond repair. So she, too, joined the millions taking thyroid meds for life.” The next panel shows a referee holding up the hand of a butterfly with boxing gloves, and says “And the winner is … Hypothyroidism caused by Hashimoto’s disease!!” while Oona’s shriveled-up thyroid slumps to the side, defeated. The next line of text reads, “but before the pill kicked in, extreme fatigue led to a fraught period of unemployment,” followed by a drawing of Oona, fallen to her hands and knees beside a pill bottle. — (Oona Tempest/KFF Health News)

The final page of the comic starts with a drawing of Miller, who says, “all these conversations pointed to a need for more research, education, and support related to these often-mystifying conditions. But despite these gaps, there’s more awareness of hypothyroidism and of autoimmune diseases in general … which is in part prompted by social media and the internet, where people are speaking up about their conditions.” A drawing of two figures jumping over steppingstones is in the center panel, while two women exchange a text of this comic at the bottom of the page. — (Oona Tempest/KFF Health News)

This illustrated report has been adapted from a KFF Health News article, “Many Autoimmune Disease Patients Struggle With Diagnosis, Costs, Inattentive Care” by Andy Miller.

Illustrations by Oona Tempest.

Creative direction and editing by Hannah Norman, with additional editing by Sabriya Rice.

Copy editing by Terry Byrne.

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.

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