If there were a competition for the gland with the most significant impact on the singing voice (although I frankly cannot imagine who in his right mind would sponsor such a silly contest), the thyroid would most likely win hands down. Since the thyroid gland is so important to singers, a too-short (and vocally-slanted) discussion of thyroid disorders is the subject of this column.
The thyroid is one of endocrine glands of the body, glands that secrete their hormones directly into the blood stream. Exocrine glands secrete their products, such as tears, skin oils and mucus, outward, onto the inner and outer surfaces of the body. The thyroid consists of two ovoid lobes that are connected by a short bridging center portion called the “isthmus.” The gland is curved around the front part of the upper trachea like a shield. (In Greek, thyreos means shield-like.)
A list of all of the effects brought about by thyroid hormones would be very long—the thyroid affects almost every part and tissue of the body. Most importantly, the thyroid sets the metabolic thermostat of the body. If the thyroid is over-active, your body is in overdrive: your heart beats rapidly, and you are constantly hungry but cannot gain weight, sweating and always feeling too warm, and prone to emotional excess. Conversely, the under-active thyroid leads to chronic fatigue, sluggishness, constipation, and a constant sense of feeling too cold. (Sounds like half the people you know?) These are the stereotypical clinical presentations of hyper-thyroidism and hypo-thyroidism. But the real story is much more subtle.
The real story is one that singers must know, since they are, as a group, particularly prone to thyroid disease and affected by its more subtle manifestations. Why are female singers “at risk”? Because thyroid disease, be it over-activity, under-activity or tumors, is almost exclusively a condition of women. And as women grow older, the incidence of thyroid disease (usually under-activity) increases. There are forms of thyroid disease that affect both sexes equally, such as goiter, which may result from inadequate iodine intake but with the wide availability of seafood and iodized salt, it is rare. Still, thyroid disease in men is relatively uncommon.
Occasionally, a mass grows within the thyroid. These nodules (or tumors) are most often—although not always—benign. Their true nature can usually be diagnosed by a painless fine-needle biopsy performed in the doctor’s office. It is for masses like these that the doctor feels for when he examines your neck. At other times, the entire thyroid, or a part of it, may be diffusely enlarged. This condition is usually associated with hypo-thyroidism, rather than a tumor.
Acute inflammation of the thyroid, more common in women, presents with pain, discomfort on swallowing, and tenderness over the mid-portion of the neck. Although the treatment is usually simple, acute thyroiditis can damage the gland and leave it under-active.
By far the commonest thyroid problem we see in singers, however, is a painless, inconspicuous low-grade hypo-thyroidism. The onset of the condition is insidious, its effects subtle. Usually there is nothing to feel in the neck and the diagnosis is made on clinical suspicion. Even a mildly under-active thyroid can affect the voice. A singer may complain that the voice feels heavy, unresponsive, and has lost its color. There may some loss of range (particularly the top) and loss of resonance. This is due to the fact that in hypo-thyroidism there is retention of fluid in the soft tissues (called, in its more obvious stages, myxedema). The vocal folds become swollen and sluggish. The voice that is generated by the larynx will then encounter pharyngeal walls, palate and tongue, which are also edematous, heavy, and acoustically altered. Hypo-thyroidism can also affect muscular function, and thus impair the fine motor control a singer needs.
The causes for hypo-thyroidism (indeed, for all thyroid disease) may be multiple and are not always known. There is definitely a familial tendency for some forms of thyroid disease: if your mother had thyroid problems, you need to be on the lookout. There is one form of hypo-thyroidism which is associated with autoimmune diseases, or those that develop when the body mistakenly damages its own components. This condition is called Hashimoto’s thyroiditis (also known, depending on your cultural ancestry, as Graves’ disease or Basedow’s disease). It is particularly prevalent in middle aged women. It may be associated with decreased saliva and mucus (another bane of the singer’s life), dry eyes, and occasionally arthritis. Other, non-vocal manifestations of hypo-thyroidism may also occur, including dry skin, thick dry hair, loss of hair or menstrual problems.
When the diagnosis of hypo-thyroidism is obvious, it is…well, obvious. But early hypo-thyroidism is anything but obvious. It can be heralded over months by a gradual deterioration in vocal quality, fatigue and other nondescript symptoms. As a (female) singer, you need to be aware of this condition, since your physician, trained to look for the more classic manifestations of thyroid disease, and you may not hear these subtle changes. Once the suspicion arises, a simple set of blood tests may uncover the problem and put you on the therapeutic road to thyroid (and vocal) health.
DISCLAIMER: The suggestions given by Dr. Jahn in these columns are for general information only, and not to be construed as specific medical advice or advocating specific treatment, which should be obtained only following a visit and consultation with your own physician.
