Thyroid Articles

Cheat Sheet / Updated 04-26-2022

Thyroid problems affect around 30 million people in the United States, says the American Association of Clinical Endocrinologists. If you suffer from a thyroid condition, this Cheat Sheet is here to help you to recognize and manage your symptoms, and avoid the triggers that can cause a flare-up of thyroid problems.

Article / Updated 03-26-2016

More than one-quarter of the world's population suffers from some level of iodine deficiency disease. That works out to 1.6 billion people. Of these, 655 million have a goiter, an enlargement of the thyroid that can sometimes be debilitating. Twenty-six million of them have brain damage, and 6 million of those 26 million suffer from cretinism; they are so handicapped by their thyroid conditions that they are completely dependent upon those around them to live. Some researchers believe that for each day we delay treating this vast problem, 50,000 infants are born with decreased mental capacity caused by an iodine deficiency. The reason so many people suffer is that the food they eat or the ground from which that food comes contains little or no iodine. All soil on earth used to contain iodine. However, over hundreds of thousands of years, the iodine has been leached out of the soil in two major areas of the earth: the high mountains and the plains, far from oceans, that were covered by water in the past. The high mountains were once covered with glaciers. As the glaciers melted, they carried iodine out of the soil, back to the ocean. In the same way, the flooded plains leached iodine from the soil and carried it back to the ocean as the water flowed away. As a result, high mountains and plains far from oceans are the areas where iodine deficiency disease is most often found. Crops that grow in such soil are iodine deficient. Animals that feed on these crops become iodine deficient. If the animal happens to be a cow that provides milk, children who drink that milk may be iodine deficient. The meat from that cow is also iodine deficient. The result is a huge public health problem. Even pets such as dogs become iodine deficient. Focusing on the vastness of the problem If you looked at a map of the world that shows the areas where iodine deficiency disease is most prevalent, you'd see that vast areas of China, Russia, Mexico, South America, and Africa are rife with the disease. Surprisingly, the United States is not spared. At one time, the iodization of salt and the addition of iodine to bread seemed to solve the problem in the U.S. More recently, as shown in a study in the Journal of Clinical Endocrinology and Metabolism in October 1998, Americans have decreased their iodine intake. Nearly 12 percent of those studied had insufficient iodine in their urine. (The urine test is a reliable measurement of daily iodine intake.) This number compares with only 3 percent with insufficient iodine intake 20 years earlier. Western Europe, also, used to be virtually free from iodine deficiency, but recent studies among Europeans have shown decreases in iodine intake as well. Paying the price at every life stage If your body lacks iodine, it can't produce sufficient thyroid hormone. This deficiency has severe consequences at every stage of life. Pregnancy Even before pregnancy, a lack of T4 hormone has a harmful effect. Women who are hypothyroid have greater difficulties becoming pregnant, and they have more miscarriages and stillbirths than women with normal thyroid function. A fetus doesn't begin to make thyroid hormone until the 24th week of pregnancy. Until then, it's dependent upon the mother's T4. During this time, the fetal brain is developing, and the entire chain of events that produces a normal brain requires T4 at every stage. If this hormone is lacking, the consequences are severe. If a fetus is deficient in T4 hormone, its brain triggers an increase in the amount of the enzyme that converts T4 to T3 within the brain. This form of the enzyme is not found in other tissues, so the brain may be protected from hypothyroidism while the rest of the body is not. The entire body's formation is dependent upon adequate T4. If sufficient hormone is not available, congenital anomalies may occur. The infant may not survive much past birth. If it does, it may not live more than a few years. In this nuclear age, it's important to realize that a thyroid gland that is not making enough thyroid hormone will take up large amounts of iodine from whatever source it can. In the case of a nuclear accident where radioactive iodine is released, a hypothyroid mother will concentrate the iodine and pass it on to her growing fetus. If radioactive iodine does not destroy the fetal thyroid, that thyroid will at least be very prone to develop thyroid cancer. Infancy A new baby deprived of iodine will have a goiter and show signs of hypothyroidism. Depending upon the severity of the lack, the baby may have cretinism. The brain of a newborn continues to develop up to age 2, so providing iodine starting immediately after birth may prevent retardation. A baby lacking in iodine also shows increased susceptibility to radioactive iodine (or any iodine). Childhood Iodine-deficient children often have goiters. They show reduced intelligence and poor motor function, and they may be deaf. Like infants, these children have a tendency to accumulate iodine from any source and are at greater risk in the case of a nuclear accident. Adulthood After the iodine-deficient child has grown up, a goiter is often present in an iodine-deficient adult, though not always. He or she is intellectually retarded and may have movement difficulties. This person's thyroid gland is highly susceptible to radioactivity. As you can see, the costs of iodine deficiency disorder are enormous both for the individual and for society. A village filled with people who suffer from widespread iodine deficiency would not be able to govern itself or provide an economic base to help better the condition of the people, or to take the steps necessary to overcome the problem.

Article / Updated 03-26-2016

The two most common causes of hypothyroidism are iodine deficiency and chronic thyroiditis. Iodine deficiency is rare in the United States and Europe but very common throughout the rest of the world. Chronic thyroiditis is an inherited condition that is diagnosed by checking the levels of thyroid autoantibodies in the blood. In addition to these two causes, there are many other reasons that people become hypothyroid. The causes detailed in this article should be ruled out before your doctor starts treating your condition with thyroid hormone replacement. Removal of the thyroid If your thyroid has been removed because of cancer or an infection, or in the course of treatment for hyperthyroidism, you will usually become hypothyroid. Only if some tissue is left behind will the thyroid possibly continue to function. Absence of brain hormones Anything that destroys the hypothalamus (the part of the brain that secretes thyrotrophin-releasing hormone) or the pituitary gland at the base of the brain (which secretes thyroid-stimulating hormone, or TSH) will produce central hypothyroidism — hypothyroidism originating in the control center of the body, the brain. A trauma, infection, or infiltration (a replacement of brain tissue with other tissue, which can occur when a patient has cancer) could cause this type of destruction. The same result can occur if the pituitary is involved with a destructive lesion that prevents the production and release of TSH, such as radiation treatment to the area of the pituitary gland. If hypothyroidism is caused by a problem with the hypothalamus or pituitary, some of the signs and symptoms associated with chronic (autoimmune) thyroiditis will not be found. In particular, hoarseness and a thickened tongue occur in autoimmune hypothyroidism but not in hypothyroidism associated with a lack of brain hormones. In addition, the thyroid is not usually enlarged in this instance, because TSH is not stimulating it. Also, the patient's hair and the skin are not coarse in this situation (but they are if the patient has autoimmune hypothyroidism). Symptoms that result from a lack of other pituitary hormones also help to differentiate central hypothyroidism from failure of the thyroid gland. These include fine wrinkling of the skin of the face and a more pronounced loss of underarm, pubic, and facial hair. Foods that cause hypothyroidism Many common foods can cause hypothyroidism if you eat them in sufficient quantities, especially if you have an iodine deficiency. These foods are called goitrogens because they can trigger the enlargement of the thyroid (a goiter) as well as hypothyroidism. They block the conversion of T4 hormone to T3, the active form of thyroid hormone. Among the more common foods that cause this condition are Almond seeds Brussels sprouts Cabbage Cauliflower Corn Kale Turnips If consuming these foods causes your condition, simply removing them from your diet will cure your hypothyroidism. It takes between three and six weeks for your thyroid to return to normal after you stop eating these foods. Drugs that cause hypothyroidism Many different medications cause hypothyroidism in the same way as the goitrogens listed in the previous section: They block the conversion of T4 to T3. The drugs you are most likely to run into include Adrenal steroids like prednisone and hydrocortisone, which treat inflammation Amiodarone, a heart drug Antithyroid drugs like propylthiouricil and methimazole Lithium, for psychiatric treatment Propranolol, a beta blocker Coexisting autoimmune diseases Occasionally, a patient with autoimmune thyroid disease has other autoimmune diseases, many of which involve other glands of the body. For example, diabetes mellitus type 1 sometimes occurs together with autoimmune thyroid disease. The cause is the autoimmune destruction of the insulin-producing cells of the pancreas. Another example is Addison's disease, the autoimmune destruction of the adrenal gland. Addison's disease is associated with severe fatigue and low blood pressure and is especially important to identify, because giving thyroid hormone without adrenal hormone to such a patient could be dangerous. Autoimmune destruction of the ovaries in women or the testicles in men may also occur when a patient has autoimmune thyroiditis. The result for women is failure to menstruate, and for men it is infertility and impotency. Another gland that may be affected by autoimmune disease is the parathyroid (which actually consists of four parathyroid glands) sitting behind the thyroid in the neck. Loss of parathyroid function results in low blood calcium and the possibility of severe muscle spasms and psychological changes. Some autoimmune diseases that affect the joints of the body are found together with autoimmune thyroiditis. Rheumatoid arthritis is the most common example, but other diseases with names like Sjogren's syndrome and systemic lupus erythematosis are also diagnosed. Be aware of a blood disease called pernicious anemia, an autoimmune disease that accompanies autoimmune thyroiditis on occasion. In this condition, cells of the stomach that produce acid are destroyed by autoimmunity. The patient is unable to absorb vitamin B12 and develops an anemia along with symptoms in the nervous system. On occasion, when these diseases occur together, treatment of one of them treats the other at the same time. For example, treating the hypothyroidism with thyroid hormone may greatly improve the diabetes.

Article / Updated 03-26-2016

Thanks to the Internet, you have access to incredible amounts of information about your thyroid. Unfortunately, much (perhaps most) of it is not accurate. Much of what you read online is based on the experiences and opinions of one or a few people who took this or that medicine or herb and got better in two weeks. Maintaining a healthy degree of skepticism is important. Here are a few misconceptions — and myth-busting facts — that may help you understand the real deal behind the little gland with the big reputation. I'm hypothyroid, so I can't lose weight If you have hypothyroidism, or if you've been treated for a thyroid condition and the cure resulted in your becoming hypothyroid, you may find that you have a hard time losing weight. The myth is that you can't lose weight if you have hypothyroidism, even when it's properly treated. The truth is that a large percentage of people who are being successfully treated for hypothyroidism weigh almost the same after being treated as they did before they developed the disease. Keep in mind that hypothyroidism is associated with fatigue. Many patients with hypothyroidism reduce their physical activity as a result. They may not restore their previous level of activity after the hypothyroidism is treated properly. The bottom line is that we all follow the principle of conservation of energy. If we take in too much energy compared to what we need, we gain weight. If we take in too little energy compared to what we need, we lose weight. Another truth is that our metabolic rate declines, as does our tendency to move around, as we age. Both changes tend to make weight loss more difficult, but it's still possible. I'm hyperthyroid, so I can't gain weight The myth that hyperthyroidism is always accompanied by weight loss is a source of confusion in making an accurate diagnosis. Although the majority of patients do lose weight when they become hyperthyroid, some patients actually gain weight — the elderly, in particular. Weight loss, as well as other symptoms of hyperthyroidism, may not always be present, especially in the elderly population. The best solution is to get thyroid blood tests every five years, beginning at age 35. I have to take thyroid medication for life Many patients are told that once they are on thyroid hormone replacement, they'll be taking it for life. For many people, this is true. Any treatment that removes or destroys much of the thyroid (such as surgery or radioactive iodine) will require treatment with thyroxine (T4 hormone) for life. However, in certain situations, hypothyroidism is temporary; you may need thyroxine for a time, but you will later stop taking it. Sometimes it may be obvious that you no longer need the medication, but other times you and your doctor may need to attempt a trial period off thyroid for 4 to 6 weeks to see if you still need it. The following are some of the conditions that require thyroid hormone replacement for a limited amount of time. Subacute thyroiditis causes the temporary breakdown of thyroid cells and the release of thyroxine from the thyroid. As this condition improves, thyroxine begins to be made and stored again, and oral thyroxine is no longer necessary. Silent and postpartum thyroiditis also cause temporary loss of thyroxine, which is restored with time. Acute thyroiditis occasionally requires temporary treatment with thyroid hormone. Depending on your diagnosis, you may be able to stop thyroid hormone treatment at some point. It's well worth checking, particularly if you are young (under 40). Thyroid disease is catching It's not hard to understand why this myth became so entrenched in the minds of the public. Most thyroid disease is inherited; so the likelihood of finding the same disease in two sisters or a mother and her daughter is relatively high, suggesting that their physical closeness to one another causes them to have the same disease. Furthermore, in areas where people don't consume enough iodine, practically everyone has thyroid disease — again suggesting that it may develop. Another situation that seems to suggest that thyroid disease is catching is the occurrence of thyroid disease after large-scale radiation exposure. Just about everyone comes down with some illness in that situation. Children, especially, often develop goiters, nodules, and thyroid cancers. An understanding of the way these diseases develop quickly clarifies the situation: The hereditary thyroid diseases affect the females of a family, usually sparing the males. After iodine is supplied, the incidence of thyroid disease rapidly declines in iodine-deficient areas. Children who take iodine pills or avoid exposure to radioactive iodine generally will not get thyroid diseases, while those who do not, will. You cannot catch thyroid disease, nor can you give it to someone else in the way that germs are passed from person to person. Iodine deficiency is a medical problem Because iodine deficiency causes hypothyroidism, goiter, and cretinism (when severe), you would think that it's a clear-cut disease that should respond to medical treatment with iodine. If this were so, the disease would have disappeared years ago. As with any major medical problem (like AIDS, breast cancer, and prostate cancer), iodine deficiency is a social, economic, and political problem as much as, or more than, it is a medical problem. To begin with, an understanding about the cause of hypothyroidism in iodine-deficient areas is often lacking. The people are poor, work very hard, and have little time for the intricacies of the cause of disease. Their poverty means that they cannot afford to pay for nurses to give them medication or inject them with iodized oil. They do not understand that certain foods, like cassava, worsen the problem, so they continue to consume large quantities of them. Sometimes, attempts to solve the problem run up against the realities of salt production. This has been the case in Indonesia, for example, where salt is made by numerous salt farmers rather than a centralized salt production facility (as is done in China). It was easier and more productive to alter the salt production to make enough iodized salt in China than it was in Indonesia. The instability of poor governments also plays a role. When the problem of iodine deficiency was recognized in Communist East Germany, iodine was provided and the disease was brought under fairly good control. After the reunification of East and West Germany, the combined government neglected the problem, and iodine deficiency began to reappear. The solution to a clearly medical problem like iodine deficiency may have to involve social, cultural, and economic changes that populations often resist, making a cure exceedingly difficult.

Article / Updated 03-26-2016

Severe hyperthyroid eye disease, though rare, can lead to blindness. Just exactly why hyperthyroid eye disease occurs isn't clear, but researchers generally believe that it has a basis as an autoimmune disorder. One suggestion is that thyroglobulin enters the muscles of the eyes, and antibodies react against it. A study from Italy in the journal Thyroid in 2001 showed that thyroglobulin can, indeed, be found in the muscle tissue of the eyes. The study demonstrated that the thyroglobulin originated in the thyroid gland, which confirms that the autoimmune reaction in the thyroid is very similar to the autoimmune reaction in the eyes. The findings of the study help bolster the argument in favor of using anti-immunity therapy for hyperthyroid eye disease. Hyperthyroid eye disease has a very negative impact on quality of life, even when it's moderate, which is usually the case. Severe eye disease occurs less than 5 percent of the time, but treatment works in only two-thirds of patients. The eye disease goes through three phases: First phase: High activity with redness of the eye, pain, tearing, and sensitivity to light. Second phase: Stabilization of the signs and symptoms. Final phase: Improvement of the eye disease, which becomes inactive. The duration of these phases varies, but the eye disease burns out within a couple of years. Steroids are helpful during the first active phase. Steroids given intravenously are more effective than steroids by mouth for thyroid eye disease. Steroids can be injected right into the muscles around the eye and are effective there. Doctors give IV steroids in very high amounts, which can cause liver damage. IV steroids are effective about 90 percent of the time, while liver damage occurs only 1 percent of the time. If steroids aren't successful, then doctors perform orbital radiation therapy. This therapy is successful about 60 percent of the time. Using both steroids and orbital radiation at the same time is even better than either alone. Recent studies of other therapies, including drugs called somatostatin analogs and antioxidants, haven't shown that these therapies are effective. Antioxidants may be useful for mild eye disease but not moderate or severe forms. Three factors are definitely important in the progression of hyperthyroid eye disease, and should be managed as strongly as possible: Cigarette smoking: Cigarette smoking not only promotes the development of eye disease but blocks the effectiveness of steroid and orbital–radiation therapy treatments. Quitting smoking is probably the most important preventive measure in this disease. Active thyroid dysfunction: Active thyroid dysfunction, whether hyperthyroidism or hypothyroidism, promotes the progression of eye disease. Both conditions need to be corrected as soon as possible. Radiation therapy: This hyperthyroidism treatment causes progression of the eye disease as well. A course of steroids can prevent this progression.

Article / Updated 03-26-2016

Hyperthyroidism, whether caused by Graves' disease or another condition, produces consistent signs and symptoms that affect every part of your body. The major abnormalities are described in the following sections, grouped according to the organ system of the body that is affected. The body generally Hyperthyroidism can cause your body temperature to be persistently high. You may lose weight despite an increased appetite. The weight loss is due to the loss of lean body tissue like muscle, not due to a loss of fat. In rare cases, a patient gains weight because she is eating so many calories. Hyperthyroidism can cause you to feel weak. You may feel lymph glands all over your body, because Graves' disease is an autoimmune disease and the lymph system is a key player in autoimmunity. Your tonsils, which are part of the lymph system, are also enlarged. There are other possible reasons for the enlargement of lymph glands that are more serious than Graves' disease, so if you experience this, see your doctor. The thyroid When Graves' disease is the cause of hyperthyroidism, your thyroid is enlarged in a symmetrical way and the entire gland is firm. When a single overactive nodule (a bump on your thyroid) is to blame for hyperthyroidism, that nodule is large, but it often causes the rest of the gland to shrink. When a multinodular goiter is responsible, you can feel many lumps and bumps on your thyroid. If you put your hand over an enlarged thyroid, you can often feel a buzz that is called a thrill and results from the great increase in blood flow in the overactive thyroid. You can hear the thrill with a stethoscope; the sound is called a bruit. The skin and hair Hyperthyroidism can cause your hands to feel warm and moist, and they may appear red. You may experience a loss of skin pigmentation (a condition called vitiligo) in places, which is another sign of autoimmunity. Other areas of your skin may appear darker. Your hair may be fine, straight, and unable to hold a curl. The heart Hyperthyroidism can cause a rapid pulse, which you feel as heart palpitations. The first sign of Graves' disease is sometimes atrial fibrillation, an irregular heart rhythm. If a patient is older and already has heart disease, hyperthyroidism can induce heart failure, or heart pain (angina) may appear or be made worse because the heart beats too rapidly. You may experience shortness of breath. The nervous system and muscles If you have hyperthyroidism, your fingers have a fine tremor when you hold your hands out. The loss of muscle tissue leads to weakness. Your reflexes are increased; some patients can't sit still. Basically, if you are hyperthyroid, most likely you're nervous, you don't sleep as much as you used to, and you have rapidly changing emotions, from exhilaration to depression. The reproductive system Hyperthyroidism can cause a decrease in fertility because it interferes with ovulation. Menstrual flow is decreased as well and may cease. The stomach and intestines If you are hyperthyroid, food moves more quickly through your intestines than it used to, and you have more frequent bowel movements or even diarrhea. You may experience nausea and vomiting. The urinary system As more blood flows, your kidneys filter more, and more urine is produced so you go to the bathroom more frequently. In turn, you feel more thirsty than usual. The eyes Any form of hyperthyroidism results in reversible changes to the eyes. Your upper eyelids may be pulled up higher so more of the white above the pupil is seen, which makes it appear as if you're staring and pop-eyed. When you are asked to look down, your upper eyelid may not follow your eye, which exposes even more white. This is called lid lag. Graves' disease can cause more serious eye problems.

Article / Updated 03-26-2016

You can take action to improve your thyroid health. If you're concerned that you have — or may have — a problem with your thyroid, you should bear in mind the following advice: If thyroid disease runs in your family, ask your doctor about screening for thyroid diseases at appropriate intervals. If you have a thyroid problem, check your thyroid function during times of major body changes, such as pregnancy. Make sure you get enough iodine in your diet, especially if you're vegetarian. If you've taken thyroid hormone replacement for several years to treat hypothyroidism (low thyroid function), ask your doctor if you can try stopping treatment to see if your thyroid can function without it. If you still experience symptoms of hypothyroidism while taking hormone replacement pills, ask your doctor if you can try taking both types of thyroid hormone (T4 and T3), although this is controversial. Remember that some medications can interact with thyroid hormones. Protect your thyroid from radiation. If your neck has had exposure to radiation in the past, ensure your doctor knows that.

Article / Updated 03-26-2016

Certain drugs can interact with your thyroid hormone to negatively affect your thyroid function. These are just a few commonly used medications that can affect your thyroid: Amiodarone Aspirin (more than 3,000 milligrams daily) Estrogen (for example, in hormone replacement therapy, or in the oral contraceptive pill) Iron tablets Iodine Lithium Propranolol Corticosteroids

Article / Updated 03-26-2016

Someone with hypothyroidism — an underactive thyroid gland — often experiences some of the following signs and symptoms. Keep in mind that these symptoms alone can't diagnose thyroid disease, and thyroid disease is sometimes present even if you don't experience all the symptoms: Slow pulse Enlarged thyroid (unless removed during previous thyroid treatment) Dry, cool skin that is puffy, pale, and yellowish Brittle nails and dry, brittle hair that falls out excessively Swelling, especially of the legs Hoarseness, slow speech, and a thickened tongue Slow reflexes Intolerance to cold Tiredness and a need to sleep excessively Constipation Increased menstrual flow

Article / Updated 03-26-2016

Someone with hyperthyroidism — an over-active thyroid gland — may experience some or all of the following symptoms. The same caution about symptoms of hypothyroidism applies here; these symptoms alone don't confirm a diagnosis. Only blood tests can do this. Higher body temperature and intolerance to heat Weight loss Weakness Enlarged thyroid Warm, moist skin Rapid pulse Tremor of the fingers and tongue Nervousness Difficulty sleeping Rapid mood changes Decreased menstrual flow More frequent bowel movements Changes to the eyes that make it appear as if you're staring