Due to the complex and varied nature of thyroid disease, this article
makes the assumption that the reader is seeking general information appropriate
to either young adults or adults rather than young children or infants.
The links at the end of the article lead to more complete, detailed information
if what you are seeking is beyond the scope of this article. There are
many, MANY causes and treatments, for example, that are not covered in
this basic overview.
WHAT IS THYROID DISEASE?
Thyroid disease begins when the thyroid gland (part of the body's endocrine
system) either produces too much ("hyperthyroid") thyroid
hormones or not enough ("hypothyroid") thyroid hormomes. There
are many reasons that either condition may develop, and it may affect
people of all ages. While women are more commonly affected than men,
thyroid disease CAN and DOES affect men as well. Unfortunately, if you
have a more rare form of thyroid disease, you may find it difficult
to convince a doctor to run a complete and thorough set of labs to get
it properly diagnosed. For some, proper diagnosis has taken decades,
and many changes of doctors.
Endocrine disorders in general are extremely
complex, so a problem in one area can affect MANY other, seemingly
unrelated, areas of the body. If you believe you have an endocrine disorder
such as thyroid disease, enlisting the help of an endocrinologist for
at least an evaluation appointment is essential - many other endocrine
problems can mimic or cause secondary hypo/hyper thyroidism, so all
other possible causes for the thyroid levels being "off" should
be explored. Pituitary or hypothalmus issues, can lead directly to one
or more seemingly thyroid-related problems - getting treatment for the
wrong problem (unnecessary surgery, radation, etc.) will only make it
worse in the long run.
Do remember that a lot of doctors tend to "see" a diagnosis
that is in their speciality - an oncologist sees cancer, a cardiologist
sees heart problems, and so on. If at all possible, you should ALWAYS
get at least a second opinion (if not a third, fourth, fifth and sixth...)
both from an endocrinologist who specializes in thyroid disease and/or
Type 1 Diabetes, AND an endocrinologist who specializes in other endocrine
disorders (and who may be more likely to catch non-thyroid causes of
thyroid-seeming problems such as issues with the pituitary and hypothalmus
NORMAL THYROID HORMONE PRODUCTION CHAIN
- Hypothalmus monitors the circulating levels of thyroid hormones
(T4 and T3).
- If levels of either one are low, hypothalmus responds with TRH -
Thyrotropin Releasing Hormone
- TRH stimulates the pituitary to produce TSH - Thyroid Stimulating
- TSH stimulates the thyroid gland to produce actual thyroid hormone
(T4) until levels return to normal.
- T4 is broken down into T3 and other derivatives for use by various
organs and muscles in the body.
- The presence of enough thyroid hormones (T4, T3) tells the hypothalmus
to stop producing TRH.
Problems can develop anywhere in this chain of production, and for
a variety of reasons. This is sometimes referred to as the "hypothalmus-pituitary-thyroid
axis" because of how inter-related the three glands are.
WHAT ARE THE SYMPTOMS OF THYROID DISEASE?
Hypothyroidism - Common symptoms demonstrate
a slow or sluggish metabolism, and may include a combination of any
or all of the following:
+ Coarseness of voice and impaired hearing
+ Cold intolerance, decreased sweating
+ Dry, coarse skin
+ Hair loss (may happen repeatedly with fluctuations of hormone levels)
+ Heart: Decreased pulse, heart enlargement, decreased output
+ Impaired memory and cognition, poor concentration
+ Increased total cholesterol and LDL
+ Muscle cramps and pain
+ Nerve-based pain
+ Possible insulin resistance
+ Side effects increase (either many, or severity) from medications
due to slow digestion
+ Slow digestion
+ Sweating - Less - or complete lack of - sweating, while still getting
+ Swelling of the face and extremities
+ Weight gain (with reduced appetite)
+ Weakness, fatigue, lethargy, and somnolence
+ Women: Menstrual irregularities
+ Note: Hair growth may completely
STOP with really severe cases of hypothyroid.
Hyperthyroidism - Common symptoms demonstrate
an overworked or over-stressed metabolism and may include a combination
of any or all of the following:
+ Confusion/memory lapses/diminished attention span
+ Fear and depression
+ Hair loss (may happen repeatedly with fluctuations of hormone levels)
+ Heart: Rapid heart rate, palpitations
+ Heat intolerance
+ Increased sweating
+ Itchy skin
+ Muscle weakness
+ Nervousness and tremor, frequent emotional changes
+ Weight loss (with increased appetite)
HOW IS IT DIAGNOSED?
Many doctors will test either a T4 and/or a TSH by themselves, since
they've been taught that any other thyroid test is irrelevant. While
this will catch most of the common thyroid problems, it will miss some
of the more subtle or uncommon ones until the patient is in very ill
health. I've seen anecdotes from people who've gone over a decade before
getting a proper diagnosis because of this problem.
More Complete Method:
A more complete thyroid panel should have all of the following items,
and be tested on the same day:
Thyrotropin Releasing Hormone (Is the body calling for it?)
Thyroid Stimulating Hormone (Generated by the pituitary and it tells
the body to make more thyroid hormone.) This is generally high in
cases of hypothyroid (because the body needs to make more), and low
in cases of hyperthyroid (because the body needs to make less.) This
has a slower adjustment period (a few weeks to go up or down by significant
amounts.) About the only time it won't rise is if the Free T4 is extremely
high, the Reverse T3 is extremely high, or there's a problem with
the hypothalmus or pituitary glands.
Thyroxine (Amount available for conversion to T3)
Triiodothyronine (Amount available for conversion to T2)
Inactive/unusable form, sometimes high in times of stress. This is
generated by the pituitary gland. Too much RT3 means the patient will
have hypothyroid signs, despite a normal T3/T4 test. RT3 should be
tested WITH the T3 - you need to see the ratio of one to the other.
Thyroglobulin Antibodies (Tg Ab), Thyroid Peroxidase Antibodies (TPO
AB) and Thyrotropin Receptor Antibody (TR AB) - these are typically
seen in an autoimmune thyroiditis situation such as Hashimoto's Thyroiditis.
If testing is only being done on the T4/T3, you'll get a more accurate
picture with several tests over the span of several days, because they
can fluctuate rapidly.
A full thyroid panel is best with other supporting labwork, including
Metabolic Panel, Cortisol,
and other things. (See the RealThyroidHelp forum link at the bottom
for details.) This will enable the doctor to better determine what the
actual problem is - especially if the patient has a non-typical thyroid
issue, and where in the thyroid production chain the problem lies -
or if it's an adrenal, hypothalmus or pituitary issue instead of a true
Treating the wrong problem, or not treating it at all because the doctor
didn't run enough tests to even SEE the problem - only makes the condition
worse over time.
HOW CAN THYROID DISEASE BE MISDIAGNOSED?
Doctors may look at the symptoms, run a T4 or TSH and see no
problem, and assume the thyroid is just fine. Meanwhile, the patient
may get handed any of these other diagnoses - or ones not on this list
- based on symptoms alone:
- Accused of being just "fat and lazy" due to weight gain
- Accused of being "noncompliant" with medications due to
fluctuating thyroid levels
- Anxiety disorders
- Arthritis, various types
- Autoimmune diseases of various types (if patient just keeps getting
- Chronic Fatigue Syndrome
- Depressive disorders
- Heart disease / arrhythmia
- Neuropathy (due to pain)
- Pre-diabetic condition (insulin resistance caused by thyroid issues)
HOW IS IT TREATED?
Treatment options depend on the cause, how fast the disease symptoms
are progressing, and and whether they are permanent or a temporary side
effect (postpartum being an example of a temporary situation.) If the
problem is due to stress, generally getting rid of all or most of the
stress will bring things back to normal, if it hasn't gone on long enough
to create generalized adrenal fatigue.
Some medications can have a negative effect on the endocrine system
in general, which can lead to symptoms of thyroid disease or other endocrine
based problems. Sometimes stopping the medications causing the problem
will help - sometimes it won't. It depends on how much damage was done
by the medication and whether the body can recover on it's own.
Most cases of hyperthyroid (such as Grave's
Disease) are treated with medications, radioactive iodine treatments
(also known as "RAI") or surgical removal of all or part of
the thyroid gland - the RAI and surgery effects are almost always permanent,
leaving the person permanently hypothyroid
(and requiring hypothyroid medications for the rest of their lives.)
Radioactive iodine is used because iodine is concentrated in high amounts
in the thyroid gland, and in substantially smaller amounts throughout
the rest of the body. There are two forms of radioactive iodine used
- the form typically used for "uptake imaging" (nuclear scintigraphy;
used to diagnose some types of hyperthyroid problems by the absorption
pattern of RAI in the thyroid gland) is the milder I-123 isotope; this
does not require any special precautions because it has a half-life
measured in hours. The other form is the I-131 isotope, this is used
in some tests, as well as in RAI treatment of some thyroid problems.
Depending on the degree of treatment, special isolation procedures must
be in place for the patient having I-131 treatment for up to a few weeks
treatment is completed.
RAI treatment commonly has temporary side effects commonly including
a sore throat lasting anywhere from a few days to a few weeks, difficulty
swallowing, and fatigue.
For cases of hypothyroid, replacement
hormones are the usual treatment of choice. There are natural and synthetic
options available, but be aware that many doctors prescribe the synthetic
form - this don't always work for the patient. The reason is that while
natural thyroid hormone replacements ("Armour" is one brand
cited often in thyroid forums) have T4 and T3 in relatively balanced
amounts, the synthetic forms DO NOT. The synthetics are T4 OR T3, not
both - and while most doctors are willing to prescribe the T4 synthetic,
it may take some hard convincing - or the patient being nearly on death's
door - for them to realize that T3 may be needed as well.
WHAT TYPES OF THYROID PROBLEMS ARE THERE?
A goiter is a dramatic enlargement of the thyroid due to multiple benign
growths within the thyroid. Generally this only causes problems when
it interferes with breathing/eating/drinking, however they do need to
be checked out to be certain it's not a cancerous growth. For cosmetic
reasons, surgery may be performed to remove the growths even if it's
not causing problems.
In many areas of the world, goiters are caused by an iodine deficiency.
In America, due to the availability of iodized salt, this isn't as common
(thought it can still happen on a salt-restricted diet, or if the patient
uses a salt form that does not contain iodine. Careful use of iodine
supplementation can avoid the deficiency problem.) In America, the more
common reason is due to an increase in the TSH by the pituitary in response
to a defect in thyroid hormone production within the thyroid gland itself.
Many goiters are a temporary situation, and will fade away with time
even without treatment. Doctors who diagnose a goiter will likely take
a wait-and-see approach, and monitor what happens over time.
Thyroid Cancers (malignancies; typically treatable)
Most thyroid cancers are considered curable (because they're not as
likely to spread to other areas of the body.) In the past, surgery has
been done first, with RAI after if the surgery was unsuccessful. These
days more patients are opting for RAI first because it's less invasive,
then following up with surgery and/or more RAI afterward if it's necessary.
Some thyroid cancers may be subtle and hard to find, leaving the patient
essentially "euthyroid" - little or no change in thyroid test
values - and may be easy to miss AS a cancer for longer periods of time.
Solitary Thyroid Nodules
These are benign lumps that commonly arise within an otherwise normal
thyroid gland. Typically there is only one lump (multiple lumps are
usually referred to as "Goiter" instead). This is simply a
harmless overgrowth of normal thyroid tissue, or it may be due to too
little thyroid hormone being produced. Like goiters, these generally
only require treatment if it interferes with breathing/eating/drinking,,
and sometimes they also may be removed for cosmetic reasons.
Hyperthyroidism/Thyrotoxicosis (too much
This category includes a variety of diseases caused by too much creation
and release of thyroid hormone. Graves Disease (a/k/a "diffuse
toxic goiter") is the most common example, followed by Plummer's
Disease (a/k/a "toxic multinodular goiter") and toxic adenoma
to make the bulk of hyperthyroid cases, with other ailments being more
rare. Generally these common ones are diagnosed with nuclear scintigraphy,
which shows how much radioactive iodine ("RAI") is taken up
by the thyroid gland - different hyperthyroid conditions affect how
the RAI is absorbed, in specific patterns that indicate which type of
hyperthyroid problem is affecting the patient.
A rare complication of hyperthyroid disease itself is a condition called
"thyroid storm" - fatal if untreated, this typically occurs
in patients with untreated or partially treated hyperthyroid who go
through a traumatic event such as surgery, accidental trauma, serious
infection, etc. (The body is trying to compensate for the change in
hormone levels, but the compensation goes into overdrive, leaving the
patient in a metabolically overstressed state.) If this happens, treatment
must begin sooner rather than later - so recognition is based primarily
on clinical signs of the hyperthyroid condition by medical personnel
rather than waiting for lab results to come back.
Hypothyroidism, general (too little thyroid
In many parts of the world, hypothyroid is due to iodine deficiency,
causing goiters. Usually hypothyroidism is a direct result of the thyroid
gland not producing enough thyroid hormones, but sometimes it's a secondary
effect of another problem such as a damaged pituitary gland, effects
of certain medications (dopamine, lithium, thalidomide, etc.), prior
radiation treatment for non-thyroid issues, tumors, and so on. Occasionally
hypothyroidism can be caused by what's often described as a "conversion
problem" - the body doesn't convert T4 to T3 in a timely manner.
This does NOT show up on a T4 test - the problem is not with the production
of T4 - but it will usually show up on a TSH test since TSH rises in
response to a lack of either T4 or T3.
If a patient decides to go on a no-salt or salt-restricted diet, iodine
should be supplemented (with selenium and a few other thyroid-supporting
nutrients) so that the patient doesn't become hypothyroid out of a simple
deficiency problem. If iodized salt is not desired (I don't like the
flavor myself, so it wouldn't surprise me) then either try sea salt
with trace minerals (there are some forms without iodine; avoid those
for this purpose), or add kelp to the diet to provide the missing iodine.
(Note: Kosher salt does NOT contain iodine!)
Thyroiditis (inflammatory/autoimmune process)
Thyroiditis is an inflammation of the thyroid gland. It generally has
three phases: Acute (hyperthyroid state), subclinical, and inactive
(closer to a hypothyroid state). The autoimmune disease known as Hashimoto's
thyroiditis is probably the most well known example because it usually
needs aggressive medical treatment by the time it's diagnosed, but it's
actually not the most common.
Quite often similar effects happen within a few weeks of a viral infection
(Mumps has been cultured in the past, but measles, influenza, mononucleosis,
coxsackievirus and others have been seen in association with thyroiditis
as well.) Thyroiditis may occur after pregnancy ("postpartum"),
and is usually temporary (a few months) in duration. Common symptoms
include pain in the neck (yes, literally!), fatigue, muscle pain and
fever, in addition to anything else that happens to be going on. The
thyroid gland is only mildly to moderately enlarged, sometimes 2-3 times
normal, and often firm to hard in density.
HOW CAN MEDICATIONS AFFECT THYROID LEVELS?
Many medications can affect a patient's thyroid hormone levels, especially
important when the patient is on thyroid hormone treatments. The most
obvious cause of fluctuation is the timing of medication dosage versus
the timing of the lab tests, or simply a change in the amount of the
Other things that can affect this are:
- Medication potency fluctuations - between batches, and brands.
- Lab changes or errors (different lab used to run the tests, etc.)
- Timing of your dosage in the day - try taking it at the same time
each day, rather than different times.
- Starting/stopping high fiber diet - fiber content should be relatively
CONSISTENT, not variable.
- Calcium and iron interfere with the absorption of thyroid hormone
replacements - separate doses by 2-4 hours.
- Soy products (high in isoflavones) may aggravate a thyroid condition,
leading to a higher TSH.
- Eating too many goitrogenic (antithyroid activity) foods such as
brussel sprouts, rutabaga, turnips, and others.
- Change of seasons - TSH can rise during colder months, and drop
during warmer months. May be more pronounced in older people and in
cold climates. Suspicion: Seasonal changes
may be related to Vitamin D deficiency
- Estrogen replacement therapy - may need more thyroid hormone.
- Menopause - with fluctuating hormone levels - can impact TSH levels.
- Supplements / drugs containing iodine.
- Antidepressants (and similar) may impair the effectiveness of thyroid
hormone replacement, and make TSH rise.
- Cholesterol medications may block thyroid hormones. If you must
take these, separate from thyroid medications by 4-5 hours.
- Steroids - cortisone, etc. - can suppress TSH and block T4 >
T3 conversion in some people.
- Stress and illness - the endocrine system responds to both, so periods
of intense stress, or the relief of such stress, may impact TSH levels.
- Progression of thyroid disease - some types of thyroid disease get
worse over time and higher doses of medication - or more aggressive
measures such as surgery or RAI - may be needed.
- Pregnancy or "postpartum depression"
WHAT MAKES FOOD GOITROGENIC?
Goitrogens are naturally-occurring substances that can interfere with
function of the thyroid gland. Foods containing goitrogens either block
iodine utilization or interefere with the natural production, communication
and conversion chain of thyroid hormones. These foods are best in small
doses to minimize the impact on existing thyroid problems. These are
compounds known as Isoflavones (in soy products) and Isothiocyanates
(in cruciforous vegetables such as broccoli, cauliflower, brussels sprouts,
cabbage, and more.) Cooking may inactivate these goitrogen substances,
since they appear to be heat sensitive.
Soy products are a common example, but there are other goitrogenic
foods as well. Fermented products (such as soy sauce) are ok, but non-fermented
products still have the goitrogenic components. See the Bad
Foods list at ThyroPhoenix and the goitrogen
list at Stop the Thyroid Madness for more details. Soy products
are especially hard to root out of the diet because they are hidden
in many things, such as "textured vegetable protein", tofu,
soy concentrate, soy protein drinks, and many other things.
In the absence of thyroid problems, these foods will not present
problems, and should still be enjoyed for their nutritional value.
I will repeat that there are many, many, MANY factors that can affect
the extent and progression of thyroid disease. A large number of thyroid
patients have united in forums and mailing lists in order to share their
experiences and "what works for them" with others. Anecdotes
from thyroid tests, symptoms, and whether natural or artificial thyroid
hormone supplements work seem to be more accurate than what the doctors
learn from pharmaceutical companies. Many patients with thyroid problems
have had to "doctor themselves" in terms of research and understanding,
in order to make their lives easier.
Please DO take the time to read the links below to get a better understanding
of both anecdotal and conventional medical information. This is far too
complex a topic to base your medical care decisions on just one article
This site contains articles on various medical
topics; however, no warranty whatsoever is made that any of the articles
are accurate - and even if a statement made about medical matters is
accurate, it may not apply to you or your symptoms. These
medical articles are provided on a general informational basis only
- nothing on this site should be construed as an attempt to offer or
render a medical opinion or otherwise engage in the practice of medicine.
Even though the authors may be capable of
doing extensive research, it must be understood that neither SphynxCatVP,
nor the rest of the contributors, are doctors, despite the presence
of any books of the medical profession in the personal libraries of
any of the authors. Any such articles are thusly written, in part or
in whole, by nonprofessionals. Consequently, there is absolutely no
guarantee that any statement contained or cited in an article touching
on medical matters is true, precise, or up-to-date.
At best, you can use the article to strike
up a conversation with your doctor or other medical professional ABOUT
your symptoms, and share any concerns you may have for them to investigate.
The medical information provided by this site is of a general nature
and CANNOT legally be considered a substitute for the advice of a medical