Thyroid

Radioactive Thyroid Tests

Many of us have come to fear radioactive substances, sometimes correctly, with so many terrible historical associations Hiroshima, Nagasaki, the Marshall Islands, Three Mile Island, and Chernobyl, to name just a few. Indeed, a very important guideline in the field of radiation safety is to make sure that anyone's exposure to radiation is as low as reasonably achievable (this phrase is referred to by its acronym, ALARA). On the other hand, thyroid disease was the first type of illness in which...

The Normal Thyroid in Pregnancy

It was customary in ancient Egypt to tie a fine thread around the neck of a young bride when it broke, it meant she was pregnant. It's normal for the thyroid gland to enlarge slightly during pregnancy because the placenta makes a hormone, human chorionic gonadotropin (HCG), that stimulates the mother's thyroid gland. Researchers have found that HCG has a very similar molecular structure to thyroid stimulating hormone (TSH). Increased TSH causes enlarged thyroid glands (goiters), such as with an...

Gestational Thyroid Disease Thyroid Disease During Pregnancy

With two rare exceptions, discussed further on, the causes of thyroid disease during pregnancy are the same as in the general population. The most common thyroid diseases in pregnancy mirror the most common thyroid diseases in the general population. As in the general population, Hashimoto's disease (see Chapter 5) is the most common thyroid disease in pregnancy, followed by Graves' disease (see Chapter 6). In both cases, the risk spikes during the first three months of pregnancy, and then...

Gestational Hyperthyroidism

Diagnosis and treatment of hyperthyroidism during pregnancy presents some unique fetal and maternal considerations. First, the risk of miscarriage and stillbirth is increased if hyperthyroidism goes untreated. Second, the overall risks to you and the baby increase if the disease persists or is first recognized late in pregnancy. As in non-pregnant women, specific hyperthyroid symptoms usually indicate a problem, but here again, some of the classic symptoms, such as heat intolerance or...

Postpartum Thyroiditis

Postpartum thyroiditis means inflammation of the thyroid gland after delivery and is often the culprit behind the so-called postpartum blues. Postpartum thyroiditis occurs in 5 to 18 percent of all postpartum women and usually lasts six to nine months before it resolves on its own. Postpartum thyroiditis is a general label referring to silent thyroiditis (see Chapter 5) occurring after delivery and causing mild thyrotoxicosis and or a short-lived Hashimoto's-type of thyroiditis (see Chapter 5),...

Misuse of Thyroid Hormone

Thyroid hormone has a shady history of inappropriate use in the past. Throughout the 1950s, 1960s, and even 1970s, overweight women were frequently prescribed levothy-roxine sodium as a weight loss drug and told that it would speed up their metabolisms, resulting in the desired weight loss. This practice is known as off-label prescribing and was the source of countless cases of thyrotoxicosis, which frequently went untreated, harming these women. It also led to many women being misdiagnosed...

Digestive Changes and Weight Gain

Because your system has slowed down, you'll suffer from constipation, hardening of stools, bloating (which may cause bad breath), poor appetite, and heartburn. The following symptoms can indicate mild, moderate, or severe depression as well as hypo- or hyperthyroidism Feelings of sadness and or empty mood* Difficulty sleeping (waking up frequently in the middle of the night)f Loss of energy and feelings of fatigue and lethargy* Change in appetite (usually a loss of appetite)*t Difficulty...

Postpartum Thyroiditis Blues or Postpartum Depression

If you look at the symptoms of hypothyroidism in Chapter 3, it's easy to see how they can be confused with symptoms of postpartum depression or the maternal blues, which affect as many as 70 percent of all women after delivery. Symptoms of maternal blues are frequent crying episodes, mood swings, and feelings of sadness, low energy, anxiety, insomnia, restlessness, and irritability. Women who experience these should find comfort in knowing that they are normal and will pass on their own in a...

How It Formed Where It Is What It Does

When my youngest son was nearly four years old, a preschool teacher gave him a standardized test to assess his vocabulary and basic knowledge. Halfway through a successful test session, Jake was told, Point to your thigh. Jake triumphantly touched the center of his neck, just above his breastbone. Wrong exclaimed the teacher. Watching the test, I was surprised. What do you mean I said, He thought you meant his thyroid gland. Where is the thyroid gland she asked me, clearly at a loss to conceive...

TSH The Most Sensitive Test to Assess Thyroid Hormone Status

Another way to assess the adequacy of thyroid function in the body is by assessing the level of thyroid stimulating hormone (TSH) produced by the pituitary gland. This test is by far the most valuable, and perhaps the most misunderstood by thyroid patients. This section looks at TSH testing in detail. One problem with trying to use the free T4 level to diagnose hyperthyroidism or hypothyroidism is that it is not very sensitive for an individual. This is because the normal range of the free T4...

Rays Ultrasounds and Other Diagnostic Pictures

Nuclear scans, as discussed previously, provide a way to find out about the thyroid gland or thyroid cancers based upon the function of the thyroid or thyroid cancer cell. This function involves taking up one or more of the scanning agents used for nuclear imaging. Besides such function, it is critical to know about the form and structure of the thyroid gland or to be able to locate thyroid cancer deposits in the body that may no longer take up radioactive scanning agents. Obviously, the first...

Iodine Deficiency

As discussed in Chapter 1, iodine is the critical ingredient used by the thyroid to make thyroid hormone. Without enough iodine in the diet, the thyroid gland cannot produce enough thyroid hormone. If this happens, the pituitary gland makes more TSH, continuing to stimulate the thyroid gland and causing it to enlarge (a condition called a goiter, discussed in Chapter 7). Most people need at least 100 micrograms of iodine each day to produce enough thyroid hormone and avoid goiter....

Iodine Excess

Too much iodine is believed to be responsible for triggering goiters and thyroid disorders, too. On the other hand, in countries where iodine has been made plentiful in the food supply, such as in the United States, hypothyroidism from iodine deficiency has disappeared while hypothyroidism from autoimmune disease has skyrocketed. It seems that excess iodine in the diet stimulates the immune system to create antibodies that attack the thyroid gland and causes it to stop making normal amounts of...

Driving While Hypothyroid

People who are moderately to severely hypothyroid, with TSH levels higher than 10, should not be driving a vehicle of any kind, flying a plane, or operating heavy machinery. These rules do not apply to the vast majority of those who are mildly hypothyroid (usually with levels 5 to 10). Thyroid cancer patients preparing for withdrawal scans (see Chapters 2 and 9), whose TSH levels will typically go above 30 while in preparation, should most definitely not be driving while hypothyroid. Clearly,...

Adrenaline Rush

An important hormone system in the body called the adrenergic system is formed from parts of the brain, nervous system, and adrenal glands (small glands that sit on top of each kidney). The hormones released by the adrenergic system are called catecholamines. Two of these hormones are adrenaline (also known as epinephrine) and noradrenaline (norepinephrine). You might remember that adrenaline is a fight or flight hormone, released when you are scared, shocked, or highly excited. When this...

Thyroid Hormone Overdose

Thyroid hormone overdose is a common problem. This is because dosages of thyroid hormone used for treatment of hypothyroidism may be selected empirically and not sufficiently monitored using appropriate laboratory tests. This results in some people remaining hypothyroid with inadequate thyroid hormone dosages and some becoming thyrotoxic with too much thyroid hormone. Poor compliance is the second most common reason for overdose. An occasional scenario is in thyroid patients who have memory...

Diagnosing Hashimotos Disease

The signs of Hashimoto's disease are not at all obvious. In its early stages, a goiter can develop as a result of inflammation in the thyroid gland. The goiter is usually firm but is not tender. The goiter's presence can suggest Hashimoto's disease, but it is usually suspected because of the sudden recognition of symptoms of hypothyroidism or detection of an elevated TSH level during routine medical evaluations. Hashimoto's disease is frequently missed as a diagnosis, however. Often, symptoms...

Hashimotos Thyroiditis

Chapter 5 is devoted to the topic of Hashimoto's thyroiditis. In the industrialized world, particularly in regions with high dietary intake of iodine or good levels of iodine supplementation, Hashimoto's thyroiditis has increased in frequency to become the most common cause of goiter. Several coincident factors contribute to the goiter in this condition. First, the immune system generates antibodies that attack the thyroid follicu-lar cells, impairing their ability to make thyroid hormone....

Graves Disease

Graves' disease is the topic of Chapter 6. It's the most common cause of a thyrotoxic goiter. When I see someone who is thyrotoxic, has bulging eyes, and has an easily seen diffuse goiter, there's no need for me (Ken) to do fancy blood tests to know that the person has Graves' disease. These goiters can be small, barely larger than a normal 18-gram thyroid, to sizes in excess of 140 grams. Once in a while, a Graves' disease goiter can cause thoracic inlet obstruction, which might prompt a...

Finding a Thyroid Nodule

Most thyroid nodules are found as obvious lumps in the lower front of the neck, seen by the person in a mirror or by a friend or family member. Sometimes a physician will find a nodule during a physical examination. This may be prompted by a complaint of a sore throat, usually completely unrelated to the nodule, but serving as a reason to focus on the neck, resulting in the nodule being found by accident. If your neck was exposed to radiation therapy during childhood, you have increased chances...

Is the TSH Suppressed

First, check your TSH level (see Chapter 2). The reason for this is very simple. The nodule cannot be an autonomous toxic nodule (ATN) if the TSH is not suppressed (under 0.2). The only type of nodule that can be treated without the need for a biopsy is an ATN because these are very unlikely to be cancers. Every other thyroid nodule that is larger than 1 centimeter (0.4 inch) in diameter requires a biopsy. This means that the course is made clear by the TSH test. If the TSH is low (less than...

The Thyroid Cyst

Thyroid cysts present a special challenge for your physician. As in the case of solid thyroid nodules, you don't need to worry about small cysts of 1.0 centimeter (0.4 inch) or less in diameter. When the cyst is larger than this, you'll need to have it evaluated properly for two reasons. First, it might contain a thyroid cancer growing from the wall of the cyst or from the solid portions of a complex nodule. Second, the cyst might grow quite large and cause pain or discomfort, sometimes...

Radiation Exposure to the Neck During Childhood

In the 1940s and 1950s, many conditions were treated with external beam radiation therapy (XRT) in the belief that it was therapeutic. For example, some physicians believed that sudden infant death syndrome (SIDS) could be caused by a baby's thymus gland (located in the mid-upper chest) pushing on the airway (clearly a false idea in the light of modern knowledge). They gave x-ray therapy (XRT) to babies to shrink their thymus glands. Other physicians felt that bad acne lesions or recurrent...

Thyroid Cancer

As we discussed in the previous chapter, thyroid cancer is typically discovered in a thyroid nodule. In some cases, however, it is found after a tumor is discovered somewhere else in the body, such as in the lungs or in a bone, with the biopsy of this tumor eventually leading to the thyroid as the source of the cancer. This chapter serves as a detailed introduction to thyroid cancer and its treatments. Chapters 2, 3, 10, and 12 are also critical to read if you have thyroid cancer, as these...

The Genetic Link

There is good evidence that some papillary and follicular thyroid cancers run in families, although such thyroid cancers are still exceedingly rare among the far larger number of non-inherited papillary thyroid cancers. Since there is not yet enough knowledge about the specific genes responsible for the few inherited cases, there is not yet a role for genetic testing. In addition, there are a few unusual genetic syndromes, such as Gardner's syndrome, Carney's complex, and Alagille syndrome,...

Survival Rates

It is impossible to give statistics regarding the rates and lengths of survival from papillary thyroid cancer because papillary cancers range from tiny occult (meaning hidden) cancers, which have no effect on your life span if left untreated, to distantly metastatic tall cell variant papillary cancers that can dramatically affect your life span if left untreated. In general, most people with papillary thyroid cancer have a typical papillary cancer with excellent long-term survival, provided...

Anaplastic Thyroid Cancer

Thyroid cancer represents the best and worst of cancer types. Occult papillary thyroid cancers are considered among the best cancers to get because they are easy to treat and grow pretty slowly in a predictable pattern. The result is almost a 100 percent cure rate in these small easy cancers. Anaplastic thyroid cancer, however, is one of the worst types of cancer to get, as it is considered one of the most aggressive cancers in existence. The good news is that anaplastic thyroid cancer is very...

Diagnostic Evaluation Long Term FollowUp

I follow a general pattern of thyroid cancer follow-up evaluation, modifying it to fit each patient's particular needs and disease features. After the thyroid surgery, removing the entire thyroid gland and all detectable tumor in the neck, the first radioactive iodine scan is usually done from six to eight weeks later. This timing is based upon the time that it takes for the TSH level to rise to greater than 30 after the thyroid gland is gone. I don't use recombinant human TSH (Thyrogen) at...

Thyroid Hormone The Inside Scoop

Thyroid hormone is the common thread to most thyroid problems. Most people with thyroid conditions end up taking thyroid hormone. People with hypothyroidism (see Chapter 3) require thyroid hormone. Those with thyrotoxicosis from hyperthyroidism (see Chapter 4), after surgery or radioactive iodine treatment (see Chapter 12), eventually need thyroid hormone because they eventually become hypothyroid. And thyroid cancer therapy (see Chapter 9) starts with surgical removal of the thyroid gland...

The Wise T4 Shopper

Some rulings by the FDA have allowed pharmacists to substitute different brands of T4 for the particular one that your physician requested (called generic substitution) without permission from the physician. Sometimes this translates into a cost savings to your insurance company. Sometimes this practice results in a greater profit margin for the pharmacy. Sometimes the co-payments on your insurance-subsidized prescription end up costing you more than the retail price if you chose not to use...

Pill Sizes Strengths of T4

Levothyroxine (T4) pills now come in a wide range of strengths. All of them, within the same brand, are the same physical size and shape, but there is considerable difference in the amount of T4 contained in each strength of pill. They range from 25 micrograms (0.025 milligrams) to 300 micrograms (0.3 milligrams). Because of the wide variety of pill strengths, your doctor should not need you to cut pills in half or take different size pills on different days. Sometimes, I need to put my...

Mixtures of T3 and T4

Since the thyroid gland normally releases 80 percent of its thyroid hormone as T4 and 20 percent as T3, it seems logical to make a tablet that combines both T4 and T3 together in a similar ratio. Some pills manufactured do just that. Unfortunately, this type of pill cannot do the same thing as a normal thyroid gland that releases a constant, steady stream of both hormones all day and night. Instead, the pill releases both the T4 and T3 completely over one to three hours. Careful consideration...

Side Effects and Risks of RAI for Graves Disease

It's pretty accurate to say that the only long-term side effect of RAI for Graves' disease is hypothyroidism. As we also explain in Chapter 19, this is actually the intention of the treatment because once you're hypothyroid, you can be treated with the proper dose of thyroid hormone, which makes you feel balanced and well again. This is preferable to the roller coaster of thyrotoxicosis from Graves' disease (see Chapter 6), which wreaks havoc on your body (and life). So, to most Graves'...

Radioactive Iodine for Toxic Thyroid Nodules

Autonomous toxic nodules (ATNs), either single or as part of a toxic multinodular goiter (TMNG), are appropriate for RAI treatment because these nodules produce enough thyroid hormone to suppress the TSH level. The TSH suppression causes the normal thyroid tissue surrounding the nodules to become suppressed also and not take up RAI. This results in protection of the normal thyroid from the RAI and specifically directs the I-131 to enter the toxic nodules that don't require TSH for their...

Preparation for RAI Treatment of Thyroid Cancer

A major difference between RAI treatment for Graves' disease or ATNs and RAI treatment for thyroid cancer is the importance of proper preparation for treatment. Radioactive iodine uptake is high in thyrotoxic Graves' disease and autonomous toxic nodules. On the other hand, whereas normal thyroid tissue takes up iodine at 1 percent per gram, papillary and follicular thyroid cancers take up iodine at from 0.01 to 0.1 percent per gram, making it important to use the best preparation to optimize...

Standard Dosing

For a long time, many physicians based their decisions on how much RAI to give for each person's treatment on custom and financial concerns. Rules from the U.S. Nuclear Regulatory Commission (NRC) stated that doses of I-131 less than 30 millicuries could be given as an outpatient dose, without the need to admit the patient to the hospital. Insurance companies and physicians jumped on the bandwagon, making the 29.9-millicurie dose the most common dose used. Physicians went to great lengths to...

If You Had Radioactive Iodine Therapy

If you were treated for hyperthyroidism or thyroid cancer with radioactive iodine, a reasonable recommendation is that you shouldn't plan to get pregnant for about six months. If you're pregnant after you had RAI, but did not wait this six-month period, you shouldn't be worried since there isn't any definite evidence that there's any harm to your child. Pregnancies should proceed normally so long as you're taking sufficient doses of your thyroid hormone replacement and the TSH is monitored...

Papillary and Follicular Thyroid Cancers in Children

Most thyroid cancers in children are papillary cancers. Follicular thyroid cancers are less common than in adults. In children exposed to radioactive fallout (as was the case in the Chernobyl accident), an unusual type of papillary thyroid cancer, known as diffuse sclerosing variant, seems to be more common. There are important differences in the way these cancers grow in children compared to adults. The cancer is more likely to invade through the covering of the thyroid gland into the soft...

Misinformation

As we discussed in the Introduction, thyroid patients are usually forced to self-educate about thyroid disease. In fact, this was certainly my (Sara's) experience when I was diagnosed with thyroid cancer in the early 1980s. Indeed, throughout the 1980s and early 1990s, it was difficult to find information on thyroid disease. By the late 1990s, as the Internet became much more accessible and popular, thyroid patients began surfing for thyroid information thyroid websites and list-servs abounded,...

RAI Causes Other Cancers

Many people treated for thyroid cancer are concerned that RAI could increase their risks of getting other cancers. The two most common cancers rumored to be linked to RAI are leukemia and breast cancer. With respect to leukemia, even with a single RAI dose of more than 800 millicuries, fewer than one out of two hundred people would go on to develop leukemia, which matches the risk in the general population. With respect to breast cancer, a study published in 2000 found an association between...

RAI Therapy for Thyroid Cancer Causes Bone Marrow Problems

It is uncommon for there to be clinically significant effects on the bone marrow from typical I-131 doses administered to treat Graves' disease or thyroid cancer. When the absorbed bone marrow radiation dose approaches 200 REM (2.0 Sievert), there may be temporary effects on the platelets, red blood cells, and white blood cells that typically become maximal four weeks after radioiodine and resolve after an additional four weeks. In most patients, I-131 doses of 250 to 800 mCi (as determined by...

Low Iodine Diet Means No Sodium So Labels That Say Low Sodium Are Fine

If added in its pure form to any water-based liquid, it will explode. If left in the air, it will burst into flames. Otherwise, it can exist as a chemical salt that means that it has a positive charge and is bound to other negatively charged chemical groups, for example sodium bicarbonate, sodium chloride, or sodium phosphate. Sodium has nothing to do with iodine or iodide. For public health purposes, table salt (sodium chloride) may be combined with sodium iodide to...

Supportive Literature

Anaplastic Thyroid Carcinoma Behavior, Biology, and Therapeutic Approaches. Thyroid 8, no. 8 1998 715-26. Ain, K. B. Management of Thyroid Cancer. In Diseases of the Thyroid, edited by L. E. Braverman, 287-317. Totowa, NJ Humana Press, Inc., 1997. Ain, K. B. Management of Undifferentiated Thyroid Cancer. Baillieres Best Practice and Research Clinical Endocrinology and Metabolism 14, no. 4 2000 615-29. Ain, K. B. Thyroid Malignancies. In Oncologic Therapies, edited by E. E. Vokes and...

Congestive Heart Failure

Congestive heart failure means that the heart is weakened and not pumping well. This is usually caused by long-standing problems such as damaged heart valves, high blood pressure, damage to the heart muscle, or, in rare cases, a variety of heart defects that could have been present at birth congenital heart defects . Your heart's job is to pump blood through the lungs to pick up oxygen and release carbon dioxide, then throughout the body to provide oxygen and nutrients. If your heart isn't...

Toxic Multinodular Goiter TMNG

If you have a suppressed TSH, there might be a detectable goiter or it might be too low in the neck to feel easily. In rare cases, you may be able to feel multiple thyroid nodules they may feel like a bag of grapes or marbles. Usually, you can feel two or three nodules in your thyroid. Since the thyrotoxicosis is further evaluated with a radioactive iodine scan, this is the test that most commonly shows the goiter to be a toxic multinodular goiter. The scan shows hot nodules (that are brighter...

Diagnosing Thyrotoxicosis andor Hyperthyroidism

Thyrotoxicosis can be easily discovered with elevated free T4 or T3 levels and a TSH level that is lower than normal (usually less than 0.2). See Chapter 2 for more details on lab testing for TSH and free T4 and T3. The challenge for diagnosing either hyperthyroidism and or thyrotoxicosis is similar for hypothyroidism the symptoms can overlap with stress, anxiety, panic disorder, low blood sugar, and cardiovascular diseases. For women, PMS and perimenopause can mask, or be mistaken for,...

Low Blood Sugar or Thyrotoxicosis

Low blood sugar, also known as hypoglycemia, triggers the very same adrenaline rush reaction that can occur in a panic attack. Low blood sugar can be measured, and a reading below 50 mg dl (or in Canada, 3.5 mmol L) is considered too low. But many people assume they suffer from low blood sugar even when their blood sugar levels are normal because they feel shaky and irritable when hungry, which is relieved by food. In fact, the common feature to panic attacks and true hypoglycemic attacks is a...

Thyrotoxicosis in Older Persons

Hyperthyroidism from Graves' disease (see Chapters 4 and 6) or a nodule (see Chapter 8) occurs in less than 1 percent of the population over sixty. In fact, it is less than one-tenth as common as hypothyroidism in the same population. When it does occur, the symptoms are not obvious and do not clearly indicate to the doctor that you have Graves' disease in the same way as they do in a younger person. Similar to hypothy-roidism, hyperthyroidism can be insidious in the over-sixty crowd it can...

Apathetic Hyperthyroidism

Apathetic hyperthyroidism refers to hyperthyroidism without clear symptoms of thyrotoxicosis (see Chapter 4). Normally, people who are thyrotoxic as a result of hyperthy-roidism have a racing heart, enlarged thyroid gland, tremor, restlessness and anxiety, and signs of thyroid eye disease (see Chapter 23). In apathetic hyperthyroidism, the telltale signs doctors count on to diagnose hyperthyroidism are absent instead, a person with apathetic hyperthyroidism may even seem calm and mild-mannered....

Believers in Wilsons Thyroid Syndrome

Wilson's syndrome is not a recognized thyroid disease or condition by any conventional thyroid practitioners or by the American Thyroid Association. Named by Dr. Denis E. Wilson, it borrows from some of Broda Barnes's theories about low body temperature as a sign of unrecognized hypothyroidism in spite of normal thyroid lab tests. In this case, Wilson, too, suggests that a host of nonspecific ill-health symptoms, which can be attributed to hundreds of conditions, combined with low body...

Thyroid Hormone Replacement

Although we will get into thyroid hormone replacement in much greater detail in Chapter 10, this section is designed to give you a beginning understanding of thyroid hormone therapy for hypothyroidism. Treatment for hypothyroid children and the elderly is discussed in greater detail in Chapters 15 and 17. In the United States, more than fifteen million prescriptions of thyroid hormone per year are sold. Even if only part of your thyroid gland was surgically removed, thyroid hormone replacement...

Why Do I Still Feel Hypothyroid

If you have normal TSH levels but still have symptoms of hypothyroidism, then you will be relieved to know that the symptoms that persist are not likely to be related to your hypothyroidism and you can, at last, investigate other causes and remedies. The goal of treating hypothyroidism is to restore your thyroid levels to normal (indicated by normal TSH). The hypothyroid state in your body may exist along with other problems. Ask people who are not hypothyroid if they're tired, depressed,...

High Blood Sugar

Thyrotoxicosis, as we discussed in Chapter 4, can increase your need for insulin if you have type 1 diabetes or in some cases of type 2 diabetes. If you have type 2 diabetes (as one in four adults over forty-five do), you are already at a much greater risk of heart attack or stroke because of blood vessel complications. It is critical that you have your diabetes medications or insulin and your blood-sugar targets reassessed by your doctor, since they can be thrown off by the symptoms of Graves'...

Heart Complications from Hypothyroidism

As we explained in Chapter 3, hypothyroidism slows down the heart, causing a slow pulse (known as bradycardia). This might cause decreased exercise tolerance, shortness of breath, or a feeling of being winded when you try to exert yourself. Prolonged hypothyroidism will also lead to the accumulation of fluids, called lymphedema, which can swell your hands and feet and mimic the type of edema seen with congestive heart failure. Because your arteries require thyroid hormone to relax,...

The Right Carbs

The diet lingo can often confuse what is meant by carbohydrates. Carbohydrates can be simple or complex. Simple carbohydrates are found in any food that has natural sugar (honey, fruits, juices, vegetables, milk) and anything that contains table sugar. These simple carbs are high on the glycemic index (see resource list in Appendix B), and should be minimized as they are higher in calories and can increase your blood sugar too rapidly, causing the sugar crashes. Complex carbohydrates are more...

Who Is Vulnerable to Autoimmune Disease

Generally, anyone can develop an autoimmune disorder. Some diseases are hereditary, while other diseases, although not directly hereditary, run strongly in families. This is referred to as a genetic tendency or inherited predisposition. Most autoimmune diseases seem to have a genetic tendency with several members of the family showing the same or similar types of autoimmune diseases. Autoimmune thyroid disease is no exception. Often, multiple family members and generations of family members,...

Sleep Apnea

Sleep apnea is a breathing disorder in which there are breathing interruptions during sleep. Apnea means want ofbreath in Greek. There are two types of sleep apnea central and obstructive. Central sleep apnea occurs when the brain fails to send the appropriate signals to the breathing muscles that cause you to breathe in and out. More common, however, is obstructive sleep apnea. This occurs when air cannot flow in or out of your nose or mouth. This can be linked to a growth or tumor in the neck...

Thyrotoxicosis and Obesity

In most cases of thyrotoxicosis (see Chapter 4), some weight loss occurs as the body and metabolism speed up. This is why thyroid hormone used to be wrongly prescribed as a diet drug. However, the hidden danger of thyrotoxicosis in obese people is that it overworks the heart in particular, which can be catastrophic for obese individuals with cardiovascular complications. Palpitations (sometimes because of atrial fibrillation) and angina (both discussed more in Chapter 25) can greatly increase...

Palpitations and Racing Heart Tachycardia

The classic heart complications associated with thyrotoxicosis are a very fast pulse and heart palpitations. In people who are hyperthyroid as a result of Graves' disease (see Chapter 6), once excess thyroid hormone levels are reduced to normal, these symptoms disappear. Treatment with either antithyroid medication (see Chapter 11) or beta-blockers (see Chapter 11) can slow the heartbeat and prevent the consequences of a racing heart, such as heart failure or atrial fibrillation. Once thyroid...

The Healing Environment Feng Shui

Pronounced fung shway, this is the ancient practice of creating energy and harmony through your environmental surroundings (landscaping, interior design, and architecture). People tend to think of feng shui as something that can bring wealth to you (as in money corners) or romance (as in hanging certain items over the bed), but this is in fact not what authentic feng shui consultants look for. Harmony has many elements COMPLEMENTARY THERAPIES FOR THYROID PATIENTS to it, and where you live, how...

Skin Changes

Thyrotoxicosis may cause your skin to develop a fine, silky texture and feel moist with remarkably few wrinkles. Because of enhanced perspiration, the constant moisture may cause a rash from inflamed pores. Sometimes there may be areas of the skin that darken, particularly in the creases of the palms and areas that become abraded. There may be areas that itch, and sometimes the skin becomes sensitive to touch, swelling with minimal contact so that you can seemingly write your name on the skin...

Psychiatric Misdiagnosis

Psychiatrists see so many thyroid patients who have been referred to them as psychiatric patients that thyroid function tests have now become standard industry practice for most psychiatric referrals. When people experience the exhaustion of too much thyroid hormone and the natural anxiety that accompanies it, but do not notice or report other physical manifestations such as a fast pulse or hyperdefecation (which can also be attributed to anxiety), they are often misdiagnosed with anxiety...

Battling the Bloat

Feeling bloated and constipated is a classic hypothyroid ailment. Much of the bloat is actually caused by constipation much is also caused by not drinking enough water. But few people understand that when you increase fiber, you have to increase water intake. So here's what you need to know about fiber and water. You can take fiber supplements and stool softeners while hypothyroid, which will help you when your fiber content is low. But these supplements can be added to a high-fiber diet as...

Diagnosing Graves Disease

The signs of Graves' disease are often obvious you may develop a goiter and display all the classic signs of thyrotoxicosis. Or you may just develop thyroid eye disease symptoms, which are usually telltale signs of Graves' disease. When the signs are obvi ous, your doctor simply confirms the diagnosis with blood tests that check your thyroid hormone levels and sometimes test for the presence of antithyroid antibodies in the blood. If you're not showing any blatant signs of hyperthyroidism but...

Screening Family Members for Graves Disease

Many Graves' disease patients wonder whether their children or other family members will develop it they may also wonder whether genetic screening is available for Graves' disease. Although it is clear that autoimmune thyroid disease has genetic risk, as of this writing, no specific gene has been identified for screening. Even if this were the case, there is no advantage to genetic screening for Graves' disease or Hashimoto's disease because neither is necessarily life-threatening, both are...

HRT Menopause and Thyroid Disease

The average woman will live until age seventy-eight, meaning that she will live one-third of her life after her menopause. Since thyroid disorders affect women so much more frequently, particularly as they age, balancing thyroid hormone replacement with the confusion surrounding traditional estrogen and progesterone hormone replacement is challenging. Since heart disease can be a major complication of hypothy-roidism or thyrotoxicosis, in the 1980s and 1990s, women with thyroid disease were...

An Introduction to Thyroid Hormone

Here, we'll introduce you to thyroid hormone, a key player in understanding how the thyroid works. In Chapter 10, we'll discuss thyroid hormone used as replacement hormone for treating various thyroid diseases in much greater detail. Thyroid hormone is essential for our existence, affecting every single cell in the body. In a very simplified view, thyroid hormone serves as the speed control for cells, controlling their speed of life. There are a few different forms of this hormone. As already...

Are There Natural Therapies for Graves Disease

Some patient literature suggests Graves' disease can be treated using natural or alternative means through a goitrogenic diet and herbs that supposedly support thyroid function. Goitrogenic foods, discussed in Chapter 3, are foods that can block thyroid hormone formation (for example, foods from the Brassica family), essentially working like antithyroid drugs. Some laypeople wonder whether large quantities of goitrogenic foods can cause hypothyroidism. Unfortunately, this is highly unlikely...

Biological Causes of Obesity

The physiological cause of obesity is eating more calories than you burn. People gain weight for two reasons they may eat excessively (often excessive amounts of nutritious foods), which results in daily consumption of just too many calories or they may eat moderately, but simply be too inactive for the calories they do ingest. Genetic makeup can predispose some body types to obesity earlier in life because of thrifty genes. But, in general, experts in nutrition agree that genetics plays only a...

Remission and Antithyroid Medication

The main benefit to going on antithyroid medication is to try your luck at achieving full remission without the need for RAI or surgery. This usually results in either an indefinite period of normal thyroid activity or lifelong hypothyroidism. In general, antithyroid drugs are effective in achieving remission about 20 to 30 percent of the time, but some doctors report even lower success rates. The main effect of antithyroid drugs is to buy time until either a spontaneous remission occurs, in...

Radioactive Iodine RAI Therapy for Graves Disease

Radioactive iodine (RAI) is the most common treatment for Graves' disease in the United States and increasing in popularity in most other parts of the world. In many ways, it is almost an ideal therapy. It has a remarkably long and safe track record with more than a half century of experience. Radioactive iodine is simply an isotope of iodine that releases radiation. The specific isotope used for treatment is iodine-131 (I-131). Since the thyroid naturally and avidly takes in iodine to form...

Causes of Hypothyroidism in Children and Teens

Just as in adults, Hashimoto's thyroiditis is the most common cause of hypothyroidism in industrialized countries. Antithyroid antibodies in the blood, particularly antithy-roid peroxidase and antithyroglobulin antibodies, are present in more than 95 percent of children with Hashimoto's thyroiditis (also known as chronic lymphocytic thyroiditis). Although occasional children with mild Hashimoto's thyroiditis might regain full normal thyroid function, most become more severely hypothyroid over...

Do You Have RTH

As discussed in Chapter 19, RTH has been misunderstood by other authors of thyroid material for patients and is sometimes misconstrued and misinterpreted to explain why thyroid patients feel hypothyroid despite normal TSH levels. Obviously, it's exceedingly unlikely that you have RTH however, how does this problem get discovered The diagnosis and evaluation of RTH is very difficult and outside the expertise and abilities of most physicians. Usually, an astute physician (often a pediatrician or...

The Specialist Standard of Care

The specialist standard of care is higher than the legal standard. This is the standard of care according to published, peer-reviewed guidelines by a professional association pertaining to the particular specialty. For thyroid specialists, the professional association guidelines are published by a few different groups, including the American Thyroid Association, the American Association of Clinical Endocrinologists, the Endocrine Society, and so on. According to the specialist standard of care,...

Subacute Thyroiditis A Pain in the Neck

Subacute thyroiditis is also known as painful thyroiditis and de Quervain's thyroiditis, after the Swiss physician who first described it. This form of thyroiditis seems to be particularly prevalent in North America although still quite uncommon. It's suspected that subacute thyroiditis has a viral cause, but there is not yet sufficient real proof that this condition is viral in origin. The condition ranges from extremely mild to severe and runs its own course the way a normal flu virus would....

Thyroid and What Does It Do

I (Ken) am often amazed, when talking with educated and articulate patients, some of whom have received years of medical treatments for a thyroid disorder, how little they know about their thyroid gland. This chapter describes the thyroid gland, covering its development, location in the body, and function. You will see how it produces thyroid hormone and what role this critical hormone plays in your body. I discuss the body's natural control systems, including the pituitary thermostat, which...

Tests That Measure Thyroid Hormone Levels

As we discussed in Chapter 1, the major thyroid hormone made by the thyroid gland is thyroxine (T4), which is known as levothyroxine (L-T4) when given as a medication. T4, called this because each T4 molecule has four iodine atoms, is converted within each cell of the body to triiodothyronine (T3, containing only three iodine atoms for each molecule). T3 is the active thyroid hormone that activates genes and does the job of thyroid hormone. When additional iodines are removed (for example,...

Tests of Metabolism

The classic test of the body's metabolism, its speed of life, is called the basal metabolic rate, the BMR. Before there were blood tests to measure TSH levels or thyroid hormone levels, the only way physicians could objectively assess thyroid status was to check the BMR. This test involves the patient resting comfortably in bed, preferably early in the morning, and then having a plastic hood placed over his or her head. A machine would then sample air from the hood and measure the rate that...

Natural Thyroid Hormone

Natural thyroid hormone, consisting of dried extracts of pig thyroid glands, is available by prescription under the brand name Armour. This is what my grandmother took years ago, along with millions of other thyroid patients of yesteryear. The patients who take it usually do just fine, but patients on natural thyroid hormone remain less balanced than those taking pure levothyroxine sodium, which offers precise dosing designed to keep people well balanced. The problem with natural thyroid...

Thyroid Tissue in the Wrong Place

In extremely rare cases, a woman's ovary can contain a teratoma, a piece of the ovary containing an assortment of tissues that resemble other body parts. These teratomas can contain thyroid tissue (struma ovarii) that becomes spontaneously overactive and produces enough thyroid hormone to cause thyrotoxicosis. Sometimes these teratomas are cancerous and can spread within a woman's body. Thyroid cancers can take up iodine and make thyroid hormone however, they are usually so inefficient in...

What Happens in Graves Disease

In Chapter 5, we described what happens in autoimmune disease and how the autoimmune response is triggered. With Graves' disease, an abnormal antibody is produced, called TSA (thyroid stimulating antibody), also known as TSI (thyroid stimulating immunoglobulin). TSA stimulates the thyroid gland to vastly overproduce thyroid hormone. Normally controlled by the pituitary gland, the thyroid's triggers are tricked into being stimulated by abnormal antibodies. This particular trigger is the thyroid...

The Pembertons Maneuver

When examining a goiter, it is important to see if it is blocking the vital structures passing between the neck and the chest (the thoracic inlet), such as the windpipe, esophagus (gullet), carotid arteries, and jugular veins. The technique, briefly described in Chapter 2, is called a Pemberton's maneuver. Here, a doctor will have you stand in front of him or her, looking straight ahead while the doctor looks at your neck. Next, he or she will have you raise your hands straight up in the air,...

Hot Nodules

Following the assessment plan described in the beginning of this chapter, this section deals with the hot nodule. This means that your TSH is suppressed (under 0.2) and you have a nodule in your thyroid gland. In addition, you have had a radioactive iodine thyroid scan (using I-131 or I-123) or a radioactive technetium thyroid scan. This scan should reveal that the nodule that is felt in the gland directly corresponds to a hot focus of radioactive tracer concentration seen in the thyroid scan....

What Causes Autonomous Toxic Nodules ATNs

As discussed in Chapter 1, each thyroid cell called a follicular cell has specialized proteins in its cell membrane skin that are receptors for TSH. When TSH is released by the pituitary gland because thyroid hormone levels are too low, it travels around in the bloodstream until it finds these TSH receptors in the thyroid follicular cell membrane and sticks there. When TSH is bound to the TSH receptor, the receptor is activated. The activated TSH receptor turns on the thyroid follicular cell,...

T3 Specific and Limited Uses

T3, also known as triiodothyronine, is the active form of thyroid hormone. It is available in pill form as liothyronine sodium (L-T3) or Cytomel (the only brand in North America). As discussed in Chapter 1, only 20 percent of the thyroid hormone made by the thyroid gland is T3, the rest being T4. Most of the T3 in each cell of the body comes from T4 that has been converted into T3 while inside that cell. This T3, inside of each cell, does essentially all of the things that thyroid hormone is...

Use of Stable Iodide to Treat Hyperthyroidism

Although, on one hand, thyroid hormone is made with iodine, very high doses of iodine will block the formation of thyroid hormone by the thyroid. This is an important use of iodine, as a saturated solution of potassium iodide (SSKI), blocking both the incorporation of iodide into thyroid hormone and the release of thyroid hormone already produced. To prevent the chance that it might serve to make more thyroid hormone, SSKI is usually not used until a thionamide (see earlier in this chapter) has...

Hypothyroidism

In adults, hypothyroidism can range from a minor annoyance, easily remedied, to a major medical problem with important, yet temporary, consequences. On the other hand, hypothyroid newborns and infants risk permanent mental retardation if thyroid hormone therapy is not started right away. To combat the effects of iodine deficiency on causing hypothyroidism in the developing countries, the World Health Organization and a number of social service organizations have made iodine supplementation an...

Autonomous Toxic Nodules in Children

Autonomous toxic thyroid nodules ATNs are quite rare in young children but sometimes are seen in children after puberty. As discussed in Chapter 8, ATNs are caused by mutations in the TSH receptor in a thyroid cell that turn it on without needing TSH. This cell eventually divides and grows into many such cells, forming a nodule. When the nodule becomes large enough to make thyroid hormone levels too high, it can cause all of the symptoms seen in Graves' disease, except that there is no...

Resistance to Thyroid Hormone RTH or Thyroid Hormone Resistance

The story of resistance to thyroid hormone (RTH) started forty years ago with my (Ken) mentor, Dr. Samuel Refetoff. As an astute medical resident in a Los Angeles emergency room, he examined a six-year-old girl after she'd been in an automobile accident. This child had a goiter, bones that appeared to be those of a younger child (on x-ray exam), and was a deaf-mute. Such findings would typically make a physician suspect the child to have had severe hypothyroidism since birth however, Dr....

Why Is the Conversion Problem Theory Harmful

The T4 T3 conversion problem statements are used to support the theory that natural thyroid hormone, questionable herbal concoctions that help with T4 T3 conversion, or regular and chronic T3 supplementation is preferable to, or healthier than, taking levothyroxine sodium (factory-made T4) at the appropriate dose. Thyroxine (T4) is the major product of the thyroid gland and is essentially a prohormone with minimal (if, debatably, any) activity of its own. It has a long and stable half-life in...

Euthyroid Sick Syndrome as a Cause of Low Grade Hypothyroidism

There is a condition known as euthyroid sick syndrome (ESS). Some books create the false impression that this is the cause of Wilson's syndrome, a fake disease that we discuss further. ESS is a leftover term from the days when T4 levels were measured using tests that sometimes failed to provide an accurate picture of the free T4 levels. When patients were severely ill, such as in a coma in the intensive care unit or on a ventilator in the burn unit, various body factors were released that made...

True Grit The Symptoms of TED

Typical TED symptoms are caused by inflammation of the eye tissues the eyes become painful, red, and watery with a gritty feeling. Sensitivity to light, wind, or sun is also common. The grittiness and light sensitivity worsen with lid retraction when your eyes are less protected by the eyelids from dust, wind, and infection, you really feel it. Other symptoms include discomfort when looking up or to the side. And while some Graves' disease patients suffer from excessive watering of the eyes,...

Thyroid Gland

A goiter is an enlarged thyroid gland. Many years ago, people's thyroid glands were large enough to see at a glance. Goiters were considered signs of beauty, i often depicted in paintings of Peter Paul Rubens, the seventeenth-century Flemish painter. In the late 1980s, while traveling through Italy, I (Ken) saw that nearly every Etruscan funeral urn in Sienna depicted a figure with a prominent goiter. Most of these goiters were the result of iodine deficiency, most severe in the Alpine regions...

Thyroiditis

Thyroiditis means inflammation of the thyroid gland. Hypothyroidism can develop from thyroiditis, and the most common cause of thyroiditis is an autoimmune disease known as Hashimoto's thyroiditis, which we discuss thoroughly in Chapter 5. In fact, Hashimoto's disease is the most common cause of hypothyroidism in North America. There are other kinds of thyroiditis that are different from Hashimoto's thyroiditis that can cause either hypothyroidism or hyperthyroidism (see Chapter 5), including...

Enlarged Thyroid Gland

As discussed in Chapter 1, an enlarged thyroid gland is called a goiter, where your thyroid will enlarge and may swell in the front of your neck. Thyrotoxic goiters develop because of hyperthyroidism. Here, a goiter develops because too much stimulation of the thyroid causes the gland to enlarge. In extreme cases, a goiter can swell to the diameter of a grapefruit. The appearance of the thyroid gland is very helpful for determining the cause of the thyrotoxicosis. In Graves' disease (see...

Treating Hyperthyroidism

Treatment for hyperthyroidism depends on the cause and can involve decreasing the function of the thyroid gland using radioactive iodine, surgery in the case of large goiters that may be multinodular, or just alleviating the symptoms of thyrotoxicosis in cases where thyroiditis is the cause, which frequently resolves on its own. Details of treatment and management of these conditions can be found in Chapter 5, on Hashimoto's disease (for treating Hashitoxicosis) and thyroiditis Chapter 6, on...

Anatomical Assessment

The following chart outlines how we classify the size of a goiter. A goiter is felt on exam but not able to be seen when the neck is fully extended. A goiter is felt on exam and also visible only when the neck is fully extended. The goiter is visible when the neck is in a normal position, and exam isn't needed. The goiter is large enough that it can be seen easily at some distance away. The normal size of a thyroid gland is measured in weight (grams), roughly corresponding to the same volume...

Reflexology

Western reflexology was developed by Dr. William Fitzgerald, an American ear, nose, and throat specialist, who described reflexology as zone therapy. But in fact reflexology is practiced in several cultures, including Egypt, India, Africa, China, and Japan. In the same way as the ears are a map to the organs in Chinese medicine, with valuable pressure points that stimulate the life force, in reflexology, the hands and feet play the same role. For example, on a reflexology map the thyroid gland...

Coping with Fatigue

If you look at the list of symptoms in Chapter 3 that comprise hypothyroidism, as well as the symptoms of exhaustion in thyrotoxicosis (see Chapter 4), many of them can exacerbate normal fatigue that is part of daily life. Hypothyroid symptoms can also be confused with chronic fatigue. This chapter discusses normal versus unusual or chronic fatigue, and suggests ways to manage both fatigue that is thyroid-related and fatigue that is unrelated to but can aggravate your thyroid condition. It's...

Parathyroid Hormone and Calcium Regulation

Here's a glimpse of a day in the life of normal parathyroid glands. The parathyroid glands make parathyroid hormone (PTH). PTH works on two major body organs the kidneys and the bones. PTH tells the kidneys to keep calcium in the blood and, at the same time, instructs the kidneys to release phosphorus into the urine. This raises calcium while lowering phosphorus in the blood. PTH also converts vitamin D from less active to more active forms. Activated vitamin D works on the intestines, helping...