Unlocking the Mysteries of Thyroid Disease

Understanding this tiny gland and its importance: A comprehensive Handbook to guide you on Your Doctor’s Visit and your Search for Better Health.

Table of Contents

1. The Thyroid Gland
2. Your thyroid gland? Where it’s at? What’s its Function?
3. Some Thyroid Facts
4. Hyperthyroidism
5. Hyperthyroidism symptoms and treatments
6. What if your diagnosis is Hypothyroidism
7. Hypothyroidism symptoms and treatments
8. Questions to ask the Doctor
9. How do thyroid issues affect women & pregnancy?
10. Symptoms Checklist
11. Source List and Links

The Thyroid gland

Your thyroid gland? Where it’s at? What’s its Function?

Your thyroid is located just below your “Adam’s apple” or larynx. This gland originates in the back of your tongue, but normally moves or migrates to the front of the neck before birth. The purpose or function of this gland is to take iodine, found in many foods that we eat, and convert or change it into thyroid hormones: thyroxine (T4) and trilodothyronine (T3). Thyroid cells are the only cells in your body, which can absorb iodine.

The thyroid gland is under the control of another gland. The gland that controls the thyroid is the pituitary gland, a small gland the size of a peanut at the base of the brain. When the level of thyroid hormones, T3 and T4 drop, this gland produces Thyroid Stimulating Hormone called TSH, which stimulates the thyroid to produce more hormones.

Some Thyroid Facts

1. You need a doctor to give you a proper diagnosis and treatment of your thyroid. You may need to seek the advice of a specialist to treat your thyroid problems. Let a skilled endocrinologist or general practice physician diagnose your condition.  A complete physical examination combined with the right tests; are the first steps to understanding how and what your symptoms reveal.
2. Your thyroid condition, if you’re a woman, can prevent you from becoming pregnant.
3. Your thyroid problem can also be an autoimmune disease, or may be combined with an autoimmune disease.
4. You may have fibromyalgia or chronic fatigue syndrome, which are not thyroid diseases, but mimic hypothyroidism.
5. You and your Doctor’s time are important. Make sure that your doctor answers all of your questions and takes the necessary time to speak with you without rushing you out of his office. Come prepared for the appointment with specific questions and concerns you have, as well as a detailed list of symptoms. Preferably in writing.
6. Normal results from thyroid panel blood tests do not mean your thyroid is normal. Unique blood tests, sonograms, and toleration testing may be needed for proper diagnosis, and those should be performed by a specialized clinic in order to properly assess your condition. In addition, what’s considered “normal” in the overall population may not be “normal” for you.
7. Make sure that your doctor is well versed on the new thyroid stimulating hormone normal test. When going for thyroid tests or any medical tests – you should ask what each test is for, why it is being taken and the results that are expected. ALWAYS get the exact results from your medical tests and keep them in a file like your taxes. They’re more important!

What is Hyperthyroidism?

Hyperthyroidism: Do you ever feel like you cannot sit still? Are you always jittery, nervous or doing things non-stop? Are you anxious, short tempered and losing weight for no reason? Take a deep breath and think about the fact that something might just be wrong.

Hyperthyroidism causes your thyroid to create more hormones that your body needs. Another term for this is overactive thyroid or Graves’ disease. It is an autoimmune disorder, in which the body’s own defense system, or immune system, stimulates the thyroid causing it to produce too much of the thyroid hormones. Thyroid nodules that speed up the excess thyroid hormones can also cause it.

Symptoms:

Pay Attention to gradual changes in your body:

It is not unusual for many sufferers to not pay attention or notice the symptoms at first. Symptoms many times begin slowly and then progress over time, ultimately causing a speeding up of your metabolism which results in the following symptoms:

1. Weight loss even though you have not started a diet or changed the way you eat.
2. Eating more than usual and more frequently
3. Rapid or irregular heartbeat
4. Anxiety, sometimes panic attacks
5. Irritable behavior and mood swings
6. Your hands and fingers tremble, skin problems develop
7. You sweat more, or cannot control your body temperature
8. More sensitive to heat
9. Muscles feel weak
10. More frequent bowel movements
11. Less frequent menstrual periods with lighter than normal flow
12. Some even developed osteoporosis, or weak, brittle bones. It might affect your bones before you exhibit any other symptoms of this disease. Especially in postmenopausal women, who are at high risk for osteoporosis?

How is Hyperthyroidism Treated?

You’ve been diagnosed with hyperthyroidism. It’s time now to get on the road to getting your symptoms under control and begin feeling better. Thyroid dysfunction and disease are as yet incurable, but highly treatable. You and your doctor must work together in tandem to determine the right course of treatment for you depending upon your symptoms, their severity, and any other health issues you may have.

NON-Invasive Hyperthyroid Treatments:

1. Beta –blockers: medications in the class of drugs known as beta antagonists, a medication that is used for a variety of reasons, including the control of hyper tension, by diminishing the effect on the body of adrenaline.  They are rarely, if ever, habit forming, but have limited effect in advanced cases of hyperthyroidism.
2. Benzodiazepines: In the class of depressant drugs, they block a specific area of receptors in the brain which the thyroid gland affects and thereby reduce the symptoms of heart palpitations, anxiety, insomnia, inability to focus and concentrate among other benefits. “Benzo’s” as they’re commonly called, can be habit forming.
3. Anti-thyroid medications: in the class of drugs known as thionamides, they are almost exclusively used for over active thyroid. Some can reverse the course of hyperthyroidism if caught early enough, and are commonly used in the control of “Graves” disease.

If you’re diagnosed with hyperthyroidism, discuss each of these drug treatments with your doctor at length before any surgical, permanent treatment or removal of your gland is considered. While most of these drugs have side effects, and can be addictive, they offer a non-surgical and reversible alternative for treatment of your symptoms.

In some cases, surgical or radioactive treatment may be necessary. The sufferer should consider their choices very carefully, and not make any decisions before they are sure they are well informed. These techniques not only can be highly dangerous if not performed well, they are also irreversible.

Keep foremost in your mind after any recommendation of surgical removal or “cleaving” (partial removal of the gland) that if you decide to remove or destroy your thyroid gland, you must take thyroid hormone pills for the rest of your life. These pills will provide your body with the thyroid hormones that your thyroid would normally make, but they are sometimes difficult to manage and find the correct dosage for. A detailed discussion again with your physician, and some Internet research on your own can greatly assist you in your decision process.

In the case of thyroid cancer, you have no option. A total thyroidectomy will be required, possibly to include follow up radioactive treatments. Routine follow up checkups are a MUST for any thyroid cancer patient. In the case of cancer, the Endocrinologist may recommend several options, including:

1. Surgery to remove most or all of the thyroid gland,
2. Radioiodine treatment to destroy the thyroid cells that produce thyroid hormones. For this specific treatment, your doctor will give you a higher dose of a different type of radioiodine than that used for the radioiodine uptake test or thyroid scans,
3. Radiation therapy,
4. Specific medications for post-surgical and ongoing treatment.

What if your diagnosis is Hypothyroidism?

What is the difference between that and hyperthyroidism?

What are the symptoms and how is that treated?

Hypothyroidism: Do you feel tired? Are you gaining weight but have not changed your diet? Do you feel sluggish? Do your muscles and joints ache? Unable to focus or think clearly? STOP! THINK! It’s time to go to the doctor and find out the cause of your symptoms before they get worse.

Hypothyroidism is the most common of all thyroid dysfunctions and diseases. It appears to affect women more than twice as much as men. It also appears to be affecting white women, who are affected at a nearly 1 in every 11 women, much more often than any other race. For example Indonesian women, who are only affected at half that rate. This highly suggests heredity as a possible primary cause of hypothyroidism.

About 95% of hypothyroidism cases occur from problems that start in the thyroid gland. In such cases, the disorder is called primary hypothyroidism. (Secondary hypothyroidism is caused by disorders of the pituitary gland. Tertiary hypothyroidism is caused by disorders of the hypothalamus.)

Hypothyroidism is a condition when your thyroid gland does not produce enough thyroid hormones, (the opposite of hyperthyroidism, where it produces too much.) A physician’s diagnosis of this condition may range from underactive thyroid to Hashimoto’s thyroiditis. Hashimoto’s is an autoimmune disease, in which the immune system attacks your thyroid, resulting in thyroid damage so severe the thyroid does not produce enough hormones. This disease can also be caused as a result of many things, including:

1. Overtreatment of hyperthyroidism
2. Radiation treatment of certain cancers
3. Total or partial thyroid removal
4. In some rare cases the pituitary gland can cause the thyroid to become less active. (secondary hypothyroidism)

What are the symptoms that signal hypothyroidism that you need to be aware of?

Like hyperthyroidism, many symptoms do not happen overnight unless surgery or radiation treatment was recently completed. They develop over several years. You might fee tired and sluggish at first. You might develop other symptoms evidencing a slowed metabolism which include:

1. Gaining weight even though you are not eating more
2. Becoming sensitive to cold
3. Constipation
4. Joint of muscle pain
5. You might feel depressed
6. Easily fatigued- constantly tired
7. Dry or pale skin
8. Puffy face
9. Hoarse voice and/or a routine sore or scratchy throat
10. For women, excessive menstrual bleeding
11. People with hypothyroidism also may exhibit high blood levels of LDL cholesterol or “ bad” cholesterol, which can increase your risk of heart disease.

Treatment:

It’s very important that you do not ignore the symptoms or this illness and get the proper treatment.

Hypothyroidism is treated with medications to supply the body with the thyroid hormones necessary to make it function properly. One medication used often is Levothyroxine. This is a man-made form of T4.

When taking T4, your body makes the T3 it requires from the T4 in the medication. A man-made form of T3 called Liothyronine is also available. Some doctors and patients prefer a combination of T4 and T3, others use T3 alone. Most patients with hypothyroidism, total thyroidectomy’s, Hashimoto’s and other hypothyroid diseases will have to remain on these or other brand thyroid hormone drugs for the rest of their lives.  Failure to maintain the minimum dosages may cause death.

Diagnosis Is the First Step in Preserving Your Health

When Do I Get Assessed?

How will you know if you have a thyroid disorder?
Remember not to ignore the changes you are going through and note in writing the symptoms that you now have that you did not have before. A simple piece of paper will suffice, but checklists of hypothyroid conditions are available across the internet.

Thyroid disorders are difficult to diagnose because their symptoms can be linked to many other health disorders or problems. Going to the doctor is the first step. Having your doctor take a complete medical history including asking if any family members have a history of thyroid disorders is the next step. Giving you a physical exam and checking your neck for thyroid nodules would follow. Depending on the symptoms you exhibit your doctor might order the following tests:

Some of the tests that can help evaluate your condition:

1. Blood tests are in order to test the level of thyroid stimulating hormone in your blood to help determine whether your thyroid is under or over active. (TSH is the hormone) Depending on the results further blood tests might be ordered to check the levels of both hormones in your blood.
2. Thyroid ultrasound or sonogram
3. Thyroid MRI scan
4. Radioactive iodine uptake test
5. Thyroid Fine needle biopsy if cancer or carcinoma are suspected

Questions to Ask Your Doctor

1. Why am I feeling so tired and sluggish? What could be causing this change? I am usually active and now I feel like all I want to do is sleep?
2. Could my symptoms that we have discussed be indicative of thyroid disease?
3. What steps do I need to take to find out what tests are in order?
4. What are the other procedures or tests that I might need?
5. How safe are these tests and procedures? Do they require any dyes or pills to be ingested? Do they have any side effects? Is there an allergic reaction possibility?
6. What is a thyroid biopsy and how is it performed? Can I stay awake?
7. What is thyroid disease, how is it treated and what are the side effects of these medications? What would happen if I did not take my medications and you just monitored me? What would happen?
8. If I have to take medication, is there any special way to take them?
9. How often do my blood levels for thyroid function need to be monitored? How long do I have to take these medications? Would there be a time that I might not have to continue with them?
10. Would surgery ever be required? When and Why?
11. Would this involve removing my thyroid? What alternative method is there?

How does thyroid disease affect women & pregnancy?Thyroid disease can be related to women’s hormones. It can affect menstrual cycles, fertility, estrogen/progesterone levels, and successful pregnancies. It can even cause a miscarriage, the ability to breastfeed and menopause.

Grave’s Disease can occur during pregnancy about 5% of the time.

Hyperthyroidism is most often due to Graves’ disease, but can disappear after term. However, Hyper and Hypo thyroidism can make it more difficult for you to become pregnant. Hyperthyroidism must be properly treated or during pregnancy the following could happen:

• Early labor or premature childbirth
• Fast Heart rate of the developing infant
• Smaller babies
• Stillbirths
• Added to that if a women is not diagnosed or properly treated during pregnancy there could be increased risk for:
• Anemia
• Preeclampsia
• Low-birth weight babies
• Problems with brain development in the infant
• Excessive bleeding after giving birth

Ask you doctor if you need a thyroid test if you thinking about getting pregnant especially if there is a family history of the condition.

Checklist – These are the symptoms that should alert you to get tested:

1. Weight loss or weight gain
2. Easily tired or fatigued
3. Restlessness
4. Rapid heart beat
5. Changes in sex drive
6. Muscle weakness
7. Inability to tolerate heat or cold
8. Tremors
9. Your thyroid gland is enlarged or your neck is swollen
10. Heart Palpitations
11. Increased sweating even in a cool environment
12. Blurred or double vision
13. Irritable
14. Nervous
15. Eye Complaints: redness or swelling or sudden loss of vision
16. Hair changes or loss
17. Restless sleep or insomnia
18. Erratic behavior and mood swings
19. Larger than normal appetite
20. Easily distracted
21. Short attention span
22. Decrease in menstrual cycle
23. Increased frequency in bowel movements

Resources:
The American Thyroid Association
“Why Am I Anxious?” by Clay Ballentine, Tate Publishing, 2010
Wikipedia

http://www.emedicinehealth.com/thyroid_problems/article_em.htm
http://www.anapsid.org/cnd/thyroid/thyroid6.html

http://www.hospitalsoup.com/medical/do-you-know-when-to-get-your-thyroid-lab-testing-done

http://www.shapefit.com/thyroid-gland-facts.html

Written by Clay Ballentine: Chairman of the National Thyroid Foundation
Compiled, Outlined & Researched by Fran Lewis
Copyright: Clay Ballentine & The National Thyroid Foundation – 2010

No part of this handbook may be reproduced or used for commercial benefit or profit without the permission of the authors.

This handbook is a resource to help people understand the thyroid gland, its malfunctions and diseases. It is not intended as medical advice and should not be considered advice in any way by any person.
The authors are not physician’s, nor licensed to practice medicine. Their opinions come from self-experience in having thyroid dysfunction and disease and their resulting research.