Thyroid Disorders

Source: Adapted from Knowing Your Options: The Definitive Guide to Choosing The Medical Treatments, Reader’s

What are thyroid disorders?

Although small (only two inches across), the butterfly-shaped thyroid gland plays a huge role in controlling your body’s basic metabolic rate, the speed at which essential chemical functions take place in your cells. The thyroid does this by secreting hormones that stimulate your tissues into using more oxygen, producing more protein, and generally working harder. If anything goes awry with this vital, double-lobed gland at the base of your throat, the resulting havoc is felt throughout your body.

Sometimes the gland puts out too much hormone, making all your systems rev up into overdrive. This disorder is known as hyperthyroidism. More common, however, is its polar opposite, hypothyroidism, which occurs when the gland releases too little thyroid hormone. Because this natural chemical affects every system in your body, when there’s not enough of it, everything s-l-o-w-s d-o-w-n. The predominant symptom, not surprisingly, is a sense of mental and physical sluggishness. Muscle aches, constipation, weight gain, dry skin and hair, and a feeling of being cold all the time often occur.

Who is at risk for thyroid disorders?

Hypothyroidism is about four times more common in women than in men. It is a particular risk for postmenopausal women.

Common types of hypothyroid disease are caused by mild autoimmune disorders in which the thyroid is the sole victim of an attack by the body’s immune system. (Hashimoto’s thyroiditis is an example of this phenomenon.) Less often, the pituitary gland in your brain fails to produce enough thyroid-stimulating hormone (TSH), the chemical that prompts the thyroid to work. Hypothyroidism can develop when that happens. While hypothyroidism frequently runs in families, it also appears for no obvious reason. Sometimes an underactive thyroid will follow treatment for an overactive one (surgery may remove too much of the gland, or radiation can affect hormone production). If other hormones are disturbed elsewhere (as in pregnancy or menopause), hypothyroidism may result.

Treatment for thyroid disorders

Because hypothyroidism means your body is getting too little thyroid hormone, the goal of treatment is simple: You’ll need to compensate for low thyroid levels by taking a replacement hormone. This daily oral medication will be necessary as long as the condition persists—in most cases, for the rest of your life. The trick is to adjust the dosage to your body’s particular needs. Your doctor will probably start you on a small amount of replacement hormone, then gradually increase your dosage as needed. Follow-up blood tests measuring TSH levels will help guide your treatment. If your hormone dosage is too low, your pituitary gland will be pumping out lots of TSH to try to get your thyroid working. As your dosage increases, your pituitary will pump out less and TSH levels will fall.

It usually takes a month or two to get the dosage exactly right. Then, every year, you’ll need to get your TSH and other thyroid levels measured to be sure your dosage is still correct. If all goes well, you’ll feel more alert and energetic in just a few weeks, and like your old self in several months. Be aware that if you stop your medication or alter your daily dosage, troublesome symptoms will inevitably reappear, and it can take weeks to get back in balance again.

Medications for thyroid disorders

If you have hypothyroidism, your doctor will most likely prescribe a synthetic thyroid drug consisting of a single hormone called T4. The body converts this to an active form called T3. Known as levothyroxine, this medication is available under several brand names, including Synthroid (the oldest and most widely prescribed), Unithroid, Levothroid, Levoxyl, and Euthyrox. Choose a brand and stay with it. Switching around is not advised, since small differences in potency between levothyroxine products may affect how you feel.

Some people, typically those who are older, lack enough of a certain enzyme that is key to the T4 to T3 conversion process. For them, a good alternative may be natural thyroid hormone, often referred to as Armour thyroid extract. This medication supplies both T3 and T4 and doesn’t require the body to convert hormones. Natural thyroid hormone is derived from the desiccated (dried) thyroid glands of cows and contains some dose-to-dose inconsistencies. However, people who have taken it for years (and done well) are often loathe to change to a synthetic drug.

Many doctors prefer the newer synthetic thyroid hormone. Liotrix (Thyrolar), for example, supplies both T3 and T4 as natural hormones do, but doesn’t pose the same risk of tablet-to-tablet variation in its hormone concentration. The synthetic forms also produce thyroid hormone levels that are easier to measure and track through standard blood tests.

If you take levothyroxine alone but just don’t feel completely well, your doctor may suggest adding a synthetic form of T3, called liothyronine (Cytomel, Triostat), to your regimen. This combination seems to work for a few select patients.

Lifestyle Changes

These self-care strategies can help manage your thyroid disorder:

• Set a schedule. Some experts say the ideal time to take your pill is first thing in the morning, at least 30 minutes before eating.
• Get exercise. Physical activity will stimulate your thyroid gland and help it absorb the hormone.
• Eat high-fibre foods if you’re constipated, but don’t overdo it: Too much fibre may inhibit absorption of thyroid hormone.
• Choose low-calorie foods to promote weight loss, but don’t go on a severe diet: Too little food lowers metabolism even further.
• Get enough iodine—from iodized salt and foods such as shellfish and saltwater fish. This mineral helps the thyroid function.
• Avoid thyroid-fighting foods, so-called because they contain substances (goitrogens) that interfere with iodine absorption and suppress thyroid activity. These include raw cruciferous vegetables (such as broccoli, cauliflower, and cabbage), raw peanuts, and soybeans. It’s safe to eat these nutritious foods, however—just cook them. Heat takes the fight out of them.

Related Procedures for Thyroid Disorders

A goiter, an enlarged thyroid gland that produces a bulge in the neck, can develop in some cases of hypothyroidism as well as hyperthyroidism. If you have a goiter that is interfering with breathing or swallowing, you may need surgery to remove it.

Alternative Therapies for Thyroid Disorders

People with hypothyroidism tend to develop elevated levels of the amino acid homocysteine. This can be a risk factor for heart disease. Vitamins, specifically folic acid and B12, will lower homocysteine levels. Taking a vitamin C and a B-complex capsule can improve thyroid function and help regulate your immune system.

Questions for Your Doctor

• Will I have to take medicines for the rest of my life?
• Is it worth trying natural thyroid hormone instead of the synthetic form?

Living with Thyroid Disorders

If you’re living with a thyroid disorder, here are a few quck tips to help you take control:

Stay on your medication. No matter how good you feel, don’t stop taking your medicine, or you’ll start feeling droopy and sick again.

Consciously monitor how you feel. If you’re still chronically tired after taking the hormone for a while, you may not be getting enough. If you’re restless or sweating, you may be getting too much. Either way, talk with your doctor.

Check your own thyroid. Occasionally use your thumb and fingertips to press very gently along the front of your neck just below the Adam‘s apple. Feel for lumps and bumps, which may signal thyroid trouble.

Remind your doctor about all the medications you’re taking. A variety of prescription drugs, including estrogen, tamoxifen, and lithium, can affect thyroid hormone levels.