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Thyroid Problems

How Do I Know If I Have Them?

A doctor can diagnose hyperthyroidism and hypothyroidism by testing the levels of thyroid hormones in your blood. Doctors measure hormones secreted by the thyroid itself, as well as thyroid-stimulating hormone (TSH), a chemical released by the pituitary gland that triggers hormone production in the thyroid.

When you are hypothyroid, higher quantities of TSH are circulating in your blood as your body attempts to foster increased production of thyroid hormones. The reverse is true with hyperthyroidism, in which TSH levels are below normal and circulating thyroid-hormone levels are high.

To determine the cause of hyperthyroidism, doctors often use radioactive iodide uptake tests, which track the amount of iodide absorbed by the thyroid gland. Iodide, obtained from the foods we eat, is a key ingredient in the manufacture of thyroid hormone, so the amount of iodide the thyroid absorbs is a reliable indicator of how much hormone the gland is producing. For this test, you must swallow a small amount of radioactive iodide in liquid or capsule form. After a predetermined wait, the doctor places an instrument over your neck to measure how much of the radioactive iodide has gathered in your thyroid.

If the results of this test suggest that the gland is collecting excessive amounts of iodide, the doctor may then conduct a radioactive iodide uptake scan. In this test, the doctor uses a special film to create a picture that shows the exact location of the radioactive iodide in your thyroid gland. The scan will reveal, for example, if the iodide is collecting in adenomas, indicating that the nodules are responsible for the excess hormone. If the scan shows that the iodide is spread equally throughout the tissue, the whole thyroid is involved in the excess production.

Some doctors believe that blood tests may not be sensitive enough to detect milder forms of hypothyroidism. Instead, they advocate monitoring your body's basal (resting) temperature. To track your basal temperature accurately, you must closely follow certain guidelines: Shake the thermometer below 95° F at night and place it where you can reach it without getting out of bed. The following morning, before you get out of bed, take your temperature via your armpit for 10 minutes while staying as still as possible. Keep records of your temperature for at least three days. (Women should do this during the first two weeks of the menstrual cycle, as their basal temperature may rise during the latter half.) Normal basal body temperatures fall between 97.4° F and 97.8° F. If your basal temperature is consistently low, you could be mildly hypothyroid.

If you have one or more adenomas, your doctor will want to keep careful records of when they were first found and how they develop, since not all adenomas produce excess thyroid hormone. In fact, most of these nodules are not malignant, especially if they remain the same size over long intervals. (Cancerous tissue, by contrast, will undergo noticeable growth.) Nodules that appear suddenly are typically fluid-filled cysts and are often benign. They can be evaluated with a noninvasive ultrasound exam. If blood tests indicate that the nodules are producing excess thyroid hormone, and if you have other symptoms, your doctor will treat you for hyperthyroidism.

In any case, you should receive periodic checkups if you have a nodule on your thyroid gland, since you may become hyperthyroid in the future. If your blood tests show elevated hormone levels, your doctor may recommend other tests, including radioactive iodide uptake tests and scans that indicate whether the nodules are "hot" or "cold." Hot nodules, or those that are actively trapping iodide and producing too much thyroid hormone, are rarely cancerous. But cold nodules — those showing low iodide concentrations — indicate a possible malignancy and need to be investigated further.

One type of thyroid cancer can be diagnosed through a simple blood test that measures levels of a hormone involved in bone formation. In most cases, however, doctors check for thyroid cancer by performing an aspiration, or biopsy, which involves drawing cells from the suspect nodule with a fine needle to determine if the tissue is malignant.

What Are the Treatments?

For thyroid disorders stemming from the over- or underproduction of thyroid hormones, both conventional and alternative treatments offer varied methods to restore hormone levels to their proper balance. Conventional treatments rely mainly on drugs and surgery. Alternative treatments attempt to relieve some of the discomfort associated with thyroid problems, or to improve the function of the thyroid gland through a variety of approaches ranging from diet supplements and herbal remedies to lifestyle changes and special exercises. You should always receive a professional evaluation for any thyroid disorder; most of these conditions require a course of treatment beyond the scope of home care alone.

Conventional Medicine
Treating hyperthyroidism requires suppressing the manufacture of thyroid hormone, while hypothyroidism demands hormone replacement. Conventional medicine offers extremely effective techniques for lowering, eliminating, or supplementing hormone production. Before deciding which treatment is best for you, your doctor will make an evaluation based on your particular thyroid condition as well as your age, general health, and medical history.

Thyroid hormone production can be suppressed or halted completely with a radioactive iodide treatment, antithyroid medication, or surgery. If your doctor decides that radioactive treatment is best, you will be asked to swallow a tablet or liquid containing radioactive iodide in amounts large enough to damage the cells of your thyroid gland and limit or destroy their ability to produce hormones. Occasionally, more than one treatment is needed to restore normal hormone production, and many patients actually develop hypothyroidism as a result of this procedure. This is the most common therapy for hyperthyroidism in the United States.

If you start using antithyroid medications such as propylthiouracil or methimazole, which are usually administered in tablet form, your hyperthyroid symptoms should begin to disappear in about six to eight weeks, as hormones already in your system run out and the medication starts to impair the thyroid's hormone production. However, you will need to continue taking the medication for about a year. After that time, you will also need to receive periodic medical exams to make sure that the condition has not returned.

Surgery is often recommended for people under 45 when their hyperthyroidism is due to toxic adenomas, since these nodules tend to be resistant to radioactive iodide. Once the tissue is removed surgically, hormone levels typically return to normal within a few weeks.

Although subacute thyroiditis can bring on temporary hyperthyroidism, this condition usually does not require medical treatment. Any pain associated with the inflamed thyroid can generally be relieved with acetaminophen or aspirin. If over-the-counter drugs don't help, a doctor may prescribe prednisone or dexamethasone — powerful anti-inflammatory drugs — for a short period of time. Since both of these drugs may encourage the development of stomach ulcers and the loss of bone mass, however, ask your doctor if you should also be taking calcium supplements.

Hypothyroidism calls for a lifelong regimen of thyroid replacement. No surgical techniques or conventional drugs can increase the thyroid's hormone production once it slows down. Although hormones from animal extracts are available, doctors generally prescribe synthetic forms of thyroid hormone, such as levothyroxine. Side effects are rare, but some people experience nervousness or chest pain while taking these drugs; usually, adjusting the levels of medication will alleviate any unpleasant effects.  However, if you are also taking tricyclic antidepressants, estrogens, the blood thinning drug warfarin, the heart drug digitalis, or if you have diabetes, make sure that you and your doctor discuss any possible interactions or other complications.  If you take calcium supplements, it is also recommended to take it 4 hours apart from levothyroxine, as calcium inhibits its absorption.

Thyroid cancer is usually treated by surgically removing either the cancerous tissue or the whole thyroid gland, a procedure known as a thyroidectomy.  If the cancer has spread beyond the thyroid, any other affected tissue, such as the lymph glands in the neck, will also be removed.

Alternative Medicine
Thyroid problems are usually easily corrected with conventional medicine. Consult your endocrinologist about complementing your conventional treatment with alternative therapies, which aim to cleanse the system, restore immune function, and balance hormone production and release.

Naturopathy and TCM
A naturopath may treat your thyroid condition with homeopathic mixtures, herbs, preparations based on traditional Chinese medicine (TCM), and acupuncture.

TCM considers thyroid disease to result from emotional distress and frustration. These block the life force energy (qi) in the liver and spleen; herbs and acupuncture release the qi. Acupuncture can reduce palpitations, irritability and insomnia.

Naturopaths are authorized to treat thyroid disease in some states; in others it is illegal. Check with your doctor or local health authority to see if your state allows naturopathic interventions.

Body Work and Nutrition
Chiropractors and osteopaths use spinal manipulation to treat thyroid disorders by reducing muscle tension and improving blood circulation.

A diet rich in protein, calcium, magnesium, and iodine supports thyroid function. You want to be sure you are receiving enough of all the B vitamins, vitamin A, vitamin C and selenium.

Avoid these products if you suffer from thyroid disease:

• The herb ephedra, found in herbal formulas, and its extracts ephedrine and pseudoephedrine, found in over-the-counter cold remedies, which can cause nervousness, insomnia, headache, and high blood pressure
• Alkaloids, including substances such as caffeine, morphine, and quinine, which increase blood pressure and heart rate

 

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