Thyroid Diseases and Conditions

There are a number of conditions that can affect the thyroid, its function and structure...

Hypothyroidism/Underactive Thyroid

Hypothyroidism means that the there is too little thyroid hormone. This can be due to a missing or undeveloped thyroid, a surgically removed thyroid, or a thyroid that is not capable of producing enough hormone due to radioactive treatment, drugs, nutritional deficiencies, nodules, infection, or atrophy. Symptoms of hypothyroidism tend to mirror the slowed metabolism that results from insufficient thyroid hormone, and include fatigue, weight gain, constipation, fuzzy thinking, depression, body pain, slow reflexes, and much more.

Conventional treatment typically involves replacing the missing thyroid hormone using prescription thyroid hormone replacement drugs. Most commonly, a levothyroxine (T4) drug is prescribed, as this is considered the "standard" treatment for hypothyroidism. The most prescribed levothyroxine drug is Synthroid, however, the other name levothyroxine drugs (including Levoxyl and Levothroid) are considered equivalent in quality, potency and effectiveness, and are less expensive.

Research has shown, however, that some patients feel better with the addition of a second hormone, T3, and so some numbers practitioners are prescribing either levothyroxine plus a synthetic T3 (Cytomel), or less commonly, levothyroxine plus specially compounded T3.

Another option is a synthetic T4 plus T3 combination drug known as liotrix (Thyrolar). While this drug is not very commonly prescribed, it is a safe and effective option for some patients.

Finally, some practitioners and patients prefer natural, desiccated thyroid, which has been available for treating hypothyroidism for 100 years. The most known brand is Armour Thyroid, others include Nature-throid and Biotech. While some physicians disparage natural thyroid and claim that it's less effective than synthetic thyroid drugs, other practitioners and patients prefer these FDA-regulated natural drugs.

Hyperthyroidism/Overactive Thyroid -- Thyrotoxicosis

Thyrotoxicosis refers to the various effects of exposure to too much thyroid hormone. Hyperthyroidism implies that this excess of hormones originated in the thyroid gland itself, and not, for example, by taking too much of your thyroid medication. Hyperthyroidism can be caused by a number of thyroid problems, including autoimmune thyroid disease, nodules that produce thyroid hormone, overdosage of thyroid hormone replacement drugs, infection, and other causes. Hyperthyroidism is typically treated by drugs to reduce the thyroid's ability to produce hormone, by radioactive iodine treatment to chemically ablate the thyroid, or by surgery.

Symptoms of hyperthyroidism tend to mirror the rapid metabolism that results from an oversupply of thyroid hormone, and include anxiety, insomnia, rapid weight loss, diarrhea, high heart rate, high blood pressure, eye sensitivity/bulging and vision disturbances, and many other concerns.

Conventional treatment in the U.S. focuses on disabling the thyroid permanently, by administering radioactive iodine (RAI) treatment, which renders most patients hypothyroid for life. Some physicians in the U.S. use prescription antithyroid drugs such as propylthiouracil (PTU) and methimazole (Tapazole) and beta blockers to calm down the thyroid and the immune system, with the hope of remission of the disease, which occurs in as many as 30% of patients. (Antithyroid drugs are the first choice, however, for doctors outside the U.S.) In rarer cases in the U.S., and more commonly outside the U.S., surgery to remove the thyroid may be the treatment. Holistic and integrative treatments prior to RAI or surgery focus on supplementing antithyroid drug approaches with natural antithyroid foods, supplements and herbs that have no side effects, as well as calming and rebalancing the immune system through nutrition, herbs, supplements, movement therapy such as yoga, and energy work. Ultimately, most people with Graves' disease and hyperthyroidism do end up hypothyroid for life as a result of RAI or surgery.

Autoimmune Thyroid Disease

There are two different autoimmune diseases in which an immune system dysfunction targets the thyroid - Graves' disease and Hashimoto's disease. In the United States, the vast majority of thyroid patients are either hypothyroid or hyperthyroid due to an autoimmune disease.

Hashimoto's disease is the most common form of thyroiditis, an inflammation of the thyroid, and so the condition is also often referred to as Hashimoto's thyroiditis. It is far more common than Graves' disease, and is the cause of most hypothyroidism in the U.S. In Hashimoto's, antibodies react against proteins in the thyroid, causing gradual destruction of the gland itself. Occasionally, before the thyroid is destroyed, it has thyrotoxic periods -- known as Hashitoxicosis -- during which the thyroid overproduces thyroid hormone. Eventually however, the gland's attack on itself destroys the ability to produce the thyroid hormones the body needs.

Symptoms of Hashimoto's disease usually parallel the hypothyroidism that results, however, the thyroid can periodically sputter into life during Hashitoxic periods, causing hyperthyroidism symptoms. For most people, treatment is for hypothyroidism and involves life-long thyroid hormone replacement. Holistic and integrative approaches tend to look at healing the underlying autoimmune imbalance, and may include nutritional support for the thyroid (i.e., selenium, tyrosine, B vitamins, etc.) and overall support for the immune system.

Graves' disease -- sometimes referred to as diffuse toxic goiter because of the usual presence of a goiter -- typically causes hyperthyroidism. In the U.S., it's thought that Graves' disease and hyperthyroidism affect slightly less than 1 percent of the US population, or slightly less than 2.9 million people. Some experts believe, however, that as many as 4 percent of Americans, or 11.8 million people, may have a mild, subclinical Graves' disease, with few or no symptoms, but exhibit blood test evidence of slight hyperthyroidism.

In Graves' disease, autoantibodies bind to the gland, which causes the thyroid to overproduce hormone, and cause hyperthyroidism. Treatment for Graves' disease follow hyperthyroidism treatment, and involves antithyroid drugs, radioactive iodine ablation, or surgical removal of the thyroid. Most Graves' disease patients end up hypothyroid over time, requiring life-long thyroid hormone replacement.

Goiter/Enlargement

Goiter is the term used to describe an enlargement of the thyroid gland. The thyroid gland can enlarge as a response to deficiencies of iodine, thyroid inflammation or infection, or autoimmune disease. The thyroid becomes large enough so that it can be seen as enlarged on ultrasounds or x-rays, and may be enlarged enough to thicken the neck area visibly. Particularly large goiters may be cosmetically problematic, and can compromise breathing and swallowing, and are often surgically removed. Smaller goiters may respond to drug treatment.

Symptoms of goiter include a swollen, tender or tight feeling in the neck or throat, hoarseness or coughing, and difficulty swallowing or breathing.

Goiter can be due to an autoimmune condition that triggers an inflamed thyroid, or due to too much or too little iodine in the diet. In the U.S., 10 to 20 percent of goiters are iodine-induced.

Treatment for goiter depends on how enlarged the thyroid has become, as well as other symptoms. Treatments can include:

• Observation and monitoring, which is typically done if your goiter is not large and is not causing symptoms or thyroid dysfunction
• Medications, including thyroid hormone replacement, which can help shrink your goiter, or aspirin or corticosteroid drugs, to shrink thyroid inflammation.
• If the goiter is very large, continues to grow while on thyroid hormone, or symptoms continue, or the goiter is in a dangerous location, i.e., the windpipe or esophagus, or cosmetically unsightly, most doctors will recommend surgery. If the goiter contains any suspicious nodules, you may also need surgery.