Glossary

Acute suppurative thyroiditis a rare form of bacterial thyroiditis, where pus and inflammation occur treated with antibiotics. Adam's apple the thyroid cartilage. ALARA acronym for as low as reasonably achievable. Amiodarone a potent medicine used to treat heart rhythm disturbances, infamous for causing different types of thyroid problems. anaplastic thyroid cancer a very rare but aggressive, hard-to-treat thyroid cancer with poor outcomes accounts for about 1.6 percent of all thyroid cancers....

Contents

Introduction Why We're Passionate About Thyroid Disease xv 1 What Is the Thyroid, and What Does It Do 3 How It Formed, Where It Is, What It Does 3 An Introduction to Thyroid Hormone 9 2 Tests and Labs Diagnosing Thyroid Disease 13 Tssts That Measure Thyroid Hormone Levels 14 TSH The Most Sensitive Tsst to Assess Thyroid Hormone Status 15 Thyroglobulin The Specific Thyroid Protein 18 Thyroid Hormone-Binding Proteins 19 Measuring Thyroid Antibodies 20 Dynamic Tssts of Thyroid Function 22 X-Rays,...

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,...

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...

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...

Restlessness and Anxiety

The typical person with Graves' disease is chronically restless, to the point where he or she cannot sit still for a minute, and is terribly anxious and worried. As discussed in Chapter 4, this is partly because of the increased sensitivity to adrenergic hormones (adrenaline and related hormones) that comes with thyrotoxicosis. There is often a distinct tremor of the hands, also resulting from the adrenaline sensitivity. In Chapter 4, we discussed how thyrotoxicosis has many crossover symptoms...

Depression and Anxiety

If you look at the list of symptoms that comprise hypothyroidism (see Chapter 3) and thyrotoxicosis (see Chapter 4), many of them overlap and collide with symptoms of depression and anxiety. This chapter discusses ways to cope with and manage depression and anxiety, often a consequence of untreated hypothyroidism or thyrotoxicosis. It's important to understand that depression is a vast topic, and there are many different types of depression. For the purposes of this chapter, we'll be limiting...

Anxiety Panic Disorder and Thyroid Disease

We discuss both generalized anxiety disorder (GAD) and panic attacks in Chapter 4, because they are commonly confused with, or aggravated by, thyrotoxicosis. In that chapter, we also discuss the hormone system in the body called the adrenergic system, which releases adrenaline (also known as epinephrine) and noradrenaline (norepi-nephrine). Normally, these hormones are released in a fight or flight response when you are scared, shocked, or highly excited. It is also these hormones that trigger...

Managing Anxiety and Panic

If you've ruled out thyrotoxicosis, and do not require a beta-blocker, talk therapy (specifically, cognitive behavioral therapy), discussed earlier, is an excellent way to manage anxiety and panic. This style of therapy can teach you to anticipate the situations and bodily sensations that are associated with panic attacks having this awareness can actually help to control the attacks. There are also a number of mental exercises that can help to control hyperventilating or fearful thoughts that...

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...

Massage

Massage therapy can be beneficial whether you're receiving the massage from your spouse or from a massage therapist trained in any one of dozens of techniques from shiatsu to Swedish massage. If you're hypothyroid, massage therapy may help to improve circulation and depression if you're thyrotoxic, it can help to relieve anxiety and calm you down. In the East, massage was extensively written about in The Yellow Emperor's Classic of Internal Medicine, published in 2700 b.c. (the text that frames...

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...

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...

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....

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...

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...

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'...

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,...

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...

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...

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...

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...

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...

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...

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...

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,...

Dry Eyes

Some symptoms of TED are not unique to people suffering from thyroid disease. Dry eyes are so common that a new syndrome has emerged in general medical practice, known as dry eye syndrome. It's estimated that roughly eleven million North Americans suffer from dry eyes, meaning that tear production is inadequate or the tears evaporate so quickly that your eyes are left gritty and irritated with every blink. Sometimes, dry eyes are a result of autoimmune disease against the tear glands and...

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...

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...

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...

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...

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...

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...

Aromatherapy

Essential oils, comprised from plants (mostly herbs and flowers), can help with many thyroid-related symptoms, particularly those associated with hypothyroidism. The easiest way to use essential oils is in a warm bath you simply put a few drops of the oil into the bath, and sit and relax in it for about ten minutes. The aroma from the oils can also be inhaled (put a few drops in a bowl of hot water, lean over with a towel over your head, and breathe) diffused (using a lamp ring, or a ceramic...

Broda O Barnes Followers

Reams of material, and an entire movement of sorts, support the ideas of late physician Broda O. Barnes, M.D., Ph.D., author of Hypothyroidism The Unsuspected Illness (1976) and Solved The Riddle of Heart Attacks (1976). Barnes also wrote about the alleged connections between hypoglycemia and hypothyroidism. Barnes practiced from the 1930s through the 1970s. His ideas were recycled by Stephen E. Langer, M.D., in a more recent book called Solved The Riddle of Illness, released in its third...

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...

Yoga

Yoga is not just about various stretches or postures, but is actually a way of life for many. It is part of a whole science of living known as the ayurveda. The ayurveda is an ancient Indian approach to health and wellness that's stood up quite well to the test of time it's roughly three thousand years old . Essentially, it divides up the universe into three basic constitutions or energies, known as doshas. The three doshas are based on wind vata , fire pitta , and earth kapha . In ayurvedic...

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...