The Natural Thyroid Diet

Thyroid Factor

Thyroid Factor is a program that was created by Dawn Sylvester to help women deal with thyroid issues. Dawn Sylvester is a 57 years old lady that has worked with 1,000's of real women. She has over the time tried to investigate the underlying reason why majority of women lose energy and also struggle with belly fat and fatigue as they age. It is a comprehensive program thatcomprises of Thyro pause, 11 kinds of thyroid saving foods that will work to help you boost fat burning Free T3. The program also teaches you all the hidden causes of thyroid which are making you fat and later a highly reliable Thyroid reboot plan which is an excellent plan you need to tackle your weight. Additionally, there are tips to reduce bulging fat fast and eventually obtain a healthy body. You also get several bonuses all aimed at helping you solve all the problems that comes with being overweight. The three bonuses you get are 21 Day Thyroid weight loss system, 101 Thyroid boosting foods and Thyroid Jumpstart Guide. Read more...

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Diagnosing Thyroid Disease

When trying to determine if fatigue, weight gain, dry skin, and other conditions are caused by a thyroid condition, other health disorders, or simply normal life variations, it all comes down to blood tests. These tests help doctors determine if you have appropriate amounts of thyroid hormone in your blood. A normal and healthy amount of thyroid hormone is known as euthyroidism. If the thyroid hormone levels are insufficient to be euthyroid, we call this hypothyroidism (described in Chapter 3). If the thyroid hormone levels are too high, the condition is termed thyrotoxicosis (described in Chapter 4). Sometimes thyrotoxicosis is present because the thyroid is overactive, making too much thyroid hormone, a situation known as hyperthyroidism. However, thyrotoxicosis can also be present without hyper-thyroidism, such as when someone takes too high a dose of thyroid hormone tablets. In this case the thyroid itself is not overactive (thus not hyperthyroid) however, the levels of thyroid...

Thyroglobulin The Specific Thyroid Protein

The thyroid gland makes a special protein called thyroglobulin. No other body organ has been found to make it. When TSH is released by the pituitary gland to stimulate the thyroid gland, it stimulates each thyroid follicular cell to make thyroglobulin. Some of the thyroglobulin is stored within the interior of the thyroid follicles as colloid (see Chapter 1). Some is combined with iodine within the thyroid cell, releasing fragments that become T4 and T3 in the bloodstream. Some of the thyroglobulin is released directly into the bloodstream. The measurement of thyroglobulin can be very useful in diagnosing thyroid conditions. In general, the level of thyroglobulin in the blood reflects the amount of thyroid tissue in the body. When the TSH level is very high, as when a person is hypothyroid, each thyroid cell makes more thyroglobulin. On the other hand, when levothyroxine tablets are given in high enough dosages to keep the TSH level very low, each thyroid cell makes much less...

Thyroid Hormone Binding Proteins

Several proteins in the blood, produced by the liver, stick to thyroid hormones. They include thyroxine-binding globulin (TBG), thyroxine-binding prealbumin (TBPA), and albumin. In addition, several cholesterol-containing particles in the blood, lipoproteins, are able to bind T4 and T3. Before good tests were available to measure the free T4, it was useful to measure the TBG level as a way to estimate the portion of the total T4 that was free. Since modern laboratory tests no longer need this estimate, the TBG level is not usually used for diagnosis of thyroid problems. It is important to note that the TBG level is frequently mistaken for a thyroglobulin level (often abbreviated as TG) with the result that the TBG is wrongly obtained in following thyroid cancer patients who need the TG level measured. The only way to ensure that you are getting a TG test (or have had one) and not a TBG test is to request a copy of all of your lab reports. If you suspect this common error was made, you...

Congenital and Neonatal Hypothyroidism

Roughly one out of four thousand babies is born with either neonatal or congenital hypothyroidism. With congenital hypothyroidism, the baby is born without a thyroid gland. In neonatal hypothyroidism, the baby is born with what appears to be a normal thyroid gland, but then develops symptoms of hypothyroidism after its first twenty-eight days of life. While the condition was present at birth, the symptoms may not manifest until later. Neonatal hypothyroidism is treated no differently from congenital hypothyroidism.

Subclinical Hypothyroidism

Now also known as mild hypothyroidism, subclinical hypothyroidism refers to hypothy-roidism that has not progressed very far, meaning that you have few or no symptoms. As you might guess, the most common cause of this is Hashimoto's thyroiditis. On a blood test, your free T4 (free thyroxine) readings would be normal or very close to normal, but your thyroid stimulating hormone (TSH) readings would be higher than normal. Right now, there is much discussion in clinical circles about doing routine TSH testing in certain groups of people for subclinical hypothyroidism. This would include anyone with a family history of thyroid disease, women over forty, women after childbirth, and anyone over age sixty. Because the TSH test is simple and can be added to any blood laboratory package, it presents an opportunity to catch hypothyroidism before serious symptoms develop, and hence prevent it and all the symptoms discussed in this chapter. The following groups of people should be screened for...

Secondary Hypothyroidism Pituitary Problems

Sometimes hypothyroidism occurs because of a pituitary gland disorder that may interfere with the production of thyroid stimulating hormone (TSH). This is fairly unusual, however. Tumors or cysts on the pituitary gland can also interfere with production of hormones from the gonads and the adrenal glands. Often, tumors can recur, requiring external beam radiation therapy to prevent further enlargement. Rarely, some pituitary tumors make a hormone known as ACTH, causing Cushing's disease in which high levels of steroids (cortisol) are made. This dangerous condition is also treated by a transsphenoidal hypophysectomy, possibly resulting in hypothyroidism from pituitary damage. Many years ago, before improved obstetrical care, excessive loss of blood during childbirth could cause a drop in blood pressure that caused part of the pituitary to die and sometimes bleed, a condition known as Sheehan's syndrome. This can still happen to anyone with an unsuspected thyroid tumor who has a rapid...

Tertiary Hypothyroidism Hypothalamus Problems

There are rare problems with the portion of the brain that is just above the pituitary, attached to the pituitary by a stalk. The most frequent is called a craniopharyngioma. This is a collection of skin cells that were left behind during fetal development and became stuck in this part of the brain. Although not cancerous, these skin cells start to grow and form cysts, which push upon the sensitive brain tissue of the hypothalamus. This portion of the brain transmits hormones down its stalk into the pituitary gland, responsible for stimulating the pituitary gland to release its own hormones. In the case of the thyroid system, this means that TRH (TSH-releasing hormone) is not sent to the pituitary gland. Consequently, the pituitary fails to make sufficient TSH to stimulate the thyroid gland, causing the thyroid to go to sleep and hypothyroidism to develop. A similar problem can happen if there is trauma (such as from an auto accident) to that portion of the brain or if a malignant...

Diagnosing Hypothyroidism

The next task in diagnosing hypothyroidism is to evaluate results of a TSH test properly. Abnormally high levels of TSH are a sign of hypothyroidism, while abnormally low levels of TSH are a sign of too much thyroid hormone, or thyrotoxicosis. It is important to note that the laboratory tests for people with symptoms of hypothyroidism should consist of both a free T4 level and a TSH level (see Chapter 2). This is because some people have trouble with their pituitary gland or brain that interferes with proper TSH production. In such situations, the free T4 level would be low while the TSH would be inappropriately normal or low.

Treating Hypothyroidism

Treating hypothyroidism involves taking thyroid hormone, which either replaces the thyroid hormone you're no longer making or supplements thyroid hormone to compensate for the inadequate amount your thyroid is making. What isn't so simple is finding the right dosage and restoring your thyroid levels to normal, determined by the TSH test discussed in the previous chapter. The American Association of Clinical Endocrinologists (AACE) revised its TSH targets in 2002, down to 0.3 to 3.0. But the TSH targets that knowledgeable thyroid specialists aim for is now 0.5 to 2.0. This is based on their clinical research as well as published data. Because it takes a lot of time to complete research studies on TSH targets, published guidelines are slow to reflect the targets used by thyroidologists practicing state-of-the-art standards of care. Indeed, most people who are euthyroid sit between 0.4 and 2.5. Revising the normal target to more realistic ranges for women has helped many hypothyroid...

Thyroid Stimulating Hormone

Thyrotropin, also known as thyroid-stimulating hormone (TSH), is a glycoprotein synthesized in the anterior pituitary. The secretion of TSH is stimulated by thyrotropin (or TSH)-releasing hormone (TRH) and inhibited by somatostatin and dopamine, secreted from the hypothalamus. In persons older than 12 months of age, the TSH concentration is low in the afternoon, rises dramatically (surges) after 1900 hours, and reaches its highest concentrations between 2200 and 0400 hours (Fig. 5.2a) 51 . Thus, at least one third of the trophic influence of TSH on the thyroid gland occurs at night. TRH is necessary for TSH synthesis, post-translational glycosylation, and secretion of a fully bioactive TSH molecule from the pituitary 48 . Altered TSH glycosylation, resulting in altered bioactivity, is seen in mixed hypothyroidism (central hypothyroidism with mild TSH elevation 5-15 mU l ) 23,49 . TSH stimulates the thyroid gland to produce thyroxine (T4) and triiodothyronine (T3). T4 and T3 circulate...

When Thyroid Hormone Doesnt Work

There are rare cases when thyroid hormone doesn't work. In this case, you would have high TSH levels in spite of taking thyroid hormone, but this has nothing to do with T4 T3 conversion. Clearly, when you don't have enough T4 in your body, or it is being poorly absorbed from your pills, you won't make sufficient amounts of T3 either. Here are the common reasons why thyroid hormone doesn't work Thyroid Hormone Resistance (a.k.a. Refetoff Syndrome) Thyroid hormone resistance is a rare genetic disorder in which the receptors that stick to T3 (then stick to specific parts of the chromosomes of each body cell) are mutated so that they don't stick to T3 very well. Because of this, much, much more T4 is needed to enter each cell and change to T3 to make up for this abnormal T3 receptor. In this case, you would have either high TSH levels, despite normal or high levels of free T4 or free T3 (making you hypothyroid), or normal TSH levels and very high levels of T4 and T3 (making you euthyroid...

Enlarged Thyroid Gland

As discussed in Chapter 1, an enlarged thyroid gland is called a goiter, where your thyroid will enlarge and may swell in the front of your neck. Thyrotoxic goiters develop because of hyperthyroidism. Here, a goiter develops because too much stimulation of the thyroid causes the gland to enlarge. In extreme cases, a goiter can swell to the diameter of a grapefruit. The appearance of the thyroid gland is very helpful for determining the cause of the thyrotoxicosis. In Graves' disease (see Chapter 6) there is usually a symmetrical goiter that can vary from slightly larger than normal to five times larger than normal. On the other hand, if there is a distinct nodule in the thyroid or asymmetry of the goiter, it suggests that there may be a toxic nodular thyroid. For more details about nodules, see Chapter 8, and for details about goiters, see Chapter 7.

Intratracheal Thyroid

Although total thyroid ectopia is an extremely rare anomaly, ectopic thyroid tissue has been reported in different organs with the normal thyroid gland in place as well. These include lingual, sublingual, thyro-glossal, laryngeal, tracheal, mediastinal, and diaphragmatic sites. Although more than 100 cases were published in Europe, mostly from Germany, only about 25 cases have been reported in the English-language literature.8 Biology. In a review of 23 cases, the patients ranged in age from newborn to 56 years, with a mean of 28.3 years, but most were young adults.9 Females outnumbered males in a ratio of 3.8 1. Clinical presentation varied from asymptomatic cases found on autopsy, to symptoms such as cough, wheezing, stridor, and dyspnea. Symptoms worsened in 3 patients during pregnancy, 1 of them also with menses.9,10 Another patient had increasing wheezing during labor and died postpartum because she had been treated for asthma and was not suspected to have an intratracheal...

Other Causes for Hyperthyroidism

Very rare types of pituitary tumors make excessive amounts of TSH. The thyroid hormone levels do not properly regulate TSH secretion in these tumors, unlike the normal pituitary gland. This is one cause of inappropriate TSH secretion resulting in thyrotoxicosis despite normal or elevated thyroid hormone levels. Another case of inappropriate TSH secretion is even less common selective pituitary resistance to thyroid hormone. In this situation, there are mutations in the thyroid hormone receptors in pituitary cells, making them less able to bind thyroid hormone than normal, and resulting in excessive amounts of TSH being made by them. Other parts of the body appear normally responsive to thyroid hormone, and the person gets symptoms of thyrotoxicosis. Sometimes there are additional hormones that stimulate the thyroid gland to produce thyroid hormones. There are situations in which cells from the placenta from a pregnancy persist despite the end of the pregnancy (known as trophoblastic...

Intrinsic Thyroid Autonomy Independent Thyroid Hormone Manufacturers

As discussed in Chapter 1, it's not uncommon for the thyroid to enlarge and or develop lumps or nodules that make their own supply of thyroid hormone in addition to the usual supply made by the rest of the thyroid gland. As soon as the nodule(s) starts to make more than normal amounts of thyroid hormone, it suppresses the pituitary's production of TSH. This causes the normal (non-nodular) portions of the thyroid gland to go to sleep since there is no TSH to wake them up. The degree of thyrotoxicosis depends upon the ability of this autonomous thyroid nodule to make thyroid hormone.

Other Forms of Thyroiditis

This section explains other kinds of thyroid inflammation in more detail and discusses the three common forms and two uncommon forms thyroiditis can take. Sometimes inflammation can be caused by the autoimmune process, as described earlier in this chapter for Hashimoto's thyroiditis. In rare cases, bacterial infections (abscesses infectious or suppurative thyroiditis) may cause a severely painful and swollen thyroid gland, along with fever and increases in the white blood count. These situations require hospitalization and intravenous antibiotic therapy. In other rare cases, painful inflammation of the thyroid gland may be associated with inflammatory nodules (granulomas) in the gland, possibly because of viral infection and known as subacute thyroiditis.

Postpartum Thyroiditis

Women with TPO antibodies are more likely to experience postpartum thyroiditis. This is a general label referring to silent thyroiditis occurring after delivery, causing mild hyperthyroidism, and a short-lived Hashimoto's type of thyroiditis, causing mild hypothyroidism. Until quite recently, the mild hypothyroid and mild thyrotoxicosis symptoms were simply attributed to the symptoms of postpartum depression, those notorious postpartum blues, thought to be caused by the dramatic hormonal and emotional changes women experience after pregnancy. But recent studies indicate that as many as 20 percent of all pregnant women experience transient thyroid problems and subsequent mild forms of thyrotoxicosis or hypothyroidism. See Chapter 13 for more information on postpartum thyroiditis.

Acute Suppurative Thyroiditis

Also known as simply bacterial thyroiditis, acute suppurative thyroiditis is a very rare condition. The term suppurative refers to the presence of bacteria and pus. Here, the thyroid gland suffers a dramatic pus-forming bacterial infection similar to the ones that cause abscesses. The thyroid gland becomes painful and inflamed, and a high fever and chills accompany the infection. Sometimes there is an abscess within the gland containing pus. Usually, the tenderness to the thyroid gland is obvious, so it's difficult to miss the symptoms. Sometimes, a fine needle biopsy can provide abscess material to examine for bacteria. Antibiotics, incision, and drainage are the treatment, with a beneficial response to this treatment confirming the diagnosis.

Thyroid Eye Disease TED

Thyroid eye disease (TED), also known as Graves' ophthalmopathy (GO) or Graves' orbitopathy, can be quite severe in people with Graves' disease. The majority of thy-rotoxic Graves' disease patients suffer from measurable TED. At one time, only those with noticeable changes to the eyes were considered to have TED, but more sophisticated methods of diagnosis reveal that eye changes are present in almost all Graves' disease patients, even though symptoms may not be noticeable. Some patients develop GO for one or more years before they develop thyrotoxicosis, while in others the thy-rotoxicosis precedes GO.

Antithyroid Medication

Sometimes, doctors (or patients) prefer to treat Graves' disease with antithyroid drugs. These drugs prevent the thyroid from manufacturing thyroid hormone and are usually a way of managing Graves' disease in the short term. Propylthiouracil (PTU) and methimazole (Tapazole) are the most commonly used drugs, and they are very useful under specific circumstances, such as Patients with severe thyrotoxicosis, to lower their thyroid hormone levels prior to I-131 treatment Controlling thyrotoxicosis in people with severe Graves' ophthalmopathy and a reluctance to undergo thyroid surgery Treatment of thyrotoxicosis in any patient in an unstable clinical condition or in thyroid storm As the production of thyroid hormone decreases, the symptoms of thyrotoxicosis will disappear. The practice is to take you off the drugs after several months of treatment, if the TSH has been normal or elevated, to see if Graves' disease relapses, which occurs about 80 percent of the time, or goes into remission....

Thyroid Carcinoma Bronchogenic Carcinoma Other Tumors

Secondary neoplastic invasion of the trachea by direct extension is most often due to carcinomas of the esophagus, thyroid, and lung. Carcinoma of the larynx may also invade the trachea directly or it may recur at the margin of the stoma from lymphatics after laryngectomy. Less commonly, hematogenous metastases involve the trachea or carina. Sites of origin include the breast, melanoma, kidney, and thyroid. Carcinoma metastatic to the mucosa of the trachea from distant primary sites is less common than metastases to the bronchial mucosa, which is in itself an uncommon phenomenon. The goals of major resection of the trachea or carina for secondary neoplasms should be the possibility of cure, or otherwise, prolonged palliation. This excludes most hematogenous metastases. Palliation of irresectable obstructing tumor may be achieved by endobronchial curettage, laser therapy, external beam irradiation, brachytherapy, or sometimes by stenting. The limited place for tracheal resection and...

Remission and Antithyroid Medication

The main benefit to going on antithyroid medication is to try your luck at achieving full remission without the need for RAI or surgery. This usually results in either an indefinite period of normal thyroid activity or lifelong hypothyroidism. In general, antithyroid drugs are effective in achieving remission about 20 to 30 percent of the time, but some doctors report even lower success rates. The main effect of antithyroid drugs is to buy time until either a spontaneous remission occurs, in which the immune system stops producing thyroid stimulating antibodies (TSA), or the autoimmune effects destroy enough of the thyroid gland to ablate the gland despite persistent TSA production. This spontaneous remission is most likely to be seen in people with very mild thyrotoxicosis and small goiters. The process can take from six months to a year, if it is going to happen at all. Such a percentage begs the question, why even bother with antithyroid medication Many patients and doctors feel...

Thyroidectomy or Partial Thyroidectomy

Another treatment is either a partial or near-total thyroidectomy (surgical removal of the thyroid gland). This is reserved for Graves' patients who are pregnant, Graves' patients with a goiter causing obstruction in the neck, patients where there is a concern that a thyroid nodule accompanying Graves' is suspicious for cancer, or patients who refuse RAI therapy. A partial or near-total thyroidectomy means that you deliberately leave behind remnants of the thyroid gland so that thyroid hormone may not be necessary. In a total thyroidectomy, the entire gland is removed. Generally, more risks are involved with thyroidectomy than with RAI therapy for Graves' disease, which is why this is not the first line of therapy for most Graves' patients. These risks include damage to the nerves that supply the vocal cords (recurrent laryngeal nerves), as well as damage to the parathyroid glands, which control calcium levels. These risks are discussed more in Chapter 9, but it's critical to...

Euthyroid Graves Disease

In some cases of euthyroid Graves' disease, no symptoms of thyrotoxicosis are present in spite of Graves' disease. In such cases, the person is noted to have the bulging eyes of Graves' ophthalmopathy, but the thyroid gland is still working normally. Many of these people will ultimately develop thyrotoxicosis however, some never do. As discussed earlier, this is more common in men than women. With euthyroid Graves' disease, it is critical to provide the appropriate measures to deal with the eye problems, while performing regular monitoring of thyroid hormone levels so as to avoid missing the development of thyrotoxicosis.

Euthyroid Diffuse Goiters

Euthyroid diffuse goiters are thyroids that are enlarged over their entirety, without any evidence of nodules or cysts. Their cause is not clearly understood. It may be because of a variety of growth factors made by the thyroid gland that stimulate its growth. Some physicians believe that environmental factors, such as waterborne contaminants (see Chapter 3), may cause these goiters, but there aren't any concrete answers regarding the causes. Although some people with euthyroid diffuse goiters are treated with sufficient dosages of thyroid hormone to suppress the TSH levels, there isn't any evidence to support this as an effective treatment to shrink these goiters. Likewise, radioactive iodine therapy is not an effective treatment for these goiters. The focus of the evaluation of euthyroid diffuse goiters is to make sure that there isn't any thoracic inlet obstruction. Another concern is to be certain that a thyroid cancer isn't missed. This is particularly important if there is...

Euthyroid Multinodular Goiters

Euthyroid multinodular goiters are thyroid glands that are enlarged and contain multiple nodules, much like a bag of marbles. Some physicians believe that euthyroid diffuse goiters can become nodular over time. With these goiters, the ultrasound exam is very important, permitting your physician to find out which nodules are dominant (largest)

The Benign Thyroid Nodule

A benign thyroid nodule is usually a benign colloid nodule. Colloid is the thick pink material normally found inside the thyroid follicles and frequently present in benign nodules. These are usually solid nodules, but sometimes a complex nodule (meaning that it is partly cystic and partly solid) is also partly a colloid nodule. It's imperative that the thyroid nodule, or enlarged portion of the thyroid gland, be accurately measured. I (Ken) often use a tape measure for this purpose. If the nodule is positioned in a way that makes it difficult to measure, a thyroid ultrasound can be used to document its size. In this way, the nodule can be reassessed eight to ten months later, to see if it has grown larger. Many benign colloid nodules will spontaneously shrink in size over that length of time. If this happens, then the diagnosis is confirmed, because the absence of progressive growth (meaning that the nodule doesn't get larger) is one of the key features of a benign nodule. Nodules...

The Malignant Thyroid Nodule

It's extremely rare for a skilled cytologist to interpret a thyroid nodule FNA biopsy as cancer unless a cancer is truly present. The types of thyroid cancer that could be seen include papillary cancer, anaplastic thyroid cancer, or medullary thyroid cancer (see Chapter 9). Follicular cancers are usually seen as follicular neoplasia (discussed in the next section). If the nodule is more than 1.0 centimeter (0.4 inch) in diameter, the surgeon will perform a total thyroidectomy (see Chapter 9). If the nodule is smaller, then the surgeon will remove half of the thyroid gland, pending the results of the final pathology exam. If the cancer is found to be anything larger or more extensive than a spot of papillary cancer (called a single focus) that is 1.0 centimeter (0.4 inch), or any other type of thyroid cancer, then the surgeon will remove the rest of the gland during a second surgery. Please note that you must never permit a surgeon to perform only a nodulectomy (surgical removal of the...

The Indeterminate or Suspicious Thyroid Nodule

In the case of an indeterminate or suspicious thyroid nodule, the cytologist can't find enough proof to suggest a thyroid cancer, yet the nodule does not have the characteristics that could prove it is a benign nodule either. Ultimately, at least one-fifth of such nodules are proved to be thyroid cancer when a pathologist evaluates the thyroid gland after it's surgically removed. When a nodule is defined as suspicious or indeterminate, no known test, short of surgery, will answer the is it cancer question. Thyroid scans, blood tests, and x-rays cannot provide any additional answers. For this reason, the most appropriate approach to a nodule with this classification is to have a surgeon remove the half of the gland containing the nodule. If the surgeon finds definitive evidence of cancer (lymph nodes with tumor, obvious signs of grossly invasive tumor) then it's appropriate to remove the entire thyroid gland at this time. Otherwise, if the pathologist finds that the indeterminate...

Preventing Thyroid Exposure from Radioactive Fallout

By using potassium iodide, we can prevent thyroid cancer from radioactive iodine fallout. Potassium iodide blocks radioactive iodine from being absorbed by the thyroid gland by providing so much iodine that it overwhelms the ability of the gland to take up radioactive iodine. This is the only specific way to protect against thyroid cancer triggered by radioactive iodine fallout potassium iodide has no protective effect against any other kind of radiation. Potassium iodide is available through pharmacies. In the event that there is an alert about a potential nuclear attack (such as a terrorist threat), ask your doctor about the best way to obtain potassium iodide. difficult to do unless an accident or incident is predicted in advance, or the air path of a specific accident is tracked and therefore anticipated. And potassium iodide is not designed as a long-term therapy because of side effects that occur with prolonged use. Complications include serious allergic reactions, skin rashes,...

Who Gets Thyroid Cancer

Thyroid cancer still remains a rare cancer, accounting for just about 2 percent of all cancers in people of all ages and 4 percent of cancers in children. Nevertheless, thyroid cancer is now ranked as the fastest rising cancer in women, topping the rate of increase in lung and breast cancers. Women outnumber men in developing thyroid cancer by three to one. Put another way, women account for 75 percent of all new cases of thyroid cancer, and 58 percent of all deaths from thyroid cancer occur in women. In 2004 in the United States, an estimated 5,900 men developed thyroid cancer, compared to 17,700 women around 620 deaths from thyroid cancer occurred in men, and 850 deaths occurred in women. This statistical imbalance may have something to do with the fact that thyroid cancers are seen much more frequently in women but seem to be more lethal in men. It is currently not known why these sex differences are seen.

What Causes Thyroid Cancer

As discussed in the previous chapter, it is well known that radiation exposure to the thyroid gland, particularly a young child's thyroid gland, predisposes the child to develop thyroid cancer in later years. Papillary thyroid cancer is the most common type. (Types of thyroid cancer will be explored later in this chapter.) Research is revealing that the chromosomes of thyroid cells are organized in a particular structural pattern in the nucleus (or center) of thyroid follicular cells. When radiation inside the cell strikes the nucleus, it causes particular breaks and rearrangements in the chromosomes that result in a greater chance that the cells will eventually become cancers. Unfortunately, known exposures to radiation seem to account for only a small portion of the thyroid cancers seen every year.

Types of Thyroid Cancers and Their Behavior

Thyroid cancer runs the gamut from the least aggressive tiny papillary thyroid cancer to the most aggressive type of tumors known in humans, anaplastic thyroid cancer. So the first order of business is to find out which type of thyroid cancer you have. There are three major groupings of thyroid cancers papillary, follicular, and anaplastic. Within each major group are subtypes that have different clinical consequences. In several studies over the last fifty years, pathologists (doctors who specialize in analyzing tissue) examined people who died from a variety of causes. They found that up to two-thirds of these deceased people had small, single microscopic papillary thyroid cancers that were less than 1.0 centimeter (0.4 inch) in size. These small cancers had not contributed to any health disorder in other words, these people had all died from something else despite these tiny cancers. These small cancers are called occult (hidden) or subclinical thyroid carcinomas and do not warrant...

Follicular Thyroid Carcinomas

Follicular thyroid cancers comprise roughly 10 percent of all thyroid cancers. They are often difficult to distinguish from benign follicular adenomas (see Chapter 8), and we strongly suggest that a second pathologist verify the diagnosis by analyzing the thyroid gland removed during surgery. These types of thyroid cancer are more likely to spread via the bloodstream to distant sites, such as the lung, bones, and liver. They tend to be more aggressive than typical papillary thyroid cancers, but less aggressive than tall cell variant papillary cancers. Hurthle cell thyroid cancers (also known as oxyphilic variant follicular cancers), like their papillary counterparts, may lose the ability to take up radioactive iodine, making them difficult to treat if they recur after surgery. A much less common type of follicular thyroid cancer is known as insular thyroid cancer. More than a decade ago, insular carcinomas were thought to be types of anaplas-tic thyroid cancer, suggesting that they...

Medullary Thyroid Carcinomas

Medullary thyroid cancers are very different from papillary or follicular cancers and account for 5 to 10 percent of thyroid cancers. Papillary and follicular cancers arise from a cancerous transformation of the thyroid follicular cells that respond to TSH, suck up iodine, and make thyroglobulin. Medullary thyroid cancers arise from a cancerous transformation of the thyroid parafollicular cells that do not share any of these functional features. Instead, both parafollicular cells and medullary cancer cells make a hormone, calcitonin, instead of thyroxine. Medullary cancer cells also make another protein called carcinoembryonic antigen (CEA). Calcitonin and CEA can be measured in the blood, serving as markers for the presence of persistent or recurrent medullary cancer after surgical removal of the primary tumor with the thyroid gland. As discussed in the beginning of this chapter, 20 percent of medullary thyroid cancers arise because of a mutation in the RET proto-oncogene. Some of...

Treatment for Papillary and Follicular Thyroid Cancers

Many people, upon discovering that they have thyroid cancer, become very anxious and are quick to follow the first treatment plan presented to them. Some may be frightened of their diagnosis, avoiding physicians and procrastinating, preventing necessary care. Others may be distrustful of establishment medicine and might seek out alternative medicine that does not cure cancer, such as herbs, vitamins, or energy healing in place of curative therapies. It is most important is to seek out physicians within reach who have the greatest expertise in this disease. Chapter 21 will discuss how you can be a well-informed consumer and full participant in your medical care. The majority of thyroid cancer patients will require treatment for differentiated papillary and follicular thyroid cancers. Appropriate treatment starts with as complete a thyroidectomy as can be accomplished, along with surgical removal of any metastatic tumor in the neck, taking care to avoid unnecessary complications. From...

Risks and Complications from Thyroid Surgery

Damage to the parathyroid glands is the most common risk of thyroid surgery. It is especially common when dealing with invasive or locally metastatic tumors. As discussed in Chapter 1, the parathyroid glands are four tiny nodules located near the thyroid gland that release parathyroid hormone (PTH). This hormone controls the calcium level in your body, telling the kidneys to keep calcium from going out in the urine and enhancing the activation of vitamin D to absorb more calcium from the intestines. If all four parathyroid glands are damaged, the loss of PTH (hypoparathyroidism) causes the kidneys to lose calcium in the urine and decreases the ability to absorb more calcium. The result is that calcium levels plummet. This causes numbness or tingling sensations around the lips, numbness or tingling of the hands or feet, muscle cramps, twitching, and sometimes seizures. If the parathyroid glands are merely bruised from the surgery, the low calcium (hypocalcemia) will be temporary,...

Thyroid Hormone Suppression Therapy

Thyroid hormone treatment in the form of levothyroxine is absolutely necessary after the thyroid is removed. In people who have never had thyroid cancer but are merely hypothyroid, sufficient levothyroxine is given to make the TSH normal (0.5 to 3.0 see Chapter 2). People with thyroid cancer should keep their TSH levels less than 0.1. This is because TSH stimulates the growth of thyroid cancer cells. When you are preparing for radioactive iodine scans or therapies, or when you need to assess the level of thy-roglobulin, you want to stop your levothyroxine to make the TSH greater than 30, stimulating thyroid cancer cells to suck up iodine and make thyroglobulin. On the other hand, it's necessary to keep the TSH suppressed (less than 0.1) at all other times, so that any thyroid cancer cells still in your body are not stimulated to grow and reproduce. Chapter 10 gives all of the details on thyroid hormone medication. Levothyroxine is the only type of thyroid hormone able to keep the TSH...

Thyroid Extracts or Natural Thyroid Hormone

More than half a century ago, the state-of-the-art thyroid hormone therapy used Thyroid, U.S.P. (United States Pharmacopoeia), a preparation of dried, cleaned, powdered thyroid glands from cows or pigs. One brand of this type of thyroid extract that came from pigs is called Armour Thyroid Tablets. These extracts contain a wide variety of hormones and chemicals from thyroid glands that are nearly impossible to accurately standardize from batch to batch. These hormones include T4, T3, thyroglobulin, and products of T3 with fewer iodine atoms on each molecule. Originally, the only way to measure the potency of thyroid extracts was by measuring the amount of iodine in the pills, a method that was extremely poor at determining the amount of effective thyroid hormone. Eventually, additional biological tests were used, but none of them are able to approach the accuracy of methods currently employed to test pure T4 pills. This inaccurate and variable-potency thyroid extract pill is...

Drugs Used to Treat Hyperthyroidism

Two main approaches are used to manage hyperthyroidism (see Chapters 4 and 6). First, you need to block the effect of thyrotoxicosis on the heart (see Chapter 4), preventing the high thyroid hormone levels from overstimulating the heart rate and risking cardiovascular disease (see Chapter 25). This is accomplished with beta-blockers. Then it's important to make a decision regarding additional therapy. For example, if you had an overactive thyroid gland from Graves' disease, and if it's appropriate to treat the overactive thyroid with radioactive iodine (see Chapter 12), this can be done immediately if you're otherwise stable and in reasonable health. The beta-blockers can diminish thyrotoxic symptoms until the radioactive iodine has reduced the thyroid hormone levels, usually several weeks later. Alternatively, antithyroid drugs (thionamides) can be used to block your thyroid from making more thyroid hormone, allowing thyroid hormone levels to diminish over the course of a couple of...

Antithyroid Drugs Thionamides

Antithyroid drugs, a class of drugs known as thionamides, block the formation of thyroid hormone by thyroid cells. If hyperthyroidism is caused by single or multiple autonomous toxic nodules (ATNs, see Chapter 8), antithyroid drugs can be used to temporarily lower thyroid hormone levels but are not useful for long-term management since ATNs don't spontaneously get better over time. On the other hand, they're often used to treat hyperthyroidism in Graves' disease, since roughly one-quarter of people with Graves' disease will see a permanent end to Graves' thyrotoxicosis after a year of treatment with thionamides (known as a remission or resolution). Although some people take thionamides for many years, I (Ken) don't advise taking them longer than one year because of potential toxicity (explained later) and because these spontaneous remissions of Graves' disease are much less likely to occur if they do not happen within the first year of thionamide treatment. Thionamides are the only...

Prevention of Hypothyroidism Because of Iodine Deficiency

Iodine deficiency, as discussed in Chapter 3, is the leading cause of hypothyroidism in the world. The daily amount of iodine that is appropriate for proper thyroid function is around 150 micrograms daily. This is the amount contained in most vitamins. Much of the population in the developing world has much lower levels of iodine in their diet. Supplementation, via iodized salt or through iodine added to the water supply, has proven effective in alleviating iodine deficiencies in specific regions. Unfortunately, a small number of older people in these regions have autonomous nodular thyroid glands (see Chapter 8). Iodine supplementation in these people permits them to show symptoms of thyrotoxicosis that were unable to develop in the absence of sufficient iodine.

Treatment of Hypoparathyroidism Low Calcium

Thyroid cancer surgery, which entails removing the thyroid gland and enlarged lymph nodes in the neck, runs a risk of damaging the parathyroid glands near the thyroid (see Chapter 1). This would cause a low calcium level in the blood, which can be severe, resulting in muscle spasms, anxiety, and abnormal numbness or tingling sensations. Most often this is temporary, caused by bruising of the parathyroid glands during surgery that resolves on its own within a few days or weeks. But sometimes this is a permanent situation that requires lifelong treatment. Low calcium caused by one or more damaged parathyroid glands is called hypoparathyroidism. To understand the treatment for hypoparathyroidism, it's important to first explain how parathyroid glands normally function otherwise, medications used to treat hypoparathyroidism will not make sense to you.

Radioactive Iodine for Thyroid Cancer

RAI treatment is the only useful treatment of papillary and follicular thyroid cancers once they have spread beyond the thyroid gland. It is the only known effective systemic thyroid cancer treatment that is, it can kill thyroid cancer cells in the entire body system, wherever they may be hiding. This is necessary because many thyroid cancers have spread to multiple sites in the neck, or distantly to the lungs or bones, long before they are discovered in your thyroid gland. Also, the smallest tumor deposit that can be seen by a human eye contains more than a million cancer cells. While the surgeon may be able to see and remove some of these during your surgery, the surgeon is incapable of finding and removing tumor deposits of one hundred thousand cells, ten thousand cells, one thousand cells, or even smaller numbers. In theory, it can take only a single cancer cell to start the process of cell division and reproduction that brings back much larger tumor deposits. This means that a...

Thyroid Disease in Pregnancy and After Delivery

This chapter discusses issues for distinct groups of women pregnant women with unrecognized or subclinical thyroid disease, pregnant women with preexisting thyroid disease, women who only first discover (or develop) a thyroid problem during pregnancy, and women who only first discover (or develop) a thyroid problem within the first six months of delivery. In the latter situation, this frequently takes the form of postpartum thyroiditis, classically misdiagnosed as postpartum depression. Autoimmune thyroid diseases, such as Hashimoto's disease (see Chapter 5) or Graves' disease (see Chapter 6), frequently strike during the first trimester of a pregnancy or within the first six months after delivery. That said, you should note that preexisting autoimmune thyroid disease as well as other autoimmune diseases tend to improve during a pregnancy but can worsen after delivery. Although the reasons for this are not known, these changes parallel the changes in estrogen levels in the pregnant...

Being Pregnant with Preexisting Thyroid Disease

If you are hypothyroid or are taking thyroid hormone for a thyroid condition diagnosed prior to this pregnancy, it's important to have your thyroid levels assessed monthly with a target TSH of between 0.5 and 3.0 (see Chapter 2) so that your dosages of thyroid hormone can be appropriately adjusted, which is necessary for the growing fetus. Tbtal T4 (or TT4) assessments are useless, since T4 naturally rises because of increased thyroxine binding globulin (see earlier in this chapter). Although very little thyroid hormone will cross over from you to the fetus, the little that does is very important, since normal thyroid hormone levels in you are critical for proper fetal development until the fetus develops its own thyroid gland. Sometimes a change in dosage is needed because requirements for thyroid hormone can increase during pregnancy. It's normal to require as much as a 30 to 50 percent increase in your dosage. In this case, doctors should generally monitor the TSH level monthly and...

Morning Sickness and Thyroid Hormone Replacement

The problem with nonstop nausea and vomiting is that your thyroid hormone pill could be poorly absorbed, leaving you hypothyroid, which is dangerous to fetal health. If you think your thyroid hormone pill came out with your breakfast, with your doctor's permission, it's probably all right to take an additional tablet as long as this isn't a frequent event. In extreme situations, your physician could give you thyroid hormone medication as an intramuscular (IM) or subcutaneous (SC) injection, but this is rarely necessary.

Gestational Hypothyroidism

If hypothyroidism is suspected while you're pregnant, your doctor will give you a TSH test. Just as in nonpregnant women, your TSH levels will be increased if you're hypothyroid, and you'll be treated with thyroid hormone replacement. As discussed earlier, sometimes pregnancy itself can mask hypothyroid symptoms. For example, constipation, puffiness, and fatigue are all traits of pregnancy as well. These symptoms will likely persist after delivery if your hypothyroidism remains untreated, and they can seriously interfere with pregnancy and your postpartum health.

Discovering Thyroid Nodules in Pregnancy

If you discover a lump (nodule) on your thyroid gland during pregnancy, investigation and treatment will vary depending on what stage you are in. If, however, a cancerous nodule is discovered well into the second trimester or in the third trimester, surgical treatment can usually wait until you deliver. Then, you will be able to have the appropriate thyroid surgery, discussed in Chapter 9.

Drugs For Treating Hyperthyroidism

Hyperthyroidism results from excess production of thyroid hormones due to various reasons. Treatment of the resulting thyrotoxicosis (Basedow's disease) consists of using drugs that inhibit excess synthesis of hormones, as well as using radioactive iodide in order to disrupt or remove thyroid gland follicles with excess activity. Drugs used for hyperthyroidism can be classified as drugs that suppress thyroid hormone synthesis in the anterior lobe of the hypophysis, and they consist of diiodotyrosine and iodine, as well as drugs that suppress thyroid hormone synthesis in thyroid glands (propylthiouracil, methylthiouracil, methimazole, and carbimazole). Thioamides are reducing agents. They inhibit thyroid hormone synthesis by inhibiting the peroxidase enzymatic system, which catalyzes oxidation of iodide ions and iodine that are consumed in food, which is necessary for iodination of tyrosine derivatives. Thus they reduce the concentration of free iodine necessary to react with tyrosine...

Thyroid Disease and Osteoporosis

Women who take thyroid hormone commonly ask about the link between thyroid disease and osteoporosis. (As mentioned earlier, contrary to what most women think, the link has nothing to do with calcitonin, which the thyroid also produces, as discussed in Chapter 1.) Again, thyroid hormone is something our body uses literally from head to toe. In general, anyone with too much thyroid hormone in her system is vulnerable to bone loss, because thyroid hormone will speed up or slow down bone cells just as it will speed or slow other processes in our bodies, such as our metabolism. Osteoblasts are the cells responsible for building bone, while osteoclasts are cells that remove old bone so that the new bone can be replaced. When you are thyrotoxic, osteoclasts get over-stimulated in short, they go nuts. They begin to remove bone faster than it can be replaced by the osteoblasts, which are not affected by too much thyroid hormone. The result You wind up with too much bone removed and subsequent...

Thyroid Disease in Infants and Children

Although children can have nearly all of the same thyroid problems as adults, the consequences are far more severe and the solutions more difficult. An infant's brain still has much further to grow and develop, requiring sufficient amounts of thyroid hormone for this to happen normally. Thyrotoxicosis can affect the heart, bones, behavior, and school achievement. Thyroid cancer in children has a greater chance of spreading to the lungs and bones than the same type of cancer in adults. In addition, infants and young children are unable to vocalize their symptoms, making it necessary for parents and physicians to be alert to signs of thyroid disease. In this chapter, we'll begin explaining thyroid diseases in the newborn and then deal with thyroid disease in young children. We'll discuss the remarkable benefits of newborn screening programs for hypothyroidism, which are now active in nearly all industrialized nations. Newborn infants are also susceptible to factors from their mothers...

Symptoms of Hypothyroidism in Newborns

Signs of hypothyroidism in newborn infants are unique to this age group. Classic features include a large tongue, umbilical hernia, enlarged fontanels (the soft spots on a newborn's skull), low muscular tone, goiter (unless the baby has thyroid dysgenesis), low body temperature (less than 36 C or 96.8 F), slow reflexes, and respiratory distress. Symptoms of hypothyroidism include constipation, lethargy, poor feeding, and prolonged newborn jaundice (yellowing of the skin). Newborn screening programs are effective enough so that more than a third of infants diagnosed with hypothyroidism have no abnormal signs or symptoms. Taking advantage of early laboratory testing, rather than waiting for infants to appear ill, is the best way of preventing permanent brain damage from hypothyroidism.

Permanent Hypothyroidism

The majority of hypothyroidism cases detected by newborn screening are permanent, most resulting from abnormal formation of the thyroid gland (called thyroid dysgenesis). Two-thirds of newborns with thyroid dysgenesis have thyroid glands in different body locations from the usual location, called an ectopic thyroid. Since the thyroid gland descends from the base of the tongue downward to the base of the neck during development of the embryo (see Chapter 1), the most common location for an ectopic thy roid is either at the tongue base or anywhere in the midline of the neck above the breastbone. Less commonly, thyroid glands may be found in the middle of the chest, sometimes even inside the heart or lower in the body. Ectopic thyroid glands are usually defective and unable to make much thyroid hormone, accounting for the infant's hypothyroidism however, sometimes they work well enough, making the discovery of a thyroid gland, appearing as a strawberry-like lump at the base of the...

Transient Hypothyroidism

A variety of iodine-containing cleansing agents or contrast dyes used in x-ray imaging tests can be given to the mother during pregnancy or to the baby after birth. Excess iodine can inhibit the production of thyroid hormone by the baby's thyroid. This is more likely to happen in small or premature babies. Likewise, medications given to the mother for Graves' disease, such as methimazole or PTU (see Chapters 11 and 13), can block the baby's thyroid from making thyroid hormone. Since the effects of excess iodine and antithyroid drugs disappear when they're no longer around, they cause only transient hypothyroidism.

Thyroid Cancer in Children

Thyroid cancer is a lifelong illness, in that it requires lifelong follow-up and monitoring for recurrent disease. When thyroid cancer is first discovered in a child, there are unique features to the cancer and unique problems in managing it. This section is divided into three parts. The first part will discuss the special problems of thyroid surgery in children. The second part will discuss papillary and follicular thyroid cancers, usually found consequent to an evaluation of a thyroid nodule or enlarged lymph node as discussed in the preceding section. The third part will deal with medullary thyroid cancers, usually found in children as part of an inherited genetic syndrome and often treated by preventative surgical removal of the thyroid after finding the responsible gene mutation with genetic screening.

Thyroid Surgery in Children

Children have special problems when it comes to thyroid surgery. First, it's important to find the right surgeon. Although pediatric surgery is a distinct surgical specialty, very few pediatric surgeons obtain sufficient experience to become excellent thyroid surgeons. In Chapter 9, we talked about the need for a surgeon to have specialized training and enough surgical thyroid cases each year to maintain his or her skills and lower the rate of complications. Since it's not very common that young children need thyroid surgery for Graves' disease, and thyroid cancers are much less common than in adults, pediatric surgeons rarely see more than several such patients each year. Thyroid surgery is rarely needed before three years of age. Pediatric surgeons (often ear, nose, and throat specialists, also known as otolaryngologists) may better serve children less than ten years of age however, adult thyroid surgeons are often a better choice for children over ten years of age. Major surgery of...

Medullary Thyroid Cancer in Children

Rarely, thyroid nodules in children turn out to be medullary thyroid cancers, a type of cancer we discuss in Chapter 9. More often, a family is already known to have at least one member diagnosed with medullary thyroid cancer (called an index patient), and the child's blood tests have shown that he or she has a mutation in the RET proto-oncogene responsible for causing this cancer. In this case, it takes only one parent with the mutation to pass it on to a child (called an autosomal dominant mutation). Furthermore, the likelihood that the mutation will cause cancer (known as penetrance) is nearly 100 percent. That means that if an individual has this mutation he or she is expected to develop this cancer at some time in his or her life. Usually, the blood relatives of the index patient should have their blood tested to see if they also have this specific gene mutation. Children in the family should be tested as early as possible. Should these tests show the presence of this mutation,...

Thyroid Disease ana Obesity

The most important fact we wish to emphasize when it comes to thyroid disease and obesity is that it is extremely common for all obese persons to wonder whether their thyroid is making them fat. This chapter will help you sort out whether your obesity predates your thyroid problem, is aggravated by a thyroid problem, or is the result of one. Obesity refers to a body size that is too overweight for good health. Obese people have greater incidences of type 2 diabetes, heart attacks, strokes, peripheral vascular disease (circulation problems, leading to many other health problems), and certain types of cancers. Hypothyroidism can aggravate obesity and complications from obesity. Hyperthyroidism or thyrotoxicosis, however, may cause an unhealthy type of weight loss, aggravating other conditions that may be linked to obesity, such as heart disease (see Chapter 25) or type 2 diabetes. It is not known how many people with thyroid disease are obese but it is clear that the majority of obese...

How Thyroid Disease Impacts Obesity

The typical obese person with thyroid disease frequently has multiple problems going on at once, which are usually complications of obesity that can become magnified with thyroid disease. For example, the majority of obese people with thyroid disease are also managing high cholesterol, hypertension, and, frequently, type 2 diabetes. Worse, many people who are obese also smoke, which aggravates preexisting obesity complications. It's a complex health-care puzzle for most thyroid specialists. The key to managing thyroid disease in obese people is to treat all problems at once treat the thyroid problem as well as obesity and other health complications. In this way, many thyroid specialists see themselves as a primary care doctor. It's not unusual for the thyroid doctor to initiate prescriptions for thyroid hormone, cholesterol and blood pressure-lowering medications, as well as the most important prescription going to the type of program that emphasizes calorie-counting (such as Weight...

The Hypothyroid Obese Individual

Although lifestyle changes, combined with restored thyroid function, can normalize blood pressure and cholesterol levels in many cases, blood pressure and cholesterol-lowering medications may be necessary, discussed in Chapter 25. thyroid is making me fat have garden-variety causes for their obesity eating more food than they burn off in activity. As we age, our metabolisms slow down, and we frequently discover that we cannot eat as much without weight gain in our forties and fifties as we did in our twenties and thirties. Hashimoto's disease, for example (see Chapter 5), tends to strike in the forties and fifties, which coincides with the metabolic slowdown, making it appear as though it is responsible for weight gain, when in fact, it is only a temporary problem. In people who are made permanently hypothyroid because of thyroid ablation or thyroidectomy, obesity is usually not caused by hypothyroidism if they are on sufficient doses of thyroid hormone (see Chapter 10). Again,...

Hypothyroidism in Older Persons

In older people, the signs of hypothyroidism are not obvious, and often few symptoms point to hypothyroidism, particularly when so many of the symptoms can be attributed to aging. For these reasons, it is recommended that anyone older than sixty be screened for hypothyroidism annually with a TSH test. Older thyroid patients report that they feel better once treated with thyroid hormone, and a lot of vague health problems will get better or even disappear. Most causes of primary hypothyroidism in older people are the result of Hashimoto's disease (see Chapter 5). Hashimoto's disease in younger people frequently causes an enlarged thyroid or goiter (see Chapter 7). In older people, Hashimoto's disease tends to be more insidious and quietly damages the thyroid gland until it shrivels up (or atrophies). Older people could walk around for years with unrecognized Hashimoto's disease unless a thyroid function test was done. Unlike younger people with Hashimoto's disease, thyroid antibody...

Treating Hypothyroidism in Older Persons

In people with a TSH of greater than 10, there is a clear benefit to treatment with thyroid hormone. In people with a TSH of 5 to 10, treatment is also likely to be helpful, although the benefits in symptoms are much less obvious. Normal ranges for TSH values in older people are generally set higher. It is not completely clear whether this is a normal and expected aspect of aging or, rather, an improper resetting of the normal range. The difference may be because some normal older people, whose blood tests were included as part of the normal samples to determine the normal range, were actually hypothyroid with elevated TSH levels, making the normal range higher than it should be. The risk of thyrotoxicosis from excessive dosages of thyroid hormone in an older person with either heart problems and or osteoporosis means that thyroid hormone dosing is often a start low, go very slow approach. This is the advice that internists and family physicians are given however, experienced...

Growing Old with Hypothyroidism and Thyroid Hormone

A lot of people are like me (Sara) they became hypothyroid as younger adults and expect to grow old with thyroid hormone therapy. In this case, your dosage will likely be adjusted as you age you may graduate to a lower dose, even if you are taking a TSH suppression dose (if you had thyroid cancer). It is not known if this is because you have developed more reliable habits of taking your thyroid hormone medication or if there is truly a reduced need for it. If you are older than sixty and are taking the same thyroid hormone dosage prescribed to you in your forties or fifties, as long as you still have a normal TSH your dosage does not need to be changed. On the other hand, if you are taking a TSH-suppression dose because of thyroid cancer, your doctor should make sure that your dosage of thyroid hormone is the lowest it can be to suppress TSH without excessive elevations of the free T4 level (see Chapter 2).

Other Thyroid Problems

In older people with goiters (see Chapter 7), nontoxic nodules (see Chapter 8), and thyroid cancer (see Chapter 9), the treatment options are usually the same as they are in younger people, with these considerations Weighing the value of doing nothing. In someone with many serious health problems, who may also be frail, treating goiters that are not life-threatening and small, low-risk malignant thyroid tumors confined to the thyroid may do more damage to the older person than just leaving him or her alone. This is a common approach in geriatric health care, especially when it is far more likely that an older person in very poor health will likely die of something else. Weighing the risk of surgery. In some cases, where surgery would be logical in a younger person, it is too risky in an older person. In these cases, the risk needs to be carefully weighed. A benign nodule or non-life-threatening goiter could be left alone an aggressive thyroid cancer (frequently the case in an older...

Thyroid Disease in a Person with Alzheimers Disease

First, thyroid disease is not more or less common in those with Alzheimer's disease. But there are special considerations for longtime thyroid patients who develop Alzheimer's or people who are first diagnosed with thyroid disease while in obvious phases of Alzheimer's disease. Alzheimer's disease affects certain areas of the brain that control memory and basic functions or abilities. This results in specific symptoms or changes in behavior, and unlike a stroke, once an ability or function is lost, it can rarely be relearned. With respect to thyroid disease, it is the loss of mental abilities that can dramatically interfere with managing both hypothyroidism and thyrotoxicosis. In Alzheimer's disease, the ability to understand, think, remember, and communicate can be severely diminished or lost. The ability to make decisions and perform simple tasks is also diminished or lost. Confusion and memory loss (initially short-term memory) occurs, and, in late stages of the disease, the...

Defects in the Production of Thyroid Hormone

As discussed in Chapters 1 and 10, production of thyroid hormone starts with transport of iodide into the thyroid follicular cells. Some people have mutations in the gene for the sodium-iodide symporter (NIS), the iodide pump. These people have large multinodular goiters that are unable to concentrate radioactive iodine and are thus hypothyroid with high TSH levels. There are also people with mutations in the gene for thyroid peroxidase (TPO), the enzyme that is partly responsible for permitting iodide to be combined with portions of the thyroglobulin molecule, a process called organification. There are additional steps in organification that are susceptible to flaws or dysfunction from mutations as well (see Chapter 15 for the incidence of organifica-tion defects).

Synthetic T4 Is Not as Good as Natural Thyroid Hormone or T3T4 Mixtures

For patients without thyroid glands, or with thyroid glands that fail to produce adequate amounts of thyroid hormone, the ingestion of a pure levothyroxine product provides all of the necessary thyroid hormone products consequent to normal metabolic and enzymatic bodily processes. The term synthetic T4 is used because this hormone is created by a pharmaceutical manufacturer using chemical reactions, much like how aspirin is made from willow tree bark or penicillin is made from mold. Making a drug or hormone in this way permits a pure, properly measured and reproducible drug that is free of natural contaminants such as viruses, bacteria, or prions. There is absolutely no conceivable role for taking natural thyroid extract or mixtures of T3 and T4. Thyroid extract is a mixture of T4, T3, thyroglobulin, and many other breakdown products with erratic pharmacokinetics, and it's nearly impossible to accurately dose for stability or, more importantly, suppression of TSH, which is necessary...

Natural Thyroid Hormone Is Better Because It Contains All Four Thyroid Hormones

In many materials, natural thyroid hormone is touted for containing all four thyroid hormones T1, T2, T3, and T4. T1 and T2 are what T4 degrades into and have no activity, offering absolutely no benefit to you. It's analogous to a bicycle having no useful purpose after losing its wheels. Thus, statements that sell T1 and T2 as any sort of added benefit indicate that the source doesn't know what he or she is talking about and has misinterpreted basic facts about thyroid hormone biochemistry.

My Obesity Is Caused by Hypothyroidism Even Though My TSH Levels Are Normal

How many euthyroid people are obese Millions Why is that Because they eat more food than they burn off in activity. We are a sedentary society that is aging and out of shape. If your TSH levels are normal, and you are clinically euthyroid, then your obesity is just as manageable as for those obese individuals with no thyroid problem. Coming from both a hypothyroid patient (Sara) and a thyroid specialist (Ken) who sees nothing but hypothyroid people all day long, we bemoan the unfortunate and inappropriate assumption made by patients that all their problems with obesity are consequent to hypothyroidism. If this were the case, all obese patients would be cured with thyroid hormone and no one with normal thyroid function would ever be overweight. Sadly, being a patient who is being treated for hypothyroidism with thyroid hormone therapy does not automatically disqualify one from the weight-control issues that plague all the other people with normal thyroid glands. During bouts of...

Low Thyroglobulin Levels Always Mean That There Isnt Any Thyroid Cancer Left

This isn't always true, especially if you have a history of Hashimoto's disease. One of the hallmarks of Hashimoto's thyroiditis is the production of antibodies directed against parts of the thyroid, particularly the thyroperoxidase enzyme and thyroglobulin. Antibodies against thyroglobulin interfere with the ability of all currently known blood tests to accurately measure the actual thyroglobulin level. They tend to make the tests register a lower thyroglobulin level than actually exists. As you know, thyroglobulin levels are extremely important to ascertain the presence of thyroid cancer after a person has had a total thyroidectomy and radioactive iodine therapy. For this reason, a low or immeasurable thyroglobulin level, in the presence of antithyroglobulin antibodies, does not provide any confidence for the absence of thyroid cancer. On the other hand, when thyroglobulin levels are elevated in the presence of antithyroglobulin antibodies, particularly when these levels increase in...

Fluoride Caused My Thyroid Cancer

We discuss environmental factors likely to have caused many thyroid cancers in Chapter 9. However, the fluoride rumor keeps resurfacing. For the record, fluoride does not cause thyroid cancer. There is not one shred of evidence demonstrating this. The diatribe on fluoride has ranged from maniacal ideas regarding Russian agents (such as those found in the famous movie Dr. Strangelove) to current attempts to overgeneral-ize from inapplicable experiments and claim causation for all of the world's ills. It's important to note many countries without fluoridation have thyroid cancer rates as high as North America.

Assessment of Thyroid Size and Goiter Rate

In contrast to urinary iodide, the prevalence of goiter reflects a population's history of iodine nutrition but does not properly reflect its present iodine status.10 Goiter assessment is made by inspection, palpation or more recently, by ultrasonography. Normative values proposed by the WHO and the International Council for the Control of Iodine Deficiency Disorders (ICCIDD) for thyroid volume by ultrasonography are based on data obtained from a large sample of iodine-replete schoolage children.58

The Hyperthyroid Diet

If you are currently in the throes of hyperthyroidism and are thyrotoxic, it's important to note that your thyroid helps to control gastric emptying, secretion of digestive juices, and motility of the digestive tract. When you're thyrotoxic, despite a voracious appetite,

What to Eat After Treatment for Thyroid Disease

People who have had thyroid disease make the mistake of thinking they have to be on a special diet to maintain a healthy weight. Unless you're actively hypothyroid, thyrotoxic, or are preparing for a whole body scan (see Chapter 2), you are in the same boat as the rest of the population your metabolism will slow down with age, which will likely cause weight gain as you approach your forties and fifties, unless you compensate with more activity. Basically, eating healthy means you must distinguish between good fat and bad fat as well as good carbs and bad carbs. The following is a brief overview of this information, which, although it exists elsewhere, is presented here to demonstrate how important it is for thyroid patients to understand that most weight and diet-related issues are not related to the thyroid per se, but to the general problem in our society of having too much food and not enough real comprehension surrounding what is in our food that makes us fat.

Complementary Therapies for Thyroid Patients

While you're managing your thyroid condition using conventional treatments, you can also incorporate complementary therapies into your treatment, which may improve your sense of well-being and health. I (Sara) have incorporated a number of these therapies into my health routines, but I must emphasize that the information in this chapter should be regarded as the feel good therapies that are, at worst, harmless, and at best, therapies that can make you, well . . . feel good Treat this as your icing rather than the cake. Potentially harmful therapies are not discussed. Although in many of my past works I have discussed specific herbal supplements (particularly the calming herbs ), in this book we have limited herbal therapies to aromatherapy. While many herbs have been shown to have health benefits, many of them conflict in some way with other medications, and can also affect how thyroid hormone may be absorbed. For example, St.-John's-wort, which was very popular in recent years, was...

What Is Thyroid Eye Disease

Thyroid eye disease tends to strike people with Graves'-related hyperthyroidism (see Chapter 6) and sometimes even those suffering from Hashimoto's disease (see Chapter 5). In clinical circles, TED is known by several different names Graves' ophthalmopathy (GO) thyroid-associated ophthalmopathy and, infrequently, dysthyroid orbitopathy. (The prefix ophthalmo means eyes, while pathy means disease. ) It is this disease that lends itself to the expression thyroid eyes bulging, watery eyes a condition known as exophthalmos (pronounced ek-sof-thal-mos ). A common symptom of excessive thyroid hormone is lid retraction. Here, your upper eyelids can retract slightly and expose more of the whites of your eyes. The lid retraction creates a rather dramatic staring look and an exaggerated expression. This specific symptom is related to the excessive activation of the adrenaline system in thy- rotoxicosis (see Chapter 4), and can be seen in nonautoimmune thyrotoxicosis. It will improve with...

Thyroid Metabolic Hormones

The thyroid gland, located immediately below the larynx on each side of and anterior to the trachea, is one of the largest of the endocrine glands, normally weighing 15 to 20 grams in adults. The thyroid secretes two major hormones, thyroxine and triiodothyronine, commonly called T4 and T3, respectively. Both of these hormones profoundly increase the metabolic rate of the body. Complete lack of thyroid secretion usually causes the basal metabolic rate to fall 40 to 50 per cent below normal, and extreme excesses of thyroid secretion can increase the basal metabolic rate to 60 to 100 per cent above normal. Thyroid secretion is controlled primarily by thyroid-stimulating hormone (TSH) secreted by the anterior pituitary gland. The thyroid gland also secretes calcitonin, an important hormone for calcium metabolism that is considered in detail in Chapter 79. The purpose of this chapter is to discuss the formation and secretion of the thyroid hormones, their metabolic functions, and...

Treating Heart Failure in Hypothyroidism

The first step in treating heart failure is to take the appropriate medications prescribed by your physician that decrease the workload of the heart and make it perform more efficiently. This includes reducing the peripheral vascular resistance (seen as high blood pressure or hypertension), decreasing the volume of blood backing up (by using diuretics), and taking medication that enhances the strength of the heart muscle. When hypothyroidism is present and contributing to the heart failure, treatment with thyroid hormone should be started as soon as possible however, it takes several weeks to fully take effect, and it is important to make sure that you are taking the proper heart medication in the meantime. It is very unusual for hypothyroidism, on its own, to be able to weaken the heart sufficiently to cause heart failure. This makes it very important to continue looking for primary heart problems and treat them in addition to treating the hypothyroidism. If you have underlying heart...

Finding a Thyroid Specialist

American Thyroid Association (thyroid.org specific URL thyroid.org patients specialists.php3) American Association of Clinical Endocrinologists (aace.com specific URL Dr. Kenneth Ain (thyroidcancerdoctor.com) allows you to arrange a consultation with Dr. Kenneth Ain regarding thyroid cancer The American Academy of Otolaryngology Head and Neck Surgery (entnet.org specific URL entnet.org ent_otolaryngologist.cfm) lists head and neck surgeons (for thyroid surgery) The American Academy of Ophthalmopathy (aao.org specific URL aao.org aao eyemd_disclaimer.cfm) lists eye specialists (for thyroid eye disease) Medicare Participating Physician Directory 1 -800-MEDICARE) provides listings of Medicare-participating specialists

Thyroid Websites of Interest

American Thyroid Association (thyroid.org) Norman, an endocrine surgeon The American Thyroid Association (thyroid.org) Thyroid Home Page (thyroid.com) website of the Santa Monica Thyroid Diagnostic Center, founded by Dr. Richard B. Gutler MyThyroid.com (mythyroid.com) thyroid site maintained by Dr. Daniel J. Drucker

Thyroid Organizations for Patients

American Foundation of Thyroid Patients (thyroidfoundation.org) Thyroid Foundation of America Inc. (allthyroid.org) Thyroid Foundation of Canada (thyroid.ca) European Thyroid Association (eurothyroid.com) Latin American Thyroid Society (lats.org) Thyroid Federation International (TFI) Member Patient Organizations Australia Australian Thyroid Foundation (thyroidfoundation.com.au) and Thyroid Australia (thyroid.org.au) Brazil Thyroid Foundation of Brazil (e-mail medneto uol.com.br) Denmark Thyreoidea Landsforeningen (thyreoidea.dk) Finland Thyroid Foundation of Finland (kolumbus.fi kilpirauhasliitto) France l'Association Fran aise des Malades de la Thyro de (thyro-asso.org) Germany Schilddr sen Liga Deutschland e.V. (SLD) (schilddruesenliga.de) Italy Associazione Italiana Basedowiani e Tiroidei (e-mail emma99 libero.it) Japan Thyroid Foundation of Japan (hata.ne.jp tfj) The Netherlands Schildklierstichting Nederland (schildklier.nl) Norway Norsk Thyreoideaforbund (stoffskifte.org)...

Thyroid Hormones Increase Active Transport of Ions Through

Activator Inhibitor

One of the enzymes that increases its activity in response to thyroid hormone is Na+-K+-ATPase. This in turn increases the rate of transport of both sodium and potassium ions through the cell membranes of some tissues. Because this process uses energy and increases the amount of heat produced in the body, it has been suggested that this might be one of the mechanisms by which thyroid hormone increases the body's metabolic rate. In fact, thyroid hormone also causes the cell membranes of most cells to become leaky to sodium ions, which further activates the sodium pump and further increases heat production. Effect of Thyroid Hormone on Growth Thyroid hormone has both general and specific effects on growth. For instance, it has long been known that thyroid hormone is essential for the metamorphic change of the tadpole into the frog. In humans, the effect of thyroid hormone on growth is manifest mainly in growing children. In those who are hypothyroid, the rate of growth...

Formation and Secretion of Thyroglobulin by the Thyroid Cells

Thyroid Cell Dit

The thyroid cells are typical protein-secreting glandular cells, as shown in Figure 76-2. The endoplasmic reticulum and Golgi apparatus synthesize and secrete into the follicles a large glycoprotein molecule called thyroglobulin, with a molecular weight of about 335,000. Each molecule of thyroglobulin contains about 70 tyrosine amino acids, and they are the major substrates that combine with iodine to form the thyroid hormones. Thus, the thyroid hormones form within the thyroglobulin molecule. That is, the thyroxine and triiodothyronine hormones formed from the tyrosine amino acids remain part of the thyroglobulin molecule during synthesis of the thyroid hormones and even afterward as stored hormones in the follicular colloid. Oxidation of the Iodide Ion. The first essential step in the formation of the thyroid hormones is conversion of the iodide ions to an oxidized form of iodine, either nascent iodine (I0) or I3_, that is then capable of combining directly with the amino acid...

Radioactive Thyroid Tests

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 radioactive substances proved essential for both diagnosis and treatment, providing the starting basis for the entire field of nuclear medicine. Radioactive iodine isotopes have played major roles in understanding normal physiology of the thyroid and the nature of thyroid diseases. Particularly in Graves' disease, toxic nodular disease, and thyroid cancer, radioio-dine has provided unique diagnostic insights and therapeutic opportunities. In this section, we'll explore the diagnostic uses of radioisotopes, starting with tests of thyroid function and ending with tests to detect and characterize thyroid diseases. Each thyroid cell takes up iodine to make thyroid...

Euthyroid Sick Syndrome as a Cause of Low Grade Hypothyroidism

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 some thyroid tests look strange. In these people, the free T4 by equilibrium dialysis test showed that the thyroid hormone levels were usually normal. Unless you're ill enough to be in an intensive care unit or on a ventilator, absolutely none of this applies, and it does not account for any TSH test abnormalities or any other thyroid test abnormalities.

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 (which leaves the person without a thyroid gland and, therefore, hypothyroid), necessitating thyroid hormone suppression therapy. As explained in Chapter 9, suppression therapy means that thyroid cancer patients require higher doses of thyroid hormone to keep their TSH levels suppressed, which suppresses any remnant thyroid cancer cells as well. Except for short-lived transient hypothyroidism from thyroiditis (see Chapter 5), treatment with thyroid hormone is lifelong. Clinical experience 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 discussed, it is made from portions of the thyroglobulin protein that are combined with iodine and then broken off. Iodine is the critical ingredient used by the thyroid to make thyroid hormone. In fact, without sufficient iodine in the diet, the thyroid gland is unable to produce enough thyroid hormone. (See Chapter 3 for more about iodine deficiency, which causes hypothyroidism.) Without sufficient iodine, a goiter (an enlarged thyroid gland) can also develop. (See Chapter 7.) Most people need...

Antithyroid Substances

Drugs that suppress thyroid secretion are called antithyroid substances. The best known of these substances are thiocyanate, propylthiouracil, and high concentrations of inorganic iodides. The mechanism by which each of these blocks thyroid secretion is different from the others, and they can be explained as follows. Thiocyanate Ions Decrease Iodide Trapping. The same active pump that transports iodide ions into the thyroid cells can also pump thiocyanate ions, perchlorate ions, and nitrate ions. Therefore, the administration of thio-cyanate (or one of the other ions as well) in high enough concentration can cause competitive inhibition of iodide transport into the cell that is, inhibition of the iodide-trapping mechanism. The decreased availability of iodide in the glandular cells does not stop the formation of thyroglobulin it merely prevents the thyroglobulin that is formed from becoming iodinated and therefore from forming the thyroid hormones. This deficiency of the thyroid...

Diagnosing Thyrotoxicosis andor Hyperthyroidism

In my (Sara's) case, I suffered from thyrotoxic symptoms for more than four years, in the belief that I had low blood sugar and panic disorder. Having been on a TSH-suppression dosage of thyroid hormone most of my adult life, as I aged, I became less tolerant but didn't realize it. A few years later, after Ken and I were married (and he witnessed a few of these episodes), he also noticed one day that my heart was racing. Ken suggested my panic attacks and hypoglycemic reactions might be caused by thyrotoxicosis, which, as discussed previously, makes people oversensitive to their own adrenaline. Of course, this would be the logical result of being on a high dosage of T4 all of those years. After starting a beta-blocker, which blocks the adrenaline rush symptoms of thyrotoxicosis, my panic attacks and hypoglycemia vanished. Anyone under the belief that he or she is suffering from panic disorder or low blood sugar should request a thyroid screening to rule out thyrotoxicosis.

Regulation of Thyroid Hormone Secretion

To maintain normal levels of metabolic activity in the body, precisely the right amount of thyroid hormone must be secreted at all times to achieve this, specific feedback mechanisms operate through the hypothalamus and anterior pituitary gland to control the rate of thyroid secretion. These mechanisms are as follows. TSH (from the Anterior Pituitary Gland) Increases Thyroid Secretion. TSH, also known as thyrotropin, is an anterior pituitary hormone, a glycoprotein with a molecular weight of about 28,000. This hormone, also discussed in Chapter 74, increases the secretion of thyroxine and triiodothyronine by the thyroid gland. Its specific effects on the thyroid gland are as follows 1. Increased proteolysis of the thyroglobulin that has already been stored in the follicles, with resultant release of the thyroid hormones into the circulating blood and diminishment of the follicular substance itself 3. Increased iodination of tyrosine to form the thyroid hormones 4. Increased size and...

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 may be prescribed. A prescription for thyroid hormone replacement pills costs anything from 30 to 80 for a three-month supply, depending on the brand. If you have a very rare problem with dyes used to color the pills, most brands offer their 50-microgram strength as a plain white pill, without dye. You can take your thyroid hormone using the white pills only. For example, if you were on a dosage of 150 micrograms, you'd take three white pills instead of the usual one blue pill that represents...

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 time unless given appropriate thyroid hormone treatment with levothyroxine. Additional causes of hypothyroidism are less common. Unusual partial defects in forming thyroid hormone (dyshormonogenesis), mild enough to evade detection as a newborn, rarely reveal themselves as they worsen in childhood. Pituitary tumors or unusual tumors in the part of the brain controlling the pituitary, the hypothalamus, may result in hypothyroidism because it interferes with TSH production. The most common type of...

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 RAI uptake in thyroid cancer treatment. As discussed in Chapter 2, there are three methods of preparing for I-131 whole body scans hypothyroid preparation (the gold standard ), The gold standard approach is a six-week withdrawal from thyroid hormone replacement (T4 or levothyroxine). This entails stopping T4 therapy and switching to T3 (Cytomel) for the first four weeks. The final two weeks, you would start a low-iodine diet (see Chapter 20), and then stop T3 and be on no thyroid hormone at all,...

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 encouraged to seriously consider hormone replacement therapy after menopause, For women in good health without thyroid disease, taking HRT in the short term to relieve menopausal symptoms is still considered a good option, as there is no evidence to suggest that short-term use (one to five years) of HRT is harmful. The study has implications only for women on oral HRT for long-term use (versus the patch) some-thing that was recommended to millions of women over the past twenty years because of...

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. If you look in the mirror, you may notice the following changes in your appearance when you are hypothyroid, compared to a photo taken in the past when your thyroid was functioning normally

Thyroid Hormone and Antithyroid Drugs

Endogenous iodine-containing thyroid hormones L-thyroxine and L-triiodothyronine are produced by the thyroid gland, which exhibits pronounced metabolic control over practically every cell in the body using the two mentioned iodine-containing hormones. By controlling the rate of oxidative cellular processes, these hormones take part in regulation of growth and development of the organism, formation of bone marrow and bone tissue they affect activity of the CNS, cardiovascular system, gastrointestinal tract, metabolism of carbohydrates, fats, and proteins they have an effect on regulation of body temperature, muscle activity, water-electrolyte balance, and reproduction, playing an extremely important role in normal physical and mental development. Unlike many other hormones, they exhibit a diffusive effect on the whole organism, not on individual organs. Synthesis, storage, and release of thyroid hormones by the thyroid gland are primarily regulated by the thyrotropin hormone, while the...

Effect of Exercise on Thyroid Function

Exercise appears to enhance the rate of utilization or disposal of T4.25 Evidence for an increase in T4 metabolism induced by physical activity comes from research, using the radioactive T4 turnover technique in which the loss of a single injection of T4 125I from the plasma was determined as a function of time, in horses26 and rats,27 28 as well as in athletes.29 In athletes, exercise resulted in the degradation of circulating T4 by 17 per day compared with 10 in the control group.29 This increased rate of T4 turnover was quantitatively similar to that found in hyperthyroid individuals, and would require approximately a 75 increase in T4 secretion rate from the thyroid gland to keep circulating levels unchanged. Increased T4 turnover is consistent with studies showing approximately half as much iodine in the thyroid glands of exercising rats as in those of non-exercising rats.33 There was no significant difference in the rate of renewal of thyroidal iodine between these groups,...

Release of Thyroxine and Triiodothyronine from the Thyroid Gland

Thyroglobulin itself is not released into the circulating blood in measurable amounts instead, thyroxine and triiodothyronine must first be cleaved from the thy-roglobulin molecule, and then these free hormones are released. This process occurs as follows The apical surface of the thyroid cells sends out pseudopod extensions that close around small portions of the colloid to form pinocytic vesicles that enter the apex of the thyroid cell. Then lysosomes in the cell cytoplasm immediately fuse with these vesicles to form digestive vesicles containing digestive enzymes from the lyso-somes mixed with the colloid. Multiple proteases among the enzymes digest the thyroglobulin molecules and release thyroxine and triiodothyronine in free form. These then diffuse through the base of the thyroid cell into the surrounding capillaries. Thus, the thyroid hormones are released into the blood. About three quarters of the iodinated tyrosine in the thyroglobulin never becomes thyroid hormones but...

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. Usually, most people with a very mild case of subacute thyroiditis would not bother to see a doctor, because they wouldn't notice any unusual symptoms other than a sore throat perhaps. But in more severe cases, you can be extremely uncomfortable. The illness usually imitates the flu. This means you'll be tired and have muscular aches and pains, a headache, and fever. As the illness progresses, your thyroid gland will swell or enlarge from the infection and become very tender. It will hurt to...

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