Questions and Answers About Your Thyroid Issues
Dr. Kristen Hairston is an assistant professor with Wake Forest Baptist Health’s Internal Medicine—Endocrinology unit. Her clinical specialties include endocrinology, thyroid disease, pituitary gland disorders, diabetes and obesity management. She recently took time to respond to common questions people have about thyroid disease.
Q. How do patients typically learn they have a thyroid problem? Are the problems obvious?
Most patients have shown signs or symptoms of thyroid disease. After discussion with their primary care physician or provider, thyroid function studies are usually ordered. Some patients, on the other hand, only find out after routine blood work. It is not very common, however, for patients to be completely asymptomatic.
Q. What are the most common thyroid problems you encounter and how do thyroid problems typically affect your patients’ lives?
The most common problems include thyroid nodules, hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid). Depending on the issue, patients can experience changes in bowel habits, sleep patterns, skin/hair texture and mood, among others.
Q. Can medicines and treatment help someone with thyroid troubles live a relatively normal life?
Absolutely. Medications and treatments are very effective in helping patients live normal lives. It is important to note that these medications and treatments are only effective if the thyroid hormone levels are truly abnormal. Regarding lifestyle/diet changes, the normal recommendations apply. These include adequate sleep, regular physical activity and a balanced diet.
Q. Once a patient has thyroid troubles, what advice do you offer them?
If you have been treated for thyroid conditions, you should understand:
- When to take your thyroid hormone medication
- Signs or symptoms of too much or not enough thyroid hormone
- When to go to your primary care physician for blood tests to check thyroid hormone levels or to check for nodules
- That other drugs you may be taking for other medical conditions could affect your health or interact with the medication for your thyroid problems; ask your doctor about possible drug interactions, side effects or warning signs.
You can further protect your health by eating a balanced diet, getting enough sleep, exercising several times a week, and getting fresh air and relaxation. Healthy living is an important part of recovery from thyroid conditions. These steps also can help to prevent future problems.
Q. What about “natural” thyroid hormones?
According to the American Thyroid Association:
Desiccated (dried and powdered) animal thyroid (Armour®), now mainly obtained from pigs, was the most common form of thyroid therapy before the individual active thyroid hormones were discovered. Although desiccated thyroid contains both T4 and T3, the balance of T4 and T3 in animals is not the same as in humans, so the hormones in animal thyroid pills aren’t necessarily “natural” for the human body.
Further, the amounts of both T4 and T3 can vary in every batch of desiccated thyroid, making it harder to keep blood levels right.
Finally, even desiccated thyroid pills have chemicals (binders) in them to hold the pill together, so they are not completely “natural.” Desiccated animal thyroid is rarely prescribed today, and there is no evidence that desiccated thyroid has any advantage over synthetic T4.
Q. Has treatment of patients with thyroid troubles changed much in recent years? How so?
According to the Hormone Foundation and Mary H. Samuels, MD:
Yes. For example, it has been known for many years that thyroid hormone is essential for normal brain development in fetuses, babies and young children. Research over the past 10 years has shown that even mild hypothyroidism—a deficiency of thyroid hormone—in the mother can have harmful effects on her fetus's brain development.
This finding has led to recommendations that women at risk for hypothyroidism or an underactive thyroid be screened during pregnancy, and that pregnant women with any degree of hypothyroidism be treated as soon as the diagnosis is made. This research has the potential to help many babies avoid impairments in brain development due to hypothyroidism in their mothers.
Thyroid nodules—growths within the thyroid gland—are common, but until recently, doctors and researchers have not known how to evaluate these nodules to make sure they are not cancerous. Studies over the past 10 years have shown that thyroid nodules are best evaluated with a neck ultrasound and biopsy, allowing patients with thyroid nodules to avoid unnecessary preliminary testing.
This finding has improved physicians' ability to accurately determine whether nodules require surgical removal or can be monitored without treatment.
Thyroid cancer treatment typically consists of a combination of surgery and radioactive iodine. After surgical removal of the thyroid gland, patients must take synthetic thyroid hormone.
Until recently, patients had to temporarily stop their thyroid hormone therapy to receive radioactive iodine treatment or undergo monitoring tests for possible cancer recurrence. This was to allow the patient's thyroid-stimulating hormone (TSH) level to rise and stimulate cancer cells to absorb iodine.
Thanks to development of recombinant human TSH, a product made in the lab, patients with thyroid cancer today can undergo radioactive iodine treatment and monitoring using recombinant human TSH, rather than having to temporarily discontinue their thyroid hormone therapy.
If you are currently experiencing thyroid issues, please contact your primary care physician.
Learn More About Your Thyroid
Here are some websites devoted to thyroid conditions and illnesses:
An independent website begun by advocate Mary Shomon, a New York Times best-selling author, and Katie Schwartz, a comedy writer who founded the website www.DearThyroid.org
The website of the American Thyroid Association, the leading organization focused on thyroid biology and the prevention and treatment of thyroid disorders
A one-stop shop for patient health awareness initiatives created and promoted by the American College of Endocrinology in conjunction with the American Association of Endocrinologists