Molly b.'s Thyroid FAQ Page 1

Frequently Asked Thyroid Questions

This Thyroid FAQ has been compiled from questions commonly asked by those looking for thyroid information. I recommend that visitors use this FAQ as an aid to discussing their personal health concerns with their doctors. While I believe the following information to be true and correct, this Thyroid FAQ is designed to be used only as a complement to any professional medical advice that you receive.

The information on this page has been arrived at from personal experience and from reading about thyroid subjects on the web and in print. I'm a person who has had a thyroid condition, but I have no medical training. Any suggestions I make are my personal ideas and opinions.

Please check with your doctor if you think that you may have a thyroid disease or if you have concerns about your thyroid treatment. If this page helps you to understand a little more about the thyroid gland, and helps you to discuss your medical care with your doctor in a knowledgeable way, then it has served its purpose.

Please note that the info in this FAQ was accurate and up to date at the time it was written, during the time that I was treated, but I would ask you to check with your own doctor, as some things may change over time! While I occasionally make updates, I am not a doctor! To FAQ Page 2

1. Q. I'm always tired, always sleepy. Could this be a thyroid problem?

A. It's possible. This is one symptom of hypothyroidism. At the same time, there are many other causes of tiredness, including sleep disorders. A person may ignore feelings of tiredness because it doesn't seem very serious, but being rested is important to everyday functioning.

2. Q. Is thyroid disease catching?

A. No, not catching, although some thyroid diseases are hereditary - if a parent has a thyroid condition, such as Graves' Disease or Hashimoto's thyroiditis, there is a strong chance that a child will also develop it in adult life. Some thyroid conditions are caused by exposure to high levels of radiation ( most likely to have occured in the 1940's and 1950's during xray treatment of children for various illness. This practice, fortunately, is no longer used. ) Some types of thyroiditis are caused by a virus. But there is no 'thyroid virus' contracted by anyone exposed to it, like there are flu and cold viruses.

3. Q. Can depression be a symptom of a thyroid condition?

A. Yes, depression and even psychosis can be present in a few cases. Depression is quite a common symptom in hypothyroid conditions in particular. If you're undergoing treatment for a thyroid condition, it's important that you report any feelings of depression to your doctor. If you're undergoing treatment for depression, you may want to find out if you've been tested for thyroid disorders. Thyroid conditions can affect a person physically, and mentally as well.

4. Q. Do only women have thyroid problems?

A. The percentage of women with thyroid problems is much higher, but men, as well as children, can develop thyroid disorders.

5. Q. What do 'hyperthyroid' and 'hypothyroid' mean? Does a low TSH mean a person is hyperthyroid and a high TSH mean they're hypothyroid?

A. 'Hyperthyroid' is a term that describes a thyroid disorder in which the thyroid gland is producing too much thyroid hormone. 'Hypothyroid' is a term that describes a thyroid disorder in which the thyroid gland is producing too little thyroid hormone.

The TSH ( Thyroid Stimulating Hormone ) blood test is the main test used to diagnose thyroid conditions. As a general rule, if your TSH test result is below the normal range, you're on the hyperthyroid side, and if your TSH test result is above the normal range, you're on the hypothyroid side.

In the United States, where TSH and other lab tests are measured in a different unit of measurement than is used anywhere else in the world, a normal TSH used to be from 0.5 to 5.0 mU/L AnyTSH result below 0.5 was considered hyperthyroid. A TSH result above 5.0 was considered hypothyroid. Note: TSH normal levels have now been changed somewhat - the new lab norms in the US are .3-3.0. In Canada a normal TSH level is .2 to 6.0.

Because there's more than one type of measurement used worldwide, the numbers may be different in your location.

The TSH level could be high in hyperthyroid disorders, although it is usually low in most hyperthyroid people, most of the time. A poorly functioning thyroid gland, when it produces thyroid hormone, will sometimes cause high TSH levels in a hyperthyroid person, as it malfunctions. If it's overworking and then underworking, it's easy to see how this disorder could result in up and down test results, over a period of several weeks. (The TSH does not change rapidly from one day to the next, but is a slow gradual process.)

Primary hypothyroidism - the most common type - will always have a higher than normal TSH in the earliest stages, while the Total T4 and FreeT4 results may be normal.

Secondary hypothyroidism - is due to an abnormality in the pituitary gland not the thyroid gland and usually includes a low TSH not a high TSH. Therefore, a person could be hypothyroid but have a TSH result that would seem to show the person is hyperthyroid. This is not a very common illness. The FT4I test is used to determine treatment with thyroid hormone replacement in these hypothyroid patients and not the standard TSH test.

6. Q. What are the general treatment options for hyperthyroid patients?

A. If a hyperthyroid condition is caused by thyroiditis, it will probably be a temporary condition and may require either no treatment, beta-blocking drugs such as Propranolol or Lopressor to help control the symptoms, or a corticosteroid to treat inflammation. One type of thyroiditis, Hashimoto's, often leads to hypothyroidism. This would require the usual thyroid hormone replacement prescription.

If hyperthyroidism is caused by a condition called Graves' Disease, the treatment choices will probably be: 1. medication 2. RAI (radio iodine therapy - may require a second treatment no sooner than 6 months later) 3. surgery

Sometimes the active symptoms in Graves' Disease will 'go away' for awhile ( into remission ) but it will return months or years later. RAI or surgery is sometimes required to treat it permanently..

Some medications used to treat hyperthyroidism are Propylthiouracil, Methimazole or Tapazole. If taking these medications, there is a small risk that a person may develop flu-like symptoms, which can mean the white blood cell count is being affected. This requires a blood test right away. Beta-blocking drugs such as Propranolol or Lopressor are also sometimes prescribed. These medications are also often used before a patient has surgery, to help decrease a hyperthyroid condition and its symptoms.

In hyperthyroidism with a multinodular goiter, choices may be limited to 2. and 3. above. I had a multinodular goiter and a thyroid cyst along with hyperthyroidism. The specialist did not recommend medication as an effective treatment, although I was prescribed Tapazole for a short while, until I had radioactive iodine treatment. She suggested RAI and surgery only if the RAI wasn't effective.

Once hyperthyroidism has been treated with RAI or surgery, a person may become hypothyroid. This may happen almost immediately, or years later. Your doctor will order blood tests occasionally, and hypothyroidism will be treated with thyroid hormone replacement, if it does occur. This treatment is to supplement the poorly functioning thyroid, to give your body normal or 'euthyroid' thyroid hormone levels.

My mother had a thyroidectomy in 1971 for a goiter, and also for what was, I believe, Grave's disease. Her symptoms indicate she was hyperthyroid. Her eyes were prominent and bulging somewhat. Her specialist told her that our family had a high risk for developing thyroid problems. She had no ill effects, and is troubled now only with severe scoliosis, at the age of 84. ( Scoliosis is not thyroid related. ) A heart condition has been diagnosed - it could be that her heart is 'wearing out' as a natural process of aging, or it may be due to long term effects of untreated thyroid problems. The eye problem gradually subsided, and her eyes returned to normal within 2 to 3 years after surgery.

7. Q. Why would the doctor prescribe a mild tranquilizer, when I'm hyperthyroid and waiting for treatment?

A. If you're having trouble getting a good night's rest, if you are feeling panicked, with a racing heart, your doctor may feel a prescription is in your best interests. I think my hyperthyroid symptoms 'crept up' on me, and now that I'm my old self again, I notice how much calmer I feel. Once your hyperthyroid condition has been treated, you may want to ask your doctor or your specialist whether a tranquilizer is still required.

8. Q. I had fainting spells and my heart started racing when I took over the counter cold medicine. Is this because I'm hyperthyroid? What foods can I eat, and what foods should I avoid if I'm hyperthyroid or hypothyroid? Are there foods that cause a goiter to develop? Will taking supplements or avoiding iodized salt help or prevent a thyroid condition?

A. Some medicines, even those sold over the counter without a prescription, can worsen the symptoms of hyperthyroidism. If you're hyperthyroid it's very important that you check with your doctor before taking any medication. And always read the warning labels. While I was hyperthyroid, the doctor told me to avoid acetylsalicylic acid (ASA) and to take acetaminophen instead, since aspirin can affect T4 readings if a person is hyperthyroid. Once you're normal/hypothyroid, providing your general health is good, these non-prescription medications are probably okay to take occasionally.

Bread, seaweed ( kelp ), seafood and ordinary table salt all contain iodine. Iodine from salt and other foods is used by the thyroid gland to make thyroid hormone.

Kelp contains very high quantities of iodine. Autoimmune thyroid disorders, such as Graves' Disease and Hashimoto's thyroiditis are aggravated by too much iodine. If you're hyperthyroid, kelp is best avoided. Too much iodine can set off hypothyroid, hyperthyroid, or thyroid enlargement (goiter) conditions if you have a poorly functioning thyroid gland. Iodine helps to prevent some types of goiter and that is why iodine is added to our salt in North America. In normal quantities this won't affect the thyroid. Salt is also needed by the body for many processes to function correctly, so drastically reducing iodized salt intake would not be a good choice for most people.

Some prescription medications are known to cause goiter, hypothyroid or hyperthyroid problems. These include Lithium and Cardorone (amiodarone).

Foods that may interfere with thyroid hormone, and should be eaten in moderation are: broccoli, cabbage, cauliflower, mustard greens, peanuts, radishes, rutabaga, and soybeans.

There are no herbal supplements that will alleviate, 'cure' or prevent a thyroid condition. There is ongoing international research into thyroid disorders, but at present there are no reliable, proven and safe do's and don'ts for prevention other than avoiding excess iodine.

If you have concerns about your diet in relation to a thyroid problem, ask your doctor, especially if you are considering taking 'health' foods, 'natural' remedies, or even vitamins ( some of these may contain iodine ).

I asked the specialist, after hyperthyroid treatment, what she would suggest, for 'dieting' - so I could gain some weight again and because I felt so run-down. She said the best thing to do was to eat a well-balanced nutritious diet. She mentioned no restrictions of any foods. It doesn't make sense to restrict yourself from good food for no reason.

There are foods/medications that must sometimes be avoided before a thyroid scan is done, so that an accurate test result can be obtained. This should be discussed at the time your scan is scheduled. Restrictions will not always be necessary. When I had a Tc-99 scan, and when I had I131 radio iodine therapy, there were no restrictions other than discontinuing Tapazole 4 days before until 4 days after the I131.

9. Q. I was just diagnosed as hyperthyroid and had trouble getting the proper diagnosis.

A. I believe this may be more common than we would like to think. Hyperthyroidism can be easily diagnosed with a couple of simple blood tests, but if these tests aren't done, the symptoms could be mistaken for panic attacks, anxiety, depression, psychosis, diabetes, cancer, ulcers and so on, resulting in some unnecessary tests and treatments. Since women more commonly have thyroid conditions, we must beware of any chauvinism on the part of the doctors who treat us. Even in our enlightened age, there are doctors who may tend to treat symptoms as neurosis etc. instead of looking for a physical cause.

10. Q. Both my parents and grandparents have been diagnosed with thyroid problems and take medication. I have the symptoms of depression - for which I take medication - and some of the others, yet whenever I have been tested for thyroid, my levels are always normal. I have been sleeping an extraordinary amount and my physician is testing me again for my thyroid. I am absolutely at my wits end and just want to feel "normal" again. Anything I should tell her or ask her to look for?

A. You may want to ask the doctor whether you have been tested for thyroid antibodies - TPOab (thyroperoxidase antibodies), TGab (thyroglobulin antibodies) and TRab (thyrotropin receptor antibodies, also known as thyroid stimulating immunoglobulins (TSI) or thyroid stimulating antibodies). Most people with Hashimoto's thyroiditis have TPOab or TGab. About half of people with Graves' Disease will also have these.

T4 blood tests might show an abnormal level, even if the TSH is normal in some medical disorders. The TSH test is usually reliable in diagnosing thyroid conditions. If symptoms similar to that of a thyroid disorder are present, and the TSH is within normal range, there may be some other medical problem that has missed diagnosis so far, or a thyroid disorder could be present, which has not shown up in the TSH results for some reason. TSH levels can be affected by some medications and also by acute illness. A thyroid scan is a reasonably simple procedure and may also be an option. This would indicate just how your thyroid gland is working and would show if there are any cysts etc. There are other medical problems that your doctor would probably consider as well, if you feel depressed and are often tired. Anemia, not enough vitamin B12, or a sleep disorder can cause these symptoms, as can some other conditions. Many people struggling with depression feel tired and may sleep a lot.

Also, does the medicine you're taking for depression cause increased tiredness as one of its side effects?

In May 1997 my TSH, T4 and T3 indicated I was hyperthyroid. In late June 1997, about 6 weeks later, the doctor told me my TSH result was normal. The copy of the lab tests that I have from June 1997 don't show that a TSH test was done. The result for Free T4 is 15.9, which is normal. The normal range is listed as 8.0 to 21.0 PMDL/L. ( I don't go to that doctor anymore. ) I was still hyperthyroid with lots of symptoms. Later blood tests, including TSH, ordered by the specialist, confirmed this. I don't like to think of what might have happened, had I not had those first tests done in May. If I had waited until June, and the test results came back normal, as they did, would I have been tested further, or told there was nothing wrong with my thyroid?

11. Q. I'm concerned that my children may develop thyroid conditions. My oldest is under the age of 10, but I was younger than that when I was diagnosed. My doctor says it's too early to run any tests.

A. The doctor may have looked for symptoms during regular checkups and may feel there's no need for blood tests, but with your family history and considering the fact that babies can be born with thyroid conditions, I'd want to be sure the doctor is familiar with thyroid disorders.

12. Q. I'm hypothyroid. My doctor has prescribed thyroid hormone pills. How long will I need to take them? Are there any side effects?

A. If you're hypothyroid from thyroiditis and you're prescribed medication, you may only need it for a few months. If the hypothyroid condition is from causes other than 'mild temporary' types of thyroiditis - Hashimoto's thyroiditis could result in your needing these pills permanently, if the thyroid gland becomes too damaged to function anymore - then you will most likely need the thyroid hormone replacement pills for the rest of your life.

Just as insulin helps persons with Type I diabetes everyday, thyroid hormone replacement helps persons with hypothyroid conditions.

Since thyroid hormone replacement is just a synthetic substitute for the natural thyroid hormone that your own thyroid would manufacture naturally, if it could, it will rarely cause side effects. The inactive ingredients ( binders to hold pills together in a shape, and the colors etc ) in all medications made by pharmaceutical companies are chosen specially for their non-allergenic qualities, so these rarely cause problems for the average person. The doctor will test your TSH level occasionally, once a year or so, to be sure the amount you're taking is what you need. Higher than needed amounts of this medication can result in an increased risk of osteoporosis. Untreated hyperthyroid conditions also increase this risk. The effects of untreated hypothyroidism would be more of a problem, since these include enlargement of the heart.

13. Q. Does everyone who is or who becomes hypothyroid gain weight?

A. Because untreated hypothyroidism can cause a lack of energy, it could result in some weight gain.

With the proper amount of thyroid hormone replacement, a person will ideally remain very close to their normal weight, energy level and so on, and with the medication, will not be hypothyroid, but will be euthyroid (normal). Regular blood testing and your own awareness of hypothyroid symptoms are probably good ways to avoid unnecessary hypothyroid-related weight gain. If you notice hypothyroid symptoms, ask to have your TSH tested, so your medication can be adjusted. Weight gain may be most common in people who aren't tested regularly, who don't take their pills as they should, and for those who have a natural, family tendency to gain weight - something that would happen whether hypothyroidism is involved or not.

There are a number of factors involved in weight gain, for many people --

Here is some info that I've found at the Mayo Clinic website-- "Causes of middle age weight gain... ...For most women, increases and shifts in weight begin during perimenopause — the years leading up to menopause. But these shifting levels of estrogen aren't the sole source of your weight gain. Aging also plays a part in your changing body composition.... -Reduced physical activity... -Increased food intake... -Slowing metabolism... -Genetics..." Read the whole article here --

In my case of weight gain [after I quit smoking] I went to the Mayo Clinic website and used the Mayo Clinic Healthy Weight Pyramid Tool to learn that I should only be taking in 1200 calories a day in order to lose weight. I have lost 50 pounds so far doing this, eating right and carefully and exercising as well. To FAQ Page 2