Thyroid for Dummies (45 page)

For example, if your temperature is 40 degrees Centigrade, you’re probably 29_031727 ch21.qxp 9/6/06 10:46 PM Page 266

266
Part V: The Part of Tens

sicker than someone whose temperature is only 38 degrees Centigrade. When it comes to thyroid autoantibodies, this notion isn’t the case, however.

No correlation between levels of autoantibodies and the severity of someone’s thyroid disease is apparent, however. Some of the sickest people with hyperthyroidism due to Graves’ disease have relatively low levels of autoantibodies, while people with milder cases of Graves’ may have high levels.

Adding to the confusion is the fact that thyroid autoantibodies often disappear after treatment with antithyroid drugs, and suggests the disease will not recur.

Also true is that very low levels of autoantibodies are often found in older women. But unless those women have abnormal thyroid function tests, the autoantibodies have little importance. Although people with low levels of autoantibodies are retested occasionally, they don’t require treatment unless a thyroid condition develops.

And autoantibody levels are not comparable between laboratories. Little consistency stems from the methods used in the tests, so a level of 1,000 at one laboratory means something very different from a level of 1,000 at another laboratory.

Very high thyroid autoantibody levels do not indicate that you have a bad case of autoimmune thyroiditis. They simply confirm the diagnosis if other signs and symptoms exist.

Clinical Symptoms Are More

Reliable Than Blood Tests

Thyroid disease is very confusing. In certain age groups, particularly older people, the expected signs and symptoms often do not exist. Sometimes, opposite symptoms are found. For example, some people gain weight as a result of hyperthyroidism, while others lose weight with hypothyroidism.

Many people, including some physicians, believe that clinical signs and symptoms are more accurate than laboratory tests when diagnosing thyroid conditions.

What would someone who relies on symptoms do with an older woman who is apathetic, does not have an enlarged thyroid, and is depressed, but has a high free T4 level and a low TSH? Her clinical signs and symptoms point to 29_031727 ch21.qxp 9/6/06 10:46 PM Page 267

Chapter 21: Ten Myths about Thyroid Health

267

hypothyroidism, but her tests show hyperthyroidism. Relying on symptoms alone, a doctor might give this patient thyroid hormone replacement. The proof of the pudding is in the eating. When treating people with confusing clinical signs according to their lab test results rather than their clinical findings, they invariably get better.

One of the problems is that signs and symptoms of hypothyroidism are often very subtle, just like many other diseases. The signs and symptoms mimic those of diseases like depression, menopause, and ageing.

Another problem is the placebo effect of any drug. If you give a group of patients a drug that’s not supposed to have any effect on the disease in question, a few of them will get better. This finding does not mean that the drug is the reason they improved.

A good physician bases his or her treatment on evidence-based medicine.

This reasoning means that single instances of improvement do not prove that a treatment is correct; they could just as easily mean that the original diagnosis is wrong.

Do not take treatment for a thyroid disease, such as hyperthyroidism or hypothyroidism, unless your thyroid function tests confirm the diagnosis.

29_031727 ch21.qxp 9/6/06 10:46 PM Page 268

268
Part V: The Part of Tens

30_031727 ch22.qxp 9/6/06 10:46 PM Page 269

Chapter 22

Ten Ways to Maximise

Thyroid Health

In This Chapter

ᮣ Keeping an eye out for thyroid disease

ᮣ Getting enough iodine

ᮣ Managing hyperthyroidism and cancer

ᮣ Avoiding drug interactions and radiation

ᮣ Staying up-to-date

This book covers a lot of information. Now it’s time to put the icing on the cake, or perhaps the exclamation point at the end of the sentence. This chapter discusses the steps you can take to ensure your best thyroid function.

You may think there’s little you can do – that your thyroid, like the River Thames, just keeps rolling along. Fortunately, that’s not true – there’s plenty you can do to maximise thyroid health.

These things fall into several categories. You can ensure that thyroid testing is done at the right intervals. You can examine yourself to determine whether the shape of your thyroid is normal. You can make sure that you’re getting the proper nutrients so your thyroid makes its hormones in sufficient quantities. And perhaps most important of all, you can stay knowledgeable about all the new discoveries concerning thyroid health and disease that appear on a regular basis.

Carrying out these actions means you’re doing all you can to take care of that little gland that weighs less than an ounce but which plays such an important role in your life and health.

30_031727 ch22.qxp 9/6/06 10:46 PM Page 270

270
Part V: The Part of Tens

Screening at Appropriate Intervals

Many symptoms of hypothyroidism are subtle or are similar to symptoms of ageing or menopause (refer to Chapter 5). Hyperthyroidism is also tricky as symptoms are not always prominent (especially in older people), and sometimes appear to point towards an underactive thyroid even though the thyroid is overactive, or the other way round (refer to Chapter 20).

The most common form of thyroid disease is autoimmune thyroiditis (also known as chronic thyroiditis or Hashimoto’s thyroiditis). It probably affects 10 per cent of the population, although only a small fraction of people with this disease actually develop hypothyroidism.

Hypothyroidism often begins when a woman is in her 30s. For this reason, and because of the confusion that exists between the diagnosis and the signs and symptoms that a person experiences, some doctors suggest screening for abnormal thyroid function at age 35, continuing at five-year intervals for life. This course of action is fine if you can afford private health screening, but thyroid tests are usually only carried out in the NHS if symptoms, signs, or family history suggest that they’re needed. Of course, if tests reveal a thyroid condition, free NHS testing is carried out as often as needed.

Screening involves having a blood test – the TSH (thyroid-stimulating hormone) test. The normal range, depending on the particular laboratory carrying out the test, is usually given as 0.3 to 4.5 µU/ml (microunits per millilitre) (check out Chapter 5). If your doctor tells you that your screening test is normal but you still have symptoms consistent with hypothyroidism, ask the doctor for the exact number of your TSH. If it’s above 2.5, ask your doctor to consider giving you a trial of treatment with thyroid hormone replacement.

Checking Thyroid Function

As Your Body Changes

If you’re taking thyroid hormone treatment, you’re on a fixed dose of medication. However, many physical states, particularly pregnancy (refer to Chapter 18), change the amount of thyroid hormone that you need to maintain normal function. The same is true as you get older.

Chemical changes that cause you to make more thyroid-binding proteins (check out Chapter 4) require you to take an increased dose of thyroid medication.

Any condition that increases your oestrogen level is an example, such as pregnancy and taking the oral contraceptive pill. As more thyroid-binding protein is made, more of your dose of thyroid binds to the protein and less is 30_031727 ch22.qxp 9/6/06 10:46 PM Page 271

Chapter 22: Ten Ways to Maximise Thyroid Health

271

available to enter your cells. You must increase your dose of thyroid hormone.

Blood tests determine when you again have enough.

Chemical changes that cause you to make less thyroid-binding protein require a decreased dose of thyroid hormone. If you take androgens (refer to Chapter 10) or have a disease that causes excessive production of androgens, you may need your dosage of thyroid hormone reduced. Less thyroid-binding protein means less binding of your thyroid dose, so more is available to enter cells. If you don’t reduce your dose of thyroid hormone in this circumstance, you could become hyperthyroid.

Another situation that occurs in pregnancy is the reduction in autoimmunity (refer to Chapter 18). If you’re treating hyperthyroidism with antithyroid pills, you may need a lower dose or none at all until the pregnancy is completed.

Then you will need treatment again.

During times of major body change such as pregnancy or illness, your need for thyroid hormone or antithyroid medication may change. The only way to know that you’re on the right dose is to have thyroid function tests at regular intervals, usually every three months.

Performing a ‘Neck Check’

Five steps are involved in doing a ‘Neck Check’. You need a hand-held mirror and a glass of water. The steps are:

1. Hold the mirror in your hand, focusing on the area of your neck just
below your Adam’s apple and immediately above your collarbone.

Your thyroid is located in this area of your neck.

2. While focusing on this area in the mirror, tip your head back.

3. Take a drink of water and swallow.

4. As you swallow, look at your neck. Check for any bulges or protrusions in this area when you swallow.
Reminder: Don’t confuse your Adam’s apple with the thyroid gland. The thyroid gland is located farther down on your neck, closer to the collarbone. You may want to repeat this process several times.

5. If you do see any bulges or protrusions in this area, see your doctor.

You may have an enlarged thyroid gland or a thyroid nodule that needs checking to determine whether cancer is present or if treatment for thyroid disease is needed.

You can detect abnormalities in the size and shape of your thyroid gland. If you think your thyroid is enlarged, see your doctor to determine if there’s any problem.

30_031727 ch22.qxp 9/6/06 10:46 PM Page 272

272
Part V: The Part of Tens

Getting Enough Iodine to

Satisfy Your Thyroid

The number of people with iodine deficiency in Europe is on the increase.

Many people do not eat good food sources of iodine, namely fish and, to a lesser extent, meat, eggs, and milk, and there’s a little iodine in fruits and vegetables, too.

Due to concerns about high blood pressure, your doctor may urge you to cut back on salt intake as salt raises blood pressure. Recommendations are to limit salt intake to less than 6 grams daily, slightly more than a teaspoon.

This reduced amount contains plenty of iodine for your diet however, as 1

teaspoon of salt contains about 400 micrograms of iodine. Or you can eat a couple slices of bread each day. Each slice of bread contains about 150

micrograms of iodine. The recommended daily intake of iodine is 150 to 200 micrograms.

Stopping Thyroid Medication, If Possible

Some people who take thyroid hormone replacement because of laboratory evidence of low thyroid function can stop their treatment at some point.

These people have hypothyroidism due to chronic thyroiditis (refer to Chapter 5). Their hypothyroidism is the result of antibodies that block the action of thyroid-stimulating hormone. Up to 25 per cent of these patients can come off treatment as, over time, the level of their blocking antibodies may fall to the point that their thyroid gland is able to make its own thyroid hormone. It’s certainly worth trying to stop thyroid hormone after a few years of treatment to see if the thyroid can function on its own.

If you have hypothyroidism due to chronic thyroiditis and have taken thyroid hormone pills for a few years, ask your doctor if you can stop the thyroid hormone replacement for a month and check your thyroid function tests.

Using Both Types of Thyroid Hormone

The thyroid gland makes two different thyroid hormones, T4, the major component, and T3, which is the active form of thyroid hormone but made in much lower amounts in the gland (check out Chapter 3).

Because drug manufacturers learned to synthesise it, T4 is the only treatment prescribed when people need thyroid hormone. It’s given so that a patient’s 30_031727 ch22.qxp 9/6/06 10:46 PM Page 273

Chapter 22: Ten Ways to Maximise Thyroid Health

273

TSH level returns to normal, as does the free T4 in the blood. This practise means that most people who are treated for hypothyroidism have a deficiency of T3.

In practical terms, this problem is not significant. However, a few people continue to complain of symptoms of low thyroid function despite normal laboratory test results. These patients may improve if T3 is added to their treatment.

Doctors find that measuring this kind of improvement objectively is difficult because the test results remain in the normal range. Monitoring relies on the subjective symptoms of the patient indicating that he or she feels better on the combination therapy compared to T4 alone.

This from of treatment is still a grey area in medicine as randomised controlled trials have not yet shown definite benefit from giving both T3 and T4. If you have symptoms of hypothyroidism and are taking T4 hormone replacement alone, ask your doctor to investigate the possibility of prescribing a small dose of T3 as you may do better with the combination.

Preventing the Regrowth

of Thyroid Cancer

If you have thyroid cancer, you’ve probably had thyroid surgery followed with irradiation to eliminate the remaining thyroid tissue. Now you want to prevent any regrowth of thyroid cancer. This prevention is accomplished with sufficient thyroid hormone to suppress the production of thyroid-stimulating hormone – meaning the goal is for your TSH level to drop below the normal range. The lower level of the normal range is usually 0.3 µU/ml (microunits per millilitre) although laboratories can vary, so you generally want a reading of 0.3 or below to ensure your thyroid isn’t stimulated.