About the Thyroid and Thyroid Disease

Thyroid Disease

The normal thyroid is a small gland weighing about an ounce that sits behind the Adam’s apple in the lower part of the neck, in front of the windpipe.

It derives its name from the Greek word thyreoeides, meaning “shield-shaped.” In fact, it looks like a bowtie or butterfly, with the two “wings,” or lobes, of the gland connected in the middle by the isthmus.

The thyroid, like other glands, is a discrete soft body made up of a large number of vessels that produce, store, and release - or secrete - some substance. Some glands secrete their products outside the body, some inside. Those that secrete hormones and metabolic substances on the inside of the body are known as endocrine glands. The endocrine glands include the thyroid, the parathyroids, the adrenal gland, the pancreas, the pituitary gland, the pineal gland, the gonads (ovaries and testes), and the thymus.

Doctors who specialize in treating patients with endocrine problems - disorders of the endocrine glands - are called endocrinologists.

Hormones are internal secretions carried in the blood to various organs. The thyroid’s main purpose is to produce, store, and release two key hormones: triiodothyronine, also called T3; and thyroxine, or T4. The numbers 3 and 4 refer to the number of iodine molecules attached to each hormone.

Thyroid cells are the primary cells in the body capable of absorbing iodine, an essential nutrient. The thyroid takes in iodine, obtained through food, iodized salt, or supplements, and combines that iodine with the amino acid tyrosine, converting them to T3 and T4.

A healthy thyroid produces about 20 percent T3 and 80 percent T4. T3 is the biologically active hormone that is used by the cells; it is several times stronger than T4. As needed, the body converts the inactive T4 to active T3 by removing one iodine molecule. This conversion process is called monodeiodination. This conversion can take place in certain organs other than the thyroid, including the hypothalamus, a part of your brain.

T3 and T4 both exist in two forms: unbound and bound. Unbound, or free, T3 or T4 are biologically active; bound T3 and T4 are attached to the thyroid-binding globulin (TBG) protein. When measured in the blood, the free, or unbound, T3 and T4 levels tend to be most representative of the actual hormone available for use by the body.

The role of your thyroid hormones is to control your metabolism - the process by which oxygen and calories are converted to energy for use by your cells and organs. There’s not a single cell in your body that doesn’t depend on thyroid hormone for regulation and for energy in some form. And the thyroid hormones have a number of functions as they travel through the bloodstream.

* They enable cells to convert oxygen and calories into energy

* Help the body process carbohydrates

* Aid in the proper functioning of muscles

* Enable proper sexual development and functioning

* Help the heart pump properly and effectively

* Help the body to breathe normally

* Help the intestinal system digest and eliminate food

* Strengthen hair, nails, and skin Help the brain to function properly Help with normal bone growth

* Now that you have some idea of what the thyroid is and its location and function, let’s go into more detail about how it fits into the overall functioning of the body.

The Thyroid Gland: Setting the Pace

When your thyroid works normally, it produces and secretes the amount of T3 and T4 necessary to keep various body functions moving at their proper pace. However, the thyroid does not do this alone. It works as part of a bigger system, one that includes the pituitary gland and the hypothalamus.

Here’s how the system works. The hypothalamus constantly monitors the pace of many of the body’s functions. It also monitors and reacts to a number of other factors, including environmental factors such as heat, cold, and stress. If the hypothalamus senses that certain adjustments are needed to react to any of these factors, then it produces thyrotropin-releasing hormone, known as TRH.

TRH is sent from the hypothalamus to the pituitary gland. The pituitary gland is stimulated to produce a substance called thyrotropin, but better known as thyroid-stimulating hormone, or TSH for short. The pituitary gland also monitors the body and can release TSH based on the thyroid hormone levels circulating in your blood.

TSH is sent to the thyroid gland, where it causes the thyroid to produce, store, and release more T3 and T4 thyroid hormones.

The released thyroid hormones move into the bloodstream, carried by a plasma protein known as thyroxine-binding globulin (TBG).

Now in the bloodstream, the thyroid hormone travels throughout the body, carrying orders to the various organs. Upon arriving at a particular tissue in the body, thyroid hormones interact with receptors located inside the nucleus of the cells. Interaction of the hormone and the receptor will trigger a certain function, giving directions to that tissue regarding the rate at which it should operate.

When the hypothalamus senses that the need for increased thyroid hormone production has ended, it reduces production of TRH. The reduced production of TRH in turn causes the pituitary to decrease production of TSH, and the reduced TSH levels send the message to the gland itself to slow production of thyroid hormone. By this system, many of the body’s organs keep working at the proper pace.

Think of the entire feedback loop as somewhat like the thermostat in your house. It’s set to maintain a particular temperature, and when it detects that your house has become too hot, it signals to either stop blowing heat (or start blowing air conditioning). And when the house becomes too cold, the heat will kick on (or the air conditioning will turn off). In similar fashion, your body is set to maintain a certain level of circulating thyroid hormone.

When thyroid disease or other conditions interfere with the system and the feedback process doesn’t work, however, thyroid problems can develop.

Prevalence of Thyroid Disorders

Thyroid problems are widespread around the world. It is estimated that more than 200 million people worldwide have thyroid disease. Thyroid problems are particularly common in areas covered at one time by glaciers, where iodine is not present in the soil and in foods. In many of these countries, as many as one in five people have an enlarged thyroid, known as goiter, usually due to iodine deficiency. According to the World Health Organization, iodine deficiency is the world’s most prevalent - yet easily preventable - cause of brain damage. It affects more than 780 million people worldwide - 13 percent of the world’s population. As many as an additional 30 percent of the population worldwide is at risk of iodine deficiency–related problems.

Pregnant women with mild iodine deficiency may give birth to children with moderate cognitive and developmental problems - a reduction in IQ of as much as 15 points. Serious iodine deficiency during pregnancy can cause stillbirth, miscarriage, on a congenital abnormality known as cretinism. Cretinism is a severe, irreversible form of mental retardation, and is most common in iodine-deficient areas of Africa and Asia.

In the United States and countries where iodine deficiency is not rampant, other types of thyroid problems are more common, especially the autoimmune disorder known as Hashimoto’s disease. According to the latest diagnostic standards, there are some 54 million people in the United States with thyroid conditions. In the United States, only one in five people with thyroid conditions are actually being treated, however.

In the United States, the majority of thyroid conditions are due to autoimmune disease. The prevalence of thyroid disease increases with age. American women face a one-in-five chance of developing a thyroid problem. Women are seven to eight times more likely than men to develop thyroid conditions.

Besides iodine deficiency and being a woman, other risk factors include genetics and heredity, personal or family history of endocrine or autoimmune disease, infection, exposure to goitrogenic foods, cigarette smoking, pregnancy, certain drugs, particular chemical exposures, and radiation exposure. The risk factors are outlined in detail in Chapter 5.

Thyroid Conditions

There are a number of conditions that can affect the thyroid’s function and structure.

Hypothyroidism or Underactive Thyroid

Hypothyroidism means there is too little thyroid hormone. It can result from a thyroid that is not producing enough hormone, has been radioactively ablated, is affected by drugs or nutritional deficiencies, or is incapable of functioning properly due to nodules, infection, or atrophy. When all or part of the thyroid is removed - as a treatment for cancer, nodules, goiter, Graves’ disease, or hyperthyroidism - the vast majority of patients become permanently hypothyroid. A small number of infants are born without a thyroid, or without a functioning thyroid; this is known as congenital hypothyroidism.

Symptoms of hypothyroidism include fatigue, weight gain, constipation, fuzzy thinking, depression, body pain, slow reflexes, and much more.

Conventional treatment typically involves replacing the missing thyroid hormone using prescription thyroid hormone replacement drugs. Most commonly, a levothyroxine (T4) drug is prescribed, as this is considered the “standard” treatment for hypothyroidism. The most popular levothyroxine drug with physicians is Synthroid, and the term Synthroid is sometimes used to describe “thyroid hormone replacement drugs” (in the same way that the brand name Kleenex has become synonymous with “tissue”). This popularity is mainly due to extensive marketing by the manufacturer, however, and all the brand name levothyroxine drugs (Synthroid, Levoxyl, Levothroid, Unithroid, etc.) are considered to be similar in quality, potency, and effectiveness. Note, however, that Levoxyl has a fast-dissolving formula; it should be taken with plenty of water and swallowed quickly so as to maximize absorption.

Research has shown that many patients feel better with the addition of T3, so increasing numbers of practitioners are prescribing either Cytomel - liothyronine - or, less commonly, levothyroxine plus compounded T3.

Another option is a synthetic T4-T3 combination drug known as liotrix (brand name Thyrolar). While this drug is not commonly prescribed, it is a safe and effective option for some patients.

From the early 1900s to the 1950s, the only form of thyroid replacement drug available was natural thyroid, which was marketed under the brand name Armour Thyroid. The drug fell out of favor with some endocrinologists in the second half of the twentieth century as a result of Synthroid’s extensive marketing efforts. However, since the 1990s, Armour Thyroid has been enjoying a resurgence in popularity with some patients and practitioners. Derived from the desiccated thyroid gland of pigs, the drug contains natural forms of numerous thyroid hormones and nutrients typically found in the actual thyroid gland, and some patients report greater improvement in symptoms using natural thyroid.

Where the thyroid is not surgically removed or chemically deactivated, holistic and integrative treatments focus on support for better thyroid and immune system function, enhancing metabolism and rebalancing the endocrine and hormonal systems through nutrition, herbs, supplements, movement therapy such as yoga, and energy work.

Hyperthyroidism or Overactive Thyroid

Hyperthyroidism - too much throid hormone - can result in thyrotoxicosis. Hyperthyroidism can be caused by a number of thyroid problems, including autoimmune Graves’ disease, nodules that produce thyroid hormone, overdosage of thyroid hormone replacement drugs, or infection. It is typically treated by drugs that reduce the thyroid’s ability to produce hormone, by radioactive iodine treatment to chemically ablate the thyroid, or by surgery.

Symptoms of hyperthyroidism tend to mirror the rapid metabolism that results from an oversupply of thyroid hormone: anxiety, insomnia, rapid weight loss, diarrhea, high heart rate, high blood pressure, eye sensitivity or bulging, vision disturbances, and many other concerns.

Here how Janine describes her hyperthyroidism symptoms:

I started to feel weird, spacey, not feeling right in the head, anxious, heart palpitations, shaky, irritable, lost my appetite, trembling body, losing weight, sweating in the night and
not sleeping, and wondering what in God’s name was wrong with me. I had dizziness and shakiness, my heart pounding, tingling in my right arm and on my right cheek. I knew there was something wrong.

The anxiety of hyperthyroidism can sometimes be so significant that it is mistaken for anxiety or panic disorder. Kelly describes the anxiety of thyroid disease:

I felt like I was on an airplane that was about to crash with uncontrollable, impending doom.

Conventional treatment in the United States focuses on disabling the thyroid permanently by administering radioactive iodine (RAI) treatment, which renders most patients hypothyroid for life. Some physicians use prescription antithyroid drugs such as propylthiouracil (PTU) and methimazole (Tapazole) and beta blockers to calm down the thyroid and the immune system, with the hope of remission of the disease, which occurs in as many as 30 percent of patients. Antithyroid drugs are the first choice for doctors outside the United States. In rare cases in the United States, and more commonly outside the United States, surgery to remove the thyroid may be the treatment. Holistic and integrative treatments prior to RAI or surgery focus on supplementing antithyroid drug approaches with natural antithyroid foods, supplements, and herbs that have no side effects, as well as calming and rebalancing the immune system through nutrition, herbs, supplements, movement therapy such as yoga, and energy work.

Ultimately, most people with hyperthyroidism do end up hypothyroid for life as a result of RAI or surgery.

Goiter

Goiter is the term used to describe an enlargement of the thyroid gland. The thyroid gland can enlarge as a response to deficiencies of iodine, thyroid inflammation or infection, or autoimmune disease. The thyroid becomes large enough that it can be seen as enlarged by ultrasound or X-ray, and may be enlarged enough to thicken the neck area visibly. Particularly large goiters may be cosmetically problematic, and can compromise breathing and swallowing; they are often surgically removed. Smaller goiters may respond to drug treatment.

Symptoms of goiter include a swollen, tender, or tight feeling in the neck or throat; hoarseness or coughing; and difficulty swallowing or breathing.

Goiter can be due to an autoimmune condition that triggers an inflamed thyroid, or too much or too little iodine in the diet. In the United States, 10 to 20 percent of goiters are iodine-induced.

Treatment for goiter depends on how enlarged the thyroid has become, as well as other symptoms. Treatments can include:

* Observation and monitoring, which is typically done if the goiter is not large and is not causing symptoms or thyroid dysfunction.

* Medications, including thyroid hormone replacement, which can help shrink the goiter, or aspirin or corticosteroid drugs, to shrink thyroid inflammation.

* If the goiter is very large, continues to grow despite drug therapy, is in a dangerous location (blocking the windpipe or esophagus), or becomes cosmetically unsightly, most doctors will recommend surgery. If the goiter contains any suspicious nodules, surgery may also be necessary.

Source: The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age by Mary J Shomon

The Thyroid Hormone Breakthrough by Mary J Shomon

Thyroid Hormone

As women, we’ve come to expect that certain things are inevitable. As young girls, we anticipate -  but at the same time dread - the first arrival of “Aunt Flo” or “my friend.” Then, for the next 30 to 40 years, we assume that premenstrual syndrome, erratic cycles, and unusually light or heavy menstrual periods are simply an unavoidable part of life.

In the meantime, women’s magazines and television news programs deliver conflicting messages: you can get pregnant from a single sexual encounter, but infertility is on the rise. Teenage pregnancy rates are down, but if you’re a 45-year-old celebrity, it’s a breeze to give birth to twins. If you can’t get pregnant after trying for a year, your doctor says you are “experiencing infertility” and shuttles you off to a fertility expert for elaborate and expensive workups. After that you’re offered costly procedures and treatments—everything from hormone treatments to in vitro fertilization - to help you have a baby.

When we are pregnant, we assume that morning sickness is to be expected - even the kind of morning sickness that goes on all day and all night throughout the pregnancy, leaving us dehydrated and debilitated. “Morning sickness is a good sign,” say the old wives’ tales, and our mothers, relatives, and friends repeat this mantra, while prescribing crackers and club soda, as if that will make it better.

And while we all want to be like the celebrity model who still has an adorable figure with a tiny baby “bump” when she’s nine months pregnant, and who gets back into size 4 jeans a few weeks later, baby at her breast, some of us definitely don’t fit into that category. Instead, we walk around feeling down in the dumps, because our hair is falling out and we have no energy. And we have a horrible feeling of guilt and failure, because we’re not making enough milk to breastfeed our baby properly. We need to supplement with formula, or worse - we can’t nurse at all.

Many of us just assume that we’re not going to have the sex drive that we had when we were young. After reading all those women’s magazines and watching enough Oprah and Discovery Channel health shows, who of us can’t recite the reasons for our low libido? Marriage, exhaustion, children, not enough time, stress - I could go on for pages listing all the reasons why “losing that spark” is an expected part of life for women.

Let’s not forget the hormonal grand finale: menopause. Now that hormone replacement therapy is in the medical doghouse, women are once again saddled with weight gain, hot flashes, night sweats, fatigue, mood swings, vaginal dryness, and low sex drive. And just to add to the fun, we now have something called perimenopause - the time before true menopause, when we have all those so-called menopausal symptoms, plus erratic and sometimes extremely heavy periods. It may come as a surprise to you - it sure did to me - that perimenopause can go on for as long as a decade!

Have I depressed you yet? You were already depressed, you say? And sort of stressed out and anxious too? Of course, depression and anxiety are conditions that we assume are a given in today’s modern life. Antidepressants and antianxiety drugs like Zoloft, Prozac, Effexor, and Zyprexa are among the most prescribed medicines in the United States today.

It may sound as if we women are destined to be victims of our hormones from our preteens into our golden years. But there is hope. And it comes from your thyroid - a small gland that is very powerful, but often overlooked when it comes to women’s complaints.

The thyroid is a bowtie-or butterfly-shaped gland located in the neck, below and behind the Adam’s apple area. It is the master gland of energy and metabolism, and a key player in our complex endocrine system, interacting with other endocrine glands such as the pancreas, adrenals, ovaries, and pituitary. The thyroid releases hormones that rise and fall in concert with other endocrine hormones, such as insulin, cortisol, estrogen, and testosterone.

When the thyroid is not doing its job properly, it can throw the body’s entire hormonal and reproductive systems out of balance.

An undiagnosed or improperly treated thyroid condition may actually be at the root of many symptoms and complaints that we assume are simply “hormonal.”

By conservative standards, there are almost 27 million people with thyroid conditions in the United States today. An estimated half of these people are undiagnosed.

And this estimate may just be the tip of the iceberg. Since 2002, experts in the endocrinology community have been calling for changes in the standards that define normal thyroid function. Some doctors are already using new standards for diagnosis and treatment, but many practitioners have yet to adopt them. According to these new standards approximately 59 million Americans are considered to have thyroid disease.

This means that, right now, according to the newly recommended standards, there are as many as 30 million Americans who don’t even know they have a thyroid problem. Millions more have been diagnosed and treated, but they may still struggle with related symptoms and side effects. And since thyroid disease affects women seven times more often than men, the vast majority of the undiagnosed are women.

You may have in your mind what many consider the stereotypical thyroid patient…a middle- aged, overweight woman. And if that’s not you, you might assume you can’t have a thyroid condition. Or you may think that only if you have an enlarged thyroid, known as a goiter, or bulging eyes could you have a thyroid problem. You may have even been told by a doctor, as one young mother was, “You can’t possibly have a thyroid problem, because if you did, you wouldn’t have been able to just have a baby!”

But being of normal weight, having a normal neck or eyes, or the fact that you were able to have a baby do not rule out a thyroid problem.

That’s why I’ve written this book. In The Thyroid Hormone Breakthrough, you’ll learn about the thyroid’s powerful connection to so many seemingly unrelated hormonal symptoms and
complaints, and why this important gland is so often overlooked. You’ll learn about the common risk factors for thyroid disease and the symptoms that can help you pinpoint a condition. You’ll learn about how to get a proper diagnosis and how treatment can improve your condition. And you’ll learn about additional treatments, both conventional and alternative, that can help you enjoy a lifetime of better health.

This book is for you if are experiencing any of these problems:

You suffer with erratic menstrual periods that may be very heavy or very light, with cycles as short as every 18 days or as long as every 60 days, lasting anywhere from 2 to 10 days. From your first period as an adolescent to the final period that signals the onset of menopause, thyroid imbalances can cause a whole array of menstrual difficulties, including irregular cycles and severe PMS.

You’re unable to get pregnant, or you’ve had several miscarriages. You may even have undergone expensive and invasive procedures to overcome these problems. An undiagnosed thyroid problem may be the real reason you can’t get pregnant. You’re pregnant, and gaining - or losing - a great deal of weight, perhaps even suffering from severe morning sickness or other debilitating symptoms. Undiagnosed or improperly treated thyroid conditions can worsen your pregnancy symptoms, and even endanger your pregnancy, increasing the risk of miscarriage, intrauterine growth retardation, preterm labor, stillbirth, and cognitive problems or mental retardation in your child.

You’re having a difficult time breastfeeding and losing the baby weight, and you’re feeling fatigued, losing your hair, and suffering from postpartum blues. The postpartum period is a common time for thyroid symptoms to appear. And undiagnosed or undertreated postpartum thyroid problems are a key factor behind low milk supply.

You have little or no interest in sex. We may think this is just the way it is after being married a few years, having children, or getting older, but libido is closely linked to thyroid function. What you think is just low libido may actually be a symptom of a dysfunctional thyroid.

You’re in your forties or fifties, and you are having a particularly difficult perimenopause or severe menopause symptoms. Many women assume that symptoms such as fatigue, weight gain, hair loss, anxiety, and depression are “normal” for women approaching or going through menopause. But in reality, this is also a common time for thyroid problems to appear, and the symptoms being attributed to menopause may actually be caused by a treatable thyroid condition.

Before I continue, I’d like to explain my own background. I’m not a doctor or health  professional. I have a degree in international studies from Georgetown University. I never expected to be writing books about thyroid disease. But back in 1995, at the age of 33, I was diagnosed with Hashimoto’s disease, an autoimmune condition that causes hypothyroidism. The diagnosis was a turning point in my life and in my career. First, I struggled to return to good health myself. Later, I expanded my own research, began to share this knowledge with others, and became a patient advocate. In 1997, I started a popular, patient-oriented website on thyroid disease, www. thyroid- info.com. In 1998, I launched the only independent print and e-mail newsletter on thyroid health and treatment from a conventional and alternative perspective. I’ve also written a number of books and magazine articles to help people overcome their health challenges.

Now I get hundreds of e-mails and letters each week from readers all over the world sharing their stories and looking for solutions to their own thyroid and hormonal problems. And I can relate. When it comes to hormonal ups and downs, I’ve had a few of my own.

I’ve gone through phases where my periods have been wildly unpredictable, sometimes coming every 21 days, and other times, every 37 days.

In 1997, when I was 35, my husband and I began trying to conceive a child—but only after I had a thorough understanding of my fertility cycles and had my thyroid condition under control and carefully monitored. Thanks to this extra planning, preparation, and knowledge, our daughter was conceived fairly quickly, and was born a happy and healthy 8½ pounds in late 1997. (Don’t let anyone tell you that a thyroid problem means you can’t have a baby. My daughter is evidence to the contrary!)

But—there’s always a but - I gained 50 pounds in the process. It was a huge struggle to lose the extra weight. My hormones went wild after the delivery, setting off a case of postpartum blues, hair loss, and extreme fatigue. I also waged a six-month touch-and-go struggle to breastfeed, which I detail here in the book.

I had a second pregnancy at 40, which ended in a miscarriage at 10 weeks. My progesterone levels were simply not high enough to support the pregnancy, apparently. Losing a baby at any point in a pregnancy is such a heartbreak.

Now, at 44, I’m mother to a second child: we adopted a precious little boy in 2005. It’s wonderful, but very tiring, to have a little one again! But one other thing is making me tired - I’m in perimenopause. Truly, it’s a challenge to stay balanced given the ups and downs of my hormones.

So, all along the way, from my efforts to get pregnant more than nine years ago to my current adventures with perimenopause, I’ve had to immerse myself in information on women’s hormones, fertility, pregnancy, postpartum health, and the endocrine system in order to understand and meet my own challenges. The result is this book, written for the millions of you who, like me, are riding the hormonal roller coaster!

Many of you don’t even know you have a thyroid problem. I hope this book can provide a road map that will help you move quickly through the process of recognizing your symptoms, getting diagnosed, and receiving proper treatment.

Many of you have already been diagnosed and treated for a thyroid condition. But if your thyroid treatment is not optimized and carefully monitored, you are opening yourself up to a number of hormonal complaints. For example, during the time you are trying to become pregnant, and during early pregnancy, proper thyroid treatment and oversight can make the difference between infertility or miscarriage and a successful pregnancy and healthy baby.

For example, Mandy has been hypothyroid since she had radioactive iodine treatment, and now she has many unresolved hormonal symptoms.

I have gained weight. Diet and exercise have produced little positive result. I have uterine fibroids that cause extremely heavy periods. So much so that for at least two days of the month, I am very limited in the activities that I can participate in, as I bleed through double/super protection in 30 minutes. This was not so before thyroid disease. I have a much lower sex drive. My interest level is dramatically different now than during hyperthyroid days. My partner of 10 years is exasperated and is talking about leaving. I became pregnant and miscarried at one point. I do not even entertain the idea that pregnancy is an option for me anymore.

There is no reason that women like Mandy should have to suffer with symptoms like this. I also hope that some of you reading this book are practitioners trying to better understand your patients. More than ever, your patients are struggling with the implications of hormonal imbalances. There’s a dizzying array of options—with everything from a birth control pill that lets you have only 4 menstrual periods a year, fertility treatments that allow women to get pregnant well into their forties and fifties, and pills, powders, and potions that all promise to solve the symptoms of menopause now that the old standby, Premarin, has fallen out of favor.

I can’t promise that thyroid treatment is the solution for every woman struggling with PMS, fertility, menopause, or other hormonal challenges. But it is a solution for some, and the benefits of diagnosis and proper treatment are immeasurable.

Source: The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age by Mary J Shomon