Questions :

1. Is goitre due to lack of iodine? Can kelp help?

2. Should I adjust may dosage of thyroxine when my thyroid "kicks up."

3. I have a lower body temperature, but my thyroid function tests are normal. Should I be taking thyroid medication?

4. My doctor found my serum levels of T4 (thyroxine) to be elevated and has cut my dosage of thyroxine. However I still feel quite tired.

5. Is thyroid cancer hereditary?

6. Why has surgery been recommended for my benign thyroid nodules?

7. I feel fine on my present dose of thyroxine. Should my dose be lowered due to a risk of osteoporosis?

8. Are specific forms of thyroid disease i.e. hypothyroidism and hyperthyroidism hereditary?

9. I have bulging eyes due to Graves' Disease but otherwise I feel better. Should my dose of thyroxine be adjusted?

10. Can physical and emotional stress trigger Graves' disease?

11. My Graves' disease was cured by anti-thyroid medication several years ago. Should my thyroid continue to be checked?

12. Are there serious side-effects with anti-thyroid medication?

13. Can radioactive iodine treatment cause cancer or sterility? If I take this treatment, will I be a danger to others?

14. I am concerned about taking thyroxine for life. Is the natural product better than the synthetic product?

15. How does hypothyroidism affect memory loss?

16. Are migraine headaches connected to a malfunctioning thyroid?

17. What non-allopathic (i.e. homeopathic) treatments are available for hyperthyroidism?

18. Are there chemicals in the drinking water that can affect the thyroid gland?

19. What is the latest medical research being carried out on thyroid disease?

20. I developed Hashimoto's thyroiditis after the birth of my child. Are my children at risk?

21. After a CAT scan I found I was allergic to iodine. Could this have triggered my thyroid disease?

22. Does age affect recovery rate for thyroid disease? What is the "normal" range for TSH and T3 RIA readings?

23. I have been treated for hypothyroidism for many years. Suddenly I felt hyperthyroid. Could stress have triggered hyperthyroidism?

24. How long does it take to feel better after hypothyroidism?

25. Is there a connection between fluoride and hypothyroidism?
1. Is goitre due to lack of iodine? Can kelp help?

ANSWER:
Iodine deficiency is the most common cause of goitre in the world but NOT in this country. We have had iodized salt for two generations, and there are many other sources of iodine now in our diets so that, if anything, we are receiving more iodine than in most places in the world. There is no point whatsoever in adding more iodine to the diet and that includes kelp, a form of seaweed high in iodine often sold in health food stores. The problem is that too much iodine is just as dangerous as too little iodine. Excess iodine can also cause goitres and can either cause a low thyroid state, (hypothyroidism) or excess output of thyroid (hyperthyroidism). It also aggravates Hashimoto's thyroiditis. In Canada it is a mistake to ingest kelp.

2. Should I adjust may dosage of thyroxine when my thyroid "kicks up."
“I have been on thyroxine for many years for the control of my hypothyroidism. However, at times I get very nervous and irritable or very fatigued and I believe it is my thyroid "kicking up". What should I do with my dosage of thyroxine?”

ANSWER:
It is a curious fact that, when patients have had an illness of any kind, they will then ascribe any type of symptom to the original illness. Thus patients who are well treated for their thyroid disorder will continue to ascribe variations in mood, fatigue, etc. to their "thyroid condition". The facts are that if you are on an appropriate dosage of thyroxine, the levels of thyroid hormone in your blood stream and in your tissues will be normal and you cannot have any symptoms related to your thyroid disease whatsoever. What you are really experiencing are the usual variations in well-being that any normal person has to endure. In some people, these variations are very wide indeed, but they cannot be attributed to the thyroid status.

3. I have a lower body temperature, but my thyroid function tests are normal. Should I be taking thyroid medication?

“I have been feeling very fatigued for many years. I also complain of constipation, lethargy, inability to concentrate and weight gain. I have seen several doctors including an endocrinologist; they have tested my thyroid with blood tests on many occasions. The tests always come back completely normal. Yet, I have been reading that these tests are not accurate and that measurements of body temperatures are more accurate. Moreover, I understand that I should be taking thyroid medication for these symptoms despite normal thyroid function tests.”

ANSWER:
Actually the routine blood tests for thyroid function are extremely accurate and precise. Moreover, the blood tests for thyroid stimulating hormone (TSH) (which is the pituitary hormone that stimulates the thyroid even more when it is failing) is extremely accurate. It is the first test to rise when thyroid function is at all low. Indeed, it will go up even before the thyroid hormone levels are detectably lower. This is a category termed "compensated" hypothyroidism. In that state, the thyroid hormone levels are still normal, the patient still feels normal but the TSH is already an indicator that the thyroid gland itself is in trouble. In your case, with a normal TSH, hypothyroidism is completely ruled out. It is important to remember that many other conditions can mimic hypothyroidism, most particularly chronic anxiety, depression and stress. It is true, however, that such people who do not have thyroid disease can "benefit" from taking thyroid medication. The reason they are benefiting is that the thyroid medication is a "placebo". The drug itself has no intrinsic benefit to them, but if people think it is going to help them, then it does. It is like fooling yourself by taking a pill that looks identical but is completely inert. If we convince ourselves that there is some good in it, then we feel much better. Sometimes this placebo effect is truly remarkable and long lasting. More often, however, it lasts for only a short time and disappears. Taking thyroxine when you do not need it, is also of some danger and cannot be encouraged. Finally, skin temperatures are of no value in diagnosing hypothyroidism despite assertions to the contrary by some. It has been clearly proven they are totally misleading and really useless. While it is true that patients with hypothyroidism do have cool skin, so do people with many other conditions. These include people with poor blood supply, severe stress, anaemia and others.

4. My doctor found my serum levels of T4 (thyroxine) to be elevated and has cut my dosage of thyroxine. However I still feel quite tired.
“I have been taking thyroxine 0.15 mgs. per day for some years. I felt well most of this time but recently I have had some rapid heart beating and sweating. My doctor found the serum thyroxine (T4) to be elevated and has cut my dosage of thyroxine down to half. Now I am feeling quite tired. What is going on?”

ANSWER:
It is entirely likely that your rapid heart beat and sweating have nothing to do with your thyroid status or thyroxine medication. The problem is that the serum thyroxine is not useful for monitoring patients who are taking thyroxine by mouth. For that purpose, the total serum triiodothyronine (total T3) is the best measure of the appropriateness of the dosage. Another problem is that the term "T3 test" means different things to different people. There is a test called the T3 resin uptake which has nothing to do with the total serum T3. Even physicians get these tests confused. The total T3 is performed by a technique called radioimmunoassay (RIA). We like this test to be in the middle of the normal range, which is 1.2-3.4 nmol/L, i.e. around 2.1-2.8 nmol/L. If the total T3 is in that order, the dosage of thyroxine is appropriate.

5. Is thyroid cancer hereditary?
“An aunt has papillary thyroid cancer and was treated. Several months ago my family doctor found a thyroid nodule on my neck and referred me to a specialist. I understand thyroid cancer is hereditary and although my doctor reassures me, I am frightened that I too may have thyroid cancer.”

ANSWER:
It should be emphasized that most thyroid nodules prove to be benign. Only about 20% of thyroid nodules turn out to be malignant, and most of these are papillary carcinoma of the thyroid which usually has a good prognosis. Carcinoma of the thyroid is generally NOT hereditary. Only one comparatively rare form is inherited and it is called medullary carcinoma of the thyroid. It only accounts for about 5% of all thyroid cancers.

6. Why has surgery been recommended for my benign thyroid nodules?
“A little over a year ago my doctor discovered a nodule and advised me that he would watch it and possibly prescribe thyroxine. Since then I developed another nodule and a cyst and experienced pain in my throat. At this time the physician I am seeing is not considering treatment with thyroxine but is suggesting surgery. I am 70 years old and am resisting this treatment. Am I taking a risk by avoiding surgery? A needle biopsy proved negative. Is there any other treatment for my condition?”

ANSWER:

The treatment with thyroxine can be for two purposes, either to suppress thyroid tissue or merely to treat hypothyroidism. It would be appropriate to suppress TSH in the case of a goitre or previous treatment for thyroid carcinoma. However, when one is trying to treat hypothyroidism, the ideal treatment would be to bring TSH down into the normal range, but not suppress it necessarily. Nevertheless, concerns which many physicians have expressed over the past few years about osteoporosis if TSH is suppressed by thyroxine have proven recently to be incorrect. Studies have shown NO reduction in bone mineral density, and no osteoporosis when thyroxine is taken even in suppressive doses. Only when patients have had actual Graves' disease -- "overactive thyroid," is there a risk of osteoporosis and even that risk is small. Nevertheless, one should strive for ideal therapy and the ideal for hypothyroidism is to have all tests of thyroid function normal.

8. Are specific forms of thyroid disease i.e. hypothyroidism and hyperthyroidism hereditary?
“I have an overactive thyroid, yet my sister has an underactive thyroid, just the opposite. Is it not strange that these two conditions have occurred in our family?”

ANSWER:
Both of these are termed "autoimmune" thyroid diseases: that is, they are both due to antibodies. In the case of the overactive thyroid, the antibody that has caused that condition stimulates the thyroid, and thus causes Graves' disease. On the other hand, your sister with hypothyroidism also has antibodies but these have damaged the thyroid and caused it to be unable to function at a normal level. Although these conditions are opposite to one another, they are in fact very closely related.

9. I have bulging eyes due to Graves' Disease but otherwise I feel better. Should my dose of thyroxine be adjusted?

“I have very prominent eyes associated with my Graves' disease. The Graves' disease was treated with radioactive iodine and indeed my goitre disappeared and I feel generally much better. I am now taking thyroxine therapy for an underactive thyroid resulting from the radioactive iodine. However, I expected my eyes to improve and they have not. Should I change my dose of thyroxine?”

ANSWER:
There is no point in changing your dosage of thyroxine, as it will not influence the progress of your eye disease either pro or con. The eye disease is not influenced by the state of your thyroid, or by the treatment for it. Indeed, it is my own personal view that the eye disease is only related to the thyroid disease through the basic cause of each. That is, the basic cause of each disturbance, the overactive thyroid on the one hand and the eye disease on the other, are very closely related, but treating the thyroid disease does not treat the eyes. It will do "its own thing". The eye disease usually reaches a plateau within a year after onset and in most instances does not progress further thereafter. The important point is that if it is severe enough, it should be treated by a good ophthalmologist who is familiar with this disorder.

10. Can physical and emotional stress trigger Graves' disease?
“Could the physical and emotional stress caused by a car accident trigger Graves' disease in a patient with no previous thyroid problems?”

ANSWER:
It cannot be proved beyond doubt that any particular physical and emotional stress is the precipitant triggering Graves' disease. However, there is much circumstantial evidence that such stresses adversely affect the immune system and thus can tip the balance in those genetically susceptible to this disorder.

11. My Graves' disease was cured by anti-thyroid medication several years ago. Should my thyroid continue to be checked?

“I have Graves' disease and was treated with propylthiouracil four years ago. My goitre shrank and after one year the propylthiouracil was discontinued. I have been feeling well since. Do I need my thyroid checked further?”

ANSWER:
Yes. Although you may stay in remission the rest of your life and be perfectly well, one cannot predict that. Your thyroid status should be considered unstable and it should be checked at least once a year. You may slowly go on into a state of hypothyroidism, or hyperthyroidism could also recur. The tendency to recurrence will be aggravated by severe stress.

12. Are there serious side-effects with anti-thyroid medication?
“I have read drug information sheets on anti-thyroid medication for Graves' disease from the pharmacist and feel very apprehensive about these drugs. My doctor did not go into such detail but I have heard there can be serious side effects. Should I ask my doctor to try a different treatment strategy because of these risks?”

ANSWER:
Anti-thyroid drugs are generally safe. There is about a 1% incidence of serious side effects and a 3-4% incidence of minor side effects. The most severe side effect is that of a sudden drop in the white blood count to extremely low levels which is indeed very dangerous. It is heralded by a very severe sore throat and mouth and high fever. If the patient immediately stops the medication, upon suffering these symptoms, recovery is usually swift. However, it is very important that cessation of the medication should be quick upon the development of such symptoms, although quite often the white count proves to be normal, and the pills can be taken once again. Very rarely, toxic hepatitis can occur, whereas rashes and joint pains are somewhat more frequent. They are not so serious.

Patients who commence anti-thyroid drugs should be warned of the side effects and told to discontinue the medication should they occur. In the other 97% of patients, there are no side effects.

Anti-thyroid drugs do constitute a very useful form of treatment, since somewhat less than half the patients can go into a permanent remission after a year's therapy with anti-thyroid drugs. It is therefore often used as a first line treatment.

13. Can radioactive iodine treatment cause cancer or sterility? If I take this treatment, will I be a danger to others?
“My doctor wishes to prescribe radioactive iodine for the treatment of my overactive thyroid. However, I fear this treatment as it may make me sterile or cause cancer. Moreover, I am fearful that I will be a danger to other people."

ANSWER:

When radioactive iodine is used to treat an overactive thyroid, the dosage is usually quite moderate, and there is no danger to other people. Indeed, the radioactivity is mostly in the form that can only travel very short distances of 2 mms. or so. This is less than one eighth of an inch. It does not even damage structures next to the thyroid gland itself. There is no increased incidence of cancer of the thyroid or other organs after radioactive iodine therapy. Moreover, there is certainly no sterility, and indeed no danger to unborn children. It is quite safe to have children after radioactive iodine although it is recommended that you wait six months after the radioactive iodine therapy has been administered, before becoming pregnant. Your doctor will give you some simple guidelines to follow for a short time immediately after your treatment (usually no more than 2-5 days).

14. I am concerned about taking thyroxine for life. Is the natural product better than the synthetic product?
“I am concerned about taking thyroxine for the rest of my life. Can I take it during pregnancies? Can I take it with other medications? What if I miss a pill? What if I take an extra pill by accident? Why can't I take the natural product rather than a synthetic preparation?”

ANSWER:
Thyroxine, although it is synthetic, is identical to the hormone made by your own thyroid gland. It is one of the safest medications that one can take. Because of this, many symptoms that patients ascribe to the thyroxine are in fact due to their own anxiety about taking medication rather than the medication itself. Thyroxine can be taken through pregnancy and nursing and does not affect either of those situations at all. It does not cross the placenta and thus does not reach the baby in the womb. It does not get into the milk except in negligible amounts as it would in any nursing mother producing her own natural thyroxine. It can be taken with any other medication as there are rarely drug interactions. If you miss a pill one day, nothing will happen or if you take two pills the next day, nothing will happen. It does not matter what time of day the pill is taken since it does not begin even to work for about a week. It can be taken throughout a patient's entire life without fear.

There is no advantage, only a disadvantage in taking the natural product, desiccated thyroid. (Occasionally it is prescribed for the RARE allergic reaction to the binder or dye in thyroxine). The shelf life of desiccated thyroid is much shorter, it is not assayed in as precise a fashion and there is considerable variation from lot to lot in its effectiveness. Thyroxine is therefore very much to be preferred.

15. How does hypothyroidism affect memory loss?

ANSWER:
Severe hypothyroidism can induce temporary memory loss. However, only in the congenital form of the disease is the memory loss permanent. In hypothyroidism occurring even in childhood, and certainly in adult life, any memory loss related to hypothyroidism is completely returned to normal when the patient is treated with thyroxine. As long as they take sufficient thyroxine to maintain them in a normal state, all functions related to thyroid activity are also normal.

16. Are migraine headaches connected to a malfunctioning thyroid?

ANSWER:
True migraine headaches are not caused by hyperthyroidism or hypothyroidism. However, both high and low levels of thyroid hormones an aggravate any kind of headache. Once the thyroid tests have been normal for several weeks, then any persistent headaches cannot be attributed to the thyroid status.

17.What non-allopathic (i.e.homeopathic) treatments are available for hyperthyroidism?

ANSWER:

There is no proven homeopathic means of treatment for autoimmune thyroid disease. Graves' disease however, can go into remission spontaneously (a 30% occurrence). This may occur as a result of sedation, relaxation, or rest.

18. Are there chemicals in the drinking water that can affect the thyroid gland?
“What elements or chemicals in drinking water are considered problematic to thyroid conditions?”

ANSWER:
It is true that in some parts of the world, there has been a relationship between drinking the water of those areas and goitre prevalence, although this has not been documented in this country. These studies indicate that goitrogenic organic compounds contaminate the water supply in certain areas. Sources of water- borne goitrogens are sedimentary rocks rich in organic matter, coals, shales, cherts, etc.

Over 30 organic compounds have been identified in activated carbon extracts of water from Columbia with anti-thyroid activity. Resorcinol and other parent phenolic and phenolic carboxylic compounds have particular goitrogenic effects.

I would emphasize once again that we generally have not been aware of water-borne goitrogens of much significance in water in Canada. We do not see endemic goitre in this country, and most of the thyroid conditions that we do see are not due to such factors.

19. What is the latest medical research being carried out on thyroid disease?
“Where is the most advanced medical research carried out on thyroid problems? What research is being done at present?”

ANSWER:

“I have had Hashimoto's syndrome for almost ten years – shortly after the birth of our second child. Are my children at risk? If so, can I do anything to minimize the risk?”

ANSWER:
Your children are at some risk of developing Hashimoto's thyroiditis, but this is not a severe or serious disorder as long as it is diagnosed and treated. Girls are four times more likely to develop the disease than boys. It may occur at any age, but is rare before puberty and it is quite common for it to occur after the birth of a child. Indeed, this form of the disease is termed postpartum thyroiditis. There really is nothing you can do to minimize the risk, but it should be kept in mind when your children are being seen by the family physician and tests of thyroid function as well as thyroid antibodies might be performed on them on an annual basis. This would be more important after puberty.

21. After a CAT scan I found I was allergic to iodine. Could this have triggered my thyroid disease?

ANSWER:
Even if you are allergic to iodine, this particular allergy or any other allergy does not trigger your autoimmune response. You should keep it in mind that Hashimoto's thyroiditis is quite common in the population. As I mentioned above, it occurs most commonly after deliveries and is related to an inherited immunological disturbance.

22. Does age affect recovery rate for thyroid disease? What is the "normal" range for TSH and T3 RIA readings?
“Does a person's age affect the recovery rate from thyroid disease or the amount of supplemental thyroid medication needed? What is considered a "normal range" for TSH and T3 RIA readings?”

ANSWER:
Certainly age will affect the recovery rate from thyroid disease, both hyperthyroidism and hypothyroidism. The older the person, the slower the recovery rate and indeed with hypothyroidism, it is necessary to be extremely careful in older people about increasing the dosage of thyroxine. The normal range for TSH depends on the type of assay utilized. Currently with the sensitive assays now available, the usual normal range is between 0.3 and 3.5 milliunits/L. For the total serum triiodothyronine (T3RIA) once again assays vary a little bit from laboratory to laboratory but the average range is 1.2-3.4 nmol/L.

23. I have been treated for hypothyroidism for many years. Suddenly I felt hyperthyroid. Could stress have triggered hyperthyroidism?
“I have been on thyroxine for 4 years. Then quite suddenly I became hyperthyroid. Is it possible that thyroxine can stay in the body for a while, then act up rather suddenly? Would a stressful event precipitate such a flare-up?”

ANSWER:
This is extremely rare and only about 30 such cases have been reported. However, what is quite common is that physicians do tests of thyroid function on patients who are taking thyroxine and discover that the serum thyroxine is elevated. This may be interpreted as being "hyperthyroid". However, the total thyroxine is not an appropriate test to measure on patients who are taking thyroxine by mouth. Rather the total serum triiodothyronine is much superior to the serum thyroxine. If the values of the total serum triiodothyronine are in the middle of the normal range, then the symptoms that the patient is experiencing are not due to the thyroxine. It is not possible that thyroxine can stay in the body for a while and then act rather suddenly. Thyroxine has a steady degradation rate in the body and nothing will change that. As I mentioned, there have been a handful of people reported whose own thyroid has become hyperactive while they have been taking thyroxine but that is extremely rare. I strongly suspect that what happened to the patient enquiring is that a serum thyroxine was elevated and that the symptoms were actually unrelated to the thyroid medication.

24. How long does it take to feel better after hypothyroidism?
“I have an inactive thyroid and have been on thyroxine for 4 months. How long will it be before I begin to feel well again?”

ANSWER:
The answer to this is that if your symptoms were due to thyroid insufficiency in the first place, and you were on an adequate dose of thyroxine, it should take no more than six weeks to feel reasonably well or at least greatly improved. It is NOT appropriate for patients to adjust their own medication according to how they feel, but rather to have it "tuned" by regular blood tests.

25. Is there a connection between fluoride and hypothyroidism?
“Do you have any information on the connection between fluoride and hypothyroidism? In a publication entitled "Vitamins, Minerals and Supplements" by H. Winter Griffith, M.D., it states not to take fluoride if you have underactive thyroid function. I have not heard of this before and am wondering what the implications are.”

ANSWER:
Fluoride is a halogen like iodine and is therefore briefly picked up by the thyroid gland, but, unlike iodine, fluoride is not incorporated into thyroid hormone. It does NOT interfere with thyroid function in any way and there is NOT concern about using fluoride even if a person is indeed hypothyroid. This is, of course, particularly true if that patient is taking thyroxine, which is certainly not interfered with by fluoride or any other substance.