Answers to the FAQs are taken from medical books or have
been provided by a range of medical advisers.
It is quite normal for physicians to have slightly differing points of
view, and these may be reflected in the answers given. The FAQs are intended to give general
information, and should not replace the advice given by your own doctor. It is recommended therefore that you discuss
any matter with your own doctor if you have further concerns, or before you
take any action.
This means that certain defensive cells in your body, whose job it is to fight diseases, particularly infectious diseases, have wrongly decided that
your thyroid cells are not yours and they are seen as being ‘enemy’ cells. The defensive white corpuscles produce antibodies and these destroy the thyroid gland.
What do the thyroid antibodies do?
In autoimmune thyroid disorders some antibodies are destructive and kill off the thyroid cells, causing hypothyroidism. Other antibodies stimulate
the thyroid cells to produce too much thyroid hormone, causing hyperthyroidism. Sometimes the destructive and stimulating antibodies occur at the same
time therefore causing an overactive thyroid gland, which will eventually become hypothyroid.
Are thyroid disorders hereditary?
It depends on how you define “hereditary”. It is not handed down from parent to child in every generation. It is “hereditary” in the sense that
auto-immune disease in your immediate family or predecessors means that you have an increased risk of a thyroid disorder yourself.
I have an overactive thyroid and my mother has an underactive thyroid, I don’t understand why we both didn’t develop the same problem.
You both have related autoimmune diseases. In your case your antibodies are stimulating your thyroid gland into producing too much thyroxine whereas
your mother’s antibodies are killing off her thyroid cells and thus her thyroid gland is not producing enough thyroxine.
My antibody blood test results were negative, so what does this mean?
If the results of antibody testing are negative, it doesn’t mean that you will not develop hypothyroidism, it just means that the risk of doing so is much lower.
Cancer
General
Apparently I have had a lump on my thyroid for some years and not noticed it; it now turns out to be malignant - how come I didn’t know?
Cancer of the thyroid is very slow growing and it could be many years before you would be aware of any symptoms.
What are the symptoms of thyroid cancer?
Mostly there are no symptoms and it is found by chance. If there are symptoms these may include:
a painless lump in the neck which gradually increases in size
difficulty in swallowing
difficulty in breathing
hoarseness of the voice
How is thyroid cancer recurrence detected? Is it possible to have a clean scan but elevated thyroglobulin?
Thyroid cancer may be considered to be recurring when it can be shown by palpation (examination by hand) or by imaging (scanning) to have recurred.
However, an increase of thyroglobulin level in the blood, even when the scan is normal, would be early evidence of recurrence and could lead to other
investigations, including CAT or MRI scans.
I have been diagnosed with thyroid cancer, is the outlook bleak?
Most thyroid cancers are very treatable and curable but there is the possibility of recurrence, especially in the very young and in the elderly.
This can occur at any stage but recurrences can normally be treated successfully so lifelong follow-up is most important.
Are all thyroid cancers the same?
No, there are different types of differentiated thyroid cancers these are:
Papillary cell carcinoma, which is the most common thyroid cancer. It is more common in younger people, particularly women.
Follicular cell carcinoma, which is less common, and tends to occur in slightly older people than those with papillary cancer.
Medullary cellcarcinoma, this is a rare cancer, which is sometimes, but not always, hereditary.
Does thyroid cancer come back after the operation?
Extremely unlikely. In most cases of papillary cancer the whole thyroid gland is removed. Follicular cancer, which is rarer, can normally be remedied by further surgery.
Children and thyroid disorders
Hyperthyroidism (Overactive Thyroid Disorder)
When would an overactive thyroid usually appear in children?
It is rare for a child to have an overactive thyroid before the age of five; the usual age of onset is about 10 years of age. It is a condition
which affects girls more than boys but boys do tend to suffer more severely from it.
How do children get an overactive thyroid gland?
Most hyperthyroidism is caused by an autoimmune disorder, which tends to run in families. It is also suggested that an overactive thyroid disorder
may be brought on by severe emotional upset or stress or a severe infection, and occasionally an excessive intake of iodine.
Is it possible to tell whether my baby will be born with congenital hyperthyroidism?
Congenital hyperthyroidism is very rare. Transient hyperthyroidism in the babies of mothers with hyperthyroidism is much more common. If any woman
has had Graves’ disease, whether it was past or present, the doctor will monitor the pregnancy closely looking for signs of hyperthyroidism. If the
unborn baby has an extremely fast heart rate or grows abnormally fast then these factors may alert the doctor to the possibility that your baby could
have a hyperactive thyroid. A blood test for antibodies is done checking the mother’s blood. If this shows positive then treatment with anti-thyroid drugs may be administered.
What happens if my baby is born with congenital hyperthyroidism?
This is very rare but if it does happen you will notice signs like a very fast heart rate and the baby will be restless. Also signs of a ravenous
appetite but failure to gain weight and failure to thrive may present themselves along with flushing of the skin and diarrhoea. Diagnosis can be confirmed
by doing a blood test to check the baby’s thyroid hormone levels. It is important to know that thyroid hormone levels are normally higher at birth and
should not cause alarm. If congenital hyperthyroidism is present, treatment is given with small doses of iodine and anti-thyroid drugs.
How would I recognise an overactive thyroid in my son?
You may notice disruptive behaviour at school or in the home, schoolwork affected by poor concentration, a large appetite but no weight-gain,
restlessness, diarrhoea and that he is tall for his age. These are some signs to look out for but often they get overlooked and the child is thought to
be disruptive and difficult and this leads to more stress for the child complicating the situation.
My teenage son has been diagnosed with an overactive thyroid. Does his thyroid condition have anything to do with his mood swings?
Most teenagers seem to suffer from moodiness to some degree. In your son’s case his disruptive and aggressive behaviour has been diagnosed as
untreated hyperthyroidism. These moods should settle down with proper medication under the supervision of an Endocrinologist.
I have recently discovered that I have Graves’ disease. I had not been feeling at all well for sometime and did surprisingly poorly in my mock A level exams this year. Is the Graves’ somehow to blame?
If Graves’ disease (overactive thyroid) is not adequately treated, a reduced ability to concentrate will certainly lead to a substandard performance.
Your specialist should be happy to write to the relevant headteacher or college tutor to explain the problem.
Children and thyroid disorders
Hypothyroidism (Underactive Thyroid)
When does an underactive thyroid usually present itself in children?
Girls are usually affected twice as often as boys and are unlikely to be younger than five but the most common age being around eight years old.
The reason for this is that even an underactive thyroid can manage a smaller person but as the child grows and becomes more active the thyroxine produced
just isn’t enough to meet the demand.
How can I tell if my daughter is suffering with an underactive thyroid gland?
You may notice that your daughter is smaller than other children or has stopped growing. She may tire easily when it comes to playing sports or
games. Weight might be slightly higher than it should be despite a poor appetite. She may suffer from constipation; have difficulty concentrating in
school, poor memory. These may be hard to detect, as you might tend to think that the child is lazy, increasingly slow, clumsy, inattentive and
disinterested. If a child doesn’t remember what they were told, or dawdles over her meals and always seems to need prompting, it is easy for the parent
or teacher to misinterpret these signs as just being deliberately difficult. A simple blood test can help to identify a thyroid disorder and thyroxine
treatment will help get them back on track.
Will my teenage daughter have to take thyroxine for the rest of her life?
Yes. Once the thyroid is damaged it cannot repair itself and thyroxine supplement is essential in order for a child to grow and develop properly.
My daughter has hypothyroidism and can’t easily fasten the top button of her school blouse anymore. Could this be due to her thyroid condition? Her teachers have been giving her a hard time.
It is very likely her thyroid has swollen slightly and therefore the pressure of her collar on her thyroid is becoming uncomfortable. The stress on
the thyroid gland stimulates the formation of antibodies as in Hashimoto’s disease, and 65% of adolescent goitre is due to this condition. Adolescent
goitre will most likely shrink over 2-3 years on its own. It is important to educate significant others that come into contact with children with
thyroid disorders to spare them any difficulties or humiliation as in this incident.
My 14 year old daughter has been diagnosed with an underactive thyroid and suffers terribly with her periods. Are the two related?
In teenage girls that have reached puberty and suffer with an underactive thyroid, their periods may become heavy, irregular and painful. This
should start to ease and become less painful and regular with proper thyroxine replacement therapy.
Children and thyroid disorders
Congenital Hypothyroidism
How is a baby tested for hypothyroidism?
The thyroid gland has a very important role in the newborn baby. It is responsible for metabolism and therefore keeping the baby warm and continuing
with growth and development. During the first few days after birth, the thyroid gland is working hard to maintain the body’s temperature and the T4
levels increase during this time. After about the fifth day a blood test is taken to check the thyroid levels by doing a heel prick on the baby and
getting a small sample of blood. This is a very good screening test for thyroid deficiency in the newborn baby.
Is this test 100% accurate?
Although no test is foolproof, the blood test is a very accurate test for hypothyroidism.
How soon after birth is a baby’s hypothyroidism treated?
The doctor will decide that your baby needs treatment if the blood screening test is positive, that is, if the TSH is high. This will mean that a
thyroid supplement is necessary and can be started at about two weeks old and should definitely be started by the time the baby is two months old.
What are the signs and symptoms to look for after birth to help detect an underactive thyroid?
Your baby will look perfectly normal after birth. You should start to watch out for things like poor appetite, always sleeping, slow to put on weight,
doesn’t seem to kick or scream much and is constipated. Other symptoms that may occur are breathing difficulties, a hoarse cry, low body temperature:
less than 36 degrees Celsius, prolonged jaundice, big tongue and floppy muscles.
My baby daughter has congenital hypothyroidism. What causes this disorder and will it affect any other children I may have?
Very early in an unborn baby’s development the thyroid gland moves from the back of the tongue to its normal position in the neck. In some babies
this does not occur and the gland may not develop at all. In others it is found in a higher position than normal and does not work so well. This is the
most common kind of congenital hypothyroidism and the chances of recurrence in any future pregnancy are extremely small and about the same as the risk
in the general population (around 1 in 3000) There is also a rarer kind of congenital hypothyroidism where the gland is in the right place but cannot
produce thyroxine normally. This type can be inherited and there is a risk that other brothers or sisters may also be affected (about 1 in 4).
Will my child who has congenital hypothyroidism grow up normally?
This is very difficult to answer, as it is impossible to guarantee that any young baby will grow up normally. However, screening has been
going on for long enough for us to know that almost all children diagnosed by screening and treated from an early age will grow up normally.
My son has congenital hypothyroidism. Will his life expectancy be shortened?
No, there is no evidence at all for this.
Can children with congenital hypothyroidism pass this condition on to any children they may have?
We do not understand the genetics of congenital hypothyroidism but there are very few cases of this happening.
When is it best to give my baby his thyroxine - morning or evening?
It does not really matter, although some parents have said that they think their children do not sleep as well if the dose is given in the evening.
How do I give my newly born baby the thyroxine tablet?
It can be crushed and put into water, so long as it is then not left to stand for a prolonged period of time as this will diminish the strength of the tablet.
Can I get the thyroxine in a suspension?
You may be able to but with suspensions it is very difficult to ensure that the exact dose is given. Crushing the tablets is better.
What happens if I forget to give my baby his daily dose of thyroxine?
Thyroxine lasts in the body for several days so that a single missed dose is not particularly serious, but obviously this should not be allowed to happen too often.
Are there any side effects of treatment for congenital hypothyroidism?
Treatment with thyroxine simply replaces the natural hormone, which the thyroid gland is unable to make. It is very effective and it is usually
fairly easy to give the correct dose. However, if too much is given it may cause symptoms in the baby such as ‘fussiness’, mild diarrhoea, and poor
weight gain. Too little thyroxine may lead to the symptoms of hypothyroidism. Over-treatment or undertreatment should not happen if blood tests are
carried out from time to time.
My newborn baby has been discovered to have congenital hypothyroidism and now has to take thyroxine. How often will he have to have his blood tested?
The dose of thyroxine is dependent on the size of the individual so will change a lot in childhood, depending how fast the child is growing. During
the first 2 years of life growth is very fast and the levels of thyroxine will need to be adjusted frequently on the basis of blood tests. These should
be undertaken at 6 and 12 weeks after birth and thereafter 12-weekly for the first year and then 4-6 monthly until the age of 3 years. After the third
birthday tests can be done annually.
My daughter has congenital hypothyroidism. She is now one year old. When will she need to be taken off thyroxine to be tested to find out whether she needs to continue with the thyroxine?
Not until she is older than 3 years, this is because of the ongoing brain development.
The heart and the thyroid
General
How does an overactive thyroid affect the heart?
An untreated overactive thyroid increases the rate at which the heart beats causing it extra stress and work. You may notice a faster heart rate and
could experience irregular heartbeats, which are referred to as atrial fibrillation. This may be present all the time and may be especially noticed in
elderly patients.
What is cholesterol and how is it related to my thyroid gland?
Cholesterol is a particular type of fat in the blood and is partially influenced by the amount of thyroid hormones secreted by the thyroid gland.
If a person has an underactive thyroid then the cholesterol may be higher than normal. Once the thyroid disorder is treated and maintained within the
reference range the cholesterol levels should go back to their previous levels. An increase in blood pressure may also be found in people with an untreated
underactive thyroid disorder.
Can hypothyroidism lead to angina?
Also starting with a large dose of thyroxine will increase metabolism and therefore increase heart rate. But if the arteries are narrowed or furred
then this too can cause angina. In this case it is better to start with small doses of thyroxine over a 3-4week period and increase slowly.
Is my thyroxine treament causing my angina?
Angina may become worse while given thyroxine but it is not the thyroxine causing the Angina. It is the case that the hypothyroid state artificially
helps angina by slowing down the metabolism and thus reducing the stress on the heart, and once thyroxine is taken the heart rate will increase to what
it should be working at normally, therefore aggravating the angina you already have.
Is there a connection between thyroxine treatment and hypertension?
I don’t know of any connection between thyroxine treatment and hypertension. Both thyroxine treatment for an underactive thyroid, and hypertension,
are common conditions and may very well co-exist in the same individual. Having an unmanaged underactive thyroid may contribute to a raised level of
cholesterol and thus increasing blood pressure due to furring for the arteries. But this is usually corrected with adequate thyroxine therapy.
High blood pressure may be the feature of untreated or inadequately treated hypothyroidism but should also return to normal with appropriate dosage
of thyroxine. Normally the recommendation would be a dose of thyroxine which restores the thyroid stimulating hormone (TSH) concentration to the lower
part of the normal range i. e. below 2. 0 mU/l.
What are Beta-blockers and why are they needed?
Beta-blockers are often used for high blood pressure by slowing down the heart rate and therefore relieving palpitations, reducing perspiration,
tremors, and anxiety. The most commonly used beta-blocker is Propranolol, which is generally a very safe drug but should not be taken if you suffer
asthmatic tendencies. Beta-blockers do not have any curative value but will help you feel more comfortable until a proper cure is reached. When
treatment no longer requires beta-blockers, the dosage will be gradually reduced over a week to 10 days before the drug is finally stopped.
Hyperthyroidism (Overactive thyroid)
General
What causes muscle weakness, aches and pains with my overactive thyroid?
When there is too much thyroid hormone circulating in the blood, it tends to hasten the normal breaking-down process of the muscle fibres to a
faster rate than they can be replaced. The muscles in response become weaker, and this is most noticeable in the thighs and shoulders.
What are “frozen shoulders”?
Frozen shoulders is a condition which often affects both sides and is common in hyperthyroidism. Inflammation of the covering of the shoulder joints
leads to a painful stiffness especially upon arising in the morning. Treatment for the overactive thyroid may considerably improve the pain and stiffness.
I have been diagnosed with Graves’ disease and notice that I get these funny patches of dry reddened skin on my lower legs. Is this normal?
Occasionally people with Graves’ disease notice a change in their skin on their lower legs. Patches develop that are slightly reddened and
thickened and appear to stand up above the surrounding normal skin. This condition is referred to as pretibial myxoedema.
How can the doctor tell from my blood test results that I have Graves’ disease?
T4 and T3 levels are raised above the normal and the TSH level is lower than the normal levels in untreated Graves’ disease.
I have Graves’ disease and I am really worried that in time my children may develop it too.
They may not but there is a chance that they could develop some autoimmune thyroid disease later in life.
I have Graves’ disease and I smoke, could the smoking make matters worse?
The eye disease that can accompany Graves’ disease is more common and more severe among people who smoke. People with hyperthyroidism caused by
Graves’ should be advised to stop smoking
I have Graves’ disease and I am finding it very difficult to control my temper, which is very out of character. Is there anything that may help me?
Yes, a beta-blocker taken for a while may help but you will find as your thyroid condition improves your temper should subside.
I have beentreated with carbimazole for 18 months for Graves’ disease. I have now been off treatment for 6 months and there is no sign of any symptoms. What are the chances that I will relapse?
There is about a 50% chance that you could relapse. It is advisable to have an annual blood test whilst in remission or sooner if you suspect the return of symptoms.
I have Graves’ disease and am really worried that I may develop the severe eye problems.
Not everyone with Graves’ disease will get eye symptoms other than minor or temporary ones. Many people with Graves’ disease (80%) have no major
complaints about their eyes throughout the course of their illness.
Are thyroid hormone levels and gastric acid levels related in any way?
If one suffers with an overactive thyroid this may cause an overproduction of gastric acid which in turn could cause discomfort. There is a rare
inherited condition in which the two may be linked, known as Multiple Endocrine Neoplasia 1 (MEN-1).
I keep suffering with migraines. Are these due to my hypothyroid condition?
There is no association between underactive thyroid and migraines, but women with an overactive thyroid have a worsening of their
migraine, which is occasionally linked to the menstrual cycle. This is believed to be due to the effects of female sex hormones (oestrogen), which are unrelated to thyroid hormones.
Hyperthyroidism (Overactive thyroid)
Treatment
How does radioiodine treatment work?
Radio-iodine is taken by mouth in capsule form. The thyroid glands cells absorb the radio-iodine, and are therefore destroyed by the irradiation.
Why do some physicians recommend a low iodine diet prior to Radio-iodine treatment?
A low iodine diet will increase the uptake of the radioactive iodine into the thyroid gland and thus maximise the effect of such doses on thyroid
function. However, this does not have a major effect and thus many physicians do not bother to prescribe a low iodine diet in this fashion.
Why is radio-iodine not given if you are pregnant or planning to get pregnant?
Radioactive iodine is not given during pregnancy, or if you planning to get pregnant within the next 4 months after treatment, because from the
third month of pregnancy the thyroid gland of the foetus absorbs iodine and therefore the baby’s thyroid would become irradiated too. As a result of
this your baby would not have a working thyroid. It is also important to not come into close contact with babies, children, or women of childbearing
years for approximately 2-3 weeks for the same reasons. All this should be explained to you in full detail before you undergo any radioactive iodine treatment.
I have hyperthyroidism and am receiving anti-thyroid drugs. I am also considering radioiodine as a treatment but I would like to become pregnant. Can I take anti-thyroid drugs while pregnant? Or would it be better to have the radio-iodine?
You are more likely to become pregnant if the thyroid status is normal. If you are on anti-thyroid drugs, this is no problem providing you are
monitored carefully in hospital. As far as radioiodine is concerned, you can get pregnant after receiving a dose of radioiodine as long as it is later
than four months afterwards. There will be no ill effects on you (apart from the possibility of development of hypothyroidism, which is almost half expected).
I run about 10 km per week and lift weights 3 times a week. While preparing for a radioactive iodine scan, when or how should I modify my workout schedule?
There is no need to modify an exercise regime while preparing for a radioactive iodine scan.
I have been given Carbimazole for my over active thyroid. Are there any side effects to this drug?
Serious side effects are rare. However, a sore throat or mouth ulcers may indicate serious adverse effects on the white blood cells which fight
infection. You must see your doctor immediately if this happens, tell him about your symptoms, and ask for a blood test which is needed urgently.
Symptom Effect
Frequency
Discuss with doctor
Stop taking drug now
Call Doctor Now
Common
Rare
Only if severe
In all cases
Headache Dizziness
X
.
X
.
.
.
Joint pain
X
.
X
.
.
.
Nausea
X
.
X
.
.
.
Rash Itching
X
.
.
X
.
.
Hair Loss
.
X
.
X
.
.
Sore throat Mouth ulcers
.
X
.
X
X
X
Jaundice
.
X
.
X
.
X
I have been given Propylthioracil for my over active thyroid. Are there any side effects to this drug?
It can occasionally cause a skin rash, which goes away once the drug is stopped. As with carbimazole, the most serious is a lowering of the white
blood cells that normally fight off infection, and can appear as a high temperature, a bad sore throat, or mouth ulcers. You must see your doctor
straight away and get a blood test, which is needed urgently if these appear. Fortunately these side effects are rare. If you cannot tolerate the
medication then alternative treatments such as surgery or radioactive iodine may be offered.
What if I react to Carbimazole and Propylthioracil?
This is very rare but if this should occur then you may have to consider radioactive iodine or surgery to treat your hyperthyroidism.
Can I carry on taking Carbimazole or Propylthiouracil on a long-term basis?
In theory there is no reason why not, if your thyroid remains under control. You will have to follow up with blood tests every 3-6 months under the care of an endocrinologist.
I have an overactive thyroid and have been prescribed carbimazole, but my heart is still pounding rapidly at night and this is keeping me awake, can anything be done about this?
Yes, treatment with a beta-blocker will probably help with these symptoms until your overactive thyroid has been brought under control with the carbimazole.
Hypothyroidism (underactive thyroid)
General
What causes an underactive thyroid?
The most common cause of hypothyroidism is autoimmunity – that is the patient makes an antibody that destroys the ability fortheir thyroid to make
normal amounts of thyroid hormone. It is possible to see if this antibody is present by undergoing testing which helps to look for evidence of impending
thyroid disease.
Who is most susceptible to getting an underactive thyroid disorder?
Thyroid disease is most common in middle-aged women, and it overlaps with the age at which the menopause occurs. There is an overlap in the symptoms
of thyroid disease and the menopause and it is not always easy to decide the cause of symptoms. Blood tests can help to diagnose both conditions.
Is there a connection between hypothyroidism and chronic fatigue syndrome?
Chronic fatigue syndrome is defined as chronic fatigue persisting for more than 3 months without any obvious and demonstrable recognised alternative
cause. Hypothyroidism can certainly cause chronic fatigue, but must be ruled out in order to make the diagnosis of chronic fatigue syndrome.
I have been experiencing swallowing difficulties. Is this related to my thyroid problem?
Unless your thyroid gland is markedly enlarged, and you would be aware of this, there is no connection between an underactive thyroid gland and
difficulty in swallowing food.
I have an underactive thyroid for which I am taking thyroxine. I wonder if this could be the cause of my continual hair loss problems?
Certainly hair loss can occur with an underactive thyroid, and hair loss occurs often months after the thyroid disease is treated, because the hair
which falls out has a short life span and therefore continues to fall despite being on thyroxine for a few months. The new hair growing in with normal
thyroid hormones levels has a normal life span and therefore the hair gradually regains its normal pattern. If your TSH levels are normal, I don’t
think it is likely that a thyroid disease is contributing to your problem. It sounds as is you could have a condition called telogen effluvium, which
can occur spontaneously for reasons, which are poorly understood although stress has been postulated to play a role in this condition. If this is the
case the hair will usually grow back in spontaneously. A dermatologist should be able to advise further.
I stopped taking my thyroxine for one week and am now experiencing hair loss. Is this normal?
It would be unlikely that experiencing hair loss after one week of stopping thyroxine treatment is related as it also takes about one week for
thyroxine to leave your system. It is usually several months after developing an underactive thyroid that hair loss will occur.
I’ve been told my thyroid is borderline hypothyroid. Will it still be difficult for me to get pregnant as I am trying to start a family?
Patients with borderline hypothyroidism should not experience any significant problems with conception.
I have heard that babies born to mothers with hypothyroidism have lower IQ’s. Is this true?
There is evidence in the literature that the children of untreated overtly hypothyroid women have a lower IQ than those of women with normal
thyroid function. There is no evidence that this also applies to women with borderline hypothyroidism.
Can an underactive thyroid be a cause of heavy periods?
Menstrual problems such as heavy prolonged periods can be a symptom of an underactive thyroid and would therefore be corrected with appropriate
thyroxine replacement.
What effect does an underactive thyroid have on one’s hair and nails?
The nails may become thicker and rougher than normal and the hair can become sparse. Both symptoms improve with adequate thyroxine replacement.
I have heard that you can diagnose hypothyroidism yourself by keeping a record of your body temperature and if your body temperature is constantly below 98.6 degrees it means that you are hypothyroid.
Temperature is not a reliable means of detecting hypothyroidism; many people have a normal body temperature that is different to the normal 98.6.
Some people also believe that testing for a slow reflex also indicates hypothyroidism. Reflexes may be altered in hypothyroidism but this may be the
case for other conditions also. The only reliable and accurate way to test for hypothyroidism is a blood test for the TSH level.
My doctor has diagnosed me with having hypothyroidism but I do not have any sort of swelling in my neck, how is this possible?
Your thyroid gland may be larger or smaller or it may even be normal in size but whatever the size of your gland, it could still be underactive
and not producing enough thyroxine.
Hypothyroidism (underactive thyroid)
Hormones
I have been newly diagnosed with Hypothyroidism and wonder whether it has been caused by the menopause and the fact that I have been taking HRT.
Thyroid disease is more common during menopause, but menopause itself does not cause thyroid problems. HRT is a hormonal replacement of oestrogen
as during menopause the body reduces its production, which can lead to thinning bones. The oral thyroxine replacement that you are now taking for
hypothyroidism is absorbed into the bloodstream and attaches itself to a protein, thyroxine binding globulin (TBG), which transports it around the body.
The remaining thyroxine roams free and is therefore called free thyroxine (free T4). It is the free thyroxine that is most active at reducing the
symptoms of hypothyroidism. The female hormone oestrogen can increase the amount of TBG in the blood and it will bind to more of the free T4 causing
the level of FT4 to decrease in the hypothyroid person. Because a hypothyroid person cannot increase thyroxine production the oral replacement must be
increased to alleviate the hypoactive symptoms. It is important for doctors who offer HRT or alternative female hormone replacement therapies or the
contraceptive pill to women to consider an increase in thyroxine doses.
I have hypothyroidism and have just started taking HRT. I have noticed my heart races now - is this due to the HRT?
There is no known link between HRT and Tachycardia (rapid heart rate).
Are premature menopause and thyroid disease related?
If one looks at women who have an early menopause, one finds a higher frequency of thyroid disease. It is probably not that the thyroid disease
causes the early menopause, it is most likely that the same conditions that predispose to premature menopause might possibly be through the mechanism
of autoimmunity. I don’t think there is any other significance to early menopause, although I think that the issue of osteoporosis should be monitored
because having an early menopause and an over/underactive thyroid might make one more susceptible to the earlier development of osteoporosis.
Should I be taking more thyroxine during specific times during my monthly menstrual cycle?
There is no evidence to show that the requirements for thyroxine vary with the menstrual cycle. It is well established that the requirements for
thyroxine increase during pregnancy and may also slightly in some patients who are taking HRT. HRT should not upset the thyroid balance in someone who is taking thyroxine.
I keep suffering with migraines. Are these due to my hypothyroid condition?
There is no association between underactive thyroid and migraines, but women with an overactive thyroid have a worsening of their
migraine, which is occasionally linked to the menstrual cycle. This is believed to be due to the effects of female sex hormones (oestrogen), which are
unrelated to thyroid hormones.
I am newly diagnosed with hypothyroidism and have noticed that I usually skip a few monthly periods. Is this normal and could it be caused by my low thyroid?
It is fairly common for hypothyroidism to cause an abnormal menstrual pattern. It is normal for the periods to return with Thyroxine replacement
but there may be a delay of some months before the periods became regular. If regular periods have not returned within 3-4 months of therapy, it would
seem sensible to check the blood concentrations of FSH, LH, prolactin and oestradiol (female sex hormones) to eliminate a cause unrelated to the
thyroid condition.
Does taking thyroxine replacement directly affect my progesterone levels?
There is no known specific evidence stating that thyroid hormones definitely affect progesterone levels. If thyroid hormones are low, then many
metabolic processes in the body, including the female sex hormones, are altered and this may be a further reason for making sure that the optimal dose is given.
Hypothyroidism (underactive thyroid)
Treatment
How is hypothyroidism diagnosed in relation to
blood test values?
The diagnosis of hypothyroidism is not easy because the onset of the condition
may take many years. Subtle changes in biochemistry blood test results usually
precede symptoms. The most sensitive indicator of developing hypothyroidism
is a rise in the TSH result. Generally a TSH result of <5 is regarded as
biochemically ‘normal’, a result of 5-10 is borderline and a result
of >10 (in a patient who is not acutely ill) is regarded as consistent
with hypothyroidism. The biochemical results have to be considered along side
clinical symptoms, and together they determine the point at which the physician
will introduce Thyroxine therapy.
I have hypothyroidism. How often should I have
my blood tested?
Thyroid blood testing should be done in 3-6 month intervals while it is
still underactive but when the thyroid is managed within the normal range,
then a yearly blood check is adequate.
Should I stop taking my thyroxine before I go for
a blood test? Would this give me a more accurate reading?
Thyroxine has a very long half-life (approximately 7 days). Therefore, blood
concentrations only vary slightly during the day and after the daily Thyroxine
tablet. Therefore, it is not normally necessary to delay taking the Thyroxine
tablet on the day of blood testing.
My blood tests suggest that my thyroxine level
is within the normal limits. I still feel a bit tired and wonder if it would
do any harm to increase my dose?
It is up to your doctor to interpret the blood test results and make sure
that an increase in your thyroxine does not make you overactive because patients
receiving too much thyroxine are at risk of thinning bones, increasing heart
rate that can lead to palpitations and high blood pressure. It all depends
on your blood test results and where exactly you sit within the normal limit.
Patients may feel at their most healthy when blood test results are tending
towards biochemical evidence of over-replacement. There is then a fine balance
for patient and doctor to agree on the preferred replacement dose.
I have recently started taking thyroxine and feel
I might be allergic to it. Have you ever heard of this before?
I have never come across anyone who is truly allergic to thyroxine, as it
is a hormone naturally produced by our bodies. Sometimes the patients are
sensitive to the fillers in thyroxine tablets, in particular lactose or gluten,
as they tend to be relatively common. There are ways of diagnosing and treating
this. Another cause of problems could be through taking too much or too little
thyroxine. This can be checked via a blood test to determine that you are
taking the correct amount.
I have tried taking thyroxine but it makes me feel
ill. Are there any homeopathic remedies that I could take instead?
The only treatment that will help an underactive thyroid is thyroid hormone
replacement. Homeopathic remedies are totally useless in this situation. If
your body has been without thyroxine for a long time it might be easier for
you to start off with a small dose of thyroxine than originally prescribed
and build the dose up gradually giving your body a chance to get used to it.
It might also be necessary to combine this treatment with a beta-blocker,
which can often overcome symptoms as thyroxine is introduced back into the
system. It might be sensible to seek a referral to an endocrinologist if you
have had difficulties in the past so that these alternatives can be discussed.
I have heard of Liothyronine and would like to
know what it is?
Liothyronine is a T3 replacement hormone and is a very potent drug. One
of the reasons that it is not widely used in the UK is that there are potential
long-term side effects from excessive use.
My blood tests came back normal but I still think
I have an underactive thyroid. What if my body could not convert T4 to T3?
There are no convincing studies showing difficulty in converting T4 to T3
except in extremely rare or clinically obvious conditions. Failure to convert
T4 to T3 at anything like a normal rate will lead to a compensatory increase
in TSH, which will overcome any potential block. This happens, for instance,
in people treated with drugs that interfere with T4 – T3 conversion;
there is a transient disturbance of thyroid function, and then things are
reset to a normal level.
Can Natural Thyroid Extract/Desiccated Thyroid
Extract be used to treat hypothyroidism?
There is no current evidence of any advantages of taking natural thyroid
extract over synthetic thyroxine. The disadvantages are that because it is
made from pooled thyroid glands from animals, which may vary from batch to
batch in their thyroxine levels, the exact dose of thyroxine cannot be estimated
precisely. Therefore one dose from one batch of tablets may well create different
thyroxine levels from the same dose in a second batch of tablets. As a result,
endocrinologists have abandoned using this in favour of the pure form of thyroxine
which is chemically exactly the same as that which is made by the normal thyroid
gland. In this sense, thyroxine treatment is as natural as possible.
Natural Thyroid Extract is not licensed in this country. The importation
of some brands, such as Armour, is permitted if approved by the United States'
Food and Drugs Administration (FDA), and standardised to the specification
of the United States Pharmacopoeia (USP). It is the decision of each individual
PCT as to whether an unlicensed product, in this case Armour, be available
on NHS prescription or private prescription (MHRA, Jan 2005).
Our most recent information from the Medicines and Healthcare Products Regulatory
Agency (MHRA) guidelines is that a prescription written by a GP for the treatment
of hypothyroidism with an unlicensed product will be exempt from prescription
charges on a named patient basis if an agreement with the local Primary Care
Trust exists. Being unlicensed in this country, the doctor would be required
to take full responsibility for any adverse effects of the treatment.
Can I take aspirin with my thyroxine tablets?
Therapeutic doses of Aspirin do not interfere significantly with either
the measurement of thyroxine in the blood or its absorption from the intestine.
Are there any drugs that should not be taken with
thyroxine?
There are no medications which are not to be taken with Thyroxine, but there
are some medications which may need your doctor to increase your dose of thyroxine,
or which need to be taken at a different time of day from the thyroxine.
Ferrous sulphate (iron) might reduce the absorption of Thyroxine and
therefore requires the patient to take an increased dose of Thyroxine.
This may also be an explanation for a low thyroid hormone level despite
a relatively high dose of Thyroxine. It would be recommended to separate
the taking of the two preparations by several hours, i. e. one in the
morning and one in the afternoon or night.
An increased dose of Thyroxine may also be required if taking drugs
such as Carbamazepine and Phenytoin used to treat epilepsy and the antidepressant,
Sertraline. If taking these drugs along with Thyroxine it would be important
for your GP to request a blood test in order to see if an increased dose
is needed or not.
There is a possibility that the calcium (taken by osteoporosis sufferers)
could affect thyroxine absorption. It would be preferable to take it at
a different time such as with your evening meal to ensure maximum absorption
of your thyroxine.
SupaSulf – is a white, crystalline powder, containing bio-available
organic sulphur, which is a vital element in all plant and animal cells.
Nutritional Laboratories (0800 389 6387) have informed us that being an
organic compound it should not have any known contraindications.
Does the use of maize flour in thyroxine tablets
hinder the absorption of the thyroxine itself?
It is true that maize contains a small amount of thiocyanate precursor and
thiocyanate can reduce the formation of thyroid hormone. However, large quantities
of thiocyanate are needed to have this effect. The relative size of a thyroid
hormone tablet and an ear of corn makes it clear that there is far too little
thiocyanate in thyroid hormone tablets to have any effect whatever on thyroid
hormone production. Moreover, if your thyroid has already stopped working,
it will not matter how much goitrogen you consume, because you cannot reduce
thyroid hormone production any further. Maize flour does not interfere with
thyroxine absorption or action.
I am being treated with Thyroxine but still feel
tired all the time. Why is this?
As long as you are being prescribed the appropriate dose of Thyroxine any
fatigue you are feeling cannot be attributed to the underactive thyroid gland.
It is simple to determine whether you are receiving the correct dose of thyroxine
by asking your physician to carry out a simple blood test measuring thyroxine
and thyroid stimulating hormone concentrations in the blood.
Is there any benefit in splitting thyroxine dose
by taking smaller amounts throughout the day?
There is no advantage in splitting the dose of Thyroxine nor does it matter
when during the day the dose is taken. This is because Thyroxine has what
is known as a ‘half-life’ of 7 days. This is the term used for
the time the body takes to reduce the blood level of thyroxine by half, and
this would explain why patients would notice no ill-effects if the dose of
Thyroxine were inadvertently missed for a few days
How long does it take to feel well again after
starting thyroxine replacement therapy?
It is often the case that the patient does not feel immediate improvement
following thyroxine therapy. One might be started on a low dose, which will
be increased at 3-4 weekly intervals. It sometimes takes several months, perhaps
6-9 months, before all the symptoms of hypothyroidism improve, but may take
longer to feel ‘normal’ again.
I am taking thyroxine replacement and have noticed
that I keep getting cramping in my legs, especially at night. Are the two
related?
A dose of 100mcg or even 125mcg per day is extremely unlikely to be associated
with the cramp like pains in the legs.
I don’t like taking medicines. Do I really
need my thyroxine?
It is important not to be under-treated or to stop taking your thyroxine.
This may lead, in the long term, to narrowing of the coronary arteries due
to increased cholesterol deposits, which supplies blood to the heart muscles
and can contribute to angina.
What is the usual daily dose of thyroxine?
The average thyroxine replacement therapy is between 100-150mcg/day, but
the range can be 100mcg to 300mcg daily depending on individual needs.
I am being treated for hypothyroidism and am experiencing
dizziness. Are the two related?
Although unsteadiness and lack of co-ordination may be symptoms of severe
untreated hypothyroidism, these symptoms disappear with effective treatment
with Thyroxine.
What is the best way to ensure the thyroid replacement
therapy is adequate?
The best measure of thyroid hormone replacement is the TSH, which should
be in the reference range, and ideally in the lower half of the reference
range to ensure optimum replacement
What is the best way or time for me to take my
thyroxine?
Thyroxine can be taken as a single dose daily, and this is the usual recommendation.
So if a dose of 150mcg is prescribed, then the three 50mcg tablets can be
taken at once at any chosen time of the day. It is recommended that one should
have a routine, for example, the single dose each morning.
Will my thyroid gland ever return to normal by
itself?
A properly diagnosed underactive thyroid gland will have to be supplemented
with thyroxine indefinitely. The thyroid gland cannot heal itself nor can
anything correct it or cure it once it has been damaged.
Can Levothyroxine (thyroxine) cause blood clots?
There is no information to suggest at all that Levothyroxine, or any other
form of thyroxine can produce blood clots. I cannot think of any mechanisms
whereby this could occur. Thyroxine, whatever the make, is given to normalise
the TSH, and this restores all aspects of physiology to normal.
Does it matter when I take my Thyroxine tablets?
It does not matter when you take your Thyroxine tablets as long as you take
them every day. People often find that they are less likely to forget them
if they include them in an everyday routine, for example first thing in the
morning before brushing their teeth.
I have just had my thyroxine increased from 50
mcg to 75 mcg per day and noticed that my hands and feet are starting to swell.
Is this due to the extra thyroxine I am taking?
Swelling of the hands and feet are signs of an underactive thyroid, but
I think it would be unlikely that this was the explanation for you given the
relatively modest increase in dose of thyroxine that has been recommended.
You should await your blood test results and if these are normal and if your
swelling persists then the thyroid is not responsible and you should consider
looking elsewhere for the cause.
I understand that now I have to take thyroxine
I no longer need to pay for my prescriptions, is this true?
Yes, that is true. Among those entitled to free prescriptions are people
with a specific medical condition. One of the medical conditions listed is
myxoedema or other conditions where supplemental thyroid hormone is necessary.
Exemption certificates may be obtained by completion of form FP92A (ES92A
in Scotland, HC1B in Northern Ireland) which is available from your doctor,
hospital or pharmacist. For further information call the Health Cost Advice
Line on 0800 9177711
I have hypothyroidism and feel so much better when
I take a higher dose of thyroxine than what has been prescribed by my doctor.
Is this safe for me?
There is tremendous debate about the correct dose of thyroxine. The consensus
is that enough should be given to ensure that levels of T4 in the blood are
at the upper limit of normal or slightly higher and the TSH at the lower limit
of normal. Although, by taking too much thyroxine, you may experience a sense
of well-being, have increased energy and even weight loss in the short term,
there are long-term dangers to the heart and a possibility of increasing the
rate of bone thinning and therefore encouraging the development of osteoporosis.
Nodules and Goitres
General
What is a thyroid adenoma?
It is a solid lump on the thyroid gland that is usually removed to ensure that it will not progress into a cancerous growth.
What is a colloid nodule?
This type of nodule consists of a large number of small cysts.
I have been told I have a cyst on my thyroid gland. What exactly is this?
A cyst is a fluid filled swelling and is usually left alone for the body to reabsorb the fluid. Thyroid cysts are virtually harmless and may be
drained to ease pressure on an out-patient basis.
I have been told I have cysts on my Thyroid gland and was given no immediate treatment for this. Is this normal?
Most thyroid cysts are benign and once they develop can persist for years. Occasionally they enlarge and become troublesome by causing some
discomfort and they may become a bit unsightly, but otherwise they are not of any real importance. If the cyst is causing no discomfort and is not
enlarging, then it is best just left alone and that is why no more follow-ups have been suggested. In time, which can be years, cysts shrink. A big
cyst may require an operation or needle aspiration to help get rid of it.
I have a developed a large goitre. Does this mean I have cancer?
Most likely not. Thyroid cancer is very rare and there are great many more non-cancerous conditions that cause enlargement of the thyroid.
What is a solitary toxic nodule?
It is a group of cells that have taken over the function of the rest of the thyroid gland. These cells are now producing too much thyroid hormone.
I have had a thyroid cyst drained. Will it come back?
It may, and if it does there is a good chance that draining it again will fix it. There are also other options that can be tried if it does recur.
I have heard the doctor refer to nodules as hot or cold. What does this mean?
The term ‘hot’ is used to describe nodules that produce excessive amounts of thyroid hormone and are considered very active. In nearly every case
the only treatment needed is that required to control the overproduction of thyroid hormone, either by drug therapy, surgery or radioactive iodine treatment.
The term ‘cold’ is used to describe an inactive nodule. Many benign lumps and cysts are ‘cold’ nodules but the doctor may also want to checkto see
if there is a chance of it being cancerous by doing a needle biopsy to check the thyroid tissue.
I have a lump on my thyroid and I am to undergo a biopsy by ‘fine needle aspiration’. What is this?
This is a virtually painless procedure carried out in a few minutes as an outpatient. Thyroid tissue or fluid containing some cells is sucked
through a fine needle into a syringe for examination under the microscope to identify what kind of cells they are. This will help doctors to discover
exactly what is wrong. It is no more painful that a simple blood test.
Osteoporosis
General
How can an untreated overactive thyroid cause osteoporosis?
Untreated hyperthyroidism can cause loss of bone density and an increased likelihood of fractures. This can be corrected once the thyroid has been treated and has returned to a normal level.
Pregnancy and fertility
General
Are thyroid disorders and infertility related? If you have one are you likely to develop the other?
There is probably an increased chance of having thyroid disease in women who have been investigated for infertility, and there is some evidence
that the presence of thyroid antibodies, in particular, is higher in women who have problems conceiving. How much of this is due to an intensive
search for an explanation for the fertility is not known, but there might very well be a relationship. I also suspect that it is not related to thyroid
autoimmunity but due to a general increase in autoimmune disease. It just happens that thyroid disease is so common that we see an increase in thyroid
autoimmunity.
How did I manage to get thyroiditis after having my baby?
This is also called postpartum thyroiditis and is a rather common condition in which thyroid hormone changes occur in the blood. These changes are
mostly subtle and temporary but might be overlooked and considered extra stress and work because of having a new baby. It is caused by the worsening
of pre-existing, mild autoimmune thyroiditis 3-6 months after the baby is delivered. In over 90% of women the thyroid recovers normal function within
the following months.
Pregnancy and fertility
Hyperthyroidism (Overactive thyroid)
Can I take anti-thyroid medication while trying to get pregnant?
You may try to become pregnant while taking anti-thyroid treatment. The anti-thyroid drug can be taken during pregnancy in low doses while
pregnant provided that the treatment is stopped 4-6 weeks before the baby is born. Once the baby is born you would have to continue with the treatment
to control your over active thyroid.
I have hyperthyroidism and am receiving anti-thyroid drugs. I am also considering Radioactive Iodine as a treatment but I would like to become pregnant. Can I take anti-thyroid drugs while pregnant? Or would it be better to have the radio-iodine?
You are more likely to become pregnant if your thyroid is normal. If you are on anti-thyroid drugs, this is no problem providing you are monitored
carefully in hospital. As far as radioiodine is concerned, you can get pregnant after receiving a dose of radioiodine as long as it is later than four
months afterwards. There will be no ill effects on you (apart from the possibility of development of hypothyroidism, which is almost half expected).
Pregnancy and fertility
Hypothyroidism (Underactive thyroid)
Is taking thyroxine safe when you are pregnant?
Normal replacement doses of thyroxine are not harmful to the foetus and is recommended as long as it is monitored to stay within the normal
maintenance levels. During the early stages of foetal development the baby cannot produce its own thyroxine and relies on the mother’s thyroxine
production therefore it is essential that enough thyroxine is available.
I have just had a baby and have been diagnosed with an underactive thyroid. Do I have to take my thyroxine for the rest of my life or will my thyroid get better?
Most patients who have an underactive thyroid gland require continuing their thyroxine treatment forever. However I note that your underactive
thyroid gland developed shortly after your daughter was born. An underactive thyroid gland developing within a few months of delivery of a child may
be temporary although in the long term such patients often go on to develop permanent underactivity of the thyroid. It is a simple matter to decide
whether or not you truly require thyroxine. The thyroxine can be stopped for some 4 weeks and a blood test then taken by your doctor to measure the
concentration of thyroxine (T4) and what is known as thyroid stimulating hormone (TSH) in the blood. This will determine if you truly have developed
an underactive thyroid and you will come to no harm not taking thyroxine for a 4-week period even if you truly require it.
I have heard that babies born to mothers with hypothyroidism have lower IQ’s. Is this true?
There is evidence in the literature that the children of untreated overtly hypothyroid women have a lower IQ than those of women with
normal thyroid function. There is no evidence that this also applies to women with borderline hypothyroidism.
I have heard that you should not colour or perm your hair during pregnancy. Does this still apply if you are taking thyroxine?
Colouring hair does involve various strong and drying chemicals. It is advised not to colour your hair during pregnancy normally and it would be
doubly wise to avoid doing so whilst hair loss could already be a problem due to thyroid deficiency.
Could breast-feeding affect my thyroid function?
There is no evidence that breast-feeding has any adverse effects on underlying autoimmune thyroiditis, nor on thyroxine requirements. Many women
breast feed without problem.
I’ve been told my thyroid is borderline hypothyroid. Will it still be difficult for me to get pregnant as I am trying to start a family?
Patients with borderline hypothyroidism should not experience any significant problems with conception.
Psychological
General
I heard that Dementia is related to hyperthyroidism. Is this true?
It is true there have been suggestions that dementia might be associated with an overactive thyroid although this is by no means firmly
accepted and the mechanisms involved, if there is an association, are unknown. It is important to put this in perspective;if there is an increase in
risk it is not large and one would expect that any risk is decreased or eliminated by successful treatment.
Could my thyroid disorder have caused my Anxiety/Depression?
The answer is almost certainly ‘no’, although symptoms of anxiety/depression are common in hyper- and hypothyroidism. Once adequately treated
the symptoms may improve. These conditions however may make underlying psychiatric illness worse and they may have to be treated in their own right.
Radio-iodine
General
I am supposed to have radioiodine treatment shortly and I am really worried that it mighthave an effect on any babies I may have in the future.
No it won’t, nor will it affect your fertility.
I have recently had radioiodine for the treatment of Graves’. The doctor told me I should avoid getting pregnant for about four months. Why is that?
This is to ensure that all the radioidine is no longer in your body. If it were and you were to become pregnant then some of the radioiodine may
be taken up by the baby’s thyroid. Radioiodine should also be avoided in women who are breast-feeding for the same reason.
I have to have radioiodine for the treatment of my overactive thyroid; I am really worried that it will cause cancer. Is this true?
Although thyroid cancer has been described in occasional patients treated with radioiodine, no relationship between radioiodine and thyroid cancer
has been found in several very large long-term studies. Similarly, the risks of leukaemia and other malignancies are either no greater than expected or only marginally increased.
Surgery
General
I have had thyroid surgery to remove my thyroid gland. I have now noticed a thickening of my scar that is becoming quite ugly and the only solution offered is steroid injections into the scar. Have you heard of this?
If a thyroidectomy scar develops keloid, which is the technical name for the lump you have described, the only chance of resolution is with
steroid treatment. I don’t think that this would worsen the problem, but there is a chance it may not totally alleviate it either.
What are the parathyroid glands?
There are usually four tiny pea sized glands that lie towards the back of the thyroid gland and they may be hidden in it. The parathyroid gland
regulates the level of calcium in your blood. If they are not functioning properly then the calcium levels fall and this may give rise to a condition
known as tetany. This will cause a feeling of numbness around your lips and mouth. Later you may experience cramping in your hands and sometimes your
feet. These symptoms are corrected by administering vitamin D and calcium.
I have had thyroid surgery but now have to take calcium supplements. Why is this?
When a patient undergoes surgical removal of their thyroid gland to treat cancer or an overactive thyroid, the parathyroid glands may accidentally
become damaged or removed and this would then cause signs related to low calcium levels in the blood. If the parathyroid glands are bruised then the
signs of low calcium levels are temporary, but if the glands are accidentally removed then permanent calcium replacement therapy will be necessary.
How might my voice be affected by my thyroid surgery?
The thyroid gland lies close to the voice box (larynx) and the nerves to the voice box. Your voice might sound hoarse or weak following surgery
due to bruising and swelling as a result of surgery. This should recover quite quickly but in a small number of cases voice changes may be permanent.
I am to have a thyroidectomy. After the operation will my eating and drinking be affected?
You may find that your neck is quite sore for a period after the operation and it may be a little painful to swallow so you may need a softer diet
for a short time. Pain-killing medication may help with this.
Is there anything I can do to reduce any risk of infection to the wound after my operation?
Keep the wound in your neck clean and dry; this will be done for you initially by the nursing staff at the hospital. After bathing or showering
gently pat the wound dry with a clean towel. Exposing the wound to the air will assist with its healing.
What care do I need to take regarding the neck wound after the operation?
Take care not to knock your wound and remember to keep the wound dry. When the skin clips are removed and the scar is healing well, you can rub
a small amount of unscented moisturising cream on the scar so it is less dry as it heals. Aloe Vera, Calendula or E45 creams are effective. Rubbing
the cream into the scar will also help to soften it.
I recently had a thyroidectomy. When should I return to work?
You will probably need to take one to two weeks off work, sometimes longer depending on the nature of your work.
Thyroid and disorders in men
General
I have hypothyroidism and also notice a low libido. Are the two related?
Yes they may be related. Having hypothyroidism means the whole body system is being dragged down which can cause lethargy and depression, and a
decreased libido can also be a part of it. Treatment with thyroxine should help to alleviate these symptoms.
Besides the usual symptoms, are there any other things I should know about how ahyperactive thyroid can affect men?
Having too much thyroid hormone (hyperthyroidism) can lead to muscle wasting and weakness, especially in thighs and upper arms. It can also upset
the balance between the principal male sex hormone (testosterone) and the female sex hormone (estradiol) in the body; Sperm production may be impaired.
There may be breast tenderness or enlargement. Libido is reduced and difficulty with erection is common. If the thyroid gland is the culprit, these
problems clear up when the thyroid hormone balance is restored to normal.
How often do men get thyroid cancer as compared to women?
Thyroid cancer is rare, 1. 6% of all cancers in women, and 0.6% of all cancers in men. However, if there are nodules in the thyroid gland, in men
they are more likely to be cancerous. Be sure your physician examines your thyroid and orders a thyroid stimulating hormone (TSH) blood test if it
seems possible your thyroid is not working right. This is especially true if you have a close relative with a thyroid problem or related immune
disorders, such as pernicious anaemia, rheumatoid arthritis or Type 1 diabetes.
Thyroid eye disease
General
I have noticed that my eyesight has deteriorated since I have been diagnosed with hypothyroidism. Are the two related?
There is no evidence that a refractive problem, needing glasses, would be linked to thyroid eye disease. I think it is much more likely that
changes in fluid caused your transient abnormalities. Fluid retention is an early and constant feature of hypothyroidism, and therefore increased
fluid in the cornea could account for refractive problems that then improved. We see similar problems in diabetics that resolve when the metabolic
abnormality is corrected. If you now have stable thyroid function but abnormal vision it is likely to be the common age-related changes in lens
function. However, your optician will be able to advise much better having examined your eyes.
Thyroid eye disease
Hyperthyroidism
Does everyone with an overactive thyroid get Thyroid Eye Disease?
Thyroid eye disease is common in Graves’ disease and many people with this condition will have some changes in their eyes. In the vast majority,
however, the changes will be minor or temporary. Eye problems can occur before, during, and after problems with the thyroid gland have been diagnosed and treated.
I have Graves’ disease and my eyes are protruding. Why does this happen?
Protruding eyes are a very prominent sign of Graves’ disease and may occur in varying degrees from mild to severe. The tissue and muscles behind
the eyes becomes inflamed and swells (oedema) thus pushing the eyes forward (exophthalmos). The lids also retract which give the eyes a staring look.
My eyes ache and keep watering all the time. Is this normal?
With Graves’ disease the tissues around the eyes begin to swell which in turn interferes with the drainage of your tears. The eyes become watery
and puffy with bags forming under the lower lids. The build up of pressure behind the eyes tires the eye muscles, which causes aching. The swelling
of the muscles can also cause double vision (diplopia) because they cannot align the eyes properly for a clear picture.
I have Graves’ disease with the eye problems and I have heard that radioiodine treatment will make the eyes worse. Is this so and if so, is there anything that will prevent this happening?
Advice is mainly based on a large study performed some years ago in Pisa, Italy. In that study, more than 400 patients with hyperthyroidism due
to Graves’ disease were closely observed to compare what happened to their eyes. One group received radioiodine alone, another group received
prednisolone (steroid tablets) before and after their radioiodine treatment, and a third group were treated just with antithyroid medication
(methimazole – very similar to carbimazole). The researchers found that 15% of the group treated with radioiodine alone had some worsening of their
eyes, although in the majority this was only transient. Overall, 5% of that group needed further eye treatment. By contrast, none of the patients
who received prednisolone with the radioiodine had any worsening of their eyes and in fact, 2/3 showed some improvement. Importantly, 3% of the group
treated with methimazole (equivalent to carbimazole) experienced some worsening of their eyes.
This study tells us that low dose steroid treatment seems to significantly reduce the risk of eye worsening with radioiodine and this is why many
doctors now recommend this treatment for patients with some degree of thyroid eye disease (however small), provided that patients have no other
conditions which preclude the use of steroid medication. It is very important that all patients are monitored to check for the development of
hypothyroidism after radioiodine as this too can aggravate the eye condition.
Thyroiditis
General
Can you explain to me what Thyroiditis is and when does it occur?
Thyroiditis simply means inflammation of the thyroid gland. There are three types which can occur. One is after a viral infection; after
pregnancy, or, thirdly, at any time as a result of autoimmunity. In the first two types the illness is temporary and the thyroid usually returns to
normal. In the autoimmune thyroiditis the thyroid gland may become permanently damaged.
Would a viral infection have been the cause of my illness during the past 2 years?
There is a condition known as subacute or de Quervain’s thyroiditis, which is the result of a viral infection of the thyroid. Characteristically
this causes the thyroid to be slightly overactive for a few weeks followed by an equally short-lived and relatively mild under activity for a further few weeks and then recovery.
What are some of the signs and symptoms with viral Thyroiditis?
These vary between patients but the main feature of the illness is pain and tenderness in the thyroid gland, which also becomes enlarged. Pain
similar to a sore throat, flu-like symptoms and /or fever may also be experienced. A thyrotoxic phase may follow the illness in which nervousness,
tremor, palpitations, insomnia and feeling warmer than normal may also occur. These symptoms usually last 2-4 weeks. If there is extensive damage to
the thyroid, symptoms of under activity may occur such as fatigue and feeling cold, and also slowing down of the body systems.
How is Thyroiditis treated?
Sometimes subacute Thyroiditis may resolve itself without treatment. The doctor may prescribe anti-inflammatory medications or even just
paracetamol. However if the pain is persistent the patient might be prescribed steroids until the symptoms subside, but not given any longer than
1-2 months. Complete recovery usually occurs in 2-5 months.
I have been diagnosed with Riedels Thyroiditis. What can you tell me about it?
Riedels Thyroiditis is an extremely rare condition in which the thyroid gland becomes replaced by scarring fibrous tissue. The thyroid may be
tender and feels as hard as wood. The condition is also known as ligneous (woody) or invasive fibrous thyroiditis. The gland becomes attached to the
overlaying skin and to deeper structures in the neck so that your windpipe may be constricted and involvement of the nerves to your vocal cords makes
your voice weak or husky. Swallowing may become difficult. Without a biopsy it may be difficult for your doctor to distinguish this condition from an
undifferentiated anaplastic cancer. An operation is usually required to relieve the constriction of the windpipe.
Riedel’s Thyroiditis may be associated with a similar fibrosis affecting the covering of the intestines (peritoneal fibrosis), structures in the
back of your abdomen (retoperitoneal fibrosis), the duct that carries bile from the liver to the intestines (sclerosing cholangitis) or structures in
the centre of the chest (mediastinal fibrosis). The cause of this very uncommon condition is unknown.
Weight and diet
Diet
I have heard that if you have a thyroid problem you should avoid iodine. I am undergoing treatment with a dressing that contains iodine. Will this interfere with me taking Thyroxine?
Iodine does influence the function of the thyroid gland but as you are taking a full replacement dose of thyroxine for an inadequately functioning
gland, it is very unlikely that iodine absorbed from the skin dressing would have any adverse effect.
I have recently discovered I have an overactive thyroid. I have lost quite a bit of weight and am worried that once treated I will become fat.
You will probably regain the weight that was lost due to having an overactive thyroid. If you were not overweight originally there is no reason
for you to become so after you have been treated.
Would using iodised salt in my diet have an affect on my thyroid treatment with thyroxine?
Basically Iodine does not interfere with the effect of thyroxine. Iodised salt in cooking would have not affected the thyroid dose either as it is such a small quantity.
I am planning a vacation by the sea and was wondering if the iodine from the sea water would help to rejuvenate my thyroid so that it will start to work on its own again?
There will be no significant improvement in iodine intake from swimming in or walking by the sea. There is absolutely no need to take an increased
dose of iodine with a failing thyroid. This can actually exacerbate the situation. Once the thyroid gland is destroyed by the immune system, no amount
of iodine will bring back thyroid function and the only treatment is thyroxine replacement.
Where does iodine come from and how does it get into our diet?
The thyroid extracts iodine from the body in order to produce the two hormones
thyroxine (T4) and triiodothyronine (T3). The iodine originally comes from
the sea, evaporates into the air and then falls by the rain onto the soil
therefore we obtain the iodine through the food that we eat. Our crops are
harvested from this soil so the iodine is passed to the grains and vegetables
that we eat, along with dairy products as the cows eat the grass from the
soil. Fish are an especially good source of iodine. If the body does not receive
enough iodine through the diet, then the thyroid can not make enough thyroxine
causing hypothyroidism. The UK is not an iodine-deficient country, and thefore
the majority of table salt produced in the UK is not supplemented with iodine.
The exception to this is sea salt. If iodine is included then it will be listed
as an ingredient on the label. For further information about salt visit the
website of "The Salt Manufacturers' Association":
www.saltinfo.com, tel: 01539 568005, email
salt@saltinfo.com
I have read that taking selenium is good for your thyroid. How much selenium should I take daily?
The recommended daily requirement of selenium is 400 micrograms per day. Selenium is found in foods such as kidney, liver, crab, other shellfish,
and Brazil nuts. North American soil is also very rich in selenium and researchers believe that they are getting enough selenium in their daily
diets without the need of a supplement. In the UK and Europe selenium levels are much lower and therefore supplementation might be considered. It is
always recommended to check with your doctor before taking any supplements.
I have a goitre and am taking selenium supplements. My doctor has advised me to stop taking these. Could you tell my why?
Selenium is an essential trace mineral found in the soil and is starting to become recognised as an important part of our diet. Selenium is a
component of the enzyme the helps to convert T4 into T3 which can lead to hypothyroidism. Taking too much selenium can also depress T3 levels so it
is important to make sure you are getting the right amount. Your doctor may feel that by taking selenium supplements you might disturb your goitre
by increasing T3 levels and therefore causing further swelling of the thyroid gland.
I would like to take a multi-vitamin but notice that it contains iodine. Would this be harmful to my thyroid as I also take 75 mcg of thyroxine each day?
There are many multi-vitamin preparations which do not contain iodine or
kelp, and these are probably the most sensible for someone with a thyroid
disease. However, the real problem with excess iodine is that it can make
a marginally underactive thyroid go severely underactive. Therefore, for someone
taking 25 or 50 mcg of thyroxine a day who has a substantial remnant of their
thyroid working, excess iodine would be considered harmful. However, for someone
with no thyroid tissue left (after surgery, radio-iodine or
after complete destruction by autoimmune thyroid disease) there are no harmful
effects on the thyroid gland from taking iodine. In cases of doubt it would
be best to check the iodine content of any multivitamin preparation, and provided
doses were moderate (25mcg per day or less) there would normally be no harmful
effects what so ever.
I have put on nearly 4 stones over the last couple of years. I think this may be due to hypothyroidism but the thyroid blood test was normal.
Hypothyroidism usually causes a weight gain of around 7-14lbs but it can make trying to lose weight a lot harder. If the blood test was in order
then you and your doctor should look for another cause for this excessive weight gain.
I read in a book recently that some vegetables from the brassica family such as broccoli and cabbage can cause hypothyroidism
The amounts of these vegetables eaten daily in a normal balanced diet would not cause hypothyroidism. The amounts needed to be consumed to have
any effect on the thyroid gland would be too un-naturally huge to be considered a reality.
I have seen supplements in the health food shop such as Chinese herbs, selenium and kelp tablets that claim to kick-start the thyroid into working again. Is this true?
No, once the thyroid stops working it cannot be stimulated into working again. In fact taking extra iodine contained in kelp (seaweed) tablets
may actually shut the thyroid gland down even more.
Weight and diet
Exercise
I have hypothyroidism and would like to start exercising again. Will this cause my condition to worsen?
Exercising does not make the condition of hypothyroidism worse. The patient may find exercise difficult before treatment, as the muscles tend to
be rather stiff and lacking energy. Obviously in this situation, exercise is difficult and can make the symptoms worse, but has no direct effect on
the disease process. Once an appropriate maintenance dose has been established, the patient will find that exercising can continue as before and that
it will also help to boost the metabolism. The rule of thumb is to listen to your body and don’t over exert yourself. Build up to an exercise regime slowly.
I run about 10 km per week and lift weights 3 times a week. While preparing for a RAI scan, when or how should I modify my workout schedule?
There is no need to modify an exercise regime while preparing for a radioactive iodine scan.