Is iodine important for thyroid health? What role does iodine play in keeping my thyroid healthy? Expand Iodine For people without an existing thyroid condition, iodine is essential as it is required for the production of thyroxine. It is particularly important in women who are pregnant as it is needed to ensure the development of a baby's brain during pregnancy and early life. Good sources of dietary iodine are eggs, milk and fish so anyone excluding these major food groups may need to consider taking a supplement containing iodine. However, for people with an existing thyroid condition, iodine supplements or kelp (a type of seaweed rich in iodine) should be avoided. This is because they often contain excessive and/or variable amounts of iodine which can worsen existing thyroid conditions. Read more about iodine and the thyroid You should only follow a low iodine diet if you have been asked by your doctor to do so if undergoing radioiodine therapy (RAI) to treat thyroid cancer. Information about low iodine diet for thyroid cancer patients h demoing RAI therapy
Can I ask for a specific brand of levothyroxine? I feel unwell on some brands. Am I able to get my GP to prescribe specific brands? Expand Getting a specific brand of levothyroxine Whilst it's extremely unusual to have reactions to levothyroxine itself, some people cannot tolerate some of the excipients (fillers) used in tablets. These include ingredients such as lactose or mannitol. This has been recognised in the MHRA levothyroxine prescribing guidance. This allows healthcare professionals to consider consistently prescribing a specific formulation known to be well tolerated by the patient. If you are experiencing persistent problems with side effects of levothyroxine, we would suggest you discuss this guidance with your healthcare professional and also to report any adverse effects to the MHRA Yellow Card system. However, please be aware that supply problems and buying policies of pharmacies mean that having a certain brand prescribed does not unfortunately guarantee you will be always be able to get hold of your prescribed brand. Many brands have virtually identical ingredients and are often made by the same manufacturer. If you are concerned about a change of brand, we would recommend you compare the ingredients of each formulation. You can find these in the patient leaflet that comes with the brand. Alternatively, you can ask your pharmacist MHRA levothyroxine prescribing guidance
Why won't my doctor test more than my TSH? Learn more about which tests are used to assess thyroid function Expand Is TSH testing sufficient or should doctors routinely test T4 and T3 levels? In the majority of people, a TSH test alone is offered as a first test for assessing thyroid function. If the TSH level is abnormal, further tests (FT4 and sometimes FT3) may then be offered to patients. Antibody tests may also be offered to confirm whether the cause is autoimmune. In people recently treated with radioactive iodine for hyperthyroidism, children and young people, or patients with known or suspected pituitary disease, FT4 should also routinely be checked. In more than 99% of people with a normal TSH, and who have no other reason to have a thyroid or pituitary problem, FT4 and FT3 will also be normal. In someone without thyroid disease, if the TSH is raised and hypothyroidism is suspected, then it should be repeated and FT4 tested. If persistently raised, then an anti-TPO Ab test may be offered. This is generally only tested on one occasion. If the TPO antibodies are positive, it is more likely the thyroid level may deteriorate over the coming months or years. Thyroglobulin antibodies (TgAB) generally do not add much to anti-TPO Ab results. If antibodies are negative, it means the person likely does not have a thyroid disorder and that the high TSH may resolve spontaneously, or there is an underlying thyroid disorder caused by another factor (e.g. following a viral infection or due to prescribed medication). If the TSH is low, measuring FT3 and FT4 will diagnose hyperthyroidism. If confirmed, a TSH receptor antibody test looking for Gravesʼ disease may be offered. In patients with known or suspected pituitary disease, the TSH level is misleading and FT4 should be measured. This is also true in other situations, such as within three months of treatment of hyperthyroidism (when the TSH may stay lower than it should be) and with some genetic abnormalities of thyroid function. If a patient has a normal TSH but persistent symptoms suggestive of hyperthyroidism or hypothyroidism, the measurement of FT4 and FT3 on one occasion is helpful to rule out a pituitary problem or these other rare conditions. When monitoring patients already on thyroid hormone, TSH measurement alone is usually sufficient. If the TSH is not normal, FT4 (and possibly FT3) should also be measured. An exception is patients taking T3 alone, or in mixed preparation, when a FT3 measurement might be helpful. Follow-up antibody tests are not normally required. NICE guidance on the assessment and management of thyroid disease
Is there a diet I should follow when diagnosed with a thyroid disorder? Is there a thyroid diet to help improve thyroid function? Expand There is no specific ‘thyroid diet’ recommended for people to follow when they are diagnosed with a thyroid condition. There are, however, certain foods and supplements that can interfere with thyroid function and the way the body absorbs levothyroxine in people with hypothyroidism. These include kelp, soya, iron and calcium. See our article on ‘diets and supplements when living with a thyroid condition.’
Does having one autoimmune disease make you more likely to develop an additional one? Read more about whether people with an autoimmune disease have a high risk of developing another one, including autoimmune thyroid disease Expand Yes. Having one autoimmune disease slightly increases your risk of developing one or more additional autoimmune condition. Someone with an autoimmune thyroid disorder is more likely to develop another autoimmune condition, such as Addison’s disease, pernicious anaemia or coeliac disease. This risk is still very small, however. For example, between 1.5% to 3.8% of people with autoimmune thyroid disease also have coeliac disease compared to 1% in the general population. [1] It is thought that about 10 per cent of people with autoimmune hypothyroidism (Hashimoto’s thyroiditis) also have pernicious anaemia. Although the risk is small, it is important that such conditions are considered in patients with autoimmune thyroid disease if they develop new or nonspecific symptoms. For example, the NICE guidance on coeliac disease recommends that anyone with an autoimmune thyroid condition is also offered testing for coeliac disease at the time of diagnosis.[2] It is also important for people with Addison’s disease, type 1 diabetes and other autoimmune diseases to be tested regularly for autoimmune thyroid disease. [1] Coeliac UK [2] NICE guidance on coeliac disease
What are the main signs of thyroid cancer? Learn how to spot signs and symptoms of thyroid cancer Expand Thyroid cancer is rare but is curable if diagnosed early. Signs of thyroid cancer include: A painless swelling or lump (nodule) in the front, lower part of your neck Hoarse voice Difficulty in swallowing and awareness of pressure when swallowing Difficulty in breathing, especially when sleeping If you discover a lump in your neck, or notice a change to an existing lump, it is important to see your GP without delay. Please remember that thyroid nodules and swellings are extremely common and 95% are benign (not cancer). See our thyroid cancer booklet
How long should I have to wait for an ultrasound scan on a thyroid nodule? Learn more about urgent and non-urgent referrals for thyroid nodules and goitre (swellings) Expand Thyroid lumps (nodules) or swellings (goitre) will usually be assessed and referred either urgently or non-urgently for an ultrasound scan. This is a guide to referral times: Same day referral Stridor (high-pitched sound when breathing) Urgent referral (two-week rule) Unexplained hoarseness of voice changes associated with a goitre Cervical lymphadenopathy (abnormally enlarged lymph nodes in head and neck) associated with a thyroid mass A rapidly enlarging, painless, thyroid mass over a period of weeks. Non-urgent referral Nodules with abnormal thyroid function tests. You should normally be referred to an endocrinologist Sudden onset of pain in a thyroid lump (this is likely to have been caused by a bleed into a benign thyroid cyst) See our guide to thyroid nodules and swellings
Do women with borderline (subclinical) hypothyroidism who are struggling to conceive need to have their thyroid levels optimised? Learn in which circumstances treatment may be appropriate for women with a borderline underactive thyroid wishing to conceive. Expand Untreated, or undertreated, hypothyroidism can make it harder to conceive and can result in poorer pregnancy outcomes. However, the evidence about the effect of borderline (subclinical) hypothyroidism on fertility is less clear-cut. If you have a diagnosis of subclinical hypothyroidism, and are not currently being treated for it with levothyroxine (L-T4), you should have a TSH measurement performed as soon as possible to see whether you need to start treatment. The tables below provide a guide to the treatment of women with subclinical hypothyroidism not currently being treated with levothyroxine (L-T4): Thyroid peroxidase antibodies (TPO Ab) positive TSH greater than reference range Treatment with L-T4 recommended TSH above 2.5 but less than reference range Consider treating with L-T4 TSH less than 2.5* Don’t treat TPO Ab negative TSH greater than 10 Treatment with L-T4 recommended TSH above reference range but less than 10 Consider treating with L-T4 TSH less than reference range (or less than 4.0)* Don’t treat *Some fertility clinics may treat people with a TSH greater than 2.5 mIU/L regardless of antibody status, but there is no real hard evidence for this. If you are already receiving L-T4 treatment for overt hypothyroidism (or subclinical hypothyroidism), it is generally recommended that your levothyroxine is increased immediately after your pregnancy is confirmed, usually by 25-50mcg daily. This is most easily achieved by doubling your current dose on two days of the week. You should then contact your GP and arrange to have a thyroid blood test . See our pregnancy and thyroid disorders alert card
What are the main symptoms of thyroid eye disease? Learn how to spot symptoms of Thyroid Eye Disease (TED) Expand Thyroid Eye Disease (TED) is an autoimmune inflammatory disorder that affects the orbit of the eye. TED is mainly seen in patients with an overactive thyroid (hyperthyroidism) caused by Graves’ disease. About 20-25% of people with Graves’ disease develop TED either before, during or after their thyroid disorder is diagnosed. More rarely it can occur in people with an underactive thyroid (hypothyroidism) or even when their thyroid is functioning normally. These are the most common symptoms of TED: Redness of the eye(s)or eyelid(s) Swelling or feeling of fullness in one or both upper eyelids Puffiness around the eyes Eyes that seem to be too wide open (staring or bulging eyes known as proptosis) Pain in or behind the eyes Gritty eyes Sensitivity to light Blurred vision or double vision You should see your doctor if you have any of these symptoms and ask whether it could be TED. See our Thyroid Eye Disease Early Warning Card
My baby has screened positive for congenital hypothyroidism. What happens next? Learn more about what treatment and care babies with congenital hypothyroidism should receive Expand Congenital hypothyroidism (CHT) is a condition resulting from an absent or under-developed thyroid gland (dysgenesis), or one that has developed but cannot make thyroid hormone because of a problem with the ‘production line’ (dyshormonogenesis). Babies with CHT cannot produce enough thyroid hormone (thyroxine) for the body’s needs. Without adequate thyroxine, babies do not grow properly and can develop permanent, serious physical problems and learning disabilities. Babies with CHT are treated lifelong with levothyroxine to replace what their body is unable to make. This treatment allows them to develop normally. If your baby’s Thyroid Stimulating Hormone (TSH) is high on the newborn bloodspot (heel prick) test, they will screen positive for a ‘suspected condition’. Your baby will require a small blood sample taken from a vein to confirm whether their thyroid hormone is low and confirm their CHT diagnosis. Usually, the local hospital’s paediatrician will phone you to arrange a testing appointment, generally on the same day. After your testing appointment, your health visitor will give you the screening result letter, along with information about CHT. This will be done in a face-to-face appointment to ensure you can ask any questions you have and be supported during your discussion with them. Your baby will then be treated with levothyroxine (taken orally) each day to replace what the body cannot make properly. This treatment should start as soon as possible and the dose will be carefully calculated according to factors, such as their weight. This dose will be adjusted regularly as your child grows. Your baby’s care will be under a paediatric endocrinologist, or a paediatrician with a special interest in endocrinology. Babies and children with CHT are closely monitored with regular hospital appointments. Typically, your baby’s thyroid function will be checked every few weeks during the first few months of life. During infancy and childhood, these will be checked every two to six months. Your baby’s care will be supported by the specialist nurses attached to the CHT team. Your health visitor will also be able to seek support from the specialist nurse to help ensure consistent care. See our guide to congenital hypothyroidism Find information and support for thyroid disorders in children