Thyroid Problems: Ten Things You May Not Know about your Thyroid

1. Thyroid Disease is not “Easy to Diagnose and Easy to Treat”

While it’s common for doctors to say “Thyroid disease is easy to diagnose and easy to treat,” the reality is that diagnosis and treatment are complicated. Many doctors don’t recognize thyroid symptoms, so patients receive antidepressants, weight loss drugs, or other treatments, instead of a thyroid test. Once thyroid problems are suspected, some doctors will perform only one test — the Thyroid Stimulating Hormone (TSH) test — and then base their diagnosis only on that result.

This narrow approach misses patients who otherwise would be diagnosed by a thorough thyroid evaluation, such as one that takes into account clinical examination, review of symptoms, a thorough family and personal history, and other blood work and imaging tests as needed. Finally, some doctors use a cookie-cutter approach to treatment, and believe that only one drug is optimal, and that once blood test levels reach a particular target, the patient is fully treated, even if debilitating symptoms remain.

To do: Spell out symptoms and family history, ask for a thorough thyroid evaluation, and be sure that the doctor’s treatment goal is resolving symptoms, not just blood test results.

2. Doctors Can NOT Rule Out Thyroid Disease Just By Looking at a Patient or Feeling The Thyroid Gland

Surprisingly in this day and age, there are still practitioners who believe that they can simply look at a patient, or feel his or her neck, and rule out thyroid disease. Looking at the patient, as well as feeling the thyroid gland for enlargement and lumps, are only a small part of a clinical thyroid examination. This exam should also include a blood pressure and pulse check, weight check, evaluation of reflexes, and careful evaluation of clinical thyroid signs, such as loss of outer eyebrow hair, swelling in face and limbs, unusual skin patches and other skin and hair disturbances. The doctor then considers the findings, in addition to blood work and medical history, to make a diagnosis.

To do: If a doctor rules out thyroid disease based on looking at a patient, or feeling the thyroid, get another opinion.

3. Millions of Patients are Stuck in the Thyroid Test Limbo Land

Many practitioners consider the Thyroid Stimulating Hormone (TSH) test the “gold standard” for diagnosing thyroid disease. Unfortunately, there is a battle in the medical community over how to interpret the results of that test. On one side are the more progressive practitioners who use 0.3 to 3.0 as the normal range, while a group of hard-liners refuse to budge from an older range of 0.5 to 5.0. Despite recommendations by endocrinologists that the newer, narrower 0.3 – 3.0 range is optimal, many labs, doctors and insurers refuse to acknowledge it. It’s estimated that some 22 million to 28 million people are considered hypothyroid according to the new, recommended standards, but remain in limbo.

To do: Says Shomon, “No one should accept that a thyroid test is ‘normal’ without finding out the exact numbers, and the normal range the doctor is to define normal. And anyone who falls in the ‘limbo’ of a TSH level of 3.0 to 5.0 and is told they’re normal should get another opinion from a more up-to-date practitioner.”

4. The TSH Test May Not Be Enough to Diagnose Some Patients

The TSH test measures one pituitary hormone that responds to thyroid function. It does not, however, test for autoimmune disease, which is the primary cause of thyroid dysfunction. Autoimmune disease may begin to cause thyroid symptoms long before the TSH test become abnormal. Many practitioners do not test for antibodies, nor do they acknowledge research that shows that treating antibody-positive/TSH-normal patients may resolve symptoms, and prevent progression to overt hypothyroidism in some patients.

To do: Patients with thyroid symptoms and normal TSH results should ask for antibody testing….especially important for those with a personal or family history of any autoimmune disease.

5. Weight Gain or Weight Loss Failure May be Due to An Undiagnosed Thyroid Condition

In addition to being Thyroid Awareness Month, January is also a time when millions of Americans embark on new diet and exercise programs, determined to keep a New Year’s resolution to lose weight. Many of those dieters are doomed to fail, however, because their best efforts are being sabotaged by an undiagnosed, untreated thyroid condition. Many people with an underactive thyroid suffer weight gain due to a slowed metabolism, or can’t lose weight despite proper diet and exercise. For these people, thyroid diagnosis and treatment can be a life-changing “diet secret.”

To do: Start a New Year’s diet with a thorough thyroid evaluation.

6. An Undiagnosed Thyroid Condition May be the Cause of Infertility, Low Sex Drive, Depression

There are women undergoing costly and invasive in vitro fertilization and assisted reproduction — but have NEVER had a thyroid test. More than half of all women in the U.S. report suffering from low sex drive at various times in their lives — few have their thyroid tested. A woman who goes to the doctor complaining of depression is more likely to get a prescription for an antidepressant than a blood test.

Despite the fact that it’s recommended that people with high cholesterol have thyroid evaluation before being prescribed a statin drug, few patients receive such testing. The reality is, despite the fact that thyroid disease is common, many practitioners simply don’t know enough about the connections to common symptoms like infertility, menstrual problems, low libido, depression, PMS, high cholesterol, and menopause problems, and so they move ahead with medications, and even costly and invasive treatments, without finding out if a thyroid problem may be the real cause.

To do: Thoroughly rule out a thyroid problem before agreeing to fertility treatment or a hysterectomy, and before starting antidepressants, cholesterol-lowering drugs, hormone replacement drugs.

7. There is More Than One Medication for Hypothyroidism

Since many doctors peddle the Synthroid (TM) brand of levothyroxine, manufactured by drug maker Abbott Laboratories, patients often are not told that there are other thyroid hormone drugs that may work as well or better for them, and cost less. For example, less expensive brand-name levothyroxine drugs include Levoxyl and Levothroid.

Beyond levothyroxine, Cytomel is a synthetic version of second hormone, T3. Thyrolar contains a combination of synthetic hormones. And Armour Thyroid is an FDA-regulated, prescription natural thyroid drug that has been on the market for more than 100 years, and is often preferred by integrative, complementary and holistic practitioners. Says Mary Shomon: “The best thyroid drug is the one that you and your practictioner decide works best, and safely, for you.”

To do: If one thyroid drug isn’t resolving symptoms, ask the doctor to try other options. If the doctor refuses, get another opinion from a more progressive practitioner.

8. Radioactive Iodine is Not the Only Option for Graves’ Disease/Hyperthyroidism

When the thyroid becomes overactive due to Graves’ disease or toxic nodules, practitioners in the U.S. most commonly recommend many radioactive iodine (RAI) ablation treatment. The goal of this treatment is to permanently and irreversibly destroy the thyroid, making it underactive, and leaving the patient hypothyroid for life. Outside the U.S., practitioners prefer to start with antithyroid drugs, which slow down the thyroid, and allow for the possibility of a remission.

To do: Patients with an overactive thyroid who are being “rushed to RAI” by a practitioner should get a second opinion from a physician who knows how to work with antithyroid drugs.

9. The Thyroid Should Be Tested Before and During Pregnancy

Failing to treat thyroid disease during pregnancy increases the risk of miscarriage, stillbirth, premature birth, developmental delays and even mental retardation in the child, so it’s essential that a pregnant woman be aware of her thyroid status. Even mild hypothyroidism during early pregnancy can put a baby at risk, so at minimum, women with any family or personal thyroid history who are considering pregnancy, and women having fertility treatments should have thyroid evaluation prior to becoming pregnant. Since more than 80% of hypothyroid women need more thyroid hormone during pregnancy, it’s also important that thyroid patients confirm a pregnancy as early as possible, and work with a practitioner to increase the thyroid dosage as needed.

To do: Women who are thinking of getting pregnant should have a thyroid evaluation. Women in their first trimester of pregnancy should have the thyroid tested. Women who are hypothyroid need to be knowledgeable, and highly proactive about their thyroid monitoring, treatment and management during pregnancy, and should plan ahead with a practitioner.

10. Doctors Who Rely Solely on Laboratory Tests — And Fail to Also Consider Symptoms — Are Not Adequately Treating Thyroid Disease

Today’s thyroid treatment tends to focus on the test results — to the exclusion of how patients feel. One prominent endocrinologist even declared that thyroid patients who had “normal” thyroid blood tests after treatment, but who continued to have debilitating symptoms, were likely suffering from mental illness. “This has to change” says patient advocate Mary Shomon . “Practicing medicine is a lot more than just reading numbers off a chart. One thing we need to remind doctors is that we are patients — not lab values!” says Shomon. “When doctors put on blinders, and refuse to consider anything but the TSH test results, a patient is not receiving optimum care, and should think about finding a new practitioner for their thyroid care.”

    Mary Shomon is the nation’s leading thyroid patient advocate. She is author of 10 popular books on health, including New York Times best-selling “The Thyroid Diet: Manage Your Metabolism for Lasting Weight Loss,” “The Thyroid Hormone Breakthrough: Overcoming Sexual and Hormonal Problems at Every Age,” “Living Well With Hypothyroidism: What Your Doctor Doesn’t Tell You…That You Need to Know,” “Living Well With Graves’ Disease and Hyperthyroidism,” “Living Well With Autoimmune Disease,” and “Living Well With Chronic Fatigue Syndrome and Fibromyalgia.”