Do Thyroid Problems Always Have To Be Treated?

Diagnosis of thyroid disease often leads to drastic treatments that have life-long effects. People who are diagnosed with overactive thyroid, with conditions such as Grave's disease, are usually treated with radioactive iodine. This destroys overactive thyroid tissue, but it increases lifetime risk of developing thyroid cancer (especially when the radioactive isotopes are given to children), and it can aggravate a complication of hyperthyroidism called exophthalmia (bulging eyes).

But the hormone in thyroid hormone replacement therapy is not the form of the hormone that the body actually uses, and many people continue to have symptoms, or re-develop symptoms, even when the doctor has done everything possible.

Everything, that is, except watchful waiting.

A Doctor Who Didn't Prescribe Radioactive Iodine

A physician herself, Nina (not her real name) was diagnosed with Grave's disease. She expected her endocrinologist to recommend that she take the radioactive iodine cocktail to burn out her thyroid and then a few months later go on thyroid replacement hormone for life. Nina's doctor, however, had another idea.

Since Grave's disease is an autoimmune condition, and the symptoms autoimmune diseases tend to wax and wane over time, Nina's endocrinologist suggested that they simply wait a few months to see if the thyroid would not correct itself. Six months later, without any treatment at all, Nina's overactive thyroid symptoms had disappeared. Although Nina continues to have annual checkups 20 years later, Nina's Graves disease healed itself and has never come back.

A Doctor Who Told Her Patient "Eat Something, Already"

Dylan was a fitness fanatic, and almost compulsive about integrating the practice of intermittent fasting (eating no food at all for two 24-hour periods each week, although he did drink water during his fasts). Dylan started feeling run down, so he went to his doctor. The labs came back and showed clearly deficient thyroid hormone.

Dylan's doctor prescribed thyroid replacement therapy, but for only three months. After Dylan completed this initial prescription, the doctor suggested that Dylan try cutting back on his fasts just to see if that was what his thyroid really needed. "Eat something, already," the doctor said.

Sure enough, when Dylan stopped intermittent fasting, his thyroid hormone levels returned to normal, and to Dylan's surprise, he started building muscle again without packing on fat. Now three years later, Dylan's thyroid hormone levels continue to be normal.

Five Questions to Ask Your Doctor If You Are Diagnosed with Thyroid Disease

If you think you have either hyperthyroidism or hypothyroidism, you need to see a doctor. Thyroid problems are not conditions you can treat on your own, and it's important to test, not guess, as thyroid expert Dr. Keith Ungar likes to say. Don't rely on just how you feel to measure your progress. Work out your treatment plan with your doctor.

Are you sure it's really a thyroid problem?

Both hypothyroidism and hyperthyroidism can be symptoms of other conditions. Hypothyroidism symptoms are not unusual in people who suffer sleep apnea, although it is the lack of sleep that is the problem. Chronic fatigue syndrome, mononucleosis, and systemic autoimmune diseases, as well as under-nutrition (as in Dylan's case), can result in the grinding fatigue, sluggishness, and weight gain that often gets people in to see their doctors.

Rarely, hyperthyroidism is caused by a tumor in the pituitary gland. In women, hyperthyroidism can be a complication of polycystic ovarian syndrome (PCOS). The condition can also occur during pregnancy, along with morning sickness. Users of cocaine sometimes develop short-term hyperthyroidism symptoms, and chronic anxiety, with disturbances in adrenal hormones, can cause temporary fluctuations in thyroid hormone. 

Are you measuring both T3 and T4? If you aren't, why not?

The thyroid makes large amounts of an inactive, storage form of thyroid hormone called T4. This hormone is converted a small amount at a time into the active form of thyroid hormone known as T3. In some people, the thyroid makes large amounts of T4, but isn't able to convert it into T3. In people who take natural thyroid hormone replacement, such as Armour Thyroid, their bodies are getting T3 from the medication so the thyroid quits making T4.

Don't worry about remembering the difference. Get your doctor to explain it to you. But if your doctor can't or won't explain T3 vs T4 measurements to you, it may be a good idea to see a different doctor.

Have you run tests for both anti-TPO (thyroid peroxidase) and anti-thyroglobulin antibodies?

Sometimes the underlying problem in a thyroid condition is an attack on the thyroid by the immune system. Sometimes doctors run dozens of lab tests without ever testing for the anti-TPO and anti-thyroglobulin antibodies that would indicate the problem is an overactive immune system rather than a fundamentally sick thyroid, which requires a different kind of treatment.

Have you ruled out euthyroid sick syndrome?

In euthyroid sick syndrome, the thyroid is healthy but some other organ is not, so the thyroid shuts down the production of thyroid hormone to conserve energy while that organ heals. The diagnosis of euthyroid sick syndrome requires more of the doctor's clinical experience than any particular lab test, but it is also a good indication that watchful waiting could be a good idea.

Is it possible I have subclinical hypothyroidism?

Sometimes thyroid hormone levels aren't high or low enough to diagnose disease, but you still feel lousy anyway. Your doctor won't give you thyroid hormone replacement therapy, but you may get guidance on appropriate nutritional supplementation to correct deficiencies in copper, zinc, and selenium (megadoses aren't necessary) and ongoing followup until you feel good again.