Is Your Immune System to Blame for Your Sluggish Thyroid?
A friend of mine turned 40 years old a couple months ago. During a recent standard physical, her doctor discovered two lumps in her neck, on either side of the thyroid. My friend was scheduled for an immediate biopsy.
She was understandably nervous. The term “biopsy” often seems to go with the word “cancer,” and even though an estimated 95 percent of thyroid nodules are benign, the risk stands out when it’s you that’s going through the test.
About a week later, the results were in, and my friend got good news: the nodules were not cancerous. Unfortunately, that didn’t make everything okay again. She still has lumps on her thyroid, and was diagnosed with “hypothyroidism,” a condition in which the thyroid doesn’t work as well as it should. She got a prescription for medication, and started taking it.
A few weeks down the road, though, not much had changed. The medications didn’t seem to be helping, and she had to admit that she still felt sort of “off.” When I asked if her doctor had discussed the issue further with her, she shook her head; not really.
Unfortunately, many women end up in the same boat. Estimates are that thyroid nodules are fairly common, affecting about half of the population, with women at a significantly higher risk than men. When talking about hypothyroidism, like my friend has, women are 8-10 times more commonly diagnosed.
But just what does a diagnosis mean? Are medications required? And what if they don’t really help? Should women be making other lifestyle changes to adjust to the condition? We answer these questions and more.
What is Hypothyroidism?
Hypothyroidism is a condition in which the thyroid isn’t as active as it should be. There can be a few reasons for this, but the main issue is that the gland isn’t doing its job.
The thyroid is a small, butterfly-shaped organ located in the base of the neck, toward the front of the windpipe and below the Adam’s apple. One side is connected to the voice box muscles, and nerves important for voice quality also pass through the thyroid. You can’t feel the gland, however, unless it’s enlarged. At its normal size, it’s impossible to see with the naked eye.
The main thing the thyroid is supposed to do is release hormones, especially hormones called triiodothyronine (T3) and thyroxine (T4). These hormones are responsible for how the body uses energy. They control metabolism and regulate a number of bodily functions, including heart rate, body temperature, growth, weight, menstrual cycles, and more.
When the thyroid no longer produces enough of these hormones, as occurs with hypothyroidism, a number of functions slow down. The following symptoms may occur:
- Intolerance to the cold
- Weight gain
- Joint and muscle pain
- Dry skin
- Heavy periods
- Slowed heart rate
- Thin, brittle hair and nails
- High cholesterol
- Puffy face, feet, and hands
What Causes Hypothyroidism?
This is often the first question on a woman’s mind: Why did I get this?
There are several things that can cause hypothyroidism. The most common is an autoimmune disease known as “Hashimoto’s thyroiditis.” Autoimmune diseases occur when the body’s own immune system malfunctions and attacks the body rather than protecting it. In Hashimoto’s thyroiditis, the immune system attacks the thyroid, causing inflammation and swelling and sometimes, nodules or small growths.
Doctors aren’t sure why Hashimoto’s shows up. A viral or bacterial infection may be to blame, or it could be genetics. If someone in your family had Hashimoto’s, for example, you are more likely to develop it, too.
Hormones may also play a factor. Hashimoto’s affects about seven times as many women as men, with symptoms sometimes showing up initially during the first year after the birth of a baby. They may then go away for awhile, but return years down the road.
Other potential causes of hypothyroidism include:
- Other types of autoimmune disease: Other types of autoimmune diseases like multiple sclerosis, rheumatoid arthritis, celiac disease, or type 1 diabetes can increase risk of Hashimoto’s. If you have one of these diseases, your immune function is already malfunctioning, and may start to affect your thyroid, too.
- Thyroid surgery: If you had part of your thyroid removed, that can slow down or even halt hormone production.
- Radiation therapy: If you went through some type of cancer in the neck or head and had to undergo radiation therapy in that area, some of that radiation may have affected the thyroid, causing hypothyroidism.
- Medications: Several medications have been linked with a higher risk of hypothyroidism, including lithium (used to treat psychiatric disorders), glucocorticoids (anti-inflammatory drugs), dopamine, somatostatin drugs (used to treat some types of cancers), rexinoids (used to treat cancer), some heart medications, and some antiepileptic drugs.
- Hyperthyroidism treatments: If the thyroid produces too little hormone, it’s called “hypothyroidism,” which is what we’re talking about in this article. But if it produces too much, it’s called “hyperthyroidism.” Treatment for this condition often includes medications that reduce thyroid function. Sometimes, these drugs can slow the thyroid too much, causing hypothyroidism.
Less common causes of hypothyroidism include:
- Congenital disease: If you were born with a defective thyroid gland, you may suffer from hypothyroidism.
- Pituitary disorder: The pituitary gland is a tiny organ at the base of the brain that is the “master gland” of the body. It tells the thyroid when to produce more hormones. If something is wrong with this gland, it may cause thyroid problems. This is a rare cause, however.
- Pregnancy: Some women may develop hypothyroidism during or after pregnancy, and then have it go away after birth, only to return down the road.
- Iodine deficiency: Iodine is a mineral critical for the production of thyroid hormones. That means if you’re not getting enough, the thyroid may slow down. This is extremely rare in the U.S., however, because iodine exists in table salt, and most of us get plenty of salt in our diets every day. Iodine is also present in shellfish, eggs, and dairy products, so it’s highly unlikely you need to take iodine supplements. Too much iodine can actually make your thyroid problem worse.
Should You Take Medication for Hypothyroidism?
A doctor can easily diagnose hypothyroidism through a blood test that checks for levels of thyroid hormones. If the levels are lower than normal, you will likely receive a diagnosis. The doctor will also look at levels of thyroid stimulating hormone (TSH), the hormone that signals the thyroid to produce more. If levels of this hormone are high, the body is trying to correct the problem, and it’s likely thyroid production is falling behind.
Once you’re diagnosed, your doctor may conduct additional tests to try to determine the cause. A complete thyroid panel can help create a picture of the overall health of the thyroid, but they are unlikely to show any smoking gun. Determining the cause is not an exact science, and often requires looking at blood tests, symptoms, lifestyle, and more.
A thorough blood test can reveal whether you have Hashimoto’s, though. The antibody part of the test will show whether or not the immune system is producing abnormal antibodies, which could indicate the presence of the autoimmune disease. In most cases, your doctor can help you determine whether this is the cause of your reduced thyroid function.
Regardless of the cause, however, the treatment is often the same: hormone replacement. In essence, you take a man-made thyroid hormone in a pill every day. The pills vary in their dosages, and your doctor will determine the best dose for you based on factors like the severity of the hypothyroidism, your age, weight, and any other health issues. Your doctor will likely watch your progress and take additional blood tests to be sure you’re on the right dose.
The key to this treatment is patience. It can take months for your symptoms to start to subside and for any enlargements in the thyroid to diminish. Thyroid hormones are slow-acting, so it takes awhile to notice any differences.
It’s also important to talk to your doctor about any other medications or supplements you may be taking. Some can interfere with your body’s absorption of the hormone, including calcium supplements, iron supplements, and aluminum hydroxide (found in some antacids). High intakes of soy foods or cruciferous vegetables can also affect absorption. (Regular intakes cause little effect.)
Usually your best approach is to take the pill in the morning and then wait at least 30 minutes before eating, drinking, or taking other medications or supplements. Talk with your doctor or pharmacist for more information.
Other Ways Women Can Help Themselves Feel Better
One of the question many women have after being diagnosed and starting medication is: Am I stuck with this for life?
First, make sure your doctor tests you for Hashimoto’s thyroiditis. Some don’t, because the treatment for hypothyroidism is the same either way, but it’s best if you know whether or not you have it. One autoimmune disease may lead to another, and you want to be aware so you can watch out for any complications down the road. Most doctors believe that Hashimoto’s, particularly, will not go away because autoimmune conditions usually don’t. You can, however, make changes to help yourself feel better, and to slow any progression of the condition.
If the cause is not Hashimoto’s, a more thorough investigation of your medical history, family history, and lifestyle may help you to create a clearer picture of your unique case. Either way, you can make lifestyle changes that will help you to recover more completely.
The main goal of your treatment should be to feel better. Your doctor will be watching out for your thyroid hormone levels, and once those are normalized, will claim success. You, however, need to be more concerned with how you feel, and how healthy and energetic you are as a whole.
To that end, here are some more recommendations for you:
- Consider selenium supplements: Selenium is a key component in the body’s ability to use thyroid hormones. If you’re not getting enough, it can cause hypothyroid symptoms. A number of promising research studies have suggested that selenium supplements at a dosage of about 200 mcg/day can be effective, specifically in Hashimoto’s disease, as they may help lower thyroid antibody levels. Talk it over with your doctor.
- Get more zinc: Zinc is another mineral critical to stimulating thyroid hormone production, and we have some evidence that many of us may not be getting enough. The Oregon State University states that in the U.S., about 12 percent of the population is at risk of zinc deficiency, with as many as 40 percent of the elderly. They add that these estimates may be low because accurate tests still don’t exist. If you are vegetarian or vegan, you are more at risk for not getting enough. Eat more oysters, beef, crab, pork, and chicken, milk, and yogurt. Consider supplements on occasion, particularly when you feel you need an immune boost, such as during cold and flu season.
- Consider vitamin B supplements: Vitamin B helps regulate energy release, so if you’re feeling fatigued or lethargic, a vitamin B supplement may help until you’re feeling better again. A number of things can deplete your body of vitamin B, including caffeine, stress, and other medications like diuretics, antibiotics, and birth control pills. In addition to supplements, eat more fish, poultry, meat, eggs, and dairy.
- Manage your stress: Stress can weaken the immune system and make it more difficult for your body to use the thyroid hormone. Try to build a stress-relieving activity into each day. Exercise, yoga, tai chi, long walks, pet therapy, and meditation are all good options. The important thing is to do something every day that helps you feel calm and relaxed.
- Eat a high-fiber diet: Hypothyroidism often causes constipation, so a high-fiber diet will help. Besides, it’s just good for you in general, and can help reduce your risk of heart disease and other health problems. Eat more fruits and veggies, beans, sweet potatoes, artichokes, bran flakes, and oatmeal.
- Exercise regularly: Because a low-functioning thyroid leads to weight gain and lethargy, you need exercise even more than the normal person. Exercise helps you maintain a healthy weight, and gives you energy. Start out slow, with a daily walk or jog, and then gradually increase your time so you’re exercising at least an hour every day.
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