In the last lecture I talked about Subclinical Hypothyroidism or SCH. And I told you that in my opinion, and that of many other doctors, there is no such thing. If you have high TSH then your thyroid is low and you need treatment.
Today I am going to talk about some thyroid diseases and conditions that do not cause low thyroid by themselves, but their treatment can and often does.
I will talk about goiter, Grave’s disease, thyroiditis, thyroid nodules, hyperthyroidism and thyroid cancer.
By far the most common thyroid problem is hypothyroidism, low thyroid. Well over 30 million people (mostly women) are diagnosed with it and at least as many also have it but are not diagnosed. Medications for hypothyroidism are in the top 5 most prescribed drugs. We have discussed low thyroid in some details, so now let’s talk about other thyroid conditions that can lead to hypothyroidism.
Goiter is a visible swelling of the thyroid; you can see it with a naked eye. There is a bulging where none should be because normal thyroid is tiny, you cannot see it or feel it. Many thyroid conditions can cause goiter. Some also produce protruding and bulging eyes, like Grave’s disease.
Thyroid nodules are very common, especially as we get older or, as I like to say, more mature. Women are 3-4 time more likely to have them. Thyroid nodules are like age spots on the skin. About 60-70% of people have thyroid nodules. Some are very small, so you can’t feel them. Some are large enough to feel. Some nodules become so big that they can interfere with breathing or swallowing, but that’s very rare. The vast majority of nodules are small, not visible, you can’t feel them and they are only visitable on a sonogram.
Most nodule are what we call “cold”, they do not produce any hormones. Some nodules are “hot”, they do produce thyroid hormones and can even cause hyperthyroidism. We do not know what causes nodules, just like we don’t know what causes age spots.
About 95% of nodules are benign. The rest could be cancerous. Any nodule larger than 1-2 cm should be suspected to be cancerous. We monitor nodules with sonograms and sometimes with fine needle biopsy to check if the cells inside are benign. Of course, what’s benign today may become malignant later on, so we keep an eye on these nodules and monitor them for any changes. If they should become malignant, we treat them like any other thyroid cancer.
Another thyroid problem is thyroiditis. The ending “itis” usually means inflammation, like arthritis, colitis, conjunctivitis. Thyroiditis is an inflammation of thyroid gland. For example, Hashimoto’s thyroiditis is an inflammation of thyroid caused by the overactive immune system, which causes hypothyroidism. But in other kinds of thyroid inflammation, there is an excess of thyroid hormones, which are stored in the thyroid gland and can be released in large amounts. There are many preformed thyroid hormones stored in the thyroid gland. An inflammation causes all these hormones to be released all at once which can create hyperthyroidism.
Thyroiditis can be caused by many things. Sometimes it happens for no apparent reason, and it’s called spontaneous thyroiditis. It can be caused by a viral infection, like a flu, then it is called subacute thyroiditis. Postpartum thyroiditis happens in a woman after she gives birth. Infectious thyroiditis is caused by a bacterial or fungal infection. All the forms of thyroiditis (except Hashimoto’s) start by releasing too much thyroid hormone, creating hyperthyroidism, and eventually the gland becomes underactive, ending up with low thyroid.
Another potential cause of hypothyroidism is, paradoxically, hyperthyroidism or overactive thyroid.
The most common cause of hyperthyroidism is Grave’s disease, also an autoimmune condition. It is responsible for about 60-80% of all hyperthyroid cases. Graves, like Hashimoto’s, is not a thyroid disease. It is caused by your immune system, which makes antibodies that look and act like TSH, thyroid stimulating hormone. As you know, TSH stimulates the thyroid gland into producing and releasing more thyroid hormones into the blood. So having too much TSH-like substance will cause the thyroid gland to overproduce thyroid hormones.
Thyroid nodules can produce thyroid hormones. This kind of nodule is called “hot” and can cause hyperthyroidism. Sometimes a person has many such nodules. This condition is called toxic multinodular goiter and accounts for 10-15% of hyperthyroidism.
Hyperthyroidism can happen in pregnant women. It’s called gestational hyperthyroidism.
Depending on the severity, hyperthyroidism is treated with medications that control the symptoms or medications that reduce the production of thyroid hormones. This does not work in some people, in which case their thyroid is removed, completely or partially. This can be done surgically or with radiation. In either case, the result is low thyroid or hypothyroidism.
Thyroid cancer is fairly rare, in 2023 there were about 40,000 cases. Most cancers happen in women 40 to 60 years old, but men and young people of both sexes can get it.
Most thyroid cancers are not aggressive and are easily treatable. They usually grow slowly, do not spread, and have a good cure rate. 5-year survival is about 99.9%. There are certain forms of thyroid cancer that are aggressive and spread quickly, but they are very rare.
Thyroid cancer sometimes has no symptoms and is discovered on routine examination. Sometimes it may feel like a lump or swelling on the neck, causing pain, hoarseness, difficulty swallowing.
Treatment usually involves removal of the thyroid gland, either surgically or with radioactive iodine. Sometimes external radiation is used. The prognosis is usually quite good, and the rate of cure is very high. But the result of this treatment is hypothyroidism.
Most cases of thyroiditis turn into hypothyroidism and need to be treated, but in some cases thyroid function can be restored with diet and supplements, so patients no longer need medications. But they need to be monitored because hypothyroidism eventually returns.
But if part or all of the thyroid gland is removed, it results in permanent hypothyroidism, so the person needs to be treated for life.
I want to emphasize that this was a very superficial discussion of thyroiditis, thyroid nodules, hyperthyroidism and thyroid cancer. The purpose of this discussion was to show that other thyroid conditions can lead to low thyroid, even though they don’t start this way.
If you know someone who might be interested in low thyroid, please refer them to LowThyroidDoctor.com so they can download this ebook. Also, if you have questions or comments, please email to DrTeplisky@gmail.com.
As an additional bonus, while available, you can get a free, no obligation 30 min phone consultation with me to see if I can help you figure out if you have low thyroid and what I can do to help you. Just book it online or call my office at 718-769-0997.