Who Is At Risk For Thyroid Cancer
About three times as many women get thyroid cancer as men. The number of women with thyroid cancer is also going up. By 2020, the number of women with thyroid cancer is expected to double, from 34,000 women to more than 70,000 women.
Thyroid cancer is more common in women who:
- Are between the ages of 25 and 65
- Had radiation therapy to the head or neck, especially in childhood, to treat cancer
- Have a history of
- Have a family history of thyroid cancer
Hypothyroidism And Hormone Replacement Therapy
Getting tested is especially important for menopausal women who decide to use hormone replacement therapy . This is because HRT can lower bioavailable T4. This means that if youre already on thyroid treatment, your dose may need to be increased, and if your free T4 levels have been normal, they may drop a bit for the first time.
Thyroid imbalances can increase your risk of:
- Cardiovascular disease
- Cognitive decline
- Bone loss
This happened with a patient of mine. She was newly menopausal and determined to stay young. Another doctor had started her on Premarin and Provera, but instead of feeling better, she felt worse. She was experiencing water retention, weight gain, depressed mood, and trouble concentrating. Because she was taking oral HRT and also had rheumatoid arthritis , I checked thyroid levels and thyroid antibodies. Not surprisingly, her TSH was mildly elevated, her free T4 was low, and she had elevated antibodies. I switched her to a more natural and topical form of HRT, and also started her on natural thyroid formula containing both T3 and T4. Over time, her thyroid and adrenal health improved through lifestyle modification, targeted nutrition, and herbs. Her thyroid dosage requirements also dropped over time.
Why Are T4 And T3 Levels Important
The function of the thyroid gland is to use, convert iodine into thyroid hormones:
Thyroxine andTriiodothyronine .
Thyroid cells are the only cells in the body which can absorb iodine. These cells combine iodine and the amino acid tyrosine to make T3 and T4. T3 and T4 are then released into the bloodstream and are transported throughout the body where they control metabolism .
The whole human well-being is depended on thyroid hormones.
The thyroid gland is the sole source of T4 and the source of only 10 to 20% of T3. The remaining 80 to 90% of T3 comes from the conversion of T4 to T3 by organs such as the liver, kidneys, brain, and skin. In other words, the body itself breaks down T4 to produce the amount of T3 it needs. When a patient begins to take levothyroxine, the level of T4 rises and becomes stable over a five-week period. From then on, the level of T4 in the blood changes very little after each pillthe level of T4 is slow to rise and slow to fall.
On the other hand, when a patient regularly takes T3, the level of T3 in the blood tends to rise and fall rapidly over a period of hours after each pill. In addition, since T3 is much more potent than T4, a patient may experience symptoms of hyperthyroidism for several hours after taking a substantial dose of T3.
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Are There Different Types Of Thyroid Removal Surgery
If your healthcare provider determines that your thyroid needs to be removed, there are a couple of ways that can be done. Your thyroid may need to be completely removed or just partially. This will depend on the severity of your condition. Also, if your thyroid is very big or has a lot of growths on it, that could prevent you from being eligible for some types of surgery.
The surgery to remove your thyroid is called a thyroidectomy. There are two main ways this surgery can be done:
- With an incision on the front of your neck.
- With an incision in your armpit.
The incision on the front of your neck is more of the traditional version of a thyroidectomy. It allows your surgeon to go straight in and remove the thyroid. In many cases, this might be your best option. You may need this approach if your thyroid is particularly big or has a lot of larger nodules.
Alternatively, there is a version of the thyroid removal surgery where your surgeon makes an incision in your armpit and then creates a tunnel to your thyroid. This tunnel is made with a special tool called an elevated retractor. It creates an opening that connects the incision in your armpit with your neck. The surgeon will use a robotic arm that will move through the tunnel to get to the thyroid. Once there, it can remove the thyroid back through the tunnel and out of the incision in your armpit.
- Are not at a healthy body weight.
- Have large thyroid nodules.
- Have a condition like thyroiditis or Gravess disease.
Understanding Reference Ranges During Pregnancy
When we talk about reference ranges it’s important that you understand what exactly they mean.
A reference range is created by local lab testing companies.
These numbers are supposed to represent the average numbers of all people in your local area.
The goal of these ranges is to include 95% of the population within the ranges provided.
This means that 2.5% of people tested fall below the reference range and 2.5% of people fall higher than the range provided.
This idea is very important, especially when it comes to pregnancy and TSH testing.
The reference ranges provided above based on trimester should only be used if your local lab company cannot calculate the TSH reference ranges for pregnant women who live local to you.
Put another way:
You should NOT be using generic reference ranges when it comes to your TSH level during pregnancy because the TSH level can vary based on geographic location, ethnicity , and other factors such as your weight and metabolism.
It’s better to CREATE reference ranges based on your location than to use the generic reference range provided above.
Unfortunately, not all lab tests do this for pregnant women because there simply isn’t enough information available.
It’s not always clear if a woman is pregnant early on which can skew the data one way or the other.
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Thyroxine Triiodothyronine And Tsh Levels
The main job of the thyroid gland is to make the hormone thyroxine, also known as T4 because it has four iodine molecules. The thyroid also makes the hormone triiodothyronine, known as T3 because it has three iodine molecules, but in smaller amounts, explains Cathy Doria-Medina, MD, an endocrinologist with HealthCare Partners Medical Group in Torrance, California. The thyroid gland makes mostly T4, the T4 has to be converted to T3, because T3 is the part of thyroxine that actually does the work, she says.
The pituitary gland at the base of the brain controls hormone production in your body. It makes thyroid-stimulating hormone , which tells the thyroid gland how much T4 and T3 to produce. The TSH level in your blood reveals how much T4 your pituitary gland is asking your thyroid gland to make. If your TSH levels are abnormally high, it could mean you have an underactive thyroid, or hypothyroidism. Thats because it indicates your pituitary gland is producing more TSH in an effort to stimulate your thyroid to produce thyroid hormone, according to the Mayo Clinic.
TSH levels go in the opposite direction of your thyroid hormone, Dr. Doria-Medina explains. If youre making too little thyroid hormone, your TSH will go up. If youre making too much thyroid hormone, your TSH will go down.
If your TSH is higher than 4.0 mU/L on repeat tests, you probably have hypothyroidism.
When Abnormal Thyroid Function Tests Are Not Due To Thyroid Disease
While blood tests to measure thyroid hormones and thyroid stimulating hormone are widely available, it is important to remember that no all tests are useful in all circumstances and many factors including medications, supplements, and non-thyroid medical conditions can affect thyroid test results. An endocrinologist can help you make sense of thyroid test results when there is a discrepancy between your results and how you feel. A good first step is often to repeat the test and ensure there are no medications that might interfere with the test results. Below are some common reasons for mismatch between thyroid tests and thyroid disease.
Non-thyroidal illness Significant illness, such as an infection, cancer, heart failure, or kidney disease, or recent recovery from an illness can cause changes transient changes in the TSH. Fasting or starvation can also cause a low TSH. An endocrinologist can help to interpret changes in thyroid function tests in these circumstances to distinguish non-thyroid illness from true thyroid dysfunction.
Test interference Biotin, a common supplement for hair and nail growth, interferes with many thyroid function tests and can lead to inaccurate results. Endocrinologists recommend stopping biotin supplements for 3 days before having a blood test for thyroid function.
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Before Taking Thyroid Supplements
Before starting any supplements for thyroid health, you first want to understand the type of thyroid dysfunction you have and the root cause. Is it autoimmune? Caused by a secondary condition such as cancer?
All of these factors can impact the type of supplements you want to take.
Also, consider getting a full thyroid panel from your doctor to be sure you actually have thyroid dysfunction.
Many people assume that trouble losing weight or feeling tired all the time indicates a thyroid problem. These symptoms can be caused by other conditions and should be diagnosed by a doctor before taking any supplements for treatment.
The ideal thyroid panel should include TSH, T4, T3, and Free T4. Many doctors only test TSH, which does not fully assess the health of your thyroid .
Once you have a complete picture of the health of your thyroid, you can then begin to look for supplements to help manage symptoms.
Always be sure to check with your doctor first before starting any supplements because they may interfere with prescribed treatment. Some supplements can impact how thyroid medications work, so you want to run anything by your doctor first.
Heres a quick look at the ones were about to go over in greater detail in this article.
Thyroid Medications During Pregnancy
If you have a high TSH then there are special changes that you must make once you know you are pregnant.
These changes include increasing your dose of thyroid medication immediately upon finding out or suspecting you are pregnant.
Because your child, especially during the early stages of development, is reliant upon your thyroid hormone until it can produce its own thyroid hormone.
During the first trimester, your child will be relying upon your thyroid gland for its thyroid hormone.
And, if you are taking thyroid medication your ability to produce thyroid hormone is limited.
This is why most doctors recommend that you increase your dose of thyroid medication anywhere from 20 to 50% .
In fact, this recommendation applies even if you miss or skip a period and suspect you might be pregnant.
The most critical time in development often occurs before you even know that you are pregnant.
Because of this, it’s very important that you pay attention to your body and try to find out if you are pregnant as early as possible.
But does that mean you can’t use other thyroid medications?
Not at all.
Instead of focusing on which medication you use, you should focus on your thyroid lab tests and how you are feeling.
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How Do I Know If My Thyroid Dose Is Correct
Monitoring thyroid levels on medication Correct dosing of thyroid hormone is usually assessed using the same tests for diagnosis of thyroid disease, including TSH and FT4. Thyroid tests are typically checked every 4-6 weeks initially and then every 6 to 12 months once stable. In special circumstances, such as pregnancy, a history of thyroid cancer, central hypothyroidism, amiodarone therapy, or use of combination T4 and T3 thyroid hormone replacement, your endocrinologist may check different thyroid tests. Additionally, your endocrinologist will evaluate for symptoms of hyperthyroidism and hypothyroidism and peform a physicial exam.
Women who are pregnant and women who may become pregnant should only be treated with levothyroxine . Only T4 efficiently crosses the placenta to provide thyroid hormone to the developing fetus. Thyroid hormone is critical in early pregnancy for brain development. Normal ranges for thyroid tests in pregnancy are different and change by trimester. Women with thyroid disease in pregnancy or who are considering pregnancy should be under the care of an endocrinologist to guide therapy.
Got Questions About Normal Thyroid Hormone Levels?
What Does It Mean When Your Tsh Is Low
Low levels typically indicates an overractive thyroid gland, which produces too much thyroid hormone. This is known medically as hyperthyroidism.
It can be caused by an autoimmune disease , goiter, excessive iodine in the body, or an overdose of synthetic thyroid hormone.
Initial hyperthyroidism treatment can involve antithyroid medications and radioactive iodine to slow down thyroid hormone production. Most respond well to hyperthyroidism medications and are treated successfully.
Summary: Low TSH levels for the average adult are less than 0.2 mIU/L. This reading typically indicates an overractive thyroid.
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How Are Thyroid Diseases Diagnosed
It can be hard to tell if you have a thyroid disease. The symptoms are the same as many other health problems. Your doctor may start by asking about your health history and if any of your family members has had thyroid disease. Your doctor may also give you a physical exam and check your neck for thyroid nodules.
Depending on your symptoms, your doctor may also do other tests, such as:
- Blood tests. Testing the level of thyroid stimulating hormone in your blood can help your doctor figure out if your thyroid is overactive or underactive. TSH tells your thyroid to make thyroid hormones. Depending on the results, your doctor might do another blood test to check levels of one or both thyroid hormones in your blood.
- Radioactive iodine uptake test. For this test, you swallow a liquid or capsule that holds a small dose of radioactive iodine . The radioiodine collects in your thyroid because your thyroid uses iodine to make thyroid hormone.
High levels of radioiodine mean that your thyroid makes too much of the thyroid hormone. Low levels mean that your thyroid does not make enough thyroid hormone.
What Are Thyroid Blood Tests And Why Are They Taken
Thyroid blood tests are used to tell if your thyroid gland is functioning properly by measuring the amount of thyroid hormones in your blood. They are done by withdrawing blood from a vein in your arm. These blood tests help to diagnose thyroid diseases.
The thyroid is a butterfly-shaped gland located in the front part of your neck. Its job is to produce thyroid hormones, which travel through your bloodstream and regulate many aspects of your bodys metabolism, including temperature, weight, and energy.
Thyroid blood tests show if you have:
- Hyperthyroidism: Overactive thyroid producing more thyroid hormones than your body needs. Hyperthyroidism speeds up your metabolism, which can cause weight loss, rapid heartbeat, insomnia, puffiness around the eyes, anxiety and other symptoms. The most common cause of hyperthyroidism is Graves disease.
- Hypothyroidism: Underactive thyroid producing too few thyroid hormones. Hypothyroidism slows down your metabolism, which can cause weight gain, menstrual irregularity, dry and puffy skin, fatigue and other symptoms. The most common cause of hypothyroidism is Hashimotos disease.
Thyroid blood tests are used to diagnose thyroid disorders associated with hyper- or hypothyroidism. These include:
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Supporting A Healthy Thyroid
Now that you have a basic overview of thyroid function, you may be wondering if there are ways to support your thyroid health in addition to medication. This is important because sometimes it can take a while before medication can correct hormone imbalance. In this case, the next best thing you can do is adjust your lifestyle habits.Managing stress: Because there is a relationship between your adrenal health and your thyroid health, its wise to get a hold on your stress levels. When you are chronically stressed, adrenal fatigue an overtaxing of the adrenal system may kick in, triggering your body to release hormones as a way of coping. This chronic stress can worsen thyroid issues, leading to imbalanced hormone levels. Chronically stressed? You might notice slowed metabolism and weight gain and stress may even further lower your levels of T3 and T4. It can also affect the conversion of T4 into T3.For this reason, its key to find a regular stress management ritual. This might be a daily yoga, meditation, or journaling break in which you disconnect from all distractions and stressors and simply focus on your breath and your emotional well-being. Regular nature walks also referred to as earthing or forest bathing have been proven to provide stress reduction on a physiological level as well.