Symptom Management: Goiters

Introduction 

Hey! Welcome back to the Thyroidcafe. Goiter. GOI-tur. It just sounds gross. When I had one, I freaked out. But there’s more to this word than its goopy sound. Goiters come in four forms and can be non-issues. But what causes goiters and how do we treat them? More importantly, when should we be concerned? Today on the blog, we address a common issue for those with all types of thyroid disease, goiters. 

So what is it?

Goiters are an enlarged thyroid gland and there are four different types. When the whole thyroid swells to form an obese butterfly, you have a Diffuse-Smooth goiter. If you have many “Lovely lady humps” all over your thyroid, it’s called Multinodular and if your goiter is hiding behind your breastbone, it’s a Retrosternal goiter. The most common form, and what I had, is a nodule. It’s just one random bump on your thyroid. 

And what causes goiters?

Ugh. You know the number one cause… thyroid disease. But there are other factors. The main one is too much, or too little, iodine. In most countries, salt contains added iodine. So if you’re like me, it’s not too little iodine. But it could be the Costco sized bag of salty chips I frequently devour. But aaanyways. Other causes are smoking, changes in hormones, lithium in some medications and radiation treatment. In my experience, stress causes goiters as well. 

Okay, okay. So how do we treat it?

For seventy years, doctors have known that thyroid replacement therapy reduces the size of goiters. So if you are having goiters, it’s a good time for your doctor to check your TSH, T3, and T4 levels.  In fact, ⅔ of all goiters reduce in size or eliminated by hormone treatment. Even if the goiter remains, we simply monitor them, unless they are accompanied by other symptoms, such as difficulty breathing or pain. 

When my goiter was treated, the doctor simple felt my neck. Then I went for an ultrasound and a needle biopsy. While “needle” makes it sound cringey, it was simple and pain free. After they studied the sample, there was no follow up needed. 

The “C word”

Only 13.7% of goiters  operated on are cancerous. While symptoms of thyroid cancer are very similar to goiters, (tight throat, voice changes etc.) there are some differences. If the soreness in the throat doesn’t change and you have difficulty breathing, or there is pain in your neck, your goiter may be more serious and needs to be looked at by a doctor. Even if it’s cancer, the five year survival rate for thyroid cancer is 98%.  So while it’s serious, there are treatment options.

Conclusion

While goiters can seem scary, they are like most things, the more you know the less you fear. I take comfort in knowing that goiters are a normal part of thyroid disease and very much treatable. If we make small lifestyle changes, we can prevent goiters from forming. Even if you’re like me, and have a propensity for chips, you can rest assured knowing goiters are probably nothing to worry about. I’m thankful that they are treatable part of this complex disease. 

Symptom Management: Muscle Weakness

Introduction

Hey, welcome back to the Thyroidcafe. I had no idea muscle weakness, myopathy, affects 79% of thyroid patients – that’s a ton of people! I’m thankful we live in a time and place in which it’s treatable, though I have my skepticism. However you may want to start treatment before I did. But don’t worry, I made it out alive.

Repelling and Hair untamed 

Contrary to the meek stereotypes of being female, and a christian, I used to love adventure sports. In the summer of 2005, I set out on my Australian outdoor adventure. After a half day hiking, we came to the twenty-five foot falls. I confidently backed off the cliff.  I didn’t know Hashimoto’s disease was stealing my strength. Weak hands shaking. Hoping to hold on as the rope slowly slipped through my hands. I made it. And brushed off my weakness, though I never repelled again. Weakness in my hands was a subtle sign of thyroid disease taking hold of my body. Myopathy can progress, making everyday events such as stairs and doing your hair difficult. It can even be life threatening if not treated. But I think I’ll just use it as an excuse for my untamed tresses. 


The science behind it

Muscle weakness is a vague symptom of thyroid disease. It can be caused by Hypothyroid Myopathy or anemia. All thyroid diseases can cause muscle weakness, aches and cramping. It is typically centralized, in your thighs and shoulders. You may need to bring it up with your doctor, as myopathy can be overlooked or confused with fatigue. Rarely, other complications arise.  As with most thyroid symptoms, we don’t know why thyroid disease causes muscle issues. 

How to not fall down a twenty-five foot waterfall

From the studies I read, myopathy is treated by addressing the thyroid disease with medication. However, T4 levels seem to be affected, so dessicate thyroid pills are the best option. Even on the correct medication, at the appropriate dosage, treatment can take up to a year to take effect. Thyroid disease makes healing into a marathon sport! Along with your pills, physical activity is recommended. However, if you suspect your muscle weakness is due to anemia, a simple iron supplement will have you Hulking in no time. 

Conclusion 

I am always skeptical when thyroid medication is seen as a comprehensive treatment for thyroid symptoms, they seem to linger. Iron pills and optimizing my dosage has lessened my muscle weakness to a liveable level. However, I don’t see anymore waterfalls in my future. 

Symptom Management: Restless Leg Syndrome

Introduction 

Hey, welcome back to the Thyroidcafe – we are discussing Restless Leg Syndrome (RLS) this week, so maybe I’ll switch to decaf for this blog? For years I suffered every night. Fighting the urge to move my legs, though I didn’t give it much thought. After ignoring this symptom, I finally did my research. The many solutions and even prescriptions available were a pleasant surprise.

My experience and symptoms 

I lay in my exhaustion. I self-medicated thyroid disease with a dozen cups of coffee, yet my eyes screamed for sleep. Yet my legs marched on. I would rub them together until wounds wore on my feet. Occurring at night or lying down, my symptoms were by the book. RLS is defined as restlessness only revived by moving your legs.  It is common in those with chronic illnesses and those with a genetic predisposition to it. So my legs wiggled with the energy I’d wished to contain for the next day. 

At Home Solutions 

After asking my online friends for at home solutions and doing my research, the response overwhelmed me. Happily, there are many solutions to RLS. Vitamin D, Iron and Magnesium are the most common dietary solutions to RLS. Magnesium can be taken as a pill or rubbed in. For me, this was the solution to RLS. The ever taxing Epsom salt bath is another popular solution and one of my favorites. I also take CBD oil. It calms both mental and physical restlessness.  If your legs are still defiant, massage and stretching may calm them, along with exercise. I had to laugh at the suggestion that RLS could be solved by getting more sleep, hello vicious cycle. Lastly, the Relaxis pad and weighted blankets were recommended. I haven’t tried either, but would love to know if they work. 


This product was recommended by fellow thyroid warrior, though I haven’t tried it myself.

More than an apple a day: Help from the Doctor 

Despite my foolish pride and overly ambitious online endeavors, one must seek help when needed. From a less invasive perspective, chiropractic care can provide relief. I fear recommending medication because of the side effects. However Ropinirole is commonly and effectively used. Ask your doctor for help if at-home remedies are not working for you. 

Conclusion: 

There are active solutions to our active legs. Through at-home and medical intervention, RLS can be one of the most manageable thyroid symptoms. For me, vitamin supplements and Epsom salt baths were the solutions. A few pills in the morning and a relaxing bath is the kind of symptom management I can handle. 

Symptom Management: Weight

Introduction

Hey, welcome back to the Thyroidcafe. You’ve heard it. A million times. “Diet and exercise would help you lose weight.” But what if there’s more? Holding to this advice alone can leave you frustrated and dejected. But know for thyroid warriors, weight issues is more dynamic than that. We are not crazy or lazy. We are working double time towards a healthier body. Fortunately, weight can be regulated, even with our disease, but it’s a fight. 

Round One: Meds

You’re cruising the highway. The wind blows and the scenery flies by you. But you slow. You push the pedal down, but sputter to a stop. A little orange light glares and you know, you’re going nowhere without gas. Expecting weight loss without getting your thyroid hormones optimal, is as effective as running a car without gas. Because thyroid hormone regulates weight, no amount of diet and exercise can compensate for uncontrolled hormone levels. So medication optimization is first on my list for a reason; it’s the cornerstone to weight loss. 

Round Two: Listening 

A yawn is not a silent scream for coffee, as much as I hate to admit it. It’s your body asking for a need, sleep. Listening to your body isn’t some mystical concept. It’s giving weight (pun intended) to your body’s basic needs. Tracking my diet is one way I learned to listed to my body’s needs. (See “Round Three” below for common problem foods.)  Second, and to my great pleasure, listen to stress levels. When we’re stressed, our bodies increase cortisol levels, which lowers thyroid levels, causing us to gain weight. This is part of the reason extreme calorie restrictions don’t work for thyroid patients. Our bodies are already taxed, adding the stress of excessive calorie restrictions doesn’t help. And if you’re like me, stress leads to gobbling cookies like Shaggy and Scooby. So soak in that bath. See that old friend. Walk in that park. There are many needs we can be attentive to, such as thirst, indigestion, sensitivity to cold, etc. study your body, to understand its needs.

Round Three: Food and water

While “don’t eat fast food or binge drink soda” remains universally good advice, there’s more to diet for thyroid warriors. For us, food can cause weight gain through inflammation. After having kids, I was puffy Marshmallow Meghan. Pictures made me shutter until I read about inflammation. The table below outlines some foods that commonly cause inflammation. I would recommend removing as many as reasonable from your diet, then adding them back in, one at a time. I allowed a few weeks between introductions, to mark how they affected me.  I post a lot of my meals on our Instagram account. They are all easy, family meals.

Foods that cause me inflammationFoods I eat like Augustus Gloop in Willy Wonka
Refined carbs, ie: “white” bread, rice etc  Sugar, Has many listed names, Trans fats, Gluten, dairy, Processed meats oils, alcoholWhole, high healthy fat, plant based proteins, fish, gluten-free food,  fruit and veggies

Another helpful tip for weight loss is to drink plenty of water. No only does this keep the body happily hydrated, it fills the stomach. Diet is a broad topic, which I hope to chat about again at the Thyroidcafe. 

Round Four: Exercise 

I subconsciously took a deep breath before writing this. If you struggle with weight caused by thyroid disease, it is likely your thyroid hormone is on the lower side. If so, you may feel exhausted by the normal events of life. I don’t want to apply undue pressure to people already suffering. Regarding exercise, do what you can, when you can. Gentle exercise, such as walking, swimming and biking are a place to start, once you feel healthy enough to do so. 

Conclusion 

I desperately want to take the burden of this disease from my fellow sufferers. The exhaustion, depression, sensitivity to cold – all of it. But the worst for me was the preconceived notions of others. Maybe it was my age, but I spent years crushed by worry that others would think I was “just lazy and fat.” But ten years on, this previously “lazy, fat” woman just wants to be healthy. I wish we could change the narrative from weight loss, to healthy weight. Because excess weight is a symptom of a larger medical issue. Prescription optimization, diet, and exercise will help you lose weight. But the bigger reward is gaining back our health. 

Sources

Symptom Management: Pain

Introduction

Hey, welcome back to the Thyroidcafe. It’s 2012. 9:00 pm and I’m in bed. Twisting and rubbing my neck, and shoulders. Attempting to silence snarling muscles. My elbows and knees soon join the cacophony, so I give up and hobble to the kitchen for pain meds. My grandmother and I walk the same way, I’m sixty years her junior. What was I to do? In those days, I popped Tylenol like a desperate starving animal. I had to find a better treatment option. 

The cause of thyroid pain

Thyroiditis could be the cause of your pain. If the front of your neck, jaw or face hurt, a doctor should be seen. Other auto-immune diseases may also be a cause of your pain. For example, arthritis is more likely in thyroid patience than the general population. Thirdly, under treated hypothyroidism is a common cause of joint and muscle pain. But what about this sporadic, systemic dull ache? Diet is the cause I have found through support groups, and personal experience. Dairy was the cause of my pain, but each person must do her own detective work. 

How to treat it 

The simple answer: you can take Neo’s red pill (Tylenol) and go down the rabbit hole of masking your soreness and avoiding the problem. But my pain persisted and I needed an explanation. Around that time, I read about the AIP diet. As I was stumbling and slurping through the diet, I noticed my body pain left. After reintroducing dairy, my pain returned. I am not recommending we put cows permanently out to pasture, but rather that each of us tries an elimination diet, to see what helps.

If you’re having other low thyroid symptoms or your pain is accompanied by swelling of your joints, it’s best to consult a physician and rule out other causes. Keep in mind, even if your blood test comes back in the normal range, it may not be optimal. Discuss your symptoms with your doctor and work towards optimization. As always, I recommend being your own Thyroid advocate.

Conclusion

Because thyroid disease has multiple manifestations, I am doing a series on Symptom Management.  Joint and muscle pain can have many causes and it may take time and detective work to find the root cause of your pain, but there are solutions. So now, after dietary changes, I can sit in bed at 9:00 pm and binge watch Netflix like a normal semi-adult. No Tylenol needed. 

“Womans world” and Thyroid Rescue

Introduction

Hi, welcome back to the Thyroidcafe. I wanted to review a  “Woman’s world” article today.  Many in the thyroid community find these articles frustrating. I have read they are misleading and harmful to those who have thyroid disease, so I thought I would look for myself. Amist recipes of bright berry cobbler and Meringue cake, is a two page spread, declaring “Thyroid rescue!” It promises to “reactivate your thyroid to melt thirty pounds in thirty days.” I was cautiously curious.

The Good 

A bold red banner declares “Thyroid Rescue” on July’s front cover, putting our disease literally front and center. At 600,000 copies sold a month, I’m thankful to raise awareness about thyroid disease. Inside the article, it “encourages everyone” to try eliminating sugar and gluten from their diet. It’s great to make the dangers of processed foods known. Giving further hope, the author highlights the importance of diet for thyroid patients by giving the testimony of thyroid warrior who gained health and lost weight on her diet. Excellent! To the right of her picture is a small paragraph. It is the only place in which they outline actual thyroid symptoms and advice. 

The Bad 

While the dietary advice is sound, the article isn’t about thyroid disease. It misleads people into thinking diet either causes or cures thyroid disease. The reader may think those who gain weight because of their thyroid disease can loose weight by changing their diet alone. This is not entirely true. For more information, click here. While diet plays a role in thyroid disease; I hate to think of people judging others based on this articles misinformation. 

The Ugly

What was great about this article, is crammed into the bottom corner. Symptoms are a one sentence synopsis, and medical treatments are an afterthought. If the article is about “Thyroid Rescue,” it’s pertinent to explain the disease and other treatments available. This would be of use to us fighting the disease and to promote understanding and sympathy.  The article places too much focus on one symptom, weight gain. Simplifying symptoms to a weight issue, misleads the reader to play on common insecurities of women. This disease has a dynamic and fundamental effect on its sufferers and the article misses that point.

Conclusion

Sadly, the “Woman’s World” article reflects a common ignorance towards our disease. The simplified suggestions of dietary changes and “sleep 7 hours” belittle the disease and treatments thyroid sufferers face. While I recognize this is no medical journal, it is one way the public sees our disease. I wish the author was more diligent in her studies. Despite this, it puts thyroid illness on display; it promotes a healthy diet and it motivates me to keep telling the truth about our disease. 

Medication Basics

Introduction

Hey, and welcome to the Thyroidcafe. Grab a seat and join me as we discuss the basics of medication. I’m thankful my local pharmacist let me interview her for this blog. She rattled off medication names long enough to dominate a Scrabble board and I grew in my knowledge. She explained each medication, who takes them and the best way to do so. Her information corroborated with the online studies I read. So I combined the information for you; I hope you like it. 

Hormone Basics

As I wrote previously (https://thyroidcafe.com/2019/07/09/diagnosis-story-part-3-getting-the-diagnosis/ ), knowing about your disease empowers you to make better choices for your health. Here is information to help:

  1.  Thyroid-Stimulating Hormone (TSH) prompts your body to make T4, which in turn produces T3. The prevailing theory on thyroid treatment is that by adding T4, the body will produce T3.  
  1. When doctors take our “Thyroid Levels,” they usually measure Thyroid-Stimulating Hormone (TSH). Here is a table to keep in mind when reading your TSH panel. 
TSH Normal Thyroid Range: 0.4 – 4.0 mU/L TSH At Risk: 2.5 m U/L – 4 mU/L
TSH Ideal Range: 2.5 mU/L 

Who can take thyroid medication 

The medication we are discussing is for people with Hashimoto’s disease and hypothyroidism. Restrictions on who can take it depends on allergies. (For example, food colouring.) Also, morality as there are animal products in some pills. 

Medications available

There are two broad categories of thyroid medication, synthetic and desiccated. Synthetic medication has many brands (Lavothyroxine, Levoxyl, Synthroid, Tirosint and Unithroid.) All synthetic brands contain solely T4. Desiccated pills are derived from either bovine or swine. Some common brands are Armour Thyroid, Nature-Thyroid, WP Thyroid, NP Thyroid. Because of their source, they contain both T4 and T3. (See below for more information) My pharmacist noted, desiccated pills are almost always on backorder. So talk to your local pharmacist about supply. 

Which medication do I choose?

Most people start with synthetic pills. They are more reliable as T4 levels are lab tested. The pharmacist recommends Synthroid as it comes in small doses increments, giving more accuracy. Desiccated pills, or animal derived pills, contain both T4 and T3. They are controversial because their hormone levels are tested less frequently. However, some studies show that a subgroup of patients improvement in mood and cognitive function on Desiccate pills. Most online articles advocate for Desiccate pills and  I hope to try them. I will report back. To read more studies, click here https://academic.oup.com/labmed/article/41/6/338/2657554. Most studies conclude that if symptoms continue, it is good to try desiccated pills.  

How do I take  medication and missed doses?

Both types of thyroid medication are best taken first thing in the morning; as they must be taken on an empty stomach. Take your medication and then wait a half hour to eat or take other medicine. It is also important to take your pills at a consistent time each day. Missed pill should be taken as soon as possible.  My pharmacist suggested that if over a few hours late, skip that day and resume a normal schedule the next day. Do not double up your pills. 

Conclusion

These are the fundamentals of thyroid medication. It is a broad and deep subject. As we grow in the knowledge of our disease, we empower ourselves to take our health into our own hands. Knowing the medications, opens our options if symptoms reappear. Once we decide, taking our pills as prescribed enables us to benefit fully from them. Now. Can someone please tell me how to wait a half hour for my coffee?

Gluten and the Thyroid Warrior

Introduction

Hey, I’m glad to see you at the Thyroidcafe. I’ve been looking forward to this topic for weeks. I know many thyroid patients suffer from the tummy troubles, as I have. So coming across this study fascinated me. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2111403/#!po=9.25926 In it, the correlation between thyroid illnesses and celiac disease is explained, as well as the symptoms of celiac disease, and testing options. But mostly, I was excited to see who was statistically most at risk of developing celiac disease, silencing critics with science. The study is thorough, but long winded, so I will summarize it here. 

Symptoms of celiac disease

I know you could just Wiki this, but here are a few:

Okay, plot twist! There aren’t necessarily any symptoms.

Seriously?!

This table outlines other symptoms that are often associated with silent celiac disease.

Thyroid Disorders and celiac disease

Yeah… so even though celiac disease was first described in the 19th century, it is underdiagnosed because some people with celiac disease show few symptoms.

Celiac disease isn’t common in the general population; only about 1% have it. However, there is a fivefold increase amongst Hashimoto’s sufferers. Those with hypothyroidism also have a slightly higher chance of having celiac disease, and those with Graves’ disease have a normal chance. The interesting thing is, both celiac disease and Hashimoto’s share the same genetic markers. It’s no wonder so many thyroid warriors suffer from sensitive tummies!

The Table below shows the prevalence of celiac disease in autoimmune thyroid disorders as shown in multiple different studies.

Author (year of publication)Population screenedPrevalence of CD
Collin et al (1994)4183 autoimmune thyroid disease4.8%
Sategna-Guidetti et al (1998)76152 autoimmune thyroid disease3.3%
Cuoco et al (1999)7822 Hashimoto’s disease
23 Graves’ disease
4.3%
Valentino et al (1999)77150 autoimmune thyroid disease3.3%
Berti et al (2000)79172 autoimmune thyroid disease3.5%
Volta et al (2001)80220 autoimmune thyroid disease3.2%
Larizza et al (2001)8190 Pediatric autoimmune thyroid disease7.8%
Meloni et al (2001)82297 autoimmune thyroid disease4.4%
Mainardi et al (2002)83100 autoimmune thyroid disease2%
Ch’ng et al (2005)42115 Graves’ disease4.5%

How to test for celiac disease

A simple blood test can determine if you have celiac disease. This test is both inexpensive and relatively painless. Eating gluten for a few weeks is the only preparation needed. The other testing option is surgical, in which a sample of the small intestine is taken and tested.

Who should test for celiac disease?

Given the increased prevalence and genetic links, testing is reasonable for those with Hashimoto’s disease, hypothyroidism, and any autoimmune disease. If you are experiencing any symptoms or have a family history of celiac disease, it’s reasonable to be tested as well. 

Why Bother?

I was diagnosed with celiac disease years before reading this study… but also there’s cookies. Before reading this study, I didn’t know that keeping a gluten-free diet can reduce the complications of thyroid disease. Some symptoms which are minimized when celiac’s keep a gluten-free diet are, malabsorption of vitamins, osteoporosis, lymphoma and aiding in absorption of thyroid medication. (See study linked above for details) While I knew anecdotally that I felt better gluten-free, I didn’t understand the depth of damage done.  

Conclusion 

It’s important to note that a gluten-free diet doesn’t prevent autoimmune or thyroid diseases, but it can help improve them. If you are a thyroid patient, and especially one with Hashimoto’s disease, testing for celiac disease is the obvious choice. A simple blood test and change in diet can be an easy step towards a healthier you. I will be posting some gluten-free food choices on Instagram if you are interested. Now off to brush up on my baking as it looks like we will be serving gluten-free goodies at the Thyroidcafe.