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: Anxiety

Introduction 

Welcome back to the Thyroidcafe. Miles from home, I went for a run. Trying to clear my head, I felt my heart began to race. I tuned into the sound of my sneakers. The crunching gravel under foot. I slowed my pace. I heaved a breath. But thoughts intruded. The house we just bought. Moving the kids away from mom. My mom.  Circular thoughts. Without end. Lord, please protect me. I knew this was a panic attack, thanks to a friend’s experience. 

Anxiety and thyroid disease

Many thyroid warriors know what anxiety feels like, but let’s define it. Anxiety is “a state of apprehension and psychic tension occurring in some forms of mental disorder.” or “distress or uneasiness of mind caused by fear of danger or misfortune.” The latter definition felt like locking eyes with myself in a mirror. And I am not the only one, 63% of thyroid patients report having anxiety. Though symptoms very, common symptoms of anxiety are: 

  1. Depression 
  2. Tummy troubles 
  3. Tension 
  4. Fears 
  5. Autonomic symptoms 
  6. Muscle tension

Doctors Advice 

The clinical recommendations sound oh so… clinical. Not to demean them, they are merely limited. Most studies conclude that any patient whose anxiety remains after treatment with thyroid hormone should be tested for anxiety disorders. From there, psychotherapy and medication are recommended… fortunately there’s more to this blog.

What Works for me

As stated above, God is a very present help in time of need. I have learned to manage my anxiety, so I no longer have panic attacks. Preventatively, I take Epsom Salt Baths, CBD oil, cut or lower my caffeine on bad days and get the best sleep and food I can.  If I already feel anxious, I try to Vulcan my way out of it by studying my thoughts. Asking: Are they good? noble? true? If not, reject them. This is where writing helps.  I also try Chamomile tea. I find, many small attacks against anxiety has brought down this giant.

Conclusion

Those with hyperthyroidism and Hashimoto’s disease are more likely than most to have anxiety. While those of us with thyroid disease are all too aware of the symptoms, we need a plan to tackle this beast. I am thankful to have good resources to handle my anxiety, so it’s no longer a major problem in my life. 

Symptom Management: Depression

Introduction 

Hey, welcome back to the Thyroidcafe. I’m sorry we missed a week. I was sick with a cold. But also, I may have opened a box… belonging to Pandora. Depression is a complex and deep topic, so I won’t be able to talk about it fully. I hope to shed some light on why thyroid disease can cause depression and some treatment options.  Okay, let’s unmask these two bandits.

Depression and thyroid disease

One of the first things I learned about my birth family was that my grandmother had Hashimoto’s disease. For years she struggled to find the right medication. Turns out, what was thought to be depression, was untreated Hashimoto’s disease. This is a common case. Depression and Thyroid disease mimic each other so well, it’s hard to determine who the real culprit is. To make matters more murky, those with Hashimoto’s disease and hypothyroidism are 31-69% more likely to have depression* Fortunately, Thyroid disease has been associated with depression since 1873, so there’s a ton of research about it

Bandit #1: Thyroid disease

This slippery sucker seems like an easy catch. Every study I read, said depression should improve once thyroid pills are taken. But you know I give major side-eye to the “Magic Little Pill Theory”. Pills aren’t magic, but they can be one of the steps to treating depression. Some depression treatments work for improving your thyroid health as well. Lifestyle and diet changes, physiotherapy and exercise are all weapons against both baddies.   

The hormones involved in thyroid disease (Thyroxine (T4),  Triiodothyronine (T3) and Triiodothyronine (rT3) and Thyroid antibodies etc.) are abnormal in those with depression, even if they do not have thyroid disease. Doctors have been using thyroid hormones to aid anti-depression therapy since the 1960’s. So these two bad bandits are also best friends. Your T4 and T3 levels are the two that seem to be linked to depression. So I recommended desiccated medication in Fundamentals of Medication. I talked to my doctor, and am making the switch myself. Wish me luck, reviews to come. Doctors are also using neuroimaging to track down the exact location of these masked mad men. If you want to read about it, see “Sources” below.

Bandit #2: Depression

If your thyroid hormones optimized, but depression continues, we may have another bad guy to catch. (okay, I’ll stop with the crime fighting) Depression is a diagnosis, not a mood. Your doctor will  test to evaluate if you have it and which type. Then make a treatment plan. As per life, it takes time and trying. Typical treatment options are:

  1. Psychotherapy: It can be what works for you: group therapy, online, workbook or in a group.  
  2. Lifestyle changes: 30 mins walking has been proven to help reduce depression, dietary changes, alcohol and drug management, and  journaling 
  3. Medications: There are many out there. Talk to your doctor about side-effects, length of time you expect to be on them, and the risks in stopping the medications. 
  4. More information

Killing my Bandits

All this studying and struggling with depression led to two conclusions. One, it’s not just “all in my head.” There are legitimate physiological reasons thyroid warriors fight depression. Two, what works for some, may not work for me- for now. While I try to be open, there are steps I am not ready to take. One may obsessively write *blushes awkwardly,* another may exercise improves their depression. Either way, we take up the sword. That’s why we have this community. So we can exchange ideas and take up arms together. 

Conclusion

Depression and thyroid disease have long been associated. The shame of past generations is slowly raising its head and staring these illnesses in the eye. While getting the proper dose of thyroid medication has been proven to improve depression, the battle doesn’t stop there. If you feel you need more help, chat with your doctor about your options. Choosing to switch to desiccated pills may help, along with lifestyle changes and other medications. Whichever way you fight, continue to be your own thyroid advocate.

Sources:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246784/

https://academic.oup.com/jcem/article/83/9/3194/2865402

https://www.liebertpub.com/doi/abs/10.1089/thy.1998.8.951

https://www.sciencedirect.com/science/article/abs/pii/S0022399905000875

https://www.karger.com/Article/Abstract/127099

*Trzepacz PT, McCue M, Klein I, Levey GS, Greenhouse J. A psychiatric and neuropsychological study of patients with untreated Graves’ disease. General Hospital Psychiatry. 1988;10(1):49–55. 

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?