Chapter
5

Types of Hypothyroidism

In This Chapter

• Causes and effects of Hashimoto’s disease
• How goiters grow
• Becoming hypothyroid despite a healthy thyroid
• How doctors and drugs can make you hypothyroid
• The dangers of iodine overdosing

If you’re gaining weight, feeling fatigued, losing hair, becoming depressed, or experiencing any of dozens of other symptoms, you may be hypothyroid. Hypothyroidism accounts for four out of five cases of thyroid disease. Over 24 million Americans are estimated to have hypothyroidism, and hundreds of millions of people suffer from it worldwide.

What Is Hypothyroidism?

As explained in Chapter 1, your thyroid regulates the energy level of every cell in your body through the production of its hormones. Hypothyroidism occurs when the levels of those hormones—primarily T3 and T4—are below normal. In fact, the first part of this disease’s name, hypo, is Greek for below (just as hypodermic refers to injections below the skin).

The lack of hormones reduces the activity and regeneration of cells throughout your body. This lowered metabolism can result in dramatic weight gain, sluggishness, confusion, insomnia, lowered sex drive, dry nails and skin, feeling cold, and/or myriad other problems. (For a more complete list, see Chapter 6.)

Hypothyroidism can range from mild thyroid underperformance—resulting in symptoms so subtle you don’t consciously notice them—to a total shutdown of your thyroid. You can even be hypothyroid if your thyroid is healthy. For example, a defective pituitary gland can order your thyroid to underperform (as we’ll explain shortly), or T3 can be blocked from “powering up” your cells by ailing adrenal glands (see Chapter 14).

Hypothyroidism is a complicated disease. On the one hand, it’s easy to treat because inexpensive prescription medication will very effectively replace whatever thyroid hormones you lack. On the other hand, hypothyroidism is often difficult to recognize because its group of wildly diverse symptoms can seem to have nothing to do with each other. Even experienced doctors who don’t happen to be thyroid experts often fail to properly diagnose it. The American Association of Clinical Endocrinologists (AACE) estimates that half of those with hypothyroidism don’t know it—making this widespread disease a quiet epidemic.

Adding to the problem is the fact most doctors are taught in medical school to prescribe T4-only medication across the board. However, many patients require a mix of T4 and T3 to fully resolve their symptoms. Further, even if you’re taking the right medication, it can be tricky to arrive at the precise dosage for achieving optimum health.

This is the first of five chapters providing you with the knowledge you need to meet the various challenges posed by hypothyroidism. Once you’ve read these chapters, you’ll know whether you should see a doctor; and how to make sure you receive the best testing, diagnosis, and treatment.

Hashimoto’s Disease

In underdeveloped countries, the primary cause of hypothyroidism is insufficient iodine. In countries such as the United States where iodine is plentiful, however, roughly 75-85 percent of hypothyroidism results from Hashimoto’s disease. This exotic-sounding illness is named after Hashimoto Hakaru, a Japanese doctor who in 1912 was the first to publish a medical analysis of it. Hashimoto’s strikes women over five times as often as men; and the odds of getting it increase as you grow older.

Causes of Hashimoto’s Disease

Hashimoto’s is an autoimmune disease. It occurs when your immune system—which normally protects you by attacking foreign invaders such as bacteria and viruses—mistakes your thyroid as a danger and starts attacking it, too.

Hashimoto’s is typically caused by a genetic disposition for an autoimmune problem coupled with a trigger that pushes the immune system over the edge. No one is certain what the primary trigger for Hashimoto’s is, but the current best guess of experts is a buildup of toxic environmental chemicals in the thyroid.

Your thyroid is especially sensitive to chemicals because it’s designed to sift through your blood, and suck in and store even the tiniest amounts of iodine it finds. This ability of your thyroid is normally wonderful, because it means you need to consume only a little bit of iodine for your thyroid to have enough of it to make its hormones.

The problem is that over the last 100 years our world has become flooded with chemicals. According to the U.S. Environmental Protection Agency there are more than 100,000 chemicals in commercial use, and over 2,300 new ones submitted to the EPA for approval every year.

Some of these substances are designed to be toxic—for example, the pesticides used to keep insects away from crops. Others include cheap and mildly toxic substances in products that aren’t eaten, but nonetheless get through your skin and into your bloodstream (this happens a lot with cosmetics). Yet others become toxic as a processing side effect, such as the corn syrup that some factories make using mercury-based components, which recent testing has found results in small amounts of mercury turning up in thousands of snacks and beverages.

Throat Quote

Give a man a fish, and he can eat for a day. But teach a man how to fish, and he’ll be dead of mercury poisoning inside of three years.

—Charles Haas

The amount of any commercial chemical you’re exposed to is supposed to be small enough to be safe. But many of these substances haven’t been around long enough for us to know what their long-term effects will be. Just as importantly, no one knows how you’ll be affected by the combination of hundreds of chemicals in your daily life that have never been tested together.

This is relevant to your thyroid because the same mechanism that allows it to draw in and store tiny amounts of iodine from your bloodstream also leads it to extract and store toxins you consume that happen to be chemically similar to iodine. The latter include mercury (which is poisonous) and perchlorate (which is used in such products as rocket fuel, and is often present in low-quality drinking water).

The iodine in your thyroid eventually gets used up in the production of hormones, but the toxins don’t. So even though your thyroid is taking in very small quantities of toxins, they’ll accumulate decade after decade. This means the longer you live, the more likely the toxins you’re exposed to will accumulate to serious levels (which is why the risk of developing Hashimoto’s increases with age). At some point the amount of toxins in your thyroid can become so significant that they’ll trigger your body’s immune system. Your antibodies (specifically, thyroid peroxidase and/or thyroglobulin antibodies) will designate them as unwelcome invaders, and multiply to assault the cells containing them and flush them out of your system.

Unfortunately, what often happens is the antibodies will mistake your healthy thyroid cells as being a threat along with the cells harboring toxins. The antibodies will respond by attacking your whole thyroid; there’s no practical way to stop them. (Your doctor could shut down your immune system, but that would be a “cure” worse than the threat to your thyroid.)

However, if you’re in the early stages of Hashimoto’s, you might be able to mitigate the situation—or at least avoid making it worse—by cutting toxins out of your life as much as possible. For details, see Chapters 18 and 22.

While environmental toxins paired with a genetic disposition are believed to be the primary cause of Hashimoto’s, there are a couple of other significant ways the disease can be triggered. The most abrupt one is a respiratory infection that induces your body to create numerous antibodies to combat it. Sometimes antibodies looking for invaders in your neck will become confused and end up attacking your thyroid—which will begin the chain of events leading to Hashimoto’s. You can also develop Hashimoto’s as a result of iodine overdoses, which at high enough levels can be perceived as toxic by your immune system.

Effects of Hashimoto’s Disease

The effects of chronic Hashimoto’s assaults vary for different people. If you have a mild case, the disease may reduce your thyroid’s ability to produce hormones by around 5 percent a year. In this situation the symptoms are so subtle and gradual that you may not realize you’re sick for a long time. But once you begin taking thyroid medication, the numerous specific improvements you’ll experience will make you suddenly aware of all the ways your body had gone wrong.

On the other hand, Hashimoto’s might attack your thyroid aggressively. This could lead to your developing symptoms in an abrupt and very noticeable way. It could also lead to one or more goiters, which are enlargements of your thyroid.

In addition, Hashimoto’s can cause temporary hyperthyroidism. While the disease will make you hypothyroid over the long term, in its early stages it kills a lot of healthy thyroid cells, and as these cells die, they’ll spill out whatever hormones they contained. This can inject surges of T4 and T3 into your bloodstream, and bring about such symptoms of hyperthyroidism as a rapidly beating heart, anxiety, and panic attacks. You can obtain relief from these symptoms by taking medication for hyperthyroidism until this stage of the disease—which is called Hashitoxicosis—eventually ends and your Hashimoto’s stabilizes into keeping you exclusively hypothyroid.

Thyroidian Tip

If Hashimoto’s is giving you the worst of both worlds by alternately making you hypothyroid and hyperthyroid, your TSH levels may appear normal on blood tests. That’s because the underproduction of thyroid hormones will be evened out by the hormone surges caused by slaughtered thyroid cells. It’s therefore important that the initial lab testing your doctor orders for you includes antibody tests, which will pick up the presence of Hashimoto’s regardless of your TSH levels.

For example, if you’re suffering from an autoimmune disease such as Hashimoto’s, the hostile chemical environment created by antibodies will prevent new thyroid cells from being capable of producing hormones. And for those suffering from insufficient iodine—which is the most common cause of goiters in underdeveloped countries—new cells won’t help because the thyroid will still lack the iodine needed to construct T4 and T3 molecules. In such cases, your body will continue to lack thyroid hormones; your pituitary gland will keep yelling at your thyroid to do something about it; and your thyroid will hopelessly keep making its goiters bigger.

If your hypothyroidism is treated in its early stages, any goiters that may have developed will never become large enough to be felt or noticed. Once you go on thyroid medication and your hormone levels return to normal, your pituitary gland will stop overstimulating your thyroid and its goiters will simply stop growing.

If you’ve been hypothyroid for a long time without treatment, though, then one or more goiters may become large enough to become visible in your neck, and/or to cause you trouble when speaking, breathing, or swallowing. In fact, the primary value of goiters is to make themselves known in this way, because they provide undeniable evidence that your body has a chronic shortage of thyroid hormones that needs to be addressed.

Checking the thyroid for goiters.
(Licensed from Shutterstock Images)

Once you’re on thyroid medication, your goiters will probably go away over time. Your pituitary gland will not only stop stimulating their growth, but will stop encouraging the replacement of dying goiter cells with fresh ones, resulting in natural shrinkage. If your goiters don’t disappear on their own, though, and if they’re large enough to be uncomfortable and/or cosmetically displeasing, you can opt to have them surgically removed.

Thyroidian Tip

It’s a good idea to check your neck periodically for growths, which could end up being harmless goiters or—much more rarely—cancer nodules (see Chapter 13). To do so, first get a handheld mirror and a glass of water. Then hold the mirror in front of you and, while keeping your eyes focused on the lower portion of your neck, drink the water. If you see any bulges that probably shouldn’t be there when you swallow, visit your doctor to have them checked out. However, don’t get confused by your Adam’s apple; your thyroid is below it, closer to your collarbone.

Pituitary Gland Disease

As explained in Chapter 1, your pituitary gland manages the activity of your thyroid by producing TSH whenever your body needs additional thyroid hormones. Most cases of hypothyroidism result from an ailing thyroid being unable to entirely fulfill the orders represented by the TSH.

However, you can also become hypothyroid if your pituitary gland becomes ill and starts underproducing TSH. In this case, even though your thyroid is entirely healthy, it’ll end up making too little T4 and T3 because that’s effectively what it’s being told to do.

This situation, called pituitary disease, can be picked up by standard thyroid blood tests. That’s because when you’re hypothyroid you’ll normally have low thyroid hormone levels and high TSH levels—the latter being a result of your pituitary gland screaming, “Make more hormones!” If the problem is with your pituitary gland, though, you’ll have low hormone levels and low TSH.

As a double check, your doctor can test the levels of other hormones regulated by your pituitary gland, such as those produced by your adrenal glands and sex glands. The chances are great that they’ll be low as well.

The most common cause for your pituitary malfunctioning is developing a non-cancerous growth called an adenoma. If the adenoma is tiny—14 millimeters or less—your doctor will treat it with medication such as Bromocriptine that can slow, and even reverse, adenoma growth. If the adenoma is larger, though, then its continued growth risks putting dangerous pressure on your nearby optic nerves. In this situation, you should consider surgery to cut out the adenoma.

Therapeutic Hypothyroidism

No matter what type of thyroid disease you start out with, the chances are your doctors will cause you to end up hypothyroid. This is called therapeutic hypothyroidism because it results from treatment you receive for a thyroid disorder.

For example, if you’re hyperthyroid, your treatment may involve surgery or radiation to reduce the size of your thyroid. In a perfect world, the reduction would be so precise that you’d end up with normal hormone production. In reality, though, your doctor will err on the side of making you mildly hypothyroid. That’s because you’re much safer being hypothyroid than hyperthyroid, and the hypothyroidism can be easily managed with medication.

As another—and more extreme—example, if you have thyroid cancer, you and your doctor may decide to surgically remove your entire thyroid. This will make you hypothyroid because your body will no longer have the ability to produce any thyroid hormones on its own. Once you start taking thyroid medication, however, your T4 and T3 levels will return to normal.

By far the most common scenario for therapeutic hypothyroidism is being on thyroid medication but remaining somewhat hypothyroid. This can happen if you’re exclusively on a T4 prescription when your body happens to also require direct T3. It can also occur if you’re taking the right medications but at dosages that are too low. In such cases, trust what you’re feeling and observing. If your physician won’t acknowledge that you’re still hypothyroid, seek a doctor who’ll focus on your symptoms instead of just your lab tests (see Chapter 4).

Drug-Induced Hypothyroidism

While therapeutic hypothyroidism stems from thyroid treatment, drug-induced hypothyroidism occurs when you become hypothyroid from medication that has nothing to do with your thyroid.

For example, patients taking lithium—typically for bipolar disorder—have a 50 per-cent chance of becoming hypothyroid and growing goiters as a side effect of the drug. That’s because lithium is chemically similar enough to iodine that the thyroid may eventually start pulling it from the bloodstream and storing it—which then doesn’t leave enough room for the thyroid to store adequate amounts of iodine. It’s largely for this reason that lithium is no longer a doctor’s first choice. However, it’s still prescribed when other medications don’t work.

An even more problematic drug is amiodarone, which is used to stabilize an irregular heartbeat. Amiodarone has a number of severe side effects, with hypothyroidism being among the milder ones.

Throat Quote

I find the medicine worse than the malady.

—John Fletcher

As a general rule, whenever your doctor prescribes a medication with which you aren’t familiar, make a point of looking up its side effects, and then pay close attention to your body to see if any of them occur. This can be tricky with hypothyroidism since its symptoms aren’t always obvious; so whenever you’re in doubt, err on the side of caution and get your blood tested. If it turns out the drug is lowering your hormone levels, switch to another drug if possible, or start taking thyroid medication to make up for its effects.

Toxin-Induced Hypothyroidism

As explained previously, if your thyroid accumulates small amounts of toxins over a long time, it may develop Hashimoto’s disease. However, it’s also possible to take in a relatively large amount of toxins in a short period of time. If the toxins are chemically similar to iodine, then you’ll become hypothyroid. In addition, you may experience severe symptoms beyond hypothyroidism. If the problem is detected early enough, though, treatment may spare you from any permanent damage.

For example, a patient named Dorothy came to me with pain in her muscles. Dorothy was used to starting a new exercise regime and having several days of muscle pain afterward. That’s normal, but Dorothy was now experiencing this kind of pain in almost all her muscles, and all the time, even without exercising. Accompanying this were severe fatigue, trouble sleeping, and depression. When she came to me she was on antidepressants and pain medications, but her quality of life was pretty miserable.

I found Dorothy tested positive for hypothyroidism, and in addition had high levels of mercury in her blood. She underwent treatment to remove the mercury from her body, and also begin taking low doses of thyroid medication. Over time Dorothy felt enormously better, and was able to wean herself off all the antidepressant and pain medications. And because the problem was caused by toxins rather than a permanently defective thyroid, Dorothy was eventually able to wean herself off her thyroid medication as well.

Iodine-Induced Hypothyroidism

Some people have the notion that if a reasonable amount of a substance is good for you, then taking a lot of it will be even better. The opposite is usually true, and a prime example is iodine.

Your thyroid is dependent on iodine to make its hormones, but it needs only a small amount—150 to 300 micrograms a day. Staying in that range is safest; and you should definitely take no more than 1,000 mcg on any given day. But as explained in Chap-ter 3, there are both alternative medicine practitioners and over-the-counter products recommending daily iodine megadoses of 1,000-50,000 mcg. Not only is this not good for you, it’ll probably make you hypothyroid.

The reason is a flood of iodine risks your thyroid abruptly making way too much of its hormones, a condition called a thyroid storm. This in turn puts you in jeopardy of going into such a severe hyperthyroid state that your heart pounds in your chest until you have a heart attack.

Your body understands this danger, so it “blows a fuse” when you feed it too much iodine by entirely shutting down your thyroid. Your thyroid won’t start working again until your body flushes the excess iodine from your system over 2-3 weeks. If you pump extreme doses of iodine into your body day after day, though, you may keep your thyroid shut down long enough to do permanent damage to it.

Alternatively, your antibodies may perceive the excess iodine as a toxic invader, and start attacking both it and your thyroid cells. This can lead to Hashimoto’s disease; or even worse, Graves’ disease (see Chapter 10).

Excess iodine can also lead to growths on your thyroid. Sometimes these will be harmless goiters, but sometimes they end up being cancerous.

The way to avoid all this is simple: stay within the recommended range of 150-300 mcg of iodine a day. That means saying no to megadose iodine pills. And it also means being aware of the iodine content of what you consume. For example, a reasonable amount of seafood is terrific for you. Inexpensive and low-calorie natural iodine sources include fish, shellfish, and the seaweeds nori, wakame, and dulse. But if you eat a great deal of seafood daily, you may be taking in too much iodine. (In fact, seaside villages tend to have high rates of thyroid disease.)

As another example, if you’re on the desiccated thyroid medications Nature-Throid or WesThroid, you’re taking in 130 mcg of iodine with each 1 grain pill, which is all the supplemental iodine your body requires.

If you’ve been overdosing on iodine without realizing it, don’t panic. The human body is resilient; and as long as you cut back to normal levels, you may well avoid any lasting damage.

The Least You Need to Know

• Hypothyroidism is a quiet epidemic, affecting over 24 million people in the United States and hundreds of millions worldwide.
• Hashimoto’s disease can be triggered by genetics, environmental toxins, a respiratory infection, or iodine overdosing.
• Goiters are noncancerous growths on your thyroid resulting from a lack of thyroid hormones.
• Even if your thyroid is healthy, you can become hypothyroid from an underactive pituitary gland, insufficient iodine, or drugs chemically similar to iodine.
• Regardless of what type of thyroid disease initially strikes you, you’ll probably end up hypothyroid.