Chapter
15

Other Thyroid-Related Diseases

In This Chapter

• Parathyroid gland problems
• Inflamed thyroid issues
• Thyroid-related tumors
• Thyroid-related eye problems

So far this book has covered hypothyroidism, hyperthyroidism, and cancer. These diseases cause over 95 percent of all thyroid-related problems. However, they aren’t the whole story.

Hundreds of thousands of people are diagnosed every year with other thyroid-related illnesses, including parathyroid disease, thyroiditis (inflamed thyroid), thyroid eye disease, and multiple endocrine neoplasia (thyroid tumors).

If you have reason to believe you’re suffering from one of these less common conditions, this chapter will provide the information you need for seeking an accurate diagnosis and successful treatment.

Parathyroid Disease

Directly behind your thyroid are small glands, each around the size of a grain of rice, called parathyroid glands. There are typically four of them, but the number can vary from person to person.

The parathyroid glands.
(Licensed from Shutterstock Images)

While your parathyroids reside right up against your thyroid, they have an entirely separate function. Their job is to create hormones that regulate the amount of calcium in your blood and bones. That might not sound like a big deal. However, calcium affects such vital functions as preventing your bones from breaking down and transmitting signals to your muscles, which among other things ensures that your heart keeps beating.

Maintaining your calcium levels within the narrow range your body requires (from 8.5 to 10.2 milligrams per deciliter of blood) is a delicate task, so anything that throws your parathyroids off-kilter can result in serious consequences.

There are roughly 100,000 diagnosed cases of parathyroid disease a year in the United States alone. That’s around 1 out of every 3,000 people. It’s twice as likely to occur in women, and it’s six times as likely to occur past age 60.

Parathyroid Disease Causes

One of the most common causes of parathyroid damage is treatment for thyroid disease. That’s because the parathyroids are so close to the thyroid.

For example, if a surgeon needs to remove part or all of a thyroid—which is usually the first step in treatment for thyroid cancer, and occasionally for hyperthyroidism—there’s a risk the surgeon will accidentally cut one of the parathyroids. This is actually one of the scenarios doctors worry about most when considering thyroid surgery … especially since the precise number, location, and size of parathyroids can be quite different from patient to patient.

Similarly, radiation can be used to either destroy a thyroid’s cancer cells or reduce the thyroid’s mass to treat hyperthyroidism. Even though the parathyroids aren’t being targeted by the radioiodine, there’s a risk they’ll become damaged simply because of how close they are to the radioactive thyroid cells. In addition, the radiation exposure poses a long-term risk of the parathyroids developing cancer or other dangerous growths themselves.

There are also rare instances in which thyroid disease becomes linked with parathyroid disease. In these cases, someone will have hypothyroidism and her calcium levels will be normal, but once she’s treated for the hypothyroidism her latent hyperparathyroid disease will kick in and dangerously increase her calcium.

Parathyroid Disease Symptoms

When something goes wrong with your parathyroids, it can show up as a variety of symptoms. You may sometimes hear these summarized as bones, stones, and groans.

Bones refers to when your parathyroids are underperforming by triggering the creation of too little calcium, a condition called hypoparathyroidism. Your body responds to this emergency by removing calcium from the place that has the most of it—your bones—so it can keep the calcium levels steady in your bloodstream. That’s okay as a short-term solution. However, if calcium continues to be removed from your bones more quickly than it’s replaced, your bones will start to break down.

Stones refers to the opposite problem: your parathyroids are overperforming and putting too much calcium in your blood, a condition called hyperparathyroidism. This can lead to the calcium turning solid and forming kidney stones.

And groans refers to the physical and psychological pain you may feel as your system is disrupted by a calcium imbalance.

As with the thyroid, an ailing parathyroid can result in numerous different symptoms. In general, though, certain symptoms are more likely to occur than others. Take a few minutes to go over this list of common clues to parathyroid malfunction and check off any symptom that applies to you.

Parathyroid Symptoms Checklist

• ❑ Pain in abdomen
• ❑ Pain in muscles
• ❑ Exhaustion
• ❑ Sluggishness
• ❑ Slowed thinking
• ❑ Insomnia
• ❑ Headaches
• ❑ High blood pressure
• ❑ Depression
• ❑ Anxiety
• ❑ Feelings of hostility
• ❑ Obsessive-compulsive behavior
• ❑ Vague sense of not feeling “right”
• ❑ Thinning hair
• ❑ Kidney stones
• ❑ Gastric reflux disease
• ❑ Bone breakdown (e.g., osteoporosis, osteopenia)
• ❑ Back pain
• ❑ Degeneration of the spine
• ❑ Spinal arthritis
• ❑ Heart palpitations
• ❑ Heart attack

If you aren’t experiencing at least four of these symptoms, your parathyroids are probably healthy. If you have four or more of these symptoms, however, then you might be suffering from parathyroid disease. If your symptoms are relatively mild, that unfortunately doesn’t mean you’re at lower risk. There’s actually no connection between the severity of parathyroid symptoms and their seriousness. And if left untreated over a long period (e.g., 15 years), parathyroid disease will typically take five years off your life.

Conversely, if you’re successfully treated for parathyroid disease, you’ll soon experience improvement in all your parathyroid-related symptoms. In fact, you’re likely to feel better in ways you didn’t even expect. That’s because some parathyroid problems occur so slowly and subtly that you aren’t even aware you have them. Once these symptoms are treated, you’ll notice improvements that make you realize you’d been operating at less than 100 percent in a variety of areas. You therefore shouldn’t hesitate to check out your symptoms by seeing a doctor.

Diagnosis and Treatment

The good news is that parathyroid disease can be detected—or ruled out—with some simple blood tests. Specifically, your doctor needs to take a small amount of your blood and then order a group of lab tests called a comprehensive metabolic panel (also known as a CMP, chemistry panel, chemistry screen, or SMAC test). These tests are so standard that many doctors perform them on their patients annually as part of a routine checkup. They identify the levels of a variety of critical chemicals in your bloodstream, including calcium.

If it turns out your blood’s calcium level, or serum calcium, is what it should be, then you don’t have a parathyroid problem. If your serum calcium is either too high or too low, though, then there’s something wrong. It could be your parathyroids, or it could be something even more serious such as cancer. Your doctor should therefore conduct follow-up blood tests—including one that measures parathyroid hormone output—to hone in on the cause.

Crash Glanding

If your doctor fails to identify the reason for your abnormal serum calcium and tells you “Don’t worry about it, it’s probably nothing,” find another doctor who’ll do the job right. Considering that possible causes range from parathyroid problems that (if left untreated) can rob years from your life to even deadlier diseases such as cancer, a discovery of serum calcium that’s off-kilter should never be ignored.

If it turns out that your body has too much parathyroid hormones—that is, if you have hyperparathyroidism—there are two primary possibilities:

• A single parathyroid gland is generating excess hormones (the situation for roughly 96 percent of patients). In this case, the solution is relatively simple: have an ENT (ear, nose, and throat) surgeon take out that particular defective gland. If you’re typical, you’ll have three normal parathyroids left, and they’ll automatically pick up the slack, producing enough additional hormones to make up for the gland that’s been removed.
• All your parathyroids are generating excess hormones (the situation for roughly 4 percent of patients). In this case, you’ll be put on permanent medication that reduces your parathyroid hormones to normal levels.

Alternatively, if your body has too little parathyroid hormones—that is, if you have hypoparathyroidism—the treatment is more complicated. You’ll need to be put on medication, but also closely monitored to ensure your body’s calcium remains at the right levels. Details are beyond the scope of this book, but your doctor will have more information.

Thyroiditis

If your thyroid feels inflamed, you may have thyroiditis.

Thyroiditis usually stems from Hashimoto’s disease (see Chapter 5). However, there are also several types of thyroiditis that are (usually) temporary illnesses. They include painful subacute thyroiditis, silent thyroiditis, postpartum thyroiditis, and iodine-induced thyroiditis.

Painful Subacute Thyroiditis

Painful subacute thyroiditis (also known as de Quervain’s thyroiditis or subacute granulomatous thyroiditis) typically occurs after a respiratory infection—for example, after you’ve had the mumps, the flu, or some other virus. If your body’s attacks on the virus create high inflammation, that can in turn spawn antibodies that end up attacking your thyroid. If this occurs, you’ll probably feel neck pain. If your thyroid swells, you may also have some trouble swallowing or talking. And you may become feverish and weak.

In addition, because nerves can sometimes carry signals of distress beyond the area actually causing the problem, you may feel pain in your ears, jaw, and/or face. Further, you’ll become hyperthyroid, which means—among other things—that your heart might start beating too rapidly.

Your doctor can diagnose this condition by giving you an iodine uptake and thyroid scan. This involves injecting you with or having you swallow a tiny amount of radioactive iodine, waiting 6-24 hours, and then scanning your neck to get a clear picture of what’s going on in your thyroid.

If you have this condition, your doctor should give you a nonsteroidal anti-inflammatory drug—essentially, a prescription-strength equivalent of ibuprofen—to reduce the inflammation. (If that doesn’t work, she can alternatively prescribe corticosteroids, which are steroid-based anti-inflammatory drugs.) In addition, your doctor should prescribe beta blockers to prevent your heart from beating too quickly.

With the help of these medications, the chances are good that you’ll be okay until the condition clears itself up. However, in rare cases—and especially if the illness is left untreated—the disease can so stress the thyroid that a permanent condition of hypothyroidism results.

Silent Thyroiditis

Silent thyroiditis (also known as painless thyroiditis or subacute lymphocytic thyroiditis) is another condition in which your body turns on itself by creating antibodies that attack your thyroid.

Unlike painful subacute thyroiditis, this illness isn’t spawned by a viral infection; no one knows what causes it. And while it enlarges your thyroid, it doesn’t make the thyroid tender and prone to pain.

As with painful subacute thyroiditis, your doctor can diagnose this condition by giving you an iodine uptake and thyroid scan.

If you have silent thyroiditis, you’ll start out as hyperthyroid. During this period, your doctor may prescribe beta blockers to prevent your heart from beating too quickly. The hyperthyroidism will typically last for 2-3 months, after which you’ll return to normal. You may then become hypothyroid for 2-3 months and require thyroid medication (see Chapter 8). After this phase, your body will probably cure itself, leaving you healthy. In rare cases, though, the thyroid can become so stressed by the illness that it ends up remaining in the hypothyroid state.

Postpartum Thyroiditis

If you’re pregnant, your body will make changes to your immune system during and after the pregnancy to ensure the health of both you and your baby. These changes are normally harmless, but 5-7 percent of women spawn antibodies that end up attacking the thyroid. (Most at risk are women with type 1 diabetes.) This typically happens 2-6 months after the baby is born, but can also occur up to a year later. Postpartum thyroiditis can also occur following a miscarriage or an elective abortion, which puts the body through the same kind of immune system changes.

The symptoms, diagnosis, and treatment for postpartum thyroiditis are the same as those for silent thyroiditis. With time and patience, this illness usually rides itself out. For around 20 percent of women, however, the thyroid ends up remaining in a hypothyroid state. And for the other 80 percent, this illness is likely to recur with subsequent pregnancies, and/or as a result of the hormonal changes that come with the onset of menopause.

Iodine-Induced Thyroiditis

For your thyroid to function properly, you need to consume 150-300 micrograms (mcg) of iodine per day. And as long as you don’t go over 1,000 mcg (1 milligram) of iodine daily, you’re likely to be fine.

If you overdose on iodine, however—for example, by taking an over-the-counter thyroid product that contains iodine megadoses, or by regularly eating a lot of kelp or other iodine-rich seafood—you may get iodine-induced thyroiditis. This can also occur if you were on a low-iodine diet for a long time and then abruptly switch to a normal intake of iodine. In either case, you’re shocking your thyroid into processing more iodine than it’s accustomed to.

The problem is that as much as 45 percent of people are estimated to have latent thyroid disease—that is, antibodies floating around for Hashimoto’s disease or Graves’ disease that normally don’t do any harm. But when your thyroid is disrupted by an abrupt change in iodine, or by steady iodine megadoses, this can trigger the antibodies into actively attacking your thyroid. As a result, you’ll suddenly become hypothyroid or hyperthyroid.

The simple solution is to stop taking the excess iodine. In many cases, your body will heal and you’ll become healthy again. However, it may be that once the thyroid disease is triggered, it becomes permanent. If this happens, you’ll need to be treated for either hypothyroidism (see Chapter 8) or hyperthyroidism (see Chapter 12), depending on your condition.

Symptoms you might feel in your eyes include:

• Continual pain, or pain when looking around
• Dryness or itchiness
• Double vision or other impaired vision
• Bloodshot eyes
• Inflammation and swelling
• Swelling in the orbital tissues

The latter can cause your eyeball to push forward, creating a wide-eyed, bulging look.

The usual treatments are eye drops and ointments to ease suffering until the disease goes away.

Thyroid eye disease can subside for a while and then return. If it disappears for more than six months, it’s usually gone for good. For about 3 percent of patients who have thyroid eye disease, however, the disease won’t end by itself. In these cases, surgery is required.

Also, even if the disease disappears on its own, the wide-eyed look can sometimes remain. When this happens, surgery is required to restore the eyes to normal.

MEN Syndrome

Around 1 out of every 30,000 people has a genetic defect called multiple endocrine neoplasia 1, or MEN1 (also known as Werner’s Syndrome); or multiple endocrine neoplasia 2, or MEN2 (also known as Sipple’s Syndrome).

MEN1 causes several different endocrine glands—the thyroid, parathyroids, pancreas, pituitary, and/or adrenals—to start growing tumors at the same time. These tumors usually aren’t cancerous. But the enlargements of the glands leads to an overproduction of hormones. This can show up as a wide variety of symptoms—headaches, blurred vision, racing heartbeat, and scores of other possibilities—because these glands affect almost every area of your body. Left untreated, the excess hormones can severely damage your quality of life, and even take years off your life.

MEN1 runs in families, and it can be detected through gene testing. It can also be diagnosed through blood tests checking hormone levels. There’s currently no cure for MEN1. However, once detected, the tumors it creates can be removed via surgery, or the excess hormones can be suppressed via medication.

MEN2 is similar to MEN1 in that it causes endocrine glands to grow tumors. Unfortunately, with MEN2 the tumors are usually cancerous. That means they can spread from the glands to other parts of your body, which makes them deadly.

MEN2 also runs in families and can be detected through gene testing. If you’re unlucky enough to win this genetic lottery, you should be closely monitored. If or when cancerous tumors occur, they can be destroyed using surgery and/or radiation.

The Least You Need to Know

• Get a comprehensive metabolic panel blood test annually to check your calcium levels; and if they’re abnormal, be sure to identify the cause.
• Avoid iodine megadoses and abrupt increases in iodine consumption.
• If your eyes have been bothering you for no reason, or if you recently gave birth, get your blood tested for thyroid antibodies.
• If your family has a history of multiple endocrine neoplasia (MEN), get your genes tested.