Unlocking the Mysteries of the Thyroid
Understanding this tiny gland and its importance
A comprehensive Handbook to guide you on Your Doctor’s Visit
and your Search for Better Health.
Clay Ballentine: Chairman of the National Thyroid Foundation
Compiled, Outlined & Researched by Fran Lewis
Copyright: Clay Ballentine & The National Thyroid Foundation - 2010
No part of this handbook may be reproduced or used for commercial
benefit or profit without the permission of the authors.
This handbook is a resource to help people understand the thyroid
gland, its malfunctions and diseases. It is not intended as medical advice
and should not be considered advice in any way by any person.
The authors are not physician’s, nor licensed to practice medicine. Their
opinions come from self-experience in having thyroid dysfunction and
disease and their resulting research.
Table of Contents
1. The Thyroid Gland
2. Your thyroid gland? Where it’s at? What’s its
3. Some Thyroid Facts
5. Hyperthyroidism symptoms and treatments
6. What if your diagnosis is Hypothyroidism
7. Hypothyroidism symptoms and treatments
8. Questions to ask the Doctor
9. How do thyroid issues affect women & pregnancy?
10. Symptoms Checklist
11. Source List and Links
The Thyroid gland
Your thyroid gland? Where it’s at? What’s its Function?
Your thyroid is located just below your “Adam’s apple” or larynx. This
gland originates in the back of your tongue, but normally moves or
migrates to the front of the neck before birth. The purpose or function of
this gland is to take iodine, found in many foods that we eat, and convert
or change it into thyroid hormones: thyroxine (T4) and trilodothyronine
(T3). Thyroid cells are the only cells in your body, which can absorb
The thyroid gland is under the control of another gland. The gland that
controls the thyroid is the pituitary gland, a small gland the size of a
peanut at the base of the brain. When the level of thyroid hormones, T3
and T4 drop, this gland produces Thyroid Stimulating Hormone called
TSH, which stimulates the thyroid to produce more hormones.
Some Thyroid Facts
1. You need a doctor to give you a proper diagnosis and treatment of
your thyroid. You may need to seek the advice of a specialist to
treat your thyroid problems. Let a skilled endocrinologist or
general practice physician diagnose your condition. A complete
physical examination, combined with the right tests; are the first
steps to understanding how and what your symptoms reveal.
2. Your thyroid condition, if you’re a woman, can prevent you from
3. Your thyroid problem can also be an autoimmune disease, or may
be combined with an autoimmune disease.
4. You may have fibromyalgia or chronic fatigue syndrome, which
are not thyroid diseases, but mimic hypothyroidism.
5. You and your Doctor’s time are important. Make sure that your
doctor answers all of your questions and takes the necessary time
to speak with you without rushing you out of his office. Come
prepared for the appointment with specific questions and
concerns you have, as well as a detailed list of symptoms.
Preferably in writing.
6. Normal results from thyroid panel blood tests do not mean your
thyroid is normal. Unique blood tests, sonograms, and toleration
testing may be needed for proper diagnosis, and those should be
performed by a specialized clinic in order to properly assess your
condition. In addition, what’s considered “normal” in the overall
population may not be “normal” for you.
7. Make sure that your doctor is well versed on the new thyroid
stimulating hormone normal test. When going for thyroid tests or
any medical tests - you should ask what each test is for, why it is
being taken and the results that are expected. ALWAYS get the
exact results from your medical tests and keep them in a file like
your taxes. They’re more important!
What is Hyperthyroidism?
Hyperthyroidism: Do you ever feel like you cannot sit still? Are you
always jittery, nervous or doing things non-stop? Are you anxious, short
tempered and losing weight for no reason? Take a deep breath and
think about the fact that something might just be wrong.
Hyperthyroidism causes your thyroid to create more hormones that
your body needs. Another term for this is overactive thyroid or Graves’
disease. It is an autoimmune disorder, in which the body’s own defense
system, or immune system, stimulates the thyroid causing it to produce
too much of the thyroid hormones. Thyroid nodules that speed up the
excess thyroid hormones can also cause it.
Pay Attention to gradual changes in your body:
It is not unusual for many sufferers to not pay attention or notice the
symptoms at first. Symptoms many times begin slowly and then
progress over time, ultimately causing a speeding up of your
metabolism which results in the following symptoms:
1. Weight loss even though you have not started a diet or changed
the way you eat.
2. Eating more than usual and more frequently
3. Rapid or irregular heartbeat
4. Anxiety, sometimes panic attacks
5. Irritable behavior and mood swings
6. Your hands and fingers tremble, skin problems develop
7. You sweat more, or cannot control your body temperature
8. More sensitive to heat
9. Muscles feel weak
10. More frequent bowel movements
11. Less frequent menstrual periods with lighter than normal
12. Some even developed osteoporosis, or weak, brittle bones.
It might affect your bones before you exhibit any other symptoms
of this disease. Especially in postmenopausal women, who are at
high risk for osteoporosis?
How is Hyperthyroidism Treated?
You’ve been diagnosed with hyperthyroidism. It’s time now to get on
the road to getting your symptoms under control and begin feeling
better. Thyroid dysfunction and disease are as yet incurable, but highly
treatable. You and your doctor must work together in tandem to
determine the right course of treatment for you depending upon your
symptoms, their severity, and any other health issues you may have.
NON-Invasive Hyperthyroid Treatments:
1. Beta –blockers: medications in the class of drugs known as beta
antagonists, a medication that is used for a variety of reasons,
including the control of hyper tension, by diminishing the effect
on the body of adrenaline. They are rarely, if ever, habit forming,
but have limited effect in advanced cases of hyperthyroidism.
2. Benzodiazepines: In the class of depressant drugs, they block a
specific area of receptors in the brain which the thyroid gland
affects and thereby reduce the symptoms of heart palpitations,
anxiety, insomnia, inability to focus and concentrate among other
benefits. “Benzo’s” as they’re commonly called, can be habit
3. Anti-thyroid medications: in the class of drugs known as
thionamides, they are almost exclusively used for over active
thyroid. Some can reverse the course of hyperthyroidism if caught
early enough, and are commonly used in the control of “Graves”
If you’re diagnosed with hyperthyroidism, discuss each of these drug
treatments with your doctor at length before any surgical, permanent
treatment or removal of your gland is considered. While most of these
drugs have side effects, and can be addictive, they offer a non-surgical
and reversible alternative for treatment of your symptoms.
Surgical & Radioactive Treatments
In some cases, surgical or radioactive treatment may be necessary. The
sufferer should consider their choices very carefully, and not make any
decisions before they are sure they are well informed. These techniques
not only can be highly dangerous if not performed well, they are also
Keep foremost in your mind after any recommendation of surgical
removal or “cleaving” (partial removal of the gland) that if you decide to
remove or destroy your thyroid gland, you must take thyroid
replacement medication for the rest of your life. These medications will
provide your body with the thyroid hormones that your thyroid would
normally make - but they are sometimes difficult to manage and find the
correct dosage for on an individual basis. A detailed discussion again
with your Physician, and some internet research on your own can
greatly assist you in your decision process.
In the case of thyroid cancer, you have no option. A total thyroidectomy
will almost always be required, possibly to include follow up radioactive
treatments. Routine follow up checkups are a MUST for any thyroid
cancer patient. In the case of cancer, the Endocrinologist may
recommend several options, including:
1. Surgery to remove most or all of the thyroid gland,
2. Radioiodine treatment to destroy the thyroid cells that produce
thyroid hormones. For this specific treatment, your doctor will
give you a higher dose of a different type of radioiodine than that
used for the radioiodine uptake test or thyroid scans,
3. Radiation therapy,
4. Specific medications for post-surgical and ongoing treatment.
What is hyperthyroidism?
What are the symptoms and how is that treated?
Hypothyroidism: Do you feel tired? Are you gaining weight but have not
changed your diet? Do you feel sluggish? Do your muscles and joints
ache? Unable to focus or think clearly? STOP! THINK! It’s time to go to
the doctor and find out the cause of your symptoms before they get
Hypothyroidism is the most common of all thyroid dysfunctions and
diseases. It appears to affect women more than twice as much as men. It
also appears to be affecting white women, who are affected at a nearly 1
in every 11 women, much more often than any other race. For example
Indonesian women, who are only affected at half that rate, about 1 out
of every 19. This highly suggests heredity as a possible cause of
About 95% of hypothyroidism cases occur from problems that start in
the thyroid gland. In such cases, the disorder is called primary
hypothyroidism. (Secondary hypothyroidism is caused by disorders of
the pituitary gland. Tertiary hypothyroidism is caused by disorders of
Hypothyroidism is a condition when your thyroid gland does not
produce enough thyroid hormones, (the opposite of hyperthyroidism,
where it produces too much.) A physician’s diagnosis of this condition
may range from underactive thyroid to Hashimoto’s thyroiditis.
Hashimoto’s is an autoimmune disease, in which the immune system
attacks your thyroid, resulting in thyroid damage so severe the thyroid
does not produce enough hormones. This disease can also be caused as
a result of many things, including:
1. Overtreatment of hyperthyroidism
2. Radiation treatment of certain un-related thyroid cancers
3. Total or partial thyroid removal due to goiters or tumors
4. In some rare cases the pituitary gland can cause the thyroid to
become less active. (secondary hypothyroidism)
What are the symptoms that signal hypothyroidism that you need
to be aware of?
Like hyperthyroidism, many symptoms do not happen overnight unless
surgery or radiation treatment was recently completed. They develop
over several years. You might fee tired and sluggish at first. You might
develop other symptoms evidencing a slowed metabolism which
1. Gaining weight even though you are not eating more
2. Becoming sensitive to cold
4. Joint of muscle pain
5. You might feel depressed
6. Easily fatigued- constantly tired
7. Dry or pale skin
8. Puffy face
9. Hoarse voice and/or a routine sore or scratchy throat
10. For women, excessive menstrual bleeding
11. People with hypothyroidism also may exhibit high blood
levels of LDL cholesterol or “ bad” cholesterol, which can increase
your risk of heart disease.
It’s very important that you do not ignore the symptoms or this
illness and get the proper treatment.
Hypothyroidism is treated with medications to supply the body with the
thyroid hormones necessary to make it function properly. One
medication used often is Levothyroxine. This is a man-made form of T4.
When taking T4, your body makes the T3 it requires from the T4 in the
medication. A man-made form of T3 called Liothyronine is also
available. Some doctors and patients prefer a combination of T4 and T3,
others use T3 alone. Most patients with hypothyroidism, total
thyroidectomy’s, Hashimoto’s and other hypothyroid diseases will have
to remain on these or other brand thyroid hormone drugs for the rest of
their lives. Failure to maintain the minimum dosages may cause death.
Diagnosis Is the First Step in Preserving Your Health
When Do I Get Assessed?
How will you know if you have a thyroid disorder?
Remember not to ignore the changes you are going through and note in
writing the symptoms that you now have that you did not have before. A
simple piece of paper will suffice, but checklists of hypothyroid
conditions are available across the internet.
Thyroid disorders are difficult to diagnose because their symptoms can
be linked to many other health disorders or problems. Going to the
doctor is the first step. Having your doctor take a complete medical
history including asking if any family members have a history of thyroid
disorders is the next step. Giving you a physical exam and checking your
neck for thyroid nodules would follow. Depending on the symptoms you
exhibit your doctor might order the following tests:
Some of the tests that can help evaluate your condition:
1. Blood tests are in order to test the level of thyroid stimulating
hormone in your blood to help determine whether your thyroid is
under or over active. (TSH is the hormone) Depending on the
results further blood tests might be ordered to check the levels of
both hormones in your blood.
2. Thyroid ultrasound or sonogram
3. Thyroid MRI scan
4. Radioactive iodine uptake test
5. Thyroid Fine needle biopsy if cancer or carcinoma are suspected
Questions to Ask Your Doctor
1. Why am I feeling so tired and sluggish? What could be causing this
change? I am usually active and now I feel like all I want to do is
2. Could my symptoms that we have discussed be indicative of
3. What steps do I need to take to find out what tests are in order?
4. What are the other procedures or tests that I might need?
5. How safe are these tests and procedures? Do they require any
dyes or pills to be ingested? Do they have any side effects? Is there
an allergic reaction possibility?
6. What is a thyroid biopsy and how is it performed? Can I stay
7. What is thyroid disease, how is it treated and what are the side
effects of these medications? What would happen if I did not take
my medications and you just monitored me? What would happen?
8. If I have to take medication, is there any special way to take them?
9. How often do my blood levels for thyroid function need to be
monitored? How long do I have to take these medications? Would
there be a time that I might not have to continue with them?
10. Would surgery ever be required? When and Why?
11. Would this involve removing my thyroid? What alternative
method is there?
How does thyroid disease affect women & pregnancy?
Thyroid disease can be related to women’s hormones. It can affect
menstrual cycles, fertility, estrogen/progesterone levels, and successful
pregnancies. It can even cause a miscarriage, the ability to breastfeed
Grave’s Disease can occur during pregnancy about 5% of the time.
Hyperthyroidism is most often due to Graves’ disease, but can disappear
after term. However, Hyper and Hypo thyroidism can make it more
difficult for you to become pregnant. Hyperthyroidism must be properly
treated or during pregnancy the following could happen:
Early labor or premature childbirth
Fast Heart rate of the developing infant
Added to that if a women is not diagnosed or properly treated during
pregnancy there could be increased risk for:
Low-birth weight babies
Problems with brain development in the infant
Excessive bleeding after giving birth
Ask you doctor if you need a thyroid test if you’re thinking about getting
pregnant especially if there is a family history of the condition.
These are the symptoms that should alert you to get
Weight loss or weight gain
Easily tired or fatigued
Rapid heart beat
Changes in sex drive
Inability to tolerate heat or cold
Your thyroid gland is enlarged or your neck is swollen
Increased sweating even in a cool environment
Blurred or double vision
Eye Complaints: redness or swelling or sudden loss of vision
Hair changes or loss
Restless sleep or insomnia
Erratic behavior and mood swings
Larger than normal appetite
Short attention span
Decrease in menstrual cycle
Increased frequency in bowel movements
This is not to be considered an all-inclusive list of symptoms, and
having a few of these symptoms may not indicated thyroid
dysfunction or disease at all. This list is meant for you to take to
your doctor, along with your own handwritten notes about your
recent health issues, to be as pro-active as possible with your
Physician and speed up your correct diagnosis – and ultimately -
The American Thyroid Association
“Why Am I Anxious?” by Clay Ballentine, Tate Publishing,