The People's Perspective on Medicine

Show 1162: How to Treat Common Thyroid Problems

Dr. David Cooper, director of the Thyroid Clinic at Johns Hopkins University, describes the best treatments for common thyroid problems.
David S. Cooper, MD, MACP, Johns Hopkins University School of Medicine
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How to Treat Common Thyroid Problems

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The thyroid gland on your neck is not very big, but it is super important. It secretes hormones that control the activity of every cell in your body. Consequently, the thyroid regulates your metabolism, your heart beats, your bowels and even your thinking. What happens when the thyroid doesn’t work as it should? How do doctors treat the most common thyroid problems?

Autoimmune conditions create common thyroid problems. As a result, levothyroxine (a synthetic thyroid hormone) is the most frequently prescribed medication in the US. In fact, nearly 20 million people have some form of thyroid disease, but not all of them know it. What are the consequences of Hashimoto’s disease and Graves’ disease?

Treating Graves, the Overactive Thyroid:

When the body makes antibodies to the thyroid receptor, the consequence is Graves’ disease. As a result of this attack, the gland makes more thyroid hormone than is needed. As a consequence, a person with Graves’ may have a rapid heart rate, tremors, weight loss, insomnia, heat intolerance, weakness, nervousness and anxiety. Some people with Graves’ disease will develop bulging eyes and eye inflammation. To treat this condition, doctors have medications such as methimazole, radioactive iodine or surgery.

Hashimoto’s and Sluggish Thyroid:

In Hashimoto’s disease, the immune system starts to destroy the thyroid gland and impairs its ability to produce hormones. Consequently, people may feel sluggish and be bothered with constipation. They may have difficulty losing weight and notice that they are losing their hair. Their skin may be extremely dry and they may become extremely sensitive to cold.

Too little thyroid hormone and too much are both common thyroid problems. In addition, doctors generally use a single synthetic hormone to treat hypothyroidism. That’s levothyroxine or T4. However, some people seem to have difficulty converting T4 to the active T3 hormone at an appropriate rate. What can they do?

Have you had experience with a malfunctioning thyroid gland? How was it diagnosed? How did the treatment go? Tell your story in the comments section. You can find our eGuide to Thyroid Hormones here

This Week’s Guest:

David S. Cooper, MD, MACP is the Director of the Thyroid Clinic and Professor of Medicine and Radiology in the Division of Endocrinology, Diabetes, and Metabolism at The Johns Hopkins University School of Medicine. His website:

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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I have been directed to have a thyroid test after a pre-op doctor found 2 small nodes during an exam. She said that only about 5 to 10% of nodes are problematic. I participated in the atom bomb tests at Yucca Flats while in the Marine Corp in 1955. We were in 5 foot trenches less than 2 miles from ground zero of an 8 kiloton bomb detonation. Veterans participating in those tests are checked for 21 different cancers that are related to the ionizing radiation exposure of those tests. The number one cancer is thyroid. Does anyone have any knowledge that exposure 54 years ago could cause thyroid cancer today?

Is it possible to make a dietary change in order to “treat” an underactive thyroid? I DO NOT want to take any prescription at all! Is there a food or foods that can offer an option to a pharmacological solution?

We are not aware that dietary changes can significantly alter thyroid hormone production.

There are other health conditions that can cause similar feelings of unwellness. I’m on Levothyroxine 50 mcg and have been for years but taking the medication never improved how I was feeling, then I discovered that I have Carcinoid Cancer which is a neuroendocrine cancer. The cancer replicates endocrine hormones which affect so much of how a person feels, many symptoms similar to hypothyroid.
One test for this is Chromogranin A.
Not to say that you have cancer but to suggest that thinking beyond the Thyroid box might be helpful.

I have been hypothyroid since 1985. Have been on so many different thyroid meds. Is the Gluten Free Diet plan the best eating for hypothyroidism?

I am on synthetic thyroid meds. I have chronic to severe constipation. Sometimes my arms turn red and itch. I also have anxiety(irritability), hair loss, occasional bruising. My endocrinologist refuses to adjust my levels. They are lower every time I get blood work. I asked about Armour I was told: “I can give it BUT it takes so long to get it adjusted.”

I am seriously considering using my family doctor and asking for Armour. I simply cannot tolerate these bouts of anxiety and irritability anymore. Dr. passes it off as a mental thing, even though dr. does agree that thyroid problems can be related to anxiety.

I sincerely appreciate all the comments here and the newsletters. It is a learning experience.

Friend of mine who owns a health food store had part of his cancerous thyroid removed after taking (for a short time) 25-50 mg of iodine in a popular throid complex. The cancer was likely there all the time and just activated by (or as the result of) the high dose iodine.

I don’t really think that Drs or endocrinologists know what to do with us but check the blood and go from there. I have had thyroid issues for many years. I cannot take the generic brand but must take the brand name Synthroid @ 100 mg. I have a fairly new endocrinologist and she was far more concerned about my 1 point over normal A1C than she was about my thyroid. I continue to gain weight, mostly due to other meds, still have hair loss, fatigue, etc. one Dr told me that my T3 was quite low but my endo Dr did not think that it was a serious factor at all. I just don’t think they have me figured out and it really bothers me. I suggested what the Graedons recommended with the other med for thyroid that has helped many people and she refused to discuss it. So tired of Big Pharma!

Has anyone had a problem of your blood pressure going up while taking thyroid medication? I am an actice 71 year young women who walks 2 – 5 miles a day,eats sensible and takes good care of myself. This is frustrating me and I would not prefer to go on BP medication.

I’ve had Hashimoto’s for decades. Nearly four years ago, I got to the point that I could barely swallow. I weighed 230 pounds and I started having terrible, sharp pains in my forearms. My ANA test came back positive. I went on an autoimmune protocol diet. I’ve been on it ever since with very few introductions of food. All of my symptoms went away as well as 75 pounds that just dropped off of me. I’ve had no problem keeping the weight off. I had no idea of the impact of certain foods on my body. The Hashimoto’s is still with me but it’s very manageable now.

I started having thyroid problems (hypo) about 25 years ago. They tested TSH, which came back 5.0…..that was when this level was in the “normal” range. After the last 10-15 years of going to many doctors (primary care, 3 endocrinologists, 2 functional medicine professionals), my medication dose finally stabilized. I take 100mcg of Synthroid and 12.5mcg of compounded ER T3. My Tsh hovers around 1.5. My antibodies went from over 1,000 to 93 on my latest test. I struggle with weight, it is difficult to impossible to lose it, and borderline high cholesterol but have thick hair and other minor, if any, symptoms. I think I was hurt by not being medicated at first then taking only T4 for many years. Hard to know.

I am 74 and have been on thyroid medication for 40 years and currently take 125 mcg of Synthroid daily. On my last doctor’s visit in March my doctor mentioned that my thyroid was “kind of low,” but that he would not do anything about it until my next visit in August. In the meantime, I have become much more fatigued, my hair is thinning, and I alternate between constipation and diarrhea. Also, my skin is excessively dry and constantly itchy. Does anyone else experience this and, if so, did you get any answers as to why?

Diagnosed following my first pregnancy, (although it took 6 months to get the diagnosis.) I had excessive energy, dizziness, irritability, rapid weight loss, and hair loss. I just did not feel like myself. Initially I was told by my gyno/obstetrician that “all new mothers feel this way.” I was given a prescription for Prozac. Finally convinced my primary care doctor to test my thyroid, as I have a family history of thyroid problems. I was put on levoxyl. That was 22 years ago, and it has remained under good control with regular every-six-months testing.

This show transmitted so many misconceptions, you need to address them in 3 or 4 shows. One example, thyroid hormones released by the gland are only 25% decarboxylated from T4 to T3. T3 is the active hormone in tissues but not what the pituitary and hypothalamus monitor(T4). 75% of T4 is converted to T3 in peripheral tissues which varies widely genetically and is inhibited strongly by amiodarone. Everybody taking amiodarone is T3 deficient – but TSH will be low and unless you test Free T3 at a good lab, you will be fooled by the tests.

Dr. Cooper treats a different population than primary care docs see and is only qualified to recommend treatment for end-stage patients.

Levoxyl is Levothyroxine. I had a Endocrinologist who said to aim for a THS of 1.0 mU/L

I am a faithful listener to the People’s Pharmacy and appreciate the shared wisdom and knowledge of you and your guests. I was very interested in today’s program because I have been on thyroid medication since I was 12 years old and am now 74.

Several years ago you had a guest who explained that some people need T3 as well as T4. I had been on Synthroid for many years. Your guests explained some of the symptoms of not having enough T3. One of the symptoms was “scalloping of the tongue.” I had just noticed within the previous 6 months that I had scalloping of my tongue. I also seemed to be biting my tongue (ouch!) a lot. After hearing about some people needing to take Armour thyroid that includes both T3 and T4, I told my doctor and showed her my tongue. She immediately prescribed Armour thyroid, and I soon started losing the scalloping and now very rarely bite my tongue. Thank you so much for your wonderful program.

If I’d been able to listen live (started 20mins past the hour), I would have asked if there have been epidemiologic studies focusing on the rise in hypothyroidsm and, possibly, thyroid cancer, being concurrent wih addition of chlorine or chloramine to municipal water sources. In a related point, while there are significant risks of iodine exposure in some of diagnostic or treatments, isn’t iodine deficiency at least as common a problem? I’ll listen to the complete podcast when I get a chance – -thanks as always for the interesting program.

I have had an underactive thyroid for around 15 yrs. Levothyroxine is prescribed at 175 mg a day. This has risen in the last 7yrs. No change to my condition. I feel ill all the time. My doctor won’t do anything more to help. Every day is a struggle. Sometimes I feel like giving up. What do I do?

I have had hypothyroidism for over 20 years. I’m very sensitive and get symptoms if my TSH is higher than 1.0. With TSH numbers, the higher the number the lower the thyroid function is. And increasing levoxyl will increase thyroid function and lower the TSH number.

So your doctor should’ve increased your dose to lower the TSH level, not decreased it. Doesn’t make sense to lower the dose because that will result in lower thyroid function and higher TSH, which is what happened. And your symptoms will be worse the higher the TSH goes.

If you can please ask to see an endocrinologist. I’ve read countless stories of problems with GPs treating thyroid disease. If you’re lucky you get a doctor who has some knowledge and will work with you. My experience time & time again has been my GP doesn’t treat me properly and argues that I’m fine even though I’m having significant symptoms. If you have one like that it’s not worth the heartache. Your best bet is an endocrinologist.

“The normal range of TSH levels is 0.4 to 4.0 milli-international units per liter. If you’re already being treated for a thyroid disorder, the normal range is 0.5 to 3.0 milli-international units per liter. A value above the normal range usually indicates that the thyroid is underactive. This indicates hypothyroidism.“ –

I hope this helps. Take care.

One endocrinologist kept looking at my labs, saying that I was good. I asked him why I felt so bad. I kept asking to switch from Synthroid to Armour, which he kept putting off. Eventually he added Cytomel. Lo & behold, my sense of smell returned AND I had more energy! (Grandmother & dad both gradually lost sense of smell so I thought it was just a family curse- not thyroid related!) Switched to a doc who was willing to try Armour (cheaper than the two separate T3 & T4 meds). Had to badger that doc to officially diagnose me with Hashimoto’s, which I already suspected that I had. The reason he was resistant was that he felt that the treatment is the same for Hashi & regular hypothyroid. I’m not convinced, so I’m trying another doc in hopes of moving me from the 85-90% recovery I feel I have reached to a full 100%.

For me, the worst part of being a thyroid patient is that there are so few docs responsive to symptoms & knowledgeable of different treatments. I have to do all my own research & fight for each scrap of progress- no matter how brain-foggy & energy-depleted I am. It would be nice to have someone in my corner sorting fact from fiction!

I was diagnosed hypothyroid about 25 years ago and have been taking mostly 100 mcg of levothyroxine, and occasionally 88 mcg. Only rarely did I take the medicine on an empty stomach in the morning at least 1/2 hour before food. Early on, the wait time was one hour. So I started taking the med at night, probably not always on an “empty” stomach. In the last 6 months I started to take the med properly. Now, my T3/T4 are okay, but the TSH is very low, so I’ve started to see an endocrinologist; just had some blood work and am awaiting results.

Indications point to my becoming hyperthyroid, so it has flipped. My eyes are dry, scratchy and tired, and drops do not help for long. I have been suffering with anxiety for years. I take trazidone for anxiety which helps me sleep, but I do not feel well-rested in the morning. I feel somewhat depressed and am aggravated easily. I feel like my problems may be self-induced by not following protocol. Looking forward to getting this resolved. My mother and siblings also take levothyroxine. Additionally, I have vasculitis, which is also an autoimmune disease.

I appreciate the information you provide in The People’s Pharmacy.

Lab tests for TSH showed some aberration. My PCP prescribed Levothyroxin (50 mg). Within a few weeks I was overcome with feelings of lightheadedness, fatigue and was always cold. While on the 50 mg dose my TSH tested at 1.6. He dropped the dose to 25 mg. While on the reduced dose my TSH was 3.2.No Change to my feelings of lightheadedness, fatigue and feeling cold.
I am now on something called levoxyl. Waiting and wondering what is going on.

From CH

When I learned that I had thyroid antibodies, I went on a gluten-free diet. The doctor performed 2 thyroid antibody blood tests, both of which returned a negative result after going on the diet. In addition, I lost weight and felt much better; and the thyroid symptoms disappeared!

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