Thyroid Disease and Diabetes: Patient Education

Both diabetes and thyroid disorders involve a dysfunction of the endocrine system, which is a group of glands that help regulate various aspects of the body's metabolism and essential biological functions.

Diabetes is a disorder characterized by an overabundance of glucose (sugar) in the blood due to insufficient insulin production by the pancreas (type 1 diabetes) or the inability of the body to utilize insulin to transport glucose into the cells (type 2 diabetes).

THE LINK BETWEEN DIABETES AND THYROID DISORDERS 

• Clinical research has found that diabetes and thyroid disease then to co-occur in patients.

• Almost one third of people with type 1 diabetes have been found to have thyroid disease. This is because type 1 diabetes and the most common thyroid disorders are autoimmune diseases, which are diseases in which the your immune system attacks a gland(s) or organ(s) of the body as it would an infection.

• People with autoimmune disease are more likely than the general population to develop other autoimmune diseases such as Addison Disease, Grave's Disease, Hashimoto's Thyroiditis  Pernicious Anemia,   Rheumatoid Arthritis   or   Lupus  and so on.

• Thyroid disorders are more common in type 2 diabetes patients because both these illnesses  tend to occur more  frequently as people age.

THYROID GLAND BASICS

• The thyroid is a butterfly shape gland at the base of the neck that lies across the trachea most commonly referred to as "the windpide". It produces and releases thyroid hormones.

• Thyroid hormones affect every cell of the body and controls many essential body functions.

• The amount of thyroid hormone made by the thyroid gland is regulated by the pituitary gland and the hypothalamus in the brain.

• The pituitary gland releases thyroid stimulating hormone (TSH) which signals the thyroid to produce more thyroid hormone. When the pituitary gland senses that there is a right amount of thyroid hormones in the body, it then decreases thyroid hormone production.
• Your doctor measures the health of your thyroid gland by measuring thyroid stimulating hormone levels. 

• Too little thyroid hormone production causes a condition known as hypothyroidism.

• Too much thyroid hormone production causes a condition knows as hyperthyroidism.

HYPOTHYROIDISM AND MILD THYROID FAILURE

• When a patient has hypothyroidism, he or she may feel tired and cold most or all of  the time, have a slow heartbeat, or feel depressed. 

• Mild thyroid failure is a mild form of hypothyroidism. In patients who have mild thyroid failure, the thyroid hormone levels are "normal", but the TSH LEVEL IS ELEVATED.

• Patients with mild thyroid failure often don't show any obvious symptoms, but untreated mild thyroid failure may lead to hypothyroidism.

 HYPERTHYROIDISM AND MILD HYPERTHYROIDISM

• Patients with hyperthyroidism may feel jittery and may experience nervousness, a rapid heartbeat or unexplained weight loss.

• Patients with mild mild hyperthyroidism have "normal" thyroid hormone levels, but the TSH LEVEL IS  DECREASED.  

• Untreated mild hyperthyroidism can progress to hyperthyroidism and may lead to potentially serious life threatening consequences such as cardiovascular disorders.

UNDERLYING THYROID DISORDERS CAN IMPACT DIABETES MANAGEMENT

• Thyroid disorders can have a major impact on glucose control, and untreated thyroid disorders can affect how diabetes is managed. 

• Hypothyroidism can decrease the insulin requirements in patients with diabetes. Symptoms of hypothyroidism are common patients with type 2 diabetes.

• Hyperthyroidism may worsen glucose tolerance or control. Symptoms of hyperthyroidism may be attributed to poor diabetic control in patients with type 1 diabetes.

• Underlying thyroid disorders may go undiagnosed because the common signs and symptoms of thyroid disorders are similar to diabetes and can be overlooked and/or attributed to other medical disorders.

TSH TESTING IS RECOMMENDED FOR PEOPLE WITH DIABETES

Because of the link between diabetes and thyroid disease,  the American Diabetes Association has recommended that people with diabetes be tested for thyroid disorders.

1. The TSH test, which measures the amount of thyroid stimulating hormone being produced in the body, is the best test for thyroid function.
2. A TSH test will give your doctor knowledge regarding the extent of thyroid function.
3. An elevated TSH Level may indicate hypothyroidism.
4. A low TSH level may indicate hyperthyroidism. 

HYPOTHYROIDISM TREATMENT BASICS

Hypothyroid patients can be treated with thyroid hormone replacement  therapy, usually with a synthetic thyroid hormone called levothyroxine sodium   

• Treatment will continue for the rest of a patient's life, with the doctor checking TSH levels every six months after the patient is stable and the correct dose is achieved for them. 

• Hypothyroidism may decrease the insulin requirement in patients with diabetes, therefore, a diabetic patient with hypothyroidism may need his/her diabetes medication dose adjusted. 

• Patients on hormone replacement therapy should not switch medication brands without checking with their doctors.

• Symptoms of fatigue, weight gain, cold hands or feet, hair loss, depression or any other new or  unusual symptom should be reported to your doctor as they may indicate your thyroid hormone replacement dose needs to be changed or adjusted.

• Hypothyroid patients should never, ever, stop a thyroid hormone replacement therapy without taking to their doctor.  Extremely low thyroid hormone levels can lead to coma and even death. 

HYPERTHYROIDISM TREATMENT BASICS

Patients with hyperthyroidism have 3 treatment options:

1. Take antithyroid drugs, which will slow down the thyroid's hormone production.
2. Radioactive iodine therapy, which will destroy thyroid cells in order to reduce the amount of thyroid hormone produce.
3. Finally, if all else fails or you are concerned and opposed to radioactive iodine therapy,  surgical removal of the thyroid gland may be recommended. 

Hyperthyroidism has been known to affect control of the amount of glucose in the blood, therefore,  treatment for hyperthyroidism should help control blood glucose levels but following treatment for hyperthyroidism many patients may develop hypothyroidism.

MORE INFORMATION: Patients who have further questions should contact their doctor. 

Thyroid Nodules Treatment

If your nodule is not cancer and is not causing problems, your doctor may watch your nodule closely. If your thyroid nodule is causing hyperthyroidism, your doctor may recommend a dose of radioactive iodine, which usually comes in a pill that you swallow. Your doctor may have you take medicine (antithyroid pills) for a few weeks to slow down the hormone production. Your thyroid hormone level needs to be normal before you can be treated with radioactive iodine.

If your nodule is cancer or is so large that it causes problems with swallowing or breathing, you'll need surgery to remove the nodule. You may also need treatment with radioactive iodine to destroy any left over cancer cells. After surgery, you may need to take thyroid medicine for the rest of your life.

Thyroid Nodule Surgery:  The extent of your thyroid nodule or tumor surgical removal will be determined by your doctor after evaluation your health history and diagnostic tests, family history and other factors.But in general either a partial or complete thyroidectomy (thyroid removal surgery), is recommended for:

• Thyroid cancer or indeterminate lesions that cannot be classified from a fine needle aspiration biopsy.

• Large thyroid nodules that cause obstructive symptoms, such as problems breathing or swallowing.

• Thyroid nodules that cause pain.

• Cosmetic reasons, to remove large visible thyroid nodules.

Radioactive Iodine: Iodine-131 concentrates in the thyroid tissue and cause tissue destruction. I-131 can be administered as a capsule or in liquid form.

• I-131 can be used to treat multinodular goiters with nodules that are producing extra thyroid hormone. Such cases are indicated by a low TSH level and elevated thyroid hormone level in the blood or a "hot" nodule on radionuclide thyroid scan. 

• After I-131 destroys the thyroid, the patient develops an underactive thyroid (hypothyroidism) and requires thyroid hormone replacement for life to maintain a normal level of thyroid hormones in the blood. Thyroid hormone replacement consists of simply a pill taken once daily by mouth, which is safe, easily tolerated, and relatively inexpensive.

Thyroid Hormone Suppression: There is controversy regarding whether physician-supervised administration of thyroid hormone may shrink the size of thyroid nodules. Many doctors believe that thyroid hormone does not effectively shrink nodules. Furthermore, there is the risk of high blood levels of thyroid hormone in patients with multiple thyroid nodules (multinodular goiter). However, clinical trials have shown that suppressive therapy may be successful in shrinking some thyroid nodules. Doctors may make this decision on a case-by-case basis and studies are still ongoing to determine the efficacy of this type of treatment. It is important to discuss the pros and cons of suppressive thyroid hormone therapy with your doctor.

Diagnosing Thyroid Cancer: Radionuclide Scanning Of The Thyroid

Thyroid Radionuclide Scanning

• This test is performed by a nuclear medicine specialist. After a small, safe amount of radioisotope (I-123 or Tc99) is taken by mouth or injected into a vein, the radiologist obtains pictures of the thyroid.
  
• Nodules can be seen as dark spots (called "cold") or bright spots (called "hot").
  
• Nodules that concentrate the radioisotope are "hot" and are usually making excessive thyroid hormone. "Hot" nodules are rarely associated with cancer and may not require FNAB investigation.
  
• Nodules that do not concentrate iodine are "cold" and are usually making less than normal amounts of thyroid hormone
   
  • More than 80%-85% of all thyroid nodules are "cold".
    
  • These nodules are typically more worrisome for cancer, and require evaluation with FNAB.

Diagnosing Benign Thyroid Nodules vs. Thyroid Cancer

FINE NEEDLE ASPIRATION BIOPSY (FNAB)

A biopsy is the only way to tell if a thyroid nodule is cancerous. But cancer may be more likely if you have:

• A single, hard lump that feels very different from the rest of the thyroid tissue or other thyroid nodules.
• A nodule that keeps growing for weeks or months.
• A nodule that does not move when you touch it.
• Swollen lymph nodes in your neck.
• A hoarse or scratchy voice that does not go away.

Some other conditions that cause similar symptoms include hyperthyroidism and thyroiditis.

• If a thyroid nodule is larger than 1 cm, or it has other worrisome characteristics seen on ultrasound or other imaging tests, then a FNAB may be performed.
  
  
• This office procedure does not require anesthesia and consists of passing small needles (similar to those used to draw blood from the arm) into the thyroid nodule in the neck. This is a quick and usually painless procedure.
  
  
• This procedure may be done on multiple nodules.
  
  
• Ultrasound guidance may be used to assist in the FNAB of nodules that are bigger than 1-1.5 cm but cannot be felt on physical examination.
  
  
• A sample of the contents of each nodule (to include fluid, blood, or tissue) are removed in the needle and examined by the pathologist under a microscope.
• Pathologists can identify certain features in the nodule sample.

FNAB results are characterized as one of the following:

• Benign: This is the most common outcome of a FNAB. The typical finding is a nodule filled with colloid protein, a normal component of the thyroid. Benign nodules can be followed over time with serial physical exams or ultrasound exams. Further intervention is only necessary if enlargement occurs or new symptoms develop. 
  
  
• Malignant: Some thyroid cancers can be diagnosed directly from the FNAB results (for example, papillary thyroid cancer). Other thyroid cancers cannot be diagnosed from the FNAB results (such as follicular thyroid cancer) because the diagnosis rests not simply upon the appearance of the tissue within the nodule, but also on the level of the invasion of surround blood vessels and tissue by the nodule. For these nodules, surgical removal of a portion or the entire thyroid is recommended.
  
  
• Indeterminate: This is neither definitively benign nor malignant. Given that the risk for cancer is increased by 20% in such cases, surgical removal of a portion or the entire thyroid is typically recommended. Often, a radionuclide scan will be done to obtain functional information (if the nodule is actively producing thyroid hormones) in order to avoid an unnecessary surgery.
  
  
• Non-diagnostic: This means that there are not enough of the tissue cells present in the sample to make a diagnosis. Non-diagnostic FNABs will typically result in a repeat FNAB or definitive surgery.

Cystic nodules more often result in a non-diagnostic FNAB due to higher fluid content than solid content in the sample obtained from the nodule.

Thyroid Nodule Diagnosis: The Basics

A physician performs an exam of you neck using his/her hands.

• Larger and more anteriorly (front) located nodules can be felt by the examiner.
  
• A physician will ask about any other medical history and any risk factors for thyroid nodules or cancer, including family history of thyroid cancer or radiation exposure of the head or neck.

Blood tests

• Thyroid stimulating hormone (TSH) levels and levels of thyroid hormone can indicate whether the thyroid is under- or overproducing thyroid hormones.
  
• Anti-thyroid antibody levels can indicate the presence of autoimmune thyroid inflammation that can be seen with Hashimoto's thyroiditis (underactive thyroid disease) or Graves's disease (overactive thyroid disease).
  
• Calcitonin levels in the blood can indicate a specific type of thyroid cancer, known as medullary carcinoma of the thyroid. However, calcitonin testing is generally not recommended as part of an initial evaluation of a thyroid nodule.

Ultrasound of the thyroid

This is a test that uses sound waves to take a picture of the thyroid. Similar to the prenatal ultrasound of the fetus, a cold lubricant jelly is placed on the neck; then, using an external probe, ultrasound images of the thyroid gland are obtained.

An ultrasound can reveal which thyroid nodules are larger than 1-1.5 centimeters, requiring further evaluation for cancer. In addition to size, other nodule characteristics that can be noted on a thyroid ultrasound include the following:

• number of nodules,
  
• location of nodules,
  
• distinctness of borders,
  
• fluid versus solid contents,
  
• other nodule contents, such as calcium deposits, or
  
• the amount of blood flow (certain newer ultrasound machines can assess blood flow to the thyroid and its nodules).

Thyroid Nodules Symptoms

Most people with thyroid nodules have no symptoms. 

Most thyroid nodules do not cause symptoms and are so small that you cannot feel them. They often are found during a physical exam or when another test, such as a CT scan or ultrasound, is done for a different reason. If your thyroid nodule is big, you may be able to feel it or you may notice that your neck is swollen

Patients may notice the following:

• A lump seen in the neck.
  
• A lump felt in the throat.
• Hoarseness of the voice.
• Difficulty swallowing and/or breathing.
• Other enlarged glands or lymph nodes in the neck.
• Rapidly growing lump or swelling in the neck. 
• Pain is only rarely associated with thyroid nodules.

Nodules may be found:

• By a physician during a routine physical exam
  
• During computed tomography (CT scan), magnetic resonance imaging (MRI), or ultrasound of the neck

Thyroid Nodules Causes

Causes of thyroid nodules can be classified as benign or malignant. 

                     

Experts do not know the exact cause of thyroid nodules. But they do know that people who have been exposed to radiation have a greater chance of developing thyroid nodules. Exposure to environmental radiation or past radiation treatment to the head, neck, and chest (especially during childhood) raises your risk for thyroid nodules.

Experts know that thyroid nodules run in families. This means you are more likely to have a thyroid nodule if one of your parents has had a thyroid nodule. Also, if you have another thyroid condition (such as goiter), you may have a greater chance of developing thyroid nodules.

Benign Thyroid Nodules

• Multinodular goiter: Multinodular goiter is an overall enlargement of the thyroid gland (called goiter) can result from nodules containing too many normal thyroid cells (referred to as hyperplasia) and/or filled with extra colloid. Colloid is the protein-containing substance normally storing thyroid hormone inside the thyroid gland.

• Hashimoto's thyroiditis: Hashimoto's thyroiditis is the most common form of underactive thyroid disease, this form of hypothyroidism can be associated with thyroid nodules and goiter.

• Thyroid Cyst: Commonly caused by a nodule which is bleeding or degenerating (breaking down), these blood or colloid-filled nodules can be associated with thyroid pain.

Benign thyroid tumors (thyroid adenomas)

• Hurthle cell adenoma
• Follicular adenoma

Malignant Thyroid Nodules

Thyroid Cancer (also called thyroid carcinomas)

• Papillary thyroid carcinoma
• Follicular thyroid carcinoma
• Anaplastic thyroid carcinoma
• Medullary thyroid carcinoma
• Thyroid lymphoma
• Metastatic cancers from other sources, including breast, kidney and lung cancers

Thyroid Nodules Overview

Most thyroid nodules do not cause problems and are not cancerous. They are often hard to notice because they are so small. Lots of people have thyroid nodules that are never found or treated. There are three kinds of thyroid nodules: solid nodules, nodules that are filled with fluid (cystic nodules), and nodules that are partially cystic. You can have one thyroid nodule or several thyroid nodules (multinodular goiter). 

You can also have some nodules that are solid and some that are cystic. Solid nodules may grow slowly over time. In rare cases, cystic nodules bleed, which can cause them to grow suddenly and become painful. Thyroid nodules usually do not prevent the thyroid gland from doing its job. But sometimes a noncancerous thyroid nodule can cause:

• Hyperthyroidism. - when one or more nodules makes too much thyroid hormone. Hyperthyroidism is treated with antithyroid medicine, possibly radioactive iodine, and very rarely, surgery. Hyperthyroidism from thyroid nodules is not very common. It occurs in fewer than 1 out of 100 people who have thyroid nodules.

• Difficulty breathing or swallowing. -Sometimes, one or more large nodules can press on your windpipe (trachea) or on your esophagus. These kinds of nodules have to be surgically removed.

FAST FACTS: 

• Only about 5 out of 100 thyroid nodules are cancerous.
• Thyroid nodules are simply "lumps" which are either solid or fluid-filled. 
• The main function of the thyroid gland in the neck is to make thyroid hormone, which is essential for normal growth and metabolism.
• Autopsy studies have revealed that up to 50% of all adults die carrying at least one thyroid nodule. These people may or may not have been aware of the presence of their thyroid nodules.
  
• Thyroid nodules are found more commonly as people age.
  
• Most of these thyroid nodules are benign and not cancerous.
  
• Only 5% of all thyroid nodules will be discovered to be thyroid cancer. 
• Finding cancer in a thyroid nodule is more likely in a person under the age of 30 or over the age of 60.

Your Thyroid Gland: The Basics Review

The thyroid is an organ that is considered part of the endocrine, or hormone, system. It is located in the neck below the Adam's apple. The thyroid's main purpose is to produce thyroid hormones. These hormones then travel through the bloodstream to all the other tissues and organs to help control metabolism in adults and growth, development, and metabolism in children.

• The thyroid is shaped like a butterfly. The two "wings" of the butterfly are the right and left lobes of the thyroid, with lie on both sides of the trachea or main breathing tube. The connection between the wings is called the isthmus.
  
  
• The two hormones that the thyroid produces are L-thyroxine(T4) and tri-iodothyronine (T3).

• The thyroxine (T4) and tri-iodothyronine (T3) hormones regulate your body's metabolic functions such as heat generation, and the utilization of carbohydrates, proteins, and fats. In children, thyroid hormones are responsible for growth and development.
  
  
• Regulatory hormones from different parts of the brain control the thyroid's production of T4 and T3. In the pituitary gland, thyrotropin-stimulating hormone (TSH) is released when more thyroid hormone is needed and travels via the bloodstream to the thyroid gland. TSH then stimulates the thyroid to produce T4 and T3.
  
  
• The pituitary gland acts like a thermostat. When there is too much thyroid hormone in the bloodstream, the pituitary releases less TSH to signal the thyroid to produce less thyroid hormone. When there is too little thyroid hormone in the bloodstream, the pituitary releases more TSH to signal the thyroid to increase thyroid hormone production. Through this "feedback" system, the production of thyroid hormone is tightly controlled.

Body Temperature and Thyroid Problems

When your thyroid hormone is working properly inside cells you will make 65% energy and 35% heat as you burn calories for fuel. Thyroid hormone is governing your basal metabolic rate, orchestrating the idling speed at which all cells make energy and thus heat. A classic symptom of poor thyroid function is being too cold. And conversely, a classic symptom of hyperthyroidism is being too hot (making too much heat). However, many people with slow thyroid are too hot, a seeming paradox that I will explain shortly.

Generally, you know all too well if you fit into the too cold category. You always want the thermostat set higher than everyone else or you have on an extra layer of clothes. You go to bed with socks on your feet or you want extra layers of blankets. When this type of coldness matches up with the symptoms of thyroid-related fatigue, you fall into the classic pattern of sluggish or hypothyroid.

In many cases of poor thyroid function a cold feeling is not quite so obvious. Dr. Broda Barnes pioneered the use of the basal temperature test to help identify sluggish thyroid function. This is done by placing a thermometer (not digital) under your arm for ten minutes before getting out of bed. This should be done ten days in a row, averaging the daily reading. Menstruating women should start their ten day test when their menstrual cycle begins, as basal temperature naturally rises 2 degrees at ovulation. If your waking temperature averages from 97.8 to 98.2 degrees it is normal. Less than 97.8 reflects sluggish thyroid function.

It should be noted that there are other factors besides thyroid that can make a person run too cold. Common ones include:

A) Protein malnutrition that is resulting in a loss of muscle. Individuals with borderline thyroid should eat at least ½ their ideal weight in grams of protein per day (avoiding excessive intake of soy protein).

B) Nutrients lacking for cellular energy production (co-enzyme B vitamins, Q10, magnesium).

C) Nutrients lacking to implement cellular DNA thyroid instructions (iron or zinc).

D) Excessive stress, which pools blood around central organs and makes hands and feet cold. Anti-inflammatory nutrients are required to fix this, along with stress management. Fish oil and squalene are very helpful.

E) A viral infection, even a subclinical viral infection. Viruses hijack cellular energy production, shutting down energy and heat production, and making excess lactic acid. This leaves one feeling cold and achy from the lactic acid. This is why you get the chills from the flu. Many viruses, like Epstein-Barr or cytomegalovirus, can operate on a low grade basis – enough to make a person cold, tired, and achy. Such individuals often wake up with a sore throat in the morning. Monolaurin is a top choice for nutrient support.

These coldness issues can masquerade as thyroid problems, and in some cases may in fact be the primary cause of the hypothyroid symptoms. The proof of the source of the problem is in the solution. Whatever helps get energy on and temperature up is what is needed. Sometimes this means thyroid support nutrition. Sometimes it is addressing any issue in A-E above. And many times it is some combination of approaches, including thyroid support.

Many individuals with hypothyroid symptoms are not cold and may even be hot. Remember, normal cell energy production is 65% energy and 35% heat. In classic low thyroid both numbers drop. However, if thyroid hormone is still signaling cells to go, but cells lack nutrients to properly make energy, then a person may make 50% energy and 50% heat. If the problem worsens a person could make 35% energy and 65% heat (and lots of anxiety). Such a problem will present itself as low thyroid, but it is really a deficiency in energy-producing nutrients like co-enzyme B vitamins, Q10, magnesium, and antioxidants.

The most common reason for true low thyroid with excess heat occurs in the overweight individual. In this case the body is trying to dispose of surplus fat calories by converting them to 100% heat. Even though cells are not making adequate energy or heat, the heat is coming from the desperate attempt of the body to get rid of fat so it doesn’t clog organs, cells, and arteries. Eating according to the Leptin Diet solves this problem. Since excess heat produces too many free radicals, extra antioxidants are a good idea.

As thyroid problems deteriorate a person becomes both heat and cold intolerant. Hot humid days are stressful; frigid winter days are stressful. The body’s heat regulating system simply struggles to keep up with environmental demands, especially when they are more extreme. Aging is generally associated with deteriorating thyroid function and troubles regulating body temperature.

Understanding your body’s heating and cooling system is central to effectively managing thyroid health.

Hyperthyroidism and Your Heart Health: What you should Know

In hyperthyroidism, caused by the overproduction of thyroid hormone, the heart muscle is "whipped" like a horse, and for a person with heart disease it's like whipping a tired horse. Thyroid hormone increases the force of contraction of, and the amount of oxygen demanded by, the heart muscle. It also increases the heart rate. For these reasons the work of the heart is greatly increased in hyperthyroidism. Hyperthyroidism increases the amount of nitric oxide in the lining of the blood vessels, causing them to dilate and become less stiff.

Cardiac symptoms of hyperthyroidism

Cardiac symptoms can be seen in anybody with hyperthyroidism, but can be particularly dangerous in people with underlying heart disease. Common symptoms include:

·         Fast heart rate (tachycardia) and palpitations. Occult hyperthyroidism is a common cause of an increased heart rate at rest and with mild exertion. Hyperthyroidism should always be ruled out with blood tests before making the diagnosis of Inappropriate Sinus Tachycardia. Especially in patients with underlying heart disease, hyperthyroidism can also produce a host of other arrhythmias such as Premature Ventricular Complex (PVC’s) ,  ventricular tachycardia and especially atrial fibrillation. Indeed, it is important to rule out hyperthyroidism in a patient with atrial fibrillation and no clear underlying cause.

·         Systolic hypertension. The forceful cardiac contraction increases the systolic blood pressure, though the increased relaxation in the blood vessels reduces the diastolic blood pressure.

·         Shortness of breath on exertion. This can be due to the skeletal muscle weakness cause by hyperthyroidism, or to a worsening in heart failure.

·         Heart failure. Hyperthyroidism itself can produce heart failure, but this condition is relatively rare. On the other hand, if pre-existing heart disease is present, worsening of heart failure with hyperthyroidism is common, and can be extremely difficult to treat.

·    Worsening angina. Patients with coronary artery disease often experience a marked worsening in symptoms with hyperthyroidism. These can include an increase in chest pain (angina) or even a heart attack.

As with hypothyroidism, hyperthyroidism can be present - and often is - without the classic, textbook symptoms. So patients with any of these cardiac symptoms that cannot otherwise be readily explained should have thyroid function measured. Furthermore, sometimes a "mild" hyperthyroidism can exist in which thyroid blood tests can be misinterpreted. In these cases thyroid hormone levels themselves are normal, but the level of thyroid stimulating hormone (TSH - a hormone excreted by the pituitary gland that regulates the thyroid gland) is low. 


A low TSH indicates hyperthyroidism, despite "normal" thyroid hormone levels. This pattern of thyroid blood tests especially ought to be sought in all patients displaying any of the above symptoms with no clear reason for them.

Treating hyperthyroidism

The "best" way of treating hyperthyroidism is controversial. In the U.S., most doctors immediately opt for ablating the overactive thyroid gland with radioactive iodine, then giving the patient thyroid hormone pills since the thyroid gland is no longer functional. This method is certainly "easiest" for the doctors, but often patients are left feeling chronically abnormal. Using drugs to partially suppress the thyroid gland - in the U. S., Tapazole or PTU - creates somewhat more of a long-term management issue for doctors, but may lead to ultimately happier patients.

Hypothyroidism's and Your Heart Health: What You Should Know

February is American Heart Month, and unfortunately, most of us know someone who has had heart disease or stroke and this month we will discuss how your thyroid health affects your heart health as well.

The thyroid, a small gland located in the neck, is responsible for modulating many vital bodily functions. By producing just the right amount of thyroid hormone, it helps to regulate the body's metabolism (specifically, how much oxygen and energy the body uses), as well as digestive function, muscle function, and the normal integrity of the skin. In fact, the thyroid has at least some effect on every organ in the body - including the heart.

For people with almost any type of heart disease, disorders of the thyroid gland can worsen old cardiac symptoms or cause new ones, and can accelerate the underlying heart problem. Even worse, doctors frequently forget to think about the thyroid when cardiac symptoms are worsening, and if they don't think of it they will miss it. Often, it's the savvy patient who reminds the doctor that thyroid function ought to be checked. This is why it is useful for those with heart disease to know a little about the cardiac effects of thyroid disease.

Disorders of the thyroid gland usually involve either the failure to produce enough thyroid hormone (hypothyroidism) or the production of too much (hyperthyroidism). Both types of thyroid disorders are common.

Hypothyroidism and the heart

Thyroid hormone is very important for normal cardiovascular function, so when not enough thyroid hormone is present neither the heart nor the blood vessels function normally. In hypothyroidism the heart muscle is weakened in both its contraction phase, and also its relaxation phase. This means that the heart cannot pump as vigorously as it should, and the amount of blood it ejects with each heart beat is reduced. In addition, because the heart muscle does not relax normally in between heart beats, a potentially serious condition called diastolic dysfunction may result. (Read about diastolic dysfunction here). Furthermore, hypothyroidism reduces the amount of nitric oxide in the lining of the blood vessels, causing them to stiffen.

Cardiac symptoms of hypothyroidism

Cardiac symptoms can be seen in anybody with hypothyroidism, but are especially likely in an individual who already has underlying heart disease. Common symptoms include:

·         Shortness of breath on exertion and poor exercise tolerance. These symptoms, in most patients with hypothyroidism, are due to weakness in the skeletal muscles; but in patients with heart disease, the symptoms may be due to worsening heart failure.

·         Slow heart rate (bradycardia.) The heart rate is modulated by thyroid hormone, so that in hypothyroidism the heart rate is typically 10 - 20 beats per minute slower than normal. Especially in patients who also have heart disease, however, hypothyroidism may worsen the tendency for premature beats and even tachycardias such as atrial fibrillation.

·         Diastolic hypertension. One might think that, because a lack of thyroid hormone slows down the metabolism, people with hypothyroidism might suffer from low blood pressure. Usually the opposite is true - the arteries are stiffer in hypothyroidism, which causes the diastolic blood pressure to rise.

·         Worsening of heart failure, or the new onset of heart failure. Hypothyroidism can make well-controlled heart failure worsen, and can produce heart failure for the first time in patients with relatively mild underlying heart disease.

·         Edema (swelling.) Swelling can occur as a result of worsening heart failure. In addition, hypothyroidism itself can produce a type of edema called myxedema, caused by an accumulation of abnormal proteins and other molecules in the interstitial fluid (fluid external to the body's cells.)

·    Worsening of coronary artery disease. While the reduction in thyroid hormone can actually make angina less frequent in patients who have angina, the increase in LDL cholesterol  (bad cholesterol) and in C-reactive protein seen with hypothyroidism can accelerate any underlying coronary artery disease.

Hypothyroidism can be an extremely subtle condition, and often occurs without the typical, constellation of "textbook" symptoms doctors usually expect. It also occurs far more commonly than most doctors realize. So if you have any of these symptoms and your doctor does not have a ready or convincing explanation for them, especially if you already have heart disease of any type, ask your doctor to measure thyroid hormone levels.

Happy Thyroid -Healthy Heart!

February is not just all about Valentine’s Day, chocolates and hearts. It’s also a good time to  focus  on self love and a little awareness of a butterfly-shaped hormone gland known as the thyroid. 


The thyroid has the difficult task of controlling your metabolism, growth, development, and body temperature. The thyroid gland is located on the throat and wraps around the windpipe. The presence of too much or too little thyroid hormone is determined by a blood test. So how will you know if you have an over or underactive thyroid and why would it happen?

There are many ways thyroid function to be affected, including the body attacking itself or cancers. Graves disease is an autoimmune disease that causes an increase in thyroid hormone. Overactive thyroid causes symptoms like more frequent bowel movements, feeling anxious, increased body temperature and sweating, loss of hair, increased heartbeat, and weight loss even with having increased appetite. It can also affect the menstrual cycle by causing lighter, shorter periods. It also possible to develop a goiter which is an enlarged thyroid gland. 

This condition is usually treated with medication to block the stimulation of the thyroid, removal of the thyroid, or radioactive iodine to help shutdown overactive thyroid cells. Many of these procedures end up causing patients to have an underactive thyroid that has to be treated with medication.

Underactive thyroid can also be caused by autoimmune disorders and the symptoms are pretty much the opposite to hyperthyroidism including feeling cold, lethargic, weight gain and constipation. Hypothryoidism, as it’s also called, can be treated with oral medications that are a replacement of thyroid hormone. Common names are Synthroid and levothyroxine.

Based on your lab results doctors will adjust your dosage to try and get you to the appropriate thyroid level. It may take months, even years, for this to happen. If you are still experiencing low thyroid symptoms the doctor will raise the dose, and vice-versa if you are experiencing symptoms of hyperthyroidism. The treatments have not changed much over the years although there are many developments in treating thyroid cancer.

It is important to know that thyroid hormone deficiencies often run in families so make sure you tell your primary care physician if anyone in your family has thyroid issues. If you do develop any of these symptoms you may want to be referred to an endocrinologist. Endocrinologists specialize in hormone disorders such as with the thyroid and diabetes. 

If you are experiencing any of these symptoms we would not recommend going the herbal or homeopathic route. Going untreated these disorders could have a long term effect on your mental abilities as well as effect other organ systems. We would also strongly discourage using hypothyroid medications as a weight loss tool as it has been in the past. The side effects and especially the effects on the heart are not worth the benefits that weight loss may have. 

If you think you are experiencing any of the symptoms of either type of thyroid disorder don’t hesitate to ask your doctor. Treatment may help you feel more like yourself again.