Certain aspects of healthcare remain misunderstood, perhaps even among healthcare providers. Our new column addresses some misconceptions. This edition focuses on thyroid disease.
A condition that not all that long ago went widely undiagnosed, thyroid disease in the United States affects an estimated 20 million people today, according to the American Thyroid Association. Screening measures have become heightened due to the previously a prevalent underdiagnosis and research in the field has helped to improve awareness of thyroid disease among all ages – from those born with congenital hypothyroidism to those living with Graves’ disease, which is more likely to affect those ages 30 and older.
Despite such progresses, disorders of the thyroid go unknown in up to 60 percent of those with the disease.1
Elite CE recently spoke with endocrinology specialists about some other aspects of hyperthyroidism (overactive thyroid gland) and hypothyroidism (underactive thyroid gland), both of which can lead to life-threatening complications the longer they go untreated or not treated appropriately.
Myth: When you have a thyroid disorder, the symptoms lead you to know about its presence.
“Symptoms of both hypo- and hyperthyroidism can be non-specific and easy to ignore,” says Maria Papaleontiou, MD, assistant professor with the University of Michigan. This underscores one of the main motives for more aggressive screening measures today. “There has definitely been an increase in the diagnosis of thyroid disease in general in recent years,” Papaleontiou continued. “As thyroid disease is more common in women, more women are therefore being diagnosed. The reasons for this trend are multifactorial, including increased screening, i.e. case-finding, for thyroid disease even in asymptomatic individuals, which in turn leads to detection of more subclinical thyroid disease, also known as mild thyroid dysfunction.” Mild thyroid dysfunction is diagnosed when peripheral thyroid hormone levels are within normal reference laboratory range, but serum thyroid-stimulating hormone (TSH) levels are mildly elevated.2 The most important implication of subclinical thyroid disease is high likelihood of progression to clinical hypothyroidism.2
Myth: For hypothyroidism, more thyroid hormone is better.
“There is a widespread misconception that more thyroid hormone when treating hypothyroidism is better in terms of giving extra energy and helping with losing weight,” said Papaleontiou. “While we agree that finding the right dose of thyroid hormone replacement is important, taking too much thyroid hormone can cause adverse effects, such as heart palpitations, tremors, insomnia, and bone loss in the long-term.” When it comes to hyperthyroidism and treatment, once the level of thyroid hormone has been reduced to a normal level the rate of bone loss will no longer be so rapid and the bone strength may improve.3 Some patients, however, will have persistent bone loss, with or without thyroid disease, and postmenopausal women are at particularly high risk.3
Myth: Patients diagnosed with thyroid disease cannot become pregnant.
“Even though both undiagnosed and untreated hypothyroidism and hyperthyroidism can lead to difficulties with fertility and make it difficult to conceive, once these conditions are successfully and adequately treated, pregnancy can successfully and safely be achieved, unless other factors exist that may be affecting fertility.” In women, low levels of thyroid hormone can interfere with the release of the egg from the ovary.4 In addition, some of the underlying causes of hypothyroidism — such as certain autoimmune or pituitary disorders — may impair fertility.4 A number of research papers have focused on the effects of thyroid hormone on testicular development and function, as well as on the relationship between altered thyroid status and infertility.5
Myth: The presence of thyroid nodules identified thyroid cancer.
“The majority, 90-95 percent of thyroid nodules are benign, with approximately half of the women over the age of 40 having them,” Papaleontiou said. “If a nodule develops in the thyroid, the discussion should be whether it would meet criteria for a biopsy to determine if it’s cancerous.” Related to thyroid and the potential for cancer, Papaleontiou said it is generally safe to delay biopsy of a thyroid nodule in the era of this pandemic, as most thyroid nodules are benign. “Even if thyroid nodules are suspicious or cancerous, there is little risk in delaying surgery to have them removed in the majority of cases,” she said. “Thyroid surgery is considered essential in cases where patients have compressive symptoms, such as difficulty swallowing or breathing due to the tumor size, there is evidence of invasion of other parts of the neck or the biopsy showed aggressive forms of thyroid cancers.”
Myth: Hypothyroidism causes obesity.
“Many patients will say, ‘I can’t lose weight, I must have trouble with my thyroid,” said Peter Singer, MD, a physician in the Keck School of Medicine of the University of Southern California. “But hypothyroidism does not cause obesity – period. For context, when you’re hyper and overactive, your metabolic rate increases. You burn more calories. And by burning more calories, you compensate by eating more. Despite this, patients may still lose weight because their bodies are so metabolically overactive. With hypothyroidism, when you don’t need as many calories because your metabolism is slow, your appetite actually decreases as a compensation and, as a result, you don’t gain that much weight. So, as a baseline, it’s unusual to gain more than 8-10 percent of your baseline weight, unless you’re significantly hypothyridic. However, if you take enough of the medication it could cause weight loss.”
Myth: Desiccated thyroid hormone preparations are natural.
“Desiccated animal thyroid mainly obtained from pigs used to be the most common form of thyroid hormone therapy before synthetic thyroid hormones were discovered,” said Papaleontiou. “However, since pills are made of animal thyroid and they are not purified, they contain proteins that are not naturally occurring outside the thyroid gland. Additionally, the balance of the active thyroid hormones is not the same in animals as it is in humans, and so this is not necessarily ‘natural’ for the human body. Desiccated animal thyroid pills also have chemical binders in them to hold them together, and thus are not ‘natural.’”
References
- General information/press room. American Thyroid Association. 2020. Accessed online: www.thyroid.org/media-main/press-room
- Fatourechi V. Subclinical hypothyroidism: an update for primary care physicians. Mayo Clin Proc. 2009; 84(1):65–71.
- Thyroid disorders and osteoporosis. British Thyroid Foundation. 2018. Accessed online: www.btf-thyroid.org/thyroid-disorders-and-osteoporosis
- Hypothyroidism and infertility: Any connection? Mayo Clinic. 2019. Accessed online: www.mayoclinic.org/diseases-conditions/female-infertility/expert-answers/hypothyroidism-and-infertility/faq-20058311
- La Vignera S, Roberto V. Thyroid dysfunction and semen quality. Int J Immunopathol Pharmacol. 2018; 32:2058738418775241.
