FAQs From Thyroid Patients
Below are the most common questions asked by my audience. The answers below are based on supporting practitioners and the researched material on this site.
Thyroid Conditions and Symptoms
What does the thyroid gland do? How does it work?
The thyroid is a vitally important gland that sits low on the front of the neck. Your thyroid is butterfly-shaped with two lobes and lies just below your Adam’s apple, in front of the windpipe. It is a gland that plays an essential role in metabolism, growth and maturation of the body. It helps to regulate many body functions since every cell in the body requires thyroid hormone for proper functioning. The gland produces several hormones, one of which is thyroxine (also known as T4) and another known as triiodothyronine (also known as T3), the active thyroid hormone. Twenty percent of the body’s triiodothyronine is made by the thyroid gland; the other 80% comes from thyroxine converted by organs such as the liver or kidneys. The thyroid gland also produces T1, T2 and calcitonin. Calcitonin is understood to play a role in regulating calcium levels in the body. For more information on thyroid disease, please see my Conditions & Symptoms page.
How do I know if I’m hypothyroid or hyperthyroid?
Proper and thorough thyroid testing along with a comprehensive symptom investigation by your doctor will tell you if you are hyperthyroid or hypothyroid. Hyperthyroidism will generally have very low markers of TSH, and hypothyroidism will generally have high markers for TSH. However, TSH can misrepresent the true thyroid state due to pituitary and hypothalamus problems. It is also not the only screening method for diagnosing thyroid disease. For instance, many patients have a “normal” TSH lab result, but have low levels of Free T3, indicating hypothyroidism. For more information regarding the types of thyroid disease, please visit my Conditions & Symptoms page and my Testing page.
What is the difference between Hashimoto’s thyroiditis and hypothyroidism?
Hypothyroidism is commonly caused by Hashimoto’s thyroiditis, but the two terms are not the same. Hashimoto’s thyroiditis is an autoimmune disease with an elevated presence of either of these antibodies: thyroid peroxidase antibody (TPOAb or anti-TPO) or thyroglobulin antibody (TgAb). These antibodies react against the proteins in the thyroid, causing gradual destruction of the gland. The gland then becomes unable to produce the thyroid hormones that the body needs, resulting in hypothyroidism. A patient does not need to have elevated levels of TSH to have Hashimoto’s thyroiditis.
Hypothyroidism is a form of thyroid dysfunction where there are low levels of thyroid hormone or an underactive thyroid gland. It is most often caused by Hashimoto’s thyroiditis. To test for hypothyroidism, a physician should administer the following labs: Free T3, Free T4, TSH, and Reverse T3. TPOab and TgAb should also be tested as well to screen for Hashimoto’s. Hypothyroidism and Hashimoto’s may have similar symptoms depending on the level of function of the thyroid gland itself. Some patients with Hashimoto’s also report fluctuating hypothyroid and hyperthyroid symptoms. Please visit my Thyroid Basics page to learn more about disorders, proper testing, and treatment options.
What is the difference between Graves’ Disease and hyperthyroidism?
Graves’ disease is an autoimmune disease where antibodies attack the thyroid gland, causing hyperthyroid symptoms in most cases. It is the most common cause of hyperthyroidism. The thyroid stimulating hormone receptor antibody (TRAb) and the thyroid-stimulating immunoglobulins (TSI) tests can assist in the screening for Graves’ disease. With Graves’, the body starts producing these antibodies which overstimulate the thyroid gland, causing it to produce too much thyroid hormone.
Hyperthyroidism is a disorder in which the thyroid gland is producing an excess amount of thyroid hormone. This condition causes a wide range of symptoms due to elevated levels of circulating thyroid hormones. As with hypothyroidism, hyperthyroidism can affect many organ systems in the body and can cause a wide range of clinical symptoms. The condition can be usually detected by the results of the TSH, T4, Free T4, Free T3 and radioactive iodine uptake (RAI-U) tests. Please visit my Thyroid Basics page to learn more about the disorders, proper testing, and treatment options.
Will I lose weight if I have an underactive thyroid? Will I gain weight if I have an overactive thyroid?
There are hundreds of symptoms of thyroid disease. Patients can have any number of these symptoms and each symptom can vary in degree from individual to individual. A common symptom of hypothyroidism is weight gain or the inability to lose weight. A common symptom of hyperthyroidism is weight loss or difficulty in gaining weight. However, not all patients will display these symptoms. If you are currently being treated for thyroid disease but are still having difficulties with weight, it might be due to your treatment type or dosage amount which may not be optimal for you. Your physician should be looking at all factors including optimal thyroid balance and other possible conditions to determine the cause of remaining symptoms.
Why did my doctor write me a prescription for anti-depressant or anti-anxiety medication?
Depression and anxiety are common symptoms of thyroid and adrenal dysfunction and many doctors miss this association. Proper thyroid treatment may be all that is needed to alleviate these issues. It is possible that you may not have optimal levels of thyroid hormone levels or that you have undiagnosed thyroid disease with these symptoms. Visit my Resource Library page to read more about the association. Please note that there may be other underlying conditions besides thyroid disease that could be the cause of depression or anxiety in patients.
Finding a Thyroid Doctor
Where can I find a good doctor who will order a full thyroid panel or prescribe treatment options?
Visit our Patient-Recommended Doctor List. This will allow you to search for patient recommended doctors in the U.S. or internationally. Some patients have found that calling their local pharmacy (or compounding pharmacy) and asking what doctor prescribes a specific thyroid medication (i.e. Armour, Cytomel, compounded T3/T4). This can help them locate a doctor who is open to treatment options. For other tips and resources about how to find a doctor, please click here.
How do I get my current doctor to order full thyroid labs or to prescribe treatment options beyond levothyroxine?
Unfortunately, not every doctor is aware of the comprehensive methods for diagnosing and treating thyroid disease. However, you can show your doctor the information on ThyroidChange’s Testing page and Medication Options page to help explain why full thyroid labs and treatment options are necessary. You may wish to find a more knowledgeable doctor who has experience in diagnosing and managing thyroid disease in my Find A Doctor page.
Do you have articles or research that I can take to my doctor?
Yes. Visit my Resource Library page that provides many credible sources of material that might be helpful as you speak with your doctor.
I live outside of the U.S. Where can I find help?
Unfortunately, finding a doctor willing to run comprehensive thyroid labs and provide treatment options in some countries can be challenging. However, resources are available on my website to help patients find help. Please visit my Find a Doctor page for tips and for a listing of doctors who have been recommended in countries outside the U.S. There is also a Patient Forum page of international support forums and groups that may help you find a doctor.
Will insurance companies pay for full thyroid labs or for seeing any doctor?
This will depend on the doctor, the laboratory, and your insurance company. Many patients find that they can submit an “out of network” claim to their insurance company and be reimbursed for partial expenses. It is a good idea to ask in advance. It’s important to note that many insurance companies place restrictions on the time and testing services that doctors can provide, such as with integrative or functional medicine doctors. Many patients are finding that they are finding the best luck with these doctors.
Labs and Test Results
What lab tests do I need?
A comprehensive thyroid panel is recommended for screening as well as careful attention to the patient’s symptom report. Free T3, Free T4, TSH, thyroid antibodies, and Reverse T3 should be tested along with a complete metabolic panel, CBC profile and nutrient tests. More information about thyroid testing and the reason for each of these tests can be found on my Testing & Diagnosis page.
Why are my labs in normal range when I have classic symptoms of thyroid disease?
Diagnosis should be based on clinical presentation in conjunction with laboratory results that serve as a guide. Lab ranges provide a large range of what “normal” levels could be, however, these ranges do not account for what is optimal for each individual. Also, current research and a growing number of physician reports suggest that the TSH test is not a sufficient measure of overall thyroid function and can be unreliable in many cases. Many physicians are finding that their patients have normal, in-range TSH levels, but do not have optimal levels of Free T3, Free T4, or Reverse T3. Please see my Testing & Diagnosis page for more information on lab testing and optimal levels. It is also important to note there is a small sub-group of patients who are antibody negative for Hashimoto’s or Graves’ disease, but are displaying symptoms. Your physician should be looking at all factors including family history, symptom presentation, and the results of a comprehensive thyroid panel.
Why did my doctor only test TSH?
The thyroid stimulating hormone (TSH) lab test is often considered the diagnostic “gold standard” for thyroid disease among many physicians. A thyroid disorder is typically diagnosed if the TSH level is above the normal range (hypothyroidism) or if the TSH level is below normal range (hyperthyroidism). However, many patients continue to suffer from ongoing symptoms despite a “normal” TSH. Your doctor may not be aware of the comprehensive thyroid tests to get the full picture of how your thyroid is functioning. If your doctor is only testing TSH, please read the FAQs under “Finding a Doctor” on this page. For more information on testing, please see my Testing & Diagnosis page.
What do my test results mean?
Please see my Testing & Diagnosis page for general guidelines about recommended tests and optimal ranges. Normal, in-reference range lab results may not be what is optimal for you. “Optimal” ranges provided by some of the top integrative thyroid practitioners are noted on this page. Keep in mind that lab results are simply guidelines and your doctor should be using them in conjunction with the patient symptom report and family history when making a diagnosis.
How do I test for adrenal dysfunction?
Adrenal dysfunction often accompanies thyroid problems. When cortisol levels are not optimal, thyroid hormone may not be utilized properly. Many physicians find that the sensitive 24-hour saliva cortisol/DHEA test to evaluate adrenal function is an excellent tool to detect suboptimal cortisol levels, particularly because it provides a more complete picture than a single cortisol blood test. While there is no large-scale research that confirms that “in normal range” cortisol and aldosterone make a significant health impact, a significant number of smaller studies and mounting anecdotal evidence from physicians point to the need for addressing adrenal function with thyroid patients. Many integrative doctors are savvy to the thyroid/adrenal relationship. Please see my Find a Doctor page to find an integrative doctor near you that may be able to help. Information on cortisol testing can be found on my Testing & Diagnosis page.
Medication and Treatment
What medications are available for the different forms of thyroid disease?
For hypothyroidism or Hashimoto’s patients, the following treatments can be used alone or in combination methods depending on the patient’s individual needs for replacement: levothyroxine (T4), liothyronine (T3), levothyroxine/liothyronine (T3/T4) combination, and natural thyroid extract (T4, T3, T2, and T1). For hyperthyroidism or Graves’ disease patients, beta blockers are often prescribed to control heart rate and either methimazole or propylthiouracil (PTU) are prescribed to prevent the overproduction of thyroid hormone. Radioactive iodine is also used in some hyperthyroid and Graves’ disease cases to reduce the amount of thyroid tissue that is resulting in the overproduction of thyroid hormone in the patient. Please see my Medication Options page for further information on this topic.
Why won’t my doctor prescribe anything more than levothyroxine?
Levothyroxine is often considered the “gold standard” treatment option for hypothyroidism among many physicians. However, mounting evidence and physician reports indicate that thyroid dysfunction can be treated in different ways depending on the cause of your imbalance, how thyroid production and conversion is operating, and its severity. Your doctor may not be aware of the comprehensive concepts for the treatment of thyroid disease. If you continue to have symptoms on levothyroxine-only, please know that there are other treatment options such as T3/T4 combination (liothyronine/levothyroxine), T3-only (for specific cases), and natural desiccate thyroid medication. If your doctor is not willing to prescribe treatment options outside of levothyroxine, please read the FAQ under “Finding a Doctor” on this page. You might also wish to visit my Medication Options page for additional information.
Is RAI (radioactive iodine) the only treatment available for hyperthyroidism?
While radioactive iodine (RAI) is the most widely-recommended treatment of hyperthyroidism, it is not the only option. The anti-thyroid medications methimazole and propylthiouracil (PTU) are options for patients with sustained forms of hyperthyroidism, such as Graves’ disease or toxic nodular goiter. These drug therapies prevent the thyroid from over-producing thyroid hormones. With RAI, the goal is to dampen or kill thyroid cells, thus creating less thyroid hormone circulating within the blood stream and into your cells and tissues. Many times, the patient is left hypothyroid and will need thyroid hormone replacement. Surgical removal of the thyroid gland with subsequent thyroid replacement hormone is sometimes an option. For more information on hyperthyroid treatment, please see my Testing & Diagnosis page.
How quickly can I expect thyroid medication to work?
It depends on the medication, dosage, and possible underlying issues that may be contributing to symptoms. It may take several weeks before you notice some improvement in your symptoms, so try to be patient and follow your healthcare provider’s directions. For others, it may take a few months. Some patients may not do well on their originally prescribed medication and their provider might choose to switch them to another treatment option. In this case, more time might be needed to evaluate the effects of the medication and the prescribed doses to observe how the patient is responding to the treatment. Speak to your physician about typical response rates and visit your brand name medication’s website for a listing of their frequently asked questions.
Why do I still have symptoms after treatment?
Mounting evidence and physician reports indicate that thyroid dysfunction can be treated in different ways depending on the cause of your imbalance and its severity. It is not as simple as giving a patient a single pill at a single dose. Every patient is different with regards to what their body needs for thyroid hormone replacement. Additionally, it is possible that you can have any number of the following issues:
1. Incorrect type of thyroid medication (i.e. T4-only, T3-only, combination methods, natural desiccated thyroid) for your body’s needs.
2. Incorrect dosage or balance of thyroid hormone medication for your body’s needs.
3. Reaction or an intolerance to a filler used in the preparation of the thyroid medication.
4. Other vitamin or mineral deficiencies such as iron, ferritin, vitamin D, vitamin B12, etc.
5. Other underlying diseases or disorders such as autoimmune diseases, adrenal dysfunction, PCOS, cardiac issues, chronic infection, Lyme disease, etc.
If you still have symptoms, please visit that Testing & Diagnosis page for essential tests and to read about optimal ranges.
When should I take my thyroid medication?
Thyroid medication should be taken with water 1 hour before meals or coffee, if taken in the morning. It should be taken at least 4 hours before or after mineral supplements (iron, calcium, iodine, magnesium). Some patients have success with taking thyroid medication prior to going to bed at night and others find that taking it before waking up is the most beneficial. The most important thing is to be consistent and take your medication at the same time every day. To avoid skewing test results, physicians have recommended to take your thyroid medication AFTER your lab testing which should be done first thing in the morning.
How do I treat adrenal fatigue or dysfunction?
Treatment or supplementing depends on the severity of high or low cortisol and should always be monitored by your healthcare provider. In cases of more severe adrenal fatigue, low doses of bioidentical hydrocortisone (HC) or sustained-release compounded hydrocortisone is commonly used. In less severe cases, some practitioners may recommend taking an adrenal glandular preparation and/or some of the following supplements: vitamin C, pantothenic acid (Vitamin B5), and adaptogens such as holy basil, ashwagandha, Siberian ginseng, or rhodiola. Phosphatidyl Serine (PS) may also be used to lower high cortisol. Many integrative doctors are savvy to the thyroid/adrenal relationship. Please see my Find a Doctor page to find an integrative doctor near you. Recommended adrenal supplements can be found on my Supplement Options page. Always consult with your healthcare provider.
What is adrenal dysfunction and how does it relate to thyroid problems?
The adrenal glands are small, bean-shaped glands that are located on top of the kidneys and are known as the “stress glands”. Cortisol is one of the hormones produced by the adrenal glands and too high or too low cortisol can have an effect on thyroid function. Too much or too little cortisol can affect the thyroid hormone conversion of T4 to T3 . Testing cortisol levels throughout the day should be incorporated with thyroid testing procedures. For more information regarding cortisol testing, please see my Testing & Diagnosis page. For recommendations on adrenal supplements, see my Supplement Options page.
What other vitamin or nutritional deficiencies are common with thyroid disease?
Physician reports and growing evidence reveal that thyroid disease is often concurrent with vitamin and mineral deficiencies such as low levels of vitamin B12, vitamin D, iron and/or ferritin. It is common to have any one of these deficiencies in thyroid patients, and a deficiency may impact the body’s utilization of thyroid hormone. For more information regarding vitamin and nutritional deficiencies that are common with thyroid disease, please visit my Testing & Diagnosis page and my Supplement Options page.
What other disorders are common with thyroid disease?
Many practitioners have discovered that adrenal dysfunction adversely affects the necessary conversion of T4 to T3. Adrenal dysfunction is extremely common in thyroid disease and may impact a patient’s ability to utilize thyroid hormone properly. Additionally, sex hormone abnormalities, celiac disease, diabetes, poly-cystic ovarian syndrome (PCOS), infections and other autoimmune disorders are commonly presented with thyroid disease. Your doctor should understand the interrelationship between thyroid disease and these conditions. For further reading on testing of these conditions, go to my Testing & Diagnosis page. For supplements that could assist some of these conditions, visit my Supplement Options page.
Are there any supplements, vitamins, or dietary changes that patients find helpful?
There are many nutritional factors that play a role in optimizing thyroid function, however, patients rarely reverse their thyroid disease with dietary changes or supplements alone. Both nutrient deficiencies and excesses can trigger or exacerbate symptoms. Please consult with your physician prior to taking any supplement considerations listed on this site. Additionally, many patients have reported that going on an anti-inflammatory diet for autoimmune-related thyroid disease helps to reduce the severity of symptoms. Many patients have reported that going on a gluten-free diet is beneficial in reducing antibodies. Gliadin (the protein found in gluten) closely resembles that of the thyroid gland and when gliadin enters the bloodstream, the immune system tags it for destruction. These antibodies to the gliadin protein can cause the body to attack the thyroid gland.
FAQ From Physicians
For additional questions, please see my FAQ for Physicians page.
Q&A Doctor Series
You may also visit patient questions that were submitted to the
Q&A Doctor Seriesand were answered by leading practitioners in thyroid healthcare.
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