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> NEED SO HELP ON THIS TX AND DX
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> ED LAKE


The Basics | Symptoms | Detection & Treatment
How Do I Know If I Have Them?


A doctor can diagnose hyperthyroidism and hypothyroidism by testing
the levels of thyroid hormones in your blood. Doctors measure
hormones secreted by the thyroid itself, and also of thyroid-
stimulating hormone (TSH), a chemical released by the pituitary gland
that triggers hormone production in the thyroid.

When you are hypothyroid, higher quantities of TSH are circulating in
your blood as your body attempts to foster increased production of
thyroid hormones; the reverse is true with hyperthyroidism, in which
TSH levels are below normal and circulating thyroid-hormone levels
are high.

To determine the cause of hyperthyroidism, doctors often use
radioactive iodide uptake tests, which track the amount of iodide
absorbed by the thyroid gland. Iodide is a key ingredient in the
manufacture of thyroid hormone, so the amount of iodide the thyroid
absorbs is a reliable indicator of how much hormone the gland is
producing. For this test, you must swallow a small amount of
radioactive iodide in liquid or capsule form. After a predetermined
wait, the doctor places an instrument over your neck to measure how
much of the radioactive iodide has gathered in your thyroid.

If the results of this test suggest that the gland is collecting
excessive amounts of iodide, the doctor may then conduct a
radioactive iodide uptake scan. In this test, the doctor uses a
special film to create a picture that shows the exact location of the
radioactive iodide in your thyroid gland. The scan will reveal, for
example, if the iodide is collecting in adenomas, indicating that the
nodules are responsible for the excess hormone. If the scan shows
that the iodide is spread equally throughout the tissue, the whole
thyroid is involved in the excess production.

Some doctors believe that blood tests may not be sensitive enough to
detect milder forms of hypothyroidism. Instead, they advocate
monitoring your body's basal (resting) temperature. To track your
basal temperature accurately, you must closely follow certain
guidelines: Shake the thermometer below 95° F at night and place it
where you can reach it without getting out of bed. The following
morning, before you get out of bed, take your temperature via your
armpit for 10 minutes while staying as still as possible. Keep
records of your temperature for at least three days. (Women should do
this during the first two weeks of the menstrual cycle, as their
basal temperature may rise during the latter half.) Normal basal body
temperatures fall between 97.4° F and 97.8° F. If your basal
temperature is consistently low, you could be mildly hypothyroid.

If you have one or more adenomas, your doctor will want to keep
careful records of when they were first found and how they develop,
since not all adenomas produce excess thyroid hormone. In fact, most
of these nodules are not malignant, especially if they remain the
same size over long intervals. (Cancerous tissue, by contrast, will
undergo noticeable growth.) Nodules that appear suddenly are
typically fluid-filled cysts and are often benign. They can be
evaluated with a noninvasive ultrasound exam. If blood tests indicate
that the nodules are producing excess thyroid hormone, and if you
have other symptoms, your doctor will treat you for hyperthyroidism.

In any case, you should receive periodic checkups if you have a
nodule on your thyroid gland, since you may become hyperthyroid in
the future. If your blood tests show elevated hormone levels, your
doctor may recommend other tests, including radioactive iodide uptake
tests and scans that indicate whether the nodules are "hot"
or "cold." Hot nodules, or those that are actively trapping iodide
and producing too much thyroid hormone, are rarely cancerous. But
cold nodules -- those showing low iodide concentrations -- indicate a
possible malignancy and need to be investigated further.

One type of thyroid cancer can be diagnosed through a simple blood
test that measures levels of a hormone involved in bone formation. In
most cases, however, doctors check for thyroid cancer by performing
an aspiration, or biopsy, which involves drawing cells from the
suspect nodule with a fine needle to determine if the tissue is
malignant.

What Are the Treatments?

For thyroid disorders stemming from the over- or underproduction of
thyroid hormones, both conventional and alternative treatments offer
varied methods to restore hormone levels to their proper balance.
Conventional treatments rely mainly on drugs and surgery. Alternative
treatments attempt to relieve some of the discomfort associated with
thyroid problems, or to improve the function of the thyroid gland
through a variety of approaches ranging from diet supplements and
herbal remedies to lifestyle changes and special exercises. You
should always receive a professional evaluation for any thyroid
disorder; most of these conditions require a course of treatment
beyond the scope of home care alone.

Conventional Medicine
Treating hyperthyroidism requires suppressing the manufacture of
thyroid hormone, while hypothyroidism demands hormone replacement.
Conventional medicine offers extremely effective techniques for
lowering, eliminating, or supplementing hormone production. Before
deciding which treatment is best for you, your doctor will make an
evaluation based on your particular thyroid condition as well as your
age, general health, and medical history.

Thyroid hormone production can be suppressed or halted completely
with a radioactive iodide treatment, antithyroid medication, or
surgery. If your doctor decides that radioactive treatment is best,
you will be asked to swallow a tablet or liquid containing
radioactive iodide in amounts large enough to damage the cells of
your thyroid gland and limit or destroy their ability to produce
hormones. Occasionally, more than one treatment is needed to restore
normal hormone production, and many patients actually develop
hypothyroidism as a result of this procedure.

If you start using antithyroid medications such as propylthiouracil
or methimazole, which are usually administered in tablet form, your
hyperthyroid symptoms should begin to disappear in about six to eight
weeks, as hormones already in your system run out and the medication
starts to impair the thyroid's hormone production. However, you will
need to continue taking the medication for about a year. After that
time, you will also need to receive periodic medical exams to make
sure that the condition has not returned.

Surgery is often recommended for people under 45 when their
hyperthyroidism is due to toxic adenomas, since these nodules tend to
be resistant to radioactive iodide. Once the tissue is removed
surgically, hormone levels typically return to normal within a few
weeks.

Although subacute thyroiditis can bring on temporary hyperthyroidism,
this condition usually does not require medical treatment. Any pain
associated with the inflamed thyroid can generally be relieved with
acetaminophen or aspirin. If over-the-counter drugs don't help, a
doctor may prescribe prednisone or dexamethasone -- powerful anti-
inflammatory drugs -- for a short period of time. Since both of these
drugs may encourage the development of stomach ulcers and the loss of
bone mass, however, ask your doctor if you should also be taking
calcium supplements.

Hypothyroidism calls for a lifelong regimen of thyroid replacement.
No surgical techniques or conventional drugs can increase the
thyroid's hormone production once it slows down. Although hormones
from animal extracts are available, doctors generally prescribe
synthetic forms of thyroid hormone, such as levothyroxine. Side
effects are rare, but some people experience nervousness or chest
pain while taking these drugs; usually, adjusting the levels of
medication will alleviate any unpleasant effects. However, if you are
also taking tricyclic antidepressants, drugs to stop blood clotting,
or the heart drug digitalis, or if you have diabetes, make sure that
you and your doctor discuss any possible interactions or other
complications.

Thyroid cancer is usually treated by surgically removing either the
cancerous tissue or the whole thyroid gland, a procedure known as a
thyroidectomy. If the cancer has spread beyond the thyroid, any other
affected tissue, such as the lymph glands in the neck, will also be
removed.

Alternative Medicine
Thyroid problems are usually easily corrected with conventional
medicine. Consult your endocrinologist about complementing your
conventional treatment with alternative therapies, which aim to
cleanse the system, restore immune function, and balance hormone
production and release.

Naturopathy and TCM
A naturopath may treat your thyroid condition with homeopathic
mixtures, herbs, preparations based on traditional Chinese medicine
(TCM), and acupuncture.

TCM considers thyroid disease to result from emotional distress and
frustration. These block the life force energy (qi) in the liver and
spleen; herbs and acupuncture release the qi. Acupuncture can reduce
palpitations, irritability, and insomnia.

Naturopaths are authorized to treat thyroid disease in some states;
in others it is illegal. Check with your doctor or local health
authority to see if your state allows naturopathic interventions.

Body Work and Nutrition
Chiropractors and osteopaths use spinal manipulation to treat thyroid
disorders by reducing muscle tension and improving blood circulation.

A diet rich in protein, calcium, magnesium, and iodine supports
thyroid function. You want to be sure you are receiving enough of all
the B vitamins, vitamin A, vitamin C, and selenium.

Avoid these products if you suffer from thyroid disease:

The herb ephedra, found in herbal formulas, and its extracts
ephedrine and pseudoephedrine, found in over-the-counter cold
remedies, which can cause nervousness, insomnia, headache, and high
blood pressure
Alkaloids, including substances such as caffeine, morphine, and
quinine, which increase blood pressure and heart rate
Reviewed by Michael W. Smith, MD, October 2001.

The Basics | Symptoms | Detection & Treatment