Author: Aron Adkins, MD
Thyroid disease can often be confusing. There are many sources of information available for patients on medical conditions involving the thyroid. However, there is often very little guidance about what information is true and accurate and what information is false or inaccurate. Patients may have unexplained symptoms that could be attributed to the thyroid, but it is often unclear. The following are a few common perceptions and the reality surrounding those perceptions.
Perception #1: Thyroid disease is the cause of my weight gain or loss.
Reality: The truth is that thyroid disease can indeed affect weight, but there are often other circumstances influencing this. Some patients who have severe overactive thyroid will often lose weight. Some patients with severe under-active thyroid will often gain weight. However, when thyroid dysfunction is mild, it may have differing affect or no affect depending on the person. Weight gain or loss is often quite variable with mild thyroid dysfunction. Mild overactive thyroid disease can often be associated with weight gain due to increased appetite. Mild hypothyroidism may or may not cause weight gain. Frequently, correction of mild thyroid disease does not unfortunately always result in significant weight changes. Weight changes are often caused by a number of different issues and should be evaluated further by a health care provider.
Perception #2: I have multiple symptoms that match thyroid symptoms, but my labs are normal. Could it still be my thyroid?
Reality: Signs and symptoms of thyroid disease can be very vague. Symptoms of fatigue, weight gain or weight changes, cold intolerance, gastrointestinal symptoms, hair loss or skin and nail changes are indeed common and can be related to thyroid disease and do indicate the need to check thyroid function test. However, there are multiple other reasons for these symptoms including iron deficiency, Vitamin D deficiency, Vitamin B12 deficiency, gastrointestinal diseases, diabetes and undiagnosed obstructive sleep apnea and others for example. Thyroid function should definitely be checked with these symptoms, but if normal, other possibilities should be investigated by your health care provider.
Perception #3: I believe my Thyroid-Stimulating Hormone (TSH) does not reflect my true thyroid function.
Reality: The TSH is the most common measured lab for evaluating thyroid function. The TSH is the signal from the pituitary gland in the brain to the thyroid which signals the thyroid to make thyroid hormone. The pituitary can be thought of as the the thermostat of the body. When thyroid levels are too low, the pituitary "thermostat" increases the production of TSH to try to get the thyroid to make additional thyroid hormone. When the thyroid levels are too high, the pituitary "thermostat" reduces the TSH signal to try to get the thyroid to reduce thyroid hormone production. In a vast majority of patients, the TSH is the best and most reliable indicator of the patient's thyroid function. However, in some patients who have a pituitary problem, history of stroke, history of head trauma or history of brain radiation, the TSH might not be an accurate and reliable indicator of thyroid function. In these people and in people whose symptoms to do not match the TSH, it is very appropriate to check free thyroid levels to see if there is a thyroid hormone excess or deficiency.
Perception #4: I worry that my thyroid could cause me to not to be able to swallow or breathe.
Reality: The thyroid can cause swallowing difficulties, but it is usually only when there is a very large thyroid goiter, or large masses or nodules within the thyroid. Although thyroid goiters and tumors of the thyroid are common, they are usually not large enough to cause an obstruction to swallowing or breathing. More common causes of swallowing difficulties include esophageal reflux, esophageal inflammation or primary problems with the muscles of swallowing. Shortness of breath is also usually not caused by the thyroid, unless the thyroid is large and compressing the airway. If there is a concern, it is best to obtain an ultrasound image of the thyroid and occasionally it is necessary to get a CT scan of the neck. Thyroid cancer can be a cause of swallowing difficulties and voice changes. These changes are usually persistent and do not come and go. If these symptoms are occurring, it is important to discuss with your health care provider.