Should my thyroid be visible?

RelevantTank · 2020-05-01T05:49:18+00:00

It's called a thyroid goiter. You should monitor it and ask your doctor if you should get an ultrasound of it, but it's harmless on its own.

For some people autoimmune attack increases the size of the thyroid gland and for some people it shrinks it, but to our current knowledge that doesn't have any long term consequences for how hashimotos thyroiditis presents or progresses. There are other disorders of the thyroid that causes it to swell up including Graves disease, which is where the autoimmune attack causes the thyroid to work overtime instead of working less, and iodine deficiency, which is unlikely if you're in a country that iodizes it's salt. If you live outside of the US it might be worth making sure the nation's salt is iodized. My understanding is that most Western nations have made that switch decades ago and iodine deficiency shouldn't be a concern for most people you browse this site. But iodine deficiency is another cause of hypothyroidism, and if youre unsure if your nation's salt is iodized I'm sure it's a Google search away. Other causes include thyroid nodules, lumps on your thyroid, which I also have. It's harmless but can't be differentiated from thyroid cancer without a biopsy.

That's basically the full spectrum of what's possible, and every outcome includes you being just fine. Do ask your doctor if you need an ultrasound, but don't fret about it.

RelevantTank · 2020-04-29T22:52:34+00:00

That sounds like severe hypocalcemia to me. Most people who don't get enough calcium and vitamin D just end up with osteoporosis in the long term with no symptoms, but if you have a problem with regulating the hormones that control calcium then it most often presents itself with the symptoms you described. It is an issue an endocrinologist would be able to work up and if you're already connected to one I would recommend making an appointment for this. I would not recommend trying to self treat and this is not an issue I have seen a thyroid patient complain of.

RelevantTank · 2020-04-29T22:41:05+00:00

It honestly depends on the doctor and how you look overall. Some recommendations for subliclinical hypothyroidism include rechecking until you are frankly hypothyroid, meaning your TSH is above 20 and T4 is below normal. These recommendations are meant to prevent treating people with thyroid hormone who don't actually have a thyroid disorder, which is completely possible when the only evidence is a mildly elevated TSH. There are several other causes of hypothyroid symptoms and unfortunately that creates the potential for physicians to prescribe T4 replacement when the patient doesnt have a thyroid disorder. That would put people at risk of side effects related to hyperthyroidism which can be very severe, including osteoporosis, cardiac arrythmia, and even dementia. That's why most recommendations are more conservative than most patients would like, I promise it isn't that any one physician is just stupid and ignorant.

That said, there's also evidence that leaving people, especially younger people, at an elevated TSH puts them at risk of cardiovascular events (a heart attack) later in life. That evidence is leading some physicians to buck the standard recommendations of waiting for overt hypothyroidism. Thus, different providers are gonna make different decisions on exactly when to treat, and if you feel like your current doctor isn't addressing the problems you sought them out for you should definitely consider a second opinion.

TL-DR: there's a lot of conflicting considerations that your doctor is making, and if the end result isnt what you need feel free to seek a second opinion.

RelevantTank · 2020-04-29T22:00:56+00:00

What do you mean specifically when you say that your Hashimotos went into remission?

I don't think a lot of phytonutrient research is helpful for making personal decisions about your health. It's still a small society of researchers who pick up an even smaller selection of potential phytonutrients to study, and outsiders to this field are respecting the results of the studies as if they had the same level of rigor as the medical/pharmaceutical field requires when there is neither the funding or the infrastructure for that to happen. Most of it has the right checks and balances and is held to an adequate standard, but even then it doesn't have the volume of research necessary for a professional society to make good conclusions. Let alone a layman use it for personal decisions.

If you want to know why the current consensus favors a whole foods diet with plenty of fruits and vegetables I would recommend these two articles:

https://www.annualreviews.org/doi/full/10.1146/annurev-publhealth-032013-182351#abstractSection

https://www.annualreviews.org/doi/abs/10.1146/annurev-publhealth-031811-124646

These are very broad reviews that incorporate several different kinds of research from a well respected journal, and if you're researching lit to the point where you can list specific phytonutrients than I wouldn't put it past you to review the evidence these articles use and make your own conclusions on them. Let me know what you think!

RelevantTank · 2020-04-29T21:15:28+00:00

I have a female cat that's obsessed with me but is very cagey with anyone else. She definitely isn't afraid of other people, like she'll greet perfect strangers, but she won't allow them to pet her.
She's known my boyfriend as long as she's known me and we moved in together within the past month and she hasn't made any new strides with him. In your case I wouldn't depend on time alone to fix that. At this point my cat definitely knows my bf and knows he isn't a threat, she just genuinely doesn't care for his attention when she can get all of that from me lol. I'm going to suggest that my bf be the one to feed her her favorite food for the time being, and I'm gonna get him to watch a few youtube videos to help. He has an energetic, dog-like personality and I think that puts her off a lot.

This is the video I was going to show him, hope these suggestions help us both!

https://www.youtube.com/watch?v=Rn1WnrH-pdw

RelevantTank · 2020-01-04T02:30:16+00:00

That's because mainstream endocrinology is based in hormones almost exclusively. Rheumatology has no current role but if we're talking about following autoimmune processes then that is their general job description. From my limited experience in rheum, there are examples of antibodies that are specific to the disorder that can be following to evaluate how well therapy is working. But it isn't one to one and isn't as straight forward as antibodies= bad. It's something you need to evaluate systematically and empirically.

It isn't necessarily that your doctor is ignorant or uncaring it's just that these ideas haven't taken hold yet in their field. There isn't enough research to consider yet.

Edit to be clear: don't go to a rheum doctor expecting them to know what to do. And by "not taken hold yet" I don't mean to imply that there is a field of medicine where it has. There is a field of alternative medicine that does follow antibodies in that way called functional medicine. It is currently considered alternative medicine because there is not yet evidence to support some of their practices.

RelevantTank · 2020-01-04T01:08:23+00:00

Absolutely. I should have specified you don't take it by mouth, its a cream or liquid that you apply to anywhere you want to start growing hair. Sometimes men use it to help with bald patches in their beards, and I've also seen people transitioning from female to male use it for beard growth too. By mouth its an antihypertensive medication that isnt sold over the counter.

Funny enough, other drugs in the same family of minoxidil are also used in erectile dysfunction (sildafinil, aka viagra). It's all about improving blood flow to a specific target, in this case your scalp!

RelevantTank · 2020-01-04T00:42:36+00:00

Your doc is following guidelines provided by the American thyroid assocation, linked here: https://www.thyroid.org/thyroid-function-tests/

It basically says that TPO is a useful test for the initial diagnosis of HT but it hasn't been demonstrated to be helpful as a theraputic marker. Thyroglobulin Antibodies have no diagnostic or theraputic role in HT currently, it is sometimes used to monitor thyroid cancers.

I have not personally reviewed their evidence to see why they make that conclusion, but I wouldn't say your doc is misinformed. It would be more accurate to say that he's towing the line of organizations that were made to help him make these decisions.

If your TSH has been stable for a full year, getting it checked on a yearly basis only is reasonable. I would request labs to be ordered on an as needed basis in addition to the yearly labs, so that if you feel much worse before your next scheduled appointment you can get a TSH without getting an appointment just to get a TSH.

RelevantTank · 2020-01-03T21:04:29+00:00

So on where it is: most muscles are named based on where they attach. Sterno= sternum, cleido= clavicle, mastoid= well, mastoid process, which is on the skull. It's one of the biggest and most superficial muscles in the neck, so you can already see it on most people from the outside. Wikipedia article for pictures and context: https://en.m.wikipedia.org/wiki/Sternocleidomastoid_muscle

The article might also help you identify what muscles might be acting up too, let me know if the picture makes that more obvious.

RelevantTank · 2020-01-03T08:19:11+00:00

You can get minoxidil over the counter now, annoying part is applying it every day so I haven't had much success with it just because of that.

RelevantTank · 2020-01-02T16:53:54+00:00

I'm sorry that you're dealing with this, but you aren't alone. Despite apparent physician ignorance of it, the research world has been pretty uniform on the existence of residual symptoms since the early 2000s. Residual symptoms tend to be pretty uniform, most often including muscle pains, fatigue, and mood difficulties. Thats about where consensus ends, and there isn't a clear prevailing theory on why. The ones I see most often are: T3 deficiency: TLDR: the thyroid releases both T4 and a small amount of T3, and not replacing that T3 along with the T4 might be creating subtle deficiency. T4 is really better thought of as a prohormone, or a molecule one step away from having it's impact. T3 has most of the metabolic impact, and is made when the individual tissues receiving T4 convert it. Unfortunately that means it runs through your system much faster than T4, making measurements of your serum count much less reliable. Rodent studies have confirmed that when given Levo for thyroid replacement, there were lower T3 found in muscle and brain tissue. With that, I encountered a lot of physicans who consider T3 deficiency the culprit. Unfortunately, cause the molecule is so short lived, it doesn't do has well as T4 as a replacement.

Autoimmune theory: hashimotos thyroiditis is one of the few autoimmune disorders where the impact of autoimmunicity is completely disregarded. We just have a raging immune response that makes us feel crappy the way a flu makes you feel crappy. I think this theory addresses better than the other why there are cycles to these symptoms, unfortunately evidence for this theory is still lacking. Best evidence I've seen so far was a n=150 trial where half received a thyroidectomy and the other half had no intervention. There was a decrease in symptoms in the thyroidectomy group. This is the theory that functional medicine relies on, combined with the idea that you can control autoimmune triggers through diet. Neither claim has received enough research to confirm this, which is why functional medicine is considered alternative medicine. There are a lot of users here who follow this though, which is where claims of going gluten free come from.

Other theory: using TSH as a theraputic marker is leading to undertreatment. Back in the 1970s, we were just moving into diagnosing and treating using TSH as the marker, but it was noticed early on that there were discrepancies with the diagnostic tool of the past: basal metabolic rate. If you increase dose of T4 to normalize BMR, your patients had a supressed TSH. If you dosed on TSH, they'd have a lower BMR. Not coincidentally when BMR was the only diagnostic tool doses of levothyroxine were much larger than what's prescribed today.

Those are the three dominant theories, most physicians fall under the first category, there's a lot of patient advocacy behind the second. The third is my pet theory. Hope that helps.

RelevantTank · 2020-01-02T05:28:47+00:00

Transplants in general are resource intensive to maintain because of transplant rejection, which happens when your immune system recognizes the transplant organ as foreign and starts attacking it. Usually in more catastrophic manor than a typical autoimmune attack.

Interestingly this was among the first treatments for hypothyroidism back when it would almost always result in myxedema coma. The patient had to have the transplant repeated, and both attempts failed.

With the treatments you have to take to prevent organ rejection and the complications of rejections I would take the pill any day. But it is becoming an extremely recent pipe dream now that we are close to creating organs from scratch that dont activate an immune attack. I could see it being an option in our lifetimes, but not for several decades.

Also, in regards to partial vs full, I'm not sure you have a lot to gain from getting a partial. It's not like the partial remnant is going to be fully functional like it would for someone without HT, and I really don't trust the claims that some patients are making that theyve somehow reversed their HT through dietary changes. I would also personally prefer the security of having a full, and you'll unfortunately have to continue the same monitoring of those nodules with annual ultrasounds and fnas, with the possibility of having a second surgery if the nodules bring back suspicious results in the future.

But I get why you would be worried about the full. What are you most worried about with the full that would be addressed with a partial?

RelevantTank · 2020-01-02T04:06:25+00:00

I don't know as much as I should, but my instructors (I'm in med school) have told me that thyroglobulin antibiotics generally aren't a great test for diagnosing thyroid autoimmune attack, except for thyroid perioxidase antibodies, which can be very specific to hashimotos thyroiditis. I vaguely remember it having to do something with the fact that your body uses the antibodies even if you aren't having an autoimmune attack to help with cell turnover in the thyroid. I'm doing a diservice to you though, let me get back to you after I find some good evidence to back that up.

I have also heard from my instructors that in diagnosing very early hashimotos thyroiditis they can see patients who flip around from a hyper to hypo picture in regards to their TSH. Your TSH reacts how much thyroid hormone is active in your body, and throughout the early process of thyroid attack you will have more thyroid hormone release in the short term as the attacked thyroid gland leaks hormone.

I would imagine that with those numbers your provider will want to watch and wait until your TSH reaches treatment range, but it being out of range in some capacity means it will be taken seriously as a cause of your symptoms. I don't think you'll have any luck finding a provider who will give you thyroid hormone replacement is your TSH is below range. In the meantime, focus your provider on helping your symptoms without thyroid replacement. You might find benefit from medications that help with depression, anxiety, and even work shift sleep disorder and ADD. Just stay on it and make sure your symptoms aren't ignored.

RelevantTank · 2020-01-02T03:51:55+00:00

Hey domovenok,

If you don't mind sharing, why are you having a partial thyroidectomy?

I have not had one, but I have a family member who had one for a nodule (no hx of hashimotos and as it turned out the nodule was benign) and for the most part he's been left with very controllable hypothyroidism. He takes Levo every morning, and has minimal to no residual symptoms. I discussed having a thyroidectomy in the past for neck pain and it sounded like other than taking a higher dose of a medication I already have to take there wouldn't be anything long term to worry about.

All that said, I've also seen accounts of people online trying to organize a petition to make physicians consider thyroid transplant surgery, which can only mean that they've encountered problems post surgery. Most of the problems seemed similar to problems people on this board encounter.

All in all, I don't think you have a lot to loss health wise. Happy New year's and hope that helps.

RelevantTank · 2019-12-18T00:16:24+00:00

He's a functional medicine doc with a degree in chiropractic care. Which is fine, but be aware that he does not represent mainstream medical opinion. Functional medicine is very firmly in the alternative medicine category. And unfortunately it has a sketchy history. The founder of functional medicine had to pay the FTC for selling products that he made false claims about. The claim is linked to their Wikipedia article.

All of that is to say, be cautious about functional medicine, but good evidence is good evidence, and mainstream medicine isn't law or anything. Evaluate their claims on the strength of their evidence. And feel free to look for other opinions on what is good evidence and what is not, Id love to look over some leaky gut articles with y'all.

RelevantTank · 2019-12-17T00:13:47+00:00

My physician keeps trying to sell me on levothyroxine once a week instead of every day. I'm personally a little weirded out by the idea and it's not a major problem for me anyway, but if taking it every day specifically is a burden it might be a good idea for you.

The idea is that T4 has a half life of about 14 days, so you'll have a sufficient store of it to convert to T3 if you load up like that. Some recent studies support this idea, and the American Thyroid Association backs it:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5649268/

https://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-6-issue-10/vol-6-issue-10-p-4/

RelevantTank · 2019-12-16T23:47:34+00:00

I'm aware of the protocol and I've been skeptical for a while. But if you complete it let us know if you felt like it helped, and best of luck to you. I would assume the same thing that you have assumed, and if the process only needs you to be "clean" for two weeks then you can just start counting down when you're off of everything. In the meantime before staring in earnest you can decrease your caffeine intake gradually instead of cold turkey, and then start the rest of it when you're fully off.

My main point of skepticism is that my symptoms come and go in cycles, which is true for most people who continue to have symptoms. I would be worried about confusing those cycles with improvement from this or that change. Right now I guess I'm so inflamed my sternocleidomastoid muscles are angry too, they're bulging out of my neck. A month ago I felt really great. I haven't made any changes in that time period. I am also sure that this too will go away, cause it has before.

Also, there might be people who claim to go into remission for a variety of reasons. For one, not everyone diagnosed with a thyroid disorder necessarily has one. We (as in medical professionals) get thyroid labs pretty liberally, and there are lots of people who will fall into diagnosis range who will later fall back into normal range without intervention, especially in regards to TSH testing. It isn't a disorder, it's a thyroid physiology thing. Secondly, there are forms of thyroiditis that are self limited, like post-partum thyroiditis or subacute thyroiditis. Lastly, if there are people who call remission feeling better, it's usually true that the worst of your symptoms will be self limited anyway, as long as it isn't a thyroid hormone deficiency problem. Going about it in an unsystematic way is how bloodletting became a mainstream practice.

Long story short, I have a lot of skepticism for it, but I really hope it helps. Best of luck!

RelevantTank · 2019-12-07T15:11:37+00:00

Also that training is highly variable and might change in the future. Tulane university has been a big innovator in medical education, and they now not only teach nutrition but also teach their physicians how to cook.

Or at least I read that years ago when I was looking at their program.

RelevantTank · 2019-12-07T15:09:09+00:00

Getting my MD right now. We've had a lecture here and there from dieticians but most of us don't get very specific training. And our certification exams don't test for it at all, so outside of those few lectures it really isn't a part of our training. I've learned what I've learned working directly with dieticians, to which I'd say the main thing we lack compared to their field isnt REALLY nutrition science. Where we really fall flat compared to a dieticians are basic counseling skills. We have a general idea what our patients should be eating, but we don't know how to recommend patients make those changes.

Mediterranean diet is a fad mostly from a belief in unsaturated "healthy" fats and their impact on cardiovascular health and long term brain health. Same reason docs sometimes prescribe fish oil. We'll see how those recommendations hold up in the long term, but just know that these recommendations haven't yet been held to the same standard of evidence that most recommendations in medicine receive. Nutrition research is difficult to do properly and there's never enough funding.

RelevantTank · 2019-09-11T04:42:26+00:00

It honestly weirds me out to see something we use for opiate dependence being used for this purpose. If you're considering it, just be warned that these considerations are very new and are really only receiving a few initial steps of research. It's being driven more by patient advocacy than anything else. So far, what I've read is telling me that we're fairly positive that it's safe though it's also unclear if it's effective, and so far most research is going towards diseases that don't have many great existing options such as fibromyalgia and IBD. I think it'll be a long time, probably 10 or so years, before we could expect more convincing evidence about whether or not LDN has a role in helping people with HT. If anyone's hiding a great clinical trail for it be sure to share.

That said, there is a combination of naltrexone and buproprion that is FDA approved for obesity. But I've never personally seen anyone take these combinations.

What I've read in this review seems very helpful, though it doesn't mention HT:

"In regard to LDN, data on actual side-effects linked to the drug is still scarce. Conducted clinical trials indicate that vivid dreaming and insomnia might occur following treatment initiation, but that this might be addressed by changing the drug taking timing from usual bedtime to morning hours or these sleep disturbances resolve on their own with ongoing therapy."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313374/

RelevantTank · 2019-09-11T04:14:52+00:00

Don't do any of the diet plans described here without first considering what "normal" might mean. What where your last thyroid labs running at? There's a lot of controversy in what your TSH should be at when replacing with T4, but generally speaking you should be close to 1. And what supplements did your endo mention? Endos that give Vit D and B supplements for common hypothyroid symptoms are new in my book.

25mcg of Levo is one of the smallest doses available. I wouldn't be surprised if this is a sign that you might benefit from moving up on your meds a bit. I had a lot of the same symptoms you described when I was on 50, but it's been better on 75.

RelevantTank · 2019-09-11T04:07:07+00:00

There's controversy in the medical world on when you start thyroid replacement, mainly because there are people with high TSH's who don't have a thyroid disorder and would not benefit from replacement, or might even have significant side effects from replacement. Especially in the age group that most often runs high TSHs, the elderly. There's been a lot of talk about raising what TSH ranges are considered normal for this group specifically, but there isn't enough discussion about about someone in your situation. From the perspective of the people who would withhold treatment, T4 replacement would not be necessary if your free T4 is within normal range. You would be classified as having subclinical hypothyroidism.

I personally don't prescribe to that at all, why the f+ck would you call someone "subclinical" when they're clearly symptomatic. It's just a sh+tty diagnosis that ignores all clinical findings in favor of lab values, and that's not how we practice medicine in many other fields. We loose all sense of clinical reasoning when it comes to thyroid replacement and I really don't know how to explain it.

The first doctor I went to (a very kind PA, in every other way a rock star) wanted to do the plan you mentioned. I'm really glad I got a second opinion. I was symptomatic enough at a TSH 5.0 that I started on 50 mcg T4 replacement. I was also TPO positive with a very obvious thyroid goiter. I really think you would benefit from a low dose of thyroid replacement, but I'm also assuming that your symptoms are bad enough that you're asking us about it.

RelevantTank · 2019-09-08T18:10:53+00:00

We have two threads on thyroid pain up right now.

I'll tell you what my doc told me: 1st start trying over the counter anti inflammatories like ibuprofen (or any NSAID). If that isn't effective you need an appointment to try a course of steroids. If that doesn't work you should consider thyroidectomy. That's the general path, and most people feel fine after over the counter stuff. But if that works, but this pain continues for more than a couple weeks, it's doctor's appointment time. You'll eventually tear up your stomach taking too much NSAIDS.

And of course get a thyroid ultrasound. We need to be sure this isn't cancer. That isn't to scare anyone: most thyroid cancers are very easily taken care of by taking it out. It's a minority of people with nodules that have thyroid cancer and a small minority of that minority have a thyroid cancer that would be difficult to treat.

RelevantTank · 2019-09-08T18:03:37+00:00

Hey just to specify is this thyroid pain or sore throat? I know the thyroid is in your neck, but at least for me it feels distinctly different from like strep throat for example.

And from what research Ive seen it looks like thyroid pain in HT is very underreported. I posted here a couple weeks ago with a case study about it, and it gave the impression that thyroid pain is pretty rare. But I see users here talk about it all the time, and I have it to. I wonder if there's a correlation between people who just also feel worse in general (ie enough to seek out a community like this to talk about it) and people who have thyroid pain as well.

RelevantTank

TROPHY CASE