Minimizing the Threats to Thyroid Health

Female doctor with protective work wear assessing a patient's thyroid health

It takes a multidisciplinary team of healthcare providers to help patients achieve and maintain a healthy thyroid.

More than 12 percent of the U.S. population will develop a thyroid condition at some point in their lifetime. That’s according to the American Thyroid Association (ATA), a professional association dedicated to education and research to improve thyroid patient care. The organization also estimates that at least 20 million Americans have some form of thyroid disease.

More than half, however—up to 60 percent, according to the ATA—are unaware of their condition. Most thyroid diseases are lifelong conditions, and, while thyroid cancers typically respond to treatment, a failure to recognize and treat thyroid cancers can have serious consequences, putting patients at greater risk for cardiovascular disease, osteoporosis and infertility, for example. Pregnant women with hypothyroidism that goes undiagnosed or undertreated are at greater risk of miscarriage, pre-term delivery and severe developmental problems in their children, according to the ATA.

There are behaviors and lifestyle choices that promote a healthier thyroid, however, and experts say healthcare providers can help educate patients on what they can do to manage risk and maintain optimal thyroid health.

Identifying risk factors

Anyone can suffer from thyroid disease; hypothyroidism can be present at birth or can develop as a patient ages, such as after menopause for a female patient, for example.

In fact, female patients are roughly five to eight times more likely to be diagnosed with a thyroid condition than male patients, according to the Cleveland Clinic.

There are other risk factors, of course, such as a family history of thyroid disease, medical conditions including pernicious anemia, type 1 diabetes, primary adrenal insufficiency, lupus or rheumatoid arthritis, for example.

Diabetic patients are also at great risk of developing a thyroid disease, according to the Cleveland Clinic, which notes that patients that already have one autoimmune disorder are more likely to develop another one.

“For people with type 2 diabetes, the risk is lower, but still there,” the Cleveland Clinic notes. “If you have type 2 diabetes, you’re more likely to develop a thyroid disease later in life.”

Type 1 diabetics may be tested more often for thyroid issues—immediately after diagnosis and then roughly every 12 months—but regular testing to check for thyroid issues is recommended for other patients as well.

Testing becomes especially crucial for those at greater risk of thyroid conditions such as hypothyroidism, as the symptoms might not be particularly noticeable at first, the Mayo Clinic points out.

Some patients might attribute symptoms such as fatigue and weight gain to “getting older,” according to the Mayo Clinic, “but as your metabolism continues to slow, you may develop more obvious problems,” such as increased sensitivity to cold, constipation, dry skin, puffy face, hoarseness, muscle weakness, depression and impaired memory.

The importance of adopting healthy behaviors

Of course, healthy habits help minimize patients’ risk for thyroid conditions. Healthcare providers should encourage patients to engage in these behaviors.

Adopting healthy eating habits is always a good idea, for example. And “what you eat has a profound impact on your thyroid gland,” according to Premier Health.

Iodine intake is important, for example. Recommended daily allowances for iodine intake are 150 mcg for adults, 220-250 mcg for pregnant women and 250-290 mcg for breastfeeding women, according to the National Institutes of Health, which note that iodized salt, dairy products, breads and seafood are common sources of iodine.

Lean proteins and beans are also recommended, along with antioxidant-rich fruits and vegetables such as blueberries, bell peppers and tomatoes, high-fiber foods in moderation, and heart-healthy fats and omega-3s.

Vitamins are critical as well. Foods containing vitamin D—fatty fish, milk, dairy products, eggs, mushrooms, for instance—are also recommended, as insufficient levels of vitamin D have also been linked to Hashimoto’s disease, an autoimmune condition that leads to hypothyroidism. Low levels of vitamin D are also known to be harmful to patients with hyperthyroidism. Vitamin B12, found in foods such as mollusks, sardines, salmon, dairy products and fortified cereals, also helps alleviate thyroid symptoms.

Victor J. Bernet, MD, chair of the division of endocrinology at Mayo Clinic Florida and president of the American Thyroid Association, also suggests maintaining normal levels of selenium, a mineral known to help regulate the metabolism of thyroid hormones and prevent thyroid disease. Food that contain selenium include Brazil nuts, sunflower seeds, tuna, crab and lobster.

“[Maintain] a well-rounded diet with adequate selenium intake,” says Bernet, who is also an associate professor at the Mayo Clinic College of Medicine. “Although selenium deficiency is not common in the U.S.”

Despite some recommendations, “it is OK to eat reasonable amounts of cruciferous vegetables—cauliflower, broccoli—as part of a well-balanced diet,” continues Bernet, who also urges avoiding over-the-counter supplements that are marketed to support thyroid function and steering clear of endocrine disruptors such as bisphenols.

“These agents may well impact thyroid hormone function and thyroid hormone levels.”

The care team is critical

Having a multidisciplinary team is critical for many conditions in endocrinology, says Angela M. Leung, MD, MSc, an associate professor of medicine in the division of endocrinology, diabetes and metabolism, department of medicine at UCLA David Geffen School of Medicine.

“[A patient’s] primary care provider—family practice, internal medicine, pediatrician, OB-GYN—will be the most important healthcare provider in regard to monitoring thyroid health and recommending when thyroid function testing is indicated,” says Bernet, adding that some cases might call for a surgeon who specializes in thyroid disorders.

“If thyroid surgery is necessary, it is important to identify a thyroid surgeon who performs thyroid surgery frequently,” he says.

The benefits of having a care team spanning multiple areas of expertise depends on the type of thyroid condition, says Leung.

For hypothyroidism, for example, levothyroxine as thyroid hormone replacement is the most commonly prescribed medication in the United States, she says.

“For this reason, many primary care providers play the main role in managing patients with hypothyroidism; if endocrinologists are consulted for unusual cases, it is important to maintain close communication with the primary care provider’s team.”

For patients with hyperthyroidism, endocrinologists very commonly advise the various options of treatment, continues Leung.

“If, however, definitive therapy like thyroid surgery or radioactive iodine are necessary, establishing and maintaining excellent communication between the respective clinicians managing those treatments—the nuclear medicine and surgery teams—together with the endocrinologist and primary care provider is optimal.

“Finally, for patients with thyroid nodules and thyroid cancer, members of an optimal multidisciplinary team, composed of both physicians and advanced practice providers, may include the primary care provider, endocrinologist, radiologist, thyroid surgeon, nuclear medicine physician,” she concludes, “and for more advanced thyroid cancer cases, a medical oncologist with expertise in this area.”

References

  1. The American Thyroid Association, 2020. Accessed Dec. 15, 2020. https://www.thyroid.org/media-main/press-room/
  2. The Cleveland Clinic, 2020. Accessed Dec. 16, 2020. https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease
  3. The Mayo Clinic, 2020. Accessed Dec. 17, 2020. https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284
  4. Premier Health, 2020. Accessed Dec. 17, 2020. https://www.premierhealth.com/your-health/articles/women-wisdom-wellness-/thyroid-health-tips-for-eating-right
  5. National Institutes of Health, 2020. Accessed Dec. 18, 2020. https://ods.od.nih.gov/factsheets/Iodine-HealthProfessional/
  6. GoodRx, 2017. Accessed Dec. 17, 2020. https://www.goodrx.com/blog/why-synthroid-is-the-most-prescribed-drug-in-the-us/#:~:text=Why%20is%20Synthroid%20(levothyroxine)%2C,of%20prescriptions%20written%20by%20physicians%3F

SIDEBAR

A Difficult Diagnosis

Given that its symptoms can be confused with those of other conditions, thyroid disease can sometimes be difficult to diagnose. There are, however, multiple tests that can be done to help determine if a thyroid condition is responsible for a patient’s symptoms. The Cleveland Clinic provides an overview of some of these tests, including:

Blood tests

Thyroid blood tests are used to tell if your thyroid gland is functioning properly by measuring the amount of thyroid hormones in your blood. These tests are done by taking blood from a vein in the arm. Thyroid blood tests are used to see if the patient has hyperthyroidism or hypothyroidism.

Thyroid blood tests are used to diagnose thyroid disorders associated with hyper- or hypothyroidism. These include thyroiditis, Graves’ disease, Hashimoto’s disease and goiter.

Specific blood tests that can be done to test the thyroid include testing of thyroid-stimulating hormone levels, T4 tests for hypothyroidism and hyperthyroidism, and free T4 or free thyroxine, a method of measuring T4 that eliminates the effect of proteins that naturally bind T4 and may prevent accurate measurement.

These tests alone aren’t meant to diagnose any illness, but might prompt healthcare providers to perform additional testing to evaluate for possible thyroid disorders, according to the Cleveland Clinic. Additional blood tests could include thyroid antibody tests and a calcitonin test used to diagnose C-cell hyperplasia and medullary thyroid cancer, both of which are rare thyroid disorders.

Imaging tests

Healthcare providers might also perform an ultrasound or thyroid scan, that allows a look at the thyroid to check for an increased size, shape or growths.

Physical exam

Another way to quickly check the thyroid is with a physical exam; a simple and painless test in which the provider feels the patient’s neck for any growths or enlargement of the thyroid.

Reference

  1. The Cleveland Clinic, 2020. Accessed Dec. 15, 2020. https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease/diagnosis-and-tests

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