Thyroid disease is one of the most common illnesses in the U.S. Approximately 12% of all Americans (20 million people) will suffer from a thyroid disorder at some point in their lives. Unfortunately, up to 60% of people who suffer from thyroid disease are unaware of their condition, and undiagnosed thyroid disease can lead to many serious health conditions. Although anybody can develop a problem with their thyroid at any point in life, women are up to eight times more likely to have a thyroid disorder than men. In fact, 1 in 8 women will develop a thyroid disorder during their lifetime.

 What Hormones does the Thyroid Produce?

The thyroid gland is a large, butterfly-shaped endocrine organ in the front of the neck, just under the voice box. It produces three vital hormones: triiodothyronine (T3), tetraiodothyronine (T4 or thyroxine), and calcitonin. The thyroid gland requires a good supply of dietary iodine for proper functioning.

 T3 and T4 hormones perform numerous important roles for our health and the proper functioning of our bodies. They help regulate brain development, metabolism, weight, energy levels, brain function, heart and gastrointestinal functions, body temperature, skin, nails, and hair growth. 

Calcitonin is made by cells called “C cells” in the thyroid and regulates the levels of calcium and potassium in the blood to maintain healthy bones.

 How does the Thyroid Function?

The thyroid requires a signal from the pituitary gland, a small gland located at the bottom of our brain, to start producing and releasing hormones. The process starts with the pituitary gland producing a hormone known as thyroid-stimulating hormone (TSH). TSH tells the pituitary gland how much hormone to make and release. TSH levels rise and fall, producing more or less hormones, depending on the body’s needs. Another small gland in the brain called the hypothalamus (just above the pituitary gland) also helps with thyroid function. The hypothalamus releases a hormone known as thyrotropin-releasing hormone (TRH). TRH stimulates TSH to send signals to the thyroid gland. This entire process, which adapts to the body’s needs, is known as the hypothalamic-pituitary-thyroid axis (HPT) 

What Can Go Wrong with the Thyroid Gland? 

Typically, the thyroid gland produces the exact quantity of hormones needed to maintain the body's metabolism running smoothly and balanced. However, sometimes, things can go wrong causing the thyroid gland to over or underproduce hormones. Too much hormone production (hyperthyroidism) can cause the body to use up energy too quickly, while too little hormone production (hypothyroidism) can slow the body down. Other things that can go wrong with the thyroid gland include the development of cancerous and non-cancerous cells, as well as damage due to an autoimmune disease.

• Hypothyroidism or an underactive thyroid is a condition where the thyroid gland does not make enough hormone. Common causes of hypothyroidism include radiation treatment, thyroid surgery, iodine deficiency, pregnancy, family history of hypothyroidism, thyroiditis (inflammation of the thyroid), and certain medications. Hashimoto’s disease, an autoimmune disorder that causes the immune system to attack the thyroid gland, leading to inflammation, is the most common cause of hypothyroidism. Some symptoms of hypothyroidism include depression, low heart rate, fatigue, weight gain, cold intolerance, achy joints and muscles, dry skin, thinning hair and eyebrows, and changes in the menstrual cycle.
  
  
• Hyperthyroidism or an overactive thyroid is when the thyroid overproduces thyroid hormones. It can be caused by many things, including an autoimmune disorder like Graves’ disease, which causes the immune system to attack the thyroid gland, produce too much thyroid hormone, and speed up the body’s metabolism. Graves’ disease is the most common cause of hyperthyroidism. Other causes of hyperthyroidism include thyroid nodules (non-cancerous lumps) and thyroiditis (inflammation of the thyroid). Some symptoms of hyperthyroidism include unexplainable weight loss, sweating, changes in menstrual cycle, tremors, irregular heartbeat, anxiety, and tiredness.

• Toxic Nodular Goiter, also known as Plummer disease, is a condition where one or more nodules (small masses) develop in the thyroid gland and produce excess thyroid hormones, which are released into the bloodstream. This leads to hyperthyroidism.  

• Thyroiditis is a group of conditions that cause inflammation of the thyroid gland, leading to over or underproduction of thyroid hormones. Causes of thyroiditis include infections, medications, radiation, and autoimmune diseases.
  
  
• Postpartum Thyroiditis is an inflammation of the thyroid that occurs in up to 10% of women after giving birth. Sometimes this goes undiagnosed as some of the symptoms of postpartum thyroiditis, such as tiredness and moodiness, are similar to the symptoms of “baby blues” that most women experience after having a baby.
  
  

• Thyroid Adenomas are mostly non-cancerous growths on the thyroid gland. They are often asymptomatic, although some of them can cause an overproduction of thyroid hormones, leading to hyperthyroidism.
  
  
• Thyroid Cancer is a condition where cancer cells form in the thyroid gland. Fortunately, these are highly treatable and generally have a good prognosis. People who have been exposed to radiation are at greater risk of developing thyroid cancer, as well as those with a family history of cancer. Age, gender, and obesity status increase the risk factors for thyroid cancer. Some symptoms of thyroid cancer can include a palpable lump on the neck, feeling like shirt collars or necklaces are too tight, swollen lymph nodes in the neck, hoarseness of the voice, and pain or tenderness in the neck.

 Thyroid Dysfunction and Fertility

Thyroid disease can cause problems in multiple body systems, including the reproductive system. Low thyroid levels are linked to abnormal menstrual cycles, anovulatory cycles where an egg is not released, and increased risk of miscarriage and pregnancy complications. 

Pregnant women with hypothyroidism are more likely to develop gestational high blood pressure, anemia, placental abruption, low infant birthweight, stillbirth, and postpartum hemorrhage. Low thyroid is easily treatable, and having healthy thyroid levels can make a positive difference in your fertility journey.

 Diagnosis and Treatment for Thyroid Disease 

Thyroid disease can be difficult to diagnose because some of the symptoms mimic other medical conditions. However, examinations like blood tests, imaging tests, and physical exams can help determine if symptoms are caused by thyroid disorders. If it is determined that the symptoms are due to the thyroid, the goal becomes to normalize the thyroid hormones to bring balance back to the body. 

Surgery, radioactive iodine, and medications can help in managing hyperthyroidism. In hypothyroidism, the treatment of choice is often a synthetic thyroid called levothyroxine. When taken daily as prescribed, thyroid levels will become regulated within a few weeks. Thyroid adenomas and cancers can be treated surgically or with radioactive iodine. Cancers may also require traditional external radiation therapy or chemotherapy.

 Lifestyle Considerations

A nutritious and balanced diet coupled with regular health care and physical activity can protect the long-term function of your thyroid gland. Since thyroid hormones are dependent on iodine, a balanced thyroid hormone profile is also dependent on good iodine intake and other important nutrients. Fortunately, most of our foods, especially in the U.S., are fortified with iodine, thus, people do not generally lack dietary iodine.

Minor changes in your day-to-day life can also go a long way to supporting your thyroid health. For instance, using iodized salt in cooking and eating iodine-rich foods like seafood, seaweed, eggs, and dairy (in moderation) can help to support your thyroid health. If you are vegan, there may be a possibility you are not getting sufficient iodine from your diet alone; discuss your options with your healthcare providers, including a nutritionist.

 Food such as soy products and cruciferous vegetables like broccoli and cabbage are known as goitrogens. These foods can interfere with the normal functioning of the thyroid gland.  Most healthy people won’t have an issue with these foods unless they are eating an excessive amount, but if your thyroid levels are already low, you might want to avoid goitrogens. There is evidence that micronutrients like selenium, zinc, copper, calcium, and iron support thyroid function. Eat a varied and nutrient-dense diet to ensure you get enough trace vitamins and minerals to support your thyroid health. 

If you are concerned about your thyroid for any reason, talk to your doctor about getting comprehensive blood work done to check your thyroid levels and make adjustments if needed.