Medically reviewed by Dr. Stacy Hengisman MD and Felice Ramallo MSRD.
Many of us have heard in passing about the importance of our thyroids, and we may even know what hormones it helps control and regulate in the body – but where it is, the signs of a thyroid disorder, and how to care for our thyroid are questions not many people know the answers to. That’s why in this article we’ll be discussing the many functions of the thyroid (spoiler: it’s critically important!), the most common thyroid conditions and their origins, how to go about getting a diagnosis if you suspect a problem with your thyroid, and how to better support thyroid health through lifestyle choices. Let’s get into it!
What you need to know about your thyroid
Where is it?
Let’s start with the basics: your thyroid is both a gland and an organ, and it’s located in the front of your neck. It’s wrapped around the windpipe, and is said to be shaped like a butterfly, with a smaller middle and wider ‘wings’ that extend on either side of your throat.
What does it do?
Since your thyroid is an endocrine gland, it plays a critical role in making hormones. It helps control many activities in your body, from how fast you burn calories, to how fast your heart beats, and a lot in between. The three hormones your thyroid produces are as follows:
- Triiodothyronine (often referred to simply as T3)
- Tetraiodothyronine (shortened to T4)
- Calcitonin
T3 and T4 are critically important as they increase our basal metabolic rate, impacting how our body uses energy and helping to control body weight, body temperature, muscle strength, and even the nervous system. Both these hormones are made in the thyroid, but the thyroid can’t produce these without some help: since iodine is one of the main building blocks of these hormones (and our bodies can’t make it intrinsically), we need to get this chemical element from our environment, namely our diet.
The thyroid also gets help deciding how much to make of each hormone from the pituitary gland, which signals to the thyroid how much more or less hormone to release into our bloodstream. When in the bloodstream, these thyroid hormones attach to transport proteins, and when our body needs hormones, more T3 and T4 can be released from within the blood. Pretty cool, right?
Which brings us to the third hormone on our list, calcitonin: this is made by C-cells, and is involved in calcium and bone metabolism, namely regulating the levels of calcium in your blood.
What if something is wrong with your thyroid?
For people with different thyroid conditions, symptoms will vary. Some people notice symptoms like feeling fatigued much of the time, weight gain, feeling cold, a fast-beating heart, feelings of nervousness – and way more, depending on what exactly is wrong with their thyroid. What is universal across patients with different thyroid disorders is the negative impact it can have on one’s daily life before treatment. If you suspect you have a thyroid disorder, or something feels off, it is critical you speak with your primary care physician to investigate the root cause behind the problem.
Most common thyroid conditions
Hyperthyroidism
Hyperthyroidism is the term to describe an overactive thyroid. This means the thyroid gland is making too many hormones. It currently impacts between 1 and 3% of the US population.
Causes of hyperthyroidism can include:
- Graves disease
- Approximately 70% of people with an overactive thyroid have this autoimmune condition. Most common in women over the age of 20, it can affect individuals of all ages and genders.
- Too much iodine intake
- Taking too much thyroid medication
- Overactive thyroid nodules
- Otherwise referred to as goiter, its most common cause is an iodine deficiency.
- Non-cancerous pituitary gland tumor
The most common symptoms of hyperthyroidism include restlessness, nervousness, increased sweating, anxiety, brittle hair and nails, weight loss, increased appetite, difficulty sleeping, racing heart rate, thin skin, muscle weakness, bulging eyes, and frequent bowel movements.
Hypothyroidism
Hypothyroidism is essentially the opposite of hyperthyroidism: it means your thyroid isn’t producing as many hormones as it needs. It affects around 4% of the US population.
Common causes of hypothyroidism include:
- Thyroiditis
- This a term used to describe a group of conditions that trigger inflammation in your thyroid gland
- Congenital hypothyroidism
- This means you were born with the condition
- Iodine deficiency
- A problem with your pituitary gland or hypothalamus
- Certain medications (such as those for bipolar disorder or cancer)
The most common symptoms of hypothyroidism include: fatigue, feeling cold a lot of the time, dry skin, memory problems, depression, slow heart rate, weight gain, fertility problems, heavy or irregular menstruation, feeling weak, muscle or joint pain, hair loss, and constipation.
Hashimoto’s disease
This is an autoimmune disease that is closely associated with hypothyroidism (though in rare cases it can cause hyperthyroidism). We’re calling it out in a separate category because of the way it prompts a thyroid disorder. In people with Hashimoto’s disease, the immune system produces antibodies that attack the thyroid gland; these large numbers of white blood cells build up in the thyroid and the thyroid’s hormone-producing cells become damaged and can’t make enough hormones. Interestingly, Hashimoto’s is about 4 to 10x more prevalent in women than men, though men can also be diagnosed with Hashimoto’s, and it often develops in women aged between 30 and 50.
The risk factors for this autoimmune disorder are the following:
- Having a family member with the condition
- Radiation exposure
- Iodine excess
- Pregnancy
- Having other autoimmune diseases
Graves’ disease
While Hashimoto’s is strongly associated with hypothyroidism, Graves is associated with its counterpart, hyperthyroidism. For unknown reasons, Graves’ triggers the body to attack its own thyroid gland tissue, and once again it is more prevalent in women than men.
The risk factors for Graves’ disease include:
- A family history of this condition
- Stress
- Being under 40
- Having other autoimmune disorders (such as rheumatoid arthritis, Chrohn’s disease, or type 1 diabetes)
Graves’ disease is thought to be responsible for approximately 70% of hyperthyroidism cases (although, like we mentioned earlier, thyroid diseases are relatively rare in the general population, accounting for approximately 5% of Americans combined).
Goiter
Goiter refers to the irregular growth of the thyroid gland and is often associated with hyperthyroidism and Graves’ disease.
Usually, goiters involve the overall enlargement of the thyroid, or the irregular growth of cells (forming nodules) in the thyroid. Sometimes a goiter may not be a cause for concern: it doesn’t necessarily have to impact thyroid function, and it may not impact the production of thyroid hormones in ideal cases. For instance, small goiters that don’t trigger any symptoms are generally left alone but monitored. Occasionally, though, goiters that cause problems will be treated as part of a larger treatment plan that addresses other coordinating conditions (such as Graves’ and hyperthyroidism).
Goiters that grow large enough to cause problems may trigger the following symptoms:
- Visible swelling on throat/neck
- Difficulty swallowing
- Difficulty breathing with ease
- Cough
- Hoarseness
- Snoring
Thyroid nodules
Finally, we reach the last most common thyroid condition: the presence of nodules on the thyroid. Most nodules (over 90%) are benign and do not cause any symptoms, in which case they go undiagnosed or untreated. According to one study conducted in the past decade, approximately 1% of men and 5% of women living in countries with iodine sufficiency have thyroid nodules that are able to be felt in a physical exam. That being said, like with other thyroid conditions we’ve discussed in this section, the rate of nodules in women is 4x that of men, while the rate of thyroid cancer in men is double that of women. In other words, women are more likely to have nodules than their male counterparts, but men with nodules on their thyroid are at higher risk for these nodules to not be characterized as benign. In either case, if you suspect you have nodules on your thyroid, it’s important you speak with your primary care physician to make sure they are nothing to worry about.
It’s worth noting that thyroid nodules not associated with Hashimoto’s, and those that do not impact thyroid function, are often not accompanied by any symptoms.
Getting a thyroid disorder diagnosis
The first step to getting answers as to whether you have a thyroid disorder is sharing your concerns with your doctor. This is of critical importance, as they can order the right tests to see what may be going on internally.
Here are some of the tests your doctor may request, and what they mean:
TSH test:
TSH is a hormone made by the pituitary gland that signals to the thyroid how much T3 and T4 to make. High TSH levels mean you may have hypothyroidism (underactive thyroid); this is because the thyroid isn’t making enough hormone, and as a result, the pituitary gland is trying to compensate for this deficiency by outputting TSH in your blood. On the other hand, a low TSH level can be indicative of hyperthyroidism (overactive thyroid). This means your thyroid is pumping out too much hormone, and so your pituitary stops releasing TSH into your blood.
If TSH tests come back unusual, your doctor will order more tests to help understand what the underlying cause is.
T4 test:
High levels of T4 typically signal an overactive thyroid, while low levels signal an underactive thyroid. There are some exceptions to this, though: if you are on birth control, your thyroid hormone levels may be higher, while illnesses like asthma, arthritis, skin conditions, and other health problems can lower T4 in your system.
T3 test:
T3 is typically tested after T4 to confirm the diagnosis. Having said that, sometimes one is normal and the other is not, so having both tested is optimal to getting an accurate diagnosis.
Thyroid antibody test:
Finally, we have the thyroid antibody test: this is particularly useful in diagnosing a thyroid disorder prompted by an autoimmune condition, such as Graves’ disease and Hashimoto’s. For instance, when your immune system attacks its own thyroid gland by mistake, your thyroid antibody test results may come back unusually high.
Usually, the above tests by themselves are enough to diagnose a thyroid disorder. However, sometimes doctors may also order imaging or other exams to get a clearer picture of your thyroid health. These can include:
Ultrasound:
This is often used to look at thyroid nodules in particular. These nodules are more often than not benign, but an ultrasound can help doctors detect if they are more likely to be cancerous. For this exam, your doctor will run a transducer over your neck, and the sound waves emitted will give a picture of your thyroid. The exam usually takes 30 minutes and is painless and noninvasive. Check out this article to understand more about ultrasounds and their multiple uses.
Thyroid scan:
This type of scan is ordered when your physician wants to evaluate the size, shape, and position of your thyroid. The test involves a small amount of radioactive iodine to check for thyroid nodules (and help find the cause of hyperthyroidism at the same time). For this exam, there is a lag in time in between injecting or consuming the iodine and undergoing the scan, running from as little as 30 minutes to as long as 24 hours. The scan itself only takes 30 minutes. (If you are pregnant or breastfeeding, thanks to the small radiation exposure, this option will be avoided).
Radioactive iodine uptake test:
This test checks thyroid function by checking how much radioactive iodine your thyroid takes up from your blood. The test itself lasts only a few minutes, but measurements are taken 4 to 6 hours after you first swallow the radioactive iodine, and then again 24 hours later.
How to support thyroid health in your lifestyle
There is limited research dedicated to understanding the role of diet and thyroid function, but what we know so far is that dietary stress in the body can be triggered by inflammation, a sensitivity, or an allergic response, as well as spikes in blood sugar, while high amounts of unhealthy fats and certain toxins or chemicals can cause immune responses.
So what are some concrete steps you can take to support your body, and by extension, help support thyroid function?
Consider eating more:
- Anti-inflammatory or Mediterranean diet foods, like fruits, vegetables, whole grains, legumes/beans, and dairy products
- Foods with very little nutritional value don’t work to support your body’s health (though they can be great as an occasional treat); try to avoid highly processed foods, instead swapping them out for nutrient-dense, high-fiber foods that help alleviate symptoms of thyroid disorder, such as fatigue and constipation.
- Olive oil, avocado oil, and healthy nuts
- These all have anti-inflammatory properties!
Consider limiting:
- Sweets and candy
- A thyroid disorder puts you at increased risk of type 2 diabetes, so try to reduce your intake of soda, candy, and artificial sweeteners. Instead try to incorporate these treats into your diet in moderation and with extra protein, fat, or fiber (for instance, by swapping half of your sweet intake to your favorite fruit, and adding nuts or full-fat dairy).
- Triggering foods
- Foods that you are sensitive or allergic to are best avoided, and if you need help identifying those, it is always a good idea to speak with a Registered Dietitian. For instance, Celiac disease is 3-fold as common in those with autoimmune conditions such as Hashimoto’s and Graves’ than in the general population, and the body’s reaction to gluten in those suffering from Celiac’s can mean iodine and selenium (important for thyroid health) are not absorbed properly.
Allara Health provides personalized treatment for hormonal, metabolic & gynecological conditions that utilizes a holistic plan that merges nutrition, lifestyle, medication and supplementation, and ongoing, expert support to heal your body.