Thyroid For Dummies E-Book

Alan L. Rubin

• Herausgeber: John Wiley & Sons
• Kategorie: Ratgeber
• Sprache: Englisch
• Veröffentlichungsjahr: 2011

Seitenzahl: 607

Beschreibung

If you or a loved one has been diagnosed with a thyroid condition, you've probably found out at least a little about this mysterious gland--just enough to want to look for answers to the many questions that keep popping up in your mind. What causes this condition? How is it treated? What can you do to get healthy again? Thyroid For Dummies, 2nd Edition gives you the detailed information you're looking for on new methods for detecting thyroid disease in both adults and children, alternative treatments, pros and cons of powerful new drugs now on the market, advice for managing the disease through changes in exercise and diet, and much more. You're discover: * What the thyroid does * How to identify a sick thyroid and recognize who's at risk * Ways to find the right thyroid doctor * How to cope with hypothyroidism in children * The hereditary connection to thyroid disease * How thyroid disease affects the elderly * The effects of hyperthyroidism during pregnancy * How to decide if surgery is necessary * Ten myths about thyroid health Updated to address advances made since the first edition, including the latest thinking on understanding thyroid disease's connection to depression and mania, Thyroid For Dummies, 2nd Edition will tell you everything you need to know about how the thyroid functions, what makes it malfunction, and what to do when a problem occurs.

Leseprobe

Thyroid For Dummies, 2nd Edition

by Alan L. Rubin, MD

Thyroid For Dummies, 2nd Edition®

Published byWiley Publishing, Inc.111 River St.Hoboken, NJ 07030-5774www.wiley.com

Copyright © 2006 by Wiley Publishing, Inc., Indianapolis, Indiana

Published simultaneously in Canada

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Library of Congress Control Number: 2006920628

ISBN-13: 978-0-471-78755-6

ISBN-10: 0-471-78755-8

Manufactured in the United States of America

10 9 8 7 6 5 4

2B/SY/QS/QY/IN

About the Author

Alan L. Rubin, MD, is one of the nation’s foremost experts on the thyroid gland in health and disease. He is a member of the Endocrine Society and has been in private practice specializing in thyroid disease and diabetes for over 28 years. Dr. Rubin was Assistant Clinical Professor of Medicine at UC Medical Center in San Francisco for 20 years. He has spoken about the thyroid to professional medical audiences and nonmedical audiences around the world. He is a consultant to many pharmaceutical companies and companies that make thyroid products.

Dr. Rubin has written extensively on the thyroid gland as well as diabetes mellitus. As a result, he has been on numerous radio and television programs talking about the cause, the prevention, and the treatment of conditions of the thyroid. He is also the best-selling author of Diabetes For Dummies and Diabetes Cookbook For Dummies, both now in second editions and translated into multiple languages including Chinese, Spanish, French, and Russian. Hislatest book is High Blood Pressure For Dummies.

Dedication

The second edition of this book is again dedicated to my wife, Enid. She smilingly let me do my work, sometimes into the wee hours of the morning, and missed many an opportunity to go out to dinner or a movie so that I could produce this book for you. If you have a fraction of the support in your life that she has given me, you are a lucky person, indeed.

Author’s Acknowledgments

The great publisher and midwife, Kathy Nebenhaus, deserves enormous appreciation for helping me to deliver yet another bright-eyed baby. Her optimism and her enthusiasm actually made this book possible. Acquisitions editor Michael Lewis played a huge role in ironing out the inevitable problems that arise when book publishing and medicine meet.

My editor, Michael Baker, did a magnificent job turning my sometimes incomprehensible prose into words that you can understand. He also conducted a whole orchestra of other editors who contributed to the book, including Melissa Wiley. My thanks to Dr. Kathleen Bethin for the technical editing of the book.

Librarian Karen O’Grady at St. Francis Memorial Hospital was tremendously helpful in providing the articles and books upon which the information in this book is based.

My teachers are too numerous to mention, but one person deserves special attention. Dr. Francis Greenspan at the University of California Medical Center gave me the sound foundation in thyroid function and disease upon which this book is based.

Finally, there are my patients over the last 28 years, the people whose trials and tribulations caused me to seek the knowledge that you will find in this book. This book is written on the shoulders of thousands of men and women who made the discoveries, tried the medications, and held the committee meetings. Their accomplishments cannot possibly be given adequate acclaim. We owe them big time.

Publisher’s Acknowledgments

We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/.

Some of the people who helped bring this book to market include the following:

Acquisitions, Editorial, and Media Development

Project Editor: Mike Baker

(Previous Edition: Joan Friedman)

Acquisitions Editor: Michael Lewis

Copy Editor: Melissa Wiley

Editorial Program Coordinator: Hanna K. Scott

Technical Editor: Kathleen Bethin, MD

Editorial Manager: Christine Meloy Beck

Editorial Assistants: Erin Calligan, David Lutton

Cartoons: Rich Tennant (www.the5thwave.com)

Composition Services

Project Coordinator: Adrienne Martinez

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Special Art: Kathryn Born

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Indexer: Aptara

Publishing and Editorial for Consumer Dummies

Diane Graves Steele, Vice President and Publisher, Consumer Dummies

Joyce Pepple, Acquisitions Director, Consumer Dummies

Kristin A. Cocks, Product Development Director, Consumer Dummies

Michael Spring, Vice President and Publisher, Travel

Kelly Regan, Editorial Director, Travel

Publishing for Technology Dummies

Andy Cummings, Vice President and Publisher, Dummies Technology/General User

Composition Services

Gerry Fahey, Vice President of Production Services

Debbie Stailey, Director of Composition Services

Contents

Title

Introduction

About This Book

Conventions Used in This Book

Assumptions

How This Book Is Organized

Icons Used in This Book

Where to Go from Here

Part I : Examining the Thyroid

Chapter 1: The Big Role of a Little Gland

Discovering the Extent of the Problem

Identifying an Unhappy Thyroid

Recognizing Who’s at Risk

Realizing the Importance of a Healthy Thyroid

Treating What Ails You

Examining Additional Contributors to Thyroid Ailments

Realizing the Consequences of Delaying Treatment

Paying Attention to Special Groups and Considerations

Keeping the Rest of Your Body Healthy

Staying Informed

Chapter 2: How the Thyroid Works

Picturing Your Thyroid

Examining the Production of Thyroid Hormones

Understanding the Function of Thyroid Hormones

Chapter 3: Finding a Thyroid Doctor

Asking the Right Questions

Consulting Possible Sources

Questions for and Observations about the Doctor on First Meeting

Reviewing Special Considerations When Choosing a Thyroid or Eye Surgeon

Chapter 4: Testing Your Thyroid

Checking Thyroid-Hormone Levels with Older Tests

Checking Your Levels with the Best Tests

Taking Nonhormonal Blood Tests

Determining the Size, Shape, and Content of Your Thyroid

Part II : Diagnosing and Treating Thyroid Conditions

Chapter 5: Dealing with Decreased Thyroid Function

Living with Autoimmune Thyroiditis

Identifying Hypothyroidism

Pinpointing the Causes of Hypothyroidism

Diagnosing Severe Hypothyroidism

Treating Hypothyroidism with Hormones

Treating Myxedema Coma

Managing Subclinical Hypothyroidism

Understanding the Nonthyroidal Illness Syndrome

Chapter 6: Taming the Hyperactive Thyroid

Detecting the Signs and Symptoms of Hyperthyroidism

Confirming a Diagnosis of Hyperthyroidism

Determining Whether Graves’ Disease Is the Culprit

Recognizing Other Causes of Hyperthyroidism

Choosing the Best Treatment for Graves’ Disease

Treating Other Causes of Hyperthyroidism

Surviving Thyroid Storm

Chapter 7: Thyroid Nodules

What’s a Thyroid Nodule?

Evaluating Cancer Risks

Securing a Diagnosis

Treating Cancerous Nodules

Dealing with Nodules That Aren’t Cancer

Chapter 8: Thyroid Cancer

Determining What Causes Thyroid Cancer

Identifying the Types of Thyroid Cancer

The Stages of Thyroid Cancer and the Treatment Options

Following up on Cancer Treatment

Chapter 9: Multinodular Goiters: Thyroids with Many Nodules

A Multinodular Goiter Grows Up

Making a Diagnosis

Choosing to Treat It or Ignore It

Treating a Multinodular Goiter

Dealing with a Goiter Behind the Sternum

Chapter 10: Drugs That Impact Your Thyroid

Revealing the Drug-Food-Thyroid Connection

Identifying the Effects of Specific Substances

Looking At the New Drugs

Discovering Whether You’re at Risk

Chapter 11: Thyroid Infections and Inflammation

Putting a Face on Subacute Thyroiditis

Coping with Postpartum and Silent Thyroiditis

Identifying Acute Thyroiditis

A Rare Form of Thyroiditis

Chapter 12: Iodine Deficiency and Excess Disease

Consuming Iodine in the U.S., Canada, and the U.K.

Realizing the Vastness of the Problem

Facing the Consequences of Iodine Lack

Managing the Problem of Iodine Deficiency

Delineating the Drawbacks of Iodization

Chapter 13: Surgery of the Thyroid

Deciding If Surgery Is Necessary

Finding Your Surgeon

Making Final Preparations Before Surgery

What Happens During Surgery

Considering a New Approach

Recuperating After the Operation

Part III : Reviewing Special Considerations in Thyroid Health

Chapter 14: The Genetic Link to Thyroid Disease

Taking Genetics 101

Probing the Origins of Genetic Thyroid Diseases

Viewing the Future of Managing Hereditary Thyroid Disease

Chapter 15: The Thyroid and Your Mental Health

The Underactive Thyroid and Your Mood

Overactivity of the Thyroid and Your Mind

Fighting Depression

Chapter 16: What’s New in Thyroid Treatment?

Treating Subclinical Hypothyroidism

Finding the Right Dose of Hormone

Dealing with Hyperthyroidism

Assessing Goiters and Nodules

Using Antithyroid Drugs Properly

Handling Thyrotoxic Periodic Paralysis

Taking New Approaches to Thyroid Cancer

Tackling Iodine-Deficiency Disease

Chapter 17: The Thyroid and Pregnancy

The Normal Thyroid During Pregnancy

Pregnancy and Hypothyroidism

Hyperthyroidism in Pregnancy

New Thyroid Nodules in Pregnancy

Chapter 18: Thyroid Conditions and Children

Understanding the Onset and Development of Thyroid Function

Screening the Newborn

Coping with Hypothyroidism in Children

Dealing with Hyperthyroidism in Children

Diagnosing Goiters in Children

Finding Nodules and Cancer in Children

Chapter 19: Thyroid Disease and the Elderly

Thyroid Changes in the Elderly Due to Aging and Nonthyroidal Disease

Real Thyroid Disease in the Elderly

Sources of Confusion in Diagnosis

Discovering Hypothyroidism in the Elderly

Hyperthyroidism in the Elderly

Thyroid Nodules in the Elderly

Chapter 20: Diet, Exercise, and Your Thyroid

Guaranteeing Your Best Nutrition

Clarifying the Thyroid-Weight Connection

Getting Enough Iodine in a Vegetarian Diet

Exercising for Your Thyroid

Uncovering a New Hormone: Connecting Leptin to Weight Loss and the Thyroid

Part IV : The Part of Tens

Chapter 21: Ten Myths about Thyroid Health

I’m Hypothyroid, so I Can’t Lose Weight

I’m Hyperthyroid, so I Can’t Gain Weight

Breastfeeding and Antithyroid Pills Don’t Mix

Brand-Name Thyroid Hormone Pills Are Best

I Have to Take Thyroid Medication for Life

Natural Thyroid Hormones Are Better Than Synthetic Hormones

Thyroid Disease Is Contagious

Iodine Deficiency Is a Medical Problem

The Higher My Autoantibody Levels, the Worse My Thyroid Disease

Clinical Symptoms Are More Reliable Than Blood Tests

Chapter 22: Ten Ways to Maximize Thyroid Health

Screening at Appropriate Intervals

Checking Thyroid Function As Your Body Changes

Performing a “Neck Check”

Getting Enough Iodine to Satisfy Your Thyroid

Stopping Thyroid Medication, If Possible

Using Both Types of Thyroid Hormone

Preventing the Regrowth of Thyroid Cancer

Using the Same Thyroid Preparation

Anticipating Drug Interactions

Protecting Your Thyroid from Radiation

Keeping Up-to-Date with Thyroid Discoveries

Chapter 23: Ten Questions Readers Have Posed

Basing Doses of Methimazole on TSH

Reversing Cold Sensitivity

Treating a Teenager for Hyperthyroidism

Taking Methimazole All at Once

Insisting on Radioactive Iodine Treatment

Treating with Thyroid after Pregnancy

Explaining Joint Problems

Taking Antithyroid Drugs Long Term

Reversing Chronic Thyroiditis

Changing Thyroid Dosage

Part V : Appendixes

Appendix A: A Glossary of Key Terms

Appendix B: Sources of More Information

Introduction

When the first edition of this book was published more than four years ago, I knew that knowledge of the thyroid and its diseases was minimal among the general public, but I had no idea of the burning desire of that same public to know more. Judging by the many thousands of copies that have been sold and the hundreds of e-mails that I have received, this book filled a huge gap. So many of you have written to thank me for helping you to understand what the thyroid does when it’s working normally and how to tell when it isn’t working normally.

The purpose of this second edition is to educate you about the newest developments since the previous edition and to fill in the areas that you tell me need more discussion and explanation. I thank you for your praise, your suggestions, and for allowing us specialists to study and understand you for the benefit of others.

As I entered the psychiatric medical unit at Bellevue Hospital the first day of my internship in 1966, I noticed a loud woman with penetrating eyes. I looked closely at her and saw that her neck was very enlarged. Because I was the new doctor on the unit, I picked up her chart and discovered that she had a case of Graves’ disease, a form of excessive thyroid production. For the next few months, I became intimately involved with her problems. She taught me a great deal about thyroid disease and probably represents the explanation for my lifelong interest in this subject. I’ve taken care of many such patients over the years (though never again in a psychiatric unit), but she stands out in my memory like a first love.

For hundreds of years, people have understood that a connection exists between a strange-looking growth in the neck and certain diseases. Until about 60 years ago, confusion reigned because people with similar growths in their necks often had opposite conditions. One group would show excessive excitement, nervousness, and shakiness; the other would show depression, sleepiness, and general loss of interest. What the two groups had in common was that they consisted mostly of women.

Around 60 years ago, measuring the chemicals that were coming from those growths (enlarged thyroid glands) became possible, and suddenly the whole picture began to make sense. Since then, a vast amount has been learned about the thyroid, the chemicals (hormones) made in that gland, and the purpose of those hormones.

In this book, you benefit from the hard work of doctors and other scientists over the last few hundred years. You find that, with very rare exceptions, thyroid diseases, including thyroid cancer, are some of the most easily treated of all disorders (which is why many thyroid specialists say, “If I have to have a cancer, let it be thyroid cancer.”)

After you read this book, I hope you’re a lot less confused than the poor thyroid itself, which doesn’t know where it is. I once heard the left side of a thyroid say to the right, “We must be in Capistrano. Here comes another swallow.” If you’ve read any of my previous books, Diabetes For Dummies,Diabetes Cookbook For Dummies, and High Blood Pressure For Dummies, you know that I use humor to get my ideas across, a technique that characterizes the For Dummies series. I want to emphasize that I’m not trying to trivialize anyone’s suffering by being comic. The work of Norman Cousins and others has shown that humor has healing properties. A positive attitude is far more conducive to a positive outcome than is a negative attitude.

About This Book

I don’t expect you to read this book from cover to cover. Because the first few chapters are a general introduction to the thyroid, you may want to start in Part I, but if you prefer to go right to information about the thyroid condition that affects you, by all means do so. If you run across any terms that you don’t understand, look for them in the glossary of terms in Appendix A.

I’ve written this book as a sort of medical biography of the Dummy family — Tami Dummy, Stacy Dummy, Linda Dummy, Ken Dummy, and other members of the clan whom you meet during your reading. These folks illustrate the fact that thyroid disease often runs in families. (Exceptions do exist to this fact, which I explain.) You meet members of the Dummy family, as well as some other fine fictional folks, at the beginning of each chapter that describes a thyroid disease so that you have a good picture of the condition I cover in that chapter.

One very big difference between thyroid disease and the other diseases that I wrote about in Diabetes For Dummies and High Blood Pressure For Dummies is that thyroid disease isn’t a lifestyle disease. You can’t cure any disease of the thyroid that I know of by changing your diet, exercising more, drinking less alcohol, or smoking fewer cigarettes. Although those changes are good for your health in general, you can’t cure thyroid disease on your own. You need your doctor’s help and sometimes the help of a specialist. What I hope you gain from this book is a good general knowledge of the thyroid gland and an understanding of the correct approach to thyroid disease. At the least, you should be able to ask much more informed questions and even decide for yourself how you want the doctor to approach your disease in some situations.

Many “facts” in the treatment of thyroid disease aren’t so factual when you look at the medical research literature. For instance, one “fact” dictates that doctors always start with a low dose of thyroid hormone when treating an older person who has low thyroid function in order to avoid overstressing the older person’s heart. But research doesn’t support this rule. This book points out many such examples of incorrect “facts” that doctors often believe with no evidence to support them.

Conventions Used in This Book

To help you navigate this book, I use the following conventions:

Italic text is used for emphasis and to highlight new words and terms that we define in the text.

Boldfaced text is used to indicate keywords in bulleted lists or the action parts of numbered steps.

Monofont is used for Web addresses. If you find that a specific address in this book has been changed, try scaling it back by going to the main site — the part of the address that ends in .com, .org, or .edu.

Sidebars are shaded gray boxes that contain text that’s interesting to know but not necessarily critical to your understanding of the chapter or topic.

And as much as I’d love to use all nonscientific terms in this book, if I did so, you and your doctor would be speaking two different languages. Therefore, I do use scientific terms, but I explain them in everyday English the first time you run across them. Plus, those difficult terms are defined in the glossary at the back of the book.

Three scientific terms come up over and over again in this book: thyroxine, triiodothyronine, and thyroid-stimulating hormone (also known as thyrotropin). I explain these terms in detail in Chapter 3. For these three words, I often use abbreviations: Thyroxine is T4, triiodothyronine is T3, and thyroid- stimulating hormone is TSH.

Assumptions

I make the assumption in this book that you or someone you care about has a thyroid condition that hasn’t been treated or perhaps isn’t being treated to your satisfaction. If this assumption doesn’t apply to you, perhaps you suspect that you have a thyroid condition and want to determine whether you should see a doctor, or you can’t get your doctor to run the necessary tests to determine whether a thyroid problem exists. Regardless of your individual situation, this book has valuable information for you.

I try to make no assumptions about what you know related to the thyroid. I don’t introduce any new terms without explaining what they are. If you already know a lot about the thyroid and its functions, you can still find new information that adds to your knowledge.

How This Book Is Organized

The book is divided into five parts to help you find out all you want to know about the thyroid gland.

Part I: Examining the Thyroid

Here is where you gain an understanding of the function of the thyroid and its location in your body. You’re able to tell if the gland is working the way it should. In this part, you learn about the medical tests that help us determine if something is wrong with your thyroid. Your doctor orders these tests, but you need to understand their meaning and which ones are appropriate for the condition you have. This understanding helps you know the severity of your condition and when it’s under control. A test that works in some situations isn’t always valid in others. I try to let you know when exceptions occur. Be careful not to frighten your doctor with the extent of your knowledge.

Because you can’t cure your thyroid disease without your doctor’s help, and often without the help of a specialist, I tell you how to find a good specialist in this part. Although far too many patients with thyroid disease exist for each one to see one of the limited numbers of specialists, in some cases a specialist is essential, and you need to know how to fine a good one in your area.

Part II: Diagnosing and Treating Thyroid Conditions

This part explains each of the conditions that affect the thyroid and how they affect you. By the time you finish with this part of the book, I may be able to retire, because you will know just about everything I know about thyroid disease: how to identify it and how to treat it. External factors also influence your thyroid, particularly drugs you may take and irradiation that you may have had. I discuss these factors in this part of the book.

Many people who wrote to me asked if certain of their symptoms were found in one of the thyroid diseases I discuss. Many people who were already diagnosed with the disease asked me if a particular symptom was part of the disease process. I add a number of minor symptoms to the lists to be more inclusive. The question also arises as to whether the presence of certain symptoms after the disease has been cured means the disease is back. I clear up that issue as well.

Part III: Reviewing Special Considerations in Thyroid Health

Thyroid conditions can have a profound effect on your mental health. You understand what’s happening in your brain along with the rest of your body when your thyroid gland is overactive or underactive. Unfortunately, such conditions impair your ability to think, so understanding this book may be more difficult for the person who hasn’t received treatment for his or her thyroid condition, which gives me more reason to be as clear as possible. Let me know if I’m not completely successful in doing this.

Throughout the book are many mentions about the hereditary nature of many of the thyroid diseases. A chapter in this part explains how people inherit thyroid diseases. You can do little to alter your genes unless you know a way to choose your parents. In that case, you wouldn’t be the same you anyway.

Three groups of people deserve special consideration in this book: pregnant women, children, and the elderly. Thyroid conditions take unusual directions in these groups, so the chapters in this part address their unique difficulties. The final chapter here offers suggestions for ways to improve your thyroid health — and your health in general — through diet, exercise, and lifestyle choices.

Part IV: The Part of Tens

Misinformation about the thyroid is rampant. In this part, I clear up some of that misinformation (though not all, because it accumulates faster than I can address it). I also show you how you can maximize your thyroid health. Thanks to all your questions, I have a new chapter in this part that answers the ten questions that recurred most often in your e-mails and seemed most important to clear up. Many things that seem so obvious to a person who has studied the thyroid and its diseases for thirty years may not be obvious for the person newly diagnosed with a thyroid disease. Keep those questions coming to me at [email protected], and who knows — your question may appear in the next edition of this book.

Part V: Appendixes

In Appendix A, you find a glossary of medical terms that relate to the thyroid; you may want to bookmark the glossary so you can go back and forth with ease as you read other chapters. In Appendix B, I direct you to the best-of-the-best Web sites, where you can get dependable facts to fill in any blank spots that remain after you read this book. Remember that Web sites are in flux. Some begin, and some close. If you want to be aware of the latest and most reliable Web sites, check at my Web site, www.drrubin.com, every so often. At my Web site, you’re able to click on a choice of one of three lists of “Related Websites” about diabetes, thyroid, and high blood pressure. They’re the most up-to-date and reliable resources on these subjects. And when you’re there, you may listen to my healthcasts (podcasts), several of which are about the thyroid gland.

Icons Used in This Book

Books in the For Dummies series feature icons in the margins, which direct you toward information that may be of particular interest or importance.

This icon means the information is essential. You want to be sure you understand it.

This icon points out important information that can save you time and energy.

This icon alerts you to situations in which you may need to dial up your doctor for some help.

This icon warns against potential problems you can encounter, such as the side effects of mixing medications.

This icon alerts you to information that, while informative, may provide a little more detail than you’re looking for.

Where to Go from Here

Where you go from here depends on your needs. If you want to understand how the thyroid works, head to Part I. If you or someone you know has a thyroid condition, you may want to pay particular attention to Part II. For help in maintaining good thyroid health, turn to Part III. If you’re pregnant or have a child or parent with a thyroid disorder, Part IV is your next stop. In any case, as my mother used to say when she gave me a present, use this book in good health.

If you’ve had an unusual or even a humorous thyroid experience you’d like to share, by all means, let me know about it by e-mailing me at [email protected]. Who knows — I may share it with the world in a future edition of this book.

Part I

Examining the Thyroid

In this part . . .

W hat exactly is the thyroid gland, and what does it do? In this part, you discover how important this little gland in your neck really is, what function it plays in your body, and how to determine if it is functioning properly. I also help you find a specialist who can help you fight thyroid disease.

Chapter 1

The Big Role of a Little Gland

In This Chapter

Crunching numbers: The incidence of thyroid disease

Recognizing signs, symptoms, and risk factors

Appreciating your thyroid’s hard work

Giving a sick thyroid some TLC

Pinpointing times of life that pose special risks

The thyroid is a little like Rodney Dangerfield: It doesn’t get the respect it deserves. Anyone who watches those primetime TV news shows knows about the importance of other body parts — the heart and lungs sure get a lot of press time. But unless you come face to face with a thyroid problem, chances are that you don’t hear much about what this little gland does and how important it is to your good health.