The One-Stop Guide to the Less Talked About Parts of your Thyroid

Although there is no magic diet that will be able to cure your thyroid problems, consuming certain nutrients such as iodine, selenium, and zinc can reduce your symptoms and help maintain a healthier thyroid. 

Understanding why these nutrients are helpful, how to consume these nutrients, and having practical recipes can be extremely daunting which is why we have created a comprehensive guide to clarify everything for you! Our medical team led by a medical doctor has looked into each of these topics to ensure that you are getting the most informative and relevant information.

 

Topics

Levothyroxine Storage

Vitamin D and Thyroid Health

Anastasia in ThyForLife team

By Anastasiia Petrenko

Did you ever have a feeling that your body becomes resistant to levothyroxine, and you get worse over time? Do not rush to conclusions – the reason behind this change may be not the prescribed dose but improper levothyroxine storage conditions, which change the tablet’s effect.

Levothyroxine storage

Even though many of us have a “medicine cabinet” in the bathroom, it does not mean that it is a good idea to store your medications there. Three main reasons why the bathroom is not safe for your tablets are:

  1. It is humid.
  2. It is hot.
  3. It is lighter than it should be.

In 2017, a group of Italian researchers conducted an experiment to observe patients with hypothyroidism whose TSH levels stayed outside the normal range despite taking levothyroxine regularly. These patients stored their tablets in the wrong places — next to heaters, near the shower in the bathroom, or by the window. When they changed the medication storage conditions and moved it away from heat, light, and humidity, their symptoms were reduced.

Even though this research had very few observed patients and requires further follow-ups, it totally makes sense as a rare bathroom fits the storage conditions necessary for any medication. Recent guidelines recommend levothyroxine storage per product at 20–25°C (68–77°F) and protected from light and moisture. You may experiment and measure these parameters in your bathroom after taking a morning shower or evening bath.

Thus, it is a good idea to move all tablets out of the bathroom. It may be convenient to have separate storage in the kitchen or other room, which should be far from children’s and pet’s sight.

Planning Your Pregnancy With Hypothryroidism

Anastasia in ThyForLife team

By Anastasiia Petrenko

Pregnancy is an exceptional period in any female’s life. Even though nearly 45% of all pregnancies in the U.S. remain unintended, more and more women decide to plan their maternity. In the medical world, this process is usually referred to as preconception.

This article will not cover typical check-ups recommended for all individuals planning to cancel their contraception to conceive a child. We aim to concentrate on the specifics of preconception in women with hypothyroidism only, reviewing all additional steps and processes they should go through to prepare for the healthiest pregnancy possible.

Hypothyroidism in Pregnancy

Mother’s hypothyroidism (if unmanaged) is harming the baby directly as during the first few months of pregnancy the fetus requires maternal thyroid hormones for normal nervous system development. Later, the baby will start producing the needed hormones themselves; however, the early-term thyroid hormone deficiency outcomes can not be reversed.

  1. PROBLEMS IN PRENATAL DEVELOPMENT

 Early studies demonstrated that children born to mothers with uncompensated hypothyroidism during pregnancy had lower IQ, an increased risk of disabling cerebral palsy, and impaired psychomotor development. We know that these possibilities sound terrifying but do not panic – if properly treated and controlled, women with hypothyroidism can have healthy, unaffected babies.

2. RISK OF INFERTILITY

Another important issue is that hypothyroidism may increase the risk of infertility. Even though this topic requires more high-quality studies, most evidence appears to support an association between overt thyroid dysfunction and an increased risk of infertility.

3. DIFFICULTIES WITH DISEASE DIAGNOSTICS

The last but not least important reason to address any thyroid-related symptoms before getting pregnant is that many thyroid disease symptoms such as fatigue, low concentration, constipation, and abnormal sensation may be mistaken for the signs of a normal pregnancy and, thus, delay needed diagnostics and treatment.

Who needs to be tested for hypothyroidism?

According to the 2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum,  routine thyroid laboratory tests are not recommended for all women planning a pregnancy. However, all females which arrived for preconception consultation or their first pregnancy appointment should undergo a clinical evaluation. If any of the following risk factors are identified, testing for serum thyroid-stimulating hormone (TSH) is recommended:

  • 1. A history of hypothyroidism/hyperthyroidism or current symptoms/signs of thyroid dysfunction
  • 2. Known thyroid antibody positivity or the presence of a goiter
  • 3. History of head or neck radiation or prior thyroid surgery
  • 4. Age >30 years
  • 5. Type 1 diabetes or other autoimmune disorders
  • 6. History of pregnancy loss, preterm delivery, or infertility
  • 7. Multiple prior pregnancies (≥2)
  • 8. Family history of autoimmune thyroid disease or thyroid dysfunction
  • 9. Morbid obesity (BMI ≥40 kg/m2)
  • 10. Use of amiodarone or lithium, or recent administration of iodinated radiologic contrast
  • 11. Residing in an area of known moderate to severe iodine insufficiency.

According to this guideline, when a suppressed serum TSH is detected in the first trimester of pregnancy, a medical history, physical examination, and measurement of maternal serum FT4 or TT4 concentrations should be performed. Measurement of TRAb and maternal TT3 may prove helpful in clarifying the etiology of thyrotoxicosis.

I have been diagnosed with hypothyroidism….now what?

First of all, it is essential to define the reason behind hypothyroidism before pregnancy because specific diagnostic tests (i.e., radioactive thyroid scan) and treatments (i.e., radioactive iodine ablation of the thyroid) are not safe for pregnant women.

The further strategy depends on your particular medical condition; in this article, we will only cover overt hypothyroidism in pregnancy. If detected before pregnancy, levothyroxine dose should be titrated to achieve a TSH level of 2.5 uU/ml or below before pregnancy. Also, be prepared that your doctor may decide to increase your thyroid medication dosage by 30-50% through the pregnancy and likely as soon as your pregnancy is confirmed.

Women with overt and subclinical hypothyroidism or those at risk for hypothyroidism should be monitored with a serum TSH measurement approximately every four weeks until midgestation and at least once near 30 weeks gestation.

Will I need any other tests?

American Thyroid Association does not recommend any additional maternal or fetal testing (such as serial fetal ultrasounds, antenatal testing, and/or umbilical blood sampling) beyond the measurement of maternal thyroid function unless needed due to other circumstances of pregnancy. This recommendation does not apply to women with Graves’ disease effectively treated with 131I ablation or surgical resection, who require TSH receptor antibody (TRAb) monitoring.

 If you want to dig deeper than standard patient-oriented guidelines, we recommend that you take time and read the Committee Opinion of the American College of Obstetricians and Gynecologists (ACOG) and the American Society Reproductive Medicine (ASRM). This source will help you to understand the basics of the pregnancy planning process from the perspective of the doctor.

COVID-19 and thyroid disease

Anastasia in ThyForLife team

By Anastasiia Petrenko

Even though many great things have already happened in 2020 and some are yet to come, most of the people will remember it as a year of the COVID-19 outbreak. Since the pandemic began, we have been surrounded by daily sensational and alarming updates on viruses’ origin, features, symptoms, treatments, and so on. Articles get published and retrieved in a week, guidelines change so rapidly that now, in September, it is hard to recall what they actually recommend for COVID-19 treatment. On some point, you could have felt frustrated on what exactly getting a coronavirus infection may lead to, and whether you, as a thyroid patient, should take any extra measures to help yourself to go through the pandemic period. In this article, we collected several evidence-based tips that address the specifics of thyroid patients’ health.

COVID-19 and thyroid diseases

Tip 1. Be kind to your mind.

Let’s be clear – it is OK to want to be updated on the recent news, care about your family’s safety, and just be curious about the humanity’s progress in the fight against COVID-19. However, if you feel constant anxiety, thoughts about the pandemic interfere with your daily routine, or you tend to imagine fatalistic scenarios – there is a need to address these feelings on your own or with the help of a professional. 

This is a general recommendation of the World Health Organization to all people across the globe but the patients with chronic thyroid conditions must take it more seriously. It goes without saying that being in the middle of a pandemic is stressful to everyone, however, people with chronic diseases such as hypo- or hyperthyroidism, Grave’s diseases, goiter, thyroid cancer, and others may experience harder times with overcoming it. Scientists have found that stress does not just act as a potential catalyst for some thyroid diseases (which isn’t surprising as stress accelerates many other illnesses) but it also works backward – thyroid disorders make it harder to overcome stress. Besides, psychological symptoms may be a side-effect of the treatment. For example, steroids can aggravate depression or beta-blockers, which are often used to slow down your heart rate and to reduce anxiety, can make some people tired, depressed, and less alert. Prolonged stress becomes chronic, negatively influencing the hypothalamic-pituitary-thyroid and hypothalamic–pituitary–adrenal axis. Thus, the people with thyroid conditions have a higher risk of getting caught in this endless “more stress – more hormonal disbalance” circle.

That is why you have to be kind to your mind and develop an understanding that you tolerate stress differently from the others. We don’t encourage you to use this fact as an excuse but maybe it makes sense to give yourself some extra self-care or approach a therapist a bit earlier than you would do it without a thyroid condition. Do not feel ashamed or scared – your feelings and emotions are a part of your personality and learning how to cope with them is nothing but a mature approach to life. Here are some general useful tips from CDC on how to approach stress: https://emergency.cdc.gov/coping/selfcare.asp

Tip 2. Make sure that you understand and address your risks correctly.

Nowadays, the media is overloaded with “people with chronic diseases are at a high risk of COVID-19 complications” statements. Even though they seem logical, it isn’t exactly the truth. First of all, the range of chronic diseases is huge – from more well-known conditions like gastritis of goiter to rare genetic syndromes and malignancies. We can’t summarize them into one group as their mechanism, location and presentation differ too much. Secondly, even though during the COVID-19 disease the virus circulates all over the body, there are always some more and less vulnerable organs to each particular infection. That’s why one shouldn’t unite all chronic health conditions into one group.

Great news – the CDC has created a list of certain underlying medical conditions that increase the risk for severe illness from COVID-19. It is kept up to date and you may find the evidence which stands behind each of the recommendations.

The group of thyroid diseases isn’t listed there, yay! However, do not rush into conclusions – cancer, obesity, use of the corticosteroids and other risks may apply to some of you. British NHS has a similar list of moderate and high-risk groups of patients on their website. Their page has a great feature – it specifies the particular types of malignant diseases and cancer treatments which have been linked to higher chances of COVID-19 infection complication. We strongly recommend you to familiarize yourself with this data and define whether you are at the risk group or not. This may help you to control the situation and understand whether you need any additional safety measures.

Tip 3. Compensate!

Whether you have a freshly diagnosed thyroid condition or a combination of chronic problems – it does not differ much in terms of the risks of COVID-19 complications as long as they remain compensated. The compensation means that the disease can’t be completely cured but due to the treatment it does not progress and the patient feels relatively well. 

COVID-19 pandemic may have canceled many scheduled plans but this shouldn’t apply to your medical appointments. Here’s a quick questionnaire to see if there’s anything you are missing at the moment:

  1. Are you feeling well? Do you experience any thyroid-related symptoms at the moment? All symptoms and signs of thyroid disease decompensation must be reported to the specialist to detect the reason behind them and prescribe a new treatment regimen which will make you feel better.
  2. Is your blood work up-to-date? Are you periodically missing the medication which has been prescribed? It may be a good moment to consider using ThyForLife, as our app is designed to assist you in the organization of your medical data and to remind you about an upcoming check-up or medication.
  3. Do you have any procedures such as fine-needle aspiration or thyroid surgery which were delayed because of the COVID-19 outbreak? Check the position of the American Thyroid Association regarding the performance of these manipulations during the COVID-19 pandemic.
  4. Do you have any other medical conditions which aren’t controlled by the physician? As mentioned above, some diseases make you more vulnerable to infections and are more likely to result in complications, especially when they are in an acute phase or poorly managed. Some of them, such as obesity, may be completely cured with the help of professionals.

The best you can do for your safety during the coronavirus outbreak besides following general epidemiological measures is to take action and get the existing problems under control. We at our company are happy to make this process easier and more convenient for you.

10 Ways of Coping with Thyroid Conditions

By Suhani Saigal

ThyForLife reached out to ten thyroid patients to learn about their strategies for coping with thyroid conditions to find practical advice for new patients.  Here are their responses:

Siham in coping with thyroid conditions

“In my culture, eating a lot of fish and salmon can balance your thyroid function. So, I eat more fish. Additionally, I walk 1 kilometre daily and try to have a minimum of 10,000 steps every day.”

Shweta in coping with thyroid conditions

“The work outs I was doing weren’t helping me so I stopped my cardio and started doing yoga. For me, yoga is the second most important thing after nutrition to manage hypothyroidism. It makes me feel lighter. We think hypothyroidism is all about the physical body, but according to me, it all starts in the brain. Yoga helps relieve the mental pressure that accompanies thyroid disorders. ”

Laauren in coping with thyroid conditions

“I’ve been dealing with this for 2 years. What has helped me cope is support from family and friends. I wasn’t familiar with my thyroid before I was diagnosed. I knew nothing about it and was totally healthy before then. I was hooked up with a friend who was coping with a similar condition. I asked her a lot of questions. She was my only support as she understood what I was going through. ” 

Caren in coping with thyroid conditions

“My sense of humor and support from my family helped me deal with anxiety. Sometimes, it is hard to get through a day but staying positive helps. I never consulted a nutritionist but might do so in the future. I made slight diet changes but gave in to temptations many times.”

Joane in coping with thyroid conditions

“Reading, being informed, learning as much as you can, and having a doctor that you are comfortable with- these are the few things that have helped. With the thyroid, normal is sometimes optimal or above optimal hormone levels, depending on your body or medication. These numbers are important but the number is not the most important. Managing your symptoms is the best way to know your health.” 

Emma in coping with thyroid conditions

“Talking to other people about their experiences and getting more information helps in understanding the illness. I indulged in lots of researching. But even now, I’d like to know more about the current research.”

Shilpa in coping with thyroid conditions

“I have hypothyroidism which involves extreme fatigue, hormonal imbalance, and hair loss. Since my TSH was very high when detected (47) I had to be put on medication. Apart from medication, my regular walks of 5 kilometres everyday and food management seem to have helped me.”

Kelvin in coping with thyroid conditions

“I visit the doctor regularly and talk to my female colleague who also has hypothyroidism. I do internet research and find information on credible websites. I have so many questions and I always want to know more about other people’s stories.”

Melissa in coping with thyroid conditions

“Understanding my body and knowing my body better is always advantageous. Awareness and knowing more has been a great way to cope with the condition. I maintain an excel file and do my own calculations to look for my own micropatterns. Having an app that has all that intelligence so it can do it for me would be so helpful.”

Natalia in coping with thyroid conditions

“I had thyroidectomy 3 years ago. What has helped my mental wellbeing is spending a lot of time outdoors, in nature. I also seek second and third opinions across medical professionals to establish common ground.”

Remember that coping with thyroid conditions is unique to each person’s body. Explore your options and see what works best for you! 

*Quotes have been altered for grammatical purposes*

How to take thyroid medication properly

By Suhani Saigal

Ingesting medication, per se, sounds fairly simple. However, it is imperative to take a few precautionary steps while taking thyroid medication to ensure effectivness.

Ingestion:

Thyroid medication is required to be taken every day. Use our app, ThyForLife, to set daily reminders and never miss a dose. Additionally, doctors have suggested that thyroid replacement medicines like levothyroxine or T4/T3 combination therapy work best when taken at the same time every day. 

Physicians believe levothyroxine should be taken on an empty stomach, preferably an hour before breakfast/coffee or approximately three to four hours after dinner. This allows for more absorption. 


There are certain nutrients whose consumption can interfere with the absorption of levothyroxine. It is suggested that antacids or supplements and multivitamins containing calcium or iron should be taken several hours before or after ingesting levothyroxine as iron can make the drug less effective and calcium interferes with absorption, as does coffee

taking thyroid medication

Prescription:

Once you have received a prescription from your doctor, be sure to ask if any other medicines that you are taking will interfere with taking your thyroid medication. When at the pharmacy, follow this checklist:

 

  • The name of the medicine that you have received matches the name on your prescription.
  • The dosage is appropriate and again, matches the dosage mentioned in your prescription. 
  • The medicine has not expired or will not expire soon. 

Some medical conditions that can affect absorption and consequently effectiveness are:

 

  1. Lactose intolerance
  2. Celiac disease
  3. Atrophic gastritis
  4. Malabsorption syndromes
  5. Helicobacter pylori infection
  6. Autoimmune gastritis
  7. Pancreatic diseases
  8. Liver disease

If you have any of these conditions, please consult your physician. 

Some thyroid medicines can have side effects and it is important to discuss them with your physicians. Furthermore, if you have any questions about your dosage/feel that your dosage needs to be increased, please get in touch with your physician to get an expert opinion before making any changes. 

If you want to know more about what to eat to help ease your hypothyroidism symptoms, read our previous blog post!

Psychology Symptoms of Thyroid Disorders

By Suhani Saigal

Those diagnosed with thyroid disorders experience a number of overwhelming symptoms. As discussed in our previous blog post, there are different types of thyroid disorders that have many different symptoms. However, when talking about thyroid disorders and their symptoms, this is what we need to keep in mind: symptoms are not always physiological and sometimes affect the mental health of the patient.

When diagnosed with hyperthyroidism (a condition wherein the thyroid gland produces hormones in excessive quantities), an individual, more often than not, is overactive. As part of this, the individual is likely to experience bouts of anxiety

Anxiety is described as feelings of tension, worry, and/or fear. Some signs of anxiety include increased heart rate, sweating, nervousness, and trembling. In most cases, anxiety is one of the most common symptoms of hyperthyroidism.

However, it is also likely that anxiety is an indirect effect of all thyroid disorders – an individual can feel anxious because of the strange and uncommon symptoms that they experience as a result of their diagnosis. This is why tracking your thyroid symptoms is crucial for maintaining a healthy mental health.

 

mental health problems for thyroid conditions

For those diagnosed with hypothyroidism, underactivity is a common symptom. They tend to lose interest in activities they previously enjoyed, withdraw themselves from social interaction, and are unable to feel pleasure – a condition known as anhedonia

Anhedonia is an evident sign of depression. Individuals with hypothyroidism are predisposed to depression. As you might remember in our previous blog post, we mentioned that one of the symptoms of hypothyroidism is feeling low. 

This symptom in combination with anhedonia may cause an individual to feel depressed. Furthermore, just like anxiety, the severity of other symptoms such as fatigue, cognitive impairment, and weight gain, caused by hypothyroidism can lead to depression.

It is imperative to seek treatment to reduce anxiety/depression if one’s symptoms are becoming increasingly overwhelming and begin to interfere in their day-to-day functioning and productivity. Professional treatment can help regain optimal mental health!

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