The thyroid is a butterfly shaped gland in the neck that runs our metabolism – the complex physical and chemical processes whereby energy is controlled. “The thyroid is like the conductor in an orchestra,” says Professor Donal O’Shea, consultant endocrinologist at Loughlinstown hospital.
“It runs your metabolic rate. Thyroid hormone (thyroxine) gives you energy. If you have too much of it, it’s like the conductor of the orchestra going too quickly and the orchestra then being a bit chaotic. A person with an overactive thyroid is jittery and fidgety and can’t sit still.
“When it’s going too slowly, it’s called an underactive thyroid – also sometimes known as hashimotos, primary hypo-thyroidism or autoimmune hypothyroidism,” he explains.
The multiple names for the condition cause a lot of confusion, he says. “I usually just tell people they have an underactive thyroid. In this situation everything is slowed down. You lack energy and you can put on a little bit of weight – about 2kg. A lot of people think it causes a lot more weight gain, but it doesn’t.”
Underactive thyroid is more prevalent than overactive thyroid because of the fact that glands are more likely to fail than over-perform, he adds.
CAUSES OF UNDERACTIVE THYROID
There is also some confusion about underactive thyroid. “You can have one if you are born with it. The heel prick test done on infants at three days is to detect an underactive thyroid that you’re born with. People sometimes get nodules in their thyroid and have them removed, which obviously causes the condition too.
“If you have an overactive thyroid and it is treated, it often becomes underactive as a result of the treatment, so by far the more common type of thyroid problem is the underactive one,” he says. The other cause is auto immune underactive thyroid, often called goitre. All that means is swollen thyroid. It is common in Ireland and more common in women, caused by lack of iodine in the diet.”
TREATMENT FOR UNDERACTIVE THYROID
The standard treatment for underactive thyroid is thyroxine, a thyroid hormone replacement. This is prescribed after the person’s T4 (thyroid hormone level) and TSH (thyroid stimulating hormone) levels are checked by blood tests.
“The replacement dose of thyroid hormone – Thyroxine – is usually very easy to calibrate and get right. Most people are on about 100 micrograms a day and they just need a blood test once a year after that to keep on track.
“For anyone diagnosed with underactive thyroid, thyroxine is prescribed for life. You have regular check-ups, usually every three months for the first year or until it settles down, and then once a year,” he says.
For 95% of people who have it it’s easy to control, but for 5% symptoms may not improve.
“At that stage, you have to look for other things that make you tired, like an underactive adrenal gland, food intolerance or high calcium levels in the blood, for example.”
CAN CAUSE BOWEL PROBLEMS
Underactive thyroid can cause a slowing in bowel movement as part of the general slowing down of the system, so constipation can be an issue.
“Once you’re on thyroid hormone that should be OK, though. It’s then down to a high-fibre, plenty-of-fluids diet,” says the professor.
But does underactive thyroid, even with medication, lead to occasional bouts of low energy? “In all, 30% of the general population would have symptoms that could be attributed to the thyroid,” Prof O’Shea says.
“That’s because the symptoms of the thyroid being underactive are tiredness, low energy, a little bit of constipation, low-ish mood, lack of vim and vigour. All of us would fit that bill several times a year. Even people on Thyroxine will get bouts of being a bit more tired, a little more constipated, a little lacking in energy. But it’s not a relapse of their thyroid problem, it’s just life continuing to deliver a slightly overstretched, tired individual sometimes.”
NOT SUCH A WEIGHTY ISSUE
In relation to weight, why is there a perception that underactive thyroid leads to substantial weight gain? “I think where the thyroid gets a bad name is around where a person treated for overactive thyroid gains a lot of lost weight quickly,” he says.
“People with untreated overactive thyroid are often delighted with the weight loss they experience as well as having a lot of energy, but then they get exhausted and find out that they’re sick.
“When they are treated they put on all the weight they’ve lost and more. This is because if you’ve had an overactive thyroid that has now become underactive you can put on a lot of weight, as you are used to being able to eat lots while it’s overactive.
“I have seen people put on 3-4 stone after an overactive thyroid was treated. The thyroid condition that goes from normal to underactive is associated with only about 2kg of weight gain, however.”
do sufferers need AN ENDOCRINOLOGIST?
Endocrinologists usually only see the complex cases, he says, with GPs managing 95% of the underactive thyroid cases in the community. “In the case of overactive thyroid, where the thyroid is physically getting bigger, you are referred to an endocrinologist quickly, however,” says Prof O’Shea. CL
>> Reader query
Knowing what advice path to take related to a condition can be difficult sometimes, as mainstream and complementary fields differ greatly in their approach. This is evidenced in the following query about underactive thyroid treatment:
is a NUTRIONIST’S ADVICE SOUND?
Reader Nicole* (28) was diagnosed with underactive thyroid eight years ago and has been on medication, Thyroxine, since then. Recently, however, she attended a nutritional therapist wanting to improve her diet, and was advised to have extra blood tests done there.
These showed that her thryoperoxidase (TPO) antibody level was 178, she says. She was worried about this high level and feared that damage could be happening to her thyroid gland because the levels were so high for so long even though she is taking the medication prescribed by her doctor.
She was advised by the nutritionist to go on a low-gluten diet, take special supplements, not drink fluoridated water and re-test to see if the levels had gone down. She is wondering if this is the right route to take.
*Full name with editorPROFESSOR DONAL O’SHEA’S RESPONSE:
He doesn’t believe that fluoridated water has any relevance and says: “The nutritionist field at the moment is a big problem. You can do a six-week online course and label yourself a nutritional therapist. That does not mean you are a dietitian. Most people think nutrition therapists are dietitians – they’re not.
“The antibody level test (TPO) tells you that you have an underactive thyroid gland, but that’s known already. This test has no impact on treatment or planning, so that’s why it is not checked. What nutritionists do is give the patient a number – 178, for example – which is meaningless. The only figures that matter are the thyroid hormone level and the thyroid stimulating hormone level in somebody who is on treatment.
“If the patient has thyroid cancer the thyroglobulin level is important – but only in that setting – and we do check it. The problem with nutritionists is that they bamboozle with figures.”
He believes that, with underactive thyroid, a high-fibre, plenty-of-fluids diet is good. “Being told to follow a low-gluten diet is broadly rubbish. If there is a serious question of coeliac disease, you should have a gastroscopy and a duodenal biopsy. What the nutritional therapist is doing is potentially harmful.
“She is monitoring levels that are meaningless. In my opinion, it’s a racket. That is not to say that diet isn’t a hugely important part of how you feel, and you do need to find a safe diet – but that isn’t one that avoids gluten unless you’re coeliac,” he explains.
>> Nutritional therapist response
Nutritional Therapists Of Ireland (NTOI) spokesperson, Brendan O’Brien, in response to our reader query (see page 21):
“The committee of NTOI has no knowledge of who this nutritionist is, therefore we cannot say if they are adhering to any particular standard of practice and thus our comments relate to the topic in general.
• “Many nutritional therapists approach healthcare from a different mindset than mainstream medicine doctors. • “Doctors’ opinions have always differed from each other, as well as from those of other professions so … it behoves members of the public to actively seek out many opinions from qualified professionals.• “In our experience, deeper investigation is needed than the standard thyroid work-up ie evaluating TSH and T4 values.• “The new information around this is not officially acknowledged - yet. But action can be taken to support health using sound nutritional principles, we believe.• “Avoidance of gluten can result in good results quite often. It could help … so why not try it and see?• “We feel that the mainstream profession – and indeed mainstream dieticians – seem to oppose this method of support, mainly because they don’t accept the new evidence or don’t understand it or they apply a pharmaceutical rationale to a nutritional intervention … when this is not appropriate.• “The NTOI view elevated TPO antibodies not as confirmation of hypothyroidism per se, but rather as evidence of dysregulated immunity.• “We believe that chronically elevated auto antibodies eventually cause destruction of the gland. Whilst Thyroxin replacement can help one’s symptoms, it does nothing to prevent gland destruction due to auto antibodies … For this a different therapy is needed, as the problem per se does not lie with the thyroid gland, but rather with the immune system, and 80% of the immune system is in the gut.”
The thyroid is a butterfly shaped gland in the neck that runs our metabolism – the complex physical and chemical processes whereby energy is controlled. “The thyroid is like the conductor in an orchestra,” says Professor Donal O’Shea, consultant endocrinologist at Loughlinstown hospital.
“It runs your metabolic rate. Thyroid hormone (thyroxine) gives you energy. If you have too much of it, it’s like the conductor of the orchestra going too quickly and the orchestra then being a bit chaotic. A person with an overactive thyroid is jittery and fidgety and can’t sit still.
“When it’s going too slowly, it’s called an underactive thyroid – also sometimes known as hashimotos, primary hypo-thyroidism or autoimmune hypothyroidism,” he explains.
The multiple names for the condition cause a lot of confusion, he says. “I usually just tell people they have an underactive thyroid. In this situation everything is slowed down. You lack energy and you can put on a little bit of weight – about 2kg. A lot of people think it causes a lot more weight gain, but it doesn’t.”
Underactive thyroid is more prevalent than overactive thyroid because of the fact that glands are more likely to fail than over-perform, he adds.
CAUSES OF UNDERACTIVE THYROID
There is also some confusion about underactive thyroid. “You can have one if you are born with it. The heel prick test done on infants at three days is to detect an underactive thyroid that you’re born with. People sometimes get nodules in their thyroid and have them removed, which obviously causes the condition too.
“If you have an overactive thyroid and it is treated, it often becomes underactive as a result of the treatment, so by far the more common type of thyroid problem is the underactive one,” he says. The other cause is auto immune underactive thyroid, often called goitre. All that means is swollen thyroid. It is common in Ireland and more common in women, caused by lack of iodine in the diet.”
TREATMENT FOR UNDERACTIVE THYROID
The standard treatment for underactive thyroid is thyroxine, a thyroid hormone replacement. This is prescribed after the person’s T4 (thyroid hormone level) and TSH (thyroid stimulating hormone) levels are checked by blood tests.
“The replacement dose of thyroid hormone – Thyroxine – is usually very easy to calibrate and get right. Most people are on about 100 micrograms a day and they just need a blood test once a year after that to keep on track.
“For anyone diagnosed with underactive thyroid, thyroxine is prescribed for life. You have regular check-ups, usually every three months for the first year or until it settles down, and then once a year,” he says.
For 95% of people who have it it’s easy to control, but for 5% symptoms may not improve.
“At that stage, you have to look for other things that make you tired, like an underactive adrenal gland, food intolerance or high calcium levels in the blood, for example.”
CAN CAUSE BOWEL PROBLEMS
Underactive thyroid can cause a slowing in bowel movement as part of the general slowing down of the system, so constipation can be an issue.
“Once you’re on thyroid hormone that should be OK, though. It’s then down to a high-fibre, plenty-of-fluids diet,” says the professor.
But does underactive thyroid, even with medication, lead to occasional bouts of low energy? “In all, 30% of the general population would have symptoms that could be attributed to the thyroid,” Prof O’Shea says.
“That’s because the symptoms of the thyroid being underactive are tiredness, low energy, a little bit of constipation, low-ish mood, lack of vim and vigour. All of us would fit that bill several times a year. Even people on Thyroxine will get bouts of being a bit more tired, a little more constipated, a little lacking in energy. But it’s not a relapse of their thyroid problem, it’s just life continuing to deliver a slightly overstretched, tired individual sometimes.”
NOT SUCH A WEIGHTY ISSUE
In relation to weight, why is there a perception that underactive thyroid leads to substantial weight gain? “I think where the thyroid gets a bad name is around where a person treated for overactive thyroid gains a lot of lost weight quickly,” he says.
“People with untreated overactive thyroid are often delighted with the weight loss they experience as well as having a lot of energy, but then they get exhausted and find out that they’re sick.
“When they are treated they put on all the weight they’ve lost and more. This is because if you’ve had an overactive thyroid that has now become underactive you can put on a lot of weight, as you are used to being able to eat lots while it’s overactive.
“I have seen people put on 3-4 stone after an overactive thyroid was treated. The thyroid condition that goes from normal to underactive is associated with only about 2kg of weight gain, however.”
do sufferers need AN ENDOCRINOLOGIST?
Endocrinologists usually only see the complex cases, he says, with GPs managing 95% of the underactive thyroid cases in the community. “In the case of overactive thyroid, where the thyroid is physically getting bigger, you are referred to an endocrinologist quickly, however,” says Prof O’Shea. CL
>> Reader query
Knowing what advice path to take related to a condition can be difficult sometimes, as mainstream and complementary fields differ greatly in their approach. This is evidenced in the following query about underactive thyroid treatment:
is a NUTRIONIST’S ADVICE SOUND?
Reader Nicole* (28) was diagnosed with underactive thyroid eight years ago and has been on medication, Thyroxine, since then. Recently, however, she attended a nutritional therapist wanting to improve her diet, and was advised to have extra blood tests done there.
These showed that her thryoperoxidase (TPO) antibody level was 178, she says. She was worried about this high level and feared that damage could be happening to her thyroid gland because the levels were so high for so long even though she is taking the medication prescribed by her doctor.
She was advised by the nutritionist to go on a low-gluten diet, take special supplements, not drink fluoridated water and re-test to see if the levels had gone down. She is wondering if this is the right route to take.
*Full name with editorPROFESSOR DONAL O’SHEA’S RESPONSE:
He doesn’t believe that fluoridated water has any relevance and says: “The nutritionist field at the moment is a big problem. You can do a six-week online course and label yourself a nutritional therapist. That does not mean you are a dietitian. Most people think nutrition therapists are dietitians – they’re not.
“The antibody level test (TPO) tells you that you have an underactive thyroid gland, but that’s known already. This test has no impact on treatment or planning, so that’s why it is not checked. What nutritionists do is give the patient a number – 178, for example – which is meaningless. The only figures that matter are the thyroid hormone level and the thyroid stimulating hormone level in somebody who is on treatment.
“If the patient has thyroid cancer the thyroglobulin level is important – but only in that setting – and we do check it. The problem with nutritionists is that they bamboozle with figures.”
He believes that, with underactive thyroid, a high-fibre, plenty-of-fluids diet is good. “Being told to follow a low-gluten diet is broadly rubbish. If there is a serious question of coeliac disease, you should have a gastroscopy and a duodenal biopsy. What the nutritional therapist is doing is potentially harmful.
“She is monitoring levels that are meaningless. In my opinion, it’s a racket. That is not to say that diet isn’t a hugely important part of how you feel, and you do need to find a safe diet – but that isn’t one that avoids gluten unless you’re coeliac,” he explains.
>> Nutritional therapist response
Nutritional Therapists Of Ireland (NTOI) spokesperson, Brendan O’Brien, in response to our reader query (see page 21):
“The committee of NTOI has no knowledge of who this nutritionist is, therefore we cannot say if they are adhering to any particular standard of practice and thus our comments relate to the topic in general.
• “Many nutritional therapists approach healthcare from a different mindset than mainstream medicine doctors. • “Doctors’ opinions have always differed from each other, as well as from those of other professions so … it behoves members of the public to actively seek out many opinions from qualified professionals.• “In our experience, deeper investigation is needed than the standard thyroid work-up ie evaluating TSH and T4 values.• “The new information around this is not officially acknowledged - yet. But action can be taken to support health using sound nutritional principles, we believe.• “Avoidance of gluten can result in good results quite often. It could help … so why not try it and see?• “We feel that the mainstream profession – and indeed mainstream dieticians – seem to oppose this method of support, mainly because they don’t accept the new evidence or don’t understand it or they apply a pharmaceutical rationale to a nutritional intervention … when this is not appropriate.• “The NTOI view elevated TPO antibodies not as confirmation of hypothyroidism per se, but rather as evidence of dysregulated immunity.• “We believe that chronically elevated auto antibodies eventually cause destruction of the gland. Whilst Thyroxin replacement can help one’s symptoms, it does nothing to prevent gland destruction due to auto antibodies … For this a different therapy is needed, as the problem per se does not lie with the thyroid gland, but rather with the immune system, and 80% of the immune system is in the gut.” 
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