DEAR DR. GOTT: I am desperate! I have all the symptoms of Grave’s disease, including a medium-sized multi-nodular goiter (which has been biopsied and the results were benign); but in spite of seeing numerous doctors, including three endocrinologists, they say I do NOT have it because my blood tests fall “within normal” range!! I am having a difficult time functioning in my day-to-day activities and am praying you can help me.
DEAR READER: Graves’ disease is hyperthyroidism, a disorder of the immune system that causes the overproduction of thyroid hormones. Normal thyroid function is regulated by a hormone released by the pituitary gland. The antibody associated with Graves’ disease, thyrotropin receptor antibody (more simply known as TRAb), has the ability to mimic the action of the pituitary hormone and essentially overrides normal regulation of the thyroid gland, resulting in overproduction of thyroid hormones.
The more common signs of the disorder include a goiter (enlargement of the thyroid gland), an irregular heartbeat, fatigue, anxiety, irritability, bulging eyes, and more. Almost half of all people with Graves have some sign of what is known as Graves’ ophthalmopathy with excess tearing, double vision, and light sensitivity, painful eyes that may be dry and irritated, with excess tearing.
Having a goiter doesn’t always indicate the thyroid gland isn’t working as it should. Your thyroid gland may still be producing normal amounts of hormones; however, the gland may be producing too much or insufficient thyroxine and T-3, hormones that circulate through your bloodstream to help regulate metabolism. These hormones control the rate at which your body uses carbohydrates and fats, are in charge of the production of proteins, they control body temperature and even have an impact on your heart rate.
There are several reasons why the thyroid gland might enlarge, to include iodine deficiency, Hashimoto’s disease, the development of fluid-filled nodules in both sides of the thyroid gland that result in over-enlargement of the gland, a single nodule that develops in one part of the gland, thyroiditis, and more.
Iodine deficiency can occur in some people who reside in high elevations or who have a diet high in hormone-inhibiting foods such as cauliflower, broccoli and cabbage. Either situation can cause goiters to develop as the gland enlarges.
Hashimoto’s is an autoimmune disorder that causes the gland to produce too little hormone, causing the pituitary gland to produce more TSH to stimulate the thyroid, causing the gland to enlarge.
Multi-nodular goiter growths can result in overall enlargement of the gland, while single nodules develop in one part of the gland only.
Thyroiditis is caused by an attack on the gland that ultimately results in swelling and damage to thyroid cells. Most forms of thyroiditis are the result of antibodies used to fight off various viruses and bacteria.
With another thought in mind, many symptoms of subclinical hypothyroidism mimic those of hyperthyroidism. This condition results when the pituitary gland produces excess TSH to stimulate the thyroid to maintain a normal level of thyroid hormones. Over the course of months to years, the thyroid gland can no longer respond to the elevated levels and that subclinical hypothyroidism turns in to overt hypothyroidism. Diagnosis using blood tests to measure thyroid hormone levels and TSH are necessary; an elevated TSH without a decreased level of thyroid hormone will indicate the presence of subclinical hypothyroidism. This condition can be treated with a medication known as thyroxine taken in pill form daily. You might speak with one of your three endocrinologists to determine if this might be your problem.
Your symptoms can be seen with other problems, as well. With normal thyroid tests from three separate endocrinologists, it may be time to look at other causes. You deserve some direct answers. They may not be the ones you want to hear but you have the right to know why everyone thinks you don’t have something you are pretty sure you have. Get to the bottom of the problem so you can get on with your life.
Readers who would like related information can order my Health Report “The Thyroid Gland” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.