3 Mistakes That Can Cost You Your Thyroid

Avoid the three common mistakes that could cost you your thyroid. istockphoto

You want to be confident that your doctors are informed, knowledgeable, and giving you the best possible advice and medical care. But there are three common mistakes that doctors -- including endocrinologists --make that could cost you your thyroid.

When you lose your thyroid or thyroid function, you become hypothyroid -- with an underactive or nonexistent thyroid gland - and will require lifelong monitoring and treatment.

You may also have residual hypothyroidism symptoms that are difficult to resolve, even with treatment.

This is why it's crucial for you to know about these possible mistakes before they happen when you still have time to take action that can change the course of your health care.

Quiz: Could You Have a Thyroid Problem?

1. Having Your Thyroid Surgically Removed After an Indeterminate or Inconclusive Fine Needle Aspiration Biopsy of Your Nodule

When your doctor identifies a suspicious thyroid nodule - whether due to size, growth, or it's deterined to be "cold" or "warm" during an uptake imaging diagnostic test -- it's important to rule out possible thyroid cancer. The next step is typically a fine needle aspiration (FNA) biopsy of the suspicious nodule or nodules. When cancer is found, the next step is typically a thyroidectomy, a surgery to remove the thyroid gland, along with follow-up treatment.

It's estimated that approximately 450,000 suspicious thyroid nodules undergo FNA annually in the United States. Up to 30 percent of the nodules assessed by FNA are labeled indeterminate/inconclusive. The pathology evaluation can't confirm or deny the presence of cancer. Typically, then, doctors have recommended thyroidectomy.

As many as 135,000 patients a year -- or around one in four of those with an indeterminate nodule -- end up having a thyroidectomy.

The challenge? Only 20 to 30 percent of those indeterminate nodules turn out to be malignant. And that means that as many as 100,000 patients each year may end up undergoing a needless thyroidectomy, forcing them to live without a thyroid gland, and live with permanent hypothyroidism.

The mistake? A test called the Afirma Thyroid FNA Analysis is available from a company called Veracyte, and when this test is used as part of the FNA, it can help avoid most inconclusive results on your thyroid nodule biopsies.

DON'T MAKE THIS MISTAKE! -- Before you agree to surgery for an indeterminate or inconclusive nodule, ask for the Veracyte Afirma Thyroid FNA Analysis test.

2. Having Radioactive Iodine (RAI) Treatment for Hyperthyroidism Without Confirming if You Have Hashimoto's Disease

The symptoms of hyperthyroidism often include anxiety, elevated heart rate, weight loss, insomnia, and other signs of an overactive thyroid. Doctors typically run the Thyroid Stimulating Hormone (TSH) test, and if your numbers are below the normal range, and suggest hyperthyroidism, the physicians diagnose hyperthyroidism and recommend treatment.

In some cases, doctors also run the Thyroid Stimulating Immunoglobulins (TSI) test, which identifies antibodies common in Graves' disease. They may also run imaging tests to evaluate the thyroid and confirm a diagnosis of Graves'-induced hyperthyroidism. If the TSI and/or imaging results confirm Graves' disease, then the next step is treatment, which can include antithyroid drugs, RAI, or surgery.

The challenge? Many doctors rely only on TSH, or TSH, Free T4 and Free T3 to diagnose hyperthyroidism. They leave out the Thyroid Peroxidase Antibodies (TPO) tests, which can identify if you have Hashimoto's disease.

If you have Hashimoto's, you may have temporary or transient periods of hyperthyroidism, which typically resolve as the gland self-destructs, eventually leaving you hypothyroid. Unfortunately, in some cases, doctors see TSH, Free T4 and Free T3 tests that suggest hyperthyroidism, and recommend immediate Radioactive Iodine (RAI) ablation treatment. This destroys the thyroid gland, all or in part, and usually results in permanent hypothyroidism.

The mistake? If you are having a hyperthyroid period of Hashimoto's disease, you typically do not need RAI ablation. And so you may end up with a chemically ablated thyroid gland, and permanent hypothyroidism-- needlessly.

DON'T MAKE THIS MISTAKE! -- Before you agree to RAI for hyperthyroidism, make sure that the doctor has run the full battery of diagnostic tests -- including an imaging test, TSI, and TPO -- and has ruled out the possibility that you are having a hyperthyroid phase of Hashimoto's disease.

3. Having Radioactive Iodine (RAI) Treatment or Surgery for Graves' Disease Without Trying Antithyroid Drugs

As discussed, diagnosis of Graves' disease is typically done by blood tests -- Thyroid Stimulating Hormone (TSH), Free T4, Free T3, and Thyroid Stimulating Immunoglobulins (TSI). In some cases, an uptake imaging test is also performed to assess whether your thyroid is overproducing thyroid hormone.

Upon confirming Graves' disease, some doctors immediately recommend RAI treatment, or less commonly, surgical removal of your thyroid.

The mistake? If you have Graves' disease, a subset of you could actually have a remission of your symptoms and antibodies -- essentially, your thyroid function returns to normal - after a course of antithyroid drugs. Unfortunately, if a doctor has immediately recommended that you have RAI or surgery, there is no going back. Your thyroid is chemically ablated or surgically removed, and you are hypothyroid for life.

DON'T MAKE THIS MISTAKE! -- Before you agree to RAI or surgery for Graves' disease, make sure that your doctor has carefully considered whether you are a candidate for antithyroid drugs. Don't accept the "Rush to RAI" or a surgical referral unless the doctor has considered the possibility of antithyroid drug treatment.

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