What to Do When You Don't Have a Thyroid Gland

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Many thyroid patients say "I don't have a thyroid! I see information about hypothyroidism and hyperthyroidism, but not for people like me with NO thyroid."

Actually, here at Verywell, you will find a great deal of information to help those of you without a thyroid gland. It just may not be clear: When you don't have a thyroid, you are hypothyroid, and your gland is unable to produce sufficient thyroid hormone.

So the vast majority of the information regarding hypothyroidism also applies to you.

Why Some People Don't Have a Thyroid

Let's clarify the situation. Why don't some people have a thyroid gland?

  • A small percentage of people are born without a thyroid or with a malformed thyroid, a condition known as congenital hypothyroidism.
  • The treatment for thyroid cancer is usually surgical removal of all—or a large part—of the thyroid gland.
  • Some people with thyroid nodules or goiter (thyroid enlargement) that is either cosmetically unsightly, or is compromising breathing or swallowing, have the thyroid gland removed surgically
  • Some people with Graves' disease or hyperthyroidism have their thyroid removed surgically. (It is typically a last-resort treatment in the U.S., where radioactive iodine—RAI—is more often performed. Outside the U.S., however, surgery is often performed as the next level of treatment for Graves' and hyperthyroidism, after antithyroid drugs.)

    So, if you don't have a thyroid gland at all, or you have a non-functioning thyroid gland, your condition is now hypothyroidism, irrespective of what disease or treatment led to the condition. 

    Underactive Thyroid/Hypothyroidism

    In addition to those who who were born without a thyroid gland, or who have had the gland surgically removed, there are other causes of hypothyroidism.

    These include: 

    • Radioactive iodine (RAI) treatment for your Graves' disease or hyperthyroidism is also known as ablation therapy. RAI either greatly impairs or completely destroys your gland's ability to produce thyroid hormone, leaving you hypothyroid.
    • Hashimoto's disease, an autoimmune condition where antibodies gradually destroy your thyroid's ability to produce hormone over time. 
    • Medications, such as lithium, that damage your thyroid's ability to produce thyroid hormone. 

    Ultimately, if you do not have any—or enough—circulating thyroid hormone due to any cause, then you are hypothyroid.

    So, to get back to the question that many ask: There is a great deal of information here at Verywell for you. Because much of the information and resources regarding hypothyroidism do, for the most part, apply to you, a good starting place for research is our Hypothyroidism Information Page.

    There are, however, some special considerations for people without a thyroid gland, and I discuss them in the next section.

    Special Considerations For People With No Thyroid

    If you were born without a thyroid, your thyroid has been surgically removed, or you have had total or near total ablation with RAI, you don't need to be particularly concerned about goitrogenic foods (i.e., brussels sprouts, broccoli, etc.) and their ability to interfere with your thyroid function. You should, however, still be careful about overconsuming too much soy-based foods, as soy may affect your ability to properly absorb your thyroid hormone replacement medication.

    Those of you without a functioning thyroid are totally dependent on your thyroid hormone replacement medication for all your thyroid hormone. If you fall in this category, you may find that you have less fluctuations in thyroid function and find it easier to stabilize your dose and maintain an optimal TSH level on a consistent dose, as compared to patients who still have a gland. (This is because when your thyroid gland is still present and capable of functioning, it may occasionally produce thyroid hormone, or increase its current production level, making regulation of your thyroid levels more difficult.)

    Thyroid cancer patients who have had the thyroid gland removed are in a unique situation in that they are typically given thyroid hormone replacement drugs at "suppressive" levels. Suppression means thaking a sufficient level of medication to keep your thyroid stimulating hormone (TSH) level very low, or even undetectable. This is considered "hyperthyroid" by most lab standards, but suppression is necessary to prevent cancer recurrence in some patients. So, some thyroid cancer patients refer to themselves as "hyperthyroid," although again, the underlying condition of having no thyroid gland means that the condition is actually hypothyroidism, and so much of the advice about hypothyroidism still applies.

    When You Don't Feel Your Best

    Whatever the cause of your hypothyroidism, if you are still experiencing thyroid symptoms, you may not be receiving optimal treatment for your condition. You'll need to proactively work with your practitioner to get better treatment.

    This may involve:

    • Trying a different brand of levothyroxine.
    • Increasing the dose, so that your TSH is lower. (Some patients report feeling the best when TSH levels are between 1 and 2.) (Again, remember that thyroid cancer patients often follow a different protocol to prevent cancer recurrence).
    • Adding a T3 drug (i.e., Cytomel, or compounded T3), to your levothyroxine, referred to as combination therapy, or T4/T3 therapy.
    • Switching to a natural desiccated thyroid drug, such as Nature-throid or Armour
    • Complementing your treatment with alternative, nutritional and mind-body support to help improve overall health and relieve symptoms.

    If you are hypothyroid and still don't feel well, a helpful next step is reading Help, I'm Hypothyroid and I Still Don't Feel Well.

    Source:

    Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 9th ed. Philadelphia: Lippincott Williams & Wilkins (LWW), 2005.

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