What Happens When You Have No Thyroid?

Portrait of an female patient having doctor checking her glands - tonsils and thyroid
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I regularly receive emails from people who say "What about me? I have no thyroid gland!" You're not writing anything for me! You're always writing about hypothyroidism or hyperthyroidism, but not about people with no thyroid."

Actually, this is not true. I write about people who have no thyroid all the time, but the people who don't have a thyroid may not realize it—because their doctors have never told them that, without a thyroid gland, they are in fact considered "hypothyroid."

But first, let's clarify the situation.

Why would someone have no thyroid?

  • A small percentage of people are born without a thyroid, with a malformed thyroid, or a thyroid that doesn't function properly. This is known as congenital hypothyroidism.
  • People who have thyroid cancer usually have all or part of their thyroid surgically removed.
  • Some people with thyroid nodules or goiter (enlargement) that are cosmetically unsightly or compromising breathing or swallowing, have their thyroid 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., after antithyroid drugs, surgery is considered the primary treatment for Graves' and hyperthyroidism. Surgical removal is the treatment of choice for pregnant women with Graves' disease/hyperthyroidism that is not responding to antithyroid drugs, and is typically performed only during the second trimester of pregnancy. 

    So, if you don't have a thyroid, or you have a thyroid but it is not functioning as it should and can't produce enough thyroid hormone, then you are considered functionally hypothyroid.

    Hypothyroidism can result from:

    • a missing thyroid
    • surgical removal of the thyroid
    • the thyroid's autoimmune self-destruction, as in Hashimoto's disease
    • nodules that make the thyroid dysfunctional
    • a thyroid that has been radioactively ablated, after RAI

    But ultimately, if you do not have any—or enough—circulating thyroid hormone, then you are hypothyroid.

    So, back to the question that many people ask. There is a great deal of information here at the Thyroid Site at Verywell.com that is relevant to you. Because all the materials regarding hypothyroidism do, for the most part, apply to your health. 

    Additional Reading

    For those who do not have a thyroid gland, here are a few key resources to help:

    Special Considerations for Those of You Without a Thyroid Gland 

    There are some special considerations for people with no thyroid gland.

    Without a functioning thyroid, you don't need to be particularly concerned about soy or other goitrogenic foods (i.e., brussel sprouts, broccoli, etc.) and their ability to interfere with your thyroid function.

    Without a thyroid gland, you may find that you have fewer fluctuations in thyroid function and find it easier to stabilize your dose and maintain an optimal TSH level on a consistent dose.

    (Compared to those who still have a thyroid, who will find that it occasionally sputters in and out of action, making regulation of levels more difficult.)

    Thyroid cancer patients are in a unique situation in that many are given thyroid hormone replacement drugs at "suppressive" levels. This means that the objective is a low or nearly undetectable TSH level close to 0. This is considered "hyperthyroid" by most lab standards, but suppression is necessary for most thyroid cancer patients to prevent cancer recurrence. So, some thyroid cancer patients consider themselves hyperthyroid, although again, the underlying condition of having no thyroid gland means that your condition is actually hypothyroidism, and so much of the advice about hypothyroidism still applies.

    When You Still Don't Feel Well 

    While thyroid cancer patients have unique circumstances regarding the need for a suppressed TSH level, others who have no thyroid and are not feeling well can investigate options for more optimal thyroid treatment.

    If you are experiencing hypothyroidism symptoms (see my Hypothyroidism Symptoms Checklist) 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 the TSH is lower (most patients seem to feel best when TSH is between 1 and 2)
    • Adding a T3 drug (i.e., Cytomel, or compounded T3), to the levothyroxine
    • Switching to a natural desiccated thyroid drug, such as Armour or Nature-Throid
    • Alternative, nutritional and complementary support for thyroid function

    People who have no thyroid glands who are having difficulty losing weight are dealing with the same issues of metabolic dysfunction and possible endocrinological and blood sugar irregularities as other hypothyroid patients. So, these patients should follow the same recommendations for anyone else with hypothyroidism who is trying to diet. Effective weight loss options for thyroid patients are featured in the Thyroid Diet Information Center.


    Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. WLL/Wolters Kluwer; 2012.

    Garber, J, Cobin, R, Gharib, H, et. al. "Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association." Endocrine Practice. Vol 18 No. 6 November/December 2012.

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