TH E HARVARD M EDICAL SCHOOL GUI DE TO OVERCOM I NG T HY R O I D P R O B L E M S JEFFREY R. GARBER, M.D. WITH SAN DRA SARDELLA WH ITE Copyright © 2005 by the President and Fellows of Harvard College. All rights reserved. Manufactured in the United States of America. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. 0-07-146975-3 The material in this eBook also appears in the print version of this title: 0-07-144471-8. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. For more information, please contact George Hoare, Special Sales, at ������������ Want to learn more? We hope you enjoy this McGraw-Hill eBook! If you’d like more information about this book, its author, or related books and websites, please click here. For more information about this title, click here Contents Acknowledgments vii Introduction ix C H A P T E R 1 1 Your Thyroid Gland How Your Thyroid Gland Works 1 When Things Go Wrong 4 Who Is at Risk for Thyroid Disease? 10 C H A P T E R 2 21 Life in the Slow Lane: Down and Under with Hypothyroidism Recognizing Signs and Symptoms 24 What Is Causing My Hypothyroidism? 30 Diagnosing Hypothyroidism 32 Treating Hypothyroidism 37 Thyroid Medications: Myths and Facts 47 C H A P T E R 3 51 Hyperthyroidism: Help, I Want to Slow Down! Recognizing Signs and Symptoms 54 What’s Causing My Hyperthyroidism? 57 Diagnosing Hyperthyroidism 59 Treating Hyperthyroidism 61 Remembering What It’s Like to Feel Good 69 iii CONTENTS C H A P T E R 4 73 A Guide to Thyroid Tests Blood Tests 73 Radioactive Iodine Tests 78 Thyroid Ultrasound 82 C H A P T E R 5 83 An Immune System Run Amok: Thyroiditis, Graves’ Disease, and Related Problems Your Immune System 84 Autoimmune Thyroid Disease 91 Graves’ Disease 97 Your Family Medical History 109 Lessons from One Woman’s Family History of Thyroid-Related Conditions 112 C H A P T E R 6 117 Your Thyroid and Pregnancy Your Thyroid and Infertility 118 From Infertility to Four Children: One Woman’s Success Story 119 Normal Hormone Changes During Pregnancy 122 Hypothyroidism During Pregnancy 123 Hyperthyroidism During Pregnancy 129 C H A P T E R 7 135 A Guide to Thyroid Lumps: The Harmless and the Worrisome Thyroid Lumps from A to Z 136 How Are Thyroid Nodules Diagnosed? 140 A Suspicious Nodule 151 Treatment Options 153 C H A P T E R 8 155 Thyroid Cancer Why Me? 156 iv Who’s at Risk for Thyroid Cancer ? 158 CONTENTS How Doctors Diagnose Thyroid Cancer 159 Treating Thyroid Cancer 165 Beating Thyroid Cancer 175 Folow-Up 178 Coping with Cancer 181 Staying Positive and Informed 182 C H A P T E R 9 185 Childhood Thyroid Diseases Hypothyroidism in Children 186 Trusting Parental Instincts 197 Hyperthyroidism in Children 198 Nodules and Cancer 203 C H A P T E R 1 0 205 Negotiating Life with Thyroid Disease You and Your Doctor 205 Taking Care of Yourself 210 C H A P T E R 1 1 215 Your Thyroid and Nuclear Radiation Lessons from Nuclear Disasters 216 Protecting Your Thyroid Gland with Potassium Iodide 219 Glossary 225 Additional Resources 233 Index 237 v This page intentionally left blank. Acknowledgments Throughout the creation of this book, from its inception through its many drafts, production, and publication, many people helped to enrich its pages. I would like to especially thank Sandy White for her extraor- dinary focus, timeliness, and wonderful writing. I am particularly grateful for Sandy’s journalistic skill, which was the key to captur- ing the experiences of patients and the views of experts that con- tributed immensely to the value of our collaborative effort. I would also like to thank editors Nancy Ferrari and Kathleen Cahill Allison of Harvard Health Publications and Judith McCarthy of McGraw-Hill for their invaluable assistance. I also want to thank the many patients I have had the privilege to participate in the care of, for the lessons they have taught me about overcoming thyroid conditions. Special thanks to those who graciously agreed to be interviewed for this book so that others could also learn from their experiences. I am in debt to many specialists who offered their expertise without hesitation. Many thanks to Rebecca S. Bahn, M.D., of the Mayo Clinic Endocrinology Division; Brian M. Casey, M.D., of the University of Texas Southwestern Medical Center Obstet- rics and Gynecology Division; James Connolly, M.D., Kevin Donohoe, M.D., Colin McArdle, M.D., J. Anthony Parker, M.D., Ph.D., and Helen H. Wang, M.D., Dr.P.H., colleagues in the Beth Israel Deaconess Medical Center departments of anatomic pathol- ogy, cytopathology, radiology, and nuclear medicine; John Kukora, M.D., President of the American Association of Endo- crine Surgeons; Stephanie Lee, M.D., Ph.D., and Elizabeth N. vii Copyright © 2005 by the President and Fellows of Harvard College. Click here for terms of use. ACKNOWLEDGMENTS Pearce, M.D., M.Sc., colleagues in the endocrine divisions of Harvard Vanguard Medical Associates and Boston Medical Cen- ter; Marvin Mitchell, M.D., Emeritus Director of the New England Newborn Screening Program; Yolanda Oertel, M.D., of the Washington Hospital Center Washington Cancer Institute; Steven I. Sherman, M.D., of the Department of Endocrine Neo- plasia and Hormonal Disorders, M. D. Anderson Cancer Center. I would like to thank William Kang and Jill Susarrey of Har- vard Vanguard Medical Associates Endocrine Division for their help with the countless tasks that led to the timely completion of this book. Thanks to my mother-in-law, Lillian, for her interest, and my wife, Sheri, and sons, Ben and Solly, for their enthusiasm and encouragement. —JRG I would like to thank Kay Cahill Allison, my mentor, and Jeff Garber, for this incredible learning experience. It was a privilege to work with a physician who is so well regarded by so many patients. For her insights, I want to thank my close friend Carmen Kenrich, who beat thyroid cancer. Thanks also to my daughters, Samantha, Allyson, and Jessica, for their patience and to my hus- band, Rob, for always encouraging me to go for it. —SSW viii