Questions and answers
Do I have to change my diet?
You may have heard that iodine has something to do with the thyroid gland. Indeed iodine is an integral part of the thyroxine (T4) and triiodothyronine (T3) molecules. A lack of iodine in the diet may cause a goitre or even hypothyroidism. This is commonly found in people who live in mountainous areas far from the sea such as the Himalayas, but the diet in the UK contains adequate amounts of iodine and you don’t need to take supplements. For the disbelievers iodised salt is available in some supermarkets. Excessive iodine intake, however, may unmask underlying thyroid disease and cause both hyperthyroidism and hypothyroidism.
Is smoking harmful?
The eye disease that accompanies Graves’ disease is more common and more severe among patients who smoke. Patients with hyperthyroidism caused by Graves’ disease should stop smoking.
Was stress responsible for making my thyroid gland overactive?
Although it is difficult to prove, most thyroid specialists are impressed by how often major life events, such as divorce or death of a close relative, appear to have taken place a few months before the onset of hyperthyroidism caused by Graves’ disease. There is now evidence that stress can affect the immune system which is abnormal in Graves’ disease. So the answer is probably ‘yes’ but there are other important factors such as heredity.
Will my new baby have thyroid trouble?
The children of mothers with Graves’ disease or a previous history of Graves’ disease may be born with an overactive thyroid gland. This is known as neonatal thyrotoxicosis and lasts for only a few weeks. The obstetrician and the paediatrician will be looking out for this rare complication which is readily treated.
Occasionally mothers with hypothyroidism give birth to a child with an underactive thyroid gland. Again this is usually short-lived and will be detected by the routine blood testing of all babies a few days after birth.
Will my children be affected?
Not necessarily. In fact, the risk is relatively small, although it is greater than that for children who have no family history of autoimmune disease. Nor is it always the same disease that runs in families. For example, a mother may have Graves’ disease, while her daughter develops type 1 diabetes mellitus.
Could my thyroid condition explain why I did badly in my exams?
It is likely to be hyperthyroidism that affects people who are the right age to be taking exams. If it is not adequately treated, a reduced ability to concentrate will certainly lead to a substandard performance and the specialist will be happy to write to the relevant headteacher or college tutor to explain the problem.
Could thyroid disease have caused my anxiety/depression?
The answer is almost certainly ‘no’, although hyperthyroidism and hypothyroidism will make underlying psychiatric illness worse. Unfortunately, even when a person with hyperthyroidism is successfully treated so that their overactive thyroid is brought under control, their psychiatric symptoms don’t disappear altogether, although they may improve.
Will my Graves’ disease recur?
If your hyperthyroidism has been effectively treated with iodine-131, it will never return. If the hyperthyroidism has settled after a single course of carbimazole there is a 30 to 50 per cent chance of recurrence, usually within 1 to 2 years of stopping the drug. Recurrent hyperthyroidism after surgery is usually apparent within a few weeks but may occur as long as 40 years after apparently successful surgery.
Does it matter if I forget to take my medication?
The occasional missed tablet is not the end of the world. Indeed symptoms of hypothyroidism caused by lack of thyroxine are not usually felt for 2 to 3 weeks after stopping the tablets so it would still be possible to enjoy a 7- to 10-day holiday if you’d inadvertently left your medication at home.
However, this is not to be recommended. Also patients with hypothyroidism may have other autoimmune diseases such as diabetes mellitus. Failure to take thyroxine regularly will affect the response to insulin and may lead to unexpected coma as a result of a low blood sugar.
Again, missing the odd carbimazole dose will not cause significant problems but symptoms of hyperthyroidism are likely to develop if you don’t take the tablets for 24 to 48 hours, especially within a few weeks of starting treatment.
I feel better when I am taking a higher dose of thyroxine than recommended by my doctor. Is this safe?
There is considerable debate about the correct dose of thyroxine. The consensus is that enough should be given to ensure that levels of T4 in the blood are at the upper limit of normal or slightly elevated and those of TSH at the lower limit of normal, or in some patients undetectable. Although, by taking excessive thyroxine, a sense of well-being, increased energy and even weight loss may be achieved in the short term, there are long-term dangers to the heart and a possibility of increasing the rate of bone thinning and therefore encouraging the development of osteoporosis.
Will tests involving radioactivity affect my fertility?
Definitely not. The amount of radioactivity involved is tiny – less than that in an X-ray – so you have absolutely no cause for concern.
Can treatment for Graves’ disease make me fat?
No, although you will probably put back any weight you lost before your condition was diagnosed and treated.
However, there’s no reason why you should end up weighing any more than you did before you started to develop Graves’ disease.
My daughter was put on thyroxine at birth because she was hypothyroid. Will she have to take thyroxine forever?
Not necessarily. She will be taken off thyroxine and then given a blood test when she’s around a year old to see whether she still needs it.
Is the time of day when I take my thyroxine tablets important?
Ideally, thyroxine should be taken at bedtime when there is less possibility of interference with its absorption by food or other medicines. However, the most important aspect of thyroxine treatment is that it is taken regularly and, if other times of the day are more convenient, so be it.
Should I stop smoking?
Definitely! Apart from the many health risks, such as lung cancer and heart disease, smoking reduces the effectiveness of antithyroid drugs, increases the risk of relapse at the end of treatment and may make any thyroid eye disease worse.