When Robert was first diagnosed with hyperthyroidism, he felt a huge sense of relief. It gave him answers and a path forward, and he believed that medication would quickly get his hormones under control. He thought he was a few weeks from feeling back to his old self.
But despite daily oral antithyroid medications, his hyperthyroidism—and his symptoms—persisted, and he began considering more dramatic solutions. Using radioactive iodine or thyroidectomy, Robert’s doctor would be able to permanently damage or surgically remove his thyroid, making overproduction of thyroid hormones impossible. But these seemed like drastic measures and he had a multitude of questions about the procedures, including the most basic of inquiries: can you live without a thyroid? Not just in terms of surviving, but in terms of quality of life? Was the cure truly better than hyperthyroidism itself?
These questions are common amongst patients considering irreversible thyroid treatment. To make the best decision about your health, you’ll want to consider the answers carefully.
Can you live without a thyroid?
The short answer is yes: with the help of hormone replacement therapy, you can absolutely live without a thyroid gland. In fact, if you’re suffering from the effects of an overactive thyroid, you may live a better and healthier life without your thyroid. Modern medicine allows us to replace naturally-produced thyroid hormones with exogenous alternatives so the body can continue functioning normally.
Still, some individuals feel strongly that removing or damaging their thyroid isn’t an appropriate or necessary solution for them. Indeed, hyperthyroidism can often be managed through antithyroid medications, beta blockers, and other pharmaceutical interventions, sometimes indefinitely. There is also emerging evidence that gut microbiota composition may be contributing factors to hyperthyroidism. As Eleonore Fröhlich and Richard Wahl write in the August 2019 issue of Trends in Endocrinology & Metabolism, this “rais[es] the prospect that probiotics and other microbiota-targeted therapies might be of benefit in thyroid disease.” Indeed, anecdotal evidence by some integrative medicine practitioners suggests that normalizing the gut microbiome and alleviating inflammation via a variety of dietary strategies may help improve thyroid function, potentially minimizing reliance on medication and preventing the need for more drastic intervention.
However, if the condition causing an overactive thyroid worsens or becomes severely volatile, many patients will choose to pursue a permanent solution.
Why are permanent solutions necessary?
Many of us hesitate before making permanent changes to our bodies—and rightfully so. Why would it be necessary to permanently disable or remove the thyroid gland? In some cases, the truth is that it isn’t a necessity, but a personal choice; some people decide, for a variety of reasons, that radioactive iodine or thyroidectomy is preferable to other forms of treatment. In other cases, the individual may not respond well to other therapies, and serious intervention is necessary in order to prevent their condition from progressing.
The damage caused by an uncontrolled overactive thyroid can be extensive, affecting muscles, bones, cardiovascular system, and reproductive organs. Eliminating all or part of the thyroid is sometimes the only way to reduce these risks. Additionally, in the case of thyroid cancer, it’s often safer to remove the thyroid altogether to ensure all cancerous tissue is destroyed. Meanwhile, goiters and nodules often require surgery when they raise hormone levels or cause pressure on the esophagus and trachea. In other words, whether a permanent solution is a good option is largely dependent on the nature of your condition.
What are these procedures like?
Radioactive iodine treatment (I-131) is typically a relatively simple and painless procedure that takes advantage of the fact that the thyroid absorbs virtually all the iodine introduced to your body. The entire treatment is performed by having you ingest a small amount of radioactive iodine, typically in the form of a pill, during a brief appointment in the clinic or hospital. That radioactive iodine will be absorbed by the gastrointestinal system and move through the body to the thyroid, where the radiation will destroy thyroid cells but have a minimal impact on the rest of your body. After the procedure, most patients return home to follow a specific set of precautions, including avoiding physical contact for a number of days to ensure that others are not exposed to the radiation. Women should also avoid pregnancy for at least 6 months and men should avoid getting their partner pregnant for at least 4 months.
Thyroidectomy is a more complex process, but can still usually be completed within a daytime hospital visit. To begin, you’ll be put under general anesthesia and receive a breathing tube. The surgeon will then make a small incision, usually near the base of your throat, and remove some or all of your thyroid gland. This surgery will typically take anywhere from 45 minutes to 3 hours depending on your condition, and most people will require at least 1-2 days off work for early recovery. Pain is usually minimal. Although some patients have few additional restrictions on their activities, others have trouble chewing and swallowing and talking following surgery. These effects usually resolve rapidly on their own. However, everyone responds to surgery differently, and your recovery may be easier or more difficult than others based on both the extent of surgical intervention and your body’s unique response. Some patients will also have to go back to their doctor to have stitches or drains removed.
What happens after permanent thyroid treatment?
After you’ve undergone radioactive iodine treatment or thyroidectomy, your body will be unable to produce thyroid hormones either in adequate amounts or at all. While this is preferable to thyroid overactivity, you may begin to experience symptoms of hypothyroidism such as fatigue, weight gain, cold sensitivity, dry skin and hair, slow heart rate, and high cholesterol.
To prevent these symptoms, you will be prescribed medications that supply your body with some combination of T4 and T3 hormones. You’ll take these medications every day for the rest of your life. Thyroid hormone medications are easily accessible, relatively inexpensive, and commonly prescribed. With help from your hormone health practitioner, you will likely be able to reach a stable maintenance dose, which makes this a sustainable treatment option in the long term. When you’re taking the correct medications at the right doses, you also shouldn’t experience side effects, making them highly tolerable for most patients.
Where can I get the best hormone care after treatment?
If you’re going to be taking thyroid medication ongoing for years to come, it’s important that you have these medications prescribed by someone with the expertise to set you up for success. You can get standard thyroid medications from any primary care physician, but it can often be challenging to get the dose and hormone combination just right for each individual. These practitioners may also not have the experience necessary to fully understand the more complex needs of people who have undergone permanent thyroid treatment. As such, you might want to consider seeing a specialist from the very beginning.
The best hormone health practitioners have the training and resources to measure and monitor your thyroid levels closely on an ongoing basis. They will work with you over time to adjust doses and medications as necessary to keep all of your symptoms at bay. Although most people respond well to standard thyroid medications, it is also possible to create customized treatments to make sure each individual has the exact regimen necessary to maintain healthy hormone levels in their body. Furthermore, we are increasingly learning that nutrition and lifestyle can play a critical role in restoring body-wide health. Choosing a practitioner who can provide holistic support based on the latest research can help ensure you have every opportunity to recover from your thyroid disorder and enhance your overall well-being.
If you need to pursue a permanent solution for your thyroid condition, take these answers as a starting place for your research. Speak with qualified medical professionals to gauge whether radioactive iodine or thyroidectomy is the best choice for your body. And rest assured that with help from ongoing hormone replacement therapy, you absolutely can live without a thyroid.
The practitioners within the BodyLogicMD network are experts in hormone health and hormone replacement therapy. Using an integrative model of care that combines pharmaceutical intervention with lifestyle counseling, BodyLogicMD-affiliated practitioners can help you address your thyroid disorder and achieve balance. To learn more, contact a local practitioner near you today, or take the BodyLogicMD Hormone Balance Quiz.
Disclaimer: These statements have not been evaluated by the Food and Drug Administration. All content on this website is for informational purposes only. The content is not intended to diagnose, treat, cure or prevent diseases.
Charlotte is a patient care coordinator specializing in bioidentical hormone replacement therapy. She is committed to helping patients who struggle with the symptoms of hormonal change and imbalance explore their treatment options and develop effective strategies to optimize wellness.