Introduction 1
About This Book 2
Conventions Used in This Book 2
What You Don't Have to Read 2
Assumptions 3
How This Book Is Organised 3
Part I: Understanding Your Thyroid 3
Part II: Treating Thyroid Problems 3
Part III: Managing Your Thyroid 3
Part IV: Considering Special Aspects of Thyroid Health 4
Part V: The Part of Tens 4
Part VI: Appendices 4
Icons Used in This Book 4
Where to Go from Here 5
Part I: Understanding the Thyroid 7
Chapter 1: Bigging It Up: The Huge Role of a Little Gland 9
Discovering the Extent of the Problem 10
Identifying an Unhappy Thyroid 11
Recognising Who's at Risk 11
Realising the Importance of a Healthy Thyroid 12
Treating What Ails You 12
Understanding the Consequences of Delaying Treatment 14
Giving Your Thyroid a Hand: Healthy Lifestyle Choices 14
Paying Special Attention: Pregnant Women, Children, and Older People 15
Staying Informed 16
Chapter 2: Feeling Fragile: The Emotional Effects of Thyroid Problems 17
Exploring How an Underactive Thyroid Slows Your Thoughts 18
Seeing How an Overactive Thyroid Can Trigger Anxiety 19
Fighting Depression 20
Finding out if your thyroid is causing depression 21
Using thyroid hormone to treat depression 22
Chapter 3: Discovering How Your Thyroid Works 25
Locating the Thyroid 26
Producing Thyroid Hormones 28
Identifying the importance of iodine 29
Regulating thyroid hormones 29
Moving thyroid hormones around 30
Understanding the Function of Thyroid Hormones 31
General functions 32
Specific functions 33
Chapter 4: Testing Your Thyroid 37
Checking Blood Levels of Thyroid Hormones 38
Total thyroxine 38
Resin T3 uptake 40
Free thyroxine index 40
Free thyroxine (FT4) 41
Free triiodothyronine (FT3) 42
Thyroid-stimulating hormone (TSH) 42
Taking Non-Hormonal Blood Tests 43
Thyroid autoantibodies 44
Serum thyroglobulin 45
Determining the Size, Shape, and Content of Your Thyroid 46
Radioactive iodine uptake and scan 46
Thyroid ultrasound 48
Fine needle aspiration biopsy (FNAB) 49
Part II: Treating Thyroid Problems 51
Chapter 5: Dealing with an Underactive Thyroid 53
Living with Autoimmune Thyroiditis 54
The extent of the problem 54
Symptoms of chronic thyroiditis 55
Approach to treatment 55
Identifying Hypothyroidism 56
Signs and symptoms of hypothyroidism 56
Confusing conditions 57
Pinpointing the Causes of Hypothyroidism 58
Removal of the thyroid 58
Absence of brain hormones 58
Foods that cause hypothyroidism 59
Drugs that cause hypothyroidism 59
Coexisting autoimmune diseases 60
Diagnosing Severe Hypothyroidism 61
Treating Hypothyroidism 61
Taking the right hormones 61
Getting the right amount 63
Testing hormone levels 64
Chapter 6: Taming an Overactive Thyroid 65
Picturing Hyperthyroidism 66
Listing the Signs and Symptoms of Hyperthyroidism 66
The body generally 67
The thyroid 67
The skin and hair 67
The heart 68
The nervous system and muscles 68
The reproductive system 68
The stomach and intestines 68
The urinary system 68
The eyes 69
Confirming a Diagnosis of Hyperthyroidism 69
Determining Whether Graves' Disease Is the Culprit 70
Causes of Graves' disease 70
Signs and symptoms specific to Graves' disease 71
Recognising Other Causes of Hyperthyroidism 73
Choosing the Best Treatment for Graves' Disease 74
Thyroid surgery 75
Radioactive iodine treatment 76
Antithyroid pills 77
Other helpful medications 79
Treating Other Causes of Hyperthyroidism 79
Surviving Thyroid Storm 80
Chapter 7: Getting the Low-Down on Thyroid Nodules 81
Discovering a Thyroid Nodule 82
Evaluating Cancer Risks 83
Securing a Diagnosis 83
The fine needle aspiration cytology 84
The thyroid ultrasound scan 85
Treating Cancerous Nodules 86
Dealing with Nodules That Are Non-Cancerous 86
Hot nodules 87
Benign cysts 87
Warm or cold nodules 87
Ignoring Small Nodules 87
Chapter 8: Coping with Thyroid Cancer 89
Determining What Causes Thyroid Cancer 90
Identifying the Types of Thyroid Cancer 91
Papillary thyroid cancer 92
Follicular thyroid cancer 93
Medullary thyroid cancer 93
Undifferentiated (anaplastic) thyroid cancer 95
Staging Thyroid Cancer 96
Treating Thyroid Cancer 97
Papillary thyroid cancer 98
Follicular thyroid cancer 99
Medullary thyroid cancer 99
Undifferentiated (anaplastic) thyroid cancer 100
Following Up Cancer Treatment 100
Chapter 9: Learning about Multinodular Goitres 101
Exploring How a Multinodular Goitre Grows Up 101
Choosing to Treat It or Ignore It 103
Making a Diagnosis 104
Treating a Multinodular Goitre 105
Part III: Managing Your Thyroid 107
Chapter 10: Taking Care with Drugs That Affect Your Thyroid 109
Revealing the Drug-Food-Thyroid Connection 109
Identifying the Effects of Specific Substances 112
Initiating or aggravating hypothyroidism 113
Creating false test results 117
Causing an increase in thyroid activity 118
Preventing Harmful Drug Interactions 119
Discovering Whether You're at Risk 119
Chapter 11: Spotting Thyroid Infections and Inflammation 123
Putting a Face on Subacute Thyroiditis 123
Causes and effects 124
Laboratory findings 125
Treatment options 126
Coping with Postpartum and Silent Thyroiditis 127
Understanding the disease 127
Interpreting lab results 128
Getting treatment 128
Identifying Acute Thyroiditis 129
Describing the disease 129
Confirming the diagnosis with lab tests 130
Treating acute thyroiditis 130
Diagnosing a Rare Form of Thyroiditis 131
Chapter 12: Overcoming Iodine Deficiency Disease 133
Realising the Vastness of the Problem 134
Facing the Consequences of Iodine Lack 135
Pregnancy 135
Infancy 136
Childhood 136
Adulthood 136
Endemic Cretinism 137
Looking at the geographic distribution 138
Contributing factors 139
Goitre: The body's defence 140
Neurologic cretinism 141
Myxoedematous cretinism 141
Managing the Problem of Iodine Deficiency 142
A sprinkle of salt 143
An injection of oil 144
A slice of bread or cup of water 145
Drawbacks of Iodisation 145
Chapter 13: Going In: Surgery on the Thyroid Gland 147
Deciding When Surgery Is Necessary 147
Talking Things Over 149
Preparing for Surgery 149
What Happens During Surgery 150
Surgical obstacles 151
Extent of surgery 152
Considering a New Approach 154
Possible Complications 155
Recuperating After the Operation 155
Chapter 14: Exciting New Approaches in Thyroid Treatment 157
Preventing Ill Effects of Large Doses of Iodine 157
Finding Out More about Hypothyroidism 158
Treating (or not treating) subclinical hypothyroidism 158
Finding the right dose of hormone 159
Determining the prevalence of hypothyroidism 160
Linking heart disease and hypothyroidism 160
Dealing with Hyperthyroidism 161
Measuring calcium levels 162
Controlling weight gain 162
Revolutionising thyroid surgery 163
Gathering clues to hyperthyroid eye disease 163
Treating Goitres and Nodules 164
Performing surgery after ethanol injections 164
Shrinking goitres 164
Developing New Approaches in Thyroid Cancer 165
Understanding the impact of radioiodine exposure 165
Blocking oestrogen slows tumour growth 166
Predicting thyroid cancer 166
Detecting residual thyroid cancer 166
Following up thyroid cancer treatment 167
Knowing what to expect from medullary thyroid cancer 168
Using recombinant TSH to treat thyroid cancer 169
Testing calcium levels after cancer surgery 170
Tackling Iodine Deficiency Disease 170
Recognising the importance of selenium 170
Using iodised oil for goitres 171
Increasing the intelligence of babies born to hypothyroid mothers 171
Chapter 15: Living with Thyroid Problems: Diet and Exercise 173
Guaranteeing Your Best Nutrition 173
Maintaining a Healthy Weight 174
Calculating your body mass index 175
Measuring your waist size 176
Losing excess weight 177
Selecting a variety of foods 177
Choosing your fats wisely 182
Checking out your cholesterol 182
Moderating your sugar intake 184
Sifting the salt 184
Drinking alcohol in moderation 185
Going Organic 186
Thinking about food safety 186
Clarifying the Thyroid-Weight Connection 187
Does my metabolism slow when I lose weight? 187
If I'm treated for hyperthyroidism, am I doomed to gain weight? 187
Considering Iodine in Your Diet 189
Getting enough iodine in a vegetarian diet 189
Exercising for Your Thyroid 190
Recognising the natural consequences of ageing 190
Working out with hypothyroidism 191
Exercising with hyperthyroidism 192
Meeting your minimal exercise needs 193
Introducing Leptin: The New Hormone on the Block 194
Understanding the functions of leptin 194
Interacting with thyroid hormone 195
Chapter 16: Helping Yourself: Herbs and Homeopathy 197
Finding a Reputable Practitioner 198
Digging into Medicinal Herbs 199
Bladderwrack 199
Bugleweed 200
Korean ginseng 200
Motherwort 200
Oats 201
Siberian ginseng 201
Turmeric 201
Valerian 201
Understanding Homeopathy 202
Discovering homeopathic remedies 202
Taking a remedy 203
Arsenicum album 203
Iodum 204
Belladonna 204
Natrum Mur 204
Part IV: Special Considerations in Thyroid Health 205
Chapter 17: Examining the Genetic Link to Thyroid Disease 207
Genetics for Beginners 207
A monk and his pea plants 208
Talk the talk 209
The great divide 209
Genes, chromosomes, and the traits they create 210
The secret lives of genes 211
Shall I form a liver or a brain? 213
The Origins of Genetic Thyroid Diseases 214
Inheriting a disease through a single gene 214
Inheriting a disease through multiple genes 216
Inheriting a chromosome abnormality 217
The Future of Managing Hereditary Thyroid Disease 218
Genetic engineering 218
The ethics of germline gene therapy 219
Chapter 18: Controlling Thyroid Disease during Pregnancy 221
Looking at Normal Thyroid during Pregnancy 222
Pregnancy and Hypothyroidism 223
Decreased fertility 223
Iodine deficiency 224
Autoimmune hypothyroidism 224
Hyperthyroidism in Pregnancy 225
Postpartum Graves' disease 229
Gestational transient thyrotoxicosis 229
Hydatidiform mole and choriocarcinoma 231
Finding New Thyroid Nodules during Pregnancy 231
Chapter 19: Developing Thyroid Conditions in Childhood 233
Understanding the Onset of Thyroid Function 233
Screening the Newborn 235
Coping with Hypothyroidism in Children 236
Transient congenital hypothyroidism 237
Congenital hypothyroidism 237
Acquired hypothyroidism 239
Dealing with Hyperthyroidism in Children 241
Signs and symptoms 241
Laboratory confirmation 243
Treatment 243
Diagnosing Goitres in Children 245
Linking Nodules and Cancer in Children 245
Chapter 20: Maturing: Thyroid Disease in Later Life 247
Assessing the Extent of the Problem 248
Understanding Sources of Confusion in Diagnosis 249
Acknowledging other diseases 249
Taking medications 250
Discovering Hypothyroidism in Older People 250
Deciphering signs and symptoms 251
Getting laboratory confirmation 252
Trying thyroid hormone for subclinical patients 252
Taking treatment slowly 253
Managing Hyperthyroidism in Older People 253
Sorting through confusing signs and symptoms 254
Securing a diagnosis 255
Checking Out Thyroid Nodules in Older People 256
Part V: The Part of Tens 257
Chapter 21: Ten Myths about Thyroid Health 259
I'm Hypothyroid, So I Can't Lose Weight 259
I'm Hyperthyroid, So I Can't Gain Weight 260
Breastfeeding and Antithyroid Pills Don't Mix 261
Brand Name Thyroid Hormone Pills Are Best 261
I Have to Take Thyroid Medication for Life 262
Natural Thyroid Hormones Are Better Than Synthetic Hormones 263
Thyroid Disease Is Catching 264
Iodine Deficiency Is a Medical Problem 264
The Higher My Autoantibody Levels, the Worse My Thyroid Disease 265
Clinical Symptoms Are More Reliable Than Blood Tests 266
Chapter 22: Ten Ways to Maximise Thyroid Health 269
Screening at Appropriate Intervals 270
Checking Thyroid Function As Your Body Changes 270
Performing a 'Neck Check' 271
Getting Enough Iodine to Satisfy Your Thyroid 272
Stopping Thyroid Medication, If Possible 272
Using Both Types of Thyroid Hormone 272
Preventing the Regrowth of Thyroid Cancer 273
Anticipating Drug Interactions 274
Protecting Your Thyroid from Radiation 275
Keeping Up-to-Date with Thyroid Discoveries 275
Part VI: Appendixes 277
Appendix A: Glossary of Key Terms 279
Appendix B: Sources of More Information 283
Index 285
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