Happy Tuesday everyone-
I recently learned that Dr. Ivan Guldvog, a surgeon in Norway is conducting a clinical trial on the effect of a total thyroidectomy for people with Hashimoto’s. A total thyroidectomy is a complete surgical removal of the thyroid gland. This procedure has traditionally been performed for people with Graves’ disease, large goiters, and for people with thyroid cancer, and results in a lifelong need for thyroid medications. (1, 2)
The procedure, like any surgical procedure, has many risks including bleeding, infection, a permanent hoarse voice, airway obstruction, and damage to the parathyroid glands, which can lead to hypoparathyroidism, a condition that can result in dangerously low calcium levels (hypocalcemia). A UK physician made headlines in 2015, speaking out about her life-threatening post-surgical experience with hypocalcemia. (2, 3)
Dr. Guldvog has performed 97 total thyroidectomies for patients with Hashimoto’s, and has reported positive results to date, most significantly:
The percentage of those reporting severe fatigue was reduced from 84% at baseline to 34% at 18 months.
Levels of TPO antibodies (thyroid peroxidase antibodies, the main antibodies found in Hashimoto’s) fell from 2,500 units/L to <500 units/L in the surgery patients versus about 3,200 units/L to 2,500 units/L among the patients treated with medications.
I had mixed feelings about this study, as a part of me was happy to see that Hashimoto’s was getting more attention from conventional medical physicians and that awareness around the struggles of patients with Hashimoto’s was increasing.
Dr. Guldvog has said “The fatigue experience with Hashimoto's disease is debilitating. People can't work. Their quality of life is very poor. Medical treatments fail to relieve all the symptoms, but complete surgical removal of the thyroid appears to be curative in most cases. Hashimoto's isn't a disease that you die of, but it can make your existence miserable."
I was also happy to see that this particular doctor was thinking beyond synthetic thyroid medications and focused on thyroid antibodies, when he stated “Thyroxine does not normalize symptoms or anti-thyroid peroxidase levels” during his presentation at the 2015 International Thyroid Congress.
However, I was also disappointed and concerned that thyroidectomy would become a standard recommendation for Hashimoto’s.
When I was a young pharmacist, I worked on a multidisciplinary team with a wonderful group of healthcare professionals: physicians, nurses, psychiatrists, psychologists, social workers, behaviorists, dental hygienists, occupational therapists and many others. This was before I knew I had Hashimoto’s, and during the time I was suffering with a horrible chronic cough (among many other mysterious symptoms). The cough was painful, uncontrollable, and sometimes resulted in me vomiting.It kept me in a constant state of worry. You see, it would pop up at very inconvenient times: like in the middle of the night when I was sleeping, and I would wake up choking, or in the middle of a presentation or work meeting, and I’d have to run out of the room and vomit into a garbage can… not pretty, I know.
I saw multiple doctors, had a battery of tests and tried every drug that was prescribed to me, from antihistamines to anxiolytics to acid blockers (this was after I had already tried every over-the-counter option). But the cough persisted, and now I had a cough, and medication side effects.
The only thing that seemed to help was taking a narcotic cough suppressant; phenergan with codeine. But I could only take it sometimes - codeine can be habit forming, and as a pharmacist, I knew that very well. And although I had a valid prescription for the cough syrup, I was also concerned that I would test positive at a random drug screen at work. It would be very awkward to explain to my boss and HR why I came up positive for a narcotic!
When I did take the cough syrup, I could only take it at night, because it made me too woozy during the day, and then I always felt hungover in the morning. So I saved it for emergencies.
I was desperate, and would have done anything to get rid of the cough. I once joked with my colleague at work that I was even willing to cut off my head if that would make the cough go away.
I thought that perhaps my tonsils were part of the problem. They always looked swollen and inflamed and I had read about tonsils contributing to a chronic cough. So I consulted with a surgeon to ask if my tonsils could be a possible cause of my chronic cough. He said it was possible, and offered to take out my tonsils. But then I learned that a few months before I started my job, a social worker who had worked at the very center where I worked had died as a results of a tonsillectomy. She was in her 20’s (like me), and the people that knew her said she was one of the kindest souls they’d ever met. Her tonsillectomy was supposed to be “no big deal”, but she suffered from uncontrolled bleeding and was only found by her family when it was too late.
I was conflicted and didn’t know what to do. I wanted to get rid of the cough and the surgeon seemed trustworthy, but I was scared. I spoke to one of my physician colleagues, and she said something very wise that I will always be grateful for: “If you consult with a surgeon, there’s a good chance that he’ll recommend surgery. When your main tool is a hammer, everything becomes a nail. Don’t be so quick to part with a body part. You have tonsils for a reason”. Her advice, and the tragic passing of the young social worker I never got to meet, solidified my decision against getting a tonsillectomy. And guess what? My chronic cough is long gone (almost 5 years), and I still have my tonsils. For me, eliminating dairy and gluten vanquished the cough within three days. I had suffered from it for 3 years, and thought I had tried ‘everything”!
And guess what? The same interventions also reduced my fatigue and thyroid antibodies.
Over the last seven years of researching Hashimoto’s, I’ve identified over 28 unique ways of reducing thyroid antibodies, and over a dozen methods for overcoming thyroid fatigue!
For some people, getting off gluten and dairy will completely reverse Hashimoto’s and its symptoms. For others, more interventions are needed, such as an autoimmune diet, treating infections, supporting the adrenals, healing the gut, addressing nutrient imbalances and getting rid of toxins. There are also supplements and medications that can suppress autoimmune symptoms and thyroid antibodies. My favorite supplements to use for reducing antibodies are Wobenzym or systemic enzymes , and I’ve also seen miraculous results with the use of low-dose naltrexone for autoimmunity.
Sometimes overcoming fatigue is as simple as taking one supplement, in the right dose. I’ve received so many thank-you notes, and random people have even given me hugs at conferences, after reading my article about Thiamine and Thyroid Fatigue.
I’ve also written more about Thyroid Fatigue in this Article: http://thyroidpharmacist.com/articles/top-10-tips-for-overcoming-hashimotos-fatigue.
Most thyroid conditions (Hashimoto's, Graves', thyroid cancer) result from an immune system that is out of balance. This can be caused by nutrient deficiencies, food sensitivities, toxins, a gut imbalance, poor stress response and/or a chronic infection that can be anywhere in the body.
Even when the thyroid is taken out surgically or treated with radioactive iodine, the immune imbalance still persists in many cases, and a person may go on to develop additional health conditions, and still feel unwell.
While Dr. Guldvog has followed many of his patients for at least 18 months and reports that most of them remain symptom-free, I personally don’t know any people that have had their thyroids removed due to Hashimoto’s. However, I do know quite a few who have had their thyroid glands removed due to Graves’ or thyroid cancer, that have gone on to develop additional autoimmune conditions within a few years, or have continued to struggle with many symptoms! This is because surgically removing the thyroid gland removes the target of the imbalanced immune system, but does not change the immune imbalance. Removing the thyroid doesn’t change the fact that there are multiple broken systems in the body.
So to me, removing the thyroid gland in Hashimoto’s is like throwing out the baby with the bathwater. It’s like killing the messenger, because in autoimmune thyroid disease, the problem is not with the thyroid gland. The problem is with the immune system.
Like most people who become healthcare professionals, I’m sure this doctor’s heart is in the right place and he is genuinely trying to help his patients. And I’m not against surgery or even surgical removal of the thyroid gland. In some cases, surgery can be the best option and can be a life-saving measure. For some patients, especially those with advanced disease that hasn’t responded to lifestyle or a root cause approach, a thyroidectomy may be the best option. Additionally, I understand that some people may not be aware of alternatives, may not be willing to change their lifestyle, or perhaps the damage may be beyond repair.
But I think one day, people will look at thyroidectomies for autoimmune thyroid disease the way we now look at lobotomies for mental health disorders.
If you are struggling with thyroid symptoms and think there’s no hope other than a thyroidectomy, I beg you to try lifestyle changes and functional medicine first. (Here’s a post about the functional medicine approach to the thyroid).
If you’ve already had a thyroidectomy, in addition to making sure your thyroid medications are optimized (you will need them for life, there’s no shame in that, and you want to make sure that you are getting the optimal thyroid medications for you!), I also encourage you to take on lifestyle changes and functional medicine, to ensure that the underlying triggers that led to the development of your condition don’t lead to another autoimmune condition.
I do provide a lot of resources for people with Hashimoto’s, including the following:
My blog, where I try to share what’s worked best for me, my clients and readers, as well as the latests research.
My Hashimoto's Root Cause book, which focuses on restoring immune balance and feeling better with Hashimoto’s (over 1000 reviews!).
My Optimizing Thyroid Medications eBook, which focuses on restoring optimal thyroid hormone levels through the use of individualized medications (this is especially important if you have had your thyroid removed).
My Hacking Hashimoto’s program, which is a 12 week course to help people with Hashimoto’s uncover their triggers and get their life back. I developed this course for people who have “tried everything”, after having worked with hundreds of people with Hashimoto’s. In surveying the participants, 75% were able to reduce their fatigue and 56% saw a reduction in thyroid antibodies within three months, among many other improvements.
Resources from Colleagues
In the last few years I've realized that making a difference in health care means partnering up with like minded individuals! Here are some resources from my amazing colleagues:
Finding Peace and Vitality in an Anxious World
A big part of autoimmune disease is overwhelm and stress. I’ve known Dr. Pedram Shojai for a few years, and he is one of those rare people who seems to accomplish a million things, yet he is always peaceful, giving and full of joy. Pedram decided to share his message in a new book, where he shares why so many of us lack the peace, joy and contentment we seek, and the real reason we feel so stressed, anxious and tired all the time….The book explains how to finally and forever achieve peace, joy and vitality… even if your to-do list is as long as your arm. To any of you who are feeling stressed out, exhausted and overwhelmed with modern life (and isn’t that ALL of us?), this might just be the answer you’re looking for. In his brand new book The Urban Monk, Pedram explains why people in Western society find it so hard to change. You can learn more HERE.
No Grain No Pain and a free Leaky Gut Solutions Manual as a bonus
I am so excited to share with you that my good friend, Peter Osborne, has a new book coming out called No Grain, No Pain which addresses how making the wrong diet and lifestyle choices can cause tissue inflammation, hormone disruption, vitamin and mineral deficiencies, and autoimmune responses that cause the body to attack itself. Right now, when you get your copy of No Grain No Pain, he is giving away a comprehensive Leaky Gut Recovery Guide. This offer expires in a few days, so make sure you take advantage of it now. Learn more HERE.
Microbiome Medicine Summit
Did you know that your body is filled with bacteria? According to research we are 50% bacteria! These trillions of organisms (known collectively as the microbiome) live all over our bodies and have a profound influence on our health. But what do you know about your microbiome? Understanding your microbiome is vitally important to understanding how to live a healthy life! This is especially true for people suffering from chronic diseases of the heart and digestive system, autoimmune disease, diabetes, thyroid disorders and more. I am honored to be one of the experts who is participating in Dr. Raphael Kellman’s The Microbiome Medicine Summit. I invite you to register for the free summit in which ground-breaking information will be presented as well as a whole new perspective that could help you improve your emotional and physical well being! You can register HERE.
I hope these resources help you on your journey!
Your Thyroid Pharmacist,
Dr. Izabella Wentz, PharmD, FASCP