Is Thyroid Disease Really So Easy to Treat?

Hypothyroidism and hyperthyroidism diagnosis and treatment

A recent spate of high-profile media coverage on thyroid disease has been promoting two key messages:

  • more people should be tested for thyroid disease, because there are millions of people in the U.S. who are undiagnosed.
  • once diagnosed, thyroid disease is easy to treat.

These ideas were most recently disseminated in an April 10, 2000 Associated Press (AP) story, "Specialists Urge Thyroid Testing," and Dr. Isadore Rosenfeld's April 2, 2000 Parade magazine article, "Could It Be Your Thyroid?"

In Parade, Dr. Rosenfeld states, "All you need to do to treat your hypothyroidism is replace the missing hormone. It's easy -- just a pill a day." In the AP article, writer Lauran Neergaard says, "Thyroid problems are easily treated, with a daily pill or, for hyperthyroidism, sometimes removing the gland."

The "daily pill" these writers are talking about is levothyroxine (brand names: Synthroid, Levoxyl, Levothyroid), a thyroid hormone replacement that contains a synthetic version of the thyroid hormone T4 (thyroxine). Levothyroxine is considered the mainstream treatment for hypothyroidism in the U.S.

Efforts to raise visibility of thyroid symptoms and to increase thyroid testing in the U.S. should be applauded. It is particularly important, given recent findings that an estimated 10 million people have undiagnosed thyroid conditions -- not 5 million as previously thought.

These findings were discussed in a recent article here at the site.

This recent public relations campaign to increase the number of people aware of and diagnosed with thyroid disease in the U.S. is, however, doing a disservice to some patients. The campaign is seriously downplaying the complexities of thyroid disease treatment and the difficulties many patients encounter in living with the hypothyroidism -- underactive thyroid condition -- that is usually the result of most thyroid disease and thyroid treatment. This was the subject of a Patient Response to AP Wire Story Press Release in which I presented arguments on behalf of hypothyroidism patients.

These writers' continued assertions of how easy it is to treat thyroid disease are not only propagating old ways of thinking, but they are contradicted by major medical organizations involved in thyroid disease, and recent journal findings. . . and particularly by patients themselves.

Is Hypothyroidism Easy to Treat With One Little Pill?

The patient foundations and medical journals don't think so.

Research from the now defunct Thyroid Foundation of America, a thyroid patient organization, found that among patients who were hypothyroid due to treatment for Graves' Disease, the majority did not feel well despite daily treatment with a thyroid hormone replacement pill.

Groundbreaking research reported on in the February 11, 1999 issue of the New England Journal of Medicine also found that levothyroxine treatment alone was not enough for many patients, and found that, for the the majority of patients participating in their study, "treatment with thyroxine plus triiodothyronine improved the quality of life for most [hypothyroid] patients." Triiodothyronine is more frequently referred to by the term T3, and one brand name, Cytomel, is available in the U.S. Some compounding pharmacies also produce a time-released version of T3.

Is Hyperthyroidism Easy to Treat?

The primary treatment for hyperthyroidism in the US is not, as stated in the AP article, removing the gland surgically, but rather, is a treatment know as radioactive iodine, or RAI.

Surgery of the thyroid would not typically be described as an easy treatment, nor can RAI be considered easy. RAI involves ingestion of a radioactive iodine liquid, and in some cases, is followed by as much as a several-day isolation from other people to avoid radiation contamination of others. The RAI slowly deteriorates the thyroid's ability to produce hormone. Eventually, most people who have received RAI become hypothyroid, and require lifelong thyroid hormone replacement treatment. And, as noted above, according to the Thyroid Foundation of America, the majority of these patients, subsequently complain of continuing symptoms.

RAI treatment also increases the risk of thyroid eye disease complications and exacerbation of the condition.

Patients Talk Back

The Internet has dramatically changed what patients know about thyroid disease, and how they communicate with their doctors. The worldwide exchange of information among thyroid patients has raised patient awareness of symptoms, options, and alternatives in diagnosis and treatment. It has also allowed patients the opportnity to find out that they are not alone in being plagued by continued symptoms, and to discover that the doctors who say one little pill is an easy treatment aren't aware of the latest information and research that is available.

Avoiding RAI for hyperthyroidism is something increasing numbers of patients are attempting to do, using alternative and nutritional approaches, Chinese medicine, and other treatments, supported by the easy communications ability provided by the Internet. One of the most vocal opponents of RAI is a patient and researcher, John Johnson, ran a listserv and forum dedicated to nutritional approaches to hyperthyroidism for several years.

Johnson put together a site -- -- dedicated to nutritional treatment of thyroid disease, and helping patients avoid RAI treatment for Graves' disease and manage hyperthyroidism using diet and supplements. Says Johnson at his website:

"Most doctors in the U.S. push RAI very heavily and try to get their patients to undergo it ASAP. Most doctors in Europe don't push RAI but favor maintenance on antithyroid drugs (ATDs) because of the high rate of "spontaneous" remissions and the possibility that RAI causes permanent damage to the body and may significantly increase the risk of cancer."

Regarding hypothyroidism, there's a movement afoot by patients who are tired of being told how easy to treat their condition is, and how it needs to be taken more seriously. On the Thyroid Forums, there are posts daily from dozens of patients who are frustrated by the fact that their doctors don't take them seriously, or dismiss symptoms that continue after treatment as unrelated to thyroid disease.

This recent media coverage has also inspired patients to speak out. Frequent poster "TheRose" had this to say about the current media coverage of thyroid disease:

"When women complain about the inaccuracies of such articles, and state our own experiences as evidence, it's written off because we're considered "moody" (at best) by sheer reason of gender! Since WE are not taken seriously, our message isn't given the credence it needs, either! Meanwhile, too many men feel they have to be seen as strong, healthy, manly, etc etc etc (Ah, stereotypes!), so they don't complain, and that skews the image of thyroid disease even further! WHAT a Catch-22!!"

Another poster, Judy writes:

"I would LOVE to be able to tell someone, anyone, the things we go through every day and not be met with that blank look or a nod of the head. My sister-in-law, who happens to also be my best friend, doesn't even seem to understand. I really feel that this comes from years of everyone hearing about thyroid disease and "that little pill" myth, and thinking well it's something that can be controlled. Wouldn't it be great to be able to stand up in front of a group of people and tell them, "this disease has affected and changed not only my life, but the lives of everyone who once knew and loved the REAL me"? Oh well, we'd probably still get that look."

And Brandy Horne, in a letter she wrote to Oprah that she shared on the forum, wrote so eloquently:

"...Many people don't see this as a major deal since there is thyroid hormone that one can take to replace what the body can no longer produce. But I am living proof that these synthetic medicines cannot do what the body can naturally. I am only 26 years old and am getting married this July, but this disease has robbed all the happiness out of this time. That little gland effects every body process. I am having trouble with my eyes, muscle pains, twitches, weakness, my immune system does not function properly, and I am always tired and depressed. Every day is a new featured "symptom". When I approached my doctors about my symptoms they just say "It must be something else." However, they can never tell me or prove it is something else. And I am not the only one. I have spoke to several thyroid patients on the thyroid disease forum and the same complaints take place. The disease affects every person's quality of life. Yes, some people do take the pill and all is well. However, a significant number of people need more. And since these thyroid drugs have been around for years, no one is interested in making it better. There is virtually no research being done on this disease that affects 13 million in this country. It is second only to diabetes of the endocrine diseases. However, diabetes and many other "popular" illnesses are constantly being studied and researched. What if people just said to all the diabetics "you have pills-take them and shut up." I hate that I have such an unpopular disease that has been stamped "solved." Well it is not solved for me and many others. Therefore, I think the key to getting the help we all need is to get some attention brought to this undertreated and often misunderstood and undiagnosed disease."

In my role as Thyroid Guide here and as a thyroid patient advocate, I receive hundreds of emails each week from hypothyroid patients in the U.S. and around the world who are receiving that so-called "easy pill a day" treatment, and are miserable, sick, and still suffering symptoms -- people who feel condemned to a life of chronic illness.

Many more post similar complaints to the Thyroid Forum.

The reality is, there are many more variables involved in treatment than a "pill a day" and other options, including time- released and staggered medication, alternative thyroid hormones and drugs, and a variety of other treatments, particularly to resolve the many symptoms that frequently remain AFTER treatment -- for the majority of patients. The perspective that once a patient is diagnosed, "one pill a day" will resolve thyroid problems is one that serves the manufacturers of those little pills, but not patients. It's a shame that "an easy pill a day" is still being promoted as the medical establishment's best thinking, when many innovative practitioners and millions of patients know that thyroid disease is a complex, multi-faceted condition that requires a variety of approaches to resolve.