Oprah Winfrey's Thyroid Journey: Is She Cured?

Years back, after talking openly about her fluctuating weight for years, celebrity Oprah Winfrey announced that she suffered from thyroid disease. While the precise diagnosis has not been fully revealed in the media, experts suspect that Oprah suffered from Hashimoto's thyroiditis—the most common cause of hypothyroidism in the United States. However, unlike the vast majority of people with the disease who experience symptoms of hypothyroidism from the start, Oprah actually had initial symptoms of hyperthyroidism called Hashitoxicosis.

Besides her somewhat unusual thyroid course, Oprah also eventually announced that she had been cured of her thyroid disease and was off medication. Her "cure" confused many fans, considering Hashimoto's thyroiditis is (for most) a chronic condition that requires lifelong treatment.

Hashimoto's Thyroiditis and Hashitoxicosis

Hashitoxicosis is a rare autoimmune phenomenon in which antibodies stimulate a person's thyroid gland to release excess thyroid hormone. Hashitoxicosis occurs prior to the classic hypothyroidism seen in Hashimoto's thyroiditis.

Hashitoxicosis is often short-lived, lasting weeks to months, but symptoms—difficulty sleeping, fast heartbeat, anxiety, sweating, heat intolerance, and weight loss, can be severe.

When the condition progresses to Hashimoto's thyroiditis, however, antibodies damage the thyroid gland so it cannot produce adequate thyroid hormone.

Depending on how severe the thyroid gland is damaged, symptoms related to low thyroid hormone levels—weight gain, fatigue, constipation, cold intolerance, etc.—may develop.

Treatment for these concerns is necessary and involves a lifelong management plan.

  • Treatment for Hasitoxicosis involves either Tapazole (methimazole) or PTU (propylthiouracil), antithyroid drugs. These work by blocking the thyroid gland from producing excess thyroid hormone.
  • Treatment for Hashimoto's thyroiditis entails the use of levothyroxine, an inexpensive thyroid drug that is taken once daily and has been found to be very effective in improving symptoms and bringing thyroid hormone levels back to normal.

Why Oprah May Have Been Able to Stop Taking Medication

The striking thing about Oprah's thyroid journey is that at one point she announced that she was "cured." She stated: "When I said I was cured, I meant I don't have the thyroid problem anymore because my thyroid levels are all in the normal range now and my doctors have taken me off of any thyroid medication."

In the end, it's likely that Oprah was first taking an antithyroid drug for Hashitoxicosis. Then, once the hypothyroid phase of Hashimoto's thyroiditis took over, thyroid hormone production may have leveled off, allowing her to discontinue her antithyroid drug.

Furthermore, the hypothyroid phase may have brought down the thyroid hormone levels to a "normal" range, so levothyroxine was also not warranted.

If her Hashimoto's thyroiditis progresses, and the thyroid gland continues to be damaged, thyroid hormone replacement medication (levothyroxine) would eventually be necessary.

What This Means For You

If you take away anything from Oprah's thyroid journey, it's that you need to be an advocate for your thyroid health—and this means, asking questions and gaining as much knowledge as you can about your diagnosis.

To start, if you have thyroid disease, here are a few questions to consider reviewing with your doctor:

Can You Help Me Understand My TSH Level?

The thyroid stimulating hormone (TSH) blood test is the "gold standard" test for diagnosing and treating thyroid conditions.

Most laboratories in the United States report a "normal" TSH as between 0.5 to 4.5 or 5.0 (mIU/L). An "abnormal" TSH would be one that is less than 0.5 mIU/L (suggesting hyperthyroidism) or higher than 4.5 or 5.0 mIU/L (suggesting hypothyroidism).

That said, there are some exceptions to this—as well as a bit of controversy.

For one, some experts believe that the upper limit of a normal TSH should be lower (around 2.5mIU/L). The problem with this change is that it would mean starting a lot more people on thyroid hormone replacement medication (levothyroxine).

Another point many experts bring up is that the "normal" TSH range of 0.5 mIU/L to 5.0 mIU/L does not take into account that TSH naturally rises with age. With that, many doctors believe that the laboratory "normal" TSH range should be higher for the elderly.

Lastly, while a "normal" TSH generally indicates a person does not need thyroid hormone replacement medication, there are a couple of exceptions. For example, the TSH reference range is different for women who are pregnant.

Likewise, research suggests that in people who have elevated thyroid antibodies but normal thyroid levels (people in the early stages of Hashimoto's thyroiditis), preventative treatment with thyroid medication can slow or stop the elevation of antibodies, help prevent progression to overt hypothyroidism, and help ease symptoms like difficulty losing weight.

In the end, there are many factors that a doctor needs to consider before deeming your TSH "normal" and determining whether or not treatment is indicated.

Bottom Line

Knowing your precise TSH value, and not just whether it is "normal," is important for your thyroid care.

What Is My Target TSH Level?

If you have been diagnosed with thyroid disease, ask your doctor what your target TSH level is. The truth is that while your doctor may aim for a TSH within the "normal" range, he should also consider other goals like improving your symptoms.

For example, if you are experiencing hypothyroid-related dry skin and constipation, then thyroid hormone replacement medication should help. If, with treatment, your TSH becomes "normal" but you are still experiencing these issues, then your doctor may aim for a lower target TSH.

Besides symptom improvement, other goals of thyroid treatment include reducing the size of an enlarged thyroid (goiter) if you have one and avoiding overtreatment, which can cause bone thinning (osteoporosis) and a heart arrhythmia (atrial fibrillation).

Have I Been Tested for Primary Adrenal Insufficiency?

Primary adrenal insufficiency is a rare autoimmune condition, but in a small (about 5 percent) of people with autoimmune thyroid disease, it may be why the reason why a person continues to experience symptoms, despite treatment of their thyroid disease.

While it's not standard to test everyone with thyroid disease for primary adrenal insufficiency, if you are experiencing persistent symptoms despite adjusting your medication, your doctor will likely consider testing for it.

A Word From Verywell

For her sake, let's hope that Oprah Winfrey's thyroid is normal and stays that way. However, given the statistics, this is likely not the case considering that, for most people, Hashimoto's thyroiditis is a lifelong condition.

Regardless, the take-home message here for you is that your thyroid journey may take some turns that you might not expect. Be reassured, though, that with resiliency, knowledge, and a true partnership with your doctor, you can gain control of your thyroid disease and feel well.

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