Advice and Resources for Patients With No Thyroid

If you don't have a thyroid you may think that there is no information geared specifically towards you. You may come across information on hyper and hypothyroidism, but nothing about having no thyroid gland. This is a misunderstanding, because if you don't have a thyroid, or your gland is unable to produce sufficient thyroid hormone, you are in fact hypothyroid and most information regarding hypothyroidism applies to you.

Why Some People Don't Have a Thyroid

Why are some people missing a thyroid gland?

A small percentage of people are born without a thyroid or with a malformed thyroid, a condition known as congenital hypothyroidism.
The treatment for thyroid cancer is usually surgical removal of all or part of the thyroid gland.
Some people with thyroid nodules or goiter (thyroid enlargement) that are cosmetically undesirable or affecting breathing or swallowing have the thyroid gland removed surgically.
Some people with Graves' disease or hyperthyroidism have their thyroid removed surgically.

If you don't have a thyroid gland at all, or you have a non-functioning thyroid gland, your condition is now hypothyroidism, irrespective of what disease or treatment led to the condition.

Underactive Thyroid/Hypothyroidism

In addition to those who were born without a thyroid gland, or who have had the gland surgically removed, there are other causes of hypothyroidism.

These include:

Radioactive iodine (RAI) treatment for your Graves' disease or hyperthyroidism is also known as ablation therapy. RAI either greatly impairs or completely destroys your gland's ability to produce thyroid hormone, leaving you hypothyroid.
Hashimoto's disease, an autoimmune condition where antibodies gradually destroy your thyroid's ability to produce hormone over time.

Medications, such as lithium, that damage your thyroid's ability to produce thyroid hormone.

Special Considerations for People With No Thyroid

While information on hypothyroidism applies to those with no thyroid, there are some special considerations for people without a thyroid gland.

Diet

If you were born without a thyroid, your thyroid has been surgically removed, or you have had total or near total ablation with RAI, you don't need to be concerned about goitrogenic foods (i.e., brussels sprouts, broccoli, kale etc.) and their ability to interfere with your thyroid function. You should, however, still be careful about overconsuming soy-based foods, as excessive soy intake may affect your ability to properly absorb your thyroid hormone replacement medication.

TSH Level Maintenance

Those without a functioning thyroid gland may find that you have fewer fluctuations in thyroid function and greater ease in keeping an optimal TSH level on a consistent medication dose, as compared to patients who still have a gland. (Patients who still have a gland find that it occasionally produces thyroid hormone, and can erratically increase or decrease its functioning, making it harder to regulate thyroid levels.)

Medications for Thyroid Cancer Patients

If you are a thyroid cancer patient who has had your thyroid gland removed, you are in a unique situation in that you are typically given thyroid hormone replacement drugs at "suppressive" levels. Suppression means taking a sufficient level of medication to keep your thyroid stimulating hormone (TSH) level very low or even undetectable. This is considered "hyperthyroid" by most lab standards, but suppression is necessary to prevent cancer recurrence in some patients.

So, while you may refer to yourself as "hyperthyroid," your underlying condition of having no thyroid gland means that you are actually hypothyroid, and much of the advice about hypothyroidism still applies to you.

A Word From Verywell

If you have no thyroid gland, information about hypothyroidism applies to you. Whatever the cause of your hypothyroidism, if you are still experiencing thyroid symptoms, you may not be receiving optimal treatment for your condition. You'll need to proactively work with your practitioner to get better treatment. This may involve:

Trying a different brand of levothyroxine.
Increasing the dose, so that your TSH is lower. For example, some patients report feeling the best when TSH levels are between 1 and 2. (Remember, however, that thyroid cancer patients often need to follow a different protocol to prevent cancer recurrence).
Adding a T3 drug (i.e., Cytomel, or compounded T3), to your levothyroxine, referred to as combination therapy, or T4/T3 therapy.
Switching to a natural desiccated thyroid drug, such as Nature-throid or Armour
Complementing your treatment with alternative, nutritional and mind-body support to help improve overall health and relieve symptoms.

Sources:

Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. WLL/Wolters Kluwer; 2012.

_{Garber, J, Cobin, R, Gharib, H, et. al. "Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association." Endocrine Practice. Vol 18 No. 6 November/December 2012.}