When You Don't Have a Thyroid Gland

When you don't have a thyroid gland, you may have symptoms like those of hypothyroidism. Hypothyroidism is when you have an underactive thyroid. This means your thyroid doesn't make enough thyroid hormone.

If you don't have a thyroid, your treatment may be similar to the treatment for hypothyroidism. Still, your thyroid hormone levels and medication doses may be unique.

This article discusses some things to keep in mind if you don't have a thyroid gland.

Why Some People Don't Have a Thyroid

There are a few reasons why you might be missing your thyroid gland. The most common ones include:

• Treatment of thyroid cancer. This often involves removal of all or part of the thyroid gland.

• Sometimes thyroid nodules or an enlarged thyroid need to be removed. A goiter, which is abnormal growth of the thyroid, may also need to be removed. This is usually because the growth affects breathing or swallowing. Rarely, an enlarged thyroid may be removed for cosmetic reasons. 
• A toxic nodule is a growth that produces thyroid hormone. Some people with a toxic nodule, a goiter, or Graves' disease have hyperthyroidism. This is when your thyroid produces too much thyroid hormone. One treatment for this type of hyperthyroidism is removal of the thyroid gland.
• A small number of people are born without a thyroid gland. It is also possible to be born with a malformed thyroid. This condition is called congenital hypothyroidism.

The thyroid gland may also have poor function even if it is not completely absent. This can cause underactivity that is worse than typical hypothyroidism.

Conditions that cause poor thyroid function include: 

• Radioactive iodine (RAI) treatment for Graves' disease is also called ablation therapy. RAI greatly reduces your gland's ability to produce thyroid hormone. It may also destroy the function of the gland. This leads to hypothyroidism.
• Hashimoto's disease is an autoimmune condition, in which the immune system attacks healthy tissue. When you have this condition, antibodies gradually destroy your thyroid's ability to produce hormones. 
• Medications like Lithobid (lithium) can also damage your thyroid's ability to produce thyroid hormone.

Hypothyroidism Symptoms

Hypothyroidism happens because of low thyroid activity. Most people with this condition have a thyroid gland.

If you don't have a functioning thyroid gland at all, you will also have the typical symptoms of hypothyroidism.

These include:

• Weight gain
• Cold intolerance
• Fatigue
• Sleep problems
• Trouble concentrating, or brain fog
• Depression
• Dry skin
• Muscle cramps

Your symptoms may change if you used to have a thyroid gland but do not have it now.

These symptoms usually get better with treatment. If your medication dose is too high, you may have opposite symptoms, like heat intolerance or weight loss.

Symptoms do not always go away completely with medication. Sometimes you need to make other life changes. Extra sleep, skin moisturizer, and heavy clothing can all help you cope with your symptoms.

Special Considerations If You Don't Have a Thyroid

You also need to consider other factors that are unique to your condition. Some of these are actually easier to manage if you do not have a thyroid gland than if you were simply hypothyroid.

TSH Level Maintenance

Hypothyroidism is monitored with a blood test that checks thyroid stimulating hormone (TSH) levels. This hormone tells your thyroid to make thyroid hormones. High TSH means you need a higher dose of thyroid hormone replacement.

Even an underactive thyroid gland can sometimes produce thyroid hormone. But the amount of hormone it makes can fluctuate unpredictably. This can make it harder to maintain regular thyroid levels with medication.

Medications After Thyroid Cancer Removal

Your situation is unique if your thyroid was removed because of thyroid cancer. Your doctor will give you "suppressive" levels of thyroid hormone replacement medications. This is done to prevent cancer recurrence.

Suppressive levels of medication keep your TSH levels low or even undetectable. According to the way thyroid lab tests are usually interpreted, you would be considered hyperthyroid.

Because you do not have a thyroid gland, though, you still need to follow the advice for managing hypothyroidism.

Summary

You may be missing your thyroid gland because it was removed, or because you you were born without one. You may also have a thyroid gland that doesn't function at all.

When you don't have a thyroid, you will have symptoms of hypothyroidism. These usually get better with thyroid hormone replacement treatment.

You may have an easier time finding the right medication dose because you won't have fluctuating thyroid hormones. 

If you had your thyroid removed because of cancer, you will need to take a "suppressive" dose of medication to keep your TSH levels low. This helps prevent the cancer from returning.

A Word From Verywell

If you still have thyroid symptoms after your thyroid gland has been removed, talk to your doctor. You may need to have your thyroid hormone replacement medication adjusted.

Work proactively with your doctor and follow up as needed. This will help make sure you're getting the treatment that's right for you.