When You Don't Have a Thyroid Gland

If you don't have a thyroid gland, you can expect to have many of the same symptoms as the more common types of hypothyroidism that occur due to an underactive thyroid gland. You may also require similar medical treatment. While that is helpful to know, there are unique considerations to keep in mind in terms of diet, thyroid hormone levels, and medication doses, too.

There are a number of reasons that you could be missing your thyroid gland, and your symptoms may change if you had your thyroid gland in the past, but do not have it now.

The most common reasons for an absent thyroid gland include:

• The treatment of thyroid cancer is usually surgical removal of all or part of the thyroid gland.
• Sometimes thyroid nodules, a goiter, or an enlarged thyroid need to be surgically removed if the growth affects breathing or swallowing. Rarely, an enlarged thyroid may be removed if it is cosmetically undesirable. 
• Some people with a toxic nodule, a goiter, or Grave's disease have hyperthyroidism when too much thyroid hormone is produced and released. One of the treatment options considered for this type of hyperthyroidism includes surgical removal of the thyroid gland.
• A small percentage of people are born without a thyroid gland or with a malformed thyroid, a condition known as congenital hypothyroidism.

There are other situations in which the thyroid gland is not completely absent, but the function is so severely diminished that the underactivity is below the levels expected from standard hypothyroidism.

These conditions include: 

• Radioactive iodine (RAI) treatment for hypothyroidism for Grave's disease is known as ablation therapy. RAI greatly impairs and may completely destroy your gland's ability to produce thyroid hormone, leaving you hypothyroid.
• Hashimoto's disease is an autoimmune condition in which antibodies gradually destroy your thyroid's ability to produce hormones. 
• Medications, such as lithium, can damage your thyroid's ability to produce thyroid hormone.

Hypothyroidism is a manifestation of low functioning thyroid hormone, and most people with hypothyroidism have a thyroid gland. But if you don't have a functioning thyroid gland at all, you will experience the typical effects of hypothyroidism as well.

They include:

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

Typically, these symptoms improve with treatment, but you can experience the opposite effects—such as heat intolerance or weight loss if your medication dose is too high. Interestingly, hypothyroidism can interfere with concentration by making you tired, but an excessive dose can interfere with your ability to concentrate by causing you to be jumpy and even manic or hypomanic.

Symptoms are not always perfectly managed with medication, and sometimes you need to make adjustments beyond taking thyroid replacement medications, such as getting extra sleep, using moisturizer for your skin, or wearing heavy clothes.

While you can expect the above if your thyroid gland has been removed, you also need to pay attention to other factors that are unique to your situation. Interestingly, some issues are a bit easier and more straightforward if you do not have a thyroid gland than if you were simply hypothyroid.

You should be careful about overconsuming soy-based foods, as excessive soy intake may affect your ability to properly absorb your thyroid hormone replacement medication, reducing the intended effects.

If you have had an underactive thyroid gland in the past, you may recall that an underactive thyroid gland can occasionally produce thyroid hormone. The gland can erratically increase or decrease functioning thyroid hormones, making it harder to regulate thyroid levels with medication.

If you had your thyroid gland removed due to cancer, you are in a unique situation in that you may be given thyroid hormone replacement medications at "suppressive" levels. Suppression means taking a sufficient level of medication to keep your thyroid stimulating hormone (TSH) level very low or even undetectable. You would then be considered hyperthyroid by most lab standards, but this degree of suppression may be necessary to prevent cancer recurrence.

In the end, while you may refer to yourself as hyperthyroid, much of the advice about hypothyroidism may still apply to you because you do not have a thyroid gland.

If you are still experiencing thyroid symptoms after removal of your thyroid gland, you may need an adjustment of your thyroid hormone replacement medication. Be sure to follow up with your doctor as advised and proactively work together to optimize your treatment and symptoms.