When You Have No Thyroid

By Mary J. Shomon

I regularly receive emails from people who say "What about me? I don't have a thyroid! You're not writing anything for me!" You're always writing about hypothyroidism or hyperthyroidism, but not about people with no thyroid.

Actually, this is not true. I write about people who have no thyroid all the time, but the people with no thyroid technically don't realize it -- because their doctors have never told them that they are in fact considered "hypothyroid."

But first, let's clarify the situation. Why don't people have a thyroid?

• A small percentage of people are born without a thyroid or with a malformed thyroid -- known as congenital hypothyroidism
• People who have thyroid cancer usually have all or part of their thyroid removed
• Some people with thyroid nodules or goiter (enlargement) that is either cosmetically unsightly, or is compromising breathing or swallowing, have their thyroid removed surgically
• Some people with Graves' disease or hyperthyroidism have their thyroid removed surgically. It is typically a last-resort treatment in the U.S., where radioactive iodine (RAI) is more often performed, but outside the U.S., after antithyroid drugs, surgery is considered the primary treatment for Graves' and hyperthyroidism

So, if you don't have a thyroid, or you have a thyroid but it is not functioning as it should to produce enough thyroid hormone, then you are hypothyroid.

Hypothyroidism can result from:

• a missing thyroid
• surgical removal of the thyroid
• the thyroid's autoimmune self-destruction, as in Hashimoto's disease
• nodules that make the thyroid dysfunctional
• a thyroid that has been radioactively ablated, after RAI

But ultimately, if you do not have any or enough circulating thyroid hormone, then you are hypothyroid.

So, to answer the question that many people write to me: There is plenty of information here at the site for you. Because all the materials here at the site regarding hypothyoidism do, for the most part, apply to you!

Special Considerations For People With No Thyroid

That said, there are some special considerations for people with no thyroid.

Without a functioning thyroid, you don't need to be particularly concerned about soy or other goitrogenic foods (i.e., brussel sprouts, broccoli, etc.) and their ability to interfere with your thyroid function

You may have less fluctuations in thyroid function and find it easier to stabilize your dose and maintain an optimal TSH level on a consistent dose. (This is compared to those who still have a thyroid, who will find that it occasionally sputters in and out of life, making regulation of levels more difficult.)

Thyroid cancer patients are in a unique situation in that they are given thyroid hormone replacement drugs at "suppressive" levels. This means that the objective is a nearly undetectable TSH level close to 0. This is considered "hyperthyroid" by most lab standards, but suppression is necessary for most thyroid cancer patients to prevent cancer recurrence. So, some thyroid cancer patients consider themselves hyperthyroid, although again, the underlying condition of having no thyroid gland means that your condition is actually hypOthyroidism, and so much of the advice about hypothyroidism still applies.

When You Don't Feel Your Best

While thyroid cancer patients have the unique circumstance regarding the need for a suppressed TSH level, others who have no thyroid and are not feeling well can investigate options for more optimal thyroid treatment.

If you are experiencing hypothyroidism symptoms (see my Hypothyroidism Symptoms Checklist) 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: