From Mary Shomon,
Your Guide to Thyroid Disease.
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I often receive emails from readers who say "What about me? I don't have a thyroid! You're not writing anything for me! You write about hypothyroidism or hyperthyroidism, but not about people with NO thyroid."

Actually, I write about people without a thyroid gland all the time, but it may not be obvious. When you don't have a thyroid, you are hypothyroid -- your gland is unable to produce sufficient thyroid hormone. So most of my information regarding hypothyroidism also applies to you.

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

• A small percentage of people are born without a thyroid or with a malformed thyroid — known as congenital hypothyroidism.
• The treatment for thyroid cancer is usually surgical removal of all -- or a large part -- of the thyroid gland.
• Some people with thyroid nodules or goiter (enlargement) that is either cosmetically unsightly, or is compromising breathing or swallowing, have the thyroid gland 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. Outside the U.S., however, surgery is often performed as the next level of treatment for Graves' and hyperthyroidism, after antithyroid drugs.)

So, if you don't have a thyroid gland, then you are hypothyroid.

This puts those without a gland in the hypothyroidism category with others who have an underactive or non-functioning gland, including:

• Those who have had radioactive iodine (RAI) treatment for Graves' disease or hyperthyroidism, and who still have a thyroid gland, but whose gland has been made either completely inactive, or underactive (hypothyroid) after the RAI "ablation" treatment
• Those with Hashimoto's disease, where antibodies gradually destroy the thyroid's ability to produce hormone

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

So, to get back to the question that many ask: There is a great deal of information on this site for you. Because all the materials regarding hypothyroidism do, for the most part, apply to you, start by visiting my Hypothyroidism Information Page.

There are, however, some special considerations for people without a thyroid gland, and I discuss them in the next section.

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 .

Those without a functioning thyroid are totally dependent on thyroid hormone replacement for all their thyroid hormone. You may find that you have less fluctuation in thyroid function and find it easier to stabilize your dose and maintain an optimal TSH level on a consistent dose, as compared to patients with autoimmune thyroid disease who still have a gland. (This is because when the gland is still present and capable of functioning, it may occasionally sputter to life and produce thyroid hormone, making regulation of thyroid levels more difficult.)

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

When You Don't Feel Your Best

If you are still experiencing hypothyroidism 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 the TSH is lower. (Some patients report feeling the best when TSH levels are between 1 and 2.) (Again, remember that thyroid cancer patients often follow a different protocol to prevent recurrence).
• Adding a T3 drug (i.e., Cytomel, or compounded T3), to the levothyroxine
• Switching to a T4/T3 synthetic drug, such as liotrix (Thyrolar)
• Switching to a natural desiccated thyroid drug, such as Armour
• Complementing your treatment with alternative, nutritional and mind-body support to help improve overall health and relieve symptoms.

But a helpful first step: Start by reading my article: Help, I'm Hypothyroid and I Still Don't Feel Well.

Sources:

Braverman, MD, Lewis E., and Robert D. Utiger, MD. Werner and Ingbar's The Thyroid: A Fundamental and Clinical Text. 9th ed. Philadelphia: Lippincott Williams & Wilkins (LWW), 2005.