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Your thyroid is a small, butterfly-shaped endocrine gland that sits on top of the trachea, near the bottom of the neck. The thyroid is like the gas pedal to your body: It’s responsible for bodily processes, including metabolism, growth, and brain development. When functioning normally, the thyroid releases a steady amount of thyroid hormones—triiodothyronine (T3) and thyroxine (T4)—into the bloodstream. But sometimes, it becomes dysregulated and releases too much (hyperthyroidism) or too little (hypothyroidism) thyroid hormones.
More than 12% of Americans will have thyroid dysfunction at some point in their lives, according to the American Thyroid Association. In fact, an estimated 20 million Americans live with thyroid disease, 60% of whom are unaware of their condition. Sometimes, serious thyroid conditions are treated by removing the thyroid, a surgery called a thyroidectomy. But is it possible to live without a thyroid? In short, yes. Here’s what you need to know.
Reasons you would not have a thyroid
When you visit your primary care provider for an annual physical, they will likely feel the front of your neck to check for nodules or other abnormalities, says Eric Ascher, DO, family medicine physician at Northwell Health’s Lenox Hill Hospital in New York. If your provider feels something unfamiliar, you may need an ultrasound to determine if you need to see a specialist, take medications, or go for a procedure such as a thyroidectomy, explains Dr. Ascher.
There are several reasons, including thyroid disorders and thyroid surgeries, why someone might have a poorly functioning or missing thyroid. These include:
Thyroidectomy
Common reasons for removal of the entire thyroid (total thyroidectomy) or part of the thyroid (partial thyroidectomy) are thyroid cancer, goiter (benign enlargement of the thyroid), hyperthyroidism (overactive thyroid), or suspicious thyroid nodules, according to the Mayo Clinic.
Depending on which procedure you have, you may or may not need to take medication. For example, if you have a partial thyroidectomy, it’s possible that the remaining portion of your thyroid will produce enough thyroid hormone to serve the body satisfactorily. After a total thyroidectomy, you’ll need a daily hormone replacement medication made of levothyroxine, a synthetic form of the thyroid hormone T4. In these cases, thyroid replacement is often a lifelong task.
Congenital malformation
Rarely, newborns are born without a thyroid. Some individuals are found to have congenital hypothyroidism, which is when a thyroid gland does not develop or doesn’t function normally. In 80%-85% of cases, the thyroid gland is missing altogether, greatly reduced in size (hypoplastic), or located in an abnormal position. Treatment must begin within two weeks of birth to ensure normal physical and mental development, which is why all hospitals in the United States test newborns 24 hours after birth for hypothyroidism with a heel stick blood draw.
Graves’ disease
A condition of too much thyroid hormone production (overactive thyroid). Graves’ disease is an immune system disorder that affects 1 in 100 Americans and often causes hyperthyroidism. This overproduction of thyroid hormones causes insomnia, anxiety, and unintentional weight loss. It’s typically treated with beta-blockers, antithyroid medications, radioactive iodine therapy, or (rarely) thyroidectomy.
Hashimoto’s thyroiditis
Similar to Graves’ disease, Hashimoto’s thyroiditis is a chronic autoimmune disorder in which the immune system attacks the thyroid and causes thyroid inflammation. It affects females seven times more commonly than men. Early in the course of Hashimoto’s, the patient may have hyperthyroidism due to thyroid inflammation, and then over time, most patients have a decrease in thyroid hormone production causing hypothyroidism. Hashimoto’s is the most common cause of hypothyroidism in the United States, and often requires lifelong thyroid replacement with an oral medication, levothyroxine.
Iodine exposure
Abnormal amounts of iodine exposure can also cause hypothyroidism, says Sapna Shah, MD, a double board-certified endocrinologist and internal medicine physician at Paloma Health, an online medical practice that treats patients with hypothyroidism. This can happen if there’s too much or too little iodine in the diet, you ingest high doses of iodine from medications or when dyes used in radiology testing contain iodine, Dr. Shah says. Iodine-induced hypothyroidism usually resolves within one to two weeks after the iodine ingestion is returned to normal. Most Americans ingest iodine in a sufficient amount in iodized salt.
Inflammation
Inflammation of the thyroid, or thyroiditis, can result in temporary thyroid dysfunction, but it’s usually reversible, says Dr. Shah. Causes of thyroid inflammation include a viral or bacterial infection, radiation, postpartum antibodies, or medications including cytokines, interferons, lithium, and amiodarone.
RELATED: Thyroid health 101: Common problems you should watch for
Can you live without a thyroid?
Yes. The thyroid is not an organ that grows back, but it is possible to survive without one. In fact, many people do, says Dr. Ascher. After a thyroidectomy, regular follow-up appointments and labwork with a primary care provider or an endocrinologist are routine.
“After your thyroid is removed, it is important to follow up with your doctor to reassess your thyroid function blood tests (TSH tests measuring levels of thyroid stimulating hormone),” Dr. Ascher says, noting that it takes six to eight weeks for bloodwork to show changes in thyroid hormone levels after a thyroidectomy.
This ensures that you’re appropriately treated with thyroid hormone replacement medications, adds Dr. Shah. “There are several options available,” she says. “The safest is levothyroxine, which is available as generic or brand and in tablet, capsule, and liquid formulations.”
Life without a thyroid
Most patients adapt very well to thyroid removal after stabilization on appropriate thyroid hormone replacement, and overall health outcomes are the same with appropriate management, says Dr. Shah. It’s common to gain weight after thyroid removal, but with appropriate hormone replacement and lifestyle interventions, most patients will lose the excess weight, she explains.
According to Dr. Shah, many patients express a difference in their quality of life postoperatively. That’s why it’s important to work with an endocrinologist who can help you work through bothersome symptoms in a safe way. For example, you may experience hypothyroid symptoms:
- Fatigue
- Sensitivity to cold temperatures and feeling cold when others are not
- Weight gain
- Hair loss or changes
- Nail loss or changes
- Dry skin
- Constipation
- Depressed mood
- Muscle cramps
- Muscle weakness
- Slowed movement
- Feeling mentally slow
“Many online resources will try to sell a quick fix for thyroid symptoms, but be wary of these,” advises Dr. Shah. “Many can improve symptoms short term, but result in worsening long-term health outcomes.” What’s more, there are no specific dietary restrictions after thyroid removal, she says. And while you might need to temporarily avoid or limit certain foods which are high in iodine, there are no permanent food restrictions.
Medication
Thyroid medications are prescribed as hormone replacement therapy to individuals with hypothyroidism for any reason: inflammation or absence of the thyroid gland. According to Dr. Ascher, levothyroxine, or name-brand Synthroid, is the most commonly prescribed drug for an underactive thyroid as well as in patients without the thyroid. It works by replacing the missing hormones, he explains.
When dosed appropriately, there are very few side effects of levothyroxine in most people, says Dr. Ascher. So if you experience symptoms when taking the medication, it’s a good idea to check in with your provider to reassess your thyroid levels.
Other medications that may be prescribed include T3, says Dr. Shah. She notes that while some patients may benefit from low-dose T3 supplementation, high-dose T3 supplementation has been associated with faster heart rates and the potential for atrial fibrillation and loss of bone density; therefore, it is not recommended.
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Regular follow-up care
Follow-up care after thyroid removal is largely dependent on the reason for your thyroidectomy, but expect to work closely with your surgeon for a few months postoperatively, advises Dr. Shah. For patients with thyroid cancer, there may be blood tests, radiology studies, and additional treatments required. Other patients may be started immediately on a thyroid medication postoperatively, with dosage adjustments needed for the first three to six months (until levels are stable and healthy), Dr. Shah explains.
RELATED: How to understand thyroid panel test results
Lifestyle changes
Adopting a healthy diet and exercise regimen in addition to taking your medication daily are important to help your thyroid and weight stabilize. See your doctor for regular follow-ups, urges Dr. Ascher, who advises taking thyroid medication every morning on an empty stomach (30 minutes before eating or drinking) to avoid food interactions in the digestive tract, particularly with calcium or iron.
For her patients, Dr. Shah says that lifestyle interventions that help the most are regular low- to moderate-intensity exercises, practicing good sleep hygiene, and appropriate stress management. And though she says there’s no strong data for a specific dietary protocol, the autoimmune protocol diet and the Mediterranean diet have helped her patients.
