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Have a small goiter and on Hashimoto's condition. Family history of thyroid disease. Treatment?

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Dr. Stephen Christensen

General & Family Physician

Practicing since :1986

Answered : 212 Questions

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Posted on Fri, 4 Jan 2013 in Thyroid Problem and Hormonal Problems
Question: Hi

I have a small goiter and antibody that indicate Hashimoto's condition. However, my thryoid reading is still normal. I have a family history of thyroid disease. I also have a family history of later life diabetes (after 50).

Should there be any change in handling, including any thyroid supplement given the preceding?

Best,

XXXXXXX
doctor
Answered by Dr. Stephen Christensen 5 hours later
Hello. I'm Dr. Christensen.
I'm sorry you're having problems with your thyroid. Your doctor may have already told you that Hashimoto's thyroiditis is an autoimmune disease. This means your immune system has decided your thyroid gland is a foreign agent, and it is producing antibodies to reject what it perceives as a threat. Unlike Grave's disease, which is another autoimmune disease that affects the thyroid gland, many patients with Hashimoto's have normal thyroid stimulating hormone (TSH) and thyroxine (T4) levels early in their illness. As the disease progresses, your T4 will probably fall, which will lead to an increase in your TSH. (Your pituitary secretes TSH to coax your thyroid to make more T4, but in Hashimoto's thyroiditis your thyroid eventually stops making T4, no matter how high your TSH rises.)
Once your TSH rises to high-normal or above-normal levels, your doctor will probably start you on thyroid thyroid function tests will determine if that's the case for you.)
By the way, Hashimoto's does have a genetic component, so the other members of your family with thyroid disease may have had Hashimoto's, too.
I hope that answers your question. I'll be available if you have additional concerns.
Good luck!
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Stephen Christensen 16 minutes later
Thank you.

My follow up questions are:

1. There is buzz on the internet that early use of thryoid hormone at low dose even when the readings are still normal helps prevent progression of Hashimoto.
Any feeling on this.

2. With a family history of diabetes, is there anything that I can do to the extent that thyroid impairment may correllate with diabetes. E.g. is it wise to follow a pre-diabetic diet pattern. My glucose fasting had been normal, but this last reading was a bit higher---101
Thanks,
XXXXXXX
doctor
Answered by Dr. Stephen Christensen 20 minutes later
There is some controversy about when to institute medical therapy for Hashimoto's. The "buzz" about starting therapy early in Hashimoto's patients is based on one small German study that only included 21 patients, which doesn't carry much weight in the eyes of most endocrinologists. Unfortunately, there haven't been any large, randomized trials to pursue this issue, and most evidence indicates that the autoimmune damage in Hashimoto's progresses inexorably, regardless of when thyroid goiter (enlarged thyroid) becomes symptomatic -- that is, begins interfering with swallowing or causing other problems -- most endocrinologists will withhold treatment until your TSH begins to rise.
Now, there is a relationship between thyroid disease and diabetes, but the specific relationship depends on what kind of diabetes you're referring to. Type 1 diabetes (yet another autoimmune disease) is more likely to occur in people with Hashimoto's, but you're a bit beyond the age where type 1 diabetes typically occurs. (The peak incidence is in early adolescence.) Type 2 diabetes, which is characterized by insulin resistance, can certainly get worse -- or possibly occur earlier -- in someone who has untreated hypothyroidism. This is another gray area that might warrant a closer look in your situation: your doctor may want to check your insulin levels to see if you're developing insulin resistance. If so, earlier treatment with thyroid hormone might be of some benefit. In the meantime, I'd suggest seeing a dietician about a diabetic diet, and if you're not already exercising for 15 to 60 minutes every day, now is as good a time as any to get started. (Check with your doc before you launch headlong into an exercise program.)
I hope that helps.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Stephen Christensen 31 minutes later

I appreciate your intelligent and well-thought out response.

The final question, though again I confess the result of internet review,

is:

1. Many sources say it is best to avoid gluten and see if that helps.

2. Some sources say it is good to supplement with selenium.

Any feeling on this?

Thanks,

P.S. My relatives, e.g., mother and grandmother got thryoid disease in early 50s
and then insulin dependent (TYPE 1.5 perhaps) diabetes about five years later.
XXXXXXX
doctor
Answered by Dr. Stephen Christensen 21 minutes later
Some studies suggest that supplementing with selenium (100 to 200 mcg daily) may slow the progression of autoimmune thyroid disease. Gluten sensitivity has been linked to thyroid problems, too. For example, individuals with celiac disease can develop thyroid autoantibodies. Again, however, there isn't enough data from well-designed studies to support gluten-free diets or routine supplementation with selenium in patients with Hashimoto's disease.
As for your family members who developed diabetes in their 50s, they may well have had type 2 diabetes, which in most patients eventually progresses to the point of pancreatic exhaustion and a need for insulin therapy. These patients are still type 2 diabetics; they've just "burned out" their pancreas. It's also possible your mother and grandmother had latent autoimmune diabetes of adults (LADA), which usually develops in individuals in their 30s and 40s.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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