I recently learned that Dr. Ivan Guldvog, a surgeon in Norway is conducting a clinical trial on the effect of a total thyroidectomy for people with Hashimoto’s. A total thyroidectomy is a complete surgical removal of the thyroid gland. This procedure has traditionally been performed for people with Graves’ disease, large goiters, and for people with thyroid cancer, and results in a lifelong need for thyroid medications. (1, 2)
The procedure, like any surgical procedure, has many risks including bleeding, infection, a permanently hoarse voice, airway obstruction, and damage to the parathyroid glands, which can lead to hypoparathyroidism, a condition that can result in dangerously low calcium levels (hypocalcemia). A UK physician made headlines in 2015, speaking out about her life-threatening post-surgical experience with hypocalcemia. (2, 4)
Dr. Guldvog has performed 97 total thyroidectomies for patients with Hashimoto’s, and has reported positive results to date, most significantly:
- The percentage of those reporting severe fatigue was reduced from 84% at baseline to 34% at 18 months.
- Levels of TPO antibodies (thyroid peroxidase antibodies, the main antibodies found in Hashimoto’s) fell from 2,500 units/L to <500 units/L in the surgery patients versus about 3,200 units/L to 2,500 units/L among the patients treated with medications.
I had mixed feelings about this study, as a part of me was happy to see that Hashimoto’s was getting more attention from conventional medical physicians and that awareness around the struggles of patients with Hashimoto’s was increasing.
Dr. Guldvog has said “The fatigue experienced with Hashimoto’s disease is debilitating. People can’t work. Their quality of life is very poor. Medical treatments fail to relieve all the symptoms, but the complete surgical removal of the thyroid appears to be curative in most cases. Hashimoto’s isn’t a disease that you die of, but it can make your existence miserable.”
I was also happy to see that this particular doctor was thinking beyond synthetic thyroid medications and focused on thyroid antibodies when he stated “Thyroxine does not normalize symptoms or anti-thyroid peroxidase levels” during his presentation at the 2015 International Thyroid Congress.
However, I was also disappointed and concerned that thyroidectomy would become a standard recommendation for Hashimoto’s.
When I was a young pharmacist, I worked on a multidisciplinary team with a wonderful group of healthcare professionals: physicians, nurses, psychiatrists, psychologists, social workers, behaviorists, dental hygienists, occupational therapists and many others. This was before I knew I had Hashimoto’s, and during the time I was suffering from a horrible chronic cough (among many other mysterious symptoms). The cough was painful, uncontrollable, and sometimes resulted in me vomiting. It kept me in a constant state of worry. You see, it would pop up at very inconvenient times like in the middle of the night when I was sleeping, and I would wake up choking, or in the middle of a presentation or work meeting, and I’d have to run out of the room and vomit into a garbage can… not pretty, I know.
I saw multiple doctors, had a battery of tests and tried every drug that was prescribed to me, from antihistamines to anxiolytics to acid blockers (this was after I had already tried every over-the-counter option). But the cough persisted, and now I had a cough and medication side effects.
The only thing that seemed to help was taking a narcotic cough suppressant; Phenergan with codeine. But I could only take it sometimes – codeine can be habit forming, and as a pharmacist, I knew that very well. And although I had a valid prescription for the cough syrup, I was also concerned that I would test positive at a random drug screen at work. It would be very awkward to explain to my boss and HR why I came up positive for a narcotic!
When I did take the cough syrup, I could only take it at night, because it made me too woozy during the day, and then I always felt hungover in the morning. So I saved it for emergencies.
I was desperate and would have done anything to get rid of the cough. I once joked with my colleague at work that I was even willing to cut off my head if that would make the cough go away.
I thought that perhaps my tonsils were part of the problem. They always looked swollen and inflamed, and I had read about tonsils contributing to a chronic cough. So I consulted with a surgeon to ask if my tonsils could be a possible cause of my chronic cough. He said it was possible, and offered to take out my tonsils. But then I learned that a few months before I started my job, a social worker who had worked at the very center where I worked had died as a result of a tonsillectomy. She was in her 20’s (like me), and the people that knew her said she was one of the kindest souls they’d ever met. Her tonsillectomy was supposed to be “no big deal,” but she suffered from uncontrolled bleeding and was only found by her family when it was too late.
I was conflicted and didn’t know what to do. I wanted to get rid of the cough, and the surgeon seemed trustworthy, but I was scared. I spoke to one of my physician colleagues, and she said something very wise that I will always be grateful for: “If you consult with a surgeon, there’s a good chance that he’ll recommend surgery. When your main tool is a hammer, everything becomes a nail. Don’t be so quick to part with a body part. You have tonsils for a reason”.
Her advice and the tragic passing of the young social worker I never got to meet solidified my decision against getting a tonsillectomy. And guess what? My chronic cough is long gone (almost 5 years), and I still have my tonsils. For me, eliminating dairy and gluten vanquished the cough within three days. I had suffered from it for 3 years, and thought I had tried ‘everything”!
And guess what? The same interventions also reduced my fatigue and thyroid antibodies.
Over the last seven years of researching Hashimoto’s, I’ve identified over 28 unique ways of reducing thyroid antibodies, and over a dozen methods for overcoming thyroid fatigue!
For some people, getting off gluten and dairy will completely reverse Hashimoto’s and its symptoms. For others, more interventions are needed, such as an autoimmune diet, treating infections, supporting the adrenals, healing the gut, addressing nutrient imbalances and getting rid of toxins. There are also supplements and medications that can suppress autoimmune symptoms and thyroid antibodies. My favorite supplements to use for reducing antibodies are Wobenzym or systemic enzymes, and I’ve also seen miraculous results with the use of low-dose naltrexone for autoimmunity.
Sometimes overcoming fatigue is as simple as taking one supplement, in the right dose. I’ve received so many thank-you notes, and random people have even given me hugs at conferences, after reading my article about Thiamine and Thyroid Fatigue.
I’ve also written more about thyroid fatigue in this article.
Most thyroid conditions (Hashimoto’s, Graves’, thyroid cancer) result from an immune system that is out of balance. This can be caused by nutrient deficiencies, food sensitivities, toxins, a gut imbalance, poor stress response and/or a chronic infection that can be anywhere in the body. Even when the thyroid is taken out surgically or treated with radioactive iodine, the immune imbalance still persists in many cases, and a person may go on to develop additional health conditions, and still feel unwell.
While Dr. Guldvog has followed many of his patients for at least 18 months and reports that most of them remain symptom-free, I don’t know any people that have had their thyroids removed due to Hashimoto’s. However, I do know quite a few who have had their thyroid glands removed due to Graves’ or thyroid cancer, that have gone on to develop additional autoimmune conditions within a few years, or have continued to struggle with many symptoms! This is because surgically removing the thyroid gland removes the target of the imbalanced immune system, but does not change the immune imbalance. Removing the thyroid doesn’t change the fact that there are multiple broken systems in the body.
Make sure to check out the responses from several thousand respondents on this open Facebook survey. The responses are remarkable.
So to me, removing the thyroid gland in Hashimoto’s is like throwing out the baby with the bathwater. It’s like killing the messenger, because, in autoimmune thyroid disease, the problem is not with the thyroid gland. The problem is with the immune system.
Like most people who become healthcare professionals, I’m sure this doctor’s heart is in the right place, and he is genuinely trying to help his patients. And I’m not against surgery or even surgical removal of the thyroid gland. In some cases, surgery can be the best option and can be a life-saving measure, such as in cases of treatment unresponsive cases of Hashimoto’s Encephalopathy or treatment unresponsive Graves’ and advanced thyroid cancers. For some patients, especially those with advanced disease that hasn’t responded to lifestyle or a root cause approach, a thyroidectomy may be the best option. Additionally, I understand that some people may not be aware of alternatives, may not be willing to change their lifestyle, or perhaps the damage may be beyond repair.
But I think one day, people will look at thyroidectomies for autoimmune thyroid disease the way we now look at lobotomies for mental health disorders.
If you are struggling with thyroid symptoms and think there’s no hope other than a thyroidectomy, I beg you to try lifestyle changes and functional medicine first. (Here’s a post about the functional medicine approach to the thyroid).
If you’ve already had a thyroidectomy, in addition to making sure your thyroid medications are optimized (you will need them for life, there’s no shame in that, and you want to make sure that you are getting the optimal thyroid medications for you!), I also encourage you to take on lifestyle changes and functional medicine, to ensure that the underlying triggers that led to the development of your condition don’t lead to another autoimmune condition.
I do provide a lot of resources for people with Hashimoto’s, including the following:
- My blog, where I try to share what’s worked best for me, my clients and readers, as well as the latest research.
- My Hashimoto’s Root Cause book, which focuses on restoring immune balance and feeling better with Hashimoto’s (over 1000 reviews!) and my book Hashimoto’s Protocol where I go over a plan on how to reverse this disease.
- My Optimizing Thyroid Medications eBook, which focuses on restoring optimal thyroid hormone levels through the use of individualized medications (this is especially important if you have had your thyroid removed). Enter your email below to download the Free eBook!
- My Hashimoto’s Self-Management Program, which is a 12-week course to help people with Hashimoto’s uncover their triggers and get their life back. I developed this course for people who have “tried everything,” after having worked with hundreds of people with Hashimoto’s. In surveying the participants, 75% were able to reduce their fatigue, and 56% saw a reduction in thyroid antibodies within three months, among many other improvements.
I hope these resources help you on your journey!
References
- Anon, (2017). [online] Available at: http://www.medpagetoday.com/MeetingCoverage/ATA/54177 [Accessed 27 Sep. 2017].
- Mayo Clinic. (2017). Thyroidectomy – Risks. [online] Available at: http://www.mayoclinic.org/tests-procedures/thyroidectomy/basics/risks/prc-20019864 [Accessed 27 Sep. 2017].
- Pratap Chand, C. (2013). Mixed Clinical Response After Total Thyroidectomy in Two Patients with Hashimoto?s Encephalopathy. Journal of Thyroid Disorders & Therapy, 02(03).
- The Telegraph (2015). Pay out for doctor still alive only because she diagnosed herself.
Lorrie- Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically, is ‘dead’, or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target. We need to re-balance the immune system to prevent this (sometimes the autoimmunity can be reversed as well). The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.
HASHIMOTO’S ROOT CAUSE BOOK
http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20
I am struggling with fatigue and liver panels that fluctuate. In 2014 my thyroid was removed, cancer was found on both sides. I can’t find my pathology report, but I think it did reference Hashimoto’s.
At the beginning of this year, I changed my diet to a whole foods, plant based diet, and for a while I felt better, but the fatigue is back.
I can’t seem to get anyone to help, and I’m not sure what to do.
Michelle – thank you for following this page. Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically, is ‘dead,’ or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target. We need to re-balance the immune system to prevent this (sometimes the autoimmunity can be reversed as well). The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition.
Hashimoto’s Root Cause
http://www.amazon.com/gp/product/0615825796?ie=UTF8&camp=1789&creativeASIN=0615825796&linkCode=xm2&tag=thyroipharma-20
Hashimoto’s Protocol
thyroidpharmacist.com/protocol
Hello,
I recently underwent a total thyroidectomy after struggling with severe painful hashimotos for over 5 years. My thyroid was so enlarged that I could not swallow, lay flat without gasping for air, or speak without pain. After much research and discussion with top thyroid specialists, I underwent a total thyroidectomy 2 weeks ago. The surgeon said it was the toughest surgery he has ever done due to the size of the thyroid. My post op course has been difficult and I spent 10 days hospitalized with hypocalcemia, vocal cord issues, and dysphagia. Things have been improving. My hope is they will continue to improve because I couldn’t live how I had been. I am a strict believer in the root cause and follow it to the T. I wish more physicians were educated on how hashimotos effects the body and stop saying that antibodies are not important. With antibodies above 3000 all the time, I can say firsthand, they are important and make me very ill. I would love to keep you updated on my symptoms post thyroidectomy. Thank you for all you do!
Lindsey – thank you so much for sharing your journey. I am so sorry you had to go through all of this. My heart goes out to you. <3 Take care of yourself! I'm looking forward to seeing your progress here.
Glad I came across this site. My question was answered about surgery. I do, however, have a question that I did not see mentioned. What about our Hormones and the need for them to be balanced as well. When one of my Doctor’s started lowering my hormone levels because of my age, it caused my Hosimotos and Goiter to swell as well as my ANTIBODIES to go crazy. When they cut my Estrogen in half, within a month or so my body starting attacking my joints to the point I was unable to walk, then my hands got so bad I almost couldn’t feed myself, was moving into knees and so on. I found a doctor about 8 months ago that started me on natural hormones, increased my levels after a blood test showed what I needed and within 6 weeks all my joint pain went away. My stress levels are so extreme and I’m in fight or flight mode 85% of the time. It’s a vicious cycle because stress affects hormones and Thyroid, while the Same time if my Thyroid was functioning better then I’d be able to handle stress better. I feel there is hope with my new Doctor, but I still feel there’s allot more to having a better life through vitamins and proper eating and exercises. As you know, when your in a flare up you have no energy and mentally your exhausted that it’s really hard to try and think about eating and exercise so I feel like I’m caught in a black hole. Is there a way to climb out and start taking my life back? And how do I get family and people in my life to understand I’m not a hypercondriac and how they can best help me and support what life style changes I may need to make? I will be 50 this year, have a 3 year old grandson, played every sport and was active until my back injuries and my Hosimotos seemed to get worse after I turned 40. I refuse to give in and 20 years of suffering now is enough. I believe I’m on the right track with my Doctor but I need help to finish the race. I’m very competitive and of course always want to come out on top and a winner. Sincerely
Heidi- Thyroid tissue can regenerate, but the rate at which it does is not always predictable. Thus, some are able to stop the autoimmune attack on their thyroid and regain normal thyroid function. Others can reduce the dose of medications, and others will need to stay on the medications indefinitely. I’m currently working on some protocols to help with tissue regeneration.
Reversing Hashimoto’s means different things to different people. For some, it means a reduction in symptoms and for others it means a reduction in your antibodies. I had both. Here a few articles that might be helpful for you 🙂
ARE YOUR ADRENALS SABOTAGING YOUR HEALTH?
https://thyroidpharmacist.com/articles/are-your-adrenals-sabotaging-your-health
REVERSING AUTOIMMUNITY? AND THE PERFECT STORM
https://thyroidpharmacist.com/articles/reversing-autoimmunity-and-the-perfect-storm/
HASHIMOTO’S SELF CARE, GETTING AND STAYING IN REMISSION
https://thyroidpharmacist.com/articles/hashimotos-self-care
Hi Dr. Wentz,
My ENT recommended a tonsillectomy for my recurring tonsillitis (happens monthly like clockwork around the time of ovulation and/or menstruation) but like you I am hesitant to do something so drastic. I have autoimmune hypothyroidism and adrenal fatigue and I feel like the constant infections are making the adrenal fatigue worse. On the flip side, if I did the surgery in an attempt to prevent the tonsillitis I’m afraid that the surgery itself and two week recovery period of fatigue, pain, stress, and lack of proper nutrition will wreak havoc on my system/adrenals. I’ve tried so many immune boosting remedies and my hormone levels came back normal so I’m not sure where to go from here.
Amanda – I’m sorry to hear it. 🙁 I highly recommend that you work with a functional medicine clinician. It’s an entire medical specialty dedicated to finding and treating underlying causes and prevention of serious chronic disease rather than disease symptoms.
FUNCTIONAL MEDICINE APPROACH TO THE THYROID
https://thyroidpharmacist.com/articles/functional-medicine-approach-to-the-thyroid
WHAT TYPE OF DOCTOR SHOULD YOU SEE IF YOU HAVE HASHIMOTO’S
https://thyroidpharmacist.com/articles/what-type-of-doctor-should-you-see-if-you-have-hashimotos
10 THINGS I WISH MY ENDOCRINOLOGIST WOULD HAVE TOLD ME
https://thyroidpharmacist.com/articles/10-things-i-wish-my-endocrinologist-would-have-told-me
CLINICIAN DATABASE
http://www.thyroidpharmacistconsulting.com/clinician-database.html
FIND A FUNCTIONAL MEDICINE CLINICIAN
https://www.functionalmedicine.org/practitioner_search.aspx?id=117
Dear Izabella!
Could you tell me what do you think about steroid injections to the thyroid glands to reduce the inflammation?
Is it safe, a good intervention? Does it have any side effect?When is it absolutely necessary?
Is it a real solution or just a quick intervention what can help but not solve the main problem?
Thank you,
Anna
I’m very curious about this…my story is had chronic fatigue to the point I couldn’t function, wake up choking etc.. anyways finally found a Dr would would test antibodies as all of my tsh levels were normal my tests revealed TpO over 30,000 other one was 6931 both these tests are suppose to be below 40. Saw specialist who could explain referred to surgeon..i should mention my thyroid it twice the size it should be and has many nodules around 2cm in size. The surgeon was amazing actually didn’t push me either way, but he said something that made me wonder, he stared if or when hashimotos kills the thyroid it hardens and then can harden around vessels, trachea and so forth. Have you heard of this? I’m suppose to have surgery in three weeks and I’m nervous if this is true I would rather it taken out before it hardens as I already am starting to see minor swallowing issues. I wish I could try to fix my body but feel it’s too late. Any advice?
Robyn – thank you for following this page. My heart goes out to you! <3
Please, understand that due to liability issues, I am unable to answer specific medical questions.
I highly recommend that you work with a functional medicine clinician. It’s a whole medical specialty dedicated to finding and treating underlying causes and prevention of serious chronic disease rather than disease symptoms.
FUNCTIONAL MEDICINE APPROACH TO THE THYROID
https://thyroidpharmacist.com/articles/functional-medicine-approach-to-the-thyroid
WHAT TYPE OF DOCTOR SHOULD YOU SEE IF YOU HAVE HASHIMOTO’S
https://thyroidpharmacist.com/articles/what-type-of-doctor-should-you-see-if-you-have-hashimotos
10 THINGS I WISH MY ENDOCRINOLOGIST WOULD HAVE TOLD ME
https://thyroidpharmacist.com/articles/10-things-i-wish-my-endocrinologist-would-have-told-me
CLINICIAN DATABASE
http://www.thyroidpharmacistconsulting.com/clinician-database.html
FIND A FUNCTIONAL MEDICINE CLINICIAN
https://www.functionalmedicine.org/practitioner_search.aspx?id=117
Dr. Wentz,
What do you know about recent problems with not having enough NatureThroid on stock? I recently had to go out of town to get my refill. Can you respond in my email please?
Thanks.
Debbie Stevens
dstevens55@msn.com
10-5-2017.
Debbie – thank you for following this page. Please email my team at info@thyroidpharmacist.com and they will be happy to help you! 🙂
I am wondering if your protocol in your book (perhaps without some of the supplements – I havent purchased the book yet) – would be helpful to someone who had Graves disease and had their thyroid removed 11 years ago. Even on Armour thyroid and with optomized levels I still struggle with fatigue and brain fog along with with our autoimmune conditions (joint problems and severe asthma). I also have ibs like symptoms. I removed gluten years ago and it helped but not enough.
Nicole – thank you for reaching out. I am so sorry you are struggling with this. <3 Graves and Hashimoto's are both autoimmune conditions that affect the thyroid. They are thought to be closely related. Sometimes one turns into the other. The difference is the site of the antibody attack. In Hashimoto's, the antibodies are found to thyroglobulin (in 80%) and thyroid peroxidase (TPO) enzyme (in 95% of people) Hashimoto's results in hypothyroidism and is usually treated with Synthroid and replacement hormone.
The same antibodies may be present in a smaller percentage of people who have Graves, but the main antibody is to the TSH Receptor (TSHR-Ab). Usually, people with Graves have hyperthyroidism, and they are treated conventionally with thyroid suppressing drugs (methimazole) or radioactive iodine to destroy the thyroid. At that point, the thyroid will no longer produce hormones on its own, and these people end up on Synthroid as well.
Most thyroid conditions result from the immune system attacking the thyroid because the immune system is out of balance. Even when the thyroid is taken out surgically or treated with radioactive iodine the autoimmunity still persists in most cases. Many people will have their thyroids removed, and will develop new autoimmune disorders such as Lupus, Rheumatoid arthritis, etc. The immune system just finds a different target.
We need to rebalance the immune system to prevent this. Sometimes the autoimmunity can be reversed as well! The gut determines your immune system. With the exception of discussing proper thyroid medication dosing, the majority of my website and my book focuses on balancing the immune system. The info I present is based on my own research and journey for overcoming my autoimmune thyroid condition. Here are the links to my books:
Hashimoto’s Root Cause
http://amzn.to/2DoeC80
Hashimoto’s Protocol
http://amzn.to/2B5J1mq
Hi Izabella! What if you have tried it all? I am a very well-versed thyroid patient. I am also a medical nut. I have tried gluten free, dairy free, whole 30, various supplements to balance adrenals, kill Epstein Barr, digestive enzymes, wheat grass juice, detoxifiers, low dose naltrexone, organic foods, exercise, bioidentical progesterone, of course desiccated thyroid meds (and still use them today). I know exactly where my thyroid levels should be and even with that and a suppressed TSH, I am struggling terribly. In addition, I went into early menopause at 45 (last cycle ended). Menopause has now brought even more issues. All of my sex hormones barely register on blood work. I had to end my business and I literally do not have a life. I want my thyroid removed if it will stop the madness. I’m done existing and want to be back to the living. This is no way to live. What’s worse is that on the outside I look PERFECTLY normal, so my family thinks I am a hypochondriac. Like who wants to be that? I just want to feel alive again. So what about those who have taken every step imaginable. Do you not agree that as a last ditch effort that thyroid removal might be the answer?
Dee – thank you for reaching out. I am so sorry to hear you are struggling with all of this. I understand how frustrating it can be. <3 Hashimoto’s is often a combination of food sensitivities, nutrient deficiencies, adrenal issues, gut issues as well as an impaired ability to get rid of toxins. Any of those things would prevent a person from getting better.
Hashimoto's is very much an individual condition. While there are root cause commonalities, each person will have their own or in some cases, more than one root cause. You will have to start with the simplest modifications, by removing triggers, followed by repairing the other broken systems to restore equilibrium, allowing the body to rebuild itself. You will need to dig down to why the immune system is imbalanced in the first place and this will tell you how you begin to finally feel better, reduce your thyroid antibodies and even take your condition into remission.
You will have to create your own health timeline. Look back at your overall history as far back as you can remember. Look for infections, periods of severe stress, the use of medications (especially antibiotics, antacids, and oral contraceptives), accidents, and exposure to toxins. These are events that may have contributed to Hashimoto's. Once you do, you will know what types of changes you need to implement to make yourself feel better. If you need further support, please check out the list of lab tests inside the “Testing” chapter of my book, Hashimoto’s Root Cause. I also offer a 12-week program, Hashimoto's Self Management Program. Here are some resources I hope you find helpful as well.
BUILDING YOUR OWN HEALTH TIMELINE
https://thyroidpharmacist.com/sample-health-timeline/
Hashimoto’s Self-Management Program
https://thyroidpharmacist.com/enroll-in-hashimotos-self-management/