DEAR DR. ROACH:
I have been diagnosed with thyroid antibodies. What are the long-term effects of these antibodies? The doctor says to start thyroid medication. I have been a vegetarian since 1983 and have a low-salt diet. I have heard about quality control issues with thyroid medicines and taking care not to consume caffeine with the medicine. Could my diet be related to the antibodies? Are there real problems with the production and timing? — R.S.
ANSWER:
In general, thyroid replacement medication is most often given to people who have symptoms and laboratory evidence of low thyroid hormone (hypothyroidism). These symptoms can be nonspecific, such as fatigue, weight gain and depression, but there are more specific changes in the skin, eyes and nervous system that an experienced clinician can identify with a meticulously careful look through a patient’s history and an exam.
There are situations in which a person may be recommended thyroid replacement even when there are no symptoms. One instance is in people with antithyroid peroxidase antibodies. A high level of these anti-TPO antibodies predicts a high risk of developing symptomatic hypothyroidism. Many experts will treat their patients who have normal thyroid levels but also have elevated thyroid-stimulating hormone levels and antibodies. (The TSH level is not the active thyroid hormone. It’s a signal hormone from the pituitary to stimulate the thyroid gland. High TSH levels mean the pituitary gland senses a low thyroid level, except in rare instances of brain tumors causing an abnormal release of TSH.)
Overt hypothyroidism develops in about 4% of these patients per year. Anti-TPO antibodies are associated with the most common form of thyroid disease, Hashimoto’s thyroiditis — an autoimmune destruction of the thyroid gland.
A vegetarian diet does not increase risk of developing thyroid problems. A low-salt diet is healthy and, likewise, does not affect thyroid levels.
You mentioned quality control. This was…
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