If you’re like most people, you probably don’t think about thyroid health very often. When your thyroid is working as it should, it’s easy to take it for granted. But healthcare professionals would like you to give some thought to thyroid health in January, which is Thyroid Awareness Month. It’s a subject worth being aware of because when your thyroid isn’t working the way it’s supposed to, it can lead to a number of health problems, some of them quite serious.

How common is thyroid disease?

According to the American Thyroid Association, more than 12% of Americans will develop a thyroid condition in their lifetime. Up to 60% of those people won’t even know they have a thyroid disease, even though the condition might be causing symptoms they don’t realize are linked to the thyroid. That’s why it’s important to consider your thyroid health—not just in January but throughout the year. Here are some fast facts to illustrate the prevalence of thyroid problems in the U.S.:

About 1 in 100 Americans aged 12 years and older have hyperthyroidism (National Institute of Diabetes and Digestive and Kidney Diseases, 2021).
About 1 in 200 people are affected by Graves’ disease—the most common cause of hyperthyroidism (National Institute of Diabetes and Digestive and Kidney Diseases, 2021).
About 5 in 100 Americans aged 12 years and older have hypothyroidism (National Institute of Diabetes and Digestive and Kidney Diseases, 2021).
About 5 in 100 Americans are affected by Hashimoto’s disease—the most common cause of hypothyroidism (National Institute of Diabetes and Digestive and Kidney Diseases, 2021).
About 5% of Americans are affected by goiter (Johns Hopkins Medicine).
New cases of thyroid cancer are estimated to reach 44,280 in 2021 and deaths from thyroid cancer are estimated to reach 2,200 in 2021 (American Cancer Society, 2021).

What is your thyroid?

The thyroid, or thyroid gland, is a butterfly-shaped gland located in your neck that is part of your body’s endocrine system. Endocrine glands are organs that make hormones, which go directly into the blood and out to other organs and tissue throughout the body to help control a host of body functions. Other endocrine glands include the pancreas, ovaries, testes, adrenal, and pituitary gland.

The thyroid produces two hormones called thyroxine (T4) and triiodothyronine (T3). Most of the thyroid’s production—about 95%—is T4. The remaining 5% is T3. Thyroid hormones affects the following:

Metabolism
Body temperature
Muscle strength
Breathing and heart rates
Body weight
Cholesterol levels
Menstrual cycles
Nervous system
Energy level

The thyroid has two lobes and sits just above the collarbone and below the larynx, or voice box. Each lobe wraps slightly around the windpipe, with the bulk of the thyroid sitting in front of it, so a malfunctioning thyroid can affect the quality of your voice in addition to the other health issues it can cause.

Common thyroid problems

The thyroid can malfunction in one of two ways: It can either produce too many hormones—a condition called overactive thyroid, or hyperthyroidism—or it can produce too few hormones, which is known as underactive thyroid, or hypothyroidism. Women are more likely than men to develop thyroid problems, but doctors aren’t completely sure why that is the case.

“While there are several theories, there is no one explanation [for the prevalence in women] thus far,” according to Cheryl R. Rosenfeld, DO, FACE, a spokesperson for the American Association of Clinical Endocrinology (AACE). “The most common thyroid diseases are autoimmune in nature, meaning when the immune system begins to attack a part of the body. Women are more likely to develop autoimmune disease [than men], so it makes sense that thyroid diseases are represented here.”

Hyperthyroidism

Hyperthyroidism, when the thyroid is producing too many hormones, is most often caused by an autoimmune disease called Graves’ disease. When someone has Graves’ disease, their immune system attacks the thyroid and causes it to increase hormone production.

Hyperthyroidism can also be caused by consuming either too much iodine or thyroid medicine; overactive thyroid nodules (a condition called toxic nodular disease); thyroiditis (inflammation of the thyroid); viral infections, or, in rare cases, a noncancerous tumor of the pituitary gland.

If left untreated, hyperthyroidism can lead to an irregular heartbeat, heart disease, high blood pressure, and other heart problems, eye pain and vision loss, thinning bones and osteoporosis, fertility problems in women, and complications during pregnancy. Symptoms of hyperthyroidism include:

Goiter
Nervousness, anxiety, irritability, or mood swings
Muscle weakness and fatigue
Trouble tolerating heat or sleeping
Tremor, usually in your hands
Frequent bowel movements or diarrhea
Weight loss

Hypothyroidism

Hypothyroidism, when the thyroid produces too few hormones, is most commonly caused by an autoimmune disorder called Hashimoto’s disease, or Hashimoto’s thyroiditis. With Hashimoto’s disease, as with Graves’ disease, the immune system attacks the thyroid, but in this case the thyroid responds by decreasing hormone production.

In some cases, hypothyroidism is present at birth. This is called congenital hypothyroidism. Other causes include thyroiditis, too little iodine in your diet, radiation treatments, certain medicines, and surgical removal of all or part of the thyroid.

If it goes untreated, hypothyroidism can contribute to high cholesterol, high blood pressure, and, in rare cases, lead to a condition called myxedema coma, in which the body’s functions can slow down to the point that the condition becomes life-threatening. Hypothyroidism during pregnancy can lead to premature birth or miscarriage and slow a baby’s growth and development. Symptoms of hypothyroidism, which can develop slowly and take months or even years to appear, include:

Goiter
Weight gain
Joint and muscle pain
Slowed heart rate
Puffy face
Trouble tolerating cold
Constipation
Dry skin
Hair loss
Heavy or irregular menstrual periods
Fertility problems in women

“Some symptoms overlap both hyperthyroidism and hypothyroidism,” Dr. Rosenfeld says, “so it is important to have a physician who has experience with thyroid disease to properly evaluate and treat a patient who has symptoms suggestive of thyroid disease.”

Goiter

Both hyperthyroidism and hypothyroidism can lead to an abnormal enlargement of the thyroid gland. This condition, called a goiter, is one of the most common symptoms of thyroid disease. A goiter can also occur when the thyroid is producing the right amount of hormones if there is another condition present that can cause the thyroid to grow abnormally.

Both T4 and T3 contain iodine, an essential element found in shellfish and iodized salt. If a person isn’t getting enough iodine, the thyroid can’t make enough thyroid hormone. This can cause the pituitary gland in the brain to send a signal to the thyroid to produce more hormones. This signal, called thyroid stimulating hormone (TSH), causes the thyroid to grow in an attempt to increase hormone production.

“Iodine deficiency is an important cause of goiters worldwide, but not in the United States,” Dr. Rosenfeld explains. “The lower the iodine level, the more likely it is that a goiter will develop.”

Goiters can also develop as a result of smoking, radiation, or genetic factors. “Smoking causes thyroid growth by preventing the thyroid from accumulating iodine, due to one of the chemicals found in cigarette smoke,” Dr. Rosenfeld says. “Exposure to radiation, usually through nuclear accidents or radiation treatments, may cause the thyroid to develop nodules and grow. Finally, and possibly the most important, is the contribution of genes to the development of thyroid nodules and goiter.”

Thyroid cancer

In rare cases, most commonly in those who have a history of exposure to high doses of radiation, people can develop thyroid cancer. The American Thyroid Association estimates that in the United States about 64,000 people a year develop thyroid cancer and fewer than 2,000 die from thyroid cancer.

To diagnose thyroid cancer, hypothyroidism, hyperthyroidism, and other thyroid disorders, an endocrinologist or other healthcare provider will conduct a physical exam and may do thyroid function tests such TSH, total T3, free T4, and thyroid antibody blood tests. In some cases, imaging tests such as a thyroid scan, ultrasound, or radioactive iodine uptake test may be performed.

3 things you can do to improve thyroid health

There is no surefire way to prevent thyroid disease, but it is possible to do a “neck check” at home to help reveal a goiter or thyroid nodule. This is done by facing a mirror and observing the lower neck while sipping water. More details on neck checks can be found on the Thyroid Awareness website.

If you think you might have a goiter or thyroid nodule, make an appointment to see your doctor right away for a thyroid ultrasound and try the following measures to help improve your thyroid health.

1. Thyroid medications

If you have been diagnosed with a thyroid problem, your doctor will most likely prescribe thyroid medications to help treat the condition and balance your thyroid hormone levels. TSH normal values are 0.4 to 4 mIU/L, according to the American Thyroid Association. Medications frequently prescribed for thyroid issues include:

Synthroid, Levoxyl, Levothroid, Unithroid, Tirosint (levothyroxine)
Cytomel, Triostat (liothyronine)
Armour Thyroid, Nature-Throid, Westhroid (thyroid desiccated)
Propylthiouracil (PTU)
Tapazole (methimazole)

As with most medications, thyroid medicines can cause side effects. Some of the most common ones are:

Appetite changes
Heat sensitivity or sweating
Headache
Weight loss or gain
Hyperactivity or sleeplessness
Nervousness
Leg cramps
Joint or muscle pain
Diarrhea, vomiting, or upset stomach
Skin rash
Changes in menstrual cycle

RELATED: Synthroid side effects

You should avoid taking antacids, PPIs (such as omeprazole, pantoprazole etc), iron supplements, aluminum, or calcium supplements within four hours of taking thyroid medication.

2. The thyroid diet

Although there is no evidence supporting the idea that diet or exercise can alter thyroid health, many people claim that the following foods can support a healthy thyroid:

Sea vegetables, like nori and edible seaweed
Maca supplements
Chlorophyll, found in plants like spinach and wheatgrass
Brazil nuts
Cruciferous vegetables (cauliflower, broccoli, kale, etc.)

Adherents to the thyroid diet also claim you should avoid certain foods like cottonseed meal and walnuts. Going gluten free and avoiding soy protein isolate may also help improve thyroid function, as may avoiding foods that contain goitrogens, which are substances that can interfere with thyroid function when consumed in excess. However, there is no particular diet that is scientifically proven to improve or worsen thyroid functions.

A balanced diet with the right amount of iodine can help your body stay healthier in general, but it won’t necessarily help you avoid thyroid issues.

“Despite what is often found on the internet, there is no food, supplement, or exercise that can improve thyroid health or prevent thyroid disease,” Dr. Rosenfeld says. “Beware of fad diets or supplements that are touted to improve thyroid health. At the very least, they are a waste of money, but they also have the potential to be harmful. Ingesting too much iodine, cruciferous vegetables, or certain supplements can adversely affect thyroid function.”

3. Get informed and talk to your healthcare provider

Perhaps the best thing you can do to improve your thyroid health, as Thyroid Awareness Month reminds us, is to learn about the signs and symptoms of thyroid disease and take action if you suspect something is wrong with your thyroid.

“Being an informed patient and working with your healthcare provider are both extremely important,” says American Thyroid Association Secretary Jacqueline Jonklaas, MD, Ph.D., a professor in the endocrinology division at Georgetown University. Additional information for patients can be found at thyroid.org.