The thyroid gland, a small, butterfly-shaped organ located in the neck, plays a crucial role in regulating hormones and metabolism. Unfortunately, some individuals may experience thyroid-related conditions that require surgical intervention, known as a thyroidectomy, leading to the removal of all or part of the gland. While surgery may be necessary to manage certain thyroid concerns, it can also have a significant impact on hormonal balance and weight management. As a result, individuals who undergo thyroid removal may experience a range of symptoms, including weight gain, fatigue, and mood changes. This article explores the impact of thyroid removal on hormonal balance and weight management, as well as strategies for managing these changes. Whether you’re preparing for thyroid surgery or recently underwent the procedure, this article will provide valuable insights and tips to help you navigate the potential challenges of thyroid removal.
The Role of the Thyroid Gland
The thyroid gland plays a critical role in regulating hormones and metabolism. It produces two hormones, thyroxine (T4) and triiodothyronine (T3), which help regulate energy production and metabolism. These hormones control the body’s metabolism, which affects how many calories are burnt at rest. The thyroid gland also produces calcitonin, which helps regulate calcium levels in the body. Hormones produced by the thyroid gland are essential for maintaining a healthy weight, regulating body temperature, and controlling heart rate.
Causes of Thyroid Removal
Thyroid removal, or thyroidectomy, is usually recommended to treat thyroid cancer, hyperthyroidism, goiters, or thyroid nodules that are overproducing thyroid hormones. Cancer is the most common reason for thyroidectomy. Removing all or part of your thyroid gland may be an option for a large goiter, which is a noncancerous enlargement of the thyroid. A large goiter may be uncomfortable or make it hard to breathe or swallow. In some cases, the thyroid gland may be removed due to non-cancerous conditions such as a thyroid cyst, severe thyroiditis, or Graves’ disease. In Graves’ disease, the immune system attacks the thyroid gland, causing it to overproduce hormones, leading to hyperthyroidism. Thyroidectomy may be an option if you have problems with anti-thyroid drugs, or if you don't want radioactive iodine therapy. Some thyroid nodules can't be identified as cancerous or noncancerous after testing a sample from a needle biopsy. In such cases, removing the thyroid gland can help alleviate the symptoms and prevent further complications.
Types of Thyroidectomy
How much of your thyroid gland is removed during thyroidectomy depends on the reason for the surgery. Surgeons typically perform thyroidectomy using general anesthesia, so you won't be awake during the procedure. The surgical team places several monitors on your body to check your heart rate, blood pressure and blood oxygen level throughout the procedure. Once you're unconscious, the surgeon makes a cut (incision) low in the center of your neck. It can often be placed in a skin crease where it will be hard to see after the incision heals. If you're having thyroidectomy because of thyroid cancer, the surgeon may also examine and remove lymph nodes around your thyroid. In some patients, the surgeon uses special equipment to monitor irritation of vocal cords during the procedure to prevent permanent damage. Thyroidectomy usually takes 1 to 2 hours.
There are several types of thyroidectomy:
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- Partial thyroidectomy: If only part of your thyroid is removed, the remaining portion typically takes over the function of the entire thyroid gland.
- Complete thyroidectomy: If your entire thyroid is removed, your body can no longer make thyroid hormone. Without medication, you'll develop symptoms of underactive thyroid (hypothyroidism).
There are also different surgical approaches:
- Conventional thyroidectomy: This approach involves making an incision in the center of your neck to directly access your thyroid gland.
- Endoscopic thyroidectomy: This approach uses smaller incisions in the neck. Surgical instruments and a small video camera are inserted through the incisions.
- Transoral thyroidectomy: This approach involves accessing the thyroid through the mouth.
The Impact of Thyroid Removal on Hormonal Balance
After thyroid removal, the body no longer produces thyroid hormones, which can result in hormonal imbalances. The lack of thyroid hormones can cause a condition called hypothyroidism, which can lead to weight gain, fatigue, depression, and other symptoms. Hypothyroidism can also cause a decrease in metabolism, leading to weight gain, and difficulty in losing weight.
In some cases, the remaining gland can compensate for the lost function, and the body can maintain a normal hormone level. However, in most cases, patients require lifelong hormone replacement therapy to supplement the missing thyroid hormones. Hormone replacement therapy involves taking synthetic thyroid hormone pills, usually levothyroxine, to replace the missing thyroid hormones.
The Impact of Thyroid Removal on Weight Management
Thyroid removal can have a significant impact on weight management. After surgery, patients may experience weight gain due to several factors, including hormonal imbalances, a slower metabolism, and changes in appetite. Some patients may also experience an increase in appetite due to hormonal changes, which can lead to overeating and weight gain.
However, some people may lose weight or not experience any weight changes. Research from 2023 did not identify specific factors that contributed to either weight gain or weight loss in people who had a thyroidectomy. Some factors that did not correlate with weight loss or gain among the participants included age, sex, thyroid function before surgery, thyroid status after surgery, and thyroid pathology (genetic testing of the removed thyroid gland).
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How thyroid removal affects your thyroid function can depend on whether your thyroid removal surgery was complete or partial, and the reason for removal. If you still have some of your thyroid gland, you may not notice significant changes to your weight following surgery. But if you had your thyroid removed due to hyperthyroidism (an overactive thyroid), you will likely have hypothyroidism (an underactive thyroid). Hypothyroidism typically slows many of your body’s functions, including your metabolism. This can potentially contribute to weight changes. However, if you’ve had your thyroid removed, you will need to take thyroid medication. You may experience weight changes until your doctor finds the right dose of medication.
Managing Weight After Thyroid Removal
Managing weight after thyroid removal can be challenging, but it’s not impossible. The key is to adopt healthy eating habits and engage in regular physical activity. Patients should also consult with their healthcare provider to determine an appropriate calorie intake for their age, gender, and activity level.
Dietary Recommendations
Patients should focus on maintaining a healthy diet that is rich in fruits, vegetables, whole grains, and lean protein. They should avoid high-calorie, high-fat foods, processed foods, and sugary drinks. Eating smaller, more frequent meals can also help control hunger and prevent overeating.
While some people promote various types of “thyroid diets,” there is little scientific evidence to support the benefits of following a specific thyroid diet. Instead, follow a balanced whole-food diet low in simple carbohydrates and refined sugars, such as the one recommended in the general dietary guidelines for Americans. Build your diet around dark leafy greens, fresh seafood, lean meats, low-fat dairy or dairy alternatives, and low-sugar fruit. Limit added sugars and saturated fat to less than 10% of your daily calories. Keep your sodium intake under 2,300 mg per day. Limit alcohol consumption to two or fewer drinks per day for men and one for women. Choose whole fruits over fruit juices or snacks. Eat a variety of vegetables. Consume at least half of your grains as whole grains. Enjoy a variety of lean proteins or plant-based options, such as beans, legumes, seeds, and nuts.
Immediately after your surgery, you may want to avoid foods that are hard, spicy, acidic, scratchy, sticky, or fried. These foods can irritate your sore throat or be difficult to swallow.
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The Role of Exercise
Physical activity is also essential for weight management after thyroid removal. Patients should engage in regular exercise, such as walking, jogging, swimming, or cycling, for at least 30 minutes per day. Exercise can help burn calories, increase metabolism, and improve overall health. Aim to incorporate some kind of movement or exercise in your everyday life consistently. It does not need to be a complicated workout. Do something that is easy to implement in your daily routine and that you enjoy! Yoga, walking outdoors, jumping rope, and going on a bike ride are great ways to get started. Over time, move up to more cardio-intensive workouts such as sprinting/running, spin classes, weightlifting, or even boxing. Exercise is important in regulating our metabolisms and thyroid function.
Foods to Consider Limiting or Avoiding
Though some studies have linked foods that contain goitrogens, such as broccoli, cabbage, and kale, to thyroid conditions, these foods are generally safe unless consumed in excessive amounts. The health benefits outweigh the small risks associated with nutritious options, such as cruciferous vegetables. If you still have concerns, cooking these foods reduces goitrogen levels.
Soy products may interfere with some thyroid hormone replacement medications. Talk to your doctor or pharmacist about potential interactions. If you consume soy products, don’t eat them close to the same time as you take your medication.
Other Drug Interactions
Avoid taking your thyroid medication at the same time as:
- Walnuts
- Cottonseed meal
- Soybean flour
- Iron supplements
- Calcium supplements
Some antacids and ulcer medications can also interfere with your thyroid medication. Talk to your doctor about potential interactions.
Hormone Replacement Therapy
Hormone replacement therapy is usually required after thyroid removal to replace the missing thyroid hormones. Patients usually take levothyroxine, a synthetic thyroid hormone, to maintain normal hormone levels. The dosage is adjusted based on the patient’s age, weight, and other factors. It’s essential to take the medication as prescribed and to have regular blood tests to monitor hormone levels.
Finding the Right Dosage
Finding the correct dose to balance your thyroid levels can be challenging and often requires titration over several weeks before you land on the best dose for you. If your dose is too high, you may be creating a hyperthyroid state because too much medication is in your system, so it is likely you could lose weight. Likewise, if your dose is too low, you may gain weight after a thyroidectomy. The correct dose of thyroid medication is paramount. Not only can the wrong dose affect your weight, but it can throw off just about every system in your body.
Regular Monitoring
Regular thyroid function tests will be required after you have a thyroidectomy. These tests will measure your TSH, T3, and T4 levels. Your doctor may also check other labs depending on why you have the thyroidectomy in the first place and also monitor for other complications like damage to the parathyroid gland. You will also need to test your thyroid function periodically once you are on the correct dose of medication. In addition, certain factors may require you to change your dose, such as significant changes in your weight, pregnancy, and some health conditions. Working with a physician specializing in hypothyroidism who understands different thyroid medication options is extremely helpful, as not all people tolerate and thrive on the same type of thyroid medication.
Lifestyle Changes
Lifestyle changes are essential for managing hormonal balance and weight after thyroid removal. Patients should avoid smoking and limit alcohol consumption, as they can interfere with thyroid hormone absorption. Stress management techniques, such as meditation, yoga, and deep breathing, can also help relieve stress and improve overall health.
Patients should also get adequate sleep, as sleep deprivation can lead to hormonal imbalances and weight gain. It’s recommended to get at least seven to eight hours of sleep every night. Additionally, patients should consult with their healthcare provider before taking any supplements or herbal remedies, as they can interfere with hormone replacement therapy.
Coping with Emotional Changes
Thyroid removal can also cause emotional changes, such as anxiety, depression, and mood swings. Coping with these changes can be challenging, but support from family, friends, and healthcare providers can help. Patients should also seek counseling or therapy to manage their emotional health and well-being.
Research Findings on Weight Changes After Thyroidectomy
A study using the Rochester Epidemiology Project examined weight and body mass index (BMI) changes at one, two, and three years of follow-up in patients with thyroid cancer and benign thyroid nodules after thyroid surgery, and in patients with thyroid nodules who did not have surgery. The study found that small changes in mean weight, BMI, and the number of patients whose weight increased between 5 and 10 kg were similar during each year of follow-up between patients who underwent surgery and those who did not. Furthermore, age >50 years, female sex, baseline BMI >25 kg/m2, and thyrotropin value at one to two years were not predictors of a 5% weight change.
A meta-analysis of 11 studies found that one to two years after surgery for thyroid cancer or thyroid nodules, patients gained on average 0.94 kg [confidence interval (CI) 0.58-1.33] and 1.07 kg [CI 0.26-1.87], respectively. On average, patients receiving care for thyroid nodules or cancer gain weight, but existing evidence suggests that surgery for these conditions does not contribute significantly to further weight gain.
Potential Complications of Thyroidectomy
Thyroidectomy is generally a safe procedure, but potential risks include:
- Bleeding
- Low parathyroid hormone levels (hypoparathyroidism): Sometimes surgery damages the parathyroid glands, located behind your thyroid. The parathyroid glands regulate calcium levels in the blood. Hypocalcemia: low calcium levels in the blood, a complication from thyroid surgery that is usually shortterm and relatively easily treated with calcium pills.
A study found that the risk of low blood calcium levels after total thyroidectomy among people who had previously undergone bariatric surgery was 2-fold higher than for people who had not undergone previous bariatric surgery. This increased risk must be carefully explained to these patients by their thyroid surgeon before choosing to proceed with total thyroidectomy. In addition, the thyroid surgeon should avoid removing the entire thyroid gland (partial thyroidectomy) whenever possible for these patients, as parathyroid glands associated with thyroid tissue that is not removed will not be in danger of being damaged during thyroid surgery.