Links between the Thyroid and Lupus
There is a strong link between lupus and problems with the thyroid, an important organ that controls metabolism, and most body processes.
Systemic lupus erythematosus (SLE) is an autoimmune disease, where the body's own immune system attacks organs and tissues throughout the body. Any organ can be affected, including the kidney, brain, skin, and joints. The thyroid can also be affected, and the symptoms that result can be challenging for people with lupus to manage.
What is the Thyroid?
The thyroid is an organ located in the throat, just under the chin, that produces hormones that are involved with the body's metabolism.
Hormones are the way that the body coordinates itself, so that the various organs in the body can work like a team. Most organs and cells send out and receive hormones, which is how they “talk” to each other. Some organs in the body specialize or are heavily involved in secreting hormones in response to other signals. These hormone-secreting organs like the thyroid are known as the endocrine system, and they act like signal towers in a massive communications network of organs that work together to adapt to situations.
In this case, the thyroid acts like a control center that can tell the body to speed up or slow down how organs process food and how the cells in the body use that energy. It also controls body temperature, heart and breathing rate, and the ability for the body to think clearly. It also controls the health and maintenance of the brain, skin, bones, and reproductive organs. The thyroid is an incredibly important organ, and there is a strong link between SLE and thyroid illnesses, and the consequences can be serious.
What Hormones are Produced by the Thyroid?
The thyroid takes its "orders" from the pituitary gland, an organ in the brain that monitors conditions throughout the body and sends hormones out to direct other parts of the body. It's an important part of how the body adapts to different conditions and keeps itself alive. The pituitary gland can also be damaged by lupus, and you can read more about that, here.
In the case of the thyroid, the pituitary sends signal hormones based on the calcium, various hormone levels in the bloodstream, temperature, food availability, and digestion. This causes the thyroid to release several important hormones.
Calcitonin regulates the amount of calcium in the bloodstream. Calcium is a mineral found in high amounts in certain foods, including leafy greens (particularly kale, broccoli, and cabbages,) and dairy products.
Calcium is usually stored in the bones, where it gives bones their strength and structure. However, calcium is used throughout the body and is essential to the nervous and musculoskeletal systems - it helps neurons function and muscles move. Because calcium is so important, the body uses calcitonin carefully controls where the calcium goes, based on where it's needed.
Thyroxine (T4) and Triiodothyronine (T3) are chemically-related hormones that the thyroid produces that "turn up" the metabolism, speeding up the activities of the body's cells and increasing body head production. T4 actually can become T3 in the bloodstream.
Reverse Triiothyronine (RT3) blocks and reverses the effects of triiodothyronine acting as a way to keep the body in balance.
More often, though, the thyroid will just reduce the amount of T3 and T4 hormones that it produces in order to slow the metabolism down. When the thyroid is healthy, there is always some T3 and T4 hormones produced and released into the bloodstream. This keeps our metabolisms at a stable level, but the thyroid can release lower amounts to slow the metabolism down.
There are many reasons why the thyroid might turn up or turn down the body's "temperature.” A faster metabolism burns more calories, processes energy more efficiently, produces more heat, and the body overall works faster. For example, athletic activity benefits from a higher metabolism - as does digestion itself.
A slower metabolism cools the body down, conserves energy and lets resources be stored for later or used elsewhere.
Keeping the Thyroid Healthy
The thyroid needs a good amount of iodine, a mineral. Not too much, and not too little. You can get iodine from most seafood, iodized salt, dairy products, eggs, organ meat (such as liver,) and enriched bread. Seaweed is an extremely good source of iodine.
When the thyroid is not healthy, particularly when it's not getting the right amount of iodine, it will swell, a condition known as a goiter. Goiters are a usually very visible (though not always) swelling in the neck, which changes appearance and puts pressure on the throat and vocal chords.
The thyroid can also be influenced by the pituitary gland, which releases a hormone that stimulates, or turns up, the activity and hormone production of the thyroid. If something has gone wrong in the pituitary gland, then it can cause the thyroid to have problems, too.
The thyroid can have abnormal growths such as toxic adenomas . Thyroid cancer is also a possibility, but is usually ruled out first.
Autoimmune diseases, such as lupus, Hashimoto's disease, Grave's disease, can cause the thyroid to not function properly.
Symptoms of Thyroid Disorders
A thyroid that isn't functioning properly can cause one of two conditions:
Hypothyroidism, where not enough thyroid hormones are released, leading to a slowdown of the metabolism and other important functions in the body.
Hyperthyroidism, when the thyroid is producing more hormones than it should, can cause an unhealthy increase in metabolism and other functions. Both are treatable conditions.
Symptoms that hint at thyroid problems include:
Swelling in the throat area, which can be very visible or only noticed as difficulty breathing or a constantly hoarse voice.
Abnormal heart rate (too slow or too fast)
Unexplained changes in weight and appetite (weight and appetite loss, or weight and appetite gain)
Difficulty handling cold or hot temperatures, and feeling unable to regulate body heat. This extreme sensitivity to temperature can come with shivering, fevers, or excessive sweating.
Irregular menstrual cycles, often with particularly heavy periods.
Pain in the joints and body, sometimes with swelling and fluid retention in the limbs. The face might also swell.
Sudden digestive issues, including constipation and diarrhea.
Thin skin and dry breakage-prone hair, indicating a lack of nutrition. In hyperthyroidism, the skin might be moist or damp, and might be accompanied by hair loss.
Muscle weakness and fatigue
Depression, anxiety, brain fog, or disordered thinking patterns
Diagnosing thyroid problems is relatively simple - a blood test can check for levels of thyroid-stimulating hormone and see if your hormones are in a normal range. If they are not in normal ranges, treatment can begin. Doctors will usually order this test if a patient comes in with some of these symptoms, just in case, though a more general blood panel can catch abnormal levels of thyroid-stimulating hormone, too. These general blood tests are sometimes ordered as a part of an annual checkup, or more frequently for people with chronic health conditions such as lupus.
The Thyroid and Lupus: What’s Going On?
However, there isn't always a direct link between lupus and hypothyroidism. Instead, researchers currently believe that this is a case of comorbidity - where a person has more than one condition at once, sometimes even conditions that overlap in symptoms. Different autoimmune diseases can have different causes and even different genetics, so researchers consider them to be their own distinct disease. However, multiple autoimmune conditions can muddy the waters and make diagnosis difficult when symptoms overlap.
One of the most common causes of hypothyroidism is Hashimoto's disease, an autoimmune condition where the thyroid is damaged by the body's own immune system and can't produce enough hormones to maintain the metabolism at a stable level. There is also an overlap between the people who are more susceptible to lupus and other autoimmune diseases. You can read more about that, here.
How are Hyper- and Hypo- Thyroidism Treated?
Hypo- and Hyper-thyroidism are treated with medications that block thyroid activity (antithyroid medications.) Beta blockers are also used to treat the metabolic symptoms of hyperthyroidism, though not the thyroid issues themselves.
In severe cases, the thyroid might have to be removed, usually through surgical means. Sometimes only part of the thyroid will be removed, but when the whole organ is removed, then the patient will have to take artificial hormones for the rest of their life. Instead of surgery, sometimes radioiodine, a radioactive version of iodine, might be used. The thyroid takes up the radioiodine and some of the cells there will die out, reducing the thyroid and treating hyperthyroidism, though it is more frequently used as a treatment for thyroid cancer.
Non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or acetaminophen are sometimes taken in certain cases. If these are not effective, prednisone and other, stronger, prescription-only anti-inflammatory drugs are sometimes also used.
Drug Interactions and the Thyroid
Thyroid medications can interfere with medications for diabetes, antidepressants, estrogen (from hormone replacement therapy and birth control,) warfarin, and heart medications.
Supplements containing magnesium, aluminum, iron, or soy proteins can also interfere.
If you are taking any of these, please let your treatment team know so that they can figure out a treatment plan for you.
A Lupuswarrior's Takeaway
In order to get the blood test for thyroid-stimulating hormone, you need to be able to describe your symptoms in a way to your doctor that encourages you to do these tests. It is an unfortunate reality that doctors will often dismiss symptoms of lupus - for example, they often attribute "tired" to a "lack of sleep" instead of a deeper underlying problem. Lupus.org recommends that you use words such as "Exhaustion" instead of tired or fatigued, and mention sudden weight gain or loss. Try to be as exact as possible about the amount of weight that you have gained or lost, and the timeframe that your weight suddenly changed. This may cause alarm bells to ring in their mind to them.
A balanced, varied, nutritious diet is important for health in general, and can really make a big difference in managing chronic conditions. For the thyroid, a diet that provides enough iodine, protein, calcium, and magnesium in particular will help support thyroid health. It’s also a great diet for lupus!
Fun Fact!
The thyroid is butterfly shaped, much like the well-known symptom of lupus, the malar rash! Although not related, you can read more about the malar rash, here.