Increased Screening Has Led to Rise in Thyroid Cancer Misdiagnosis

November 19, 2014
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The Risks of Over-Diagnosis

Finding tiny benign tumors that really do not need treatment is known as over-diagnosis—a phenomenon that is also common in other kinds of cancer screening, particularly breast cancer.

It’s emotionally difficult to take a “wait and see” approach once a tumor has been noted on a test or scan, but treating it can do far more harm than good if it’s benign. Far more people die with thyroid cancers than from them.

Left alone, a benign, slow-growing tumor might never cause a problem—indeed as many as one-third of people die with small thyroid tumors that remained undetected throughout their lives,³ and the cancer didn’t actually cause their death.

Removing and treating harmless tumors, however, can lead to a slew of cascading health problems. For example, surgical removal of your thyroid means you need to take thyroid hormones for the remainder of your life.

For many, this will lead to less than optimal hormone function. Chronic hormone deficiency, depression, and other symptoms of low thyroid function can become lifelong companions as a result... Surgical removal of the thyroid can also result in accidental damage to your vocal cords and/or parathyroid glands.

In South Korea, two percent of patients suffer vocal cord paralysis, and 11 percent end up with hypoparathyroidism as a result of damage to the parathyroid glands—the latter of which detrimentally affects calcium regulation in your body.

Experts Call for Restraint in Screening for Thyroid Cancer

The answer, some cancer experts say, is to simply reduce screening that finds these tiny, harmless cancers. One of the South Korean authors of the featured paper⁴ goes so far as to propose thyroid cancer screening should be banned. As noted by the New York Times:

“[C]ancer experts said the situation in South Korea should be a message to the rest of the world about the serious consequences that large-scale screening of healthy people can have.

‘It’s a warning to us in the US that we need to be very careful in our advocacy of screening,’ said Dr. Otis W. Brawley, chief medical officer at the American Cancer Society. ‘We need to be very specific about where we have good data that it saves lives.’

...These tiny cancers, called papillary thyroid cancers, are the most common kind and are the sort typically found with screening. They are known to be the least aggressive.

The epidemic was not caused by an environmental toxin or infectious agent, said Dr. H. Gilbert Welch of Dartmouth, an author of the paper.⁵

‘An epidemic of real disease would be expected to produce a dramatic rise in the number of deaths from disease,’ he said. ‘Instead we see an epidemic of diagnosis, a dramatic rise in diagnosis and no change in death.’

...[T]he lesson from South Korea should be heeded, said Dr. Barnett S. Kramer, director of the division of cancer prevention at the National Cancer Institute. ‘The message for so long is that early detection is always good for you,’ he said.

But this stark tale of screening gone wrong ‘should acutely raise awareness of the consequences of acting on the intuition that all screening must be of benefit and all diagnoses at an early stage are of benefit.’”

One in Eight Women Have Thyroid Disease

While the actual incidence of thyroid cancer may not be on the rise, thyroid disease has become very prevalent in today’s world, courtesy of a number of different lifestyle factors.

According to Dr. Christiane Northrup, MD, one in eight women aged 35-65 has some form of thyroid disease⁶—underactive thyroid being the most common. More than one-quarter of women in perimenopause are diagnosed with hypothyroidism, in which insufficient amounts of thyroid hormone is produced.

Thyroid hormones⁷ are used by every cell of your body, which is why the symptoms can vary so widely. For example, thyroid hormones regulate metabolism and body weight by controlling the burning of fat for energy and heat. Thyroid hormones are also required for growth and development in children. Symptoms of hypothyroidism may also include but are not limited to the following:

Fatigue, loss of energy, and general lethargy	Cold intolerance
Muscle and/or joint pain	Decreased sweating
Depression	Puffiness
Weight gain	Coarse or dry skin and hair
Hair loss	Sleep apnea
Carpal tunnel syndrome	Forgetfulness, impaired memory, and inability to concentrate
Menstrual disturbances	Decreased appetite
Impaired fertility	Constipation
Fullness in the throat and hoarseness	Increased risk of heart disease
Increased “bad” cholesterol (LDL)	Weakness in extremities
Emotional instability	Blurred vision
Mental impairment	Decreased hearing
Bradycardia (reduced heart rate)

The Effect of Thyroid Disease on Mental Health

Depression and other mental health problems are perhaps particularly notable symptoms of thyroid dysfunction—if nothing else because it’s a common side effect that is easily overlooked and therefore misdiagnosed. If your depression is due to an underactive thyroid, clearly the answer to your problem is not an antidepressant but rather addressing your thyroid function... As explained by Dr. Northrup:

“The thyroid is a butterfly-shaped gland located in the area of your neck just below the Adam’s apple. It’s part of the endocrine system, and it secretes the hormones thyroxine (T4) and triiodothyroxine (T3), which regulate the body’s metabolic rate. Thyroid function is very complex and exerts a profound effect on the function of nearly every other organ in the body. Therefore, smooth functioning of the overall body chemistry depends on the health of your thyroid gland.

It is not uncommon for women with thyroid problems to suffer from depression. One explanation for this is that the most biologically active form of thyroid hormone, T3, is actually a bona fide neurotransmitter that regulates the action of serotonin, norepinephrine, and GABA (gamma aminobutyric acid), an inhibitory neurotransmitter that is important for quelling anxiety.”

It’s important to realize that thyroid dysfunction is a complex issue, with many variables. As noted by Dr. Northrup, midlife hypothyroidism can be related to underlying estrogen dominance, in which case taking thyroid hormone fails to address the root of the problem. Medications can also disrupt your thyroid function, in which case the most appropriate remedy may not be to add thyroid hormone.

Known thyroid-disrupting drugs include steroids, barbiturates, cholesterol–lowering drugs, the antiepileptic drug Dilantin, and beta-blockers. Heavy metal toxicity is yet another factor that can be part of the problem (to learn more about this, please listen to my interview with Dr. Jonathan Wright, below). Last but not least, Dr. Northrup⁸ also points out that thyroid disease oftentimes has an emotional/spiritual component:

“Thyroid disease is related to expressing your feelings, something that until relatively recently had been societally blocked for women for thousands of years. In order to have your say—and maintain your thyroid energy—you must take a fearless inventory of every relationship in which you feel you don’t have a say...

One more thing, thyroid disorders are also related to our relationship to time. The thyroid is adversely affected by feeling as though there’s never enough time or that you are running out of time. This feeling also results in adrenal burnout (which is related to thyroid disorders.). Our culture’s relationship to time is very unbalanced... A starting point here is to realize that you have all the time there is. Literally. And all the time that anyone else has—24 hours in a day.

You can change your relationship to time by changing the way you pay attention... Take regular moments during the day to simply put your attention on something. Notice a beautiful flower. Or a tree. Or the sky. Slow down and pay attention. Eventually this little practice will improve your relationship to time.”

Treating Overactive Thyroid

The reverse condition, in which too much thyroid hormone is produced, is called hyperthyroidism. While far less common, it can be a very serious condition. Making matters worse, conventional treatment options usually involve using radioactive iodine, which is a disaster, or surgery. According to Dr. Jonathan Wright, there may be a much better and safer option: a combination of iodine and lithium. This treatment originated at Walter Reed Army Medical Center (WRAMC), at their department of thyroid. They had enough people with hyperthyroidism there that they were able to divide them into four treatment groups, receiving either:

Lithium
Lugol’s iodine
Lithium first and then, three or four days later, iodine
Lugol’s iodine first, and then three or four days later, lithium

The group that started with Lugol’s iodine and finished with lithium did significantly better than all of the other groups in getting the hyperthyroidism under rapid control. More than two decades ago, The Mayo Clinic also published an article on the treatment of hyperthyroidism using lithium. Here, they used lithium alone, and were also able to bring abnormally high T3 and T4 numbers down to normal within a week to 10 days. It didn’t work on everybody though.

According to Dr. Wright, Walter Reed’s system is profoundly effective. Of all the people treated for hyperthyroidism in Dr. Wright’s clinic, amounting to about 40, there have only been two cases where the protocol failed. Normal levels can often be achieved in less than two weeks. In summary, the treatment is as follows:

Patient starts out on five drops of Lugol’s iodine, three times per day
After four or five days, patient starts receiving 300 mg of lithium carbonate, one to three times per day

The Importance of Iodine for Thyroid Function

Iodine is the key to a healthy thyroid and efficient metabolism. Even the names of the different forms of thyroid hormone reflect the number of iodine molecules attached -- T4 has four attached iodine molecules, and T3 (the biologically active form of the hormone) has three -- showing what an important part iodine plays in thyroid biochemistry.

As your body cannot produce its own iodine, it must be obtained from your diet. Iodine is sequestered into your thyroid gland, where it is incorporated into the thyroid hormones thyroxine (T4) or triiodothyronine (T3). In healthy individuals these hormones are precisely regulated by thyroid-stimulating hormone (TSH), and are required by all metabolically active cells in your body. Unfortunately, iodine deficiency is extremely common these days, and while toxic exposure plays a significant role in thyroid disease, this nutritional deficiency is an important factor.

More than 11 percent of all Americans—and more than 15 percent of American women of child-bearing age—have urine iodine levels less than 50 micrograms per liter (mcg/L),⁹ indicating moderate to severe iodine deficiency. An additional 36 percent of reproductive-aged women in the US are considered mildly iodine deficient (<100 mcg/L urinary iodine). The American Academy of Pediatrics recommends taking an iodine supplement during pregnancy, as most pregnant women are deficient.¹⁰

Your iodine levels can also be affected by toxic exposures. Iodine is a member of a class of related elements called "halogens," which includes bromine, fluorine, and chlorine. When they are chemically reduced, they become "halides" (iodide, bromide, fluoride, and chloride). Most people today are exposed to these halogens/halides via food, water, medications, and environment and these elements selectively occupy your iodine receptors, further deepening your iodine deficit. Additional factors contributing to falling iodine levels include:

Water fluoridation	Diets low in fish, shellfish, and seaweed	Vegan and vegetarian diets
Decreased use of iodized salt	Less use of iodide in the food and agricultural industry	Use of radioactive iodine in many medical procedures, which competes with natural iodine

How Much Iodine Do You Need?

In Japan, the daily dose of iodine obtained from the diet averages around 2,000 to 3,000 micrograms (mcg) or 2-3 milligrams (mg), and there’s reason to believe this may be a far more adequate amount than the US recommended daily allowance (RDA) of 150 mcg. Some argue for even higher amounts than that, such as Dr. Brownstein, who recommends 12.5 milligrams (mg) on a regular basis. Other proponents of higher iodine amounts include Guy Abraham, an ob-gyn and endocrinologist at the University of Southern California, and Dr. Jonathan Wright, a pioneer in natural medicine. To learn more about iodine supplementation at higher dosages, and other treatment protocols for correcting thyroid dysfunction, I highly recommend listening to my interview with Dr. Jonathan Wright.

Download Interview Transcript

Take Control of Your Thyroid Health

Thyroid hormones are used by cells throughout your body, making it very important to address your thyroid health. Again, iodine is the key to a healthy thyroid, and it’s also important for the prevention of breast cancer. If you’re not getting enough from your diet (in the form of seafood), you’d be well advised to consider taking a supplement, ideally a high-quality seaweed supplement (be sure to check its source to avoid potential radioactive contamination), or other iodine-containing whole food supplement.

As for thyroid hormone replacement, you have two basic options: bioidentical or synthetic hormones.¹¹ Bioidentical thyroid hormones—which are what I recommend using—include Nature-Throid and Westhroid. They’re made from desiccated pig thyroid glands and contain the full spectrum of thyroid hormones: T4, T3, T2, and T1. Synthroid (generic brand: Levothyroxine) is synthetic, and contains only T4. Keep in mind that in some cases, if you're borderline hypothyroid, you may actually only need an iodine supplement rather than a thyroid hormone replacement.

With regards to screening, there’s ample evidence suggesting that thyroid cancer screening is unnecessary unless you have reason to suspect cancer. Also remember that screening does not equate to prevention. Addressing your thyroid health is far more important and beneficial than relying on screening to alert you to a potential problem. Especially considering that the chances of over diagnosis are great, and treating an otherwise harmless tumor may result in greater harm than leaving it alone and simply focusing on lifestyle factors such as diet and detoxification to improve your thyroid health.