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No Thyroid or Thyroidectomy - What About Calcitonin

author avatar Dr. Eric Berg 08/31/2023

Recently, I had a question about long-term complications that come with having a thyroidectomy. The good news here is that, in my opinion, you don’t really have to have any complications after this procedure.

Over the years, I’ve had quite a few people come into my office after having a thyroid removal and they did just fine. Out of all the things that can happen to a person and all the organs that you could potentially have removed, I think that, with having the thyroid out and being on a certain hormone protocol, you could do just fine.

That said, there are two things that you have to think about for this to happen: your calcitonin levels and your parathyroid glands.

In this article, I will cover:

Let’s dive in.

 

The Basics of Normal Thyroid Function

Before we dive in, the first thing I want to say is that I’m not giving you medical advice here. This is not going to trump or stamp out any medication you’re already taking, and you should check with your doctor before implementing any of the advice or suggestions that I give.

Instead, I’m giving your information and research.

First, let’s talk about normal thyroid function and how it all works.

Endocrine system negative feedback loop


The thyroid is ultimately controlled by the hypothalamus, a small structure in the brain that’s responsible for:

  • Releasing hormones
  • Regulating body temperature
  • Maintaining daily physiological cycles
  • Controlling appetite
  • Managing of sexual behavior
  • Regulating emotional responses
     

The hypothalamus makes a hormone called thyroid releasing hormone (TRH). It also tells the nearby pituitary gland to release a hormone called thyroid-stimulating hormone (TSH). Those hormones then go down to the thyroid and tell the thyroid to produce and release thyroxine (T4) and a little bit of triiodothyronine (T3).

T4 is an inactive thyroid hormone, while T3 is the active version. Both are essential for brain development in infants and for metabolic activity in adults. Specifically, these hormones help the brain, heart, liver, muscles, and other organs of the body function properly.

In order for T4 to work in the body, it has to be converted into T3. This actually works through several organs, including the liver and the kidneys. 80% of T4 is converted through the liver, and 20% is converted through the kidneys to make T3.

Then, T3 goes into all the cells and it affects metabolism and many other things. Once it’s done its job, there’s a signal that’s sent back to the pituitary and the hypothalamus, turning these off. So you have a negative feedback loop.

 

Understanding Thyroidectomy

The thyroid can be removed for many reasons, including cancer, a noncancerous enlargement of the thyroid (goiter), or an overactive thyroid (hyperthyroidism). All of these can be serious conditions with lots of side effects.

Cancer, of course, requires removing most, if not all, of the thyroid. Goiter calls for thyroidectomy only if it causes severe symptoms like difficulty breathing or swallowing. Hyperthyroidism can require a thyroidectomy if it begins to cause big issues, which could include:

  • Hot flashes, sweating
  • Tachycardia
  • Anxiety, nervousness
  • Weight loss
  • Hair loss
  • Difficulty sleeping, restlessness
  • Tremors in the hands
  • Weakness
  • Diarrhea
  • Emotional instability, irritability or fatigue
  • Goiter
  • Moist, sweaty skin
  • Exophthalmos, lid lag
     

The number of complications that a thyroidectomy can cause - and the number of meds that you need to take post-op - depends largely on whether it’s a partial thyroidectomy (after which your thyroid can usually continue to function normally), a hemithyroidectomy (where half of the thyroid is removed) or a total thyroidectomy.

Total thyroidectomy will require daily treatment with thyroid hormone to replace the thyroid’s natural function. If you don’t take the replacement medication, you will start to see the signs and symptoms of an underactive thyroid or hypothyroidism. That said, these concerns are expected and usually immediately addressed by the doctor - so you shouldn’t be concerned. What’s not always addressed are complications with calcitonin and the parathyroid gland.

 

Possible Complications: Calcitonin and the Parathyroid Gland

When a person has their thyroid removed, there are two points that I think we should emphasize.

Concern #1: Parathyroid

You have something called the parathyroid glands that are right next to the thyroid. These glands produce the peptide hormone PTH, which plays an important role in calcium homeostasis. Importantly, thyroid function and parathyroid function do not overlap: the thyroid regulates the body's metabolism and has no effect on calcium levels while parathyroid glands regulate calcium levels and have no effect on metabolism.

Parathyroid regulates calcium levels


Now, you may think - ok, then I need the parathyroid for strong bones? But it’s much more complex than that. Calcium is the element that allows the normal conduction of electrical currents along nerves - it’s how our nervous system works and how one nerve “talks” to the next.

It’s also the primary element that causes muscles to contract. If your calcium levels drop even slightly below normal, you could feel foggy or confused. The brain demands a normal steady-state calcium level, so any change in the amount of calcium can cause significant concerns. Similarly, too much parathyroid hormone causes high calcium levels, which can make a person feel run-down, irritable, and even depressed or lacking energy.

That’s why you want to make sure that your doctors don’t take those four glands out as well during the thyroidectomy.

Concern #2: Calcitonin

The second point that I want to bring up is about something called calcitonin. Very few people talk about calcitonin, and there’s not commonly an emphasis on this hormone, but it’s also important.

Now, the thyroid gland consists of two types of cells: follicular cells, which produce T3 and T4, and parafollicular cells, which produce and secrete thyrocalcitonin, or calcitonin.

Calcitonin opposes the action of the parathyroid hormone, helping to regulate the blood’s calcium and phosphate levels. It does this by inhibiting the activity of the osteoclasts, the cells that break down bone.

When the osteoclasts break down bone tissue, the calcium enters the bloodstream. By preventing the breakdown of bone, calcitonin lessens the amount of calcium in the blood. The hormone also seems to decrease the amount of calcium the kidneys can re-absorb, lowering levels further.

Overall, the hormone can help prevent osteoporosis. There’s even a therapy called salmon calcitonin that’s used for post-menopausal osteoporosis. It’s also used for spinal stenosis, which is basically when the space around the spinal column is smaller because there’s a calcium build-up. Calcitonin also helps this condition.

What happens is, once you have the thyroid removed, you’re typically put on a synthetic T4 like Synthroid. That synthetic T4 doesn’t have calcitonin in there.

So the question must become where are you getting your calcitonin from?

 

Prevent Complications By Asking the Right Questions

To sum up, the two important questions to ask if you have your thyroid removed are where are you getting your calcitonin from and are they leaving the parathyroid glands intact in the body?

Consider Calcitonin Supplementation

If you are concerned about depleted calcitonin levels post-op, you can consider taking a complete thyroid extract complex called armour thyroid. You can check with your doctor on this - a lot of doctors don’t like to use it because it’s hard to regulate, so they prefer to use just the T4. But I think it’s really important to bring it up to your doctor and also ask the big question where am I getting my calcitonin?

Maintain a Healthy Diet

Besides that, once this gland is removed and you’re on your hormones, I don’t think there’s anything you should do that’s special or different other than getting on your healthy keto and intermittent fasting.

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Disclaimer: Our educational content is not meant or intended for medical advice or treatment.

Editor’s Note: This post has been updated for quality and relevancy.

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