What Does It Take to Cure an Illness?

Can We Control Our Health?

It can be extremely frustrating to receive a diagnosis for which there is no known cause and to then be told that there is only one treatment option with no other prospects. While I agree that, in most cases, there are currently no effective alternatives for thyroid replacement, the situation need not be so dire. The frustration is understandable, but not inevitable.

This patient’s comment, “nothing is irreversible,” raises an intriguing question: How much control do we really have over our own health?

Well, let's consider what determines our health in the first place.

On the most basic level, there are three factors:

• The genes we are born with
• The environments we are exposed to
• The choices we make

Notice, we can really only control one of the three: our choices. Nevertheless, our choices often influence the other two. For example, some of us carry a set of genes that predispose us to lung cancer if we smoke. If we choose not to smoke, however, those genes will remain largely irrelevant to our health. This is true even though we will keep them with us until the day we die from something else.

Poverty is an extreme example of an unhealthful environment. But, if we make certain choices about our education and improve our economic situation even slightly, we can dramatically improve our odds for a healthy future. Of course, this works both ways. The genes and environments we are dealt can have a tremendous impact on our choices. Rising out of poverty, for example, is often impossible no matter how many “right” choices we make. And, adopting unhealthful habits such as smoking, excessive drinking, and overeating are often not just a simple matter of exercising our own free will. Social pressures, addictions, and other factors beyond our immediate control can influence our “choice” to engage in these behaviors.

The influence of these three factors varies from disease to disease and even from person to person with the same disease. For example, some people with high blood pressure need to take medications for the rest of their lives. No amount of effort on their part can overcome the genes they have or the environments they are in. Other individuals, however, are able to cure their high blood pressure by choosing to make significant lifestyle changes. The same is true for other chronic diseases like high cholesterol , type 2 diabetes , and to some extent, certain cancers.

What About Hypothyroidism?

Supplementing iodine in the diet can reverse many cases of hypothyroidism worldwide. Iodine deficiency as a cause for hypothyroidism, however, is rare in the United States. Most cases, particularly in young women, are due to an autoimmune condition called Hashimoto’s thyroiditis. Cells from the immune system fail to appropriately recognize components of the thyroid gland as self, and launch an attack against them. The result is thyroid inflammation and the eventual loss of thyroid hormone production. These autoimmune conditions are actually quite common; other examples are type 1 diabetes , rheumatoid arthritis , and multiple sclerosis .

Like most diseases, the cause of autoimmunity involves both genetic and environmental factors. But unlike iodine-deficient hypothyroidism, the specific environmental factor is unknown. While it’s true the decisions we make can influence many health outcomes, there is currently no evidence that any of our choices can prevent Hashimoto’s thyroiditis (or any other autoimmune disorder) or coax a hormone-depleted thyroid gland to start producing hormones once again.

So does this mean hypothyroid patients should give up and take hormone replacement for the rest of their lives?

The answer is yes and no. While taking thyroid hormone may be necessary for the foreseeable future, this is not the same as giving up. Many of us can make the choice and do the hard work necessary to cure our high blood pressure or cholesterol. But for hypothyroidism, and other less curable but treatable diseases, we still have a choice; it’s just a different one. We can choose to accept this new reality, adapt to it, and move on to fight the battles we can win right now. Depending on your perspective, this could be cure enough.