When does your thyroid go wrong?
Do you feel tired day in and day out? Do you have dizziness, weight gain, chills, or hair loss? Or is it the opposite situation for you: leaping around a lot? Sweating a lot? Or anxious and restless? Your thyroid may be the culprit. This huge regulator of the body and mind can sometimes go wrong, especially in women. Proper treatment is vital so you can feel in good shape and avoid serious health problems.
What is the thyroid gland?
The thyroid is a butterfly-shaped gland located in the front of the neck. It produces hormones that control the rate of metabolism – the system that helps the body use energy. When the thyroid gland is dysfunctional, metabolism can slow down or speed up by interfering with the production of thyroid hormones. A range of symptoms can occur when hormone levels are too low or too high.
Symptoms: Weight gain or loss
Unexplained weight change is one of the most common signs of thyroid dysfunction. Weight gain is a sign of low levels of thyroid hormones, also known as hypothyroidism. Conversely, if the thyroid produces more hormones than your body needs, you may experience unexpected weight loss. This is called hyperthyroidism. (For comparison) Low thyroid is more common.
Symptoms: Swelling in the neck
A swelling or enlargement in the neck is an obvious clue that something is wrong with the thyroid gland. An enlarged thyroid gland can occur with either hypo- or hyperthyroidism. Sometimes it is due to nail cancer or a nodular goiter with a mass inside the thyroid gland. It may also be due to other causes not related to the thyroid.
Symptoms: Changes in heart rate
Thyroid hormones can affect almost every organ in the body, and can also affect the heart rate. Patients with low thyroid can have a slow heart rate, while hyperthyroidism can do the opposite. And it can lead to increased blood pressure and heart palpitations.
Symptoms: Changes in energy or temperament
Thyroid dysfunction can lead to significant changes in energy levels and temperament. Patients with low thyroid can feel tired, slow to respond and depressed. Patients with hyperthyroidism can cause anxiety, sleep disturbances, irritability, and irritability.
Symptoms: Hair loss
Hair loss is another sign of thyroid imbalance. It is present in all cases of low thyroid and hyperthyroidism. In the vast majority of cases, hair will grow back when thyroid function returns to normal.
Symptoms: Chilliness or fear of heat
Thyroid dysfunction disrupts the body’s ability to regulate body temperature. Patients with hypothyroidism often feel colder than usual. Hyperthyroidism, on the contrary, sweats a lot and is afraid of heat.
Other symptoms of hypothyroidism: dry skin and brittle nails; numbness and tingling in the fingers; constipation; prolonged periods; muscle weakness or hand tremors; vision problems; diarrhea; irregular periods
Is thyroid disorder still a menopausal manifestation?
Because thyroid disorders can cause changes in the menstrual cycle and mood, their symptoms are often mistaken for menopausal symptoms (i.e., menopause). If a thyroid problem is suspected, a simple hematology test can clarify whether the real culprit is menopause or a thyroid problem, or both.
Who should be tested?
According to ATA recommendations, everyone should be tested for thyroid function every five years, starting at age 35. Multiple tests should be done if there are symptoms or other risk factors. Low thyroid is most often seen in women over the age of 60. Hyperthyroidism is also more common in women and in people over 60 years of age. Family history can increase the risk of the disease.
Thyroid neck examination
Looking closely in the mirror can help you detect an enlarged thyroid gland that needs to be palpated by your doctor. Hold your head up, take a sip of water, and as you swallow, examine the neck below the thyroid cartilage and above the collarbone. Check for swelling or protrusion and repeat several times. If there is swelling or a lump, see your doctor immediately.
Diagnosis of thyroid disorders
If your doctor suspects a problem with the thyroid, a blood test can help find the answer. Test the level of thyroid stimulating hormone (TSH), an important hormone that regulates the work of the thyroid gland. If TSH is high, it usually means that thyroid function is too low (hypothyroidism). If TSH is low, it usually indicates an overactive thyroid (hyperthyroidism). Your doctor will also check the levels of other thyroid hormones in your blood.
Hashimoto disease (Hashimoto)
The most common cause of low thyroid is Hashimoto’s disease. This is an autoimmune disease in which the thyroid gland is attacked by itself. As a result, the thyroid gland is destroyed and does not produce enough thyroid hormone. Hashimoto’s disease runs in families.
Other causes of low thyroid
In some cases, low thyroid can be caused by diseases of the pituitary gland, which is located at the base of the brain. This gland produces TSH, which promotes the work of the thyroid gland. If the pituitary gland does not produce enough TSH, thyroid hormone levels will drop. Other causes of low thyroid include thyroiditis and medications that affect thyroid function.
Grave’s disease
The most common cause of hyperthyroidism is Grave’s disease. This is also an autoimmune disease that attacks its own thyroid gland, causing it to release too much thyroid hormone. grave’s disease is characterized by a pronounced, uncomfortable protrusion of the eyeballs.
Other causes of hyperthyroidism
Hyperthyroidism can also come from a nodular goiter. These lumps in the thyroid gland sometimes produce thyroid hormones. Large masses can have a noticeable enlargement of the thyroid gland. Smaller ones need to be detected by ultrasound.
Complications of thyroid disease
If left untreated, low thyroid can raise cholesterol levels and patients are more likely to have strokes or heart attacks. In severe cases, very low thyroxine levels can trigger loss of consciousness and a life-threatening drop in body temperature. Untreated hyperthyroidism can lead to serious heart problems and osteoporosis.
Treatment of low thyroid
A doctor will prescribe thyroid hormone tablets, such as Eugenol, for those diagnosed with low thyroid. After a few weeks, there will be a significant improvement in symptoms. Long-term treatment can lead to excess energy, lower cholesterol levels, and weight loss. Most people with low thyroid need to take medication for life.
Treatment of hyperthyroidism
The most common approach is anti-thyroid medication, which lowers thyroid hormone levels. The hyperthyroid state may eventually go away, but many people will need to continue taking medication for a long time. Other medications are used for symptomatic conditions, such as rapid pulse and tremor. Another treatment option is radioactive iodine, which can destroy the thyroid gland within 6-18 weeks. Once the thyroid gland is destroyed, or surgically removed, most patients must again take thyroid hormone tablets.
Surgical treatment of thyroid disease
Removal of the thyroid gland can treat hyperthyroidism, but only if medication has failed or if the thyroid gland is enlarged. Surgical treatment is also indicated for people who have a combination of thyroid nodules. Once the thyroid gland is removed, most patients will need daily thyroid hormone supplementation to avoid developing hypothyroidism.
Knowledge about nail cancer
Nail cancer is rare and least lethal. The main symptom is a swelling or lump in the neck, and less than 10% of thyroid nodules will be cancerous. When nail cancer is diagnosed, the most common treatment is surgery, followed by radioactive iodine or external irradiation therapy.
What is hyperthyroidism?
Hyperthyroidism refers to a state in which an overactive thyroid gland produces large amounts of thyroid hormones into the bloodstream. Toxic goiter is a state of intoxication, caused by an excess of thyroxine produced from any cause. It can be an excess absorption of thyroxine or an excess production of the thyroid gland itself. These terms are often confused by doctors and patients, but in this set we use the term “hyperthyroidism”.
What are thyroid hormones?
Thyroid hormones promote cellular metabolism. They are produced by the thyroid gland. The thyroid gland is located in the lower neck, below the thyroid cartilage. The gland wraps around the trachea and is shaped like a butterfly, connected by two wings (lobes) and a middle part (isthmus). The thyroid gland takes iodine from the blood (mostly from food such as seafood, bread, salt) and uses it to produce thyroxine.
Thyroid hormone regulation-command axis
The thyroid gland itself is regulated by another gland in the brain, the pituitary gland. In turn, the pituitary gland is partially regulated by thyroxine in the blood (feedback regulation of the pituitary gland by thyroxine) and partially regulated by another gland, the hypothalamus, also located in the brain. The hypothalamus secretes a hormone called thyrotropin-releasing hormone (TRH), which signals the pituitary gland to secrete thyrotropin (TSH). Next, TSH stimulates the thyroid gland to secrete thyroxine. If any of these three glands are overactive, too much thyroid hormone may be produced, which in turn leads to hyperthyroidism. The production of thyroid hormone is regulated by the pituitary gland. If there is too little thyroid hormone in circulation to meet functional needs, the pituitary gland releases TSH, which stimulates the thyroid gland to produce more hormone. The opposite is true.
What causes hyperthyroidism?
Common causes include
Graves’ disease
Functional adenomas (“hot nodules”) and toxic multinodular goiter (TMNG)
Excessive absorption of thyroid hormones
Abnormal secretion of TSH
Thyroiditis (inflammatory disease of the thyroid gland)
Excessive iodine uptake
Let’s look at each of these conditions next
Graves’ disease
Graves’ disease, caused by overactive thyroid function, is the most common cause of hyperthyroidism. In this condition, the thyroid gland is often uncontrolled, meaning that it loses its response to the regulation of the pituitary gland through TSH. The condition is hereditary and is more prevalent in women, about five times more often than in men. Diagnosis of Graves’ disease requires nuclear scans and serologic testing. It often has ocular (Graves’ ophthalmopathy) and cutaneous (Graves’ dermopathy) lesions.
Functional adenoma and toxic multinodular goiter
The thyroid gland becomes nodular with age (as do many other parts of the body). In most cases, these nodules do not produce thyroxine and do not require treatment. Occasionally, a nodule may become “autonomic”, meaning that it no longer responds to pituitary regulation via TSH and produces thyroid hormone independently. this is especially true for nodules over 3 cm in size. When a single nodule produces thyroid hormone independently, it is called a hyperfunctional nodule. If there are multiple such nodules, it is called a toxic multinodular goiter. Functional nodules are easily detected by thyroid scans.
Excessive intake of thyroxine
Excessive intake of thyroxine medication is actually very common. This can happen if there is a lack of follow-up for patients on medication. Others may try to lose weight and other goals and abuse the drug as well. When these patients have a thyroid scan, they may be diagnosed due to an underground rate of radioactive iodine intake.
Abnormal TSH production
A pituitary tumor may produce very high levels of TSH (thyroid stimulating hormone). It sends excessive signals to the thyroid gland to secrete thyroxine. This is rare and may be related to other abnormalities of the pituitary gland. To confirm the diagnosis, the endocrinologist will do many tests to evaluate TSH production.
Thyroiditis (inflammation of the thyroid gland)
Inflammation of the thyroid gland can occur after a viral illness (subacute thyroiditis) and is associated with fever and sore throat, which is painful when swallowing. There is tenderness in the thyroid gland and usually discomfort in the neck. Inflammation of the thyroid gland with accompanying elevated lymphocytes (called lymphocytic thyroiditis) can also occur. In these cases, the inflammation causes a “hole” in the gland and increases the amount of thyroid hormone entering the bloodstream. Lymphocytic thyroiditis is common in post-pregnancy women and is actually seen in 8% of postpartum women. In these cases, the hyperthyroid state lasts for 4-12 weeks, after which a hypothyroid state (low thyroid hormone output) often develops and lasts until almost 6 months. The majority of infected women return to a normal state. Thyroiditis can be diagnosed by a thyroid scan.
Excessive iodine intake
The thyroid gland uses iodine to synthesize thyroid hormones. Too much iodine can lead to hyperthyroidism. Iodine-induced hyperthyroidism is common in patients with underlying disorders of the thyroid gland. Certain medications, such as amiodarone (cortisone), a drug used to treat heart disease, contain large amounts of iodine and are associated with abnormal thyroid function.
What are the symptoms of hyperthyroidism?
There are a number of signs and symptoms of hyperthyroidism: however, mild cases usually do not manifest. patients over 70 years of age may not have typical clinical signs. Usually, the symptoms become more pronounced when the degree of hyperthyroidism is severe. Symptoms are usually associated with an increase in the body’s metabolic rate. In older patients, arrhythmias and heart failure may occur. In the most severe cases, untreated hyperthyroidism may lead to thyroid crisis with hypertension, fever, and heart failure. Mental changes, such as confusion and foresight, may also occur.
How is hyperthyroidism diagnosed?
The following signs should be suspected: tremors, excessive sweating, smooth and soft skin, thinning hair, tachycardia, and an enlarged thyroid gland. There may be swelling of the skin around the eyes and a characteristic gaze due to elevation of the upper eyelids. Progressive symptoms are easy to detect, but early symptoms, especially in the elderly, can be very inconspicuous. All cases require hematological tests for a definitive diagnosis. The primary means of detection is the measurement of blood TSH levels. As mentioned earlier, TSH is secreted by the pituitary gland. The blood test can clarify the presence of excessive thyroid hormone levels, but it does not indicate a specific cause. If there is clear involvement of the eye, a diagnosis of Graves’ disease can essentially be made. When combined with antibody screening (Graves’ disease) and radiolabeled iodine scans (iodine concentration in the thyroid) can help diagnose underlying thyroid disease. These tests are chosen on an individualized basis.
How is hyperthyroidism treated?
Treatment options include
Symptomatic treatment
Anti-thyroid medications
Iodine radiation
Surgery
Allopathic treatment.
Medications are available to rapidly treat symptoms caused by excess thyroid hormone, such as tachycardia. The main class of drugs are beta blockers [e.g., Zymosan (propranolol), atenolol (Tenormin), metoprolol (Lopressor)]. These drugs counteract the effect of thyroxine in increasing the metabolic rate, but they do not lower the level of thyroxine in the blood. The doctor’s decision as to which patients need treatment depends on a number of parameters, including the underlying cause of the hyperthyroidism, the patient’s age, the size of the thyroid gland and co-morbidities.
Anti-thyroid medications
There are two antithyroid medications available in the United States, methimazole (tabazol) and propylthiouracil (PTU). These drugs accumulate in the thyroid gland and block the synthesis of thyroxine. PTU also blocks the conversion of T4 to the more active T3. The main risk of these drugs is occasional impairment of leukocyte synthesis (requiring anti-infective therapy) caused by bone marrow suppression (granulocyte deficiency). If a patient develops a fever, sore throat or any manifestation of infection while taking the medication, they should see their doctor immediately. The actual incidence of the feared granulocyte deficiency is less than 1%. The dose of antithyroid medication should be adjusted so that the thyroid function is as close to normal as possible. Usually, long-term medication is only seen in patients with Graves’ disease.
Radioactive iodine
Radioactive iodine is given orally (in pills or water) in a single dose to clear the overactive thyroid gland. The dose of nail clearing treatment is different from an iodine scan. Radioactive iodine is given after a routine iodine scan and the presence or absence of hyperthyroidism is diagnosed based on the amount of iodine uptake. The radioactive iodine is taken up by the active thyroid cells and thereby destroys them. The iodine is only taken up by the thyroid cells and the destruction is localized, so there are no systemic complications with this treatment. Radioactive iodine excision has been used safely for over 50 years and the only major reasons why it cannot be used are pregnancy and breastfeeding. In general, a single iodine excision is sufficient in 80% of patients. The thyroid gland can return to normal 8-12 weeks after treatment.
Permanent hypothyroidism is the main complication of this treatment. Temporary hypothyroidism can last up to 6 months, if it is longer than 6 months, replacement therapy (T4 or T3) is usually required.
Surgery
Surgical partial removal of the thyroid gland (partial thyroidectomy) used to be a common treatment for hyperthyroidism. This is done to remove the part of the thyroid that produces too much thyroxine. However, if too much is removed, it can lead to hypofunction. In this case, thyroid replacement therapy is required. The main complication of surgery is damage to the surrounding tissues, including the nerves that innervate the vocal cords and the four small glands in the neck that regulate calcium levels in the body (parathyroid glands). Accidental removal of these glands may result in low calcium and require calcium replacement therapy. With the use of radioiodine therapy and anti-thyroid medication, surgery is not as pervasive as it once was.
What is best for you?
If you are concerned that you may have too much thyroid hormone, you should describe your symptoms to your doctor. A simple blood test is the first step in diagnosis. With this, you and your doctor will be able to decide what to do next. If treatment is needed, the important thing for you to do is to let your doctor know of any concerns or questions you may have about available treatment options. Remember that thyroid disorders are common and the causes of hyperthyroidism are easily diagnosed and treated for connoisseurs.