1. What are the common thyroid disorders?
Thyroid diseases are one of the most common endocrine diseases, and can include simple goiter (with or without nodules, mostly related to iodine deficiency), thyroiditis (including acute, subacute and chronic lymphatic thyroiditis), diffuse toxic goiter (Graves’ disease) and thyroid nodules (including benign and malignant) according to their etiology; they can be divided into thyroid diseases with normal thyroid function, hypothyroidism (often caused by chronic thyroiditis, surgery and radioactive iodine 131 treatment) and hyperthyroidism (Graves’ disease is the most common).
2.What are the symptoms of hyperthyroidism and how to prevent and treat it?
Typical symptoms of hyperthyroidism include: fear of heat, excessive sweating, panic, anxiety, increased appetite and food intake with weight loss, increased number of stools, and even diarrhea. Some patients may have arrhythmias such as atrial fibrillation and liver function impairment, while others may have apathy and depression. The cause of hyperthyroidism is not well understood, but it has a certain genetic predisposition, and care should be taken to avoid fatigue, excessive mood swings and excessive iodine intake.
The treatment of hyperthyroidism includes general symptomatic treatment such as nutrition, rest, low iodine diet and heart rate control. The generally accepted treatments for hyperthyroidism include medication, subtotal thyroidectomy and radioactive 131 iodine therapy.
(1) Anti-thyroid drugs, mainly methimazole (tabazol) or propylthioxypyrimethamine. Their advantages: exact efficacy, do not lead to permanent hypothyroidism, or temporary hypothyroidism, but can be recovered by adjusting the medication. Anti-thyroid drugs are suitable for most people with hyperthyroidism. Disadvantages: non-curative, easy to relapse; long treatment time, most of which takes 2-3 years; more side effects (especially suppression of the blood system, skin allergy, effects on the liver, etc., which are difficult to predict); regular check-ups of T3, T4, TSH, liver function, blood routine are needed to adjust the dosage of anti-thyroid drugs and prevent adverse drug reactions;
(2) Surgery Advantages: clear efficacy and short treatment period. Disadvantages: Hyperthyroidism surgery is more dangerous, more traumatic and more expensive. There will also be neck scars after surgery, which will affect the aesthetics. Parathyroid gland injury leads to hypoparathyroidism and damage to the recurrent laryngeal nerve, with an incidence of 1% to 2%. Complications are related to the surgeon’s skill and experience. The recurrence rate of postoperative hyperthyroidism is about 10%, and hypothyroidism occurs in 5% to 10% of patients immediately after surgery. Surgery is no longer routinely recommended for the treatment of hyperthyroidism;
(3) Radioactive 131 iodine. Its biggest advantage is that it is suitable for most people with hyperthyroidism (not suitable for pregnant women and breastfeeding) and can shrink or disappear the enlarged thyroid gland. The one-time cure rate can be over 90%, the total efficiency rate is over 95%, and the recurrence rate is only 1% to 4%. There are no side effects such as allergy, white blood cell drop, liver damage, etc., and the cost is low. The disadvantage is: some patients will develop hypothyroidism (hypothyroidism), but they can take oral thyroxine tablets or thyroxine tablets to maintain normal thyroid function, and treatment is simple and effective as long as it is detected early.
The specific choice of the above three hyperthyroidism treatment methods requires full communication and communication between patients and doctors, and individualized treatment.
3.The main manifestations and hazards of hypothyroidism
The main symptoms of hypothyroidism are as follows: fatigue, easy sleepiness or weakness, fear of cold, low memory, slow reaction, hoarseness, depression, constipation, irregular menstruation or infertility, muscle and joint pain and rough skin, etc. Hypothyroidism in pregnant women can significantly affect fetal brain development and even cause malformation, and hypothyroidism in children and adolescents has a greater impact on their intelligence. In addition, hypothyroidism in adults can lead to an increased chance of hyperlipidemia and heart disease, which can cause pericardial and pleural effusions, etc. However, the treatment of hypothyroidism is simple, safe and effective. As long as the dosage of thyroid tablets or thyroxine tablets is properly adjusted, there are almost no side effects and the cost is low.
4.How to prevent and treat hypothyroidism during pregnancy in women
It has been reported that the incidence of hypothyroidism (including subclinical hypothyroidism) during pregnancy is about 5%-10%. In view of the greater impact of hypothyroidism during pregnancy on the mother and fetus, it is recommended that women should preferably have a thyroid function test before pregnancy or when pregnancy is detected, especially women who
(1) Have a personal history of thyroid disease;
(2) have a family history of thyroid disorders;
(3) have a goiter;
(4) Positive thyroid antibodies;
(5) Signs and symptoms suggestive of hyperthyroidism or hypothyroidism, including anemia and elevated serum cholesterol levels;
(6) Complicated type 1 diabetes mellitus;
(7) Complications of other autoimmune diseases;
(8) Infertility;
(9) History of head and neck radiation therapy;
(10) History of miscarriage and preterm delivery.
Treatment of hypothyroidism in pregnancy: if hypothyroidism is diagnosed before pregnancy, the dose of levothyroxine should be adjusted before pregnancy to a TSH not higher than 2.5 mU/L; in pregnant women with hypothyroidism, the blood thyroxine should be normalized as soon as possible (within 1-2 weeks) and the TSH level should be maintained between 0.5 and 2.5; at 4-6 weeks of pregnancy, the dose of levothyroxine usually needs to be increased by 30-50%; If significant hypothyroidism develops during pregnancy, the dose of levothyroxine depends on rapidly achieving or maintaining serum TSH concentrations below 2.5 mU/L in early pregnancy (first trimester) and below 3.0 mU/L in April through June and July through mid-September.
Thyroid function must be measured every 30-40 days; women with autoimmune thyroiditis (Hashimoto’s thyroiditis) who have normal thyroid function in early pregnancy are at higher risk of developing hypothyroidism and need to be monitored for their TSH values; subclinical hypothyroidism, levothyroxine treatment improves possible adverse outcomes for the mother at delivery, but the role for long-term neurodevelopment of the fetus is unclear.
However, because the potential benefits outweigh the risks, levothyroxine replacement therapy is still recommended in pregnant women with subclinical hypothyroidism, and TSH levels can be used as a reference for the recommended thyroxine dose adjustment: TSH 5-10 mIU/L, 25-50ug/day; 10-20 mIU/L, 50-75ug/day; >20 mIU/L, 75-100 mIU/L. In general, the application of thyroxine replacement therapy during pregnancy does not require concern about the possible adverse effects of subclinical hyperthyroidism during pregnancy; the dose of levothyroxine needs to be adjusted downward in most postpartum hypothyroid patients compared to pregnancy.
5.How can I tell if I have hypothyroidism?
How do you know if you need to be tested to determine if you are indeed suffering from hypothyroidism.
You can get a general idea by taking a self-test based on the following. If you answered “yes” to 5 or more of the following questions, it is recommended that you go to the hospital for screening:
(1). I feel weak, sleep a lot, and have low energy and strength;
(2). My brain is not working well, my mind is confused, I have difficulty concentrating, and my memory is not good;
(3). Every part of my body, including my intestinal function and my metabolic level, seems to be running slower, and I have gained weight;
(4). My skin and hair became dry, gray, and easily broken, and my nails became brittle;
(5). I often feel cold, even when everyone else feels comfortable;
(6) I have many negative thoughts and feel depressed;
(7) My movements and reflexes have slowed down;
(8) I feel stiffness and pain in my muscles and bones, and my hands feel numb;
(9) My blood pressure increases and my heartbeat slows down;
(10). My cholesterol level has increased.
6. How can I tell if a thyroid nodule is “benign” or “malignant”?
A thyroid nodule is a mass or masses of abnormal tissue structure in the thyroid gland caused by various reasons. The incidence of thyroid nodules in the general population is about 3-7%, while the incidence of thyroid nodules in the physical examination population is about 20%-70%, with the majority of thyroid nodules being benign and only 5% being malignant. For thyroid nodules, it is important to select the appropriate method to identify the benignity and malignancy of the nodules in order to determine whether the patient should be followed up or undergo thyroidectomy.
Ultrasound is a sensitive test for evaluating thyroid nodules, with the following features suggesting possible malignancy: microcalcifications; irregular nodule margins; disturbance of blood flow within the nodule; hypoechogenicity; echogenic heterogeneity; irregular margins; extra-thyroidal extension of the gland; and a cross-sectional anterior-posterior diameter larger than the left-right diameter.
If more than 2 features are present at the same time or if one of the features is present again in a hypoechoic nodule, the sensitivity of the diagnosis of malignant disease can be increased to 87%-93%, and the specificity of the diagnosis of malignancy is >80% when three features are present, with fine needle aspiration cytology of the thyroid nodule if necessary. If the nodule is confirmed malignant by cytology, the thyroid gland and tumor should be removed; if the lesion is benign, follow-up can be continued.