What is Thyroid Disorders?

Overview

Your thyroid is one of your body’s most important glands. When your thyroid does not work properly, it can cause you to feel nervous or tired; make your muscles weak; cause weight gain or loss; impair your memory; and affect your menstrual flow. A thyroid disorder can even cause miscarriage and physiological condition.

About twenty million Americans—more of them girls than men—are laid low with a thyroid unwellness or disorder, according to the American Thyroid Association (ATA). In fact, associate calculable one in eight girls can develop a thyroid disorder at it slow in her life.

Thyroid Disease in Women
Women area unit 5 to eight times a lot of doubtless to own Thyroid pathology than men, but most don’t know they have it. Women typically overlook their symptoms or mistake them for symptoms of different conditions. For example, women are at particularly high risk for developing thyroid disorders following childbirth. Symptoms like fatigue and depression area unit common throughout this era, but these are also symptoms of thyroid disease. The ATA estimates that more than half of thyroid conditions remain undiagnosed.

How the Thyroid Works

The thyroid could be a butterfly-shaped secreter you’ll feel at the bottom of your neck, just below your larynx (voice box). Two lobes (the “wings” of the butterfly) fit on either side of your windpipe.

The thyroid gland manufactures and stores thyroid hormone (TH), often referred to as the body’s metabolic hormone. Among different actions, TH stimulates enzymes that mix atomic number 8 and aldohexose, a method that will increase your basal metabolic rate(BMR) and body heat production. The hormone also helps maintain blood pressure, regulates tissue growth and development and is critical for skeletal and nervous system development. It plays an important role in the development of the reproductive system.

Types of Thyroid Disorders
The thyroid gland can malfunction in one of three ways:

  • It can release too little TH, resulting in a condition known as hypothyroidism(underactive thyroid).
  • It can release too much TH, resulting in a condition known as hyperthyroidism(overactive thyroid).
  • Its tissue can overgrow, resulting in a nodule, a small lump in part of the gland. Most nodules are harmless growths, but some are cancerous. In fact, according to the ATA, less than one in 10 thyroid nodules are cancerous. However, despite this relatively low incidence, thyroid cancer is currently the fastest growing cancer in women.

Hypothyroidism

When too little TH is released, the body’s metabolic rate decreases, and the body slows down. Hypothyroidism often goes undiagnosed because its symptoms are often mistaken for or attributed to other conditions. Symptoms include:

  • fatigue
  • depression
  • low body temperature
  • weight gain
  • dry or itchy skin
  • thin, dry hair or hair loss
  • puffy face, hands and feet
  • decreased taste and smell
  • slow heart rate
  • constipation
  • poor memory
  • trouble with concentration
  • hoarseness or husky voice
  • irregular or heavy menstruation
  • muscle aches
  • infertility
  • high cholesterol
  • goiter (enlarged thyroid gland)

Hypothyroidism will occur ad lib, develop throughout or when gestation or when treatment for adenosis. You can turn with it or it will be caused by Hashimoto’s redness, the leading explanation for gland disease within the us.

Named for the Japanese health care professional who first described it in detail,Hashimoto’s thyroiditis is an autoimmune disease. That means the immune systemattacks the body’s healthy tissues rather than fighting off incursive bacterium or viruses. In this case, the immune system produces antibodies to attack the thyroid gland as if it were a foreign substance that needed to be destroyed. The ensuing injury results in reduced production of TH.

Hyperthyroidism

When too much TH is released, the body’s metabolic rate increases, and yourmetabolism speeds up. Symptoms of hyperthyroidism include:

  • nervousness/irritability
  • weight loss
  • fast or irregular heart rate
  • heat intolerance or increased perspiration
  • changes in appetite
  • sleep disturbances (such as insomnia)
  • muscle weakness
  • trembling hands
  • more frequent bowel movements
  • shorter and scantier menstrual flow
  • exophthalmos (bulging eyes)
  • goiter (enlarged thyroid gland)

Hyperthyroidism is caused by nodules composed of thyroid cells that manufacture THwithout relevancy the body’s want. It may also develop throughout or once maternity and will be caused by Graves’ disease. Symptoms of hyperthyroidism may also result from overtreatment of hypothyroidism with synthetic TH or from thyroiditis, an inflammationof the thyroid gland, which leads to an overproduction of TH.

Graves’ disease, another autoimmune condition, is the leading cause of hyperthyroidism, accounting for 85 percent of hyperthyroidism cases. Graves’ disease differs from Hashimoto’s rubor therein the antibodies flip the thyroid on, causing the thyroid gland to enlarge and overproduce TH. Other antibodies may also attack eye muscle tissue and the skin on the front of the lower leg. Graves’ disease was named for Robert Graves, an Irish health care professional who first discussed this form of hyperthyroidism. It is a completely treatable disease and is rarely fatal.

Thyroid Nodules

There are four ways to diagnose a thyroid nodule:

  • You or your health care professional feels a growth while manually examining your throat, even though you have no symptoms.
  • You have trouble swallowing and, upon evaluation, your health care professional identifies a nodule.
  • You have symptoms of hypothyroidism or hyperthyroidism.
  • You have an imaging study of your neck performed for an unrelated reason (i.e., CT scan, MRI, carotid ultrasound) that discovers the nodule.

All nodules should be evaluated by a specialist, such as an endocrinologist or an internal medicine specialist, to determine if the nodule is caused by a thyroid cancer. In addition to ordering blood tests described earlier, your doctor will examine the structure of the thyroid gland using one or more of the following tests:

  • Ultrasound. An ultrasound test uses soundwaves to create a picture of the structure of the thyroid gland and accurately identify and characterize nodules within the thyroid. The American Thyroid Association guidelines recommend ultrasound imaging as the first step in the evaluation of a nodule. If the nodule is filled with fluid, it suggests a thyroid cyst. A solid nodule doesn’t necessarily mean cancer, but it may mean that further testing is required. This test can also find other nodules that can’t be felt with a manual examination. It is often used to guide biopsies of nodules. A thyroid ultrasound is also the best test to determine the size of the nodules and to follow any growth over time.
  • Biopsy. In this test, called a fine needle aspirate, a very thin needle is inserted into the gland and several samples of tissue are sucked out (aspirated). The samples are then analyzed under a microscope. This is the best test to determine if a thyroid cancer is present. A biopsy is usually performed if the nodule is larger than 1.5 cm and occasionally with smaller nodules depending on your risk factors and how concerned you and your doctor are. This procedure is done in the doctor’s office, and patients usually return home or to work after the biopsy without any ill effects.
  • Thyroid scan. As with a radioactive iodine uptake test described earlier, in a thyroid scan you either swallow a radioactive iodine pill or get injected intravenously with a radioactive chemical known as technetium. A special camera is then used to view the size, shape and function of the gland based on the amount of radioactive material absorbed. This helps determine whether the nodule is “hot” (usually benign but overactive) or “cold” (inactive and either benign or malignant).

Treatment

The treatment you receive depends on the sort of thyroid disorder you have got, what is inflicting it and your overall medical condition. In general, there area unit 3 classes of treatment: prescription medication, radioactive iodine and surgery (thyroidectomy).

Hypothyroidism

Hypothyroidism, including Hashimoto’s thyroiditis, is the simplest of the three types of thyroid disorders to treat. It needs a daily dose of prescription artificial T4, called levothyroxine sodium (L-thyroxine, L-T4). You and your health care professional will work together to find the right dose for you based on your symptoms and blood tests.
You’ll need to take T4 for the rest of your life, although the dose may change. You will also need periodic blood tests to evaluate the dose.

Many years past, the only treatment available for hypothyroidism was desiccated thyroid, the dried and powdered thyroid glands of animals. It contains both T4 and T3. While desiccated thyroid is still available today, few health care professionals advocate this “natural” therapy. Desiccated thyroid produces variable blood levels of thyroid hormones, not the steady and predictable levels needed for optimal health.

If your T4 dose is too low—if you remain somewhat hypothyroid—you may experience symptoms of hypothyroidism (depression, low body temperature, dry or itchy skin, poor memory, muscle aches, slowed reflexes, among other symptoms). If your dose is too high—if you become somewhat hyperthyroid—you may notice symptoms of hyperthyroidism (nervousness, weight loss, fast or irregular heart rate, changes in appetite, insomnia, muscle weakness or fatigue, decreased menstrual flow, among other symptoms). Over time, TH excess will increase your risk of Associate in Nursing abnormal rhythm or pathology.

In the u. s., levothyroxine is available as four branded products (Levoxyl, Levothroid, Synthroid and Unithroid) and several generic versions. All of the branded and generic preparations contain an equivalent hormone—levothyroxine—and area unit effective in treating hypothyrodism. However, because the preparations may differ in the amount of levothyroxine they contain, many experts have expressed concerns about potential adverse effects caused by switching between manufacturers as will happen with the generic T4 preparations. For example, the 100 mcg dose of one preparation may contain the same amount of T4 as the 112 mcg dose of another preparation, so switching between preparations may actually represent a dose change.

Generally, you should stick with one T4 product for treating hypothyroidism, generally a branded T4. However, because of insurance issues, you may not have a choice between branded or generic. If potential, continue one generic manufacturer to stay the amount fairly consistent in your body. If you must change generics or brands, talk to your health care professional—he or she may have to repeat your blood tests and change the dose to maintain the desired effect or prevent toxicity.

If you do switch brands or change to a generic T4, you should have your TSH level checked six weeks later. In general, because multiple manufacturers produce generic versions, those on generic T4 should have their TSH levels monitored more frequently.

Hyperthyroidism

If you are diagnosed with hyperthyroidism, including Graves’ disease, your health care professional will consider several factors to determine the best treatment for you. These include your age, your general health and the cause and severity of the hyperthyroidism. Available treatments embody I-131 hot iodine (the type of hot iodine that damages thyroid tissue), antithyroid medicine and surgery.

A dose of hot iodine works to wreck the endocrine gland, ending the adenosis. After the iodine is run, the secretor shrinks and blood levels of TH drop. In most, the hyperthyroidism is completely resolved within three to six months. The main side effect is the development of hypothyroidism. Occasionally, you may develop a sore throat one or two weeks after the treatment.

Some folks with adenosis receive antithyroid medicine like organic compound (PTU) or methimazole (Tapazole). These drugs are designed to interfere both with the thyroid gland’s uptake of iodine and with one or more of the steps required for the thyroid to make TH. Because iodine is essential for TH production, reducing the amount of iodine the thyroid gets reduces the amount of TH it produces. Some people with Graves’ disease may go into a long-term remission of more than a year after one or two years of treatment, after which the drugs are stopped.
Surgery to get rid of a part of the hyperactive endocrine gland is often suggested to treat adenosis. Like hot iodine, people that endure surgery typically become hypothyroid. Complications include damage to the parathyroid glands that control the body’s calcium levels and damage to the nerves that control your vocal cords, leading to hoarseness.

Since any of the 3 treatments for adenosis will result in glandular disease, it’s important that you learn to recognize the symptoms of too little thyroid hormone: depression, low body temperature, dry or fidgety skin, poor memory, muscle aches and slowed reflexes. Let your health care skilled recognize if you expertise any symptoms

Nodules

If a nodule is benign—as most are—it will probably simply need to be monitored, not treated. If a biopsy is unclear or identifies a malignancy, then you will need a thyroidectomy, or removal of all or part of the thyroid.

A thyroidectomy is performed under general anesthesia and takes about two hours. If the diagnostic test showed a malignancy, the surgeon usually removes the entire thyroid and some surrounding lymph nodes. If the biopsy was unclear, the surgeon may remove just one lobe of the thyroid and, while you’re still under the anesthetic, wait for it to be tested for cancerous cells. If these cells are present, the surgeon removes the other lobe. If the cancer has spread outside the thyroid, the surgeon may also remove the lymph nodes in your neck.

If you have thyroid cancer you may require treatment with a large dose of the I-131 form of radioactive iodine about six weeks after surgery to destroy any remaining cancerous tissue. The use of hot iodine in thyroid cancer has modified in recent years and is beign used less ofttimes. This is because many patients with small cancers, who are at low risk for cancer recurrence, do not appear to benefit from radioactive iodine since they are most likely cured with surgery alone. You should discuss this with a thyroid cancer specialist. You also begin lifelong TH replacement therapy. In most cases, the surgery and radioactive iodine cure the cancer.

As with different surgery, the minor risks include infection, bleeding and scar tissue on the neck. Major facet effects from surgery square measure rare and involve complications to neck structures getting ready to the thyroid, including damage to the parathyroid glands that control your body’s calcium levels and damage to the nerves that control your vocal cords, leading to hoarseness. These complications, however, occur in less than 1 percent of patients operated on by experienced surgeons. If the parathyroid gland glands square measure broken throughout surgery, you’ll need calcium supplements and possibly other drugs.

Prevention

There is no way to prevent thyroid disorders, but by managing the disorder you can prevent complications. For instance, left untreated, Graves’ disease can weaken your heart muscles, leading to heart failure, and can lead to osteoporosis or severe emotional disorders. Depression, a symptom of hypothyroidism, can also have devastating effects if you don’t treat the underlying condition.

Thus, even if your treatment is working, keep the following in mind:

  • Be aware of any changes in however you’re feeling. Don’t disregard symptoms because you think they could be due to something else.
  • Choose ahealth care professional who is knowledgeable about autoimmune disorders in general and thyroid diseases in particular. Make sure this person listens to what you say and takes your symptoms seriously.
  • Explain however you’re feeling to your health care skilled. You may even need to stay a journal, making brief notes about your symptoms and what you think may be causing them. Include those symptoms that ar the foremost irritating, when they seem to be the hardest to tolerate (for example, are certain symptoms worse during a particular phase of your menstrual cycle?), and what, if anything, causes them to get better or worse. You could use the journal to jot down questions you may want to ask during your medical visit.
  • Let your health care professional know about any pattern of autoimmune diseases in your family’s medical history, since many are genetic in nature. You can create a family tree with the help of the “My Family Health Portrait” resource offered by the U.S. Surgeon General.
  • Make sure your health care professional examines you thoroughly and orders any lab tests to help diagnosis your condition.
  • Seek out second, third or even fourth opinions if you are not satisfied with how your evaluation and treatment are progressing.
  • Although there is no known method to “cure” some thyroid disorders (such as Graves’ disease and Hashimoto’s thyroiditis), there is effective treatment, and the healthier you are in general, the better your body are going to be ready to deal with treatment. A healthy diet, exercise, meditation and other mind-body therapies have given many patients relief and comfort but cannot take the place of standard medical treatment.

If you begin thyroid hormone replacement therapy:

  • Find a way to remember to take your pills every day. Some people report that associating their pill taking with something else they do every day—such as brushing their teeth—helps them remember.
  • Alert other health care professionals about the medication you’re taking to avoid interactions with other drugs.
  • Notify your health care professional if you become pregnant.
  • Be vigilant about yearly checkups to reassess your dose.

Facts to Know

  1. Of the calculable twenty million Americans United Nations agency have thyroid disorders, concerning sixty % haven’t
    Thyroid disorders, such as Hashimoto’s thyroiditis and Graves’ disease, are autoimmune diseases—that is, conditions in the immune system that attack healthy tissue instead of fighting against invading bacteria and viruses. Autoimmune diseases area unit a lot of common in ladies than in men.
  2. Research shows that there’s a robust genetic link between thyroid illness and alternative response diseases as well as sure sorts of polygenic disorder, anemia and inflammatory disease.
  3. According to the American Association of Clinical Endocrinologists, Hashimoto’s thyroiditis is about seven times more common in women than men.
  4. If thyroid problems go undiagnosed, they can increase risk for serious conditions such cardiovascular disease, osteoporosis and infertility.
  5. Physical and emotional stress could trigger response disorders like exophthalmic goiter. Stress adversely affects the system and takes its toll on those genetically vulnerable to these sorts of disorders.
  6. According to the American Association of Clinical Endocrinologists, Hashimoto’s thyroiditis is about seven times more common in women than men.
  7. Postpartum thyroiditis occurs in 5 percent to 10 percent of women following childbirth.
  8. Most thyroid cancers are completely curable, and all are treatable to some extent. The exception is a rare type of thyroid cancer called anaplastic carcinoma. An aggressive tumor that rapidly invades the neck, anaplastic carcinoma is likely to spread to other parts of the body and is extremely hard to treat. About 2 percent to 5 percent of thyroid cancers are in this category.
  9. Radioactive iodine, used as a diagnostic test (I-123) or as treatment (I-131) for thyroid disorders, is safe and has no side effects for most people.

Key Q&A

  1. What is thyroiditis?What is thyroiditis?Thyroiditis is an inflammation of the thyroid gland. It can result in a nodule, or it can cause hypothyroidism, hyperthyroidism or both (one followed by the other).
  2. What role does the thyroid play in the body?The thyroid gland makes, stores and releases thyroid hormone (TH), which is known as the body’s metabolic hormone. TH tells the body how briskly to use energy. If there is too much TH in your blood, you become hyperthyroid, and you use energy too fast. If there is too little TH in your blood, you become hypothyroid, and you use energy too slowly.
  3. What causes hypothyroidism?The most common cause of hypothyroidism in the United States is an autoimmune disease known as Hashimoto’s thyroiditis. Hypothyroidism will|can also} occur spontaneously; will develop throughout or once pregnancy; is gift at birth; or can develop once hyperthyroid treatment..
  4. What is the cause of hyperthyroidism?The most common cause of hyperthyroidism is an autoimmune disease known as Graves’ disease. It can also be the result of nodules (lumps in the gland) that cause an overproduction of TH. Hyperthyroidism also can develop during or after pregnancy.
  5. Is Graves’ disease curable?Graves’ disease is not curable, but it is rarely fatal and is a completely treatable disease. Remission may be permanent, but the thyroid should be checked periodically to be sure. Severe stress can aggravate a recurrence.
  6. What causes postpartum thyroiditis?The cause of postpartum thyroiditis is not known, but it is believed to be an autoimmune disease similar to Hashimoto’s thyroiditis. As with Hashimoto’s, postpartum thyroiditis is associated with the development of anti-thyroid antibodies.
  7. What if I need treatment for hypothyroidism or hyperthyroidism while I’m pregnant?Pregnant women are at an increased risk of developing thyroid dysfunction as compared to the general population. Any lady with a previous history of a thyroid downside, a family history of thyroid disease or symptoms of thyroid dysfunction should be tested for thyroid dysfunction as soon as she knows she is pregnant. TH (T4) is absolutely safe to take during pregnancy and is essential for the health of the fetus if you are diagnosed with hypothyroidism. If you’re diagnosed with adenosis, antithyroid drugs may be used. If a woman is allergic to these drugs, surgery may also be considered at certain times during the pregnancy (the second trimester). Radioactive iodine isn’t associate choice throughout gestation as a result of it’ll pass into the foetus and harm its endocrine.
  8. Is there a relationship between thyroid disorders and osteoporosis?Untreated adenosis or overtreated glandular disorder will increase your risk for pathology. However, hormone treatment for glandular disorder that keeps the thyroid levels within the traditional vary doesn’t increase the danger of pathology. Bones typically renew themselves in an exceedingly method known as bone turnover or reabsorption. Because hyperthyroidism increases the body’s metabolism, bone turnover also is increased. This increase causes old bone tissue to dissolve before new tissue is fully formed, which does not give the body enough time to produce enough minerals for the new bones. The result: thin or weakened bones—osteoporosis.
  9. Do some people have both hyperthyroidism and hypothyroidism?The use of thyroid hormone or antithyroid drug treatment can, over time, produce the opposite effect, especially if the dose of medication given is too high. This means that if you’re taking antithyroid medication for adenosis, you could become hypothyroid; if you are taking thyroid hormone medication for hypothyroidism, you could become hyperthyroid. Pay close attention to how you feel and be aware of the symptoms for each type of thyroid disorder.
  10. Do chest and dental x-rays place me at a higher risk for thyroid cancer?X-rays used today to take images of the head and chest are not harmful. While the thyroid will get exposed to small doses of radiation throughout dental X-rays, there is no evidence to date that these low doses cause thyroid cancer. However, it is prudent (and mostly standard practice) to use a thyroid shield when getting dental X-rays.In contrast to X-rays performed today, radiation procedures from the 1920s to the 1960s for inflamed tonsils, adenoids, lymph nodes or an enlarged thymus gland could put you at risk. There is a clearly established relationship between thyroid cancer and these early radiation treatments of the pinnacle and neck. If you believe you were exposed to this type of treatment as a child or an adult, you should have your thyroid checked annually.
  11. Do mammograms place me at a higher risk for thyroid cancer?There is no evidence that the tiny amounts of radiation from mammograms even reach the thyroid and, thus, there is no evidence that mammograms increase your risk for thyroid cancer. It is not necessary to use a thyroid shield during a mammogram.
  12. Can taking your morning basal body temperature accurately predict a thyroid disorder?No. Some folks have commonly high or low waking body temperatures. The only thanks to accurately diagnose a thyroid disorder is with a sensitive thyrotrophic hormone biopsy.