What are thyroid disorders?
- Thyroid disorders are conditions that affect the thyroid gland, a butterfly-shaped gland in the front of the neck. The thyroid has an important role to regulate numerous metabolic processes throughout the body. Different types of thyroid disorders affect either their structure or function.
- The thyroid gland is located below the Adam’s apple and wrapped around the trachea (windpipe). A thin area of tissue in the gland’s middle, known as the isthmus, joins the two thyroid lobes on each side. The thyroid uses iodine to produce vital hormones. Thyroxine, also known as T4, is the primary hormone produced by the gland. After delivery via the bloodstream to the body’s tissues, a small portion of the T4 released from the gland is converted to triiodothyronine (T3), which is the most active hormone.
- The function of the thyroid gland is regulated by a feedback mechanism involving the brain. When thyroid hormone levels are low, the hypothalamus in the brain produces a hormone known as thyrotropin-releasing hormone (TRH) that causes the pituitary gland (located at the base of the brain) to release thyroid-stimulating hormone (TSH). TSH stimulates the thyroid gland to release more T4.
- Since the thyroid gland is controlled by the pituitary gland and hypothalamus, disorders of these tissues can also affect thyroid function and cause thyroid problems.
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What are the specific kinds of thyroid disorders?
- Thyroid nodules
- Thyroid cancer
- Poor concentration or feeling mentally “foggy”
- Dry skin
- Feeling cold
- Fluid retention
- Muscle and joint aches
- Prolonged or excessive menstrual bleeding in women
Some common causes of hypothyroidism include:
- Hashimoto’s thyroiditis (an autoimmune condition that causes inflammation of the thyroid gland)
- Thyroid hormone resistance
- Other types of thyroiditis (inflammation of the thyroid), such as acute thyroiditis and postpartum thyroiditis
Hyperthyroidism describes excessive production of thyroid hormone, a less common condition than hypothyroidism. Symptoms of hypothyroidism usually relate to increased metabolism. In mild cases, there may not be apparent symptoms. Symptoms and signs of hyperthyroidism can include:
- Fast heart rate
- Intolerance for heat
- Increase in bowel movements
- Increased sweating
- Concentration problems
- Unintentional weight loss
Some of the most common causes of hyperthyroidism are:
- Graves’ disease
- Toxic multinodular goiter
- Thyroid nodules that overexpress thyroid hormone (known as “hot” nodules)
- Excessive iodine consumption
Nodules are lumps or abnormal masses within the thyroid. Nodules can be caused by benign cysts, benign tumors, or, less commonly, by cancers of the thyroid. Nodules may be single or multiple and can vary in size. If nodules are excessively large, they may cause symptoms related to compression of nearby structures.
How are thyroid disorders diagnosed?
- Blood tests are typically done to measure levels of thyroid hormones and TSH. Blood tests to identify antibodies against thyroid tissue may also be ordered by your doctor, such as titers of anti-thyroglobulin, anti-thyroperoxidase, or TSH receptor-stimulating antibodies.
- Imaging tests are commonly used when thyroid nodules or enlargements are present. Ultrasound can visualize the consistency of the tissue within the gland and can often reveal cysts or calcifications. Ultrasound examination cannot distinguish a benign from a malignant process.
- Thyroid scans using radioactive iodine are often performed to evaluate the function of thyroid nodules. The thyroid is the only location in the body that takes up iodine, so when radioactively labeled iodine is given, it is taken up by the thyroid gland.
- An imaging test typically shows the uptake of radioactive iodine by normal thyroid tissue. Areas or nodules that are producing excess hormone (referred to as hyperfunctioning) will show increased uptake of iodine. These are referred to as “hot” nodules or areas. By contrast, so-called “cold” nodules represent areas with decreased iodine uptake. “Cold” nodules do not produce excess hormones and can sometimes represent cancer.
- Fine needle aspiration and biopsy are techniques that remove a sample of cells or tissue from the thyroid gland for examination and diagnosis by a pathologist, who is a physician trained in the diagnosis of conditions based on tissue samples.
- Fine needle aspiration (FNA) uses a long, thin needle to withdraw a sample of cells from the thyroid. FNA can be performed in the doctor’s office. Sometimes, ultrasound imaging is used to guide the FNA procedure. A biopsy is the surgical sampling of a tissue.
What is the treatment for thyroid disorders?
Thyroid disorders can be treated by medications or, in some cases, surgery. Treatment will depend on the particular disease of the thyroid.
Medications can be given to replace the missing thyroid hormone in hypothyroidism. Synthetic thyroid hormone is given in pill form by mouth. When hyperthyroidism is present, medications can be used to decrease the production of thyroid hormone or prevent its release from the gland. Other medications can be given to help manage the symptoms of hyperthyroidism, such as increased heart rate. If hyperthyroidism is not controlled with medications, radioactive ablation can be performed. Ablation involves giving doses of iodine labeled with radioactivity that selectively destroys the thyroid tissue.
Surgery can be used to remove a large goiter or a hyperfunctioning nodule within the gland. Surgery is necessary when there is a possibility of thyroid cancer. If the thyroid gland is removed entirely, the individual will need to take synthetic thyroid hormone for life. Thyroid surgery can also be used in Graves’ Disease (subtotal thyroidectomy) and was the treatment of choice prior to RAI therapy and anti-thyroid medications. It is not used much now.
What is the outlook for thyroid disorders?
In most cases, thyroid disorders can be well managed with medical treatment and are not life-threatening. Some conditions may require surgery. The outlook for most people with thyroid cancer is also good, although patients with thyroid cancer that has spread throughout the body have a poorer prognosis.
Thyroid Disease Symptoms and Signs
- Thyroid disease is a common problem that can cause symptoms because of over- or under-function of the thyroid gland.
- The thyroid gland is an essential organ for producing thyroid hormones, which maintain are body metabolism.
- The thyroid gland is located in the front of the neck below the Adam’s apple.
- Thyroid disease can also sometimes lead to enlargement of the thyroid gland in the neck, which can cause symptoms that are directly related to the increase in the size of the organ (such as difficulty swallowing and discomfort in front of the neck).
Are You Having Thyroid Problems?
It’s hard to tell if you have thyroid abnormalities. You might feel run down and tired, or have what is known as “brain fog.” You may be gaining weight, pregnant, or experiencing hair loss. Others may feel “hyper,” anxious, or sweat a lot more than usual. All of these are common symptoms of thyroid disorders.
The thyroid gland regulates many processes within the body, and women are particularly likely to have disorders that affect the function of this essential gland. Recognizing and treating these conditions is critical for optimum health and preventing long-term health problems.
The thyroid gland is located in front of the neck. It has right and left lobes that confer a butterfly-shaped appearance. The hormones produced by this gland control the body’s metabolism, or the processes by which the body uses energy. Disorders that affect thyroid function can either speed up or slow down metabolic processes, which can lead to a wide range of symptoms.
- Changes in weight can signal an abnormal function of the thyroid gland. Low levels of thyroid hormones (hypothyroidism) can cause weight gain, while unexpected weight loss can signal that too much thyroid hormone is being produced (hyperthyroidism). Hypothyroidism is much more common than hyperthyroidism.
- Hypothyroidism and Hyperthyroidism Symptoms: Swollen Neck. A goiter is an enlargement of the thyroid gland. As shown here, an enlarged thyroid can be seen as a swelling in the front of the neck. A goiter can occur with either hypothyroidism or hyperthyroidism. It can sometimes also result from tumors or nodules that develop within the thyroid gland.
- Hypothyroidism and Hyperthyroidism Symptoms: Changes in Heart Rate. The hormones made in the thyroid gland affect almost every organ in the body, including the heart. Hypothyroidism can cause the heart to beat more slowly, while hyperthyroidism causes a fast heartbeat. Elevated levels of thyroid hormones also can lead to increases in blood pressure and the sense that your heart is pounding (palpitations).
- Hypothyroidism and Hyperthyroidism Symptoms: Changes in Mood. Thyroid disorders can affect emotions, energy, and mood. Hypothyroidism can cause symptoms like depression, tiredness, and feeling sluggish. Hyperthyroidism is associated with sleep disturbances, irritability, anxiety, and restlessness.
- Hypothyroidism and Hyperthyroidism Symptoms: Hair Loss. Hair loss is a common sign of a thyroid problem. Both too high and too low levels of thyroid hormones can lead to hair loss. The hair typically grows back once the condition is treated.
- Hypothyroidism and Hyperthyroidism Symptoms: Body Temperature. The thyroid affects the regulation of body temperature, so those with hypothyroidism often report feeling cold. In contrast, people with hyperthyroidism tend to have excessive sweating and an aversion to heat.
- Hypothyroidism and Hyperthyroidism Symptoms: Other Symptoms
- Other symptoms and signs of hypothyroidism include: Constipation
- Changes or abnormalities in the menstrual cycle
- Dry skin and brittle nails
- Tingling and numbness in the hands or fingers
- Hypothyroidism and Hyperthyroidism Symptoms: Other Symptoms
Other symptoms and signs of hyperthyroidism include:
- Problems with vision
- Irregularities in the menstrual cycle
- Trembling hands
- Muscle weakness
Is It Menopause or Thyroid Disorder?
Thyroid disorders can cause symptoms that are mistaken for those of a woman approaching menopause. Both menstrual cycle changes and mood changes can result from the menopausal transition or from thyroid conditions. Blood tests can determine which of these conditions is responsible for your symptoms. It’s also possible to have a combination of the two causes.
When Should You See a Doctor?
Your doctor may recommend tests if you have symptoms or risk factors for thyroid disease. Both hypothyroidism and hyperthyroidism are most common in women over 60 years of age. A family history of thyroid disease increases your risk of developing thyroid conditions.
Neck Check for Thyroid Disorders
Examining your neck in the area of Adam’s apple while you swallow can sometimes detect if your thyroid is enlarged. Swallow while tipping the head back, and examine your neck and the area above the collarbones. If you see any lumps or bulges, see a doctor.
Thyroid Disorders Tests
Blood tests can diagnose many thyroid conditions. Thyroid-stimulating hormone (TSH) is a hormone that controls the activity of the thyroid gland. If your TSH is high, this typically signals that your thyroid function is low (hypothyroidism). In contrast, low levels of TSH suggest hyperthyroidism. Your doctor may also order tests to determine the levels of other thyroid hormones. Imaging studies and tissue biopsies are other tests that are sometimes used to evaluate thyroid problems.
Hypothyroidism Causes: Hashimoto’s Disease
Hashimoto’s disease, an autoimmune condition, is the most common cause of hypothyroidism. In Hashimoto’s disease, the immune system mistakenly targets and damages the thyroid gland, so not enough hormones are produced. Hashimoto’s disease tends to run in families.
Hypothyroidism Causes: Pituitary Gland
The pituitary gland is located at the base of the brain. It controls the functions of many other glands in the body, including the thyroid. The pituitary gland produces TSH, which signals the thyroid gland to make thyroid hormones. If there is a problem with the pituitary gland and not enough TSH is produced, hypothyroidism can result. Inflammation of the thyroid and taking certain medications can also cause low thyroid hormone levels.
Hypothyroidism Causes: Grave’s Disease
Graves’ disease is the most common cause of elevated thyroid hormone levels. This is another autoimmune condition in which the immune system targets the thyroid gland.
What Is Grave’s Disease?
In Grave’s Disease, the immune system attack triggers the release of high levels of thyroid hormones. A swelling behind the eyes is one of the characteristic signs of Graves’ disease, as shown in this photo.
Hypothyroidism Causes: Thyroid Nodules
Thyroid nodules are lumps that are found inside the thyroid gland. These lumps can begin producing high levels of thyroid hormones, leading to hyperthyroidism. Large lumps may be obvious, while smaller nodules can be visualized with an ultrasound examination of the thyroid.
Untreated hypothyroidism can raise cholesterol levels and increase your risk of heart attack or stroke. If thyroid hormone levels drop to extreme lows, coma and a life-threatening lowering of body temperature can occur. Other complications of untreated hypothyroidism include a loss of bone density and heart problems.
Treatment for hypothyroidism usually involves taking thyroid hormones in pill form. Symptoms usually improve within a few weeks of beginning therapy. Most of those affected will have to take thyroid hormones throughout their life. Over time, treatment can result in weight loss, increased energy, and lowered cholesterol levels.
There are several treatments available to fight hyperthyroidism. The best approach can be determined by a doctor, who will likely consider how severe the hyperthyroidism is, as well as a patient’s medical history.
Antithyroid medication, which attempts to lower the amount of thyroid hormone produced, is the most common treatment for hyperthyroidism. Many people need to take this medication long-term. You may need other kinds of medication to treat certain symptoms, like tremors or fast heart rate.
Radioactive iodine is a treatment option that destroys the thyroid gland over a period of weeks. This is an oral medication.
Beta-blockers don’t actually treat thyroid level disorders, but they do improve the symptoms of high blood pressure, rapid heart rate, and heart palpitations.
Hyperthyroidism Treatment: Surgery (Thyroidectomy)
Surgery to remove the thyroid gland is recommended for hyperthyroidism when antithyroid drugs do not work, or if there is severe enlargement of the gland. Surgery can also be used to treat thyroid nodules or tumors. After surgical removal of the gland, most people need to take thyroid hormones in pill form.
Thyroid cancer is not common, and it is among the least deadly types of cancer.
Thyroid Cancer Symptoms
A lump or swelling in the thyroid gland is the most common sign, and only about 5% of thyroid nodules are malignant (cancerous).
Thyroid Cancer Treatment
Some thyroid cancer, but not all, is treated by surgery followed by radioactive iodine therapy or radiation therapy. Thyroid cancer is almost never treated with external radiation.