Thyroid Disease

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The Thyroid Foundation of Canada estimates that 200 million people in the world have some form of thyroid disease. While it can affect both genders, thyroid disorders are four to seven times more common in women.

The thyroid is a small gland located under the Adam’s apple in front of the neck. The thyroid gland produces and secretes hormones into the bloodstream, which play an important role in controlling such functions as body temperature, heart rate, blood pressure and weight.  An overactive thyroid can lead to hyperactivity, hand tremors and an irregular heart rhythm, while an underactive thyroid will often cause fatigue and sluggishness. This section provides you with up-to-date information about thyroid disease and the main types of thyroid conditions.

If you suspect that you have a thyroid condition, learn about the common symptoms, as well as the laboratory tests used for diagnosis. With several treatments available, thyroid disorders are for the most part able to be cured or managed.

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The thyroid gland is shaped like a butterfly and is located under the Adam’s apple in front of the neck. While it only weighs about 20 grams, the thyroid gland produces and secretes thyroid hormones into the bloodstream that are essential to all growth and metabolism. The main hormones released by the thyroid are triiodothyronine, abbreviated as T3, and thyroxine, abbreviated as T4.

Thyroid hormones play an important role in controlling such functions as body temperature, heart rate, blood pressure and weight.  An overactive thyroid can lead to hyperactivity, hand tremors and an irregular heart rhythm, while an underactive thyroid will often cause fatigue and sluggishness.

The most common problems that develop in the thyroid include:

  • Hypothyroidism: An underactive thyroid
  • Hyperthyroidism: An overactive thyroid
  • Goiter: An enlarged thyroid
  • Thyroid Nodules: Lumps in the thyroid gland
  • Thyroid Cancer: Malignant thyroid nodules or tissue
  • Thyroiditis: Inflammation of the thyroid
  • To learn more about these, see Types of Thyroid Conditions.

Many health issues, such as autoimmune conditions, cardiac disease, reproductive difficulties, diabetes and arthritis are associated with a poor-functioning thyroid gland. Research has shown that early diagnosis and treatment can, in many cases, reduce the incidence or severity of these health issues.

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Here are the main types of thyroid conditions:

Hypothyroidism

Hypothyroidism occurs when the thyroid gland fails to produce sufficient amounts of the thyroid hormones T4 and T3. When thyroid hormone level drops, cells throughout the rest of the body slow their activity causing symptoms that include fatigue, depression or weight gain. One of the most common causes of hypothyroidism is the autoimmune disease called Hashimoto's disease, in which antibodies gradually target the thyroid and destroy its ability to produce thyroid hormone. Hypothyroidism can also occur if the thyroid is improperly formed at birth, all or part of the thyroid is surgically removed, or if the thyroid is damaged by radiation or certain medications.

Hyperthyroidism

Hyperthyroidism occurs when the thyroid gland becomes overactive and produces too much thyroid hormone. The most common cause of hyperthyroidism is the autoimmune disease known as Graves’ disease, where antibodies target the gland and cause it to stimulate and speed up hormone production. Symptoms most commonly associated with hyperthyroidism include nervousness, irritability, a racing heart, and excessive sweating.

Goiter

A goiter simply refers to the abnormal enlargement of the thyroid gland. The presence of a goiter does not necessarily mean that the thyroid is malfunctioning – just that there is a condition present that is causing the thyroid to grow abnormally. According to the xxx , one of the most common causes of goiter formation worldwide is iodine deficiency. The thyroid may also become enlarged due to conditions such as Hashimoto's disease, Graves' disease, or other thyroid imbalances.

Thyroid Nodules

A thyroid nodule is an abnormal growth of cells that forms a lump within the thyroid gland. While most are non-cancerous, a small proportion of nodules are cancerous. The majority of thyroid nodules do not cause symptoms or affect thyroid function. If they grow very large in size, they may cause symptoms of compression like difficulty swallowing or breathing.

Thyroid Cancer

Thyroid cancer is the most common cancer of the endocrine glands.  It occurs when abnormal cells in the thyroid gland begin to grow uncontrollably, causing one or more nodules to form. Cancerous nodules can invade the tissues of the neck, spread to the surrounding lymph nodes, or to the bloodstream, and then to other parts of the body. For more information, see Thyroid Cancer.

Thyroiditis

When the thyroid becomes inflamed, due to bacterial or viral illness, this is known as thyroiditis. It can be acute occurring over a few days, subacute occurring over a few weeks or chronic occurring over several months to years. 

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Thyroid conditions most often cause your thyroid gland to underproduce thyroid hormone (hypothyroidism), or overwork and produce too much of it (hyperthyroidism). Because the thyroid gland is a regulator of all body functions, the symptoms of thyroid problems are wide-ranging and may affect your mood, energy, body temperature, weight, and much more. Some of the most common signs and symptoms of hypothyroidism and hyperthyroidism are listed below.

Hypothyroidism

Hypothyroidism symptoms include:

  • Weak, slow heart beat
  • Feeling run down, tired or sluggish
  • Muscular weakness and aches in and around the joints
  • Sensitivity to cold
  • Dry skin and brittle fingernails
  • Patchy hair loss on the scalp or body
  • Slowed mental processes and poor memory
  • Constipation
  • Swelling in the front of the neck due to thyroid enlargement (goiter)
  • Weight gain
  • Heavier menstrual flow
  • Depression
  • High cholesterol

Hyperthyroidism

Hyperthyroidism symptoms include:

  • Rapid forceful heartbeat
  • Extreme nervousness and irritability
  • Hand tremors
  • Muscular weakness, especially in the upper arms or thighs
  • Weight loss in spite of increased appetite
  • Restlessness, anxiety and sleeplessness
  • Profuse sweating and heat intolerance
  • Increased bowel movements or diarrhea
  • Fine brittle hair
  • Eye changes, such as a bulging of one or both eyes
  • Swelling in the front of the neck due to thyroid enlargement (goiter)
  • Lighter menstrual periods
  • Infertility
  • Generalised itching (with or without hives)

Because the symptoms of thyroid illness are quite variable and can often be mistaken for other conditions, a doctor should be consulted for a proper diagnosis.

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If your symptoms indicate that you might have a thyroid condition, your doctor will do a physical examination of your neck. This will include feeling the thyroid to see whether the entire gland is enlarged and whether any nodules are present. However, it is not until your doctor takes a small sample of your blood that he or she can accurately determine whether your thyroid is functioning normally.

According to Harvard Health , the Thyroid Stimulating Hormone (TSH) test is the single best screening test to diagnose thyroid disease. If the level of TSH circulating in your bloodstream is high, it means that your pituitary gland is sending a loud message to a failing thyroid that is not producing enough hormone, and you are hypothyroid. If TSH levels are below normal, you have too much thyroid hormone, and you are hyperthyroid.

Normally, this blood test is enough to confirm the diagnosis, but sometimes other thyroid function tests are required. These include the Free T4 (FT4) test, which measures the active part of the thyroxine hormone, and the Free T3 (FT3) test, which measures the active part of the triiodothyronine. Ocassionally, but not often, the thyroid antibodies test will be done, to check the cause and severity of the thyroid disorder.

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There are several treatments for thyroid conditions. The best approach for you depends on the particular problem you have, your age, physical condition and the severity of your disorder. Treatment can include:

  • Thyroid replacement therapy: Thyroid replacement therapy is used to treat hypothyroidism by replacing the thyroid hormone your body is missing. Pure synthetic T4, called levothyroxine sodium, works in the same way your own thyroid hormone would normally work. Your doctor will need to periodically measure the thyroid-stimulating hormone level to guide the treatments and get the dosage amount right. As synthetic thyroid hormone is replacing a hormone that naturally occurs in your body, side effects are rare.
  • Anti-thyroid medications: These medications gradually reduce symptoms of hyperthyroidism by slowing hormone production of your thyroid gland. They include Tapazole and propylthiouracil (PTU). Symptoms begin to improve in six to 12 weeks, but patients are usually kept on anti-thyroid medications for up to 18 months before other treatment is offered. Side effects of these drugs include skin rashes, hives, fever or joint pain. Both drugs can also cause serious liver damage.
  • Radioactive iodine: Taken by mouth to treat hyperthyroidism, radioactive iodine causes the gland to shrink by killing thyroid cells. Most patients will experience an improvement in symptoms within three to six months. However, as this treatment slows thyroid activity, the consequence is that it can cause hypothyroidism. This means that you may eventually need to take medication every day to replace thyroxine.
  • Beta blockers: If you’re suffering from hyperthyroidism, your doctor might prescribe beta-blockers (atenolol, propranolol), which won’t reduce your thyroid levels but can help alleviate symptoms like shakiness and a rapid heart rate. 
  • Surgery (thyroidectomy): Thyroidectomy is used to treat thyroid disorders such as cancerous nodules, goiter and hyperthyroidism. If the goiter or thyroid nodules are found to contain cancer or are highly suspicious of containing cancer, they should be surgically removed. Patients with hyperthyroidism who can't tolerate anti-thyroid drugs and don't want to or can't have radioactive iodine therapy, such as pregnant women, may also be candidates for thyroid surgery. How much of your thyroid gland is removed during thyroidectomy depends on the reason for surgery. If only a portion is removed, your thyroid may be able to function normally after surgery. If your entire thyroid is removed, you will need daily treatment with thyroid hormone to replace your thyroid's natural function.
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