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Thyroid Disease

Understanding the basics of thyroid disorders

10289590_xxlTHE THYROID IS a butterfly-shaped gland located on the front of the neck. Consisting of two side lobes connected by a bridge (isthmus) in the middle, the thyroid gland lies below the Adam’s apple, along the front of the windpipe.

The thyroid gland produces thyroid hormones – mainly triiodothyronine (T3) and thyroxine (T4) – that influence almost all of the body’s metabolic processes, including growth and development, and body temperature. Sufficient thyroid hormone is crucial for brain development during infancy and childhood – a lack of thyroid hormones in the system at an early age (foetal age) can lead to the development of cretinism (mental retardation) and dwarfism (stunted growth).

Disorders of the Thyroid

Thyroid disorders can range from a small, harmless goiter (enlarged gland) to life-threatening cancer. The most common thyroid problems involve abnormal production of thyroid hormones –hyperthyroidism (production of too much thyroid hormones), and hypothyroidism (production of insufficient thyroid hormones).

Though all types of hyperthyroidism are caused by  the overproduction of thyroid hormones, they are classified by how this process occurs:

Grave’s disease – autoimmune condition that stimulates overproduction of thyroid hormones

Toxic adenomas – nodules that develop in the thyroid gland secreting thyroid hormones (some goiters may contain several of these nodules)

Subacute thyroiditis – inflammation of the thyroid that causes the gland to “leak” excess hormones (this results in temporary hyperthyroidism that generally lasts a few weeks but may persist for months)

Pituitary gland malfunctions or cancerous growths in the thyroid gland – a rare case, but hyperthyroidism can develop from these

A drop in thyroid hormones, as in the case of hypothyroidism, can cause low energy levels in the body. Hypothyroidism is caused by several factors:

Hashimoto’s thyroiditis – an autoimmune disorder wherein the body attacks thyroid tissue, causing tissue death and stops the production of hormones

Removal of the thyroid gland – as in the case of goiter, the thyroid have been surgically removed or chemically destroyed

Exposure to excessive amounts of iodide – cold and sinus medicines, the heart medicine amiodarone, or certain contrast dyes given before some X-rays may expose an individual to too much iodine. Anyone who had previous thyroid problems is at a greater risk of hypothyroidism.

Lithium – an antimanic agent prescribed to treat and prevent episodes of mania (frenzied, abnormally excited mood) in people with bipolar disorder, has also been implicated to cause hypothyroidism

Incidence and Symptoms

Thyroid disorders are more common in women, usually of child-bearing age, and the elderly. Sometimes the condition leads to enlargement of the thyroid gland in the neck (goiter), which can cause symptoms that are directly related to the increase in size of the organ (i.e. difficulty swallowing and discomfort in front of the neck). The symptoms of thyroid problems are varied, depending on the cause of the thyroid disorder, but generally include:

•             Nervousness and tremor – along with agitation, can signal an over-function of the thyroid gland (hyperthyroidism)

•             Mental fogginess and poor concentration – can be seen in both hyperthyroidism and hypothyroidism. While sluggishness and depressed mood are often associated with hypothyroidism, hyperthyroidism can also lead to a reduced capacity for concentration.

•             Menstrual changes – hypothyroidism is sometimes associated with excessive or prolonged menstrual bleeding, while hyperthyroidism can be characterised by reduced menstrual flow

•             Feeling bloated – fluid retention is often a sign of an underactive thyroid gland

•             Racing heartbeat – an increased heart rate (tachycardia) and palpitations can be symptoms of hyperthyroidism

•             Aches and pains – muscle aches and pain can accompany different types of thyroid problems

•             Weight gain – a modest weight gain is usually associated with hypothyroidism

•             Weight loss despite normal eating habits – usually associated with hyperthyroidism

•             Bulging eyes (Graves’ ophthalmopathy) – more common in patients with hyperthyroidism

•             High cholesterol levels – increase in cholesterol levels can occur in hypothyroidism

•             Heat intolerance – individuals with overactive thyroid gland often complain of intolerance to higher temperatures

•             Feeling cold – those with an under-functioning thyroid may feel constantly cold

•             Frequent bowel movements or diarrhoea – associated with hyperthyroidism

Please note, however, that some of the symptoms can be tell-tale signs of other conditions as well. It is always best to work closely with your doctor in order to arrive at the correct diagnosis.

Diagnostic Tests

Diagnostic tests to determine a thyroid disorder involves blood testing for free T4, T3 and TSH (Thyroid Stimulating Hormone). Depending on the severity of the condition, your doctor may order an ultrasound of the thyroid, and other imaging techniques/thyroid scan and/or thyroid biopsy and tumor markers (thyroglobulins) in the case of thyroid cancer.

Treatments for Thyroid Disorders

Since thyroid disorders are basically the malfunctioning of the thyroid, the mechanism of action of the treatments used mainly involves regulation of the hormones produced. In hyperthyroidism, doctors use anti-thyroid medication and radioactive iodine to slow the production of thyroid hormones. The most common anti-thyroid agents are carbimazole, methimazole, and propylthiouracil (PTU). Potassium perchlorate, on the other hand, is a less common anti-thyroid agent.

In some cases, treatment of hyperthyroidism involves surgery to remove all or part of the thyroid gland. Once diagnosed and treated, most patients respond well to treatment and are able to manage their condition.

In the case of hypothyroidism, the standard treatment involves daily use of the synthetic thyroid hormone levothyroxine (i.e. Levothroid, Synthroid, etc) – oral medication that restores adequate hormone levels, thus reversing the signs and symptoms of hypothyroidism.

Management

Oral treatments in both hyperthyroidism and hypothyroidism are usually life-long, and involve dosage adjustment depending on the subsequent levels of your thyroid hormones –which your doctor has to check on a regular basis (i.e. yearly, twice-yearly, every three months, etc). Usually one to two weeks into treatment and the patient will feel significant reduction of symptoms. In the case of Grave’s disease, treatment with anti-thyroid agent must be done continuously for six months to two years in order to be effective. Sudden cessation of medication can lead to recurrence of the disorder. Indeed, management of any thyroid condition must be done closely with your doctor, usually an Endocrinologist, who specialises in endocrine disorders.

Oral treatments in both hyperthyroidism and hypothyroidism are usually life-long, and involve dosage adjustment depending on the subsequent levels of your thyroid hormones –which your doctor has to check on a regular basis (i.e. yearly, twice-yearly, every three months, etc). Usually one to two weeks into treatment and the patient will feel significant reduction of symptoms. In the case of Grave’s disease, treatment with anti-thyroid agent must be done continuously for six months to two years in order to be effective. Sudden cessation of medication can lead to recurrence of the disorder. Indeed, management of any thyroid condition must be done closely with your doctor, usually an Endocrinologist, who specialises in endocrine disorders.

 

References and further reading:

http://women.webmd.com/guide/understanding-thyroid-problems-basics

http://women.webmd.com/picture-of-the-thyroid

http://www.mayoclinic.com/health/hyperthyroidism/DS00344

http://www.mayoclinic.com/health/hypothyroidism/DS00353

http://www.webmd.com/a-to-z-guides/hyperthyroidism-directory

http://www.webmd.com/a-to-z-guides/hypothyroidism-directory

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by Gloria D. Gamat
Posted by ezyhealth on Oct 7 2013. Filed under Medical Section. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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