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THYROID DISORDERS

What is the Thyroid? The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid's job is to make thyroid hormone. The main thyroid hormone is thyroxine, also called T4 because it contains 4 iodine molecules. Thyroid Hormone is carried through the blood to every tissue in the body. Thyroid hormone is essential to help each cell in each tissue and organ to work right. For example, thyroid hormone helps the body use energy, stay warm, and keep the brain, heart, muscles, and other organs working as they should.

Hypothyroidism

Hypothyroidism is an under active thyroid gland (.hypo-. means under. or. below normal.). Hypothyroidism means that the thyroid gland cannot make enough thyroid hormone to keep the body running normally. People are hypothyroid if they have too little thyroid hormone in their blood. Common causes are autoimmune disease, surgical removal of the thyroid, and radiation treatment. Low thyroid hormone levels cause the body's functions to slow down, leading to general symptoms like dry skin, fatigue, loss of energy, and memory problems. Hypothyroidism is diagnosed by a simple blood test for thyroid-stimulating hormone (TSH). Hypothyroidism is treated by replacing the missing thyroid hormone with synthetic thyroxine pills, which the person must take every day for life. With daily treatment, most patients recover completely.

Who is at risk?

Hypothyroidism is one of the most common thyroid disorders. It affects people all over the world, of every age, sex, race, and level of wealth and education. About 2-3% of Americans have pronounced hypothyroidism, and as many as 10-15% have sub clinical (mild) hypothyroidism. More than half of people who have hypothyroidism do not know it. The most common cause of hypothyroidism is autoimmune disease.

Risk factors for hypothyroidism are:

  • Family history: Having a relative with thyroid disease
  • Older age: Hypothyroidism is commoner in old age
  • Being female: Hypothyroidism is more common in women
  • Being white or Asian
  • Having another autoimmune disorder, such as type 1 diabetes

The rate of hypothyroidism goes up:

  • During pregnancy
  • After delivery
  • Around menopause

People at Risk, should have their thyroid function tested yearly

Hyperthyroidism

The term hyperthyroidism refers to any condition in which there is too much thyroid hormone in the body. In other words, the thyroid gland is overactive.

What are the symptoms of hyperthyroidism? Thyroid hormone generally controls the pace of all of the processes in the body. This pace is called your metabolism. If there is too much thyroid hormone, every function of the body tends to speed up. It is not surprising then that some of the symptoms of hyperthyroidism are nervousness, irritability, increased perspiration, heart racing, hand tremors, anxiety, difficulty sleeping, thinning of your skin, fine brittle hair, and muscular weakness-especially in the upper arms and thighs. You may have more frequent bowel movements, but diarrhea is uncommon. You may lose weight despite a good appetite and, for women, menstrual flow may lighten and menstrual periods may occur less often. Hyperthyroidism usually begins slowly. At first, the symptoms may be mistaken for simple nervousness due to stress. If you have been trying to lose weight by dieting, you may be pleased with your success until the hyperthyroidism, which has quickened the weight loss, causes other problems. In Graves' disease, which is the most common form of hyperthyroidism, the eyes may look enlarged because the upper lids are elevated. Sometimes, one or both eyes may bulge. Some patients have swelling of the front of the neck from an enlarged thyroid gland (a goiter).

Causes of Hyperthyroidism: The most common cause (in more than 70% of people) is overproduction of thyroid hormone by the entire thyroid gland. This condition is also known as Graves' disease. Antibodies in the blood that stimulate the thyroid to grow and secrete too much thyroid hormone cause Graves' disease. This type of hyperthyroidism tends to run in families, and it occurs more often in young women. Little is known about why specific individuals get this disease. One or more nodules or lumps in the thyroid that may gradually grow and increase their activity so that the total output of thyroid hormone into the blood is greater than normal characterize another type of hyperthyroidism. This condition is known as toxic nodular or multinodular goiter. In addition, people may temporarily have symptoms of hyperthyroidis if they have a condition called thyroiditis. This condition is caused by a problem with the immune system or a viral infection that causes the gland to leak thyroid hormone. It can also be caused by taking too much thyroid hormone in tablet form.

Treatment of Hyperthyroidism

Either Anti thyroid Medication, Surgery or Radioactive Iodine Treatment can treat hyperthyroidism. The Choice of Therapy depends on the patient's situation and should be decided between you and your Physician.

Thyroid Nodules and Thyroid Cancer

The term thyroid nodule refers to any abnormal growth of thyroid cells into a lump within the thyroid. Although the vast majority of thyroid nodules are benign (noncancerous), a small proportion of thyroid nodules do contain thyroid cancer. Because of this possibility, the evaluation of a thyroid nodule is aimed at discovering a potential thyroid cancer.

Thyroid Cyst. If the nodule is filled with fluid or blood, it is called a thyroid cyst. When a patient is diagnosed with a Thyroid Nodule or Cyst, it is necessary to exclude the rare possibility of thyroid cancer by doing a Fine Needle Aspiration, FNA or Thyroid Biopsy .

Thyroid Fine Needle Aspiration Biopsy: FNA A fine needle biopsy of a thyroid nodule may sound frightening, but the needle used is very small and a local anesthetic can be used. This simple procedure is done in the doctor's office. It does not require any special preparation (no fasting), and patients usually return home or to work after the biopsy without any ill effects. For a fine needle biopsy, your doctor will use a very thin needle to withdraw cells from the thyroid nodule. Ordinarily, several samples will be taken from different parts of the nodule to give your doctor the best chance of finding cancerous cells if a tumor is present. A pathologist then examines the cells under a microscope. FNA is usually done under Ultrasound Guidance.

Thyroid Cancer

Thyroid cancer is the most common endocrine-related cancer; however, it is rare compared to other cancers. In the United States, there are only about 20,000 new patients annually. Even though the diagnosis of cancer is terrifying; the outlook for patients with thyroid cancer is usually excellent. First, most thyroid cancer is easily curable with surgery. Second, thyroid cancer rarely causes pain or disability. Third, effective and well-tolerated treatment is available for the most common forms of thyroid cancer.

How is thyroid cancer diagnosed? A diagnosis of thyroid cancer is made based on a biopsy of a thyroid nodule or after the nodule is removed during surgery (see Thyroid Nodule section). Although thyroid nodules are very common, less than 1 in 10 harbors a thyroid cancer.

Treatment and Prognosis

The treatment of thyroid cancer depends on the type of cancer and may include surgery, radioactive iodine therapy and treatment with slightly higher doses of thyroid hormone. The prognosis for the more common types of thyroid cancer is good especially when the cancer is discovered at an early stage. Patients with thyroid nodules should under go FNA as soon as possible to exclude or for early diagnosis of thyroid cancer.

Radioactive Iodine RAI Therapy

A radioactive isotope is a substance that gives off radiation. Iodine can be made into two radioactive isotopes for medical uses: I-123 and I-131. These isotopes can be given by mouth to patients with suspected thyroid conditions. RAI is then concentrated inside thyroid cells exactly like iodine and can be used to diagnose or treat thyroid problems.

The radiation that RAI gives off can either be harmless to the thyroid cells (I-123) or the radiation may destroy the thyroid cells (I-131). RAI that is not concentrated in the thyroid gland is eliminated from the body through sweat and urine. RAI is safe to use in individuals who have had allergic reactions to seafood or X-ray contrast agents, since the allergic reaction is to the compound containing iodine, not the iodine itself.

RAI for thyroid imaging

I-123 is the isotope used to take pictures of the thyroid gland (Thyroid Scan). A very small "tracer" dose of I-123 is given to the patient, who then returns 3-6 h later so pictures of the thyroid gland can be taken using a camera that picks up the radiation emitted by the RAI. The camera is part of a machine that looks similar to an X-ray or CT scanning machine. In addition to getting the scan or picture, the amount of radiation being given off can also be counted to determine how active the thyroid gland is (Radioactive Iodine Uptake, RAIU). Since the radiation emitted by I-123 is harmless, no special precautions are necessary after a thyroid scan or RAIU. The total radiation dose that you receive during a thyroid scan is less than you would get if you had a routine chest X-ray. There is usually no side effects to I-123 given for thyroid imaging studies.

RAI for treatment of thyroid disorders

I-131 is the isotope used to destroy both normal and cancerous thyroid tissue. Normal Thyroid Tissue. Small doses of I-131 (5-30 millicuries, mCi) are given to destroy or "ablate" overactive thyroid tissue (see Hyperthyroidism brochure). This turns an overactive thyroid gland often time into an underactive thyroid gland. Doses of I-131 in the middle range (25-75 mCi) may be used to shrink large thyroid glands that are functioning normally but are causing problems because of their size. Patients can go home after the RAI treatment, although they are asked to follow some precautions. It is common for patients to experience some pain in the thyroid after I-131 treatment for hyperthyroidism. Aspirin, ibuprofen or acetaminophen can treat this pain. The RAI treatment may take up to several months to have its effect. Thyroid Cancer. Large doses of I-131 (30-200 mCi) are used to destroy thyroid cancer cells (see Thyroid Cancer section). If you are given a higher dose, you may be asked to stay isolated in a special room in the hospital for about 24 hours to avoid exposing other people to radiation, especially if there are small children living in the same home with you. The regulations that determine whether a patient needs to be isolated or can go home after the treatment are different in different states. Since the salivary glands weakly concentrate iodine, there may be pain and swelling of the salivary glands after high doses of I-131 therapy for thyroid cancer. This can be prevented or reduced by sucking on lemon drops after the therapy.