Problems with the Thyroid include a variety of disorders that can result in the gland producing too little thyroid hormone (hypothyroidism) or too much thyroid hormone (hyperthyroidism). Thyroid disorders can affect the heart rate, mood, bone health, pregnancy and many other functions.’ We had a chat with Dr. Chandrika  Subasinghe, Consultant Endocrinologist at the Colombo North Teaching Hospital, Ragama on common Thyroid Disorders.  

Q WHAT DOES THE  THYROID DO? The thyroid is a small butterfly-shaped gland located in front of your neck. It is an important part of your endocrine (hormone) system. It secretes thyroid hormones (Thyroxine/T4 and Triiodothyronine/T3) which mainly regulate the speed of the metabolism (chemical reactions, which transform food into energy within the cells). These hormones affect almost all organs and control most of the important functions of the body. Thyroid hormone production and release from the thyroid gland is controlled by another hormone called TSH (Thyroid stimulating hormone) which is secreted from the pituitary gland, another hormone gland located within the brain.

Q WHAT ARE THE DIFFERENT TYPES OF THYROID DISEASES?

Hyperthyroidism and hypothyroidism: The most common thyroid disorders involve abnormal production of thyroid hormones. Too much thyroid hormone production or overactive thyroid results in hyperthyroidism, while inadequate thyroid hormone production or underactive thyroid leads to hypothyroidism.

Goiter: Goiter is the enlargement of the thyroid gland, which results in a neck lump. This neck lump (the goiter) can be smooth and diffuse or irregular and lumpy. Some goiters can produce normal amounts of hormones, while other goiters can be overactive or underactive resulting in hyperthyroidism or hypothyroidism.

Thyroid nodules and cancer: These are lumps in the thyroid gland. Mostly these lumps are harmless, but rarely these lumps could be cancer.

Q WHAT ARE THE RISK FACTORS FOR THYROID DISEASE? Anyone can have thyroid problems, and thyroid disorders are common. Women are five to eight times more likely than men to be diagnosed with thyroid disease. You also have high risk if you:

• Have a family history of thyroid disorder
• Have other autoimmune diseases
• Have Downs syndrome, Turner syndrome
• Are on certain medications: Lithium, Amiodarone
• Have Iodine deficiency
• Had Thyroid surgery, Radio Iodine treatment, and Radiation to the neck in the past

Q WHAT ARE THE SYMPTOMS?

Hypothyroidism: Underactive thyroid produces too little or no thyroid hormone. In this case, the metabolism of your body slows down and you feel sleepy, cold and lethargic. Other main complaints include a puffy face, hoarse voice, hair loss, dry skin and weight gain. Your heartbeat slows down and you can develop constipation. Women may experience heavy menstrual bleeding or irregular periods.

Hyperthyroidism: An overactive thyroid produces too much thyroid hormone, which speeds up the body’s metabolism. You can lose body weight significantly despite increased appetite. Excessive sweating, fever, anxiety, loose motions are other common symptoms. Your heart beats fast, so you can experience palpitations and difficulty in breathing. In some types of hyperthyroidism, you can develop eye problems including budging, tearing, red, swollen eyes.

Goiter, thyroid nodules and thyroid cancer: You or your family/ friends may notice a lump in your neck. You may feel something heavy moving in front of your neck while swallowing. Large lumps can result in difficulty in swallowing and breathing.

Q IS IT A SERIOUS AILMENT? Thyroid diseases affect many parts of your body and health. If you follow your treatment plan and manage your condition very well, it is usually not serious. Even after the completion of treatment for most thyroid cancers, you can live a healthy long life.

If thyroid disorders are not diagnosed or not treated properly, they can cause serious complications. Extreme cases of hyperthyroidism and hypothyroidism very rarely can result in life-threatening emergencies needing ICU care. Rare complications of Hyperthyroidism: Abnormal irregular heartbeat (Atrial fibrillation) and stroke, heart failure, osteoporosis and bone fractures. Rare complications of Hypothyroidism: very slow heartbeat (severe bradycardia, heart blocks), heart failure, depression, and confusion.

Q WHAT ARE THE TESTS THAT CAN BE DONE TO CONFIRM IT?

• Blood Tests: Thyroid function tests (measuring TSH and thyroid hormones in the blood) are used to diagnose thyroid functional disorders. Serum TSH and serum-free thyroxine (FT4) are the most commonly performed tests.
• Hypothyroid patients will have low thyroid hormone (low Free T4), while they will have more signals from the brain (high TSH) y Hyperthyroid patients will have high levels of thyroid hormone (high Free T4 and high Free T3), while their signals from the brain will be very low (suppressed or undetectable TSH).

Imaging studies/ Ultrasound scan of thyroid (USS Thyroid): This is the most commonly performed imaging study to diagnose thyroid disorders. It is a two-dimensional image of the thyroid gland created by sound waves sent through a hand-held instrument. It is a painless no-risk procedure. It is used to diagnose and describe characteristics of goiters, nodules and thyroid cancer.

Fine Needle Aspiration cytology (FNAC) of thyroid: This is a procedure done to take a small sample of the gland using a needle. This is mostly done under USS guidance. These samples are analyzed under a microscope to diagnose thyroid disorders.

Q WHAT IS THE TREATMENT FOR IT?

Hypothyroidism: If your thyroid gland is underactive, mostly you will require lifelong treatment with THYROXINE. Thyroxine is a tablet and it should be taken on an empty stomach, early in the morning. Nothing should be taken including tea, until a minimum of 30 minutes after the ingestion of the thyroxine tablet. Your doctor will adjust the dose based on blood test results (serum TSH).

Hyperthyroidism: Tablets are given to block thyroid hormone production (eg: CARBIMAZOLE). In addition, other drugs like PROPRANOLOL are used to slow down your heart rate and control other symptoms. Other than drugs, Thyroid surgery and radio iodine treatment are also used to control overactive thyroid. Goiter and  Thyroid nodules: Some, but not all will need thyroid operation to remove the enlarged thyroid gland or thyroid nodules. Treatment for thyroid cancer mainly includes thyroid operation and radioiodine treatment.

Q CAN ONE LIVE A NORMAL LIFE WITH THYROID DISEASE? If your thyroid disorder is treated properly and controlled well, you can live a healthy normal life. If you are a young woman with thyroid disease, you can become pregnant and have a normal healthy child, with proper control of the disease. Hypothyroid pregnant women should not stop the Thyroxine tablet but should meet the doctor and get the dose adjusted when pregnant. Even patients with thyroid cancer could live a normal life after proper treatment.

Summary

1. Thyroid disorders are common, especially among females.
2. The most common problems include hypothyroidism (underactive gland), hyperthyroidism (overactive gland), thyroid goiter and nodules.
3. Blood tests (Serum TSH, thyroid hormone levels), and USS thyroid are used to diagnose thyroid disease.
4. If the disease is treated properly, you can live a healthy normal life.
5. If thyroid disease is not diagnosed and treated, it can result in serious problems and even life-threatening conditions.

By Kshalini Nonis