Thyroid Problems

The thyroid hormones play a significant role in regulating the basal metabolic rate, food intake and thermogenesis. Hyperthyroidism, also known as overactive thyroid, is a common thyroid problem marked by high levels of T3 and T4 and low TSH levels. Inflammation of the thyroid gland often leads to temporary hyperthyroidism. Hypothyroidism or underactive thyroid is another common thyroid problem marked by low serum levels of T3 and T4 but increased levels of TSH. Thyroid cancer is a serious thyroid problem and the most common endocrine cancer in the world.

Following are the most common thyroid problems:

• Hyperthyroidism: This condition is characterised by excessive secretion of thyroid hormone due to overactivity of the gland.
• Hypothyroidism: Hypothyroidism is a condition in which an underactive thyroid gland secretes lesser than normal amounts of thyroid hormone.
• Thyroid cancer: Thyroid cancer is the most common malignant endocrine tumour. Depending on the histological characteristics, thyroid cancer can be classified as follows:
  • Differential thyroid cancer: It comprises papillary thyroid cancer (PTC) and follicular thyroid cancer (FTC). This type of cancer is derived from epithelial cells and is a common form of thyroid cancer.
  • Anaplastic thyroid cancer (ATC): ATC is an aggressive but rare form of thyroid cancer; only 2% of thyroid cancers are ATCs. It has undifferentiated cells having no similarity to the thyroid tissue.

These problems will be discussed in greater details ahead.

Hyperthyroidism

The most common symptoms of hyperthyroidism are:

• Weight loss
• Nervousness, anxiety, irritation and mood swings
• Goiter
• Fatigue
• Shortness of breath
• Increased heart rate
• Sensitivity to heat
• Loss of sleep
• Increased thirst
• Dryness and redness of eyes
• Hair loss and thinning of hair

Hypothyroidism 

Following are the signs and symptoms of hypothyroidism:

• Weight gain
• Fatigue
• Brittleness of hair and nails
• Dry and thick skin
• Hair loss
• Sensitivity to cold
• Depression
• Muscle cramps
• Hoarseness of voice
• Mental disturbances

Thyroid Cancer

The symptoms of thyroid cancer may appear similar to the symptoms of neck cancer or any other disease condition causing respiratory problems. If you suspect any symptoms, it is best to see your endocrinologist for further investigations. Following are the signs and symptoms of thyroid cancer:

• Fast-growing lump in the region of the neck
• Swelling in the neck
• Pain in the neck that extends to the ear
• Changes in voice quality which do not go away
• Difficulty in swallowing
• Difficulty in breathing
• Constant coughing which is not associated with any respiratory infection or allergy.

Hyperthyroidism 

Causes

There are several causes of hyperthyroidism. Let us look at these causes in detail:

• Graves’ disease: The most common cause of hyperthyroidism is Graves’ disease. It is an autoimmune condition, where autoantibodies stimulate the gland to produce and secrete excessive amounts of thyroid hormones. The condition is more common in women than in men.
• Nodules on the thyroid gland: Benign (non-cancerous) nodules on the thyroid gland can result in excessive secretion of the hormones.
• Increased iodine uptake: Iodine is an essential micronutrient for the production of thyroid hormones. However, excessive iodine intake can result in hyperthyroidism.
• Pregnancy: Hormonal changes during pregnancy can cause hyperthyroidism. Tumour of pituitary gland: A non-cancerous growth in the pituitary gland can lead to excessive production of thyroid hormones.

Risk factors

• Pregnancy
• Smoking
• Existing autoimmune conditions like Sjogren’s syndrome

Hypothyroidism 

Causes

Hypothyroidism is the most common disorder occurring due to hormone deficiency. It may either be primary hypothyroidism, which occurs due to a thyroid gland disorder or secondary hypothyroidism which occurs due to a disorder of the pituitary gland or hypothalamus.

The causes of primary hypothyroidism are as follows:

• Hashimoto’s disease: A chronic autoimmune inflammation of the thyroid gland which leads to an underactive thyroid.
• Iodine deficiency: Iodine plays a major role in the synthesis of thyroid hormones after being taken up by the thyroid gland, and its deficiency can lead to hypothyroidism.
• Thyroidectomy: Surgical removal of the thyroid gland as a treatment for an overactive thyroid can later lead to hypothyroidism.
• External radiotherapy.
• Overenthusiastic treatment with anti-thyroid medication for treating hyperthyroidism can lead to reduced thyroid hormone production.
• Thyroid dysgenesis (underdeveloped thyroid).
• Congenital hypothyroidism.

The causes of secondary hypothyroidism are:

• Pituitary adenoma (non-cancerous growth)
• Pituitary surgery
• Head trauma
• Hypothalamic tumours

Risk factors

A family history of hypothyroidism increases your risk of having an underactive thyroid. Congenital hypothyroidism is very common in this case. Further, an iodine-deficient diet is a significant risk factor.

Thyroid Cancer

Causes

A number of factors can contribute to the occurrence of thyroid cancer, the most common being genetic predisposition. Let’s have a look at the causes of thyroid cancer:

• Genetic factors: People with thyroid cancers have the highest possibility of having inherited genes, which may cause this cancer. Genetic mutations and the presence of susceptibility genes are a major cause of thyroid cancer.
• Radiation exposure: Radiation is a well-known carcinogen. Thyroid gland is extremely sensitive to ionising radiations at a young age. These radiations cause carcinogenic mutations. Diagnostic imaging procedures can also increase the risk of thyroid cancer.
• Diabetes: Increased insulin resistance and increased TSH levels are factors likely to increase the risk of thyroid cancer in diabetic patients.
• Hormones: Oestrogen is considered to play an important role in the development of thyroid cancer. Further, a study showed that women who have had a hysterectomy are at greater risk of thyroid cancer.
• Lifestyle factors: Diet containing high levels of nitrate and a variety of food additives may contribute to thyroid cancer. Smoking and lack of physical activity also play a major role in its occurrence.
• Autoimmunity: Patients with Graves’ disease and Hashimoto’s thyroiditis exhibited a greater risk of thyroid cancer.

The role of iodine intake in causing thyroid cancer is controversial. Some studies suggest that insufficient iodine intake leads to thyroid cancer, while there are some reports which indicate that marine products rich in iodine make the population more susceptible to thyroid cancer. So, the relationship is not completely established and therefore it is best that you consume iodine in the range of recommendation.

Risk factors

The major risk factors for thyroid cancer are as follows:

• Female gender
• Genetic factors
• Increased TSH levels
• Autoimmune diseases
• Exposure to toxic chemicals and radiations

Hyperthyroidism 

The condition cannot be prevented as the exact cause is not known. However, by reducing stress, quitting smoking and having a balanced diet, one may reduce the risk.

Hypothyroidism

The most common causes of hypothyroidism are familial and hormonal, so, prevention is difficult. ; However, the condition can be easily diagnosed and is treatable. A balanced diet with adequate intake of iodine can help prevent the condition.

Thyroid Cancer

The prevention of thyroid cancer is a challenge; however, detection of the faulty genes, followed by the removal of the thyroid gland can help prevent cancer. Avoiding excessive exposure to radiations can also help in minimising the risk of thyroid cancer.

Hyperthyroidism

Timely diagnosis of the problem can help in prompt treatment. The primary investigation begins with a thorough patient history and physical examination of the neck region. The following diagnostic tools are available:

• Blood investigation: To check levels of TSH, T3 and T4
• Nuclear imaging of iodine uptake by the thyroid gland
• Ultrasound imaging of nodules on the gland
• Biopsy of any abnormal growth on the gland
• Eye examination

Hypothyroidism

The diagnosis of hypothyroidism is based on the presence of characteristic symptoms, including sudden weight gain, as well as clinical examination and tests to ascertain the exact levels of thyroid hormones. A comprehensive review of the family and medical history is an essential part of the diagnosis. The following diagnostic tests are done:

• Blood investigation: To check levels of TSH, T3 and T4
• Ultrasound imaging of thyroid gland.

Thyroid Cancer

If your signs and symptoms point towards the possibility of thyroid cancer, your doctor will carry out a thorough physical examination to check for swellings in the neck as well as lymph nodes. A family history will also be elicited. The following diagnostic tools are used:

• Blood investigation: To check for levels of TSH, T3, T4, calcitonin and thyroglobulin
• Fine needle aspiration biopsy
• Tissue biopsy
• Imaging studies: X-ray, ultrasound, radioactive iodine uptake imaging, CT scan and MRI can help in the detection of cancer.
• Laryngoscopy to detect the movement of vocal cords
• Genetic screening for detecting faulty genes, although this is not widely available and is expensive.

Hyperthyroidism 

Treatment

The common treatment modalities include:

• Medication: Radioactive iodine ablation, anti-thyroid medication like neomercazole to slow down the release of hormones and anti-inflammatory drugs to relieve symptoms can be prescribed
• Surgical removal of a part of the thyroid gland or thyroidectomy.
• Artificial tears for symptomatic relief from dryness of the eyes.

Lifestyle Management

Apart from regular medications, simple lifestyle changes can work wonders to keep thyroid activity in check. Regular health check-ups, quitting smoking and performing regular yoga can is good for managing the condition. A balanced diet rich in vitamins, proteins, calcium, iodine and magnesium can help ease the symptoms and improve overall health.

Hypothyroidism

Treatment

A daily oral dose of thyroxine is the most common treatment approach. Sometimes, combination therapy may be recommended. It is also advised to get regular blood investigations once the treatment is started so that the dose of the medication can be adjusted according to the hormonal levels in the blood. In Ayurveda, many herbs have been used to treat hypothyroidism. You may talk to your doctor about their uses and dosage.

Lifestyle Management

In addition to daily medication, regular check-ups along with sufficient levels of exercise and yoga can help keep thyroid hormone levels in control.

Thyroid Cancer

Treatment

The treatment for thyroid cancer is based on the type and stage of thyroid cancer. The following treatment modalities are commonly used:

• Surgery: Partial or complete removal of the thyroid gland and removal of the lymph nodes in the neck
• Radioactive iodine therapy to ablate the remaining thyroid tissue after surgery
• External radiation therapy
• Chemotherapy: Intravenous infusion of anti-cancer drugs
• Targeted therapy: Oral medications that target the cancerous tissues

Lifestyle Management

Lifestyle modifications with a balanced dietary intake, regular physical activity and quitting smoking can help to some extent.

Hyperthyroidism 

Prognosis

The clinical manifestation of the disease will depend upon the age, sex and overall health of the patient. If untreated, the disease may progress and affect your eyes and skin.

Complications

Hyperthyroidism may result in some serious complications such as:

• Cardiovascular complications, such as stroke and congestive heart failure
• Paralysis
• Osteoporosis
• Menstrual irregularities, which may eventually lead to infertility.
• Thyroid storm where there is release of a high amount of thyroid hormones leading to a state of emergency.

Hypothyroidism 

Prognosis

The disease is treatable with a proper daily dose of thyroxine. In the absence of proper treatment, it may progress further and lead to serious complications.

Complications

An untreated underactive thyroid can lead to complications like atherosclerosis due to deposition of cholesterol within the arteries. At times, it may also cause enlargement of the thyroid gland to meet the hormonal requirements. Yet another serious complication of this condition is a life-threatening condition called myxoedema coma, which is marked by a masked appearance of the individual’s face and hypothermia, bradypnoea and the presence of seizures.

Thyroid Cancer

Prognosis

Early detection and treatment help to control the cancerous growth. Carcinoma will affect the thyroid hormone levels and lead to complications like cardiovascular and metabolic problems.

Complications

Cancer can spread to surrounding regions and affect vocal cord function. It can also spread to the lymph nodes, resulting in more complications.

All in all, thyroid problems can be easily detected and managed by timely visits to your endocrinologist. Lifestyle changes in addition to regular intake of medication and periodic check-ups can help you control the condition and avoid serious complications.