Article: What are the Most Common Thyroid Disorders?

May 28th 2016Back

May is the International Thyroid Awareness Month, and on this occasion, Dr. Wiam Hussein - Senior Consultant Endocrinology and Diabetes, writes about the most common thyroid disorders and how to treat them


Thyroid diseases are some of the most common endocrine disorders, however; these disorders can be easily diagnosed and treated. 


The thyroid gland is prone to several distinct problems, some of which are extremely common. These problems can be broken down into those concerning the production of hormone (too much, or too little) and those due to increased size causing pressure on the surrounding neck structures or simply appearing as a mass in the neck. 
The thyroid is a gland, shaped like a butterfly, considered one of the largest endocrine glands in the body, and rests in the middle of the lower neck. Its primary function is to control the body’s metabolism. The thyroid gland produces hormones that influence essentially every organ, tissue and cell in the body. When the thyroid produces too much hormone, the body uses energy faster than it should (hyperthyroidism). When the thyroid doesn’t produce enough hormones, the body uses energy slower than it should (hypothyroidism). 


Thyroid disease can be difficult to diagnose because symptoms are easily confused with other conditions. Fortunately, there is a simple blood test that can identify thyroid disorders early; therefore making the disorder easy to control before the onset of the symptoms. Thyroid diseases are life-long conditions and with careful management, people with thyroid disease can live healthy and normal lives. People with family history of thyroid are at risk of having it. Those with diabetes, Vitiligo, obesity, high cholesterol, hypertension, depression, infertility and irregular cycles should take extra care and be screened for thyroid disorders.

Underactive Thyroid Gland (Hypothyroidism) 

Common symptoms of this condition include fatigue, lack of concentration and forgetfulness, muscle aches, constipation, dryness of the skin, dry coarse hair, weight gain, infertility and heavy menstrual periods. Slow heart rate, intolerance to cold and puffiness around the eyes may also occur. In some people the thyroid gland may be enlarged but this could be improved with treatment.
 
Thyroid hormone (Thyroxine) is important for women in order to get pregnant and is important for the fetus especially in the first 3 months. Pregnancy is perfectly safe in women who are on stable Thyroxine replacement; however, regular medical checks during pregnancy are important because of the possible increase in Thyroxine dose, which may be necessary as pregnancy advances to avoid complications to the fetus. It is most important that thyroxine treatment should be continued, especially early in pregnancy. If untreated it may increase the risk factors for heart disease and hardening of the arteries.

Treatment


Treatment of hypothyroidism is to take thyroid hormone replacement in the form of a small tablet daily for life. The hormone, which has rarely has any side effects and produces almost no allergic reactions. With careful monitoring, your doctor will adjust your dosage accordingly and a stable dose of thyroxine will be reached.  Pregnancy, major stress or illness can increase the need for thyroid hormone. Thyroxine replacement does not interfere with any other conditions.

Overactive Thyroid Gland (Hyperthyroidism)


The clinical name for an overactive thyroid gland is: hyperthyroidism (excess of thyroid) but Graves’ disease is the commonest form of the disease. It often runs in families and can occur at any age. It is seen in women eight times more often than men. 


Symptoms do not generally come all at once and are due to the effects of excess amounts of thyroid hormone on body function and metabolism. In simple terms, all the metabolic processes are "speeded up"; for example, the pulse rate is rapid (over 100), bowel function is increased (diarrhea), and the sweat glands work excessively. The nervous system is also stimulated so that the patient becomes irritable and nervous. Other common symptoms include muscle weakness, hand tremors, weight loss, sleep disturbances, enlarged thyroid gland, feeling warm and infrequent scant menstrual periods. The eyes are affected and present with eye irritation, and bulging eyes.


Treatment


Generally requires the normalization of thyroid hormone production. Treatment could involve drug therapy to block hormone production, radioactive iodine treatment that disables the thyroid, or even thyroid surgery to remove part or the entire gland.
Although radioactive iodine is by far the simplest and most convenient treatment, it is underused in this area. More often than not, patients end up hypothyroid due to the radioactive iodine, and have to take thyroid hormone for life. 

Thyroid Nodules

A thyroid "nodule" is a localized swelling within the thyroid gland. It could be a single swelling, or multiple ones (multi-nodular goiter). Nodules are common and often cause no symptoms. Although cancer is uncommon, it is important to investigate thyroid nodules to rule-out cancer.

 
Thyroid nodules are usually small, painless and they do not cause any pressure effects in the neck. Most patients do not even notice the swelling. Their doctors find the swelling when they have routine medical checkups or are examined for other conditions. Thyroid nodules are usually firm, smooth, and easily felt if they are large enough (over 1 cm in diameter). Smaller nodules are only detectable by ultrasound. 


The next step is to carry out a fine needle biopsy of the thyroid nodule. Cells and fluid are examined to determine whether this is benign or malignant. 


We advice to look at the mirror and drink water. If you see a mass moving up and down below the apple then you need to be checked. 


Thyroid cancer

Thyroid cancer is uncommon but it is still the eighth-most common cancer in USA but is the second-most common cancer among women in the GCC.

Thyroid tumors typically present as a one sided painless thyroid nodule in a clinically normal patient. This may have been noticed by the patient or picked up as an incidental finding on an ultrasound of the neck. Patients presenting with a hard nodule should raise concerns. The presence of change in voice in the presence of a thyroid nodule suggests thyroid cancer until proven otherwise. Thyroid function tests and fine needle aspiration should be done to rule out malignancy.


Dr Wiam Hussein
Senior Consultant, Royal Bahrain Hospital
American Board of Endocrinology and Diabetes - Cleveland Clinic Ohio