As an endocrinologist, I help manage issues related to hormones in the body. I see many patients with thyroid disorders, which can lead to a variety of health issues.
Where is the thyroid gland located and what does it do?
The thyroid gland is a small gland located in the lower front part of the neck. It’s sort of shaped like a bowtie, and is about four inches across. It’s very small, but controls almost every function of the body.
Here are some of the body functions that are impacted by the thyroid gland:
- Heart rate
- Body temperature
- Weight and metabolism
- Growth (in children)
- Skin texture and health
- Menstrual cycles in women
- Mood, depression, anxiety
- Mental clarity and concentration
- Bowel regularity and habits
- Muscle strength and coordination
- Bone health
So as you can see, when something within the thyroid isn’t quite right, then the rest of the body can be significantly affected.
What are the most common causes of thyroid problems?
- Thyroid problems fall into three major categories
- Hypothyroidism (underactive thyroid)
- Hyperthyroidism (overactive thyroid)
- Thyroid tumors
Each of these has a different symptom set, and different causes. The causes can be genetic, acquired or unknown.
Hypothyroidism is the most common type of thyroid problem. It means that the thyroid is not producing enough thyroid hormone. Some of the causes of hypothyroidism include genetic predisposition (an example is Hashimoto’s Disease), which is an immune reaction that can destroy the thyroid. Other causes include thyroid inflammation, surgical removal of the thyroid (because of a tumor), radiation damage (if the neck area had been treated for cancer, for example, or a person had received radioactive iodine for treatment of overactive thyroid), or finally, congenital absence of the thyroid.
Symptoms of Hypothyroidism
- Weight gain, despite poor appetite—slowing of metabolism
- Dry skin, brittle hair
- Slow heart rate
- Heavy menstrual cycles
- Difficulty with concentration
The simplest diagnosis is a blood test, checking for TSH (thyroid stimulating hormone) which is produced by the pituitary gland in the brain. This hormone stimulates the thyroid. If someone is diagnosed with hypothyroidism, a medication is usually prescribed that acts as a synthetic version of the thyroid hormone. It’s taken one time per day, first thing in the morning on an empty stomach. The doses vary by hormone levels, age, weight, and other health factors.
Is Hypothyroidism Hereditary?
Yes, thyroid disease is very commonly hereditary. That’s why if someone underactive thyroid, their children/siblings should be monitored, and then tested if they show any signs of hypothyroidism. Fortunately, when you know it runs in the family you can watch for it, and also, it’s usually easily diagnosed and treated.
Hyperthyroidism is less common than hypothyroidism. It can also be caused by an immune system problem (such as Grave’s Disease), or it can be caused by thyroid nodules that produce too much thyroid hormone.
Symptoms of Hyperthyroidism:
- Weight loss, despite a large appetite
- Rapid heartbeat, and even palpitations
- Shakes, tremors
- Anxiety, feeling “wound up,” and insomnia
- Muscle weakness, changes in walking gait
- Light or even absent menstrual cycles
- Brittle hair
- Excessive sweating, heat intolerance
- Blurred vision, and sometimes “bulging” eyes appearance.
The simplest diagnosis is a blood test, checking for TSH (thyroid stimulating hormone) which is produced by the pituitary gland in the brain. This hormone stimulates the thyroid. In this case, TSH would be low, because would indicate the thyroid doesn’t need additional stimulation—it’s already over-active.
Treatment for Hyperthyroidism
If someone is diagnosed with hyperthyroidism, there are three treatment options:
- Medications that make the thyroid slow down and make less hormone.
- Radioactive iodine treatment, which is a pill that eliminates thyroid hormone production. Most patients do end up having underactive thyroid after this, but as I’ve mentioned earlier, this is more easily addressed and treated.
- Surgery to remove the thyroid. (Again, that will lead to underactive thyroid, but that is treatable.) This is truly a last resort, when other treatments don’t work.
Thyroid tumors, or nodules, are very common. They can be found in about 1/3 of the population, and can be assessed by simple thyroid ultrasound. Many times, the initial discovery is made during a routine doctor’s exam. Sometimes when certain imaging tests are done of the neck (such as to look at a spinal problem), these tumors/nodules are just found “by accident” during those tests.
Thyroid nodules vary in size, and often don’t cause any problems. Some can be large, and cause difficulty swallowing or even choking.
Evaluating Thyroid Tumors
If someone has a nodule, we want to assess three things:
- If the nodule is affecting thyroid function—causing either hypo or hyperthyroidism.
- Rule out possible cancer. This is usually done with a fine-needle biopsy.
- If it’s large enough to cause physical problems, such as trouble swallowing.
If none of these are the case, we leave them alone and just monitor it with ultrasound. If there are problems, we address them individually, and then later, often end up addressing hyper/hypo thyroid issues.
When someone is concerned they may have a thyroid problem, they should check with their primary care doctor. He or she can then provide the appropriate initial testing, and then a referral if needed. I am currently accepting endocrinology patients at my practice here at Deaconess Clinic Downtown. You can learn more about me on my web page.