Thyroid Disease

Overview

The thyroid is a small gland that is located in the front of the neck below the larynx, or voice box. Along with the pituitary, adrenal, and other glands, the thyroid is part of the endocrine system, which produces, stores, and releases hormones into the blood stream to control various functions of the body’s cells. The production of thyroid hormones is regulated by thyroid-stimulating hormone (TSH), which is made by the pituitary gland. The thyroid hormones are known as triiodothyronine (T3) and thyroxine (T4).

What Is the Function of the Thyroid?

The thyroid produces hormones that regulate the body’s metabolism—the way the body uses energy. In addition to their effects on metabolism, thyroid hormones also affect brain development, breathing, heart and nervous system functions, body temperature, muscles strength, skin dryness, menstrual cycles, weight, and cholesterol levels.
Thyroid Imbalances

Hyperthyroidism

Hyperthyroidism is a disorder that occurs when the thyroid makes more thyroid hormone than the body needs. According to the National Institutes of Health (NIH), hyperthyroidism affects about 1 percent of the U.S. population and women are five to 10 times more likely to develop the disorder than men.

Factors that may increase chances of developing hyperthyroidism include a personal or family history of thyroid problems, certain medical conditions (pernicious anemia, type 1 diabetes, or adrenal insufficiency), a diet high in iodine, use of iodine-containing medications, age older than 60 years, and pregnancy or birth within the past six months.

Causes of hyperthyroidism include:

  • Graves disease—an autoimmune disease where an antibody causes overproduction of thyroid hormone
  • One or more thyroid nodules—lumps that can become overactive and produce too much thyroid hormone
  • Thyroiditis—inflammation of the thyroid gland, which causes stored thyroid hormone to leak and raise hormone levels in the blood
  • Ingesting too much iodine—through medications, including some used to treat heart conditions, and certain supplements
  • Overmedicating with synthetic thyroid hormone for treatment of underactive thyroid

Symptoms of hyperthyroidism include:

  • Nervousness or irritability
  • Fatigue or muscle weakness
  • Trouble sleeping
  • Heat intolerance
  • Hand tremors
  • Rapid and irregular heartbeat
  • Frequent bowel movements or diarrhea
  • Weight loss
  • Mood swings
  • Goiter (an enlarged thyroid that may cause your neck to look swollen)

Diagnosing Hyperthyroidism

To diagnose hyperthyroidism, a doctor will discuss a patient’s symptoms and perform a physical examination. If he or she finds reason to suspect hyperthyroidism, several tests may be used to confirm a diagnosis. Tests are also used to help determine the cause of the condition.

Tests for diagnosing hyperthyroidism include:

Thyroid-stimulating Hormone (TSH) Test
This test detects small amounts of TSH in the blood to measure thyroid activity. When there is too much thyroid hormone in the blood, the pituitary gland stops producing TSH. In general, a TSH level reading below normal indicates hyperthyroidism and a reading above normal indicates hypothyroidism.

T3 and T4 Test
If you have hyperthyroidism, this test will show that levels of T3 and/or T4 are higher than normal.

Radioactive Iodine Uptake Test
A measurement of the amount of iodine your thyroid collects from the bloodstream, this test will help show what is causing hyperthyroidism. Different levels of iodine uptake indicate different conditions.

Thyroid Scan
This scan shows how and where iodine is distributed in your thyroid to help diagnose the cause of hyperthyroidism.

Treating Hyperthyroidism

Doctors consider the cause of hyperthyroidism and how severe it is when choosing treatment. Other factors like a patient’s age, possible allergies to and side effects of medications, pregnancy, and heart disease are also considered. The goal of treatment of hyperthyroidism is to bring thyroid hormone levels to a normal range. Doing so is intended to prevent long-term complications and relieve symptoms.

Beta blockers may be prescribed to help control symptoms of hyperthyroidism until other medications begin working. Though beta blockers do not stop thyroid hormone production, they do block the effects of thyroid hormone on the body, which can help control symptoms like tremors, rapid heartbeat, and nervousness.

Antithyroid drugs, such as methimazole and propylthiouracil, block the way the thyroid gland uses iodine to make thyroid hormone. When antithyroid drugs are used, it may take several weeks or months before thyroid hormone levels reach a normal range. Potential side effects include allergic reactions (rashes and itching), a decreased white blood cell count (which lowers resistance to infection), and, rarely, liver failure. Pregnant women should not take methimazole and should be monitored if they are taking propylthiouracil. Both drugs should only be taken in small doses among women who are breastfeeding.

In radioiodine therapy, patients are administered iodine-131, which the thyroid gland collects in the same way that it regularly collects iodine in order to make thyroid hormone. The radioactive iodine, however, will gradually destroy the cells that make the thyroid gland; it will not affect other tissues in the body. Most patients who undergo radioiodine therapy will develop hypothyroidism; this, however, is considered an acceptable outcome, as hypothyroidism is easier to treat and has fewer long-term complications than hyperthyroidism. This treatment is not used in pregnant women or women who are breast feeding.

Thyroid surgery is the least-used treatment for hyperthyroidism. It involves surgical removal of all or most of the thyroid gland. Removal of part of the thyroid may cause thyroid hormone levels to return to normal. Some patients, however, may develop hypothyroidism; these patients will need to take synthetic thyroid hormone, as will patients who have their entire thyroid removed (in this case, they will use thyroid hormone replacement for life). Thyroid surgery may be a treatment option for pregnant women who cannot tolerate antithyroid drugs, people with very large goiters, or people who have cancerous thyroid nodules. There are risks associated with thyroid surgery (damage to the parathyroid gland or laryngeal nerve, for example); more-experienced surgeons have a low rate of permanent complications.

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