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Thyroid Problems

Thyroid problems lead to the thyroid not releasing enough thyroid hormones. These problems can be caused by a variety of processes in the body, such as pituitary gland problems, not enough iodine or the immune system attacking it.

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About This Condition

Understanding Thyroid Problems

Common Thyroid Problems

The thyroid is a gland in the neck. It makes thyroid hormone. A hormone is a chemical messenger for the body. If there is a problem with the thyroid, the level of thyroid hormone may change. This can lead to symptoms.

Hypothyroidism

This is when the thyroid gland doesn’t make enough hormone. The most common cause of hypothyroidism is Hashimoto thyroiditis. This occurs when the body’s immune system attacks the thyroid gland. Hypothyroidism may also occur if there’s a severe deficiency of iodine in the body. The thyroid needs iodine to make hormones. Problems with the pituitary gland can lead to not enough production of thyroid hormone. Hypothyroidism will also occur if the thyroid gland is removed during surgery. Thyroid disease, generally hypothyroidism, also develops sometimes after pregnancy.

Common symptoms include:

  • Low energy and tiredness.

  • Depression.

  • Feeling cold.

  • Muscle pain.

  • Slowed thinking.    

  • Constipation.

  • Heavier menstrual periods with prolonged bleeding.

  • Weight gain.

  • Dry and brittle skin, hair, nails.

  • Excessive sleepiness.

Hyperthyroidism

This is when the thyroid gland makes too much hormone. The most common cause is Graves disease. This is due to the body’s immune system telling the thyroid to make too much hormone. Another cause is a small bump (nodule) in the thyroid gland. This can cause hyperthyroidism if the cells in the nodule make too much thyroid hormone and stop hormone production in the rest of the thyroid gland.

Common symptoms include:

  • Shaking, nervousness, irritability.

  • Feeling hot.

  • A rapid, irregular heartbeat.

  • Muscle weakness, fatigue.

  • More frequent bowel movements.

  • Shorter, lighter menstrual periods.

  • Weight loss.

  • Hair loss.

  • Bulging eyes.

Nodules

Nodules are lumps of tissue in the thyroid gland. Most often, the cause of nodules isn’t known. But they may be more common in people who’ve had medical radiation to the head or neck. Sometimes nodules can be felt on the outside of the neck. Most of the time, the nodules cause no symptoms and don’t affect the amount of thyroid hormone. Most nodules are not cancer. But sometimes a nodule may be cancer. Age, gender, family history of thyroid cancer, and history of radiation exposure are each potential risk factors in the development of cancer.

Goiters

A goiter is an enlargement of the thyroid gland. When the gland enlarges, you may see or feel a swelling on your neck. A goiter can develop in someone with a normal thyroid, overactive thyroid, or underactive thyroid.

Diagnosing a Thyroid Problem

Your healthcare provider thinks you may have a thyroid problem. In many cases, a thyroid problem can be easy to diagnose. Your healthcare provider is likely to ask about your medical history, give you a physical exam, and have you take blood tests. You may also need other tests. Based on the results, your healthcare provider may refer you to a hormone specialist (endocrinologist) or a surgeon.

Medical history

Your healthcare provider will ask about your medical history. Tell him or her if you:

  • Have had changes in body temperature, heartbeat, weight, or energy level.

  • Are taking any medicines or supplements.

  • Have ever had thyroid surgery.

  • Have a family history of thyroid problems.

  • Are pregnant or plan to become pregnant.

  • Have ever been treated with radiation to the head or neck.

Physical exam

After the medical history, your healthcare provider will examine you. He or she will feel your neck to check your thyroid gland for changes in size or shape. Your healthcare provider may also look for changes in heart rate, reflexes, muscle strength, or skin texture.

Blood tests

Your healthcare provider will order blood tests. They may include:

  • TSH test. This shows how much thyroid stimulating hormone (TSH) is being made by the pituitary gland. This test can show if your thyroid is normal, overactive (hyperthyroidism), or underactive (hypothyroidism).

  • T3 and T4 tests. These show the levels of T3 and T4 thyroid hormones in the blood. This test can help diagnose hyperthyroidism or hypothyroidism.

Other tests

Based on the results of your exam and blood tests, you may have other tests. They may include:

  • Thyroid antibody tests. These are blood tests that look for problems with the immune system. These tests are most often to look for underactive or overactive thyroid.

  • Ultrasound. This test uses sound waves to create an image showing the size and shape of the thyroid gland. It is most often used to check for a lump in the thyroid (nodule) or enlarged thyroid (goiter).

  • Radioactive iodine uptake test. This test measures how much iodine the thyroid gland takes in. It is most often to check for overactive thyroid.

  • Thyroid scan. This is an imaging test that can show if part of the thyroid gland is making too much thyroid hormone. It is most often used to check for overactive thyroid.

Fine needle aspiration (FNA)

If you have a nodule, you may have a fine needle aspiration done. This is a type of biopsy. A biopsy is a procedure to remove a small sample of tissue. FNA is the best test to find out if thyroid cells are cancer. The healthcare provider uses a needle to take cells from the thyroid. The cells are then checked with a microscope. If cancer is suspected, other tests may also be done to help determine the type of cancer. Risks and complications of FNA are rare, but include mild discomfort, bleeding, and skin infection.

Treating hypothyroidism

Your healthcare provider has diagnosed a thyroid problem and will work with you to create a treatment plan. Even if you don’t have symptoms, getting proper care is important. These are the most common types of thyroid disorders and their treatments.

Hypothyroidism is an underactive thyroid. There is no cure for this condition. But treatment can relieve most or all of your symptoms caused by the low thyroid hormone levels. Treatment is done with daily thyroid hormone pills. Thyroid hormone pills replace the hormones your thyroid doesn’t make. You will likely need to take a daily pill for the rest of your life.

Your healthcare provider will adjust your dose to achieve the right hormone levels. Take the thyroid hormone pill on an empty stomach, without other medicines. This is to make sure it works as it should.

Over time, your dose may be adjusted. The medicine has minimal side effects if the dosage is correct. But if the dosage is too high, you may have symptoms of an overactive thyroid. These include nervousness, irritability, fast heartbeat, tremors, trouble sleeping, and brittle hair. If the dosage is too low, you may have symptoms of an underactive thyroid. These include dry skin, low energy, sleepiness, and memory problems. Tell your healthcare provider if you notice any symptoms of thyroid problems.

Treating hyperthyroidism

Hyperthyroidism is an overactive thyroid. The treatments include:

  • Anti-thyroid medicine. This can reduce the amount of thyroid hormone made by your thyroid gland. Reactions from this medicine are rare. But in some cases, it can cause a dangerous drop in white blood cells, and liver damage. Talk with your healthcare provider for more information. If you have a fever or sore throat while taking this medicine, tell your healthcare provider right away.

  • Radioactive iodine ablation. This is the most common treatment for hyperthyroidism. It’s done by taking a pill or liquid dose of radioactive iodine. This treatment destroys the thyroid cells that are making too much hormone. You may need daily thyroid hormone pills after this treatment.

  • Surgery. This is done by removing part or all of your thyroid gland. After surgery, you may need to take daily thyroid hormone pills.

  • Beta-blockers. The treatments above may be used alone or with beta-blockers. These are medicines that can reduce symptoms caused by too much thyroid hormone. In some cases, symptoms from too much thyroid hormone can be controlled by beta-blockers alone.

Treating nodules

If you have benign nodules, you may not need treatment right away. Instead, your healthcare provider may advise regular exams and ultrasound tests to see if the nodules grow. If treatment is needed, it may include:

  • Anti-thyroid medicine. If a benign thyroid nodule is causing an overactive thyroid, your healthcare provider may first treat it with anti-thyroid medicine. If this doesn’t work, you may need one of the below treatments.

  • Radioactive iodine ablation. This is the most common treatment for hyperthyroidism. It’s done by taking a pill or liquid dose of radioactive iodine. This treatment destroys the thyroid cells that are making too much hormone. You may need daily thyroid hormone pills after this treatment.

  • Surgery. This may be done to treat nodules that are causing symptoms, such as choking, or trouble swallowing. Surgery is done by removing part or all of your thyroid gland. Surgery to remove cancerous nodules may be followed by radioiodine iodine ablation. After surgery, you may need to take daily thyroid hormone pills.

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