CONDITIONS

Thyroid Conditions

What Is Thyroid Conditions

Thyroid conditions affect the proper functioning of the thyroid, a small gland located in the neck that influences most of the body’s metabolic function through the production of two hormones – T3 (triiodothyronine and T4 (thyroxine). The production of T3 and T4, which are collectively referred to as thyroid hormone, is regulated by thyroid stimulating hormone or TSH, a hormone produced by another small gland in the brain known as the pituitary. Thyroid hormone is known to affect energy production, growth, development, and the functioning of the circulatory, nervous, and reproductive systems. Because of these widespread effects, improper levels of thyroid hormone caused by thyroid conditions can have major effects on the body including appetite changes, weight gain or loss, fatigue, hair loss, and heart palpitations.

There are four major types of thyroid diseases and conditions. These are:

  • Hypothyroidism. Also called underactive thyroid. . This condition develops when the thyroid gland doesn’t make enough thyroid hormone.
  • Hyperthyroidism. Also called overactive thyroid. Hyperthyroidism develops when increased TSH production by the pituitary causes the thyroid gland to produce too much thyroid hormone.
  • Thyroid Nodules. Thyroid Nodules are small growths on the surface of the thyroid that vary in size and typically do not majorly interfere with thyroid function . Occasionally, thyroid nodules can cause hyperthyroidism, can be cancerous, or can grow large enough to interfere with breathing or swallowing.

What Causes Thyroid Conditions

The causes for thyroid conditions vary from condition to condition. Below are suspected causes for each type of thyroid condition.


Hypothyroidism

  • Hashimoto’s disease, also called Chronic Lymphocytic Thyroiditis, is the most common cause of hypothyroidism. In Hashimoto’s disease, the body’s immune system attacks and weakens the thyroid gland, causing it to become underactive. Doctors and researchers are unsure of the exact cause of the body’s immune response against the thyroid and, however some suspect that it might be connected to genetics or exposure to a specific bacterium.
  • Congenital hypothyroidism or hypothyroidism at birth: For unknown reasons, some babies are born with a thyroid that is not fully developed or doesn’t function properly. Symptoms of congenital hypothyroidism might not be noticeable at first, so the majority of newborns in the U.S. are screened for hypothyroidism to ensure early detection and treatment.
  • Surgical removal of part or the entire thyroid. If part of the thyroid is surgically removed, the remaining part may produce normal amounts of thyroid hormone or it may fall short, causing the development of hypothyroidism. If the entire thyroid is removed during surgery, the result is always hypothyroidism.
  • Radiation treatment of the thyroid Radioactive iodine, a common treatment for hyperthyroidism, gradually destroys the cells of the thyroid. Most patients who receive radioactive iodine treatments for serious medical conditions or hyperthyroidism also develop hypothyroidism.
  • Medications. Several drugs can interfere with thyroid hormone production and lead to hypothyroidism, including amiodarone, which is used to treat certain heart conditions, lithium, which is used to treat certain psychological disorders, and cancer drugs interleukin-2 and interferon alpha.

Hyperthyroidism

  • Graves’ disease. This is the most common cause of hyperthyroidism. In Graves’ disease, the immune system over-reacts and makes an antibody called thyroid-stimulating immunoglobulin (TSI) that attaches to thyroid cells. TSI mimics the action of thyroid stimulating hormone (TSH) and stimulates the thyroid to make too much thyroid hormone, resulting in hyperthyroidism.
  • Hyperfunctioning thyroid nodules, or toxic adenomas. Thyroid nodules are growths that occur on the surface of the thyroid gland. These nodules are common and usually noncancerous, and about 3 to 7 percent of the U.S. population has them. Occasionally, nodules produce thyroid hormone and become overactive, or hyper-functioning, causing hyperthyroidism.Thyroiditis, or inflammation of the thyroid. For unknown reasons, the thyroid can become inflamed, which causes stored thyroid hormone to leak out of the thyroid gland. Consuming too much iodine. There are significant amounts of iodine contained in medications such as amiodarone (used to treat heart problems), certain cough syrups, or in supplements containing seaweed. Overmedicating with synthetic thyroid hormone. People with hypothyroidism (underactive thyroid) are often given synthetic thyroid hormone to help resolve a thyroid hormone deficiency. However, if given in too high a dosage, synthetic thyroid hormone can cause hyperthyroidism. People who take synthetic thyroid hormone should see their doctor at least once a year to have their thyroid hormone levels checked and follow the health care provider’s instructions about the dosage

Thyroid Nodules

Thyroid nodules are caused by an overgrowth of thyroid tissue. All of the causes of thyroid overgrowth are unknown, but so far, scientists have identified the following:

  • Iodine deficiency. A lack of iodine in the diet can cause thyroid nodules to develop.
  • Thyroid cancer. This is an extremely rare cause of thyroid nodules. Only 5% of thyroid nodules are cancerous.

Risk Factors For Thyroid Conditions

There are several factors known to influence the risk of developing a thyroid disease or condition. These include:

  • Sex. Women are five to eight times more likely than men to have thyroid problems.
  • Age. Most cases are in people 50 years or older.
  • Previous thyroid conditions. Previous thyroid problems, including goiters. Increase the risk of developing additional thyroid conditions. Patients who have had surgery in the past to correct a thyroid problems are also at an increased risk for thyroid conditions
  • Family history. Thyroid conditions have been found to be more likely if an immediate family member or close relative has a condition.
  • Pregnancy. The physical changes in a woman’s body during pregnancy can worsen pre-existing thyroid conditions or cause new conditions to develop.

In addition to the overarching risk factors for thyroid conditions, there are specific risk factors for varying thyroid conditions and diseases. These include:

Hypothyroidism:

  • Radiation to the thyroid, neck or chest. Radiation treatment can kill thyroid cells and make them unable to produce thyroid hormone, causing hypothyroidism.
  • Other autoimmune diseases. Because hypothyroidism is suspected to be an autoimmune disease, having other autoimmune diseases makes an individual more susceptible to the condition.
  • Turner Syndrome, a genetic disorder. Researchers have found a link between hypothyroidism and individuals with Turner Syndrome, however the cause of this link remains unknown.

Hyperthyroidism

  • Type 1 diabetes and other autoimmune diseases. Because Graves’ disease, a known cause of hyperthyroidism, is an autoimmune disease, other autoimmune diseases such as type 1 diabetes, put individuals at a higher risk of developing hyperthyroidism.
  • Primary adrenal insufficiency, a hormonal disorder.
  • Excessive iodine consumption. Eating large amounts of food containing iodine, such as kelp, or using iodine-containing medications such as amiodarone. Iodine is a key component in the production of thyroid hormone. If it is present in excess, it can cause the thyroid to become overactive.
  • Age. Being older than age 60. Graves’ disease, the most common cause of hyperthyroidism, is more likely to occur at a later age.

Diagnosing Thyroid Conditions

If your doctor suspects you may have a thyroid disease or condition, he or she will most likely:

  • Ask about your medical history, to find out about previous conditions and assess your general risk of thyroid conditions.
  • Conduct a physical exam to find out whether or not there are any physical abnormalities in the thyroid, including enlargement or shrinkage.

If your doctor suspects you may have hypothyroidism, he or she may conduct the following diagnostic tests:

  • Thyroid Stimulating Hormone (TSH) Test. This test is an extremely accurate blood test that measures T3 and T4 levels. Low levels of T3 and T4 in the blood can be signs of hypothyroidism.
  • T4 Testing. Even if your TSH test comes back normal, it does not rule out the possibility of a hypothyroid. If your symptoms still point to a hypothyroid diagnosis, your doctor may measure the level of free T4, a more specific test that can help confirm a hypothyroidism diagnosis.
  • Anti-thyroid Microsomal Antibodies Testing. Anti-thyroid microsomal antibodies are produced by the immune system to attack thyroid cells. If a blood test determines their presence, it shows that there has been thyroid damage, which could potentially lead to hypothyroidism. This autoimmune damage characterizes Hashimoto’s thyroiditis. Most primary care physicians do not test for anti-thyroid microsomal antibodies, so your doctor may refer you to a specialist called an endocrinologist for this test.

If your doctor suspects you may have hyperthyroidism, he or she may conduct the following diagnostic tests:

  • A physical exam with special attention to tremors in fingers, eye changes, and overactive or underactive reflexes .
  • Blood tests. These tests measure the levels of thyroxine and TSH in your blood. High levels of thyroxine and low or nonexistent amounts of TSH indicate an overactive thyroid.
  • Radioactive iodine uptake test. For this test, you take a small, oral dose of radioactive iodine. Over a period of time, the iodine collects in your thyroid gland because your thyroid uses iodine to manufacture hormones. You’ll be checked after two, six or 24 hours (sometimes after all three time periods) to see how much iodine your thyroid gland is absorbing. A high uptake of radioiodine indicates your thyroid gland is producing too much thyroxine. The most likely cause is either Graves’ disease or hyper-functioning nodules, both signs of hyperthyroidism.
  • Thyroid scan. During this test, you’ll have a radioactive isotope, a substance that has chemical properties that make it able to be seen by medical imaging techniques, injected into the vein on the inside of your elbow (or sometimes a vein in your hand). As the radioactive isotope travels to your thyroid, you lie on a table with your head stretched backward while a special camera produces an image of your thyroid on a computer screen.

Thyroid nodules typically do not have symptoms and therefore aren’t noticed or diagnosed until they are causing other problems with the thyroid. However, if nodules are discovered during a physical exam, you may undergo the following testing to ensure that the nodules are benign:

Symptoms of Thyroid Conditions

Hypothyroidism: The symptoms of hypothyroidism can be subtle and are frequently thought to be the result of normal aging. Symptoms become more obvious as the condition worsens. Below are the most common symptoms:

  • Fatigue
  • Depression
  • Modest weight gain
  • Constipation
  • Cold intolerance
  • Dry coarse hair and/or dry skin
  • Muscle cramps
  • Increased cholesterol levels
  • Leg swelling
  • Joint or muscle pain

Hyperthyroidism: Not everyone has the same symptoms. Here’s what you may experience with hyperthyroidism:

  • Appetite change either decreasing or increasing
  • Insomnia and fatigue
  • Frequent bowel movements or diarrhea
  • Heart palpitations
  • Heat intolerance and increased sweating
  • Irritability
  • Confusion or memory loss
  • Muscle weakness
  • Nervousness
  • Shortness of breath
  • Sudden paralysis
  • Tremor/shakiness
  • Vision changes
  • Hair thinning
  • Itching and hives
  • Possible increase in blood sugar

Prognosis

Hypothyroidism: In most cases, thyroid hormone levels return to normal with proper treatment. You will likely have to take a thyroid hormone replacement medicine for the rest of your life.

Hyperthyroidism: Not everyone has the same symptoms. Here’s what you may experience with hyperthyroidism:

  • Appetite change either decreasing or increasing
  • Insomnia and fatigue
  • Frequent bowel movements or diarrhea
  • Heart palpitations
  • Heat intolerance and increased sweating
  • Irritability
  • Confusion or memory loss
  • Muscle weakness
  • Nervousness
  • Shortness of breath
  • Sudden paralysis
  • Tremor/shakiness
  • Vision changes
  • Hair thinning
  • Itching and hives
  • Possible increase in blood sugar

Living With Thyroid Conditions

Hypothyroidism:

  • Maintain a healthy diet. Eat plenty of fruits and vegetables and nix processed foods.
  • Avoid iodine. Taking iodine drops or eating foods containing large amounts of iodine – such as seaweed or kelp – may cause or worsen hypothyroidism or hyperthyroidism.
  • Exercise regularly. This will keep your weight and mood stable.
  • Take your medication as prescribed: It stabilizes your thyroid levels.
  • Be patient. At the beginning of treatment and at different times throughout your life, your doctor might need to adjust your medication dose to make sure you’re at the dose that’s right for you. This includes trips to the doctor’s office and simple blood tests.
  • Keep learning. Understanding your condition and treatment inside-out can help you feel more in control
  • Get support and inspiration from other people living with hypothyroidism. Check out online support groups.

Hyperthyroidism:

  • Eat a healthy diet and avoid food and supplements containing iodine including shellfish.
  • Reduce stress by listening to music, taking a long bath or meditating in a quiet place
  • Aim for a regular sleep schedule.
  • Try yoga. Certain poses work to balance thyroid output.
  • Avoid caffeine and other stimulants as they may worsen certain symptoms such as fast heartbeat, nervousness, or concentration difficulties
  • Try putting ice packs on the throat to help to reduce inflammation
  • Eat plenty of cruciferous vegetables, which can help depress the thyroid such as cabbage, cauliflower, broccoli, Brussels sprouts, and spinach.

Thyroid Nodules:

Thyroid nodules typically do not have symptoms and therefore do not interfere with day-to-day life. However, it is always good to maintain a balanced lifestyle, to ensure that your condition does not worsen. A few things you can do to keep a balanced lifestyle include:

  • Take your prescribed medication at a regular time, to ensure an equal dosage of the medication in the body at all times.
  • Maintain a healthy diet.
  • Exercise regularly.

Screening

The US Preventative Services Task Force was unable to determine whether or not the benefits of screening for thyroid conditions outweighed the potential harm of unnecessary preemptive treatment. Screening for thyroid conditions is therefore not officially recommended. Since signs of thyroid conditions can be detected through basic blood tests and physical exams, many physicians choose to test patients that they feel may be at risk for developing thyroid conditions. If a doctor suspects an individual may have a thyroid condition, he or she may conduct several tests to arrive at a diagnosis.

Prevention

There are no proven ways to prevent thyroid conditions.

Complementary and Alternative Treatment

Hypothyroidism

Some people report the following alternative treatments are helpful, but there is no scientific evidence to confirm these claims.

  • Selenium. Low selenium may reduce the effectiveness of the thyroid hormones, and some studies have linked low levels of selenium with low thyroid function.
  • Vitamin A is another nutrient that has an important role to play in thyroid function, and a deficiency of this nutrient does seem to lower thyroid output. Other nutrients that are believed to be important for thyroid health include the minerals calcium and magnesium, and the amino acids L-tyrosine L-glutamine and L-glycine.
  • Various Chinese herbs.
  • Heat therapy. Saunas help to eliminate stored toxin, which may interfere with thyroid function.
  • Natural thyroid hormone. The quality and effectiveness of these natural agents sold in health food stores are unregulated. Some may not work at all. Others may have an active ingredient that does work but that may be dangerous to certain people.
  • Acupuncture. May correct hormonal imbalances.

Hyperthyroidism:

According to the University of Maryland Medical Center, these complementary therapies may help minimize symptoms of mild hyperthyroid.

  • Daily multivitamin containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
  • Diet rich with Omega-3 fatty acids such as salmon or take a fish oil supplements to help decrease inflammation and help with immunity. Omega-3 fatty acids can have a blood thinning effect. If you are taking blood thinning medications, speak to your doctor before taking Omega-3 fatty acids.
  • Calcium and vitamin D. Because hyperthyroidism may contribute to thinning bones, it’s important to get enough calcium every day to help prevent osteoporosis.
  • Green tea (Camellia sinensis) instead of caffeinated products.
  • Lemon balm tea 300 – 500 mg 3 times daily, to normalize an overactive thyroid. Steep 2 tbs. lemon balm in one cup of boiling water. Strain and cool.
  • Acupuncture may help correct hormonal imbalances.
  • Cruciferous vegetables such as cabbage, cauliflower, broccoli, Brussels sprouts, spinach, may help reduce inflammation.

Always let your doctor know of any complimentary or alternative treatments you plan to try before starting them, as they may interfere with your medications.

When To Contact A Doctor

If you think you may have a thyroid condition or disease or are experiencing any of the symptoms of one, schedule an appointment with your doctor. He or she will be able to make a diagnosis or refer you to a specialist if necessary.

If you’ve been diagnosed with hypothyroidism and are taking hormone replacement, see your doctor if you have any of the following symptoms, which could be signs of an overdose:

  • Palpitations
  • Rapid weight loss
  • Restlessness or shakiness
  • Sweating

Call your doctor immediately if you have been diagnosed with hyperthyroidism and:

  • You feel very irritable.
  • You have unusually high or low blood pressure compared to your normal blood pressure.
  • You feel nauseated, are throwing up, or have diarrhea.
  • Your heart is beating very fast or you have chest pain.
  • You have a fever.
  • You are confused or feel sleepy.
  • You cannot breathe well or you feel very tired, which can be symptoms of heart failure.
  • You develop symptoms of Graves’ ophthalmopathy, such as bulging, reddened eyes.
  • You feel very tired or weak.
  • You are losing weight even though you are eating normally or more than usual.
  • Your throat is swollen or you are having trouble swallowing

If you’ve been diagnosed with thyroid nodules, contact your doctor immediately if:

  • The growth of your nodules accelerates or is uncontrollable
  • You notice a raspy voice lasting longer than one month
  • Pain or swelling in the neck area occurs.

Questions For A Doctor

If your doctor tells you your thyroid is underactive, or overactive, you’ll want to find out more about your condition. Here are some questions to ask:

  • Why did I get a thyroid condition?
  • What’s the best treatment for me?
  • Are there alternatives to the treatment you’re advising?
  • Will I need to have treatment for the rest of my life?
  • What are the side effects of treatment? How can I cope with them?
  • What are the chances that someone else in my family will have a thyroid condition?
  • Should I see a specialist?