Thyroid Disorders—Testing and Treatment
According to the American Thyroid Association (ATA), undiagnosed thyroid dysfunction can put individuals at risk for a number of serious health conditions including, cardiovascular disease, osteoporosis, and infertility. Although extremely rare, if left untreated, certain conditions such as hypothyroidism can even lead to life threatening conditions including “myxedema” a comatose state due to a slowdown in metabolism.
The ATA predicts that more than 12 percent of Americans will develop a thyroid condition in their lifetime. Fortunately, most disorders respond positively to treatment interventions.
Who needs thyroid testing?—Why Women are Vulnerable
While thyroid disorders affect both men and women at different times in their life, studies indicate that females are actually 5 to 8 more times likely to suffer from thyroid dysfunction than their male counterparts. This means that 1 in every 8 women will develop some type of thyroid disorder in her lifetime.
While it is not known for sure why women are more susceptible to thyroid dysfunction, some scientists theorize that women’s hormonal systems are more complex than men’s, and are therefore more readily affected by xeno-estrogens (false estrogens) found in the environment. Xeno-estrogens are chemicals found in many products including, plastics and pesticides. These tend to mimic naturally produced hormones in women and have the potential to greatly disrupt the female endocrine system. This is due, in part, to the large numbers of estrogen receptors found in the female body. Women also have more problems with yeast and candida infections that can contribute to endocrine imbalances.
It is also possible that more women than men seek treatment for thyroid dysfunction because of female-related symptoms. Women notice changes in their menstrual cycles such as, unusually light flow, heavy flow, or the absence of a period altogether. Women may also have difficulty getting pregnant, because ovulation is irregular. Some may also develop thyroid problems during a pregnancy.
What does the thyroid do?
The thyroid gland primarily regulates metabolism, however, it impacts most of the body’s organs in some way. Weighing no more than 18 ½ grams for men, and 14 ½ grams for women, the thyroid plays an important role in the body’s endocrine system. By converting iodine, found in many foods, the thyroid releases hormones, commonly referred to as thyroxine (T4) and triiodothyronine (T3) into the bloodstream.
Thyroid hormone affects:
- Brain development
- Heart function
- Nervous system function
- Body temperature
- Strength of muscles
- Dryness of skin
- Menstrual cycles
- Cholesterol levels
Types of Thyroid Disorders
There are two types of thyroid disorders in general; those that cause abnormal function, and those that are from abnormal growths in the gland itself. Though they can certainly affect younger people, thyroid disorders are most common in older adults. Disorders involving function are very often caused from over or under production of thyroid hormone, while growth disorders usually involve either benign nodules, or thyroid cancers. While benign nodules are much more common than cancerous growths, malignant thyroid tumors are still 90% treatable with the right medical interventions.
Hypothyroidism (under-production of thyroid hormone) in the U.S. is most often caused by Hashimoto’s disease. This occurs when the body’s immune system attacks the thyroid by mistake, damaging its ability to make enough thyroid hormone.
Hypothyroidism can develop slowly and may create symptoms including:
- Feeling cold
- Weak muscles
- Weight gain
- Joint pain
- Dry skin
- Dry hair
- Slow heart rate
- Less sweating
- Puffy face
- Hoarse voice
- Heavy period
- High (bad) cholesterol
Testing for Thyroid Disorders
Blood and imaging tests can be used to detect and diagnose thyroid conditions.
- TSH—Thyroid-stimulating hormone accurately measures the amount of hormone produced by the pituitary gland.
- T3 and T4—Measures T3 and T4 thyroid levels.
- TSI—Measures thyroid-stimulating immunoglobulin.
- Antithyroid antibody test—Measures markers in the blood, known as antibodies.
- T3 Uptake—Measures proteins in the blood that carry thyroid hormones.
- Free Thyroxine (T4) Index—Compares free T4 to protein bound T4.
- Reverse T3—Measures Reverse T3, produced sometimes when the body is under stress.
Tests can be ordered by a physician and performed at a laboratory or taken at home using an approved home test collection kit.
CT scans, ultrasound, and nuclear medicine tests all provide images of the thyroid gland. Shape, size, or position of the gland can indicate causes for certain thyroid diseases, as well as identify nodules. The radioactive iodine uptake test checks thyroid function and can help determine why an individual has hyperthyroidism.
Treatment for Thyroid Disorders
Most thyroid disorders respond well to synthetic hormone replacement therapies that mimic natural thyroid hormone.
Hypothyroidism, which signifies a hormone deficiency, is successfully treated with thyroid medication. Treatment is usually ongoing.
Hyperthyroidism indicates the body is producing too much thyroid hormone. Heart rate and metabolism are most often affected. A common condition known as “Grave’s disease” involving the immune system is responsible for many cases of hyperthyroidism.
Based on the symptoms of hyperthyroidism and the cause for the condition, a physician may choose one of the following treatment options:
- Antithyroid medicine—Blocks thyroid from new thyroid hormone production.
- Beta-blockers—Temporarily block thyroid hormone effects while further treatment is explored.
- Radioiodine—Kills thyroid cells to stop over-production of hormone. May cause permanent hypothyroidism.
- Thyroid surgery—Removes some or all of the thyroid gland. May cause hypothyroidism to be permanent.
Thyroiditis involves inflammation of the thyroid due to a faulty immune system, caused by one of the following:
- Autoimmune diseases, (including type 1 diabetes and rheumatoid arthritis)
- Bacterial infection
- Viral infection
- Hashimoto’s disease
- Postpartum thyroiditis
Medication may be used to treat thyroiditis. Postpartum thyroiditis may resolve on its own several months after pregnancy.
Goiter occurs when the thyroid is greatly enlarged, causing neck swelling.
This may resolve on its own, but can also indicate a thyroid disease needs treatment. Medication or surgery to shrink the thyroid is common.
Nodules are growths on the thyroid gland that may be solid, fluid-filled, or blood-filled.
Treatment for nodules may involve surgery, radioiodine, or simple monitoring if nodules do not change.
Thyroid cancer affects cells found within thyroid tissue.
Treatment may involve surgery to remove thyroid completely, or just affected tissue. Radioiodine may be used after surgery to kill any remaining cancer cells in the thyroid or other parts of the body.
The thyroid, responsible for so many regulatory processes within the body can become diseased or damaged for a number of reasons. While treatment outcomes are generally favorable, thyroid conditions go undiagnosed in 60% of the cases. Testing for thyroid function is a critical first step toward healing, and a healthy endocrine system. Finding an endocrinologist to manage symptoms and treat the underlying cause of thyroid dysfunction is essential.
1Association, A.T. (2017) ‘General information/press room – American thyroid association’, Available at: http://www.thyroid.org/media-main/about-hypothyroidism/ (Accessed: 18 January 2017).
2CDC (2010) HTDS guide – about thyroid disease: Section summary. Available at: https://www.cdc.gov/nceh/radiation/hanford/htdsweb/guide/thyroid.htm (Accessed: 18 January 2017).
3LLC, T.W. (2017) What is the thyroid? Available at: https://www.womenshealth.gov/a-z-topics/thyroid-disease (Accessed: 18 January 2017).
4Pankow, B., Michalak, J. and McGee, M. (1985) ‘Adult human thyroid weight’, Health physics., 49(6), pp. 1097–103.
5Thyroid tests (2016) Available at: https://www.niddk.nih.gov/health-information/health-topics/diagnostic-tests/thyroid-tests/Pages/default.aspx (Accessed: 18 January 2017).
Is There Any Permanent Treatment For Thyroid Issue?
That depends on the type of thyroid condition present and the reason for the dysfunction. The most common thyroid disorders include hypothyroidism, hyperthyroidism, and thyroid nodules (either benign or malignant).
Each of these conditions (excluding malignant cancer) can be classified as transient, secondary, or primary. Transient conditions are only temporary and disappear when the cause is gone. Secondary thyroid disorders involve some other organ dysfunction and resolve when that is treated. A primary condition originates in the thyroid gland itself and may or may not be permanently treatable.
Hypothyroidism is an inability of the thyroid gland to produce enough thyroid hormone and can be caused by an iodine deficiency in the diet. This is fairly uncommon in the U.S., however. If thyroid cells have been destroyed by an infection or disease, replacement thyroid stimulating hormone in the form of oral medication is usually prescribed.
Hyperthyroidism exists when the thyroid produces too much thyroid hormone. Treatment can include anti-thyroid medications, beta-blockers, surgery, or radioactive thyroid therapy. Both surgery and radioactive therapy would be permanent.
The presence of a thyroid nodule alone may not warrant treatment, as long as the cells are benign and don’t affect thyroid hormone levels. If several nodules exist, contain malignant cells, or have spread to the lymph nodes, surgery and radiation may be necessary, as well as supplemental medication indefinitely.
Thyroid support through nutritional supplementation may be all that is needed in some cases where conditions are mild.
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