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Thyroid diseases contain many different types from an
overactive thyroid called “hyperthyroidism” or a low performing thyroid called “hypothyroidism”. Your thyroid make thyroid hormones. When it produces too much this is “hyper-”
and not enough is “hypo-”. The thyroid
gland can also become enlarged. This
condition is called “goiter”. If the
thyroid gland swells it is called “thyroiditis”. When there are lumps in the thyroid gland
they are called “thyroid nodules”. “Thyroid
Cancer” of the gland is also included in thyroid diseases. Women are more likely than men to develop
thyroid diseases.
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Your
thyroid (THY-roid) is a small gland found at the base of your neck, just below
your Adam's apple. The thyroid produces two main hormones called T3
and T4. These hormones travel in your blood to all parts of your body. The
thyroid hormones control the rate of many activities in your body. These
include how fast you burn calories and how fast your heart beats. All of these
activities together are known as your body's metabolism. A thyroid that
is working right will produce the right amounts of hormones needed to keep your
body’s metabolism working at a rate that is not too fast or too slow.
What is hyperthyroidism?
Some
disorders cause the thyroid to make more thyroid hormones than the body needs.
This is called hyperthyroidism (hy-pur-THY-roi-diz-uhm), or overactive thyroid.
The most common cause of hyperthyroidism is Graves' disease.
Graves’ disease is an autoimmune disorder, in which the body's own defense
system, called the immune system, stimulates the thyroid. This causes it to
make too much of the thyroid hormones. Hyperthyroidism can also be caused by
thyroid nodules that prompt excess thyroid hormones to be made (see What are thyroid
nodules?).
What are the symptoms of
hyperthyroidism?
At first,
you might not notice symptoms of hyperthyroidism. They usually begin slowly.
But over time, a speeded up metabolism can cause symptoms such as:
- Weight loss, even if you eat the same or
more food
- Eating more than usual
- Rapid or irregular heartbeat or pounding
of your heart
- Anxiety
- Irritability
- Trouble sleeping
- Trembling in your hands and fingers
- Increased sweating
- Increased sensitivity to heat
- Muscle weakness
- More frequent bowel movements
- Less frequent menstrual periods with
lighter than normal menstrual flow
In
addition to these symptoms, people with hyperthyroidism may have osteoporosis,
or weak, brittle bones. In fact, hyperthyroidism might affect your bones before
you have any of the other symptoms of the disorder. This is especially true of
postmenopausal women, who are already at high risk of osteoporosis.
What is
hypothyroidism?
Hypothyroidism
(hy-poh-THY-roi-diz-uhm) is when your thyroid does not make enough thyroid
hormones. It is also called underactive thyroid. The most common cause of
hypothyroidism in the United States is Hashimoto's
disease. Hashimoto’s disease is an autoimmune disease, in which the
immune system mistakenly attacks the thyroid. This attack damages the thyroid
so that it does not make enough hormones. Hypothyroidism also can be caused by:
- Treatment of hyperthyroidism
- Radiation treatment of certain
cancers
- Thyroid removal
In rare
cases, problems with the pituitary gland can
cause the thyroid to be less active.
What
are the symptoms of hypothyroidism?
Symptoms of hypothyroidism tend to develop
slowly, often over several years. At first, you may just feel tired and
sluggish. Later, you may develop other symptoms of a slowed down metabolism,
including:
- Weight gain, even though you are
not eating more food
- Increased sensitivity to cold
- Constipation
- Muscle weakness
- Joint or muscle pain
- Depression
- Fatigue (feeling very tired)
- Pale dry skin
- A puffy face
- A hoarse voice
- Excessive menstrual bleeding
In
addition to these symptoms, people with hypothyroidism may have high blood
levels of LDL cholesterol. This is the so‑called "bad" cholesterol,
which can increase your risk for heart disease.
What are thyroid nodules?
A thyroid
nodule (NAHD-yool) is a swelling in one section of the thyroid gland. The
nodule can be solid or filled with fluid or blood. You can have just one
thyroid nodule or many.
Most
thyroid nodules do not cause symptoms. But some thyroid nodules make too much
of the thyroid hormones, causing hyperthyroidism. Sometimes, nodules get to be
big enough to cause problems with swallowing or breathing. In fewer than 10
percent of cases, thyroid nodules are cancerous.
Thyroid
nodules are quite common. By the time you reach the age of 50, you have a 50
percent chance of having a thyroid nodule larger than a half inch wide. The NIH
does not know why nodules form in otherwise normal thyroids.
You can
sometimes see or feel a thyroid nodule yourself. Try standing in front of a
mirror and raise your chin slightly. Look for a bump on either side of your
windpipe below your Adam's apple. If the bump moves up and down when you
swallow, it may be a thyroid nodule. Ask your doctor to look at it.
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What is
thyroiditis?
Thyroiditis
(thy-roi-DY-tiss) is inflammation, or swelling, of the thyroid. There are
several types of thyroiditis, one of which is Hashimoto's
thyroiditis. Other types of thyroiditis include:
Postpartum
thyroidits
Like Hashimoto's disease, postpartum thyroiditis seems to be caused by a problem with the immune system. In the United States, postpartum thyroiditis occurs in about 5 to 10 percent of women. The first phase starts 1 to 4 months after giving birth. In this phase, you may get symptoms of hyperthyroidism because the damaged thyroid is leaking thyroid hormones out into the bloodstream. The second phase starts about 4 to 8 months after delivery. In this phase, you may get symptoms of hypothyroidism because, by this time, the thyroid has lost most of its hormones. Not everyone with postpartum thyroiditis goes through both phases. In most women who have postpartum thyroiditis, thyroid function returns to normal within 12 to 18 months after symptoms start.
Like Hashimoto's disease, postpartum thyroiditis seems to be caused by a problem with the immune system. In the United States, postpartum thyroiditis occurs in about 5 to 10 percent of women. The first phase starts 1 to 4 months after giving birth. In this phase, you may get symptoms of hyperthyroidism because the damaged thyroid is leaking thyroid hormones out into the bloodstream. The second phase starts about 4 to 8 months after delivery. In this phase, you may get symptoms of hypothyroidism because, by this time, the thyroid has lost most of its hormones. Not everyone with postpartum thyroiditis goes through both phases. In most women who have postpartum thyroiditis, thyroid function returns to normal within 12 to 18 months after symptoms start.
Risk
factors for postpartum thyroiditis include having:
- An autoimmune
disease, like type 1 diabetes
- A personal history or family
history of thyroid disorders
- Having had postpartum thyroiditis
after a previous pregnancy
Silent or
painless thyroiditis
Symptoms are the same as in postpartum thyroiditis, but they are not related to having given birth.
Symptoms are the same as in postpartum thyroiditis, but they are not related to having given birth.
Subacute
thyroiditis
Symptoms are the same as in postpartum and silent thyroiditis, but the inflammation in the thyroid leads to pain in the neck, jaw, or ear. Unlike the other types of thyroiditis, subacute thyroiditis may be caused by an infection.
Symptoms are the same as in postpartum and silent thyroiditis, but the inflammation in the thyroid leads to pain in the neck, jaw, or ear. Unlike the other types of thyroiditis, subacute thyroiditis may be caused by an infection.
Most
people with thyroid cancer have a thyroid nodule that is not causing any
symptoms. If you have a thyroid nodule, there is a small chance it may be
thyroid cancer. To tell if the nodule is cancerous, your doctor will have to do
certain tests (see How are thyroid
diseases diagnosed?). A few people with thyroid cancer may have
symptoms. If the cancer is big enough, it may cause swelling you can see in the
neck. It may also cause pain or problems swallowing. Some people get a hoarse
voice.
Thyroid
cancer is rare compared with other types of cancer. It is more common in people
who:
- Have a history of exposure of the
thyroid to radiation (but not routine X-ray exposure, as in dental X-rays
or mammograms)
- Have a family history of thyroid
cancer
- Are older than 40 years of age
What is
a goiter?
A goiter
is an abnormally enlarged thyroid gland. Causes of goiter include:
- Iodine deficiency. Iodine is a
mineral that your thyroid uses for making thyroid hormones. Not getting
enough iodine in your food and water can cause your thyroid to get bigger.
This cause of goiter is uncommon in the United States because iodine is
added to table salt.
- Hashimoto's
disease
- Graves'
disease
- Thyroid
nodules
- Thyroiditis
- Thyroid
cancer
Usually,
the only symptom of a goiter is a swelling in your neck. But a very large or
advanced goiter can cause a tight feeling in your throat, coughing, or problems
swallowing or breathing.
Having a
goiter does not always mean that your thyroid is not making the right amount of
hormones. Depending on the cause of your goiter, your thyroid could be making
too much, not enough, or the right amount of hormones.
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How are
thyroid disorders diagnosed?
Thyroid
disorders can be hard to diagnose because their symptoms can be linked to many
other health problems. Your doctor will start by taking a medical history and
asking if any of your family members has a history of thyroid disorders. Your
doctor will also give you a physical exam and check your neck for thyroid
nodules. Depending on your symptoms, your doctor may also do other tests, such
as:
Blood
tests
Testing the level of thyroid stimulating hormone (TSH) in your blood can help your doctor figure out if your thyroid is overactive or underactive. TSH tells your thyroid to make thyroid hormones. Depending on the results, your doctor might order another blood test to check levels of one or both thyroid hormones in your blood. If your doctor suspects an immune system problem, your blood may also be tested for signs of this.
Testing the level of thyroid stimulating hormone (TSH) in your blood can help your doctor figure out if your thyroid is overactive or underactive. TSH tells your thyroid to make thyroid hormones. Depending on the results, your doctor might order another blood test to check levels of one or both thyroid hormones in your blood. If your doctor suspects an immune system problem, your blood may also be tested for signs of this.
Radioactive
iodine uptake test
For this test, you swallow a liquid or capsule containing a small dose of radioactive iodine (radioiodine). The radioiodine collects in your thyroid because your thyroid uses iodine to make thyroid hormones. Then, a probe placed over your thyroid measures the amount of radioiodine in your thyroid. A high uptake of radioiodine means that your thyroid is making too much of the thyroid hormones. A low uptake of radioiodine means that your thyroid is not making enough of the thyroid hormones.
For this test, you swallow a liquid or capsule containing a small dose of radioactive iodine (radioiodine). The radioiodine collects in your thyroid because your thyroid uses iodine to make thyroid hormones. Then, a probe placed over your thyroid measures the amount of radioiodine in your thyroid. A high uptake of radioiodine means that your thyroid is making too much of the thyroid hormones. A low uptake of radioiodine means that your thyroid is not making enough of the thyroid hormones.
Thyroid
scan
A thyroid scan usually uses the same radioiodine dose that was given by mouth for your uptake test. You lie on a table while a special camera creates an image of your thyroid on a computer screen. This test may be helpful in showing whether a thyroid nodule is cancerous. Three types of nodules show up in this test:
A thyroid scan usually uses the same radioiodine dose that was given by mouth for your uptake test. You lie on a table while a special camera creates an image of your thyroid on a computer screen. This test may be helpful in showing whether a thyroid nodule is cancerous. Three types of nodules show up in this test:
- Thyroid nodules that take up
excess radioiodine are making too much of the thyroid hormones, causing
hyperthyroidism. These nodules show up brightly on the scan and are called
"hot" nodules.
- Thyroid nodules that take up the
same amount of radioiodine as normal thyroid cells are making a normal
amount of thyroid hormones. These are called "warm" nodules.
- Thyroid nodules that do not take
up radioiodine are not making thyroid hormones. They appear as defects or
holes in the scan and are called "cold" nodules.
Hot
nodules are almost never cancerous. A small percentage of warm and cold nodules
are cancerous.
Thyroid
fine needle biopsy
This test is used to see if thyroid nodules have normal cells in them. Local anesthetic may be used to numb an area on your neck. Then, a very thin needle is inserted into the thyroid to withdraw some cells and fluid. The withdrawal of cells and fluid is called a biopsy (BY-op-see). A special type of doctor called a pathologist (path-ol-uh-jist) examines the cells under a microscope to see if they are abnormal. Abnormal cells could mean thyroid cancer.
This test is used to see if thyroid nodules have normal cells in them. Local anesthetic may be used to numb an area on your neck. Then, a very thin needle is inserted into the thyroid to withdraw some cells and fluid. The withdrawal of cells and fluid is called a biopsy (BY-op-see). A special type of doctor called a pathologist (path-ol-uh-jist) examines the cells under a microscope to see if they are abnormal. Abnormal cells could mean thyroid cancer.
Thyroid
ultrasound
The thyroid ultrasound uses sound waves to create a computer image of the thyroid. This test can help your doctor tell what type of nodule you have and how large it is. Ultrasound may also be helpful in detecting thyroid cancer, although by itself it cannot be used to diagnose thyroid cancer. You may have repeat thyroid ultrasounds to see if your nodule is growing or shrinking.
The thyroid ultrasound uses sound waves to create a computer image of the thyroid. This test can help your doctor tell what type of nodule you have and how large it is. Ultrasound may also be helpful in detecting thyroid cancer, although by itself it cannot be used to diagnose thyroid cancer. You may have repeat thyroid ultrasounds to see if your nodule is growing or shrinking.
How is
hyperthyroidism treated?
Your
doctor's choice of treatment will depend on the cause of your hyperthyroidism
and how severe your symptoms are. Treatments include:
- Antithyroid medicines block the
thyroid's ability to make new thyroid hormones. These drugs do not cause
permanent damage to the thyroid.
- Radioiodine damages or
destroys the thyroid cells that make thyroid hormones. For this treatment,
your doctor will give you a higher dose of a different type of radioiodine
than is used for the radioiodine uptake test or the thyroid scan.
- Surgery to remove
most of the thyroid.
- Beta (BAY-tuh)-blockers are
medicines that block the effects of thyroid hormones on the body. These
medicines can be helpful in slowing your heart rate and reducing other
symptoms until one of the other forms of treatment can take effect.
Beta-blockers do not reduce the amount of thyroid hormones that are made.
If your
thyroid is destroyed by radioiodine or removed through surgery, you must take
thyroid hormone pills for the rest of your life. These pills give your body the
thyroid hormones that your thyroid would normally make.
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How is hypothyroidism treated?
Hypothyroidism
is treated with medicine to supply the body with the thyroid hormones it needs
to function right. The most commonly used medicine is levothyroxine
(le-voh-thy-ROK-suhn). This is a man-made form of T4. It is exactly the same as
the T4 that your thyroid makes. When you take T4, your body makes the T3 it
needs from the T4 in the pills. A man-made form of T3, called liothyronine
(ly-oh-THY-roh-neen), is also available. Some doctors and patients prefer a
combination of T4 and T3 or T3 by itself. Most patients with hypothyroidism
will need to be on thyroid hormone treatment for the rest of their lives.
How are
thyroid nodules treated?
Treatment
depends on the type of nodule or nodules that you have. Treatments include:
- Watchful waiting. If your nodule
is not cancerous, your doctor may decide to simply watch your condition.
This involves giving you regular physical exams, blood tests, and perhaps
thyroid ultrasound tests. If your nodule does not change, you may not need
further treatment.
- Radioiodine. If you have
nodules that are making too much of the thyroid hormones, radioiodine
treatment may be used. The radioiodine is absorbed by the thyroid nodules,
and it causes them to shrink and make smaller amounts of thyroid hormones.
- Alcohol ablation (uh-BLAY-shuhn).
In this procedure, your doctor injects alcohol into thyroid nodules that
make too much of the thyroid hormones. The alcohol shrinks the nodules and
they make smaller amounts of thyroid hormones.
- Surgery. All nodules
that are cancerous are surgically removed. Sometimes, nodules that are not
cancerous but are big enough to cause problems breathing or swallowing are
also surgically removed.
How is
thyroid cancer treated?
- Surgery. The main
treatment for thyroid cancer is to remove the entire thyroid gland, or as
much of it as can be safely removed. Often, surgery alone will cure the
thyroid cancer, especially if the cancer is small.
- Radioiodine. A large dose
of radioiodine will destroy thyroid cancer cells with little or no damage
to other parts of the body.
How is
goiter treated?
The
treatment for goiter depends on the cause of the goiter. If your goiter is
caused by not getting enough iodine, you may be given an iodine supplement to
swallow and T4 hormone, if need be. Other treatments include:
- Radioiodine to shrink the goiter,
especially if parts of the goiter are overactive
- Surgery to remove part or almost
all of the thyroid
Are there any complementary or
alternative treatments for thyroid problems?
To date,
the NIH doesn’t know enough about alternative treatments for thyroid problems.
Your doctor can explain which treatment options are best for you.
Can
thyroid disorders cause problems with pregnancy?
Both
hyperthyroidism and hypothyroidism can make it more difficult for you to become pregnant.
Hyperthyroidism
that is not properly treated during pregnancy can cause:
- Early labor and premature babies
- Preeclampsia
(pre-ee-CLAMP-see-uh), a serious condition starting after 20 weeks of
pregnancy that causes high blood pressure and problems with the kidneys
and other organs
- Fast heart rate of the developing
baby
- Smaller babies
- Stillbirths
Women who
have hypothyroidism that is not diagnosed or properly treated during pregnancy
may be at increased risk for:
- Anemia (lower
than normal number of healthy red blood cells)
- Preeclampsia
- Low birth weight babies
- Problems with brain development in
the baby
- Abnormal bleeding after giving
birth
If you
are pregnant or are thinking about becoming pregnant, ask your doctor if you
need a thyroid test. This is especially true if you or a family member has a
history of thyroid problems or conditions related to thyroid disorders,
including:
- Prematurely gray hair
- White patches on the skin
- Type 1 diabetes
Can I exercise if I have a
thyroid problem?
Some
people with thyroid problems may find exercise difficult. It is important to
talk to your doctor about the right amount of physical activity for you.
Should
I get tested for thyroid diseases?
Ask your
doctor or nurse if you need to have a thyroid test. This is especially important
if you are of childbearing age, have already had a thyroid problem, or have had
surgery or radiotherapy affecting the thyroid gland. You may also be at higher
risk if you have:
- Goiter
- Pernicious anemia
- Type 1 diabetes
- Vitiligo
- Prematurely gray hair
At any
age, be sure to ask your doctor about any thyroid disorder symptoms you might
have.
The above information is from the National Institutes of
Health (NIH) and their department of Women’s Health.
Read more online at their websites:
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