Thyroid Disorders - Everything You Should Know

What is thyroid disease?

Thyroid disease is a general term that is used for all medical conditions that interfere with the thyroid gland’s ability to make the optimum level of thyroid hormones. Generally, the two most common thyroid disorders are hypothyroidism and hyperthyroidism.

Hypothyroidism occurs when the thyroid gland makes too little thyroid hormone, which results in tiredness, lethargy, weight gain, etc. On the other hand, hyperthyroidism occurs when the thyroid gland is overactive and produces too much thyroid hormone. Hyperthyroidism can result in anxiety, increased heart rate, etc.

Additionally, other thyroid disorders include goiter and thyroid cancers. Goiter is the enlargement of the thyroid gland as a result of irregular cell growth resulting in lumps/nodules in the gland. While thyroid cancer is a malignant growth of the gland that can metastasize to other parts of the body.

How are thyroid diseases caused?

Thyroid problems are caused due to a variety of issues- such as iodine deficiency (or excess) in the body. Other common reasons are autoimmune disorders, bacterial (or viral) infection, nodules, medical treatments, etc. Knowing the exact cause of the thyroid disease is important to treat it effectively and permanently.

Types of Thyroid Disorders

• Thyroid cancer
• Goiter
• Hyperthyroidism
• Nodules on Thyroid Gland

Causes

• Inflammation of the thyroid gland (thyroiditis)

• Hashimoto’s thyroiditis – an autoimmune condition of the thyroid gland

• Postpartum inflammation of the thyroid gland

• Iodine deficiency

• Non-functional thyroid gland in newborns

• Graves’ disease, also known as diffuse toxic goiter – overactivity of the thyroid gland

• Thyroid nodules also called toxic multi-nodular goiter

• Excessive iodine

Symptoms

• Large, solid swelling in the throat

• Anxiety, irritability, and nervousness

• Difficulty in sleeping

• Rapid weight loss or gain

• Muscle tremors and weakness

Diagnosis

Self- Diagnosis

Most thyroid problems are often easily self-diagnosed as they are accompanied by irregular growth of the thyroid gland. Examine the front of your neck and feel for any lumps, nodules, or irregular growths. If you do, then consult an ENT doctor immediately.

Physical Examination

Once you visit an ENT doctor, they will collect your entire medical history and family history and assess if you are at risk for thyroid problems. The ENT doctor will also perform an extensive physical examination to determine if your thyroid gland is enlarged, bumpy or tender. If there are any suspicious results in the physical examination, then your ENT doctor will schedule the appropriate diagnostic tests for you.

Diagnostic Tests

The most common diagnostic tests for thyroid disorders are:

• Blood tests: Blood tests to measure the thyroxine (T4 hormone) and thyroid-stimulating hormones help confirm the diagnosis of thyroid disorder. High levels of thyroxine and low or nonexistent amounts of TSH are indicators of hyperthyroidism (overactive thyroid gland).
• Radioiodine uptake test: This test is performed to determine how much iodine the thyroid gland is intaking by having the patient ingest radioactive iodine. Higher iodine intake is a sign of extra thyroxine production due to either Graves’ disease or hyperfunctioning thyroid nodules.
• Thyroid scan: It is performed by injecting radioactive iodine into the bloodstream to visualize iodine uptake by the gland and determine whether the patient has thyroid issues such as hyperthyroidism, cancer, or other growths.
• Thyroid ultrasound: Ultrasounds are very helpful for imaging thyroid problems in patients where radioactive exposure is contraindicated, for example, pregnant women, developing children, etc.
• Tissue biopsy: If the patient has suspicious growth on the thyroid gland, a fine-needle aspiration biopsy may be performed to extract tissue from the thyroid gland to determine if the patient has thyroid cancer.

Based on the patient’s symptoms and severity, the doctor may need to issue other diagnostic tests such as antibody tests, endoscopy, etc.

Risks & Complications

Risk factors leading to thyroid diseases

• Family history of thyroid disease
• Medical conditions like pernicious anemia, type 1 diabetes, primary adrenal insufficiency, lupus, rheumatoid arthritis, Sjögren’s syndrome, and Turner syndrome
• Medicines that interfere with iodine absorption or have high iodine concentrations
• Women in old age, especially above 60
• Medical history of thyroid issues or cancer

If left untreated

If thyroid diseases are not treated properly and promptly, they can lead to a variety of issues such as:

• Exophthalmos, or proptosis, i.e., bulging out of eyes, leading to blurred vision, or in severe cases, complete loss of vision
• Heart issues, like increased heart rate, irregular heart rhythm, and in severe cases, heart failure
• Osteoporosis, i.e., brittle bones
• Red and swollen skin, especially in the shin and feet regions
• Thyrotoxic crisis, worsening of symptoms like fever, rapid heart rate, etc., leading to delirium and irregular heartbeat, that requires immediate medical attention
• Benign thyroid growths (goiter) can also obstruct the airway and voice box and lead to breathing and speaking difficulties.
• Nerve damage leading to tingling, numbness, and pain in the limbs
• Infertility
• Birth defects
• Miscarriage or premature birth
• Mental health issues like anxiety, delirium, depression, etc.
• Myxedema
• Graves eye disease, dermopathy, heart problems, and osteoporosis.
• Suspicious nodules/growths on the thyroid gland can be a sign of metastatic thyroid cancer.

Myths and Facts

Myth: Hypothyroidism only occurs in middle-aged women.

Fact: Though it mostly occurs in women, hypothyroidism is an endocrine disorder that can occur at any age and in both genders. Low thyroid hormone levels in men are a common factor behind poor sexual libido and erectile dysfunction.

Myth: All patients with thyroid problems get goiter.

Fact: No, goiter, i.e., the enlargement of the thyroid gland, may not occur in the early stages of the thyroid disease. In fact, nowadays, it is more common for even severe thyroid problems not to have an associated goiter.

Myth: Patients can stop taking thyroid supplements once their hormone levels are normal.

Fact: If you are undergoing thyroidectomy, you may need to take thyroid hormone replacement supplements such as TSH and thyroxine for the rest of your life. This is why often hemithyroidectomy surgeries such as subtotal thyroidectomy or thyroid lobectomy surgeries are preferred.

Myth: Consumption of brassica family vegetables like cabbage, cauliflower, broccoli, etc. can lead to thyroid issues.

Fact: Various research studies have indicated that cooked consumption of these vegetables does not affect the thyroid gland. They can even be consumed raw in small quantities.

Myth: All lumps or nodules on the thyroid are signs of thyroid cancer.

Fact: This is a common misconception but only 5% of thyroid nodules/growths are cancerous, the rest are all benign.

Myth: Thyroid cancer is incurable.

Fact: If detected early, thyroid cancer can be easily cured through thyroid surgery and radioiodine treatment (radiotherapy).

Myth: Women can’t get pregnant if they have thyroid disease.

Fact: With proper care and treatment, including thyroid supplements and hormone replacements, women can get pregnant even with thyroid disease.

Myth: Surgery is necessary for the treatment of all thyroid disorders.

Fact: If the growth is benign, thyroidectomy is only performed if the patient is having significant trouble breathing or swallowing or if the thyroid gland is causing cosmetic issues.

Prevention

You can reduce the risk of thyroid disease by doing the following:

• If you are a smoker, then you should quit smoking.
• Some studies have linked soy consumption to thyroid disease, so if you are consuming soy products, you should stop.
• If you are getting X-rays, then you should ask for a thyroid collar to protect the thyroid gland from radiation exposure.
• Selenium is an important mineral for thyroid health. If you are low on selenium, you should consider taking supplements.
• Perform self-checks of the thyroid gland regularly so that if you have any lumps, growths, or nodules, they can be detected and treated early.
• Incidence of thyroid disease is often linked with celiac disease, so get yourself checked and treated promptly.
• If you are low on iodine, then consider taking iodine supplements.

When to consult a doctor?

You should consult an ENT/endocrinologist if:

• you are feeling tired and weak all the time and you are experiencing extreme weight gain or loss issues.
• you have a thyroid nodule or lump.
• you have an enlarged thyroid gland.
• you are having difficulty getting pregnant.
• you have hair loss and skin rashes with dry and scaly skin.
• you are pregnant.
• you have pituitary gland troubles.
• you are not feeling better despite treatment from your family doctor.

Questions to ask your doctor .

• Are there any alternatives to surgical treatment for me?
• How much experience do you have?
• Have you performed any successful thyroidectomies before?
• How much of my thyroid gland will be removed? How will it be decided?
• What surgical technique will be used to perform my thyroidectomy?
• How can I prepare for surgery?
• How much follow-up will I need after surgery?
• How long will I have to take supplements after my surgery?
• Will the surgery affect my quality of living in any way?
• How will I take my thyroid replacement hormones?
• Will I have a scar after the surgery? How long will it be?
• Can I reduce my chances of postoperative complications?
• How long will I be hospitalized after the surgery?
• What will my recovery entail?

Thyroidectomy Treatment Overview

The main goal of thyroid disease treatment is to return the thyroid hormone levels to normal. It can be done surgically and conservatively, depending on the patient’s health, the nature and severity of the condition, etc. Some common conservative treatments for thyroid disease are:

• Anti-thyroid drugs (methimazole and propylthiouracil) help stop the thyroid gland from making excess thyroid hormones.
• Radioactive iodine damages a part of the thyroid glands and prevents them from making thyroid hormones.
• Beta-blockers help control and manage the symptoms caused due to thyroid disorders.
• Thyroid replacement medications like synthetic thyroid hormones (levothyroxine), thyroid supplements, etc. help manage low thyroid hormone levels.

Other than this, patients can also get surgical treatment through a thyroidectomy to surgically remove part of the thyroid gland.

Insurance coverage

Thyroid treatments, both conservative and surgical, have long-term repercussions such as thyroid replacement supplements, systemic disorders, etc., which can make the treatment very expensive. Since it comes under the list of pre-existing conditions such as diabetes, its treatment may not be covered under insurance.

Most leading healthcare providers in India, such as Max Bupa, New India,  Religare, United India Insurance, Care Health, etc., cover the cost of thyroidectomy. If you have a health insurance policy and are unsure whether it covers thyroid treatment, then consult your insurance provider regarding your insurance coverage.