Thyroid disease

Tuesday, October 03, 2017

Thyroid disease is a common problem that can cause symptoms because of over- or under-function of the thyroid gland. The thyroid gland is an essential organ for producing thyroid hormones, which maintain are body metabolism. The thyroid gland is located in the front of the neck below the Adam’s apple

Here are 10 Familiar Symptoms:

Muscle and Joint Pains Tendonitis

Neck Discomfort

Enlargement, Hoarseness, Goitre

Hair Loss, Hair Changes, Skin Changes

Constipation, Bowel Problems, Diarrheal, Irritable Bowel

Menstrual Irregularities and Fertility Problems

Family History of Thyroid and Autoimmune Disease

High Cholesterol, Unresponsive to Cholesterol Medications

Depression and Anxiety

Unexpected Weight Changes without Changes to Diet and Exercise

Fatigue, Exhaustion

The thyroid, a butterfly-shaped gland located in the neck, is the master gland of metabolism. When your thyroid doesn’t function, it can affect every aspect of your health, and in particular, weight, depression and energy levels.

Undiagnosed thyroid problems can dramatically increase your risk of obesity, heart disease, depression, anxiety, hair loss, sexual dysfunction, infertility and a host of other symptoms and health problems.

So, the importance of recognizing the signs and symptoms, and getting a proper diagnosis and treatment, is clear.

How are thyroid disorders diagnosed?

In addition to thorough medical history and physical exam, specialized tests are used to diagnose thyroid disorders.

Blood tests are typically done to measure levels of thyroid hormones and TSH. Blood tests to identify antibodies against thyroid tissue may also be ordered by your doctor, such as titers of anti-thyroglobulin, anti-thyroperoxidase, or TSH receptor stimulating antibodies.

Imaging tests are commonly used when thyroid nodules or enlargement are present. Ultrasound can visualize the consistency of the tissue within the gland and can often reveal cysts or calcifications. Ultrasound examination cannot distinguish a benign from a malignant process.

Thyroid scans using radioactive iodine are often performed to evaluate the function of thyroid nodules. The thyroid is the only location in the body that takes up iodine, so when radioactively labeled iodine is given, it is taken up by the thyroid gland. An imaging test typically shows uptake of radioactive iodine by normal thyroid tissue. Areas or nodules that are producing excess hormone (referred to as hyper functioning) will show an increased uptake of iodine. These are referred to as “hot” nodules or areas. By contrast, so-called “cold” nodules represent areas with decreased iodine uptake. “Cold” nodules do not produce excess hormone and can sometimes represent cancer.

Fine needle aspiration and biopsy are techniques that remove a sample of cells or tissue from the thyroid gland for examination and diagnosis by a pathologist, who is a physician trained in the diagnosis of conditions based on tissue samples. Fine needle aspiration (FNA) uses a long, thin needle to withdraw a sample of cells from the thyroid. FNA can be performed in the doctor’s office. Sometimes, ultrasound imaging is used to guide the FNA procedure. A biopsy is the surgical sampling of a tissue.

THYROID HORMONES

The thyroid gland contains cells that secrete chemical substances called hormones. The main two hormones made by the thyroid gland are called thyroxin (T4) and triiodothyronine (T3), with T4 being produced in much greater quantities than T3.

T3, however, is the primary active hormone. T4 is much less active and while it does produce a limited effect, most of the T4 must be converted to T3 before it can be used by the body. This conversion takes place in particular organs (primarily the liver) and tissues, and is extremely important for the overall functioning of the body.

These hormones act like chemical messengers and deliver instructions to various tissues and organs (target organs) via the bloodstream. The cells within these organs then use the thyroid hormones and respond by speeding up or slowing down their activities. Overall, the thyroid gland is responsible for the speed of metabolism (metabolic and chemical processes) in our bodies, by affecting every cell, tissue, organ and organ system. The thyroid gland is therefore essential for life, growth and development.

Thyroid hormones affect body temperature and circulation, appetite, energy levels, growth, skeletal development, muscle tone and agility, cardiac rate (force and output), fluid balance, blood sugar levels, central nervous system function, bowel function, blood fat (cholesterol) levels, and the regulation of fat, carbohydrate and protein metabolism in all cells.

The amount of T3 and T4 produced by the thyroid gland is controlled by the pituitary gland at the base of the brain. It does this by secreting Thyroid Stimulating Hormone (TSH). When the levels of T4 and T3 fall, the pituitary secretes more TSH. When T4 and T3 levels rise, the pituitary secretes less TSH. Normally this complicated production and control system ensures that the body has just the right amount of T3 and T4, but it can go wrong.

ABNORMAL FUNCTION

When the thyroid gland produces too much thyroid hormone (becoming overactive), the condition is called Hyperthyroidism. When the thyroid gland produces too little thyroid hormone (becoming under active), the condition is called Hypothyroidism.

The most common cause of Hyperthyroidism is an autoimmune condition called Graves’ disease. With Graves ‘disease the body produces antibodies which behave like TSH and stimulate the thyroid gland uncontrollably, to make too much thyroid hormone.

The most common cause of Hypothyroidism is also an autoimmune condition, called Hashimoto’s Thyroiditis. With Hashimoto’s Thyroiditis, white blood cells invade the thyroid gland and attack the tissue and the immune system produces antibodies which interfere with the production of the thyroid hormones.

With some individuals there can be a malfunction at the cellular level, where the cells of the body do not respond to or utilise thyroid hormones correctly. The receptor sites in cells may be resistant to thyroid hormones and the chemical messages may not be received. The successful conversion of T4 into T3 may also be hindered within the cells, and the body is then starved of sufficient amounts of T3. These problems with T4 to T3 conversion and thyroid hormone resistance are uncommon, and they can be easily misdiagnosed.

Another uncommon problem relates to the pituitary gland. It can malfunction and produce too much or too little TSH. This has a direct impact on thyroid function and the amount of T4 and T3 produced.

Thyroid related illnesses have a variety of causes, and sometimes the problem is not with the thyroid gland itself. Whatever the cause, abnormal physical and mental symptoms will appear, which can range from mild to severe.

Neck Discomfort, Enlargement, Hoarseness, Goitre

People with hypothyroidism may experience aches and pains in muscles and joints, especially the arms and legs. Fibromyalgia-like pain is also common for people with an under active thyroid.

There is also a tendency to develop carpal tunnel in the arms/hands, tarsal tunnel in the legs, and planters fasciitis in the feet.

People who are hyperthyroidism may have pain or weakness in upper arms, and calves.

For more information about pain associated with various thyroid conditions, read Muscle and Joint Pain with Thyroid Disease. A feeling of swelling in the neck, a visibly enlarged neck, discomfort with turtlenecks or neckties, difficulty swallowing, or a hoarse, raspy voice can all be signs of thyroid disease.

Specifically, when the thyroid becomes enlarged, this is known as “goitre,” and can be a sign of both hyperthyroidism and hypothyroidism.

To help find out if your thyroid may be enlarged, try a simple “Thyroid Neck Check” test at home.

Hair Loss, Hair Changes, Skin Changes

Hair and skin are particularly vulnerable to thyroid conditions, and in particular, hair loss is frequently associated with thyroid problems.

With hypothyroidism, hair frequently becomes brittle, coarse and dry, and can break easily, and falling out more easily. Skin can become coarse, thick, dry, and scaly.

In hypothyroidism, there is also a unique and very specific symptom: The loss of hair in the outer edge of the eyebrow.

With hyperthyroidism, severe hair loss can also occur, hair can become fine and thin, and skin can become fragile and easily irritated.

There is also an unusual rash that can appear on the skin of the shins, known as pretibial myxedema or thyroid dermopathy.

Constipation, Bowel Problems, Diarrheal, Irritable Bowel

Severe or long-term constipation, and constipation that does not respond to treatments and remedies, can be associated with hypothyroidism.

Diarrhoea, loose stools, and irritable bowel syndrome (IBS) are frequently associated with hyperthyroidism.

Heavier, more frequent and more painful periods are frequently associated with hypothyroidism.

Menstrual Irregularities and Fertility Problems

Women with hyperthyroidism often experience shorter, lighter or infrequent menstruation -- or even the cessation of menstrual periods entirely.Women with undiagnosed or improperly treated hypothyroidism in particular can also experience infertility and recurrent miscarriage.

If you have a family history of thyroid problems, or a family history of autoimmune disease, you are at a higher risk of having a thyroid condition yourself.

Family History of Thyroid and Autoimmune Disease

You may not always be aware of thyroid problems in your family, though, because especially among older people, it is often referred to as “glandular trouble” or “goitre.” So pay attention to any discussions of glandular conditions or goiter or weight gain due to “a glandular problem,” as these may be indirect ways of referring to thyroid conditions.

You should also be aware of autoimmune conditions - such as rheumatoid arthritis and multiple sclerosis - in your family history. Autoimmune disease in first degree relatives - parents, siblings, and children -- increase your risk of having an autoimmune condition, and autoimmune thyroid diseases Hashimoto’s and Graves’ disease are among the most common. High cholesterol levels, especially when they are not responsive to diet, exercise or cholesterol-lowering medications can be a sign of undiagnosed hypothyroidism.

High Cholesterol, Unresponsive to Cholesterol Medications

Unusually low cholesterol levels may be a sign of hyperthyroidism.

For more information, read Combating High Cholesterol That is Due to Hypothyroidism

Depression and Anxiety

Depression or anxiety - including the sudden onset of a panic disorder - can be symptoms of thyroid disease.

Hypothyroidism is most typically associated with depression, while hyperthyroidism is more commonly associated with anxiety, panic attacks, and bipolar disease. Depression that does not respond to antidepressants may also be a sign of an undiagnosed thyroid disorder.

You may be on a low-fat, low-calorie diet with a rigorous exercise program, but are failing to lose weight. Or maybe you’re even gaining? Or you may have joined a diet program or support group, such as Weight Watchers, and you are the only one who isn’t losing any weight. Difficulty losing weight -- or unusual weight gain - can be signs of hypothyroidism.

Unexpected Weight Changes without Changes to Diet and Exercise

On the opposite end, you may be losing weight while eating the same amount of food as usual - or even losing while eating more than normal -- can be symptoms of hyperthyroidism.

Fatigue, Exhaustion

Note, however, that a subset of patients have opposite responses -- hypothyroid patients who lose weight or are underweight and can’t gain weight, and hyperthyroid patients who gain weight or can’t lose with diet/exercise.

Feeling exhausted when you wake up, feeling as if 8 or 10 hours of sleep a night is insufficient or being unable to function all day without a nap can all be signs of thyroid problems, especially hypothyroidism.

With hyperthyroidism, you may also have night times insomnia that leaves you exhausted during the day.

For further information Visit the EFSTH, MRC, number of NGO and Private Clinics, also E-Mail azadehhassan@yahoo.co.uk, send text only to Dr Azadeh 002207774469/3774469, Email azadehhassanmd10@gmail.com

Author DR AZADEH Senior Lecturer at the University of the Gambia, Senior Consultant in Obstetrics & Gynaecology, Clinical Director at Medicare Health Services

Source: Picture: Dr Azadeh