How Is Graves’ Disease Diagnosed
Graves’ disease is diagnosed based on a visit with a doctor who will review the symptoms and examine the patient.
It’s important to do lab tests too, because many people can have some of the symptoms of hyperthyroidism for other reasons. Sometimes the blood tests aren’t enough to be sure of the diagnosis and other tests are needed, like a thyroid scan or ultrasound.
Signs And Symptoms Of Thyroid Problems
Symptoms of thyroid problems aren’t always obvious. In fact, the ATA estimates that up to six in 10 people with thyroid problems do not know they have them. Both hypothyroidism and hyperthyroidism can cause feelings most people have from time to time, such as mood swings or tiredness, so how can you tell the difference between an everyday symptom and something that needs treatment? Check in with your body often, and if any of the following signs persist, talk to your physician.
Questions To Ask Your Doctor
- What type of thyroiditis do I have?
- What is the likely cause of my thyroiditis?
- What are the results of my blood test? What do these results mean?
- Will I need to take medicine? If so, for how long and what are the side effects?
- Are there any lifestyle or diet changes I can make to manage symptoms?
- What is my risk of long-term health problems?
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When To Contact Your Doctor
If youve checked off signs and are not feeling yourself, discuss this with your primary care doctor. These signs dont necessarily mean that you have thyroid disease. By asking you about your symptoms, your doctor can decide whether you need a blood test to check for thyroid disease.
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ImagesImage 1: Getty ImagesImages 2, 3, 4: Used with permission of the Journal of the American Academy of Dermatology: J Am Acad Dermatol. 2003 Jun 48:970-2.
ReferencesAi J, Leonhardt JM, et al. Autoimmune thyroid diseases: etiology, pathogenesis, and dermatologic manifestations. J Am Acad Dermatol. 2003 48:641-59.
Anderson CK, Miller OF. Triad of exophthalmos, pretibial myxedema, and acropachy in a patient with Graves’ disease. J Am Acad Dermatol. 2003 48:970-2.
Bae JM, Lee JH, et al. Vitiligo and overt thyroid diseases: A nationwide population-based study in Korea. J Am Acad Dermatol. 2017 76:871-8.
Callen JP. Dermatologic manifestations in patients with systemic disease. In: Bolognia JL, et al. Dermatology. . Mosby Elsevier, Spain, 2008: 681-2.
Kalus AA, Chien AJ, et al. Diabetes mellitus and other endocrine diseases. In Wolff K et al. Fitzpatricks Dermatology in General Medicine . McGraw Hill, China, 2008:1470-4.
What Are Symptoms Of Thyroiditis
Symptoms of inflammation of the thyroid gland include:
- Low thyroid hormone
Tests for inflammation of the thyroid gland may include:
- Thyroid function tests
- T3 and T4 in the blood
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How Many Of These Signs And Symptoms Do You Have
Dry, pale, and cool skin Moist, velvety, and warm skin like a babys Dry skin with deep cracks and scale Deep, noticeable lines on your palms and soles Yellowish-orange color on your palms and soles Doughy and swollen face, especially on your eyelids, lips, and tongue Widening nose Sweating less than before Goiter Protruding eyes Flushing on your face and red palms Darker skin in the creases of your palms, on your gums, or elsewhere in your mouth Rashes, especially in the creases of your skin Painless lumps and patches of scaly, discolored skin, and the affected skin feels hard and waxy Reddish spots on the skin that come and go
When eyes protrude, its often a sign of thyroid disease.
Painless lumps and patches of scaly skin feel hard and waxy
Lumps on discolored skin that feel hard and waxy can be a sign of thyroid disease.
Thinning eyebrows on the outer edge Coarse, dull, dry, and brittle hair that breaks easily Soft and fine hair with lots of shedding Thinning hair or balding patches Growing more slowly Dry, itchy scalp and dandruff Less hair on your legs, arms, and other areas
Thick, dry, and brittle with visible ridges Soft, shiny, and easily crumble Growing more slowly Peel, crumble, or break easily Lift up Curved with swollen fingertip and thickening skin above the nail
Curved nails with swollen fingertip
Itchy skin without a rash Untreatable and itchy hives
Existing skin disease
Does An Enlarged Thyroid Cause Symptoms
Anatomical changes to your thyroid, such as changes to the size or shape of your thyroid, are most often found incidentally.
Patients are often quite surprised that they even have a thyroid issue until they are notified by their physician during a routine exam.
Problems which cause changes in the shape and size of thyroid usually do NOT cause problems with the production of thyroid hormone.
This is important because the symptoms associated with dysregulated thyroid hormone production are often profound and easy to identify.
Instead, disorders to the shape and size usually are asymptomatic.
What this means is that they do NOT cause any symptoms.
Now, this isn’t true for all disorders because there are always exceptions.
These issues might present as problems swallowing, changes to your vocal cords or a change in your voice, or a bulge that is noticeable in your neck.
Occasionally, if your enlarged thyroid is due to swelling or inflammation, then you might also experience pain when touching your neck.
Some conditions which result in an enlargement of your thyroid gland are reversible and may go away on their own while others may persist and cause permanent thyroid damage .
Hopefully, you’re beginning to understand that in order to really understand what is happening with your thyroid gland you will need further evaluation.
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Causes Of An Enlarged Thyroid
Knowing that your thyroid is enlarged is not a diagnosis by itself.
It’s more helpful to think of an enlarged thyroid gland as an observation or as a description of what is happening.
This is because there are actually many different conditions which result in thyroid gland enlargement.
These conditions range from infections, inflammation of the gland, nutrient deficiencies, cancer and even autoimmune disease.
An important part of treating an enlarged thyroid gland is correctly identifying and diagnosing what is happening.
This important step can be done through blood testing and imaging .
The range of medical conditions which can cause thyroid gland enlargement include:
- Thyroid nodules and thyroid cysts
- Thyroiditis caused by inflammation, infection or autoimmune disease
- Hashimoto’s thyroiditis
- Iodine deficiency
These diseases can be differentiated based on how they present , how they affect the size of your thyroid gland , how they look on ultrasound imaging and how they affect thyroid hormone production.
Is It Menopause Or Thyroid Disorder
Thyroid disorders can cause symptoms that are mistaken for those of a woman approaching menopause. Both menstrual cycle changes and mood changes can result from the menopausal transition or from thyroid conditions. Blood tests can determine which of these conditions is responsible for your symptoms. It’s also possible to have a combination of the two causes.
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How Is Graves’ Disease Treated
Doctors usually treat Graves’ disease with anti-thyroid medicines. These medicines slow the release of thyroid hormones from the gland. They usually bring hormone levels down to normal within a couple of months.
Many people with Graves’ disease need to take anti-thyroid medicines for a long time to control the condition sometimes for the rest of their lives.
Some might need other treatment if anti-thyroid medicines don’t help or cause side effects, or if the disease is very hard to control. In these cases, two permanent treatment options can be used: radioactive iodine treatment and surgery.
Radioactive iodine is the most commonly used permanent treatment for Graves’ disease. RAI damages the thyroid gland so that it can’t make too much thyroid hormone. This doesn’t harm other parts of the body. The RAI treatment is taken in capsules or mixed with a glass of water. The thyroid gland quickly absorbs the RAI from the bloodstream and, within a few months, the gland shrinks and symptoms slowly disappear.
Surgery to remove most of the thyroid gland is called a thyroidectomy. It’s done in a hospital under general anesthesia, so the person is asleep and feels nothing. A small incision in the lower central part of the neck usually leaves a thin scar. It’s common to have some pain for a few days after the surgery, but most people feel much better within a few days.
Radiation Treatment Of The Thyroid
Radioactive iodine, a common treatment for hyperthyroidism, gradually destroys thyroid cells. If you receive radioactive iodine treatment, you probably will eventually develop hypothyroidism. Doctors also treat people who have head or neck cancers with external radiation therapy, which can also damage the thyroid if it is included in the treatment.
Feel The Bumps And Enlargements
Gently touch the area around your thyroid gland to try to palpate any enlargement, bumps, or protrusions. To differentiate between the thyroid and the other structures of your neck:
How Does Eating Diet And Nutrition Affect Hypothyroidism
Your thyroid uses iodine to make thyroid hormones. However, if you have Hashimotos disease or other types of autoimmune thyroid disorders, you may be sensitive to iodines harmful side effects. Eating foods that have large amounts of iodinesuch as kelp, dulse, or other kinds of seaweedmay cause or worsen hypothyroidism. Taking iodine supplements can have the same effect.
Talk with members of your health care team
- about what foods to limit or avoid
- if you take iodine supplements
- about any cough syrups you take because they may contain iodine
If you are pregnant, you need more iodine because the baby gets iodine from your diet. Talk with your doctor about how much iodine you need.
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Symptoms Of Inflammation In Hashimoto’s Patients
#1. Fluctuating thyroid levels.
The most common symptom of inflammation in Hashimoto’s is that of fluctuating thyroid hormone levels.
What do I mean?
I’m talking about changes to your hormone FUNCTION.
Inflammation is associated with either a DOWNWARD trend in thyroid function or an UPWARD trend in thyroid function.
Most people will experience this as LOW thyroid function, meaning the symptoms of hypothyroidism or low thyroid.
This is why Hashimoto’s is often referred to as Hashimoto’s hypothyroidism.
Because it causes hypothyroidism!
BUT, it can also cause hyperthyroidism.
Inflammation can damage the thyroid and result in TOO much thyroid hormone production which leads to hyperthyroid symptoms.
Acute damage tends to cause this problem while chronic long-term inflammation tends to cause LOW thyroid function.
One of the reasons that Hashimoto’s patients struggle to identify how they feel is because this process can go up and down like a roller coaster.
One week you can feel hyperthyroid and the next you can feel hypothyroid which can seem confusing.
But if you understand what inflammation is doing then it doesn’t have to be.
The goal is obviously to cool down this inflammation to stabilize your thyroid function.
#2. Feeling run down
Do you ever feel like you just don’t have the energy that you used to?
Like it’s difficult to get out of bed and do your day to day activities?
Or how about just not having the drive or motivation to do the things that you know you HAVE to do?
What Is The Thyroid Gland
The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroids job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormone helps the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.
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Causes Of Your Thyroid Pain
While thyroid pain can be caused by many possible reasons the disorders that are commonly responsible for thyroid pain are as follows:
- Thyroid cyst causes pain in the thyroid gland
- Viral thyroiditis: a viral infection caused by mumps virus, coxsackie virus, adenovirus etc
- Thyroid tumor can cause severe thyroid pain
- Subacute granulomatous thyroiditis , also referred to as painful sub-acute thyroiditisorde Quervains thyroiditis is a common thyroid disorder that can cause pain and tenderness in front of the neck or throat.
- Hashimotos disease
- Advanced carcinoma of the thyroid gland that spreads to distant body sites causes unbearable thyroid pain along with other complications
- A goiter is benign enlargement of the thyroid gland that can cause pain in the thyroid gland
- Trauma or injury to the neck or throat can also result in severe thyroid pain in neck
- Inflammation of the thyroglossal fistula orthyroglossal cyst is associated with thyroid pain
- Hyperthyroidism can cause thyroid pain
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What Is The Treatment For Thyroiditis
Treatment for inflammation of the thyroid gland depends on the type of thyroiditis and the symptoms.
- Treatment for thyrotoxicosis includes beta blockers to decrease palpitations and decrease tremors
- Treatment for low thyroid hormone includes thyroid hormone replacement
- Treatment for thyroid pain includes anti-inflammatory medications such as aspirin or ibuprofen. Steroids such as prednisone may be used if pain is severe.
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Key Points About Postpartum Thyroiditis
- Postpartum thyroiditis happens when a womans thyroid becomes inflamed after having a baby. It may first cause the thyroid to be overactive. But in time it can lead to an underactive thyroid.
- Experts dont know what causes this condition.
- You are more likely to get it if you had antithyroid antibodies before pregnancy. Other risk factors include having type 1 diabetes or a history of thyroid problems.
- A blood test can often tell if you have an overactive or underactive thyroid.
- Treatment is based on how severe your symptoms are.
What Do You Do When Your Child Has A Thyroid Nodule
The first step if your child has a thyroid nodule is to get an ultrasound. This will help your healthcare provider assess the quality of your childs nodule and determine if additional workup is needed. In some cases a repeat ultrasound is needed, and in some cases a biopsy. This all depends on what it looks like on the ultrasound. Some nodules require labs to look at how the thyroid is functioning.
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Who Is At Risk Of Developing Thyroid Problems
Women and people over 60 years of age have a higher risk of developing either hypothyroidism or hyperthyroidism. If you’ve been pregnant or had a baby within the past six months, you also face a higher risk.
Personal or family history risk factors can also play a role, including:
- Prior thyroid problems, such as a goiter or a family history of them
- Prior thyroid surgery or radiation treatments to the neck or chest
- Anemia, type 1 diabetes, lupus, rheumatoid arthritis, Turner’s syndrome or Sjogren’s syndrome
- Consuming high-iodine foods, medications or supplements
Symptoms Of Enlarged Thyroids
Located at the base of the neck, the thyroid produces hormones that regulate a variety of crucial bodily functions, ranging from helping us keep warm and use energy to fueling proper function of organs and muscles. The development of a goiter doesnt mean the gland isnt working. But this enlargement, which can happen slowly or quickly, may also signal the thyroid is making too much or too little hormone.
What signs of a goiter should you watch for? Dr. Shifrin says size matters. Watch for an enlargement of the thyroid, he says, including swelling at the base of your neck. Every enlarged gland should be checked for cancer.
According to the American Thyroid Association, you should also watch for these signs:
- Trouble swallowing, breathing or speaking normally
- Tightness in the throat
Most goiters arent cancerous, Dr. Shifrin says, but you should still have it checked by your primary physician or an endocrine specialist. Blood tests alone cant usually determine if thyroid cancer is present. Ninety percent of thyroid cancers are detected by palpating the gland and a thyroid ultrasound, Dr. Shifrin says.
The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.
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What Are The Symptoms Of Hypothyroidism
Hypothyroidism has many symptoms that can vary from person to person. Some common symptoms of hypothyroidism include
- thyroiditis, or inflammation of the thyroid
- congenital hypothyroidism, or hypothyroidism that is present at birth
- surgical removal of part or all of the thyroid
- radiation treatment of the thyroid
- some medicines
Less often, hypothyroidism is caused by too much or too little iodine in the diet or by disorders of the pituitary gland or hypothalamus.1 Iodine deficiency, however, is extremely rare in the United States.
Who Is More Likely To Develop Hypothyroidism
Women are much more likely than men to develop hypothyroidism. The disease is also more common among people older than age 60.1
You are more likely to have hypothyroidism if you
- had a thyroid problem before, such as a goiter
- had surgery or radioactive iodine to correct a thyroid problem
- received radiation treatment to the thyroid, neck, or chest
- have a family history of thyroid disease
- were pregnant in the past 6 months
- have Turner syndrome, a genetic disorder that affects women
Your thyroid is also more likely to be underactive if you have other health problems, including
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