Diagnosing And Treating Thyroid Disorders
Hypothyroidism and hyperthyroidism are generally easy to diagnose using a simple blood test to measure the amount of thyroid hormones in the blood.
There are several different treatment options for patients suffering from either condition, including hormone replacement therapy for hypothyroidism or drugs to limit thyroid function for hyperthyroidism. Hyperthyroidism also can be permanently corrected by surgically removing all, or part, of the gland.
While both conditions can usually be treated successfully, its rarely a one-size-fits-all equation.
Hyperthyroidism tends to be easier to treat because you can simply remove the gland, Nakhle said. However, after doing so, the patient will need to use drugs to replace the thyroid hormones, which are the same drugs used for people with hypothyroidism. The hormone replacement drugs are successful about 90 percent of the time, but occasionally there are patients who dont respond well to any of the options.
What Happens If A Goiter Is Left Untreated
Hypothyroidism can lead to a variety of complications if left untreated, including: Goiter is caused by a lack of thyroid hormone, which causes the thyroid gland to be constantly stimulated, ultimately resulting in its enlargement. A goiter is the medical term for this condition. Goiter may be unsightly and interfere with breathing and swallowing.
What Are Goiters And Thyroid Nodules
An enlarged thyroid gland can be felt as a lump under the skin at the front of the neck. When it is large enough to see easily, it’s called a goiter.
A thyroid nodule is a lump or enlarged area in the thyroid gland. A nodule may simply be swollen tissue, an overgrowth of normal thyroid tissue, or a collection of fluid called a cyst. Most thyroid nodules in children are not caused by cancer.
You Experience New Or Worsening Symptoms
If you have lived with untreated thyroid disease for years, you may have gotten used to living with symptoms. When starting medication, your appetite may change, you may be feeling tired, or you could experience a change in your bowel movements.
Some thyroid medications can also cause hair loss, which most find frustrating and undesirable.
Discuss these issues with your doctor, as they can be the effects of normalization of your thyroid hormone levels or even overtreatment of your condition. You may need a dose adjustment or a different medication.
How Can A Thyroid Ultrasound Help With Diagnosis
An ultrasound can give your doctor a lot of valuable information, such as:
- if a growth is fluid-filled or solid
- the number of growths
- where the growths are located
- whether a growth has distinct boundaries
- blood flow to the growth
Ultrasounds can also detect a goiter, a swelling of the thyroid gland.
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Uses For A Thyroid Ultrasound
A thyroid ultrasound may be ordered if a thyroid function test is abnormal or if you doctor feels a growth on your thyroid while examining your neck. An ultrasound can also check an underactive or overactive thyroid gland.
You may receive a thyroid ultrasound as part of an overall physical exam. Ultrasounds can provide high-resolution images of your organs that can help your doctor better understand your general health. Your doctor may also order an ultrasound if they notice any abnormal swelling, pain, or infections so that they can uncover any underlying conditions that might be causing these symptoms.
Ultrasounds may also be used if your doctor needs to take a biopsy of your thyroid or surrounding tissues to test for any existing conditions.
Can A Thyroid Problem Heal Itself
Occasionally, the condition may resolve without treatment. Follow-up appointments are important to monitor hypothyroidism over time, however. If hypothyroidism doesnt go away on its own within several months, then treatment is necessary. If left untreated, this condition eventually may lead to serious health problems.
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How Hypothyroidism Causes Facial Swelling
Hormonal imbalances act as a catalyst for a number of changes in our body, and lower production of thyroid hormones is not the exception.
Hypothyroid people experience various symptoms that affect their quality of life, and facial swelling is one of them.
Its perfectly natural to wonder how hypothyroidism leads to puffiness in the face, but it would be difficult to pinpoint a single mechanism.
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Thyroid Goiter: When Is A Ct Scan Ordered
When physical examination and or ultrasound cannot completely determine how far the goiter actually goes, then a CT scan should be ordered. The CT scan will show areas that the thyroid goiter extends and prepare the expert thyroid surgeon their safe and effective approach to remove all of the goiter gland and spare all other structures. Even though a thyroid goiter may extend extensively below the sternum and go well into the chest, these goiters can almost routinely be removed through a relatively straight forward low collar incision in the lower neck. If your surgeon is telling you that they need to split your chest or open your sternum, make sure that you have identified a highly experience thyroid surgeon. Again, such approaches are almost never actually required.
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Imaging And Evaluating Your Thyroid
Ultrasound is a nearly painless procedure which allows radiologists to look at the size, shape, texture and other characteristics of your thyroid gland.
Because the thyroid gland is near to the surface of your skin it can easily be assessed with this type of imaging.
Doctors are often taught that the only way to hurt someone with an ultrasound is by throwing the machine at them.
Ultrasound is very important if you have an enlarged thyroid because it can further help to diagnose what exactly you are dealing with.
If you have a single large thyroid nodule, ultrasound can pick up that nodule and give information regarding the size, shape, and consistency of the nodule.
This information can help to determine if the nodule is benign ) or potentially cancerous and also help determine if you need a biopsy.
Other conditions which cause thyroid enlargement may be consistent and make your thyroid look “irregularly inconsistent” throughout the entire gland.
Conditions which cause this type of pattern tend to result in inflammation of the entire gland or may be caused by nutrient deficiencies such as iodine deficiency.
In addition to ultrasound testing, there are other ways to check your thyroid gland such as uptake tests or CT scans .
What Is An Enlarged Thyroid
This is more of a symptom of thyroid disease than a medical condition. Your thyroid is one of the endocrine glands and is located in the front portion of your neck. This gland is important because it secretes hormones that help to regulate your metabolism, your growth, your sexual development, and many other different functions. The thyroid glad secretes three hormones, which are triiodothyronine, calcitonin, and thyroxin. An enlarged thyroid is often referred to as a goiter by physicians.
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Lab Testing For Your Thyroid
Looking at your thyroid gland via imaging doesn’t usually give you any information about the FUNCTION of the thyroid gland.
The function of your thyroid gland is very important because it relates to how well your thyroid is able to produce thyroid hormone.
Any change to the ability of your gland to produce thyroid hormone will result in very specific symptoms that are too big to be ignored and these symptoms will often drive people into the Doctors office for evaluation.
Fortunately, many conditions that result in thyroid gland enlargement usually do not interfere with thyroid hormone production.
Some conditions, such as Hashimoto’s thyroiditis, cause both thyroid gland enlargement AND thyroid hormone issues.
Because of this each and every patient with a known or suspected thyroid gland issue should undergo thyroid function testing with blood tests.
To test your thyroid function you will need the following tests:
- TSH – This will help you understand if your brain is talking to your thyroid gland.
- Free T3 – This is the most important thyroid hormone in your body and is responsible for the majority of thyroid cellular activity/
- Free T4 – This is the most abundant thyroid hormone in your body and is important because it acts as a reservoir for T3 thyroid hormone.
- Thyroid Antibodies – The presence or absence of thyroid antibodies can help you understand if you have an autoimmune disease or if your body is attacking your own thyroid gland.
Treatments For An Overactive Thyroid
An overactive thyroid is usually treatable.
The main treatments are:
- medicine that stops your thyroid producing too much of the thyroid hormones
- radioiodine treatment where a type of radiotherapy is used to destroy cells in the thyroid, reducing its ability to produce thyroid hormones
- surgery to remove some or all of your thyroid, so that it no longer produces thyroid hormones
Each of these treatments has benefits and drawbacks. You’ll usually see a specialist in hormonal conditions to discuss which treatment is best for you.
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.
Other Causes Of Hyperthyroidism
Hyperthyroidism can also result from thyroid nodules. These are lumps that develop inside the thyroid and sometimes begin producing thyroid hormones. Large lumps may create a noticeable goiter. Smaller lumps can be detected with ultrasound. A thyroid uptake and scan can tell if the lump is producing too much thyroid hormone.
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Causes And Signs Of An Enlarged Thyroid
Theres a good reason medical checkups typically include a quick but gentle pat-down of your neck area by health care providers. Among other conditions, theyre looking for a goiter, an enlarged thyroid gland that may spell health problems but can also be harmless.
Goiters affect about 16 percent of people worldwide, ranging from just under 5 percent in the United States to 28.3 percent in Africa, according to the National Institutes of Health. But the most common cause of goiters globallya lack of the nutrient iodineisnt a significant issue in the U.S., where iodized salt is routinely used.
In our country, many goiters are idiopathic, meaning we dont know the reason why they occur, says Alexander Shifrin, M.D., an endocrine surgeon with Hackensack Meridian Health.
Still, various risk factors can make it more likely that youll develop a goiter. These include:
- Gender: Women experience more goiters than men, as well as more thyroid problems overall.
- Age: Goiters happen more often in those over age 40.
- Family history: If you or a family member have dealt with an autoimmune disease, this ups your risk for a goiter.
- Pregnancy and menopause: Thyroid problems happen more often during these hormone-fluctuating times in womens lives.
- Radiation exposure: Those whove undergone radiation treatments to the head, neck or chest, or have been exposed to radiation from a nuclear facility or accident, are more prone.
What Is Hypothyroidism
is when your thyroid does not make enough thyroid hormones. It is also called underactive thyroid. This slows down many of your body’s functions, like your metabolism.
The most common cause of hypothyroidism in the United States is . In people with Hashimoto’s disease, 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:
- Radiation treatment of certain cancers
- Thyroid removal
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Are There Any Side
Surgery carries the normal risks of any operation , and will result in an underactive thyroid. It can rarely cause specific complications with damage to the recurrent laryngeal nerve resulting in a hoarse voice, or damage to the glands around the thyroid , which control calcium. This may result in a low calcium level in the blood, which would require medication.
How Is Goitre Treated
Treatment depends on the underlying cause of the goitre. Simple goitre, where there is no thyroid hormone imbalance and no problems arising from the size of the thyroid, is unlikely to cause problems. In case the goitre is large and symptomatic , it may be appropriate to consider surgery , though this will result in the patient requiring lifelong thyroxine replacement.
Treatment of overactive and underactive thyroid is explained in articles on hyperthyroidism and hypothyroidism, respectively.
Are Thyroid Nodules Cancer
The vast majority more than 95% of thyroid nodules are benign . If concern arises about the possibility of cancer, the doctor may simply recommend monitoring the nodule over time to see if it grows.
Ultrasound can help evaluate a thyroid nodule and determine the need for biopsy. A thyroid fine needle aspiration biopsy can collect samples of cells from the nodule, which, under a microscope, can provide your doctor with more information about the behavior of the nodule.
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Who Is At Risk For Thyroid Cancer
About three times as many women get thyroid cancer as men. The number of women with thyroid cancer is also going up. By 2020, the number of women with thyroid cancer is expected to double, from 34,000 women to more than 70,000 women.
Thyroid cancer is more common in women who:
- Are between the ages of 25 and 65
- Had radiation therapy to the head or neck, especially in childhood, to treat cancer
- Have a history of
- Have a family history of thyroid cancer
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What Is The Evaluation Of A Thyroid Goiter
The following are a list of tests that are required in the evaluation of a patient with a Thyroid Goiter.
- Complete Medical History and Physical Examination
- T3 and T4
- Thyroglobulin Antibody
- Thyroid Stimulating Immunoglobulin
- Ultrasound with possible Fine Needle Aspiration guided
Medical history and physical examination is required for all patients with a thyroid goiter
If there is a suspicion that you may have a thyroid goiter, your health care professional will want to know your complete medical history. You will be asked questions about your possible risk factors, symptoms, and any other health problems or concerns. If someone in your family has had a diagnosis of thyroid goiter, thyroid cancer or other endocrine cancers, these are important factors.
Whos At Risk For Hyperthyroidism
According to the National Institute of Health , hyperthyroidism affects approximately 1.2% of the population in the US. Although it occurs in both men and women, its up to 10 times more likely in females.
Youre at higher risk for hyperthyroidism if you:
- Have a family history of thyroid disease
- Have pernicious anemia
- Have primary adrenal insufficiency, also known as Addisons disease
- Consume an iodine-rich diet or medications containing iodine
- Are over the age of 60
- Were pregnant within the past 6 months
- Had thyroid surgery or a thyroid problem such as a goiter also known as a swollen thyroid gland
What are hyperthyroidism symptoms?
Though an overactive thyroid brings on a constellation of high thyroid symptoms , some of them dont seem obviously linked to the condition . Heres what to look for.
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Graves Disease Diagnosis And Treatment
A simple physical exam can reveal an enlarged thyroid, enlarged bulging eyes, and signs of increased metabolism, including rapid pulse and high blood pressure. Your doctor will also order blood tests to check for high levels of T4 and low levels of TSH, both of which are signs of Graves disease. A radioactive iodine uptake test might also be administered to measure how quickly your thyroid takes up iodine. A high uptake of iodine is consistent with Graves disease.
Theres no treatment to stop the immune system from attacking the thyroid gland and causing it to overproduce hormones. However, the symptoms of Graves disease can be controlled in several ways, often with a combination of treatments:
- beta-blockers to control rapid heart rate, anxiety, and sweating
- antithyroid medications to prevent your thyroid from producing excessive amounts of hormone
- radioactive iodine to destroy all or part of your thyroid
- surgery to remove your thyroid gland, a permanent option if you cant tolerate antithyroid drugs or radioactive iodine
Successful hyperthyroidism treatment usually results in hypothyroidism. Youll have to take hormone-replacement medication from that point forward. Graves disease can lead to heart problems and brittle bones if its left untreated.