Thyroid: types, symptoms & treatment

What is the thyroid gland and its functions?

At the base of the neck, under the larynx (voice box,) there is a little endocrine gland called the thyroid gland that resembles a butterfly or a bow. The left and right lobes of the thyroid gland lie against and around the windpipe. The lobes are connected by a strip of tissue. An average human thyroid gland weighs about 20 to 40 grams. It creates the hormones triiodothyronine (T-3) and thyroxine (T-4), which assist in processes like:

• Processing fats and carbs
• Keeping the body at the right temperature
• Producing proteins
• Protecting bone health
• Promoting metabolism
• Maintaining the nervous system, and regulating reflexes and concentration

In children, these hormones are critical in promoting growth and brain development. The development of a foetus also depends on thyroid hormones. These hormones aid in the brain and nervous system's development. Calcitonin, which aids in the processing of calcium for our bones and regulates the amount of calcium in the body, is also produced by this gland. This hormone works with the parathyroid hormones, which are released by the parathyroid glands (small rice-sized structures at the bottom of the neck). Humans usually have four parathyroid glands. Normally, the hormones required to keep your body functioning are produced by your thyroid. Thyroid disease is brought on by any form of thyroid gland malfunction, which has an impact on hormone production. Every cell in the body responds to thyroid hormones. So, any impairment can throw the body's equilibrium out of order.

Types of thyroid disorders

There are different types of thyroid problems that can be caused if there is any kind of issue with the thyroid gland. They are:

Hypothyroidism: Hypothyroidism is a condition in which your thyroid gland may not generate enough hormone, which slows down your metabolism. You may feel tired, put on weight, and find it hard to endure cold temperatures if you have an underactive thyroid. People can get hypothyroidism at any age irrespective of the gender or ethnicity. It is a prevalent condition, especially in women over the age of 60 year. After menopause, women are typically more susceptible to developing hypothyroidism than they are earlier in life. Varied reasons can lead to hypothyroidism like the autoimmune disease and Hashimoto’s disease where your immune system attacks the thyroid gland. This attack can cause inflammation, which gets in the way of hormone production. Other reasons can be thyroiditis (an inflammatory condition of the gland), radiation from the treatment of hyperthyroidism, genetic factors, and iodine deficiency. The symptoms of hypothyroidism can be:

• Fatigue
• Low tolerance for cold
• Weight gain
• Sluggish movements
• Memory problems
• Muscle cramps
• Dry and scaly skin
• Brittle nails and thinning hair
• Decline or loss of libido
• Carpal tunnel syndrome
• Irregular menstrual cycle, where periods can also be heavy
• Muscle and joint pain
• Depression

Hyperthyroidism: When your thyroid gland produces excess thyroid hormones than your body requires, the condition is known as hyperthyroidism or overactive thyroid. Women and people over the age of 60 years are highly likely to have hyperthyroidism. An immune system condition called Graves' disease is found to be the most common cause of hyperthyroidism. People who have a family history of thyroid disease, eat too much iodine, are pregnant or recently had a baby, have a vitamin B12 deficiency, or have type 1 diabetes are also at risk of developing hyperthyroidism. The symptoms of hyperthyroidism are:

• Sudden or unexplained weight loss
• Feeling nervous, irritable, and anxious
• Goitre
• Increased sweating
• Arrhythmia
• Trouble sleeping and fatigue
• Frequent bowel movements
• Hand tremors
• Hyperactivity
• Irregular and/or light menstrual periods
• Reduced libido
• Anxiety and depression

Adults over 60 years old could experience different symptoms from younger age groups. For instance, they can stop eating or become more reclusive around others. This can be misinterpreted as dementia or depression. Hashimoto’s thyroiditis: This condition is also referred to as Hashimoto’s disease, where the thyroid gland becomes inflamed. This is an autoimmune condition, in which the body's tissues become targets of the immune system. A goitre (neck swelling brought on by an enlarged thyroid gland) might result in this condition. It is the most commonly found reason behind hypothyroidism. The precise reason for Hashimoto's thyroiditis is unknown, but many variables are thought to play a role. Having a family history of thyroid or autoimmune disease is a common factor. Hashimoto’s thyroiditis is also found more often in women than men; so, sex hormones can also play a role. The intake of too much iodine whether in your diet or through medication can affect the thyroid gland’s hormone production. Radiation exposure is also known to be a cause. The symptoms of Hashimoto’s disease are:

• Fatigue
• Pale and/or puffy face
• Muscle and joint pain
• Weight gain
• Constipation
• Difficulty getting pregnant
• Inability to bear cold temperatures and get warm
• Hair thinning or loss, brittle hair
• Heavy or irregular menstrual periods
• Depression

Goitre: This is an abnormal enlargement of the thyroid gland. Goitre can cause no symptoms at all, but the most noticeable one is a swelling or lump in the neck. This lump is usually not painful, and it is also not dangerous. However, you should still go to the doctor and have it checked to rule out anything serious. Goitre can be caused by hypothyroidism, hyperthyroidism, thyroiditis, and thyroid nodules, in addition to iodine deficiency. Goitre can occur in people who are going through menopause, puberty, or pregnancy. Then, there is the autoimmune disease, such as Grave's disease, which can cause this condition. Thyroid cancer can occasionally cause goitre. Thyroid nodules: Thyroid nodules are abnormal lumps of cells on the thyroid gland. They are common, most often noncancerous (benign), and rarely cause symptoms. They can be cancerous in rare cases. Sometimes the nodules can get enlarged to the point they cause discomfort because they are pressing against your trachea or your oesophagus. There are also some cases where these nodules end up producing thyroxine, which increases the hormone level in your body. You may experience symptoms of hyperthyroidism. Thyroid cancer: This is a rare type of cancer that occurs when cells mutate at an abnormally rapid rate. It can manifest itself as a nodule or a solid mass in the thyroid gland. Thyroid cancers are classified into several types, the most common of which are papillary thyroid cancers and follicular thyroid cancers. Thyroid cancer responds well to treatment, and depending on the stage at which it was discovered and diagnosed, there is a good chance of survival. There are different stages of cancer to understand where the cancer is located and how much it has grown or spread in the body. The staging also helps doctors determine how serious the cancer is and then decide on the treatment course. This classification ranges from stages I (1) through IV (4). The lower the number, the less likely cancer has spread. A greater number, like stage IV, indicates that cancer has spread considerably. Doctors usually use the TNM staging system to answer these vital questions:

Tumour (T): How big is the cancer? Where is it located? Node (N): Has the cancer spread to the lymph nodes? If so, then where and how many nodes are affected? Metastasis (M): Has the cancer spread to other parts of the body? Doctors assign the cancer stage by combining the T, N, and M categories to determine the cancer stage. This staging system for thyroid cancer varies according to tumour type. The stage of papillary or follicular thyroid cancer is also determined by the patient's age. Thyroid cancers usually do not show any signs and symptoms, but as they grow over time, you may experience the following:

• Lump on the neck
• Swollen lymph nodes in your neck
• Difficulty swallowing
• Change in voice, especially hoarseness
• Difficulty breathing
• Having a cough without being sick

Thyroid disease in women

The thyroid gland's functions are closely related to a woman's reproductive system, especially if the gland is overactive or underactive. Puberty and menstruation: Puberty and menstruation can happen prematurely or abnormally late due to thyroid disorders. Furthermore, unusually high, or low thyroid hormone levels can result in light or very heavy period flow, irregular menstrual cycles, or absent menstrual periods (amenorrhea). Reproduction: Ovulation may be affected by an overactive or underactive thyroid. Thyroid problems may prevent ovulation altogether. Additionally, if a woman has an underactive thyroid, her risk of developing cysts in the ovaries increases (hypothyroid). Severe hypothyroidism can also cause breast milk production while restricting ovulation. Pregnancy and postpartum: Thyroid problems during pregnancy can be harmful to the foetus and can lead to thyroid issues in the mother after giving birth, like postpartum thyroiditis. Thyroid hormone deficiency can result in miscarriages, premature delivery, stillbirth, and postpartum haemorrhage. Pregnant women who have an overactive thyroid are more likely to suffer from severe morning sickness. Menopause: Thyroid problems can cause menopause to begin early (before age 40 or even in the early 40s). Some symptoms of hyperthyroidism (overactive thyroid) can be confused with early menopause. Menstrual irregularities, hot flashes, insomnia, and mood changes are examples. Treating hyperthyroidism often can alleviate or prevent the onset of early menopause symptoms.

Other effects of thyroid disease

Mental and psychological effects: Anxiety or depression are common in those who have a thyroid imbalance. Mood swings can also become more severe as the thyroid disease progresses without being treated. You may also have trouble sleeping, lack of concentration, loss of motivation, excessive stress, and a short temper if you have hypothyroidism. Anxiety and panic attacks, mood swings, sleep problems, irritability, and anger issues, can occur because of hyperthyroidism. These issues can be treated with psychotherapy and psychiatric intervention. However, seeking treatment for your thyroid imbalance will also help alleviate these issues. Sexual dysfunction: Thyroid disease can cause a loss of libido in both men and women. Men may experience erectile dysfunction and ejaculation problems. Women may experience pain during sex because of vaginal dryness and hypoactive sexual desire disorder, where the person has a lack of desire for physical intimacy. Such issues can cause further stress in people's marital and romantic relationships, leading to anxiety or depression. Thyroid-disease-related sexual problems typically resolve once the thyroid condition is addressed. The same strategies for tackling sexual dysfunction are usually effective in treating thyroid-related sexual issues.

Diagnosis of Thyroid

After reading so much about the thyroid gland and thyroid disorders, one can’t help but wonder how an issue can be detected. To determine whether you have hypothyroidism, a blood test to verify your thyroid hormone levels is the most effective method. Your doctor will check for evidence that your thyroid gland is larger than it ought to be or if your pulse has become too fast if you have hyperthyroidism. The doctor will also examine for any hand tremors. Because goitre can sometimes have no symptoms at all except for an abnormal enlargement of the neck, a physical exam can help confirm its presence. Your doctor will also order additional tests to know the thyroid's size, look for any nodules, determine if the thyroid is overactive or underactive, and the cause behind the goitre. Hashimoto’s disease can also be detected using various tests like blood tests to know the levels of triiodothyronine (T-3) and thyroxine (T-4), and antibody tests. You may be able to see thyroid nodules yourself in a mirror. If you notice you have one or many, then going to a doctor to get it checked out is the best way forward. An endocrinologist is a doctor you need to consult, who, along with a physical exam may also order a thyroid scan, blood tests, ultrasound, and a biopsy. A thyroid biopsy is typically performed by inserting a fine needle into the solid mass. For thyroid cancer, the only obvious way to confirm the diagnosis is through a biopsy. CT scans and MRIs may also be ordered. Before that, a physical exam will take place along with some blood tests.

Treatment

Different thyroid diseases have different treatment methods for managing or preventing them. Once you have received your diagnosis, your doctor will decide the appropriate way in which your issue should be treated. Here is an overview of what to expect:

Hypothyroidism: Most hypothyroidism cases are treated by substituting the amount of hormone that your thyroid gland no longer produces. Typically, this is done with a medication called levothyroxine. This medication, when taken orally, enhances the amount of thyroid hormone your body makes to balance your levels. Hypothyroidism is a treatable condition. However, you will be required to take medications for the remainder of your life to normalise the hormone levels in your body. You can maintain your quality of life with proper management and follow-up consultations with your doctor to ensure that your treatment is progressing in the right direction. Hyperthyroidism: Medication, radioactive iodine treatment, and surgery are the three treatment options. Thioamide will be prescribed to you to prevent your thyroid gland from producing extra thyroid hormone. In addition, you may be required to have a beta blocker pill. Radioactive iodine treatment is a type of radiotherapy that destroys thyroid cells that are overproducing hormones or reduces the enlarged thyroid gland. Although the term ‘radioactive’ may cause concern, this method is both safe and effective. This medication is taken orally and does not require any hospitalisation. However, hospitalisation is possible if the dosage needed is greater. Most patients require only one dose to correct their hyperthyroidism, whereas some may require more. Surgery is usually the very last resort. If the situation is critical, your thyroid gland will be removed entirely (thyroidectomy), but this can result in hypothyroidism, which will necessitate lifelong hormone therapy. Goitre: Most goitres are small and harmless, and don't need to be treated. In most cases, blood tests and ultrasound scans can help figure out the cause of your goitre. If it is caused by a medical condition, like an underactive or hyperactive thyroid, it is usually treatable with medications. If your goitre is making it challenging for you to breathe and swallow, you may need surgery to have a part of or the entire thyroid gland removed. Hashimoto’s disease: The treatment for this is the same as that for hypothyroidism. Levothyroxine, a synthetic hormone, is used to treat hypothyroidism caused by Hashimoto's disease. The synthetic hormone functions similarly to thyroxine, which is produced naturally by the thyroid. The treatment objective is to regain and ensure adequate thyroxine levels while improving hypothyroidism symptoms. This treatment will be required for the entire duration of your life. Thyroid nodules: Because only a minority of nodules are found to be malignant or cancerous, doctors usually do not worry too much unless there is major discomfort or pain. However, if that rare occurrence does happen, then the doctor will give you thyroid hormones to ingest orally. If that does not work either, the last option is surgery. Thyroid cancer: Your doctor will determine which treatment you require based on the type of thyroid cancer you have. The stage in which the cancer was identified and diagnosed also influences clinical judgement. Thyroid cancers are typically treated with:

• Surgery - An operation performed to remove the thyroid gland may involve removing all or most of the thyroid tissue. • Hormone therapy - The hormones produced by the thyroid can be replaced or supplemented with the help of thyroid hormone therapy. Thyroid hormone therapy medication is typically taken orally. • Radioactive iodine treatment - This treatment employs a radioactive form of iodine to kill thyroid cancer cells that stayed after surgery. • External radiotherapy - An external beam radiation machine is used to kill cancer cells in specific areas of your body. If your cancer does not respond to other treatments or recurs, radiation therapy may be proposed. • Chemotherapy - This is a drug treatment in which chemicals are used to eradicate cancer cells. Numerous chemotherapy drugs can be taken either alone or in combination. Some are tablets or capsules; however, the majority are administered intravenously. Sometimes chemotherapy is combined with radiation therapy.