Thyroid dysfunction

Tue, Feb 11th 2014, 11:03 AM

People suffer from symptoms every day that they may not think anything of, but which in actuality could mean that they have a thyroid disorder because they don't realize that the thyroid gland influences almost all of the body's metabolic processes.

Thyroid disorders can range from small, harmless goiter (enlarged gland) that needs no treatment to life-threatening cancer. Too much thyroid hormone results in a condition known as hyperthyroidism; insufficient hormone production leads to hypothyroidism.

Symptoms can range from low energy levels, dry skin, feeling cold all the time, weight gain, depression, joint pain, menstrual irregularity for women (prolonged periods), swelling around the eyes, high blood pressure, slow heart rate, delayed reflexes, anemia on lab tests, low sodium, high cholesterol and even fluid around the heart, according to endocrinologist Dr. Tanya Thompson-Badamosi.

Speaking at the recent Doctors Hospital Distinguished Lecture Series, Thompson-Badamosi spoke about normal thyroid function, the role of thyroid hormones, the causes, symptoms, and treatments of hypothyroidism and hyperthyroidism.

Millions of people around the world suffer from thyroid dysfunction -- and many people have no idea that the small bow tie-shaped gland in their neck is to blame. The most common thyroid problems involve abnormal production of thyroid hormones, and although the effects can be unpleasant or uncomfortable, most thyroid problems can be managed if properly diagnosed and treated.

According to the doctor, one of the most important nutrients a body needs to ensure normal thyroid function is iodine, the daily allowance of which varies according to age. The medical practitioner said pregnant women and nursing mothers need more than a regular adult; and that children between the ages of one and eight do not need as much as an infant for normal development because growth is not as rapid.

"The function of the thyroid is very important for fetal development. Babies need it in order to develop properly in terms of their growth as well as brain development, so a lack of thyroid hormone, or congenital hypothyroidism can result in a condition called cretinism -- stunted growth and mental retardation," said Thompson-Badamosi.

"It's also needed for metabolism and this includes brain and heart regulation, so in adults, the bone and heart are commonly affected [and] you can develop an irregular heart rhythm, atrial fibrillation, bone loss, increased bone turnover and this can lead to osteoporosis.

"According to the doctor, the lack of iodine should not be a problem for most Bahamians as the Bahamian diet is rich in the nutrient that can be sourced from seafood, salt, kelp and multi-vitamins.

"The typical Bahamian diet means that iodine should actually be very rare in this country," said the endocrinologist.

Famous people who have had thyroid disorders include former United States President George Bush and his wife, Barbara, who both had Graves' disease, a form of hyperthyroidism (over active thyroid); Olympic gold medal sprinter Carl Lewis, who had hypothyroidism; and singer Rod Stewart, who had thyroid cancer.

"Thyroid hormones are regulated by a hormone called TSH (Thyroid Stimulating Hormone) a hormone that is made by the Pituitary gland in the brain," she said.

"If thyroid hormones are high, then TSH should be low; if thyroid hormones are low, then TSH should be high. If the TSH is not appropriately high or low, then maybe there's an issue with the pituitary gland in the brain."

Hypothyroidism

Hypothyroidism is an under-activity of the thyroid gland function. According to the doctor, a blood test should show low thyroid hormones with a high TSH because the gland is trying to stimulate the thyroid gland to make more of the hormone.

Types of hypothyroidism include Hashimoto's thyroiditis, which the doctor said is the most common cause of hypothyroidism, an autoimmune condition in which the body attacks thyroid tissue; removal of the thyroid gland surgically or chemically destroyed and exposure to excessive amounts of iodine from cold and sinus medicines, the heart medicine amiodarone or contrast dyes given by some x-rays like the CAT scan.

Symptoms of hypothyroidism include very low energy levels, dry skin, feeling cold all the time, weight gain, symptoms of depression, joint pain, menstrual irregularity for women (periods can be prolonged); and signs include Periorbital puffiness (swelling around the eyes), high blood pressure, slow heart rate, delayed reflexes, and on labs, anemia can be found as well as hyponatremia, high cholesterol, and fluid around the heart.

Hyperthyroidism, or thyrotoxicosis, is an over activity of the thyroid gland. It can also be caused by sources outside of the body such as taking too much iodine or thyroid supplements from natural food stores. Other causes include Graves' disease.

Symptoms of hyperthyroidism or thyrotoxicosis include palpitations or rapid heart rate (the sensation that the heart is fluttering), atrial fibrillation which is an irregular heart beat, excessive sweating or heat intolerance, weight loss, increased frequency of bowel movements, mood changes and irritability.

Basically the metabolism speeds up... everything speeds up in the body. Other signs of thyrotoxicosis include lid lag, meaning you can see the whites of the eyes, shortness of breath, goiter, increased bone turnover which can lead to decreased bone density and possibly osteoporosis, insomnia or difficulty sleeping and excessive shaking.

Treatment of hypothyroidism includes thyroid hormones that include T-4 (thyroxine) and T-3, with T-4 the mainstay of treatment. There are many preparations of thyroid hormones, the most common being synthroid, levothyroxine, levoxyl and T-3 contained in Sidamel.

A more natural form of thyroid hormone is desiccated thyroid (a mix of thyroid hormones from beef and pork thyroid glands) which the doctor said some people prefer, although she added levothyroxine, levoxyl, or synthroid, is the mainstay of treatment for hypothyroidism.

Hyperthyroidism

Hyperthyroidism can occur in several ways: Graves' disease, due to the production of too much thyroid hormone; nodules developing in the thyroid gland secreting thyroid hormones; subacute thyroiditis, an inflammation of the thyroid that causes the gland to "leak" excess hormones which can also cause hypothyroidism. Essentially, it is a caused by a viral illness or some other illness leading to the development of inflammation of the thyroid gland.

When there is all of this inflammation in the thyroid gland, all of the thyroid hormones spill out into the blood stream into the circulation. This actually makes a person hyperthyroid overactive because the thyroid hormone levels in the blood are very high; they're low in the rest of the organ, though, and eventually the person may become euthyroid, meaning at normal thyroid function. But this is short term because then they become hypothyroid when all of those thyroid hormones are removed from the circulation.

After several months people with subacute thyroiditis can eventually recover normal thyroid function. It can also occur through pituitary gland malfunctions or cancerous growths in the thyroid glandThe number one treatment for primary hyperthyroidism, according to Thompsons-Badamosi, is anti-thyroid medications -- methimazole anthithyroid and proplthiouracil, with methimazole anthithyroid being the better of the two because proplthiouracil can cause liver toxicity and liver damage leading to liver failure; although it is the preferred medication for pregnant women with hyperthyroidism in the first trimester of pregnancy.

The second treatment option for hyperthyroidism is radioactive iodine that is essentially an oral dose of radioactive iodine that goes to the thyroid gland and burns out the over-functioning part of the thyroid gland.

According to the doctor, the risk that is that it will work too well, which she said commonly happens and then patients actually develop hypothyroidism. This is very common, and that's treated with thyroid-hormone pills. That is thought to be better to treat hypothyroidism than hyperthyroidism.

The third treatment option for hyperthyroidism is surgery, which Thompson-Badamosi said is usually a last resort or is done if medications or radioactive iodine for some reason cannot be used. She said this treatment option would also render a person hypothyroid if the thyroid gland is taken out because they will need thyroid replacement.

Thompson-Badamosi said treatment for subacute thyroiditis is a little different from primary hyperthyroidism and that treatment is mainly supportive with the symptoms treated; so aspirin is used to treat the symptoms of the inflammation and the pain in the neck, along with NSAIDS (non-steroidal anti-inflammatory drugs) such as ibuprofen and they are not effective. High-dose steroids can be used over several weeks to months depending on the patient's symptoms.

Thyroid nodules

The endocrinologist said thyroid nodules are also not uncommon either and can be either benign or malignant, but that they do need to be evaluated.

She said the first thing that should be done is a test for TSH, the thyroid-stimulating hormone. If the blood test returns showing low TSH, she said the person is likely hyperthyroid in which case a thyroid scan should be the next test performed.

If the test comes back and the TSH is normal, or even if it's high, indicating hypothyroidism, she said the nodules then need to be evaluated further, so a thyroid ultrasound should be done for all thyroid nodules whether the TSH is high or low.

"Depending on the size and characteristics of the thyroid nodules, that determines if a biopsy should be done," she said. "Generally if the nodule is about a centimeter and it's solid, then a biopsy should be done.

The reason this is done is to ensure there are no suspicious cells, suspicious findings, pre-cancerous lesions or even thyroid cancer.

"The majority of thyroid nodules are actually benign, but that cannot be predicted with a thyroid ultrasound, so in many cases, a biopsy is necessary.

"Solid nodules, the doctor said, should be biopsied when they're at least one centimeter in size -- smaller if a person has a high-risk history.

There are four main types of primary thyroid cancer -- papillary thyroid cancer, the most common thyroid cancer (accounting for 60 percent to 80 percent of thyroid cancers and fortunately it's the one also with the best prognosis).

It's treated with surgery, possibly radioactive iodine after to burn out and destroy any remaining cells after the surgery, and then thyroid hormone replacement).

Follicular thyroid cancer is the second most common type (15 percent to 30 percent of thyroid cancers which also has a good prognosis).

It is treated pretty much the same way as papillary thyroid cancer. Medullary thyroid cancer is treated surgically.

It can also be a genetic thyroid cancer. There are certain conditions called MEN (multiple endocrine neoplasia) where medullary thyroid cancer is one feature of other endocrine disorders and is usually genetic.Anaplastic thyroid cancer is found in one percent to 10 percent of cases.

It is a very rare form of thyroid cancer, but it's the most aggressive. Treatment is usually palliative surgery. It has a poor prognosis.

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