Thyroid problems can have a dramatic impact on a huge variety of bodily functions. If you are a woman aged 35 or over, the chances of you suffering from thyroid problems is especially high. Therefore we would like to take a look at the two most common thyroid disorders – hypothyroidism or an underactive thyroid and hyperthyroidism or an overactive thyroid. It is important to note the difference between the two conditions.
What are the most common Thyroid Problems?
Hypothyroidism, also known as underactive thyroid, is a common condition where your thyroid gland does not create enough of a thyroid hormone called thyroxine.
Hyperthyroidism, on the other hand, is where the thyroid produces too much thyroxine.
What does the thyroid gland do?
The thyroid gland is found in the front of the neck below the larynx (voice box) and has two lobes, one on each side of the windpipe. Hormones released by the gland travel through your bloodstream and affect nearly every part of your body, from your heart and brain, to your muscles and skin.
Thyroid hormones regulate your metabolism. This is the way your body uses energy and without enough thyroxine many of the body’s functions slow down. This means your body makes less energy and your metabolism becomes sluggish.
What causes hypothyroidism?
- Hashimoto’s disease – This autoimmune disorder causes the body to produce antibodies that attack and destroy the thyroid gland. This leads to inflammation of the gland and interferes with its ability to produce thyroid hormones.
- Thyroiditis – This is the inflammation of the thyroid gland and it causes thyroid hormone to leak out into the blood stream. This raises the hormone levels and leads initially to hyperthyroidism. After a couple of months, this usually develops into hypothyroidism. Thyroiditis can be caused by bacterial or viral infection and can result from an autoimmune condition and pregnancy.
- Radiation therapy – This is often used to treat certain cancers such as Hodgkin’s disease and lymphomas. It damages cells in the thyroid making it more difficult for the gland to produce thyroxine.
- Radioactive iodine treatment – This is a common treatment for an overactive thyroid and works by destroying the cells of the thyroid gland thereby decreasing the production of thyroxine.
- Medications – A number of drugs can interfere with the production of thyroid hormone. These include amiodarone(Cordarone), lithium, interferon alpha, and interleukin-2.
- Too little iodine in the diet – Iodine is needed for the production of thyroid hormones. Your body doesn’t make iodine so you need to take it in through your diet. Iodised table salt is a rich source as are shellfish, saltwater fish, dairy products, eggs and seaweed.
- Thyroid surgery – Surgery to remove the thyroid will lead to hypothyroidism. If only part of the gland is removed, the remaining part may still be able to produce enough hormone for the body’s needs.
- Pituitary gland abnormalities – This gland makes a hormone called thyroid stimulating hormone (TSH) which tells your thyroid how much hormone it should make and release. Pituitary tumours or surgery can affect the function of the gland. If a woman loses a large amount of blood or has severe low blood pressure after childbirth, the gland can be damaged.
- Problems with the thyroid at birth – In cases of congenital hypothyroidism, babies are born with a thyroid gland that does not function properly.
Who is at risk of hypothyroidism?
Women, particularly older women, are more likely to develop the condition than men. This also applies if you have a close family member with an autoimmune disease. Other risk factors include:
- Age (growing older)
- Race (being white or Asian)
- Prematurely greying hair
- Autoimmune disorders such as type 1 diabetes, Coeliac disease, rheumatoid arthritis, multiple sclerosis, Addison’s disease, pernicious anaemia, lupus or vitiligo
- Down syndrome
- Bipolar disorder
- Turner syndrome
What are the signs and symptoms?
- Unexplained weight gain or difficulty losing weight
- Dry skin
- Thin brittle hair or fingernails
- Changes in the menstrual cycle including heavy periods
- Cold intolerance
- Slowed heart rate
- Swelling of the thyroid gland (goiter)
- Joint and muscle pain
- Puffy face, feet and hands
Tests and diagnosis of thyroid problems
If you have symptoms of hypothyroidism, your doctor will undertake a thorough physical examination, talk through your medical history and will order blood tests to check hormone levels.
The most common blood test is the TSH test. This detects the amount of thyroid stimulating hormone (TSH) in the blood. If the reading is above normal, then the patient is usually considered to have hypothyroidism. Low levels of TSH are usually an indication of an over active thyroid. Additional tests include the T4 test and the thyroid autoantibody test.
Treatment and prevention
If you are found to have the condition, your doctor will prescribe a synthetic thyroid hormone T4. This pill is to be taken every day and you will then need regular blood tests to check your thyroid hormone levels. As certain other medications can interfere with how your body absorbs synthetic thyroid hormone, it is important that your doctor knows about all the medicines, supplements and over-the-counter products that you take.
Iodine is an essential mineral for the functioning of the thyroid. Iodine requirements increase in pregnancy so it is important to ensure that you take in sufficient by including iodised salt in your diet and take prenatal vitamins.
Diet can affect the way in which the body absorbs thyroid medication. Any major dietary change should be discussed with your doctor.
Hypothyroidism is usually able to be managed with medical advice and medications. These medications will usually need to be taken for the rest of your life.
What about hyperthyroidism?
Hyperthyroidism, also known as overactive thyroid, is a condition in which your thyroid gland makes and releases more thyroid hormone than your body needs. Thyroid hormones regulate our metabolism and while a lack of them causes our body functions to slow down, an excess can cause a lot of things in your body to speed up.
With treatment, you can lead a healthy life but without treatment, hyperthyroidism can lead to serious heart problems, bone problems such as osteoporosis and a dangerous condition called thyroid storm.
Women are between five and ten times more likely to develop the condition than men.
Causes of hyperthyroidism
- Graves’ disease is the most common cause and is an autoimmune condition whereby the body’s immune system creates an antibody that causes the thyroid gland to make an excessive amount of thyroid hormone. Graves’ disease can run in families and is most common in women aged 20-40.
- Nodules in the thyroid gland can develop and affect the regular function of the gland.
- Thyroiditis causes the gland to swell, leaking thyroid hormone into the bloodstream.
- Excessive iodine intake can cause the gland to produce too much of the thyroid hormones thyroxine (T4) and triiodothyronine (T3).
- Intake of thyroid hormone medication can be a problem if too many doses are taken.
- Certain medications used to treat heart problems contain a large amount of iodine. One such example is amiodarone which is prescribed for atrial fibrillation.
Signs and symptoms of hyperthyroidism
- A swelling in the neck called a goiter occurs in most people with the condition
- Irregular and rapid heartbeat, sometimes with palpitations
- Shakiness and muscle weakness especially in the thighs and upper arms
- Anxiety, nervousness and irritability
- Increased bowel movements and more frequent urination
- Weight loss despite increased appetite
- Eyes that bulge out especially in patients with Graves’ disease
- Hair changes including thinning, brittleness and alopecia
- Rapid fingernail growth
- Excessive sweating
- Extreme tiredness
- Shaky, trembling hands and redness on the palms
- Loss of interest in sex
How is hyperthyroidism diagnosed?
If you have any of these symptoms you should make an appointment with your GP. It is important to note that these symptoms could be due to other medical conditions and disorders. Your doctor will ask about your symptoms and carry out a physical examination.
They will also order a blood test known as a thyroid function test. This will check for levels of thyroid-stimulating hormone (TSH), thyroxine and triiodothyronine. If your test results are abnormal, your doctor may also send you for a thyroid ultrasound to check for nodules or inflammation. In some cases, a special diagnostic scan is made using radioactive iodine called a radioactive iodine update test (RAIU).
What are the treatment options?
- Anti-thyroid drugs. This type of medication prevents the thyroid gland from producing excess amounts of thyroxine or thriiodothyronine.
- Radioactive iodine. The dose of radioactivity is very low and is not harmful but the overactive thyroid cells quickly absorb this iodine and soon die. It may take a few months for the therapy to relieve the symptoms and a second dose may be needed. Patients will develop an underactive thyroid and will need thyroid hormone supplements for the rest of their lives. This therapy is not suitable during pregnancy.
- Surgery. This involves removing all or part of the thyroid and is suitable for pregnant women or when other therapies are not suitable. Most people will then need thyroid hormone replacement medication for the rest of their lives.
- Beta-blockers. These medicines will slow down the heart rate but will not lower the thyroid hormone levels.
Complications can occur if the condition is untreated and can lead to congestive heart failure, miscarriage, irregular heart rhythm, osteoporosis and bone fractures.
In extreme circumstances, if symptoms suddenly worsen, it is vital to seek immediate medical attention to avoid what is known as a thyroid storm. This uncommon reaction can be triggered by an infection, injury or trauma and is life threatening requiring immediate medical treatment.
In conclusion, thyroid problems can, with proper care, be easily diagnosed and treated. It is vital that patients adhere to the treatment guidelines given to them, to ensure effective and long-term relief.
If you would like help and advice in relation to your thyroid problems, please follow the link to the charity Thyroid UK
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