Thyroid care

The thyroid, a butterfly shaped gland, is situated below the Adam’s apple. It controls metabolism of the body. The gland also plays a vital role in the maintenance of health. Factors like heart rate and calorie burning are controlled by it.

The thyroid produces two main hormones, thyroxine and triiodothyronine. The duo maintains the rate at which your body uses fats and carbohydrates; it helps control your body temperature; it influences your heart rate, and helps regulate protein metabolism. Your thyroid gland also produces calcitonin, a hormone that helps regulate the amount of calcium in your blood.

The rate at which thyroxine and triiodothyronine are released is controlled by the pituitary gland and hypothalamus – located at the base of your brain. This acts like the thermostat for your whole system.

When your thyroid gland malfunctions, the production of its hormones fluctuates. When under-active, it leads to a condition called hypothyroidism; when it is overactive, the outcome is hyperthyroidism

The hypothalamus and the pituitary glands may also be the cause of certain thyroid disorders.

Hypothyroidism

Women are more susceptible to hypothyroidism than men are. An untreated hypothyroid, over a period of time, may lead to major health problems.

Any malfunction of the thyroid gland also slows down normal body functions. This may lead to physical and mental sluggishness. The severest form is called myxoedema.

When left untreated, hypothyroidism can lead to a number of health problems, viz.,

• Goitre. In goitre, the thyroid gland becomes enlarged
• Heart problems. Hypothyroidism increases the levels of LDL, or bad, cholesterol; it also leads to an increased risk of heart disease
• Psychological problems. Slow mental functioning and depression can occur early in hypothyroidism patients; it may also worsen with the passage of time. A sluggish thyroid results in decreased libido too
• Myxoedema. A long-term result of hypothyroidism, myxoedema can sometimes be severe. It can also trigger life-threatening conditions, including coma. The condition is marked by heightened cold intolerance, drowsiness, unconsciousness and lethargy. An individual showing symptoms of myxoedema requires immediate medical attention. However, the problem often is: myxoedema is slow in its onset. Also, symptoms, if any, may go unnoticed for several years.
• Congenital birth defects. Birth defects in babies born to women with thyroid problem is a cause for concern, no less.

Symptoms

Symptoms of hypothyroidism develop slowly. This is reason enough why it tends to remain undetected.

• General feeling of lethargy
• Weight gain
• Swollen face
• Memory loss
• Hoarse voice
• Drowsiness
• Swollen and painful joints
• Muscular aches
• Increased sensitivity to cold
• Constipation
• Pale, dry skin
• Thin, brittle fingernails
• Thin and brittle hair
• Unexplained hair loss
• Elevated blood cholesterol levels
• Muscle weakness, especially in your lower extremities
• Heavier than normal menstrual periods
• Depression.

Causes

1. Removal of thyroid gland
2. Disorder of pituitary gland, or the hypothalamus
3. Hashimoto thyroiditis. This is a disease in which the thyroid gland is attacked by the body’s immune system itself
4. Radioactive iodine treatment
5. Medicines like lithium used for the treatment of psychiatric disorders
6. Exposure to radiation
7. Post-partum hypothyroidism. During pregnancy, the body produces antibodies vis-a-vis one’s own thyroid gland.

Symptoms of untreated hypothyroidism worsen with time. Additionally, individuals affected by the disorder may turn depressive, forgetful, and slow-witted.

Tests

• T4 test
• Serum TSH [Thyoid stimulating hormone]

Detection of hypothyroidism is based on the levels of TSH and thyroid hormone [thyroxin] in your blood. Low levels of thyroxin and high levels of TSH indicate an under-active thyroid. TSH is high in primary hypothyroidism; it is low or low-normal in secondary hypothyroidism.

There may also be other anomalies:

• Increased serum prolactin
• Low serum sodium
• Anaemia
• Increased cholesterol levels
• Increased liver enzymes.

Management

Hypothyroidism is treated with a daily dose of the synthetic thyroid hormone, levothyroxine. It has to be taken orally life-long. On starting the medication severity of symptoms reduce and the body starts its recovery towards normal functioning.

Hyperthyroidism

As long as your thyroid releases proper amounts of hormones, your system functions normally. However, sometimes your thyroid produces too much of these hormones. This upsets the balance of chemical reactions in your body. This condition is known as hyperthyroidism, or overactive thyroid disease. The disorder can lead to increased metabolism, weight loss, sweating, nervousness, and irritability.

Symptoms

• Sudden weight loss, often accompanied by ravenous appetite
• Rapid heartbeat [tachycardia] – up to 200 beats per minute, irregular heartbeat [arrhythmia], or pounding of your heart [palpitations]
• Nervousness, anxiety or anxiety attacks, and irritability
• Tremor – usually, fine trembling in your hands and fingers
• Sweating
• Changes in menstrual patterns
• Increased sensitivity to heat
• Changes in bowel patterns, especially frequent bowel movements
• An enlarged thyroid gland [goitre] may appear as a swelling at the base of your neck
• Fatigue, muscle weakness
• Sleeplessness
• Loss of libido
• Apathy and depression
• Excess urination.

Older adults are more likely to have either no symptoms or very subtle signs, such as increased heart rate, heat intolerance and a tendency to become tired during ordinary activities. Sometimes, an uncommon problem called Graves’ ophthalmopathy may affect your eyes. In this disorder, your eyeballs become dry and protrude.

Causes

• Graves’ disease. The cause of severe hyperthyroidism is Graves’ disease, an auto-immune disorder in which antibodies produced by your immune system stimulate your thyroid to produce too much thyroxine
• Toxic adenoma/toxic multinodular goitre. This form of hyperthyroidism occurs when lumps in the gland produce excessive thyroxine
• Thyroiditis. Sometimes your thyroid gland can become inflamed for unknown reasons. The inflammation can cause excess thyroid hormone stored in the gland to leak into your bloodstream. One rare type of thyroiditis, known as subacute thyroiditis, causes pain in the thyroid gland. Other types are painless; they may sometimes occur after pregnancy [post-partum thyroiditis].

Screening

Your physician/therapist will first check for symptoms and signs by physical examination. You may also need to undergo blood tests that measure the levels of thyroxine and TSH in your blood. High levels of thyroxine and low or non-existent amounts of TSH indicate an overactive thyroid. These tests are particularly necessary for older adults, who may not have classical symptoms of hyperthyroidism.

If blood tests are positive, your physician/therapist may recommend one of the following tests to help determine the cause for overactive thyroid:

• Radioactive iodine uptake test. For this test, a small, oral dose of radioactive iodine [radioiodine] is given and the thyroid is checked after two, six, or 24, hours for iodine absorption. A high uptake of radioiodine indicates your thyroid gland is producing too much thyroxine. The most likely cause is either Graves’ disease or hyper-functioning nodules. If you have hyperthyroidism, but your radioiodine uptake is low, you may have thyroiditis. Knowing what’s causing your hyperthyroidism can help your physician/therapist to plan appropriate treatment. A radioactive iodine uptake test isn’t uncomfortable; it exposes you to a small amount of radiation.
• Thyroid scans. During this test, you’ll have a radioactive isotope injected into the vein on the inside of your elbow, or sometimes into a vein in your hand. You will be asked to lie down on a table with your head stretched backwards, while a special camera produces an image of your thyroid on a computer screen. The time needed for the procedure may vary, depending on how long it takes for the isotope to reach your thyroid gland. You may have neck discomfort with this test, and you will be exposed to a small amount of radiation. Sometimes, you may need to undergo a thyroid scan as part of radioactive iodine uptake test. In this case, orally administered radioactive iodine is used to image your thyroid gland.

Surgery

Surgery – to remove the whole thyroid, or part of it – is not extensively used, because most common forms of hyperthyroidism are quite effectively treated by medications.

Radioiodine

In this therapy, radioactive iodine is given orally [either by pill, or liquid] on a one-time basis to ablate a hyperactive gland. Since iodine is only picked up by thyroid cells, the destruction is local, and there are no widespread side-effects with the therapy. Radioactive iodine ablation has been safely used for over 50 years – it is, however, not used in pregnant and breast-feeding women.

Thyrostatics

Thyrostatics are drugs that inhibit the production of thyroid hormones. There is a problem associated with their use: too high a dose of thyrostatics, surgery and radiation treatment, can cause hypothyroidism.

When symptoms begin to reduce you will start feeling better. However, if you lose a lot of weight, your physician/therapist may supplement your diet with extra protiens and calories. In addition to this, your physician/therapist may recommend you to take a calcium supplement because hyperthyroidism can thin your bones.