Thyroid Problems
Hypothyroidism, hyperthyroidism, lumps, and goiters, oh my!
This week’s article builds on /health-fitness/womens-health/what-does-the-thyroid-do. If you haven’t already done so, please go back and read /health-fitness/womens-health/what-does-the-thyroid-do before reading this. Today I am going to focus on what happens when things go wrong with the thyroid gland, spending most of my time discussing when it stops working. I’ll also discuss some of the issues around thyroid replacement medication.
There are four main problems the thyroid can have:
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It can get big
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It can have lumps
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It can put out too much hormone
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It can shut down
What Is an Enlarged Thyroid?
When the thyroid gland is enlarged, it gets the unfortunate name, “goiter.” I don’t like the word “goiter.” It joins “gout,” “shingles,” and “scabies” as those medical conditions with ugly names. If I had an enlarged thyroid, I’d hit whoever called it a goiter.
Since the thyroid gland is in the neck, an enlargement of the gland will cause neck swelling as its main symptom. If they get big enough, goiters can also make it difficult to breathe, and sometimes they even cause pain.
What Causes an Enlarged Thyroid?
The main cause of thyroid enlargement is inflammation, which is where white blood cells enter the gland and cause it to swell. The fancy word for an inflamed thyroid is thyroiditis. The other significant cause of thyroid enlargement is lack of iodine in the diet, which is one of the main reasons iodine is added to salt.
Thyroiditis has three main causes:
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Medications
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Auto-Immune disease
The last two causes are sometimes associated with an increase in put out by the gland, which you will recall is called hyperthyroidism. But regardless of the cause, a big thyroid isn’t normal and should be brought to your doctor’s attention.
Are Lumps on Your Thyroid Cancer?
Sometimes people get lumps, or nodules on their thyroid gland. The big worry here is thyroid cancer, and so usually blood radiology tests are performed to decide if more tests need to be done. Most lumps end up not being serious, but suspicious ones get a needle stuck in them to check for cancer cells.Â
The good news is that thyroid cancer is not very aggressive, and is usually fixed by simply removing the thyroid surgically. Like thyroid enlargement, lumps aren’t normal and should prompt you to see your doctor.
What is Hyperthyroidism?
are usually associated with an enlarged gland, and are usually caused by auto-immune diseases. Auto-immunity is where the body develops antibodies against a certain part of the body. There are many autoimmune diseases, but two focus their immunity on the thyroid gland: Grave’s disease and Hashimoto’s thyroiditis. Grave’s disease causes hyperthyroidism, whereas Hashimoto’s initially causes hyperthyroidism, followed by permanent destruction of the thyroid gland.
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Nervousness and sweating
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Increased heart rate
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Increased bone loss and osteoporosis
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A serious heart condition called atrial fibrillation, a fib.
Atrial fibrillation happens in 10-20% of people with hyperthyroidsim, and so all people with new onset a fib should get their thyroid checked.
The treatment of Grave’s disease is to shut down the gland with medication and then permanently disable it with surgery or radiation.
Actually, the most common cause of hyperthyroidism is when people take too much thyroid medication. The serious problems associated with too much hormone should underline just how important it is to get the .
What Is Hypothyroidism?
Hypothyroidism is by far the most common thyroid problem I encounter as a physician. Hashimoto’s thyroiditis is the most common cause, but certain viruses can cause it too, as can surgeons wielding knives. Unlike hyperthyroidism, however, hypothyroidism is usually subtle in its onset. The most common symptoms with hypothyroidism are very nonspecific, and include:
As you may have noticed, a lot of people have symptoms of hypothyroidism. There are a lot of tired, , bald people who are depressed about their weight gain. Most do not have hypothyroidism, but I do often test for it just in case. The dream of taking a pill to fix all of these problems drives many people to my office asking to have their thyroid checked.
All people with high and women with irregular periods should be screened for hypothyroidism. Truthfully, I find hypothyroidism more in this group than in the obese, tired, crowd.
What Is the Treatment for Hypothydroidism?
Treating hypothyroidism is a subject of much discussion and controversy because doctors don’t always agree on which medications should be used. Some feel that medication aimed at producing only one specific thyroid hormone (T4) is the solution. The most common medication given for that is levothyroxine, (or Synthroid), and it’s the most common drug used to treat hypothydroidism.
Another school of thought says that medication given should mimic two thyroid hormones (T4 and T3), not just one, to more closely reproduce the body’s normal state. That can either be done by adding a small dose of synthetic T3 in the form of a medication called Cytomel, or by using a combination drug. The most commonly used combination drug is Armour Thyroid, which is derived from crushed up pig thyroid. Some doctors are vehemently opposed to the use of Armour Thyroid because of consistency problems, whereas others think that the mix of T4 and T3 helps with making people feel more “normal.”
I’ll finish off this article by giving my quick and dirty tips on treating hypothyroidism.
Quick and Dirty Tips for Thyroid Problems
Tip 1: Take your Medicine. If you have a low thyroid gland and have been prescribed thyroid replacement medication, you need to take it diligently. Low thyroid can not only make you tired and fat, it can lead to other significant problems that could shorten your life.
Tip 2: Get your levels checked regularly. Lots of things can cause thyroid levels to vary, so even if your levels have been fine you should get them checked at least once a year. After any change in dosage it takes about two months for things to stabilize enough for thyroid blood levels to be trustworthy.
Tip 3: If you still have symptoms, consider using T3. This comes from my own personal experience taking care of patients with low thyroid. I’ve seen the fatigue associated with a low thyroid improve significantly after adding T3 in the form of Cytomel. I am not a huge fan of Armour Thyroid (something about crushed up pig thyroid makes me hesitate), but as long as the blood tests are OK and the patient feels good, I will flex with people’s wishes.
I am really only scratching the surface of thyroid disease, but more details would get dull to the non-thyroid crowd out there. But everyone should at least understand this very common problem and get tested if there are any symptoms suggesting a low or high thyroid level.Â
Be sure to check out Girlfriend MD‘s article “Do You Need Hormone Balancing?” for more information.
If you have topics that you want me to cover, send them to create new email, or you can submit them to me on twitter or my Facebook page.Â
Let me once again remind you that this podcast is for informational purposes only. My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.Â
Catch you next time! Stay Healthy!