Thyroid disorders are not uncommon and can have a significant impact on people's lives. But often they are not diagnosed until a woman finds a lump or a family member notices changes. For a breakdown of the symptoms and treatments, we turn to Dr. William Valente, an endocrinologist with a focus on thyroid disorders at Mercy Medical Center.
Question: What is the thyroid?
Answer: A small gland at the base of the neck, just above the notch of the breast bone, the thyroid is about the size and shape of a butterfly. Its main function is to secrete the hormone levothyroxine, or T4, into the bloodstream. Ultimately, T4 is changed into the active hormone T3 in virtually all cells of the body.
This T3 sets the metabolic activity for bodily functions. Too much, and the body functions too rapidly; too little, and the body functions too slowly, but is comfortable in the midzone under the tight control of the pituitary gland located at the front base of the brain.
Q: How common are problems and who is most affected?
A: Thyroid problems are surprisingly common, particularly in women. Most often the gland develops lumps or nodules which patients may fear are cancerous; cancer is much less common than these often-encountered nodules. Some researchers report that up to 60 percent of women will have small thyroid nodules on neck sonograms. Cancer occurs in only a small percentage of these nodules and can be screened with a fine-needle biopsy.
Q: What is the difference between hyperthyroidism and hypothyroidism?
A: Overactive (hyperthyroid) and underactive (hypothyroid) problems are also common, and the family physicians often check for these when patients are ill. Hyperthyroid patients experience such symptoms as heart racing, muscle trembling, loss of weight and unexplained anxiety. In contrast, hypothyroid patients may experience muscle tiredness and aches, constipation, excessive dryness to skin and hair, or mild weight gain.
Q: Why do they often go undiagnosed?
A: These symptoms can be subtle and may go unnoticed for weeks to months before an astute family physician checks the blood thyroid levels. The diagnosis is usually obvious from the sensitive blood studies now used by the clinical laboratories. Thyroid testing of certain high-risk groups like pregnant women, "out of sorts" older patients and children with growth issues are routinely recommended.
Q: What are the treatments?
A: Treatment of thyroid diseases is effective and usually restores the patient to a normal state of health. Hypothyroidism is treated with levothyroxine pills daily, though care must be given to use the same branded T4 pills. Changing generic thyroid medication is not recommended in this situation due to variable absorption rates; patients should remain on the same brand of T4 once stabilized.
Overactive thyroid disease is usually treated successfully with methimazole. Radioactive iodine can be used to shrink the gland or surgery may be necessary to remove it. Most patients with thyroid cancer do well with this form of treatment. Some require radioiodine to remove remnant thyroid cancer, and all patients will need to continue on T4 replacement and make periodic visits to the doctor.
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