Hello, in this HealthSketch we’d like
to talk to you about thyroid disorders, which are conditions of the thyroid gland.
Thyroid disorders can affect anyone: men, women and children, but they are more
common in women, and become more common with age. The thyroid gland is a small butterfly-shaped
organ that is found in the neck just in front of the voice box. It makes the
thyroid hormones, T3 and T4, which act as chemical ‘messengers’, travelling
through the blood stream to all the cells and tissues in the body. These thyroid hormones
control the speed at which your body works, which is also called your body’s ‘metabolism’.
They therefore affect your heartbeat, energy levels, digestion, body temperature, and
even how you think and feel. For such a small gland, which many people haven’t heard of,
it has a huge effect on how our bodies work! Because of this, it is important to have the
right amount of thyroid hormones in the body: if there is too little then the cells
work too slowly, but if there is too much, the cells work too quickly. The brain helps
to keep levels in check by measuring the levels of thyroid hormones in the blood. If
levels are low, the pituitary gland releases Thyroid Stimulating Hormone, or ‘TSH’, to
stimulate the thyroid gland to release more thyroid hormones. If thyroid hormone levels are
too high, then less TSH is released by the brain. In this way, the levels of thyroid hormones
in the blood are usually kept in balance. However, in some people, the
thyroid gland doesn’t work properly. An underactive thyroid gland can lead to
too little thyroid hormone being made, which is called hypothyroidism (because
hypo means ‘too little’). Others can have an overactive thyroid gland, where thyroid
hormone levels are too high, which is called hyperthyroidism (because hyper means ‘too much’).
These are the two main types of thyroid disorder. The symptoms of hypo and
hyperthyroidism are very wide-ranging: In hypothyroidism, the body’s metabolism slows
down. This can lead to symptoms such as tiredness; weight gain; feeling cold; constipation; dry
or thinning hair; muscle weakness and aches; a hoarse voice; ‘pins and needles’ in the
hands; slow speech, movements and thoughts; low mood and anxiety; memory problems; and
concentration problems. In babies and children, hypothyroidism can also affect normal growth
and development if not treated properly. In hyperthyroidism, by contrast,
the body’s metabolism speeds up. This leads to a very different pattern
of symptoms, such as: a racing heartbeat; loss of weight; feeling sweaty and shaky; feeling
uncomfortably hot; diarrhoea; thirst; itchiness; mood swings; feeling anxious and irritable;
concentration problems; and restlessness. While these symptoms are wide ranging, it is
rare to experience all of them, and they may be missed or confused with other conditions. For some
people, symptoms are subtle and hardly noticeable, while for others, they can have a significant
impact on daily life. Depending on the cause, symptoms may come on quickly over a matter
of days, or slowly over many months or years. Thyroid disorders may also have other effects,
such as: a swollen thyroid gland (known as a ‘goitre’), nodules or lumps on the thyroid,
and eye problems (which are most likely to affect people with an overactive thyroid and
are sometimes called ‘thyroid eye disease’). Uncontrolled thyroid disorders can also lead
to problems with fertility and pregnancy, and long-term heart problems. Therefore,
it is important to get a diagnosis, even if symptoms are mild. Thyroid disorders are diagnosed by checking
the levels of thyroid hormones in the blood and sometimes by a physical examination.
Usually, in hypothyroidism, TSH will be high and T4 will be low, and in hyperthyroidism,
TSH will be low and T4 will be high. Depending on your diagnosis there may be further
investigations, such as follow up blood tests, and possibly a thyroid scan or biopsy,
to find out the underlying cause. So, what are these underlying
causes of thyroid disorders? • Rarely, hypothyroidism can be present at
birth, when babies are born with a thyroid gland that does not develop or work properly. This is
called congenital hypothyroidism, and all babies receive a blood spot test at birth to screen for
this, so it is almost always picked up early. • Thyroid disorders can also be
acquired at any age throughout life, including childhood, through a range of causes:
o Of these, autoimmune causes are the most common: like with other autoimmune conditions, the
body’s own immune system is the problem, creating antibodies that either attack or
stimulate the thyroid gland. Hypothyroidism is usually caused by Hashimoto’s disease and
hyperthyroidism is most commonly caused by Graves’ disease. Both of these can run in families.
o Thyroid nodules: are extra lumps or nodules of thyroid tissue, which are
usually benign (or non-cancerous) but they can affect thyroid hormone levels. Very
rarely these nodules will be cancerous which will require specialist treatment.
o Iodine deficiency: which is more common in the developing world.
o Other rarer causes of thyroiditis: such as after an infection, after pregnancy,
or with certain medications such as lithium and amiodarone. These are usually temporary.
o Problems with the pituitary gland in the brain. o And as a consequence or side
effect of thyroid treatment. So how are thyroid disorders treated? The main
aim of treatment is to ensure the right levels of thyroid hormones in the blood. If levels are too
low, then synthetic thyroid hormone medication can be taken as a replacement. If levels are too high,
antithyroid medication can be taken to dampen down the overactivity of the thyroid gland. Apart from
medication, treatment for an overactive thyroid can also include taking a radioiodine capsule,
which targets thyroid tissue, or surgery to remove some or all of the thyroid gland, which may
also be recommended for a goitre or for nodules. Replacement medication may be
needed after these treatments. Whatever the treatment, and even if
no treatment is currently needed, it is important to have regular blood tests so
that your doctor can monitor your thyroid function and adjust dosage if needed. This monitoring
is particularly important during pregnancy. So, what can you do to improve your condition?
It is important to take medication regularly as prescribed, for example, on an empty
stomach at the same time each day. Leading a healthy lifestyle is recommended,
such as having a well-balanced diet and stopping smoking. This is especially important
with hyperthyroidism and thyroid eye disease. Smokers are much more likely to develop
thyroid eye disease than non-smokers. Living with a thyroid condition can also
affect your mood and sense of wellbeing, and it can help to talk about this
with your doctor, friends and family. Many find it helpful to join patient support
groups, to connect with others who are going through similar experiences. While these can be
lifelong conditions, symptoms usually respond well to treatment, and so most people with thyroid
disorders will lead normal and healthy lives. We hope this HealthSketch has been
helpful to you and those around you.
