Tackling thyroid woes

January is Thyroid Awareness Month as thyroid diseases are one of the commonest endocrine disorders which are easily diagnosed and treated.

However, thyroid disease is usually under-diagnosed and under-treated which can affect a high percentage of the population, so we at the Gulf Diabetes & Endocrinology Specialist Centre want to highlight the condition.

The thyroid gland is prone to several distinct problems which can be broken down into those concerning the production of hormone (either too much or too little) and those due to increased size causing pressure on the surrounding neck structures or simply appearing as a mass in the neck.

The thyroid is a gland, shaped like a butterfly, which is considered one of the largest endocrine glands in the body and rests in the middle of the lower neck. Its primary function is to control the body's metabolism. It produces hormones which influence essentially every organ, tissue and cell in the body.

When the thyroid produces too much hormone, the body uses energy faster than it should (hyperthyroidism). When the thyroid doesn't produce enough hormones, the body uses energy slower than it should (hypothyroidism).

Thyroid disease can be difficult to diagnose because symptoms are easily confused with other conditions. Fortunately, there is a simple blood test which can identify thyroid disorders early and treatment can easily control the disorder even before the onset of symptoms.

Thyroid diseases are life-long conditions and, with careful management, people with thyroid disease can live healthy and normal lives. People with a family history of thyroid are at risk and those with diabetes, vitiligo, obesity, high cholesterol, hypertension, depression, infertility and irregular cycles should be screened.

Underactive Thyroid Gland (hypothyroidism)

Common symptoms of the condition include tiredness, lack of concentration and forgetfulness, muscle aches, constipation, dryness of the skin, dry coarse hair, weight gain, infertility and heavy menstrual periods. Slow heart rate, memory problems, intolerance to cold and puffiness around the eyes may also occur. In children growth may be delayed. In some people the thyroid gland may be enlarged but this may improve with treatment.

Thyroid hormone is important for women in order to get pregnant and is important for the foetus, especially in the first three months.

Pregnancy is perfectly safe in women who are on stable thyroxine replacement. However, regular medical checks during pregnancy are important because of the possible increase in thyroxine dose which may be necessary as pregnancy advances to avoid complications to the foetus. It is most important that thyroxine treatment should be continued, especially early in pregnancy.

If untreated it may increase the risk factors for heart disease and hardening of the arteries.

Treatment

Treatment of hypothyroidism is to take thyroid hormone replacement in the form of a small tablet daily for life. The hormone rarely has side effects and produces almost no allergic reactions. With careful monitoring, your doctor will adjust your dosage and a stable dose of thyroxine will be reached. Pregnancy, major stress or illness can increase the need for thyroid hormone. Thyroxine replacement does not interfere with any other conditions.

Overactive Thyroid Gland (Hyperthyroidism)

The clinical name for an overactive thyroid gland is hyperthyroidism (excess of thyroid) but Graves' disease is the commonest form of the disease. It often runs in families and can occur at any age. It is seen in women eight times more often than men.

Symptoms do not generally come all at once and are due to the effects of excess amounts of thyroid hormone on body functions and metabolism. In simple terms, all the metabolic processes are 'speeded up', for example the pulse rate is rapid (over 100), bowel function is increased (diarrhoea), and the sweat glands work excessively.

The nervous system is also stimulated so that the sufferer becomes irritable and nervous. Other common symptoms include muscle weakness, hand tremors, weight loss, sleep disturbances, enlarged thyroid gland, feeling warm and infrequent/scant menstrual periods. The eyes are affected and present with eye irritation and bulging.

Treatment

Generally requires the normalisation of thyroid hormone production. Treatment could involve drug therapy to block hormone production, radioactive iodine treatment that disables the thyroid or even thyroid surgery to remove part of or the entire gland.

Although radioactive iodine is by far the simplest and most convenient treatment, it is underused in this area. More often than not, patients end up hypothyroid due to the radioactive iodine and have to take thyroid hormone for life.

Thyroid Nodules

A thyroid nodule is a localised swelling within the thyroid gland. It could be a single swelling or multiple ones (multinodular goitre). Nodules are common and often cause no symptoms. Although cancer is uncommon, it is important to investigate thyroid nodules to exclude cancer.

Thyroid nodules are usually small and painless and they do not cause any pressure affects in the neck. Most patients do not even notice the swellings which are often discovered by doctors during routine medical check-ups or on examination for other conditions. Thyroid nodules are usually firm, smooth and easily felt if they are large enough (over one centimetre in diameter). Smaller nodules are only detectable by ultrasound.

The next step is a fine needle biopsy of the thyroid nodule which enables cells and fluid to be examined to determine whether the nodule is benign or malignant.

The centre advises looking in the mirror while drinking some water. If you see a mass moving up and down below the Adam's apple then you need to be checked.

Thyroid cancer

Thyroid cancer is relatively uncommon but it is still the eighth commonest cancer in the USA and the second commonest cancer among women in the Gulf. In the GCC, it is believed that screenings and awareness campaigns are responsible for the rise in diagnosis but no definite figures exist.

Thyroid tumours typically present as a one-sided painless thyroid nodule in a clinically normal patient. This may have been noticed by the patient or picked up as an incidental finding on an ultrasound of the neck. Patients presenting with a hard nodule should raise concerns.

Change in voice in the presence of a thyroid nodule suggests thyroid cancer until proven otherwise. Thyroid function tests and fine needle aspiration should be done to rule out malignancy.

As part of Thyroid Awareness Month the centre is organising a forum for doctors to familiarise them with the symptoms and treatment of thyroid disorders.

l The writer is medical director and consultant endocrinologist, Gulf Diabetes & Endocrinology Specialist Centre, Bahrain