Thyroid Problems

Thyroid problems affect millions of people in the United States every year. The thyroid gland is a roughly “bow tie” shaped gland in the neck that is draped around the wind pipe (trachea) below the “Adam’s apple” (larynx) and above the breast bone (sternum). It is one of several endocrine or hormone glands in the body. Its main function is to produce two major thyroid hormones (called T3 and T4), which regulate metabolism in the body. The more thyroid hormones it produces, the faster the body’s chemistry operates which affects literally all organs in the body. Normally the pituitary gland in the brain controls the amount of thyroid hormones the thyroid produces by making just the right amount of thyroid stimulating hormone (TSH) which stimulates the thyroid to secrete thyroid hormones into the bloodstream. But, just as Murphy’s Law predicts, things can go wrong!

The three most common problems requiring treatment are over production of thyroid hormone, under production, and masses or lumps in the gland, which can be cancer.

Thyroid hormone overproduction causes the body chemistry to speed up. This condition, called hyperthyroidism, can lead to rapid weight and muscle loss, weakness, sweating, diarrhea, thinning hair and nails, fatigue, poor sleeping and fast or irregular heart rate. Some people have another side effect causing the eyeballs to bulge in their sockets. A simple blood test will diagnose the problem. The condition usually responds very well to either medication or radioactive iodine pills, or less often, surgical removal of the thyroid gland.

Underactive production of thyroid hormone, called hypothyroidism, results in fatigue, lethargy, fluid retention, dry skin, slowed thought and reflexes, weight gain, and occasionally depression. Anyone feeling really tired and run down for a prolonged period of time should have a blood test run to check for this. Thyroid hormone pills easily treat this condition and result in rapid improvement.

Lumps or masses in the thyroid can be cancerous but usually do not affect the hormone levels or blood tests. Your doctor should always feel the thyroid during a thorough physical examination, but you can also feel your own neck at home. Any lumps or firmness in the gland needs to be checked for cancer. This is usually done with a thyroid ultrasound and often a thyroid scan as well. In addition, most thyroid specialists feel any large masses should have cells sampled for cancer by a needle aspirate or biopsy. This is a very easy office procedure with minimal discomfort. When all the information is back, you and your doctor can decide whether or not you should have the abnormality surgically removed. Some smaller thyroid masses have such a low risk of cancer that they can safely be watched without surgery. Any nodule or mass that enlarges or anyone with a family history of thyroid cancer or a past history of neck radiation has a higher cancer risk and is more likely to need surgery. All of these things should be explained by your throat surgeon when you decide about surgery.

Sometimes even expert thyroid surgeons disagree on when to operate and how much to remove, so a second opinion is never a bad idea if you want one.

If you are not sure if your thyroid has been checked, just ask your doctor or nurse practitioner on your next visit. They’ll be glad to do it for you.