Adult Thyroid Disorders

The thyroid, a butterfly-shaped gland, is found in the front of the neck. It’s part of the endocrine system. A healthy thyroid cannot be seen or felt. It secretes the hormones T4, T3, rT3, and calcitonin.

T4, T3, and rT3 play an integral role in regulating metabolism, body temperature, digestion, mental acuity, heart rate, blood pressure, fertility, skin, and bone health. Calcitonin helps control the blood’s calcium levels.

Iodine is essential for the making of the thyroid’s hormones. The main sources are iodized salt, seaweed, cod fish, dairy, shellfish, tuna, and eggs.

More common thyroid disorders

Goitre: The enlargement of any part or all of the thyroid is called a goitre. Most are harmless. However, they are serious when they compromise breathing by growing under the sternum (breast bone) thereby compressing the trachea (windpipe). In addition to the conditions below, iodine deficiency, and hormone changes associated with puberty, pregnancy, and menopause, can cause a goitre. Treatment depends on the cause.

Hyperthyroidism (overactive thyroid): In this instance, the thyroid is producing too much T3 and T4. The sufferer may report weight loss, increased appetite, tremors, irregular and rapid heart rate, excessive sweating, irregular menstrual cycles, insomnia, mood swings, heat intolerance, tiredness, anxiety, irritability, frequent bowel movements, swelling at front of the neck, bulging eyes, and brittle hair. Women are more likely to be affected. Causes include autoimmune disease (e.g. Greaves’ disease), thyroid nodules, inflamed thyroid (i.e. thyroiditis), consuming too much iodine, and pregnancy. If untreated it can lead to atrial fibrillation, heart failure, osteoporosis, stroke, eye complications, skin discolouration, and thyroid storm. It’s diagnosed by way of thyroid function blood tests (TSH, T3 & T4). It is treated with anti-T3/ T4 medication, beta-blockers (initially), surgery (thyroidectomy), or radioactive iodine. For Greaves’ disease, additional treatments include smoking cessation, natural tear eye drops, and skin creams.

Hypothyroidism (underactive thyroid): Here, the thyroid does not produce enough T3 and T4. Those affected often report tiredness, weight gain, constipation, depression, dry skin, muscle aches, puffy face, thinning of hair, voice hoarseness, irregular and heavy periods, slow heart rate, poor memory, and being unusually cold. Women are more likely to be affected. Causes include autoimmune disease (e.g. Hashimoto’s), surgical removal of the thyroid (thyroidectomy), neck radiation, medicines (e.g. lithium), iodine deficiency, pregnancy, and pituitary failure. If untreated it can lead to heart complications, peripheral nerve damage, infertility, birth defects, and coma. It is diagnosed by way of thyroid function blood tests. The condition is treated with tablets containing levothyroxine.

Hashimoto’s (Autoimmune) Thyroiditis: The body’s immune system mistakenly attacks the thyroid tissue resulting in significant damage to the gland. Risk factors include being female, middle age, having another autoimmune condition, pregnancy, excessive dietary iodine, radiation exposure, genetic factors, viral infections, and environmental factors. Complications include goitre, depression, reduced libido, prolonged and heavy menstrual bleeding, miscarriage, preterm birth, erectile dysfunction, and reduced sperm count. It is diagnosed by checking the blood’s T3, T4, and TSH levels and antibody levels to thyroid peroxidase. The treatment is synthetic T4 and T3 thyroid hormone replacement.

Thyroid Nodule(s): These are fluid-filled or solid growths that develop within the thyroid. When singular it is referred to as a thyroid nodule and when multiple they are referred to as multinodular (goitre). The vast majority are not cancerous. In some instances, the nodule may produce excessive T3 and T4 and the sufferer may experience symptoms of hyperthyroidism. Less commonly the person may experience symptoms of hypothyroidism. Thyroid nodules develop as a result of an overgrowth of normal thyroid tissue, akin to fibroid development in the uterus. Chronic inflammation and iodine deficiency can also be triggers. Treatment is often watchful waiting once the swelling has been determined to be non-cancerous. When very large or if breathing is compromised, surgery is recommended. Medication is prescribed if there is concurrent hyperthyroidism or hypothyroidism.

Thyroid cancer: While there are 4 types, it is an extremely rare type of cancer. The common presentation is a woman in her 30s who reports a painless lump at the front of her neck. Sometimes there is unexplained hoarseness, a protracted sore throat, and problems swallowing. About 95 percent respond well to surgery, radiation, and or chemotherapy and have a very high cure rate.

Author: Dr. C. Malcolm Grant – Family Physician, Family Care Clinic, Arnos Vale. Former tutor in the Faculty of Medical Sciences, University of the West Indies, Cave Hill, Barbados. Host of the radio program Physician On Call. For appointments: clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp).

Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper, or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided.