Oops! I have a thyroid disease

The thyroid gland: The thyroid gland is a butterfly-shaped small gland located at the middle line of neck, under the cartilage prominence called “Adam’s apple”. Although it is only 25 gram in weight, it has an essential role on growth and development because of the hormones it secretes.  The thyroid gland is also called as the “regulator of whole body functions”. It produces thyroid hormones. These hormones contain iodine. The most important hormones are called as T3 and T4. These hormones are essential for the development and continuity of vital functions.

Thyroid gland diseases: Thyroid gland diseases range from simple goiter to thyroid cancer. The most commonly seen thyroid gland diseases are irregularities of thyroid hormon production. “Hypertiroidism” occurs when thyroid hormones are oversecreted, while “hypothyroidism” occurs when thyroid hormons are insufficiently secreted. The inflammation of thyroid gland, caused by any reason, is called “thyroiditis”. If the thyroid gland is greater than normal, this is called “goiter”. In goiter, the thyroid gland is enlarged, but its functions may not be deteriorated. Several signs, such as difficulty in swallowing and breathing may occur due to this enlargement.

Signs and symptoms of hypothyroidism:
o    Fatigue, muscle weakness, tiredness
o    Intolerance to cold
o    Thickening of the skin
o    Constipation
o    Dull mood
o    Weak and decreased heart rate
o    Forgetfulness

Signs and symptoms of hyperthyroidism:
o    Tremor of the hands
o    Muscle weakness
o    Nervousness, sleeplessness, difficulty in concentration
o    Weight loss
o    Intolerance to hotness, excessive sweating
o    Diarrhea
o    Increased heart rate, palpitation

It should not be forgotten that a person can be a thyroid patient without the abovementioned findings. Because of this, I think that it is useful to perform thyroid ultrasound and thyroid function tests in every individual.

Let’s order the thyroid diseases by items:
1-    Increased and decreased thyroid hormone levels
2-    Enlarged thyroid gland (Goiter)
3-    Solitary or multiple nodular thyroid tissue (Nodular or multinodular goiter)
4-    Thyroid cancer
5-    Inflammatory thyroid diseases  (Thyroiditis)
6-    The disruption of normal thyroid functions by drugs
Some drugs can affect thyroid hormones:
1-    Steroid (cortisone) containing drugs
2-    Salisilats (Aspirin and equivalants)
3-    Lithium (can be used for psychiatric disorders)
4-    Sulphonamides (is a group of antibiotics)
5-    Amiodarone (can be used for hypertension)
Thyroid disease may develop in anyone, but the following individuals have a higher risk.
1.    Those who live in places with iodine deficiency,
2.    Those who have thyroid disease in their families,
3.    Those who have diabetes mellitus and rheumatoid arthritis,
4.    Pregnant women and newly-delivered mothers,
5.    Women over 60 years,
6.    Men over 70 years,
7.    Those who received radiotherapy.

Goiter: It is mostly encountered in areas, which are fed poor in iodine in our country. It is defined as the enlargement of thyroid gland. If solitary or multiple nodules accompany the enlargement of thyroid tissue, it is defined as nodular or multinodular goiter. Simple goiter is the type of goiter, which only consists of thyroid gland enlargement with normal levels of thyroid hormones and which is not related with nodules, cancer or inflammatory processes.

Thyroid nodules: These are masses originating from the differentiation of cells of the thyroid gland, which are located in the front part of the neck. These nodules may be solitary or multiple and may be several in size. Nodules may be solid or cystic and may be milimetric or may be that big that it can cover the whole neck.
Although thyroid nodules can be seen more frequent in woman than men, most nodules do not give any sign and because of this reason, they are generally detected incidentally during ultrasonographic evaluation for another reason. When it is detected, a fine needle aspiration biopsy has to be performed, in order to exclude cancer. If a nodule is rapidly growing, if lymph nodes around the neck region are enlarged, if the lymph node or nodule is very firm and adhesive, if hoarseness or dysphonia exists and if the nodule is scintigraphically cold and solitary, “thyroid cancer” should be suspected.

Thyroiditis: This is defined as the inflammation of the thyroid gland. Patients suffering from thyroiditis may have pain in the fron neck region.
Graves’ disease: It is an “autoimmune” disease of the thyroid gland of unknown origin.  Namely, the thyroid gland becomes strange to the body and a substance called “TSH receptor antibody” is being produced. This substance causes excessive hormon production by stimulating the thyroid gland. The reason why these substances are produced is not known yet.  These patients may have “toxic goiter” and may suffer from protrusion of the eyes (ophtalmopathy).
Most of the hyperthyroidic patients have (70-80 %) “Graves’ disease”.
Besides, “hyperthyroidism” may develop in the first stages of inflammatory situations of the thyroid gland (thyroiditis).  Some of inflammatory situations may cause fever and pain in neck.
Hashimoto’s disease: It is another disease in which body’s immune system attacks the thyroid tissue. It generally represents with hypothyroidism.

Thyroid cancer:  Thyroid cancer is a disease, which is increasingly seen more frequent day by day. One should be aware of those individuals who have a nodule originating from the thyroid gland, may develop thyroid cancer. Thyroid nodules are more frequent in women than men; however, it should not be forgotten that the frequency of cancer in nodules of men is greater than nodules of women. The relationship between radiation and thyroid cancer is certain.  Apart from other cancers, thyroid cancer is mostly curable. There are several types of thyroid cancer; the most frequently (90% of the patients) seen types are papillary and follicular ones.  These most frequently seen cancer types give good response to treatment. Treatment mostly consists of surgical and radioactive iodine treatment. Rarely, radiotherapy and chemotherapy may be required. The rarer types that influence thyroid are medullary cancer, anaplastic cancer and lymphoma. The familial transmission is particularly seen in medullary cancer. Thus, the children of patients having medullary cancer should be screened.

Diagnostic methods in thyroid diseases: Currently, methods that investigate the functionality of the thyroid gland are well improved.  If these tests are wisely chosen and used, it is possible either to evaluate the condition of the gland or to detect the reason of the functional change if it exists, in most of the cases. The mainly used tests are as follows:
– Measurement of circulating thyroid hormones in blood
– Thyroid ultrasonography
– Thyroid sintigraphy
– Assessment of thyroid antibodies in blood
– Measurement of calcitonin in blood

So, in which situations requires a goiter patient surgical treatment? It is sufficient to take a look at the following items to answer this question:
1-    The suspicion or detection of cancer in a patient who is in follow-up for goiter,
2-    A large goiter that can lead to compression findings, such as difficulty in swallowing and/or difficulty in breathing),
3-    The enlargement of thyroid gland towards the mediastinum,
4-    Thyrotoxicosis,
5-    Having cosmetic concerns because of a huge goiter.


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