Thyroid

Introduction to thyroid disease

When I was asked to write an article on "thyroid disease", I took a very deep breath. The task seemed daunting. As any Endocrinologist (hormone specialist) knows, there are many subtopics within this giant topic, and an article like this could go on for a hundred pages! So, once I caught my breath, I decided to simply design this article to present a "rough guide" to the thyroid. This article will be an outline or introduction to many conditions that involve the thyroid gland. As you read through this, you will find a number of links that will take you to more in-depth articles dealing with the specific topic in question. 

Thyroid 101: What is the thyroid and what does it do?

The thyroid is a butterfly-shaped gland located in the front of the neck just below the Adams apple. The gland wraps around the windpipe (trachea) and has a shape that is similar to a butterfly formed by two wings (lobes) and attached by a middle part (isthmus). The thyroid gland works like a tiny factory that uses iodine (mostly from the diet in foods such as seafood and salt) to produce thyroid hormones. These hormones help to regulate the body's metabolism and effects processes, such as growth and other important functions of the body.
The two most important thyroid hormones are thyroxine (T4) and triiodothyronine (T3), representing 99.9% and 0.1% of thyroid hormones respectively. The hormone with the most biological power is actually T3. Once released from the thyroid gland into the blood, a large amount of T4 is converted to T3 - the active hormone that affects the metabolism of cells throughout our body.

 

Thyroid hormone regulation - the chain of command  

The thyroid itself is regulated by another gland located in the brain, called the pituitary. In turn, the pituitary is regulated in part by the thyroid (via a "feedback" effect of thyroid hormone on the pituitary gland) and by another gland called the hypothalamus.

The hypothalamus releases a hormone called thyrotropin releasing hormone (TRH), which sends a signal to the pituitary to release thyroid stimulating hormone (TSH). In turn, TSH sends a signal to the thyroid to release thyroid hormones. If overactivity of any of these three glands occurs, an excessive amount of thyroid hormones can be produced, thereby resulting in hyperthyroidism. Similarly, if underactivity of any of these glands occurs, a deficiency of thyroid hormones can result, causing hypothyroidism.

Hypothalamus - TRH

Pituitary- TSH

Thyroid - T4 and T3

The rate of thyroid hormone production is controlled by the pituitary gland. If there is an insufficient amount of thyroid hormone circulating in the body to allow for normal functioning, the release of TSH is increased by the pituitary in an attempt to stimulate more thyroid hormone production. In contrast, when there is an excessive amount of circulating thyroid hormone, TSH levels fall as the pituitary attempts to decrease the production of thyroid hormone.
There is another hormone that is produced by the thyroid called calcitonin. Calcitonin is produced by specific cells in the thyroid gland, and unlike T3 and T4, it is not involved in this regulation of metabolism. Calcitonin is a hormone that contributes to the regulation of calcium and helps to lower calcium levels in the blood. Excess calcium in the blood is referred to as hypercalcemia.

What types of thyroid disease can occur when the function of the thyroid is affected??

If the thyroid itself is under-active, or if the regulators of the thyroid gland are not functioning properly, hypothyroidism can result. There are many causes of hypothyroidism such as the following:

• Hashimoto's thyroiditis (autoimmune thyroiditis)
  
• Postpartum thyroiditis (inflammation of the thyroid gland after pregnancy)
  
• Acute thyroiditis
  
• Silent thyroiditis
  
• Thyroid hormone resistance
  
• Medications that affect thyroid function [such as amiodarone (Cordarone)]

If the thyroid is overactive, or if the regulators of the thyroid gland are pushing the thyroid to produce too much hormone, hyperthyroidism can result. Some of the causes of hyperthyroidism are listed below:

• Graves' disease
  
• Toxic multinodular goiter
  
• Toxic nodule ("hot" nodule)
  
• Excessive intake of iodine
  
• Hashitoxicosis
  
• Medications (ingesting thyroid hormone)

What signs and symptoms can occur if thyroid function is affected?

If the thyroid is under-active, symptoms of hypothyroidism may occur. The signs and symptoms of hypothyroidism vary widely, depending on the severity of hormone deficiency. Some of the complaints experienced by patient's with hypothyroidism include:

• fatigue
  
• mental fogginess and forgetfulness
  
• feeling excessively cold
  
• constipation
  
• dry skin
  
• fluid retention
  
• non specific aches and stiffness in muscles and joints
  
• excessive or prolonged menstrual bleeding (menorrhagia)
  
• depression

Hyperthyroidism is suggested by a number of signs and symptoms. Patients with mild disease usually experience no symptoms. In patients older than 70 years of age, the classical manifestations may also be absent. In general, the symptoms become more obvious as the condition worsens. The symptoms are usually related to an increase in body metabolism. Common symptoms are listed below:

• Excessive sweating
  
• Heat intolerance
  
• Increased bowel movements
  
• Tremor (usually a fine shake)
  
• Nervousness; agitation
  
• Rapid heart rate
  
• Weight loss
  
• Fatigue
  
• Decreased concentration
  
• Irregular and scant menstrual flow

In older patients, irregular heart rhythms and heart failure can occur. In its most severe form, untreated hyperthyroidism may result in "thyroid storm," a condition involving high blood pressure, fever, and heart failure. Mental changes such as confusion and delirium may also occur. In Graves' disease, there may be eye changes and skin changes in addition to the other findings listed above.

What types of thyroid disease can occur when the structure of the thyroid is affected??

Structural problems with the thyroid gland can occasionally result in altered function, such as toxic multinodular goiter and toxic nodules (adenomas) leading to hyperthyroidism. However, in most cases, structural problems occur in glands that have normal function. These conditions range from simple and benign cysts to more serious problems such as thyroid cancers (papillary, follicular, medullary and anaplastic are the different types of thyroid cancer that may arise). Enlargement of the thyroid gland is referred to as a goiter. Goiters can form and can range in size from hardly noticeable to large enough to require surgical removal. Additionally, the actual location of the thyroid in an individual can be in an abnormal area of the body due to developmental abnormalities. 

What signs and symptoms can occur if thyroid structure is affected?

• Depending on the size and location of the gland, symptoms can include compression of the trachea and/or esophagus leading to trouble breathing or swallowing.
  
• The gland may be so enlarged that it may become cosmetically unappealing.
  
• If the gland increases in size rapidly (such as bleeding into a cyst) there may be local pain.
  
• If the underlying problem is cancer, there may be enlargement of lymph nodes, and more systemic symptoms such as weight loss, night sweats and changes in appetite. 

How is the diagnosis of thyroid disease made?

Blood tests

Blood tests are often used to help determine thyroid function. Thyroid stimulating hormone (TSH) is often a screening tool and can be used along with serum T3 and T4 levels. If these hormones are abnormal, and further information regarding a possible cause is needed, antibody levels in the blood can be checked. Depending on the clinical situation, your doctor may look for specific antibodies such as:

• Antithyroglobulin antibodies
  
• Anti TPO antibodies
  
• TSH receptor stimulating antibodies
  
• If cancer is suspected, a thyroglobulin level may be ordered, and in rare circumstances, a calcitonin levels may be checked.

Imaging

If there is concern about the structure of the gland, if size needs to be quantified or if there is a suspicion of cancer, imaging tests may be performed. Common modes of imaging include an ultrasound of the thyroid gland and radioiodine scanning and uptake. The ultrasound helps show size and consistency of the gland (for example, it is good at detecting cysts or calcifications within a gland), but it cannot always tell a benign gland from a cancerous gland. Ultrasounds may be done in a doctor's office or in a hospital Radiology department.
Thyroid scans involve the use radioactively labeled form of iodine and are usually performed the Radiology department of a hospital or clinic. Since the thyroid is the only tissue in the human body that picks up iodine, the scan is very specific for finding thyroid tissue. If the thyroid is not picking up iodine normally, "spots" show up on the scan. A "cold" spot implies that the tissue is not picking up enough iodine compared to the rest of the gland. This may be seen in nonfunctioning nodules and may also be a sign of malignancy.
A "hot" spot implies that the tissues in that area is taking up more iodine than the surrounding tissue, and is overactive. This may be seen in a toxic nodule. Hot spots are rarely ever cancerous. In addition, there are comparison values to determine what normal thyroid uptake should be. A normal thyroid picks up 8%-35% of the administered dose of iodine within 24 hours. If values above or below this range is seen, it may point to underlying thyroid disease.

Biopsy
A biopsy provides a tissue sample for a pathologist to look at. This is usually the gold standard, especially when looking for diseases such as cancer. Thyroid biopsies are usually performed using a fine need to aspirate cells from the gland. This is often referred to as fine needle aspirate or an FNA. FNAs can be done in a doctor's office or in a clinic setting, and may involve an ultrasound machine to help guide the needle. Tissue samples can also be obtained during surgery. An FNA is a safe easily performed procedure, however, depending on the skill of the person performing the procedure, there is a chance that the aspiration may not yield enough tissue, or that the sampling is not of the right area.

What is the treatment for thyroid disease?

Depending on the specifics of the disease being treated, medications, surgery or radioactive therapy may be used as treatment modalities.

Medications
Medications may be used to treat hyperthyroidism to reduce the production of thyroid hormone, its release from the gland and/or to treat the signs and symptoms that occur in hyperthyroidism such as a rapid heart beat. In hypothyroidism, synthetic thyroid hormone is used to replace the inadequacy of thyroid hormone. Occasionally, in the case of a large goiter, Thyroid hormone replacement may be given in small doses in an attempt to shrink the gland size. It should be mentioned that there are "natural" thyroid compounds available on the market. These vary in their effects and in their dosing and are beyond the scope of this discussion. Steroids and other anti-inflammatory medications, such as NSAIDs, may also be used to reduce inflammation of inflamed thyroid glands.

Surgery
Surgery is the treatment of choice when the thyroid gland is causing compressing the airway resulting in difficulty in breathing or swallowing. In addition, surgery can performed to remove a nodule that is overactive, remove a goiter that is disfiguring, or when cancer is a possibility. Depending on the reason for the surgery, part of a lobe, a whole lobe or the whole thyroid (perhaps with surrounding tissue) may be removed. When the entire thyroid gland is removed, medical replacement with synthetic thyroid replacement is required

Radioactive ablation
When hyperthyroidism is inadequately responding to medications, radioactive ablation may be tried. In contrast to the scans described above, the iodine in this situation is labeled with a tracer that destroys the thyroid tissue. Ablation is used in cases of hyperthyroidism that do not respond to medications, particularly Graves' disease. This form of therapy is also used along with surgery to treat certain forms of thyroid cancer.

 

A Few Simple But Natural Tips For Thyroid Health

Avoid stimulants such as alcohol, tea and coffee as they might disrupt your glandular system, which may result in additional imbalances.
Avoid Fluoride. Fluoride, chlorine, and iodine are all chemically inter-connected. Fluoride and chlorine impede the body's iodine receptors in your thyroid gland, which results in diminished iodine that may reduce hormone production levels and may lead to hypothyroidism. Employ toothpaste that is fluoride. Avoid fluoride, including that present in town water supplies.
Consume a healthy, wholesome food diet consisting of large quantities of raw vegetables and fruits. You should consider adding in natural whole food supplements and essential vitamins but you must eat as well.
Reduce or even better eliminate foods that are low in energy like, fried foods, sugar,,saturated fats, excessive alcohol, red meat excessive tea and coffee and processed foods.
Detoxify your system. Do a full body cleanse every six months or at least annually. We highly suggest this herbal colon cleanse as an easy way to free your system of accumulated toxins and impurities.
Employ natural thyroid supplements. The thyroid needs precise care for optimal health and performance. Correct thyroid function needs sufficient quantities of B-vitamin compounds, zinc, iodine, and copper, manganese and molybdenum, the amino acid; L-Tyrosine is also essential for connecting neurotransmitters linked with normal hormone production.
In addition to the above vitamins, minerals, and many specific herbs can also assist enhance the performance of the thyroid gland and your whole glandular system along with providing a rich supply of natural nutrients identified to be fantastic for thyroid health.
These ingredients work synergistically to encourage normal thyroid function. Instead of adding hormones to your body from an external source, Thyromine is a total thyroid support formula that offers several well tested nutrients that help stimulate your thyroid gland to create normal quantities of thyroid hormone.

http://www.underactivethyroids.com is a great resource for anyone with a thyroid disorder. Marcus Williams set out to discover more information about thyroid conditions to better understand his wife's condition. The more he read, the more he learned that there are many myths circulating about thyroid disorders that may be preventing sufferers from leading better lives.
That's why he wrote a free mini course to expose these myths and to develop a resource that fellow sufferers could use to make better informed decisions about their health.