Thyroid Disease

What Is Thyroid Disease?

The thyroid is a gland in the neck which makes hormones that control the rate of many bodily activities. The thyroid can develop problems such as these:

  • It might become very large in goitre. This happens in people who don’t get enough iodine in their diets
  • It might make more hormones than your body needs to run optimally. This is called hyperthyroidism
  • It may fail to make enough hormones in hypothyroidism
  • Lumps may develop in the gland
  • Cancer can develop in the thyroid.

What are the symptoms of thyroid disease?

The thyroid can fail to make enough thyroid hormone either because it can’t or it is not being stimulated sufficiently to do so. This is called hypothyroidism. A child with hypothyroidism may have the following problems:

  • You may have concerns about the child’s short height or poor growth.
  • The child’s skin may feel more dry or rougher than normal.
  • The child may be having difficulties with passing stool.
  • The child will generally lack energy, play less or sleep more.
  • The child may be unusually sensitive to cold weather.

In hyperthyroidism the thyroid gland is more active than usual or receives more intense stimulation. Thyroid hormones are produced in excess. The following problems may be observed.

  • The child may be losing weight despite eating more.
  • Child may show swings of emotions like being irritable, easy crying and being increasingly excitable.
  • The skin may appear flushed and sweatier
  • The muscles may lose some strength
  • The heartbeat is frequently rapid and can be felt by the child.
  • The thyroid gland may swell.
  • The eyes may look protruded with eyelid that are sluggish or lagging. Blinking may be less than usual.
  • The child may find it difficult to focus on simple activities.

When one has thyroid disease it makes it more likely that their other glands could also have problems. Conditions such as diabetes and tumors of the pituitary and adrenal glands can occur alongside thyroid disease.

People who have thyroid tumors might have tumors affecting other glands, a hereditary condition called  multiple endocrine neoplasia (MEN). When this is the case the following problems can occur:

  • Loss of control of blood sugar which either dips too low or climbs too high.
  • Milky discharge may be noted from the breasts.
  • A child may develop puberty signs at an earlier age than expected.
  • The person may complain of frequent headaches and problems with vision.
  • The blood pressure may be  higher or lower than normal
  • Absent or infrequent periods may suggest a thyroid problem.

What are the complications of thyroid disease?

  • Thyroid disease affects the normal development of a child.
  • Children with thyroid disease often have slow growth. If it is not treated early the child may not grow to the optimal height.
  • Changes of puberty like menstruation and development of secondary sexual features may be delayed. The changes may ,in later life, affect the fertility of those affected. Girls who are affected may have complications later in life when they get pregnant and during delivery.
  • When there has been low levels of thyroid hormones (hypothyroidism) changes can occur in the body. In a condition called myxedema there is swelling of the face, which can include lips, eyelids, and tongue ;the skin also swells and thickens. It may cause breathing difficulties, low blood pressure, lower than normal body temperature, confusion and convulsions
  • Thyroid problems can lead to problems with blood pressure. They can make the heart beat irregularly and may even lead to heart failure which is when  the heart is unable to pump sufficiently to maintain blood flow to meet the body’s requirements.
  • Thyroid cancer can develop in some children.

 

What causes thyroid disease?

The body can make antibodies that destroy parts of the thyroid gland.This makes the thyroid produce less thyroid hormones. This happens in Hashimoto’s disease.

The immune system produces an antibody that stimulates the thyroid gland to produce more hormones. This happens in Grave’s disease.

Abnormal nodules in the thyroid gland can produce excessive thyroid hormones. This occurs in toxic nodular goiter or toxic thyroid adenoma

A tumor in the pituitary gland can produce excess thyroid stimulating hormone which stimulates the thyroid gland to produce more hormones.

The pituitary gland can become insensitive to thyroid hormones which makes it less responsive to higher levels of thyroid hormones in circulation.

Infections by viruses or bacteria can cause the thyroid to be inflammed. This is called thyroiditis and may lead to damage of thyroid hormone producing cells.

How is thyroid disease diagnosed?

It may take a while before thyroid disease is diagnosed because the symptoms are easily confused with those caused by other conditions. The following tests can be done to define the thyroid problem better:

Levels of thyroid stimulating hormone (TSH) circulating in the blood. This is produced by a gland in the brain called the pituitary and it’s work is to stimulate the thyroid to produce more thyroid hormone. The TSH levels increase when there is less thyroid hormone in the body and decreases when there’s more than enough.

Blood levels of freely circulating Thyroxine, or free T4 will be found to be low in hypothyroidism.

For thyroxine to be active it is converted to triiodothyronine or T3. Blood levels of T3 is useful in evaluating for hyperthyroidism.

Many people have thyroid disease because their bodies produce antibodies that either damage or stimulate the gland. Usually antibodies are produced by the body to fight off foreign agent or particles like germs and harmful substances. In this case the antibodies damages a part of the body. Measuring levels of thyroid antibodies may help to uncover the cause of thyroid disease.

There are two kinds of scans that can be used to diagnose thyroid disease. One is The radioactive iodine uptake test, or RAIU test, that shows how well the thyroid is functioning. A RAIU scan can be recommended if the blood results indicate that one has an overactive thyroid. The other is Thyroid Scan which shows the size, shape, and position of the gland

A fine-needle biopsy might be done to help show whether a nodule or swelling has cancerous cells. In a biopsy a thin needle is inserted into the thyroid nodule and swelling and some tissue or fluid is taken from it. The fluid or tissue sample is examined in the lab to check for abnormal cells.

How is thyroid disease treated?

Treatment depends on the type of thyroid problem, the severity of symptoms and one’s ability to tolerate the treatments.

If the thyroid is overactive and producing too much thyroid hormones treatment is aimed at stopping or reducing the production of the hormones. Here are the options:

Antithyroid medications may be given.

Radioactive iodine (RAI) may be given to destroy all or a portion of the thyroid hormone producing gland.

All or part of the thyroid may be removed surgically in a procedure called thyroidectomy

Other medicines like beta blockers may be given to reduced the symptoms of excess thyroid hormones.

Most patients who are treated for excess thyroid hormones eventually end up producing less than normal levels hence becoming hypothyroid. They are usually given Thyroid hormone replacement drugs to supplement their thyroid hormone needs.

In goitre one produces less thyroid hormone than needed and is hypothyroid. Thyroid hormone replacement drugs are given for treatment. If the goitre is due to lack of iodine in the diet Iodine supplement may be recommended.

Thyroid nodules that are not causing any symptoms may be left alone but those that cause pain or pressure over the throat may be made to shrink using medicine or radioactive iodine or surgery.

Treatment of thyroid cancer involves removal of the gland. This may be followed by radioactive iodine (RAI) treatment to ensure all remaining thyroid cells are destroyed. Patients going through this procedure cannot later produce thyroid hormones on their own and will need to be on require lifelong thyroid hormone replacement treatment .

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