January is national thyroid awareness month. This butterfly-shaped gland, located at the base of your neck, manufactures hormones that regulate your body’s metabolism. Different disorders can arise when your thyroid produces too much hormone (hyperthyroidism) or not enough (hypothyroidism).
Problems can range from a goiter (a noncancerous enlargement in the neck) to an autoimmune disease that requires constant monitoring. Most thyroid disorders are more common in women than men, and the risk in both sexes increases with age. The most common thyroid problems are a result of abnormal production of thyroid hormones.
TOO MUCH THYROID HORMONE—OR NOT ENOUGH?
If your thyroid produces too much hormone, your bodily functions tend to speed up, a condition known as hyperthyroidism. Symptoms include nervousness, irritability, heavy sweating, racing pulse, anxiety, difficulty sleeping, thinning of your skin, brittle hair and muscle weakness. You may lose weight without intending to. If you’re a woman, your menstrual flow may become spotty or less regular.
Conversely, an underactive thyroid, known as hypothyroidism, doesn’t produce enough hormone to regulate your body’s many processes. The result is a feeling of sluggishness or persistent fatigue. You may gain weight even on a normal, healthy diet. Other symptoms, such as constipation, muscle aches, joint pain, or even depression, can be easily mistaken for other conditions, so you may not be aware that your thyroid is to blame.
Both conditions can be caused by various factors. The most common cause of hyperthyroidism is Graves’ disease, a hereditary autoimmune disorder that mistakenly tells your antibodies to attack the thyroid, causing it to produce excess thyroid hormone. The eyes may seem enlarged, almost bulging, and some people have swelling or nodules in the neck that may develop into a goiter. Graves’ disease may develop at any age in men or women, but it’s much more common in women in their 20s. Other risk factors that predispose you to hyperthyroidism include stress, pregnancy, and smoking.
DIAGNOSIS AND TREATMENT OF HYPERTHYROIDISM
In a simple physical examination, your doctor will feel for an enlarged thyroid gland and a rapid pulse, and will look for moist, smooth skin and tremors in your fingers or hands. The diagnosis of hyperthyroidism should be confirmed by laboratory tests that measure the amount of two thyroid hormones, called T-3 and T-4, in your blood.
There is no cure for either Graves’ disease or hyperthyroidism, but symptoms can be controlled. Your doctor can prescribe anti-thyroid drugs, which work by blocking the thyroid’s ability to produce new hormone. Radioactive iodine, taken orally, can slow the production of thyroid. In extreme cases, or if you can’t tolerate the medicines, your doctor may advise surgery to remove all or part of your thyroid gland. The purpose of these treatments is to shrink the thyroid until the level of thyroid hormone in the blood returns to normal.
Some doctors will prescribe a class of drugs known as beta-blockers. Normally used to control high blood pressure or angina, beta-blockers can have the same effect on the symptoms of hyperthyroidism, such as rapid pulse and tremors. This is usually temporary until other forms of treatment have a chance to take effect. Beta-blockers do not affect the levels of hormone in your body.
Hypothyroidism results from an underactive thyroid gland that can’t produce sufficient hormones. The most common cause of hypothyroidism is an autoimmune disorder known as Hashimoto’s thyroiditis, in which the immune system mistakenly attacks the thyroid gland, suppressing its ability to produce hormones. There’s no known cure for Hashimoto’s thyroiditis.
Hypothyroidism can also be caused by anything that damages or suppresses the thyroid gland, such as medication to treat hyperthyroidism, surgery to remove all or part of the thyroid, or radiation therapy for head or neck cancer. Some medications can contribute to hypothyroidism, including lithium, used to treat certain psychiatric disorders. Talk to your doctor about any medications you are taking.
The main treatment for hypothyroidism is to take thyroid hormone pills that can raise thyroid hormone levels and help relieve the symptoms of the disease. Surgery is sometimes necessary to remove all or part of the thyroid gland, but such advanced cases are rare. Be sure to follow dosing directions carefully, since too much of the medication can cause hyperthyroidism.
Most cases of hypothyroidism are mild and the symptoms often mimic symptoms of many other conditions. Hypothyroidism can also cause slowed mental functioning and depression may occur. Be sure to tell your doctor if you experience any of these symptoms.
Mayo Clinic, “Goiter.” https://www.mayoclinic.org/diseases-conditions/goiter/symptoms-causes/syc-20351829
Mayo Clinic, “Hyperthyroidism (overactive thyroid).” https://www.mayoclinic.org/diseases-conditions/hyperthyroidism/symptoms-causes/syc-20373659
Mayo Clinic, “Hypothyroidism (underactive thyroid).” https://www.mayoclinic.org/diseases-conditions/hypothyroidism/symptoms-causes/syc-20350284
Wallace, Ryan, “Six Common Thyroid Disorders and Problems.” Healthline. Last update:August 30, 2018. https://www.healthline.com/health/common-thyroid-disorders#hashimotos-disease