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It’s estimated that one in ten Canadians suffer from a thyroid condition, and of those, approximately fifty per cent go undiagnosed. But what is a thyroid and how do you know if it’s healthy? Dr. Shelia Wijayasinghe has everything you need to know.
What is your thyroid?
The thyroid gland is powerful and has influence over your heart rate, digestions, mood, menstrual cycle, energy level and how your body uses energy and metabolism. It’s located at the base of the throat and is shaped like a butterfly.
The hormones produced by the thyroid gland are called triiodothyronine (T3) and thyroxine (T4) and they have an enormous impact on your health, affecting all aspects of your metabolism. They maintain the rate at which your body uses fats and carbohydrates, help control your body temperature, influence your heart rate and help regulate the production of proteins. An underactive thyroid is called hypothyroidism and it happens when the thyroid gland fails to produce enough hormones. An overactive thyroid is called hyperthyroidism, which is a condition in which your thyroid gland produces too much of the hormone thyroxine.
Symptoms of an underactive thyroid?
The signs and symptoms of hypothyroidism and hyperthyroidism vary depending on the severity of the hormone deficiency. But in general, any problems you have tend to develop slowly, often over a number of years. Both conditions can mimic other health conditions, which can delay diagnosis. At first, you may barely notice the symptoms of hypothyroidism, such as fatigue and weight gain, or you may simply attribute them to getting older. But as your metabolism continues to slow, you may develop more-obvious signs and symptoms. These signs and symptoms include fatigue, increased sensitivity to cold, constipation, dry skin, weight gain, puffy face, hoarseness, muscle weakness, elevated blood cholesterol level, muscle aches, tenderness and stiffness, pain, stiffness or swelling in your joints, heavier than normal or irregular menstrual periods, thinning hair, slowed heart rate, depression and impaired memory.
When this condition isn’t treated, signs and symptoms can gradually become more severe. Constant stimulation of your thyroid gland to release more hormones may lead to an enlarged thyroid. You also may become more forgetful, your thought processes may slow, or you may feel depressed.
Symptoms of an overactive thyroid
One of the major symptoms of hyperthyroidism is sudden weight loss, even when your appetite and the amount and type of food you eat remains the same or is even increased. Hyperthyroidism can also affect your heart, by pounding of your heart (palpitations), rapid heartbeat (more than 100 beats a minute), or irregular heartbeat. Symptoms also include; increased appetite, nervousness, anxiety, irritability, tremor(hands & fingers), sweating, changes in menstrual patterns, increased sensitivity to heat, changes in bowel patterns, an enlarged thyroid gland (may appear as swelling at the base of your neck), fatigue, muscle weakness, difficulty sleeping, skin thinning, brittle hair, and exophthalmos (eyes looked pushed out due to swelling of muscles behind eye).
Who is most at risk?
Thyroid disease can impact both men and women. However, women are 4-7 times more likely than men to develop thyroid problems, according to the Thyroid Foundation of Canada.
Is thyroid disease hereditary?
Yes, thyroid disease is hereditary and commonly affects other members in the family. Genetics play a big role in thyroid conditions so if you have a first degree relative with a thyroid condition, your risk is higher to develop one as well. Many thyroid conditions are due to autoimmune conditions. This is when your immune system fights itself/the organs in your body. If you or a family member has any other autoimmune conditions, this also increases your risk of thyroid disease.
How can thyroid illness be diagnosed?
There is a Thyroid-Stimulating Hormone test (TSH) that you can take that will measure the levels of thyroid-stimulating the hormone. This is a simple blood test that screens for issues with the thyroid. A low TSH indicates that your thyroid gland may be overactive while a high TSH indicates that you may have an underactive thyroid – counter-intuitive! If you have swelling of the thyroid gland, imaging studies can be done, like an ultrasound to see if there is a growth.
What are the risk factors of thyroid cancer?
The most significant risk factors to thyroid cancer are:
- Gender: Women are 3x more likely than men to develop thyroid cancer
- Family history: Having a first degree relative with thyroid cancer.
- Diet low in iodine: In North America we get iodine in salt and other foods but this risk is especially relevant in areas around the world where iodine is low in many people’s diets.
- Radiation exposure: From diagnostic tests, power accidents, or nuclear accidents; head and neck radiation as a child poses more of a risk than if you receive radiation as an adult. Being exposed to radiation when you’re an adult carries much less risk of thyroid cancer.
What is a thyroid cyst? How do you know when you have one and do you do anything?
Thyroid cysts are common solid or fluid-filled lumps that form in the thyroid. The vast majority of thyroid nodules are benign (noncancerous), but about 2 or 3 in 20 are cancerous. Treatment depends on the type of nodules you have and symptoms. Some nodules produce extra hormones that can cause hyperthyroid symptoms (weight loss, increased sweating, tremor, nervousness, rapid heart rate).
A few thyroid nodules are cancerous (malignant), but determining which nodules are malignant can’t be done by symptoms alone. Most cancerous thyroid nodules are slow growing and may be small when they’re discovered. Aggressive thyroid cancers are rare, but these nodules may be large, firm, fixed and rapid growing. Although most thyroid nodules are noncancerous and don’t cause problems, ask your doctor to evaluate any unusual swelling in your neck. It’s important to evaluate the possibility of cancer with imaging and potential biopsies/surgery.
Treatment for thyroid disease
Treatment depends on the type of thyroid disease and the cause of the disease:
- Hypothyroidism: For underactive thyroid, you can take a synthetic hormone, which is safe and effective once the proper dose has been found.
- Hyperthyroidism: For overactive thyroid – there are anti-thyroid medications that will decrease the release of hormones or radioactive iodine which will stop the thyroid from functioning. In the case of radioactive iodine, you will often need replacement thyroid hormone after treatment. In some cases, surgery can be warranted if the hyperthyroidism is due to an active nodule that’s producing excess hormone.
- Cancer: Surgery is the treatment for cancer/cancerous nodules. If the nodule is localized to one side of the thyroid, sometimes a partial thyroidectomy which preserves the other normal half can be done (so the patient can avoid taking medication to replace thyroid hormone).
Experiencing symptoms? When to see the doctor
We tend to ignore symptoms such as fatigue, and weight gain, attributing it to stress/life circumstances. While these symptoms may be due to other factors, if they are persistent, cause dysfunction and don’t reverse with things like getting good sleep, exercise, and diet – get checked out. This is especially true if you have any risk factors for thyroid disease, which put you at a higher risk for developing a condition (i.e. family history, autoimmune conditions.)
If you’re having any symptoms of hyperthyroidism (rapid heart rate, frequent stools, sweating), it’s important to get checked out too.
If you’ve had any previous thyroid surgery, radioactive iodine or radiation therapy – you may need periodic thyroid testing. If you’re already taking thyroid medication and have persistent symptoms, be sure to check in with your doctor to ensure you’re on the correct dose. Over time, you may need to change your dosage.