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What Causes Thyroid Problems and How are They Diagnosed?

January is National Thyroid Awareness Month, but patients often do not naturally give a lot of attention to this important gland. Your thyroid sits at the front of your trachea, or windpipe, in your neck and while it’s a small gland, it has several crucial functions concerning your metabolism and it helps regulate other body functions by constantly releasing a steady amount of thyroid hormones into the bloodstream.

This month we’re encouraging everyone to take notice of their thyroid given that thyroid problems are common among Americans, affecting roughly 20 million people, but more concerning is that up to 60% of those with thyroid abnormalities do not realize they have a problem. Below, we will take an in-depth look at common thyroid conditions including their causes, symptoms, diagnosis and treatment.

Classifying Thyroid Problems: Hyperthyroidism vs. Hypothyroidism

The majority of thyroid problems can be classified into one of two categories: hyperthyroidism and hypothyroidism. If a person is hyperthyroid, they have an overactive thyroid gland, meaning their thyroid produces too much of its hormones. Conversely, hypothyroidism means the thyroid is not producing enough hormones, leading to a slower-than-normal metabolism.

Hyperthyroid Conditions

Graves’ Disease

Graves’ disease is the most frequent cause of hyperthyroidism. It is an autoimmune disorder, meaning your immune system inappropriately attacks normal cells in your thyroid. The condition has a hereditary component, so people who have family members with Graves’ are more likely to develop the disease. Graves’ is also more common in women than men and mostly affects those younger than 40.

Graves’ is characterized by tremors, bulging eyes, red and thickened skin on the legs, increased perspiration, fatigue, and rapid heartbeat or heart palpitations. It is important to note that not every patient will exhibit all of these symptoms. If you experience any of these signs, it is important to consult your primary care physician or endocrinologist immediately, and heart symptoms always require emergency medical attention.

Your doctor can diagnose Graves’ with a combination of examinations, blood tests, and thyroid imaging. There are anti-thyroid medications available to treat Graves’ disease. Other treatment options may include surgical removal of all or a portion of your thyroid and radiation therapy to the thyroid to reduce its activity.

Multinodular Goiter

This condition occurs when lumps or knots develop on your thyroid. Goiter can cause overproduction of your thyroid hormones. Not all thyroid enlargements lead to hormone problems, but toxic multinodular goiter is a specific type of goiter that causes hyperthyroidism.

Any swelling of your neck needs immediate medical investigation. In addition to the thyroid lumps, multinodular goiter can cause symptoms like those listed for Graves’ disease above. Doctors investigate multinodular goiter with physical examinations and laboratory blood tests. They will also usually perform a thyroid ultrasound to delineate the problem further. In many cases, a fine needle aspiration biopsy is ordered to rule out thyroid cancer and other conditions.

Depending on test results, a goiter may need surgical removal. In this case, your doctor will refer you to a surgeon who will explain the procedure in detail and answer all your questions.

Hypothyroid Conditions

Hashimoto’s Thyroiditis

You can think of Hashimoto’s thyroiditis much like an opposite to Graves’ disease. Like Graves’, Hashimoto’s is an autoimmune disorder, however, in this case, the attacks from your immune system damage your thyroid to the point that it is no longer able to produce sufficient amounts of hormones.

Common symptoms resulting from this hormone underproduction include weight gain, constipation, fatigue, a puffy facial appearance, depression, slow heart rate, and memory problems. Most hypothyroidism patients are women past middle age, but the condition can strike any sex, race and age.

Your doctor can often diagnose hypothyroidism with a simple blood test. Treatment usually consists of thyroid supplementation. This means taking oral medication in the form of synthetic thyroid hormones to make up for your lack of naturally-produced hormones.

Thyroid Damage

Damage to your thyroid can also result in hypothyroidism. The symptoms, diagnosis and treatment are identical to Hashimoto’s thyroiditis. The only difference is that instead of an autoimmune problem, the hypothyroidism is caused by an injured or absent thyroid.

This problem is most frequently encountered in patients who have had their entire thyroid or some thyroid tissue surgically excised to treat thyroid cancer or hyperthyroidism. Other situations that can cause these problems include physical trauma to the thyroid or radiation damage to the thyroid, likely from cancer radiotherapy.

Taking Care of You and Your Thyroid

Given the pervasiveness of thyroid disease, we owe it to ourselves to share the message of thyroid awareness, not just in January, but throughout the year. If you’re concerned about the possibility of having a thyroid issue and/or are experiencing any of the symptoms discussed, we encourage you to schedule an appointment with your primary care physician.

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