By Tomer Davidov, MD
Thyroid disease is a common problem that affects an estimated 20 million Americans — especially women — according to the American Thyroid Association.
In fact, as the American Thyroid Association reports, women are up to eight times more likely than men to have thyroid problems, which may or may not cause symptoms.
If you suspect you might have a thyroid condition, talk with your doctor. Most thyroid problems can be effectively treated with medication or surgery.
Thyroid Hormones Control Metabolism
The thyroid is a butterfly shaped gland located in the front of your neck. It releases thyroid hormone, which is essential for controlling important functions in your body, including your metabolism.
Metabolism is the process by which the fats, proteins and carbohydrates you consume are broken down and used as energy to fuel your body. Thyroid hormones also help to maintain your body’s temperature, blood pressure and heart rate.
When the thyroid is working properly, it releases an adequate amount of thyroid hormone that keep the body’s metabolism working. As the hormone is used, the thyroid replaces it.
Thyroid disease occurs when a person’s body produces too much or too little thyroid hormone. It is fairly common and can run in families. At least 12% of the U.S. population will develop a thyroid condition in their lifetime, according to the American Thyroid Association.
Hyperthyroidism Versus Hypothyroidism
Two of the most common disorders of the thyroid are called hyperthyroidism and hypothyroidism.
Just as the term “hyper” describes something that is hyperactive or unusually energetic, hyperthyroidism occurs when the thyroid gland overproduces hormones, forcing the body to use energy too quickly.
Some common symptoms of hyperthyroidism include:
- Fast heartbeat
- Increased sensitivity to heat
- Weight loss
- Hand tremor
- Insomnia
- Irritability
- Nervousness
- Bulging eyes
The autoimmune disorder Graves’ Disease is a common cause of hyperthyroidism, and it tends to run in families.
Like the prefix “hypo,” which means low or under, hypothyroidism causes the body to produce too little thyroid hormone.
Some common symptoms of hypothyroidism include:
- Fatigue
- Increased sensitivity to cold
- Constipation
- Weight gain
- Dry skin
- Hair loss
- Menstrual irregularity
Hashimoto’s disease, a condition in which the immune system attacks the thyroid, is the most common cause of hypothyroidism.
Patients with hyper- and hypothyroidism may have a normal sized thyroid without thyroid nodules or an enlarged gland, sometimes with thyroid nodules.
Thyroid Nodules
Thyroid nodules are another common thyroid condition, which is characterized by an abnormal growth of thyroid cells that forms a lump within the thyroid gland. About a third of the population has thyroid nodules, and it occurs more in women.
The vast majority – more than 90 percent – of thyroid nodules are benign and do not cause cancer.
However, the American Cancer Society estimates that 44,280 new cases of thyroid cancer will be diagnosed in the United States this year and more than 2,200 people will die from the disease.
Most people with thyroid nodules have normal thyroid function and do not have any symptoms. When symptoms do occur, they can include:
- A palpable lump in the neck
- Pain or pressure in the front of the neck
- Swelling in the neck
- Difficulty swallowing
- Hoarseness
- Choking
- Difficulty breathing
Diagnosis and Treatment
Diagnosing thyroid conditions typically begins with a simple laboratory test to your thyroid function by measuring the levels of thyroid hormones in your blood. Your doctor may also perform an ultrasound to check for nodules. If a nodule is detected, a biopsy is often performed to test for cancer.
Hyperthyroidism treatment typically starts with anti-thyroid medications and other drugs that can slow the heart rate and improve symptoms of tremors and irritability.
If hyperthyroidism persists for a year or more, definitive treatment with radioiodine may be considered. This treatment may be used to destroy thyroid cells and prevent the release of thyroid hormone. Alternatively, surgery may be used to remove the dysfunctional thyroid gland that is causing issues.
Hypothyroidism is often treated with a synthetic thyroid hormone that aims to return hormone levels back to their normal range.
Depending on their size and whether they are causing symptoms, benign thyroid nodules may be left alone and regularly monitored or may be surgically removed.
Surgical removal is typically recommended for thyroid nodules that are cancerous or suspected to be cancerous. Thyroidectomy, which is the complete surgical removal of the thyroid gland, is the most common surgery for thyroid cancer, according to the American Cancer Society. The surgery is performed through a small incision across the front of the neck.
After the thyroid is removed, patients will need to take synthetic thyroid hormones for their remainder of their lives.
Thyroid disease may be common, but once diagnosed it can be effectively treated and your hormone levels, and metabolism, can be restored.
To find a physician with Penn Medicine Princeton Health, call 888-742-7496 or visit www.princetonhcs.org
Tomer Davidov, MD, is board certified in general surgery and is a fellow of the American College of Surgeons. He is a member of the Medical Staff at Penn Medicine Princeton Health.