THYROID DISORDERS
Introduction to thyroid disease
The thyroid gland or simply, the thyroid in vertebrate anatomy, is one of the largest endocrine glands. The thyroid gland is found in the neck, below the thyroid cartilage (which forms the laryngeal prominence, or "Adam's apple"). The isthmus (the bridge between the two lobes of the thyroid) is located inferior to the cricoid cartilage.
The thyroid gland controls how quickly the body uses energy, makes proteins, and controls how sensitive the body is to other hormones. It participates in these processes by producing thyroid hormones, the principal ones being triiodothyronine (T3) and thyroxine which can sometimes be referred to as tetraiodothyronine (T4). These hormones regulate the rate of metabolism and affect the growth and rate of function of many other systems in the body. T3and T4 are synthesized from both iodine and tyrosine. The thyroid also produces calcitonin, which plays a role in calcium homeostasis.
The thyroid gets its name from the Greek word for "shield", due to the shape of the related thyroid cartilage. The most common problems of the thyroid gland consist of an overactive thyroid gland, referred to as hyperthyroidism, and an underactive thyroid gland, referred to ashypothyroidism.
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| Thyroid and parathyroid |
When I was asked to write an article on "thyroid disease", I took a very deep breath. The task seemed daunting. As any Endocrinologist (hormonespecialist) knows, there are many subtopics within this giant topic, and an article like this could go on for a hundred pages! So, once I caught my breath, I decided to simply design this article to present a "rough guide" to the thyroid. This article will be an outline or introduction to many conditions that involve the thyroid gland. As you read through this, you will find a number of links that will take you to more in-depth articles dealing with the specific topic in question.
Thyroid 101: What is the thyroid and what does it do?
The thyroid is a butterfly-shaped gland located in the front of the neck just below the Adams apple. The gland wraps around thewindpipe (trachea) and has a shape that is similar to a butterfly formed by two wings (lobes) and attached by a middle part (isthmus). The thyroid gland works like a tiny factory that usesiodine (mostly from the diet in foods such as seafood and salt) to produce thyroid hormones. These hormones help to regulate the body's metabolism and effects processes, such as growth and other important functions of the body.
The two most important thyroid hormones are thyroxine (T4) andtriiodothyronine (T3), representing 99.9% and 0.1% of thyroid hormones respectively. The hormone with the most biological power is actually T3. Once released from the thyroid gland into the blood, a large amount of T4 is converted to T3 - the active hormone that affects the metabolism of cells throughout our body.
What is the Thyroid?
The thyroid is a small gland, shaped like a butterfly, located in the lower part of your neck. The function of a gland is to secrete hormones. The main hormones released by the thyroid are triiodothyronine, abbreviated as T3, and thyroxine, abbreviated as T4. These thyroid hormones deliver energy to cells of the body.
Your thyroid gland is a small, butterfly-shaped gland located just below your Adam's apple. 
The thyroid produces hormones that affect your body's metabolism and energy level. Thyroid problems are among the most common medical conditions but, because their symptoms often appear gradually, they are commonly misdiagnosed.
The thyroid produces hormones that affect your body's metabolism and energy level. Thyroid problems are among the most common medical conditions but, because their symptoms often appear gradually, they are commonly misdiagnosed.
The three most common thyroid problems are the underactive thyroid, the overactive thyroid , and thyroid nodules.
HYPOTHYROIDISM (Underactive thyroid)
The most common cause of hypothyroidism is Hashimoto's thyroiditis. In this condition, the body's immune system mistakenly attacks the thyroid gland.
Common symptoms of hypothyroidism are:
Common symptoms of hypothyroidism are:
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Hypothyroidism
When the thyroid gland is underactive, improperly formed at birth, surgically removed all or in part, or becomes incapable of producing enough thyroid hormone, a person is said to be hypothyroid. One of the most common causes of hypothyroidism is the autoimmune disease called Hashimoto's disease, in which antibodies gradually target the thyroid and destroy its ability to produce thyroid hormone.
Symptoms of hypothyroidism usually go along with a slowdown in metabolism, and can include fatigue, weight gain, and depression, among others.
Symptoms of hypothyroidism usually go along with a slowdown in metabolism, and can include fatigue, weight gain, and depression, among others.
The symptoms of hypothyroidism -- an underactive thyroid -- tend to mirror the slowing down of physical processes that results from insufficient thyroid hormone. Common symptoms include fatigue, weight gain, constipation, fuzzy thinking, low blood pressure, fluid retention, depression, body pain, slow reflexes, and much more.
HYPERTHYROIDISM (Overactive Thyroid)
The most common cause of hyperthyroidism is Graves' disease. This occurs when the body's immune system overstimulates the thyroid.
Common symptoms of hyperthyroidism are:
Common symptoms of hyperthyroidism are:
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When the thyroid gland becomes overactive and produces too much thyroid hormone, a person is said to be hyperthyroid. The most common cause of hyperthyroidism is the autoimmune condition known as Graves' disease, where antibodies target the gland and cause it to speed up hormone production.
Most thyroid dysfunction such as hypothyroidism or hyperthyroidism is due to autoimmune thyroid disease. Autoimmune disease refers to a condition where the body's natural ability to differentiate between its tissues, organs and glands, vs. outside bacteria, viruses or pathogens, becomes disrupted. This causes the immune system to wrongly mount an attack on the affected area, by producing antibodies. In the case of autoimmune thyroid disease, antibodies either gradually destroy the thyroid, or make it overactive.
The two autoimmune diseases that directly affect the thyroid are Hashimoto's disease and Graves' disease. The symptoms of Hashimoto's disease usually parallel the hypothyroidism that is a result of the disease. Occasionally, however, while the thyroid is failing, it can have periods where it sputters into life and even becomes temporarily overactive. This is known as Hashitoxicosis. Symptoms then can be confusing, with cycling over a period of days or weeks between hypothyroidism and hyperthyroidism symptoms. To understand the difference between hypothyroidism and Hashimoto's disease,
Goiter/Thyroid Nodules
Sometimes the thyroid becomes enlarged -- due to Hashimoto's disease, Graves' disease, nutritional deficiencies, or other thyroid imbalances. When the thyroid become enlarged, this is known as a goiter.
Some people develop solid or liquid filled cysts, lumps, bumps and tumors -- both benign and cancerous -- in the thyroid gland. These are known as thyroid nodules.
Some people develop solid or liquid filled cysts, lumps, bumps and tumors -- both benign and cancerous -- in the thyroid gland. These are known as thyroid nodules.
Symptoms of goiter -- an enlarged thyroid -- include a swollen, tender or tight feeling in the neck or throat, hoarseness or coughing, and difficulty swallowing or breathing. Sometimes, the goiter is visbible to yourself or others.
Symptoms of nodules depend on what action they are having. Some cause no symptoms, while others may cause difficulty swallowing, a feeling of fullness, pain or pressure in the neck, a hoarse voice, or neck tenderness. Some nodules trigger hyperthyroid-like symptoms such as palpitations, insomnia, weight loss, anxiety, and tremors. Nodules can also trigger hypothyroidism, and symptoms might include weight gain, fatigue, depression. Nodules can sometimes cause cycling back and forth between hyperthyroid and hypothyroid symptoms.
What types of thyroid disease can occur when the function of the thyroid is affected??
If the thyroid itself is under-active, or if the regulators of the thyroid gland are not functioning properly, hypothyroidism can result. There are many causes ofhypothyroidism such as the following:
- Hashimoto's thyroiditis (autoimmune thyroiditis)
- Postpartum thyroiditis (inflammation of the thyroid gland after pregnancy)
- Acute thyroiditis
- Silent thyroiditis
- Thyroid hormone resistance
What types of thyroid disease can occur when the structure of the thyroid is affected??
Structural problems with the thyroid gland can occasionally result in altered function, such as toxic multinodular goiter and toxic nodules (adenomas) leading to hyperthyroidism. However, in most cases, structural problems occur in glands that have normal function. These conditions range from simple and benign cysts to more serious problems such as thyroid cancers (papillary, follicular, medullary and anaplastic are the different types of thyroid cancer that may arise). Enlargement of the thyroid gland is referred to as a goiter. Goiters can form and can range in size from hardly noticeable to large enough to require surgical removal. Additionally, the actual location of the thyroid in an individual can be in an abnormal area of the body due to developmental abnormalities.
Risk Factors for Thyroid Disease
Some of the key risk factors for thyroid disease include...- Female: Women are at greater risk than men.
- Age - being 50 and above poses the highest risk of thyroid disease, though it can strike at any age.
- A personal or family history of thyroid and/or autoimmune disease increases risk.
- Surgical removal of all or part of the thyroid, or radioactive iodine treatment to the thyroid -- both which typically result in an underactive thyroid.
- Being left-handed, ambidextrous or prematurely gray mean greater risk of autoimmune disease, including thyroid problems
- Being pregnant or within the first year after childbirth
- Current or former smoker
- Recent exposure to iodine via contrast dye or surgical antiseptic
- Iodine or herbal supplements containing iodine, in pill or liquid form
- Living in an iodine-deficient area
- Various medical treatments, including Interferon Beta-1b, Interleukin-4, immunosuppressants, antiretrovirals, monoclonal antibody (Campath-1H), bone marrow transplant, Lithium, amiodarone (Cordarone), and other medications
- Overconsumption of raw goitrogenic foods, i.e., Brussel sprouts, turnips, cauliflower, soy products and others
- Overconsumption of soy foods
- Recent neck trauma, biopsy, injection or surgery
- Radiation exposure, through radiation to neck area, or exposure to nuclear facility or accident, i.e., Chernobyl
- High stress life events
Thyroid hormone regulation - the chain of command
The thyroid itself is regulated by another gland located in the brain, called the pituitary. In turn, the pituitary is regulated in part by the thyroid (via a "feedback" effect of thyroid hormone on the pituitary gland) and by another gland called the hypothalamus.
The hypothalamus releases a hormone called thyrotropin releasing hormone (TRH), which sends a signal to the pituitary to release thyroid stimulating hormone (TSH). In turn, TSH sends a signal to the thyroid to release thyroid hormones. If overactivity of any of these three glands occurs, an excessive amount of thyroid hormones can be produced, thereby resulting inhyperthyroidism. Similarly, if underactivity of any of these glands occurs, a deficiency of thyroid hormones can result, causing hypothyroidism.
Hypothalamus - TRH
Pituitary- TSH
Thyroid - T4 and T3
The rate of thyroid hormone production is controlled by the pituitary gland. If there is an insufficient amount of thyroid hormone circulating in the body to allow for normal functioning, the release of TSH is increased by the pituitary in an attempt to stimulate more thyroid hormone production. In contrast, when there is an excessive amount of circulating thyroid hormone, TSH levels fall as the pituitary attempts to decrease the production of thyroid hormone.
There is another hormone that is produced by the thyroid called calcitonin. Calcitonin is produced by specific cells in the thyroid gland, and unlike T3 and T4, it is not involved in this regulation of metabolism. Calcitonin is a hormone that contributes to the regulation of calcium and helps to lower calcium levels in the blood. Excess calcium in the blood is referred to ashypercalcemia.
Thyroid Cancers
Main article: Thyroid cancer
Cancers do occur in the thyroid gland and are more common in females In most cases, the thyroid cancer presents as a painless mass in the neck. It is very unusual for the thyroid cancers to present with symptoms, unless it has been neglected. One may be able to feel a hard nodule in the neck.
[edit]Non-cancerous nodules
Further information: Thyroid nodule
Many individuals may find the presence of thyroid nodules in the neck. The majority of these thyroid nodules are benign (non cancerous). The presence of a thyroid nodule does not mean that one has thyroid disease. Most thyroid nodules do not cause any symptoms, and most are discovered on an incidental examination. Doctors usually perform a needle aspiration biopsy of the thyroid to determine the status of the nodules. If the nodule is found to be non-cancerous, no other treatment is required. If the nodule is suspicious then surgery is recommended.
[edit]Congenital anomalies
A persistent thyroglossal duct or cyst is the most common clinically significant congenital anomaly of the thyroid gland. A persistent sinus tract may remain as a vestigial remnant of the tubular development of the thyroid gland. Parts of this tube may be obliterated, leaving small segments to form cysts. These occur at any age and might not become evident until adult life. Mucinous, clear secretions may collect within these cysts to form either spherical masses or fusiform swellings, rarely larger than 2 to 3 cm in diameter. These are present in the midline of the neck anterior to the trachea. Segments of the duct and cysts that occur high in the neck are lined by stratified squamous epithelium, which is essentially identical to that covering the posterior portion of the tongue in the region of the foreamen cecum. The anomalies that occur in the lower neck more proximal to the thyroid gland are lined by epithelium resembling the thyroidal acinar epithelium. Characteristically, next to the lining epithelium, there is an intense lymphocytic inflitrate. Superimposed infection may convert these lesions into abscess cavities, and rarely, give rise to cancers.
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