What Does the Thyroid Do?
This small butterfly-shaped gland located at the base of your neck is a vital part of the body’s endocrine system — a network of glands that produce various hormones that regulate metabolism, development, mood, tissue function and so on.
The thyroid in particular controls several vital body functions — metabolism in particular. It secretes the hormones calcitonin, T4 (thyroxine) and T3 (triiodothyronine) into the bloodstream, which control the rate at which cells and organs turn nutrients into energy and the amount of oxygen cells use (i.e. metabolism). This gland is thus responsible for regulating your body’s metabolism.
What is Thyroid Disease?
Thyroid disease or disorders refer to a medical condition that prevents your thyroid from making the right amount of hormones.
This comes in the form of overproduction or underproduction of hormones — known as hyperthyroidism and hypothyroidism, respectively. There are several diseases that can cause your thyroid to be hyperactive or underactive (which we will cover further down). When your thyroid doesn’t work as it should, it can impact your health in both subtle and severe ways.
Another form of thyroid disease occurs in the form of cancer. This happens when the cells in your thyroid mutate and these abnormal cells multiply rapidly, which results in a tumor forming. If not detected early or treated swiftly, thyroid cancer could result in a loss in thyroid function and the cancer spreading to other parts of the body.
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Different Types of Thyroid Disorders
Hyperthyroidism refers to a condition when the thyroid glands produce too much thyroid hormone (T4 and T3).
This may result in your metabolism speeding up abnormally and causing your body to use up energy too quickly, which can result in tiredness, unexplained weight loss, hand tremors, anxiety and so on.
Here are some disorders that may result in hyperthyroidism:
The most common cause of hyperthyroidism, Graves’ disease, is an autoimmune disorder that results in an overactive thyroid that produces more hormones than the body needs. This disorder accounts for around 70% of hyperthyroidism disorders.
Women are more likely to get Graves disease than men, and individuals with existing autoimmune disorders are more prone to developing it (more in Risk Factors).
Hyperfunctioning Thyroid Nodules
Also known as toxic thyroid nodules, nodules (lumps) that grow on the thyroid gland and cause it to overproduce hormones can result in symptoms of hyperthyroidism.
Depending on the number of lumps that are found on the thyroid, this condition is labeled as either toxic adenoma (single lump) or multinodular goiter (multiple lumps).
Symptoms include those of hyperthyroidism, with the possibility of a visibly enlarged thyroid gland and/or a lump on that area.
This condition refers to inflammation of the thyroid due to an autoimmune disease or infection, which results in damage to the thyroid cells. This results in a temporary increase of thyroid hormones in the bloodstream due to the stored hormones in the gland leaking out (known as thyrotoxicosis, which hyperthyroidism is a subset of).
This is often followed by hypothyroidism as the cells in the thyroid undergo further chronic damage (see Hypothyroidism Disorders)
A condition called postpartum thyroiditis may occur after a pregnant woman delivers a baby, causing temporary high levels of thyroid hormones in the blood, followed by temporary hypothyroidism. The thyroid typically restores to its normal function within 12 to 18 months.
Thyroid disorders may also result in hypothyroidism, which is when the thyroid produces too little thyroid hormone for the body to function normally.
On the flip-side of this, your thyroid can make too little thyroid hormone. This is called hypothyroidism. When you have too little thyroid hormone in your body, it can make you feel tired, you might gain weight and you may even be unable to tolerate cold temperatures.
Here are the main causes of hypothyroidism:
Hashimoto’s thyroiditis is an autoimmune disease that attacks the thyroid cells, causing them to become inflamed and damaged. This inflammation is what causes the gland to become underactive and not produce enough thyroid hormone.
Symptoms include those of hypothyroidism, and occurs most commonly in middle-aged women (though men and children may also develop Hashimoto’s thyroiditis.
Surgical Removal of Part or All of the Thyroid Gland
A patient may undergo surgery to remove part or all of their thyroid gland if they suffer from Graves’ disease, thyroid nodules or thyroid cancer.
A side effect of the surgery may mean that their body may not be able to produce sufficient levels of thyroid hormone, if any at all if the entire thyroid is removed. Thyroid replacement treatment may have to be administered in order to get the body functioning normally.
Besides surgery for the above hyperthyroidism disorders and thyroid cancer, radioactive iodine treatment is another option. This form of treatment utilises doses of radioactive iodine to destroy the thyroid gland cells, which results it the thyroid also losing part or all of its function.
Too Much or Too Little Iodine
A proper iodine balance (obtained through food intake) within the body is essential for proper thyroid function, as this element is needed to produce the thyroid hormones. Having too little iodine results in insufficient thyroid hormone being produced, while too much iodine can also cause or worsen hypothyroidism.
When an infant is born without a thyroid or with an underdeveloped thyroid, this is called congenital hypothyroidism. This results in a severe deficiency of thyroid hormones in the infant’s body, which can lead to developmental and neurological issues.
Thyroid cancer is the most common cancer to affect the endocrine system, and is the 9th most common cancer to affect women in Singapore. Cancer of the thyroid occurs when the thyroid gland cells mutate and multiply abnormally. In later stages of cancer, it may spread to other parts of the body.
If you notice a lump on your thyroid region or you suspect that something might be wrong, don’t hesitate to consult with your doctor. Detecting cancer early is vital in increasing one’s cancer survival rate, so it’s important to keep up with your regular health screening.
Symptoms of Thyroid Problems
Hyperthyroidism and hypothyroidism may share some similar symptoms, though they also have differences.
Symptoms of an overactive thyroid (hyperthyroidism) can include:
- Experiencing anxiety, irritability and nervousness
- Elevated heart rate
- Sleeping problems
- Unexplained weight loss
- Muscle weakness and tremors
- Irregular menstrual periods or loss of menstrual period
- Experiencing hot flashes and an intolerance to heat
- Excessive sweating
- Having vision problems or eye irritation (particular for Graves’ disease)
- Having an enlarged thyroid gland (goiter)
Symptoms of an underactive thyroid (hypothyroidism) can include:
- Dry skin
- Slow heart rate
- Unexplained weight gain
- Increased sensitivity to cold
- Memory problems
- Muscle weakness and soreness
- Heavier than usual menstrual periods
- Having an enlarged thyroid gland (goiter)
The most common detectable symptom of thyroid cancer is a nodule or goiter visible on the neck. However, not all visible lumps are cancerous, and likewise, not all cancerous lumps can be felt or seen — some may only show up on an ultrasound.
Other symptoms include breathlessness and hoarseness (if the cancer has spread to the larynx (voice-box)).
Thyroid Disorder Complications to Watch Out For
If left untreated, both hyperthyroidism and hypothyroidism can lead to serious health complications.
Hyperthyroidism complications include:
Some serious complications that may arise include rapid rate, atrial fibrillation (a heart rhythm disorder that increases your risk of stroke) and congestive heart failure.
Since too much thyroid hormone interferes with your body’s ability to utilise calcium for bone repair and growth, hypothyroidism may lead to osteoporosis, which increases your risk for bone fractures.
People with Graves’ disease may develop eye problems, including bulging swollen eyes, sensitivity to light, and blurry/double vision. If left untreated, these eye problems may lead to vision loss.
Hyperthyroidism increases your risk of thyrotoxic crisis — a sudden intensification of hyperthyroidism symptoms that leads to fever, rapid pulse, muscle weakens and delirium. Immediate medical care is required in cases like this.
Hyperthyroidism may result in the thyroid gland becoming enlarged (a condition known as goiter). A large goiter can affect your appearance and may even interfere with your ability to swallow and breathe.
Hypothyroidism complications include:
Due to the association of higher levels of low-density lipoprotein (LDL) cholesterol — known as the ‘bad’ cholesterol — and individuals with hypothyroidism, these individuals are also at higher risk of heart diseases and heart failure.
Mental Health Issues
Depression is a symptom that may occur early in the onset of hypothyroidism and may become more severe over time if left unchecked.
Long-term hypothyroidism may result in cause damage to your peripheral nerves, which carry information from the brain and spinal cord to the rest of the body. This may cause pain, numbness and tingling in the arms and legs.
Myxedema (severely advanced hypothyroidism)
This life-threatening condition is the result of long-term untreated hypothyroidism. Its signs and symptoms include swelling in the face and the lower limbs.
A myxedema crisis occurs when the body is unable to withstand the effects of hypothyroidism, and results in the body going into a state of shock. This can result in death. Immediate emergency medical treatment is required for this situation.
Low levels of thyroid hormone can interfere with ovulation in women. Hypothyroidism may also be an indicator of another medical issue such as an autoimmune disorder, which impairs fertility as well.
Infants with congenital hypothyroidism have a higher risk of birth defects, and are also more prone to facing developmental problems if their hypothyroidism is left untreated. However, if their condition is diagnosed within the first few months and appropriate treatment is administered, this increases their chances of developing normally.
Thyroid Disorder Risk Factors
Thyroid disorders can be developed by anyone, regardless of age or gender. However, certain factors increase one’s chances of developing thyroid disorders.
- Gender. Women are 5-8 times more likely to develop thyroid disorders as compared to men
- Having a family history of thyroid disease
- Having diabetes. Since type 1 diabetes is an autoimmune disorder, the chances of developing another autoimmune disorder on top of it is more likely. The risk is lower for people with type 2 diabetes, though it is still higher compared to people who don’t have diabetes.
- Taking medication high in iodine (amiodarone).As mentioned before, high levels of iodine can result in thyroid disorders as the thyroid requires a balanced level of iodine to produce the right amount of hormone.
- Being over the age of 60
- Having had a previous thyroid disorder or cancer and underwent radiation treatment and/or surgery.
Diagnosing Thyroid Disorders
Figuring out if you have a thyroid disorder can be tricky, as the symptoms may be easily confused for other conditions.
That said, there are medical tests that can be done to determine if your thyroid is function properly.
The three main ways in which a thyroid disorder can be medically diagnosed are:
- Blood tests
- Scans and ultrasounds
- Physical exams
A thyroid function test (TFT) checks the level of your thyroid hormone produced by your thyroid (T3 and T4) and the thyroid-stimulating hormone (TSH) produced by the pituitary gland.
This test will then determine if you have hyperthyroidism or hypothyroidism — high T4 and low TSH levels point to hyperthyroidism, while low T4 and high TSH levels point to hypothyroidism.
Scans and Ultrasounds
Imaging tests allow medical professionals to get a visual on your thyroid and what’s happening within your body. This will allow them to check for enlargements, lumps and any other abnormalities.
An imaging test such as an ultrasound is quick and painless.
A physical examination in your doctor’s office is probably the quickest way to determine if there are any detectable signs of thyroid disorders such as lumps or enlargements, which may be worth following up on with the above two tests.
Thyroid Disease Treatment
When it comes to treating thyroid disorders, there are several options. These include:
- Thyroid medication
- Radioactive Iodine treatment
For most thyroid disorders, the first line of treatment is usually medication.
The two most common types of medication used to treat hyperthyroidism are beta-blockers and anti-thyroid drugs.
Beta-blockers like propranolol and atenolol are more to improve the symptoms of hyperthyroidism — they block the effect of the thyroid hormone on other parts of your body, and do not change the amount of thyroid hormone being produced by the thyroid.
On the other hand, antithyroid drugs (carbimazole, thiamazole and propylthiouracil) act directly on the thyroid gland in order to decrease thyroid hormone production. These medications can be quite effective at controlling hyperthyroidism after a few weeks of taking them.
If you have hypothyroidism, thyroid replacement medication like levothyroxine may be prescribed. These drugs are a synthetic way to raise thyroid hormone levels in the body and may be useful in controlling hypothyroidism.
The main downside of thyroid medication is that the issues often come back once medication is stopped.
As there are different medications for hyperthyroidism and hypothyroidism, you will have to consult with your GP and obtain a prescription first. Head here to find out more about how you can obtain your thyroid medication in a fuss-free way.
Radioactive Iodine Treatment (RAI)
This treatment is one of the most widely used methods to permanently treat hyperthyroidism.
Small doses of radioactive iodine are administered orally and are absorbed by the thyroid cells via the bloodstream — the thyroid cells are the only cells that absorb iodine, so over time, the radioactivity destroys the thyroid cells.
Side effects are minimal, as the RAI is not taken up by any of the other cells and is cycled out of the body naturally. Hypothyroidism (as mentioned above) is likely the most major side effect, and occurs when too many thyroid cells are destroyed by the RAI. This can be treated with thyroid replacement medication.
Thyroid surgery (thyroidectomy) to remove part or all of the thyroid gland is the most invasive form of treatment, and is usually recommended if you’d like to remove a large unsightly goitre, or if a cancerous growth is found.
The amount of thyroid removed is subjected to the severity of the patient’s condition. Your body will need a few weeks to heal from the surgery itself, and you will typically be prescribed thyroid replacement medication to counteract the low levels of thyroid hormones post-surgery.
Do consult with your doctor about the various options available and about which one may be the most suitable for you.
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