What is Thyroid Disorders?
Internal Medicine/Physician, Jaslok Hospital, 30 years of experience
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What is a Thyroid?
The thyroid is a butterfly-shaped gland present in front of the trachea (windpipe) in the neck. The function of the thyroid is to secrete hormones that alter and regulate the functioning of the body. Thyroxine (T4) and Triiodothyronine (T3) are the thyroid hormones. These hormones are secreted by the thyroid gland directly into the blood and travel to various organs in the body. These hormones control the metabolic activities of the body.
- What are Thyroid Disorders?
- What are the Types of Thyroid Disorders?
- What are the Causes of Thyroid Disorders?
- What are the Symptoms of Thyroid Disorders?
- What are the Investigations done in case of Thyroid Disorders?
- What are the Treatments for Thyroid Disorders?
- What Food to Eat and Avoid in Thyroid Disorders?
- Frequently Asked Questions about Thyroid Disorders
What are Thyroid Disorders?
The abnormal functioning or any derangement in the levels of the thyroid hormones is indicative of a thyroid disorder. The main hormones used as indicators are:
- Thyroid Stimulating Hormone (TSH): It is a hormone secreted by the pituitary gland (master gland) in the brain. The production of thyroid hormones T3 and T4 is controlled by TSH. T3 and T4 in turn reduce the secretion of TSH.
- Thyroxine (T4): It is one of the hormones secreted by the thyroid which regulates the basal metabolic rate as well as protein synthesis.
- Triiodothyronine (T3): It carries out the same functions as T4 but is more potent and is secreted in a lesser quantity.
What are the Types of Thyroid Disorders?
Thyroid disorders are mainly covered under the broad term known as goiter. The enlargement of the thyroid gland is called Goitre. It is categorized as follows:
Simple (Non-Toxic) Goitre: It is a benign enlargement of the thyroid gland without any alteration in the function of the gland, that is; it is in a Euthyroid state (Normally functioning). Types of simple goiter:
- Diffuse hyperplastic (Most common)
- Colloid goiter
- Multinodular goiter
Toxic Goitre: It is associated with increased secretion of T3 and T4. Enlargement may or may not be present. The patient is in a hyperthyroid state (Above normal functioning). The person shows symptoms of hyperthyroidism.
- Graves disease ( Know more about- What is Grave’s Disease? )
- Plummer’s disease
- Toxic solitary nodule
Neoplastic Goitre: It occurs due to cancerous growth that may be benign or malignant. ( Know more about- What is Goiter? )
- Benign
- Malignant- Carcinoma thyroid (Know more about: Causes of thyroid cancer)
Thyroiditis: Inflammation of the thyroid due to an autoimmune process causing either hyper or hypo functioning of the thyroid gland. (Know more about: What is Hypothyroidism? )
- Hashimoto’s Thyroiditis
- De Quervain’s Thyroiditis
- Riedel’s Thyroiditis
What are The Causes of Thyroid Disorders?
Thyroid disorders can occur due to the following causes:
- Deficiency of Iodine (Most common)
- Consumption of Goitrogens: They are chemicals that inhibit the synthesis of thyroid hormones
- Autoimmune: The body creates antibodies that excessively stimulate or inhibit the thyroid causing hyperthyroidism or hypothyroidism respectively
- Exposure to Radiation
- Long-Standing Simple Goitre: Can undergo transformation into cancer
- Genetic Susceptibility
- Rare causes: Due to bacterial infections or secondary to other diseases
What are the Symptoms of Thyroid Disorders?
Thyroid disorders may have the following symptoms:
- Painless swelling in front of the neck
- Palpitations (Hearing your own heartbeat)
- Cardiac rhythm irregularities
- Tachycardia (Elevated heart rate)
- Exophthalmos (Protrusion of the eyeballs)
- Anxiety
- Insomnia
- Depression. (Know more about: Symptoms of depression)
- Altered menstrual cycle
- Infertility
- Increased or decreased basal metabolic rate causing loss of weight or gaining of weight
- Intolerance to changes in temperature
- Due to compression- Dyspnoea (breathlessness), Dysphagia (Difficulty swallowing), Hoarseness of voice, Fainting attacks
What are the investigations done in the case of Thyroid Disorders?
The basic investigation done for diagnosis of any thyroid disorder comes under the term known as a Thyroid Profile. The following tests are included in a Thyroid Profile:
- Thyroid Function Test: Serum T3, T4, TSH
- Ultrasonography (USG) of Thyroid
- Thyroid CT Scan or MRI
- Serum LATS: Long-Acting Thyroid Stimulator (LATS) Antibodies are seen in cases of Graves Disease
- Serum Calcitonin: May be elevated in carcinoma of the thyroid
- FNAC: Fine Needle Aspiration Cytology is done to look at the microscopic morphology of the cells which helps detect cancer as well as the type of cancer
- X-ray of the neck: Extent of enlargement and effect of enlarged thyroid on the surrounding structures. Presence of calcification (seen in CA Thyroid)
- X-ray of the chest: To check for the spread of cancer or for extension of enlarged thyroid into the chest cavity
- Indirect Laryngoscopy: To visualize the movement of the vocal cords (Decreased movement in case of nerve compression)
What are the Treatments for Thyroid Disorders?
The treatment for thyroid disorders depends on the type of disorder the patient is suffering from. The main lines of treatment for thyroid disorders are Medical, Surgical Hormonal, and Radiation.
Simple (Non-Toxic) Goitre:
- Medical: Iodine supplementation
- Surgical: Subtotal Thyroidectomy, in which both lobes and the isthmus of the thyroid are removed but some part at the junction of the trachea and esophagus is preserved.
Toxic Goitre:
- Medical: Antithyroid drugs that reduce the production of thyroid hormones.
- Radiation: Radioactive Iodine tablets, help destroy thyroid tissue to attain a euthyroid state.
- Surgical: It is usually the last option when the medical line and radiation therapy fail. Either a total thyroidectomy or a subtotal thyroidectomy is done.
Neoplasm of the Thyroid:
- Surgical: Total thyroidectomy along with Central Node Compartment Neck Dissection. (Lymph Nodes in the neck are removed)
- Hormonal: High dose thyroxine suppresses the TSH secretion preventing further increase in size.
- Radiation: Radioactive Iodine. Radiation therapy for secondaries.
- Chemotherapy
Thyroiditis:
- Hormonal: L-Thyroxine supplementation to treat hypothyroidism.
- Medical: Steroid therapy to treat inflammation and reduce autoimmune antibodies.
- Surgical: Subtotal or Hemi thyroidectomy is performed if the thyroid is greatly enlarged or is causing compression of the surrounding structures and causing discomfort to the patient.
One of the most important treatments of Thyroid Disorders is Thyroidectomy. This procedure is done by general surgeons across different cities and hospitals in India, with great success and precision.
What Food to Eat and Avoid in Thyroid?
There are no diet restrictions as such when it comes to any thyroid disorder. The most important aspect is to have a well-balanced diet with nutritive foods along with adequate exercise. This is supplementary to the treatment given by the doctor and is not to be used as a replacement for treatment. It helps prevent further problems that may arise due to thyroid disorder. The only foods that one with any thyroid disease may have to avoid are foods containing Goitrogens. Its role has been explained in the causes. Foods containing goitrogens are:
- Soy foods- Tofu, soy milk, soybeans, etc.
- Cassava
- Millets
- Cruciferous vegetables- Cabbage, broccoli, cauliflower, etc.
These foods are only harmful in large quantities and are otherwise safe to eat.
Frequently Asked Questions about Thyroid Disorders
What are the problems associated with thyroid enlargement?
Problems associated with thyroid disorders are explained above in the symptoms. Problems that arise specifically due to enlargement of the thyroid are:
- Dyspnoea (breathlessness) due to compression of the windpipe
- Dysphagia (Difficulty swallowing) due to compression of the esophagus
- Hoarseness of voice due to compression of the Laryngeal nerve (nerve supplying the vocal cords)
- Fainting attacks due to compression of the Common Carotid Artery which carries blood to the brain
Is thyroid disease incurable?
No, like any disease; treatment of the thyroid is also possible. Thyroid treatment can be done by medicines, surgery, etc. It is important to consult a doctor immediately if there is a suspicion of any thyroid disease.
When should thyroid medicines be taken?
The tablet for the thyroid can be taken on an empty stomach in the morning. Apart from this, some people may take the pill 50 minutes before a meal.
What are the normal levels of thyroid hormones?
TSH- 0 to 5 IU/ml (International Units per ml)
T3- 1.2 to 3.1 nmol/l (nanomoles per liter)
T4- 55 to 150 nmol/l
Free T3- 3 to 9 nmol/l
Free T4- 8 to 26 nmol/l
(Note: Normal ranges vary from lab to lab)
Is a thyroid test done on an empty stomach?
No, for a thyroid function test one does not have to be fasting.
What to do to eliminate thyroid disorders from the root?
Follow the instructions given by your doctor to eliminate the thyroid from the root. Apart from this, the use of some home remedies can help in eliminating the thyroid from the root. Supplementing the doctor’s treatment with maintaining a balanced diet and doing regular exercise is important. Do not try any other home remedies or medications without consulting a doctor.
Does thyroid disease cause a sore throat?
Yes, thyroid disease is caused due to disturbances in the thyroid gland. Apart from this; it may be caused due to an imbalance in hormones, symptoms like sore throat, swelling, and heaviness may occur.
How does thyroid cancer happen?
The exact cause of thyroid cancer is not known, but an enlarged thyroid gland may increase the risk of cancer. The thyroid gland helps in controlling heart rate, weight, and hormones. Thyroid cancer occurs when cells undergo mutations. The abnormal cells begin to form tumors, and the abnormal cells may invade the surrounding tissue. From here it starts spreading to other parts of the body. Thyroid cancer can be classified based on the cells found in the tumor.
In how many days does the thyroid heal?
By getting the treatment of thyroid done in the right way, the patient can get rid of it quickly within months. The treatment of thyroid depends on the condition of the patient, as some people are advised to take the medicine daily. Some people are treated based on other tests to help them recover from the thyroid.
How much does a thyroid test cost?
The cost of a thyroid test, commonly comprising TSH, T3 and T4 parameters is INR 300- INR 500, but it can be less or more than this at some places.
What happens if you have thyroid in pregnancy?
Having thyroid problems in pregnancy comes with many risks. Due to abnormal thyroid gland hormones, problems arise in the mental and physical development of the baby. Apart from this, the baby may be born prematurely or the mother may have frequent miscarriages. Thus, thyroid tests are usually done prior to conception as well as during pregnancy. If one is diagnosed with thyroid disease during pregnancy it is usually not a very big issue. There are many drugs that are safe for use during pregnancy. If more definitive treatment is required then only the safe drugs are given until delivery, after which the mother can be taken for surgery or radiotherapy.
We hope that we could answer your questions regarding Thyroid disorders through this article.
If you want more information and treatment of Thyroid disorders, you can contact an Endocrinologist.
We only aim to give you information through this article. We do not recommend medication, treatment in any way. Only a doctor can give you the best advice.
