Everything You Ever Wanted to Know About TheThyroid[1]

8/18/2019 Everything You Ever Wanted to Know About TheThyroid[1]

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Everything You Ever Wanted to

Know About the Thyroid

(but were afraid to ask…)

Caroline Messer, MD

Board Certified Internist, Endorinologist,and !hysiian "utrition #$eialist


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Topics

► Thyroid Nodules

► Hyperthyroidism

► Hypothyroidism


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Introduction


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%A&' If I have an issue with (y $arathyroid,

does this affet (y thyroid hor(one levels)


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Thyroid Nodules


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Thyroid Nodules

► Thyroid nodules are very common; up to half of

all people have at least one nodule althou!h

most do not know about it

► "ost nodules don#t chan!e the amount of

thyroid hormone in the body but some cause

the thyroid to make too (uh hormone$ These

nodules are very rarely cancerous$

%A&' Can thyroid nodules derease the a(ount

of thyroid hor(one (y body is (a*ing)


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%auses of Nodules


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&ossible 'ymptoms

► symptomatic found on routine e*am or

durin! ima!in! test performed for another

condition

► +ifficulty swallowin! voice hoarseness

shortness of breath

► 'ymptoms from havin! too much thyroid

hormone


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+ia!nosis Thyroid -ltrasound

► Thyroid ultrasound should be performed on allpatients with a suspected nodule or nodular !oiter onphysical e*amination or with nodules incidentally

noted on other ima!in! studies (carotid ultrasound%T ".I or &/T scan)

► Thyroid ultrasono!raphy is used to answer 0uestions

about the si1e and anatomy of the thyroid and nearbystructures in the neck

► ,indin!s can be used to select nodules that re0uire

,N biopsy based on si1e and features


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+ia!nosis ,N

► Thin needle used to remove small tissue samples fromthe nodule$ 'amples are e*amined with a microscope$

► ,N biopsy can be performed in the office with a localanesthetic (numbin! medicine)

► ccurately identifies cancer in a suspicious thyroidnodule$ In some cases the biopsy does not containenou!h tissue to make a dia!nosis and sur!ery isnecessary

► .esults of the biopsy will be one of the followin! 2 3eni!n (non cancerous) 2 "ali!nant (cancer) 2 &ossible or suspicious for mali!nancy

2 Non dia!nostic or insufficient


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+ia!nosis Thyroid 'can

► 4ow T'H the nodule may be producin!

hi!h levels of thyroid hormone

► The ne*t step is to have a thyroid scan to

see if the nodules are producin! thyroid

hormone


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► %an help determine if a nodule is producin! thyroidhormone (i$e$ 5hot6 or 5to*ic6)

►&erformed after swallowin! a small dose of aradioactive substance

► Nodules that absorb the substance are usuallynot cancerous

► Nodules that do not absorb the substance are called5cold6 and have a 78 risk of bein! cancerous

Thyroid Nodule +ia!nosis

Thyroid 'can

%A&' Can a thyroid san itself ause aner

beause of the radioative iodine)


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Thyroid 'can .esults


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Treatment

+epends on Type of Nodule

► 9atchin! : waitin! 2 we don#t always treat nodulesri!ht away$ 9e will often repeat yearly thyroidultrasounds to monitor their si1e

► .adioactive iodine 2 comes in a pill or li0uid that youswallow$ Has a small amount of radiation and candestroy a lot of the thyroid !land$ -sed only to treatnodules that make too much thyroid hormone$

► 'ur!ery to remove the thyroid nodule 2 a procedure todrain fluid from the thyroid nodule if it is filled with fluid

%A&' I was $laed on synthroid (any years ago to

shrin* the si+e of (y nodules-. Does this wor*)


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Hyperthyroidism


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9hat is it

► Hyperthyroidism is the medical term for anoverative thyroid (hyper < e*cessive)

► In people with hyperthyroidism the thyroid!land produces too (uh thyroid hormone

► 9hen this occurs the body=s metabolism isinreased which can cause a variety of

symptoms


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'ymptoms

► n*iety irritability trouble sleepin! even psychosisor depression

► 9eakness (particularly the upper arms and thi!hs

makin! it difficult to lift heavy items or climb stairs)

► Tremors (of the hands)

► &erspirin! more than normal difficulty toleratin!hot weather

►.apid or irre!ular heartbeats


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'ymptoms

► ,ati!ue

► 9ei!ht loss in spite of a normal or increased appetite

► ,re0uent bowel movements

► 'ome women have irre!ular menstrual periods orstop havin! their periods alto!ether$ This can be

associated with infertility

► "en may develop enlar!ed or tender breasts orerectile dysfunction which resolves when

hyperthyroidism is treated


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%auses >raves#

► "ost common cause of hyperthyroidism

► Not clear why it develops in most peoplealthou!h it is more common in certain families

► In people with >raves= disease the immunesystem produces an antibody that stimulates thethyroid to produce too much thyroid hormone

► "ost common in women between the a!es of?@AB@ but can occur at any a!e in men orwomen


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Hyperthyroidism Thyroiditis

► &ainless (Dsilent6 or 5lymphocyticD) thyroiditis and

postpartum thyroiditis are disorders in which the thyroidbecomes temporarily inflamed and releases thyroidhormone into the bloodstream causin! hyperthyroidism

► &ostpartum thyroiditis can occur several months afterdelivery$ 'ymptoms may last for several months oftenfollowed by months of hypothyroid symptoms such asfati!ue muscle cramps bloatin! and wei!ht !ain

► 'ubacute thyroiditis is thou!ht to be caused by a virus$ Itcauses a painful tender enlar!ed thyroid !land$ Thethyroid becomes inflamed and releases thyroid hormoneinto the bloodstream; the hyperthyroidism resolves when

the viral infection improves


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+ia!nosis

► 4ow T'H elevated TB and TE► TE levels are often disproportionately hi!her

than TB in hyperthyroidism; TE

measurements may be valuable forevaluatin! and followin! patients with this

disorder$

► Thyroid scan may also be recommended tohelp determine the cause of hyperthyroidism

(>raves= disease to*ic nodular !oiter or

thyroiditis)


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Thyroid 'can .esults

E. Thyroiditis


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Treatment ntiAThyroid +ru!s

► ntiAthyroid dru!s such as methima1ole and propylthiouracil workby decreasin! how much thyroid hormone the body makes$ 3othare very effective but methima1ole is preferred because of a!reater risk of serious side effects with &T-

► These medications can be used

2 s a short term (BAF weeks) treatment in people with >raves=disease or to*ic nodular !oiter before treatment withradioiodine or sur!ery

2 s a lon! term (GA? years) treatment for >raves= disease$ Thedisease !oes into remission in about E@8 of people and antiA

thyroid dru!s can be used to control hyperthyroidism whilewaitin! to see if remission occurs

► &eople who have very mild >raves= disease may have as hi!h as a7@A@8 chance of remission$ It is possible to have a relapse yearslater and most people will need to eventually consider permanenttreatment with radioactive iodine or sur!ery


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Treatment 3etaA 3lockers

► 3etaAblockers such as atenolol are often started as

soon as the dia!nosis of hyperthyroidism is made

► 9hile betaAblockers do not reduce thyroid hormoneproduction they can control many of the symptoms

such as rapid heart rate tremors an*iety and heat

intolerance

► Cnce the hyperthyroidism is under control (with antiA

thyroid dru!s sur!ery or radioactive iodine) the

betaAblocker is stopped


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Treatment .adioactive Iodine

► +estroyin! the thyroid with radiation called radioiodine

ablation is a permanent way to treat hyperthyroidism

► The amount of radiation used is small and does not causecancer or infertility

► .adioiodine is !iven in li0uid or capsule form and worksby destroyin! much of the thyroid; takes JAGF weeks

► &eople with severe symptoms older adults and people

with heart problems should first be treated with an antiAthyroid dru! to control symptoms

► "ost people who take radioiodine develop hypothyroidismand will need to take thyroid hormone supplements for the

rest of their lives


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Treatment 'ur!ery

► lthou!h sur!ical removal of the thyroid is a permanent curefor hyperthyroidism it is used far less often than antiAthyroiddru!s or radioactive iodine because of the risks (ande*pense) associated with thyroid sur!ery

► The risks include dama!e to the nerves of the voice bo* andparathyroid !lands

► However sur!ery is recommended when 2 lar!e !oiter blocks the airways makin! it difficult to breathe$

2 Kou cannot tolerate antiAthyroid dru!s and you do not want to useradioiodine

2 There is a nodule in the thyroid !land that could be cancerous

► "ost people develop hypothyroidism after sur!ery and

re0uire treatment with thyroid hormone


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Hypothyroidism


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► Hypothyroidism is a condition in whichthe thyroid !land does not produceenou!h thyroid hormone

► It is the most common thyroid disorder

9hat is it


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%auses

► In L78 of cases hypothyroidism is due to aproblem in the thyroid !land itself and is calledprimary hypothyroidism

► .arely hypothyroidism is a result of decreasedproduction of thyroidAstimulatin! hormone(T'H) by the pituitary !land

► Thyroid problems are more common in womenincrease with a!e and are more common inwhites and "e*ican mericans than in blacks


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'ymptoms


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'ymptoms

► +ecreased sweatin! thick skin coarse or thin hair

brittle nails

► "ild swellin! around the eyes

► 'lowed heart rate and decreased overall cardiac

function leadin! to fati!ue and shortness of breath

with e*ercise

► "ild hi!h blood pressure and elevated cholesterol

► Ton!ue swellin! hoarse voice and sleep apnea


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'ymptoms

► %onstipation

► bsent or infre0uent periods to very fre0uent and

heavy periods

► "y*edema coma 2 in people with severe

hypothyroidism trauma infection e*posure to the

cold and certain medications can rarely tri!!er a

lifeAthreatenin! condition called my*edema coma

which causes a loss of consciousness and

hypothermia (low body temperature)


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+ia!nosis

► Blood tests 2 T'H is the most sensitive

test because it can be elevated even with

small decreases in thyroid function

► Thyro*ine (TB) the main product of the

thyroid !land may also be measured to

confirm and assess the de!ree ofhypothyroidism

%A&' Why aren/t you he*ing (y T0 levels)


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Treatment

► >oal of hypothyroidism treatment is to return blood levels ofT'H and TB to the normal ran!e and to alleviate symptoms

► Treatment for hypothyroidism is thyroid hormone

replacement therapy usually !iven as an oral form of TB

► TB should be taken G* per day on an empty stomach (Ghour before eatin! or ? hours after)$ >eneric (levothyro*ine)and brandAname ('ynthroidM 4evo*ylM 4evothroidM

-nithyroidM) formulations are e0ually effective

► However it is preferable to stay on the same type of TBrather than switch between brand name andor !enericformulations


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Treatment

► If a switch is necessary a blood test is usuallydone J weeks later to determine if the dose

needs to be adOusted$ %olorAcoded tablets

can help with dose adOustments$

► 'ome clinicians prescribe another form of

thyroid hormone triiodothyronine (TE) in

combination with TB$ However since TB isconverted into TE in other or!ans most

studies have not shown an advanta!e of

combination TE : TB therapy over TB alone$


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Treatment

► In most cases symptoms be!in to improve

within ? weeks of startin! thyroid replacement

therapy$ However people with more severe

symptoms may re0uire several months of

treatment before they fully recover$

%A&' All the hat sites reo((end Ar(our1

thyroid. Why don/t you)

%A&' Why an/t I treat (y hy$othyroidis( with

iodine)


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&2A

%aroline "esser "+ %%+LGB ?BGAG@7@

cmesserPmkm!$com
mailto:[email protected]:[email protected]

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Everything You Ever Wanted to Know About TheThyroid[1]