Common Thyroid Problems

The thyroid hormone is a hormone (chemical messenger) made in the thyroid gland from Iodine. The thyroid gland is located at the lower part of the neck in front, just outside the windpipe. The thyroid hormone travels around the body, controlling the metabolic rate of our body. In children, it is also important for growth. Some common thyroid problems are hyperthyroidism (high thyroid), hypothyroidism (low thyroid), and thyroid nodules.

1. Hyperthyroidism

Too much thyroid hormone causes our metabolic rate to go up. Common symptoms are palpitations, feeling hot all the time, weight loss, hand tremors, breathlessness, irritability and hair loss. Some patients also develop a “staring” look of their eyes, leg swelling and protruding eyes. The most common cause of hyperthyroidism is Graves’ Disease. It is a problem of a hyperactive immune system that forms antibodies that attack the thyroid cells, forcing them to grow and make too much thyroid hormone. Rarer causes are include a “toxic nodule” (a growth in the gland that makes too much thyroid hormone) and “toxic nodular goitre” (many growths in the gland that makes too much thyroid hormone).

Without treatment, the high metabolic rate strains the heart and can cause heart failure, arrhythmias (irregular heart beat), or even thyroid storm (a dangerous condition where patients develop heart failure, vomiting, diarrhea, high fever and drowsiness).

A simple blood test can confirm the high thyroid state. The actual cause can be found by doing a TSH-receptor antibody level (TRAb) and a thyroid ultrasound. Patients with Graves’ Disease have high TRAb levels and a hyperactive inflamed thyroid gland on ultrasound. A thyroid uptake scan can confirm any toxic nodules or multinodular goitre.

Graves’ Disease is typically treated with medication and there is a good chance (about 20%) of a permanent cure with 18 months of continuous medication. If it does not resolve, or if the patient is allergic to the medication, they can be treated with radioactive iodine or surgery. Toxic nodules and toxic multinodular goitre are usually treated with radioactive iodine or surgery.

2. Hypothyroidism

Too little thyroid function causes our metabolic rate to come down. Common symptoms are feeling cold all the time, constipation, weight gain, dry skin and hair loss. The most common cause is Autoimmune Thyroiditis in which a hyperactive immune system attacks and destroys the thyroid cells. Other causes are previous surgery or radioiodine treatment.

Without treatment, the low metabolic rate can cause heart failure, leg swelling and severe drowsiness.

A simple blood test can confirm the low thyroid state. The actual cause can be found by doing doing a TPO and Tg antibody level, and a thyroid ultrasound which showed an inflamed or shrunken gland.

Treatment is simple with thyroid hormone replacement.

3. Thyroid Nodules

Thyroid nodules occur quite commonly, and most of them (95%) are benign. Patients are advised to undergo an ultrasound-guided thyroid biopsy. A needle is inserted under ultrasound guidance and cells extracted to be analysed. In the unlikely event that the nodule is cancerous, surgery is needed. Benign nodules can be quite safely monitored, unless they are very big (>4 cm in size) where surgery is also advised. A thyroid cyst is a special kind of nodule which is mostly filled with liquid or colloid. If it is totally liquid, it can be drained dry and the cyst may completely disappear.

Prepared by:
Dr. Daniel Wai Chun Hang
Daniel Wai Diabetes, Thyroid and Hormone Pte Ltd

Disclaimer: The views and opinions in the article are the writer’s own and do not necessarily reflect those of Mount Elizabeth Medical Centre (MEMC). The writer is fully responsible for the accuracy, completeness and usefulness of the information provided in the article. MEMC will not be liable for any errors, omissions or copyright issues with regard to the contents of the article.