THYROID AWARENESS

thyroid The thyroid gland is a small, butterfly-shaped gland located in the lower front of the neck, above the collarbones, and below the voice box (larynx). Your thyroid gland makes hormones that help control the function of many of your body’s organs, including your heart, brain, liver, kidneys, and skin. Making sure that your thyroid gland is healthy is important to your body’s overall well-being. Two types of thyroid diseases are Hypothyroidism and Hyperthyroidism.

HYPOTHYROIDISM Hypothyroidism is an often-hidden health problem in which the master gland of metabolism—the thyroid—produces less hormone than the body needs, impacting virtually all organ systems in the body. It is one of the most misunderstood, misdiagnosed and prevalent medical conditions in the U.S. Studies estimate that more than 10 percent of the general population suffer from the disease, however hypothyroidism frequently goes undiagnosed. The early effects of hypothyroidism are often mild, appear gradually and aren’t concentrated in a single area of the body, so it’s easy to disregard them or attribute them to other causes. Also, two people with the disease may have entirely different symptoms, and one person’s can develop quickly, while the other person’s symptoms may take years to emerge. Some people with hypothyroidism have no symptoms at all. And as we age, diminished or faulty hormone production is common, so it’s understandable that older patients in particular often go undiagnosed.

symptoms Sensitivity to cold Constant fatigue Menstrual cycle changes Slow pulse High cholesterol Increased sensitivity to medication Constant fatigue Depression Weight gain and fluid retention Dry, brittle hair and nails Dry, itchy skin Muscle or joint pain or stiffness Constipation

diagnosis TSH (THYROID-STIMULATING HORMONE OR THYROTROPIN): An increased TSH level in the blood is the most accurate indicator of primary (non-pituitary) hypothyroidism. Production of this pituitary hormone is increased when the thyroid gland even slightly underproduces thyroid hormone. ESTIMATES OF FREE THYROXINE: The active thyroid hormone in the blood. It is important to note that there is a range of free thyroxine levels in the blood of normal people, similar to the range for height, and that a value of free thyroxine that is “within normal limits” for the general population may not be appropriate for a particular individual. THYROID ANTIBODIES: Indicates the likelihood of auto-immune thyroiditis being the cause of hypothyroidism.

Treatment of hypothyroidism Hypothyroidism is generally treated with a single daily dose of levothyroxine, given as a tablet. An experienced physician can prescribe the correct form and dosage to return the thyroid balance to normal. Older patients who may have underlying heart disease are usually started at a low dose and gradually increased while younger healthy patients can be started on full replacement doses at once. Thyroid hormone acts very slowly in some parts of the body, so it may take several months after treatment for some features to improve.

hyperthyroidism Hyperthyroidism develops when the body is exposed to excessive amounts of thyroid hormone. This disorder occurs in almost one percent of all Americans and affects women five to 10 times more often than men. In its mildest form, hyperthyroidism may not cause recognizable symptoms. More often, however, the symptoms are discomforting, disabling or even life-threatening.

Symptoms of hyperthyroidism Fast heart rate, often more than 100 beats per minute Becoming anxious, irritable, argumentative Trembling hands Weight loss, despite eating the same amount or even more than usual Intolerance of warm temperatures and increased likelihood to perspire Loss of scalp hair Tendency of fingernails to separate from the nail bed Muscle weakness, especially of the upper arms and thighs Loose and frequent bowel movements

Symptoms of Hyperthyroidism Smooth skin Change in menstrual pattern Increased likelihood for miscarriage Prominent "stare" of the eyes Protrusion of the eyes, with or without double vision (in patients with Graves’ disease) Irregular heart rhythm, especially in patients older than 60 years of age Accelerated loss of calcium from bones, which increases the risk of osteoporosis and fractures

Diagnosis of hyperthyroidism Sometimes a general physician can diagnose and treat the cause of hyperthyroidism, but assistance is often needed from an endocrinologist, a physician who specializes in managing thyroid disease. Characteristic symptoms and physical signs of the disease can be detected by a trained physician. In addition, tests can be used to confirm the diagnosis and to determine the cause.

Diagnosis of hyperthyroidism TSH (Thyroid-Stimulating Hormone or Thyrotropin) Test - A low TSH level in the blood is the most accurate indicator of hyperthyroidism. The body shuts off production of this pituitary hormone when the thyroid gland even slightly overproduces thyroid hormone. If the TSH level is low, it is very important to also check thyroid hormone levels to confirm the diagnosis of hyperthyroidism. Estimates of free thyroxine and free triiodothyronine – the active thyroid hormones in the blood. When hyperthyroidism develops, free thyroxine and free triiodothyronine levels rise above previous values in that specific patient (although they may still fall within the normal range for the general population) and are often considerably elevated. TSI (thyroid-stimulating immunoglobulin) - a substance often found in the blood when Graves’ disease is the cause of hyperthyroidism. Radioactive iodine uptake (RAIU) - a measurement of how much iodine the thyroid gland can collect, and thyroid scan, which shows how the iodine is distributed throughout the thyroid gland. This information can be useful in determining the cause of hyperthyroidism and, ultimately, its treatment.

Treatment of hyperthyroidism Appropriate management of hyperthyroidism requires careful evaluation and ongoing care by a physician experienced in the treatment of this complex condition. Before the development of current treatment options, the death rate from severe hyperthyroidism was as high as 50 percent. Now several effective treatments are available and, with proper management, death from hyperthyroidism is rare. Deciding which treatment is best depends on what caused the hyperthyroidism, its severity and other conditions present.

TYPES OF TREATMENT FOR HYPERTHYROIDISM Antithyroid Drugs In the United States, two drugs are available for treating hyperthyroidism: propylthiouracil (PTU) and methimazole (Tapazole). Except for early pregnancy, methimazole is preferred because PTU can rarely cause fatal liver damage. These medications control hyperthyroidism by slowing thyroid hormone production. They may take several months to normalize thyroid hormone levels.

TYPES OF TREATMENT FOR HYPERTHYROIDISM Radioactive Iodine Treatment Iodine is an essential ingredient in the production of thyroid hormone. Each molecule of thyroid hormone contains either four (T4) or three (T3) molecules of iodine. Since most overactive thyroid glands are quite hungry for iodine, it was discovered in the 1940s that the thyroid could be “tricked” into destroying itself by simply feeding it radioactive iodine. The radioactive iodine is given by mouth, usually in capsule form, and is quickly absorbed from the bowel. It then enters the thyroid cells from the bloodstream and gradually destroys them. Maximal benefit is usually noted within three to six months.

TYPES OF TREATMENT FOR HYPERTHYROIDISM Surgical Removal of the Thyroid Although seldom used now as the preferred treatment for hyperthyroidism, operating to remove most of the thyroid gland may occasionally be recommended in certain situations, such as a pregnant woman with severe uncontrolled disease in whom radioiodine would not be safe for the baby. Surgery usually leads to permanent hypothyroidism and lifelong thyroid hormone replacement therapy.

TYPES OF TREATMENT FOR HYPERTHYROIDISM Other Treatments A drug from the class of beta-adrenergic blocking agents (which decrease the effects of excess thyroid hormone) may be used temporarily to control hyperthyroid symptoms until other therapies take effect. In cases where hyperthyroidism is caused by thyroiditis or excessive ingestion of either iodine or thyroid hormone, this may be the only type of treatment required. Iodine drops are prescribed when hyperthyroidism is severe or prior to undergoing surgery for Graves’ disease.

RESOURCES & MORE INFORMATION American Association of Endocrine Surgeons: http://www.endocrinesurgery.org/ American Thyroid Association: http://www.thyroid.org/ Graves Disease & Thyroid Foundation: http://www.gdatf.org/ International Thyroid Federation: http://www.thyroid-fed.org/tfi-wp/ Light of Life Foundation: http://checkyourneck.com/ National Institute of Health/Medline Plus: http://www.nlm.nih.gov/medlineplus/thyroiddiseases.html ThyCa: Thyroid Cancer Survivors' Association: http://www.thyca.org/