Understanding Thyroid Problems -- Diagnosis and Treatment

How Do I Know If I Have a Thyroid Problem?

Your doctor can diagnose hyperthyroidism and hypothyroidism by testing the levels of thyroid hormones in your blood. Doctors measure hormones secreted by the thyroid itself, as well as thyroid-stimulating hormone (TSH), a chemical released by the pituitary gland that triggers hormone production in the thyroid.

When you are hypothyroid, higher quantities of TSH are circulating in your blood as your body attempts to increase production of thyroid hormones. The reverse is true with hyperthyroidism, in which TSH levels are below normal and circulating thyroid-hormone levels are high.

UNDERSTANDING  GOITER - TREATMENT - 

How Do I Know if I Have a Goiter?

A goiter may be large enough for you to see or to feel with your hand, or it may remain unnoticed until a doctor discovers it, perhaps during a routine exam. In any case, the first step is to determine whether the goiter is a symptom of another thyroid condition.  An ultrasound of the thyroid gland may help to determine the size of the gland and the presence of nodules.  Radioactive iodide uptake tests track how much iodide the thyroid takes in within a certain time period.  Higher-than-normal amounts indicate possible hyperthyroidism; low levels indicate hypothyroidism. Blood tests also can measure levels of thyroid hormone.

What Are the Treatments for a Goiter?

A goiter may require no treatment, especially if it is small and thyroid hormone levels are normal. However, if the goiter develops because of excessive thyroid hormone production, fails to produce enough hormone, or causes discomfort, you will need treatment.

Treatment involves getting the thyroid hormone levels back to normal, usually with medication. When the medication takes effect, the thyroid may begin to return to its normal size. However, a large nodular goiter with a lot of internal scar tissue will not shrink with treatment. If the goiter is uncomfortable, causes overproduction of thyroid hormone unresponsive to medications, or becomes cancerous, the entire thyroid gland may have to be surgically removed.

If you have a goiter your doctor may want to reevaluate it on a periodic basis with ultrasound to be sure that it is not growing or developing nodules.

To identify the cause of hyperthyroidism, doctors often use radioactive iodide uptake tests, which track the amount of iodide absorbed by the thyroid gland. Iodide, obtained from the foods we eat, is a key ingredient in the manufacture of thyroid hormone, so the amount of iodide the thyroid absorbs is a reliable indicator of how much hormone the gland is producing. For this test, the doctor places an instrument over your neck to measure how much background radioactivity there is. Then, you must swallow a small amount of radioactive iodide in liquid or capsule form. After a predetermined time (usually 4-6 hours and at 24 hours), the doctor again places an instrument over your neck to measure how much of the radioactive iodide has gathered in your thyroid.

If the test suggest that the gland is collecting excessive amounts of iodide, the doctor may then conduct a radioactive iodide uptake scan. In this test, the doctor uses a special film to create a picture that shows the exact location of the radioactive iodide in your thyroid gland. The scan will reveal, for example, if the iodide is collecting in nodules, indicating that the nodules are responsible for the excess hormone production. If the scan shows that the iodide is spread equally throughout the tissue, the whole thyroid is involved in the excess production.

Nodules that appear suddenly are typically fluid-filled cysts and are often benign. They can be evaluated with a noninvasiveultrasound exam. If blood tests indicate that the nodules are producing excess thyroid hormone, and if you have other symptoms, your doctor will treat you for hyperthyroidism.

In any case, you should receive periodic checkups if you have a nodule on your thyroid gland. Further tests will show if the nodule has the potential to become cancerous.

In most cases, however, doctors check for thyroid cancer by performing an aspiration, or biopsy, in which a tissue sample of the nodule is taken and examined. One rare type of thyroid cancer can be diagnosed through a blood test that measures levels of a hormone involved in bone formation. 

What Are the Treatments for Thyroid Problems?

For thyroid disorders stemming from the over- or underproduction of thyroid hormones, both conventional and alternative treatments offer varied methods to restore hormone levels to their proper balance. Conventional treatments rely mainly on drugs and surgery. Alternative treatments attempt to relieve some of the discomfort associated with thyroid problems, or to improve the function of the thyroid gland through a variety of approaches ranging from diet supplements and herbal remedies to lifestyle changes and special exercises. 

Understanding Thyroid Problems -- Diagnosis and Treatment

You should always receive a professional evaluation for any thyroid disorder; most of these conditions require a course of treatment beyond the scope of home care alone.

Treating hyperthyroidism requires suppressing the manufacture of thyroid hormone, while hypothyroidism demands hormone replacement. Conventional medicine offers extremely effective techniques for lowering, eliminating, or supplementing hormone production. Before deciding which treatment is best for you, your doctor will make an evaluation based on your particular thyroid condition, as well as your age, general health, and medical history.

Treatments for Hyperthyroidism

Thyroid hormone production can be suppressed or halted completely in these ways:

·         Radioactive iodide treatment

·         Anti-thyroid medication

·         Surgery

If your doctor decides that radioactive treatment is best, you will be asked to swallow a tablet or liquid containing radioactive iodide in amounts large enough to damage the cells of your thyroid gland and limit or destroy their ability to produce hormones. Occasionally, more than one treatment is needed to restore normal hormone production, and many patients actually develop hypothyroidism as a result of this procedure. This is the most common therapy for hyperthyroidism in the U.S. 

If you start using anti-thyroid medications, your hyperthyroid symptoms should begin to disappear in about six to eight weeks. However, you will need to continue taking the medication for about a year. After that time, you will also need to receive periodic medical exams to make sure that the condition has not returned.

Surgery is sometimes recommended for people under age 45 when their hyperthyroidism is due to toxic nodules, because these nodules tend to be resistant to anti-thyroid medications. Once the tissue is removed surgically, hormone levels typically return to normal within a few weeks.

Treating Subacute Thyroiditis

Although subacute thyroiditis can bring on temporary hyperthyroidism, this condition usually does not require medical treatment. Any pain associated with the inflamed thyroid can generally be relieved with acetaminophen (Tylenol or Anacin, e.g.) or asprin. If over-the-counter drugs don't help, a doctor may prescribe prednisons or dexamethasone -- powerful anti-inflammatory drugs -- for a short period of time. Since both of these drugs may encourage the development of stomach ulcers and the loss of bone mass, however, ask your doctor if you should also be taking calcium supplements.

Treating Hypothyroidism

Hypothyroidism calls for a lifelong regimen of thyroid replacement. No surgical techniques or conventional drugs can increase the thyroid's hormone production once it slows down. Doctors generally prescribe synthetic forms of thyroid hormone, such as levothyroxine. Side effects are rare, but some people experience nervousness or chest painn while taking these drugs; usually, adjusting the levels of medication will alleviate any unpleasant effects. Tell your doctor if you are also taking tricyclic anti depressants, estrogens, the blood-thinning drug warfarin, the heart drug digitalis, or if you havediabetes, to make sure medications don't interfere with the thyroid treatment. Magnesium, aluminum, iron and even soy may interfere.

Treating Thyroid Cancer

Thyroid cancer is usually initially treated by surgically removing either the cancerous tissue or the whole thyroid gland, a procedure known as a thyroidectomy. If the cancer has spread beyond the thyroid, any other affected tissue, such as the lymph glands in the neck, will also be removed.

What About Alternative Medicine for Thyroid Problems?

Thyroid problems are usually easily corrected with conventional medicine. Consult your endocrinologist about using alternative therapies, which aim to cleanse the system, restore immune function, and balance hormone production and release.

Naturopathy and TCM

A naturopath may treat your thyroid condition with homeopathic mixtures, herbs, preparations based on traditional Chinese medicine (TCM), which attributes thyroid disease to emotional distress, and acupuncture. Both methods aim to remove blocks to one's ''life force energy.''

Naturopaths are authorized to treat thyroid disease in some states; in others, it is illegal. Check with your doctor or local health authority to see if your state allows naturopathic interventions. In addition, it is important to discuss with your doctor if these methods are working to treat your thyroid problem and not just treating the stress associated with thyroid disease.

There are no good studies showing the effectiveness of these methods in treating thyroid disorders.

Body Work and Nutrition

Chiropractors and osteopaths use spinal manipulation to treat symptoms of thyroid disorders by reducing muscle tension and improving blood circulation.

A diet rich in protein, calcium, magnesium, and iodine supports thyroid function. You want to be sure you are receiving enough of all the B vitamins, vitamin A, vitamin C, and selenium, which, in high doses, may cause thyroid problems.

Avoid these products if you suffer from thyroid disease:

·         The herb ephedra, found in herbal formulas, and its extracts ephedrine and pseudoephedrine, found in over-the-counter cold remedies, which can cause nervousness, insomnia, headache, and high blood pressure

·         Alkaloids, including substances such as caffeine, morphine, and quinine, which increase blood pressure and heart rate