Dealing with thyroid issues

Thyroid gland is a small butterfly-shaped gland located in the front of neck at the base. This gland produces two hormones – T3 and T4, which essentially controls our body metabolism rate by helping the cells to utilize energy, thus maintaining the functioning of major organ systems. Iodine obtained from diet is the primary fuel for this gland. The thyroid functioning is controlled by our master gland which is situated in the base of brain, the Pituitary gland. This releases thyroid stimulating hormone, TSH, to control the production and release of thyroid hormones based on our body needs.

Imagine thyroid as an engine driving our body functions at a certain speed. What happens when for some reason the engine malfunctions?

Slowing down (Hypothyroidism):  At times thyroid gland may not be able to meet the body requirements because of iodine deficient diet, inflammation of gland or autoimmune causes. As a result of which T3 and T4 levels may decrease and pituitary gland tries to stimulate the thyroid by increasing release of TSH. This may result in unexplained tiredness, weight gain, loss of appetite, thinning of hair, constipation, dry skin, rough voice, menstrual cycle irregularity, sad or low mood, in severe cases may also cause depression, infertility. Some of these patients may develop thyroid gland swelling (Goiter) due to overstimulation of the gland.

Treatment is to start thyroid hormone replacement. Usually treatment may continue for long period and requires regular follow up to maintain the hormone levels in normal range. With the exception of needing to take a pill once daily and getting labs checked, there are no restrictions to everyday life and activities. Patients with hypothyroidism can and should have productive and rewarding lives.

With regards to diet, sufferers should avoid fatty processed foods, reduce intake of vegetables like cabbage, cauliflower, broccoli, kale and include more of seafood, eggs, milk and dairy products.

Speeding up (Hyperthyroidism): When the gland goes into overdrive, it produces excess hormones pushing the body metabolism to speed up. This may cause irritability, anxiety, hand tremors, palpitations or heart racing, weight loss despite increased appetite, increased bowel movements, excessive sweating and difficulty in sleeping. Some patients may notice eyes bulging or neck swelling (Goiter) due to increased thyroid gland size. The hyper functioning of thyroid gland, known as Grave’s disease, may run in families and more often seen in young women.

The diagnosis of this condition requires estimating level of thyroid hormones and TSH in blood, as well as Thyroid scan to look at presence of any lumps in the gland. Treatment is decided based on the cause and severity of hyperthyroidism, age and other health factors.

Low iodine diet is advised before some treatment including non-iodized table salt, cruciferous vegetables like cabbage, broccoli, kale, unsalted nuts & butter, egg whites, oats, potatoes and iron rich foods.

Thyroid in children: Children may present with similar symptoms like adults but two important symptoms in children are slowing of height – an important early sign of hypothyroidism in children and pubertal development that may be delayed in adolescents.

Children with overt hypothyroidism (elevated TSH and low T4 levels) are treated by replacing the amount of hormone that the child’s own thyroid can no longer make. The goal is to bring the T4 and TSH back to the normal range.

Too much thyroid hormone speeds up most functions of the body and may lead to decreased ability to concentrate (attention-deficit like symptoms), decreased school or work performance, moodiness and irritability. If suspicious of any of these symptoms, it is advisable to evaluate with a doctor and do the assessment.

Thyroid swelling:  Although thyroid nodule noticed as a lump in the neck is a common clinical problem, very few of them may be cancerous. Thyroid cancer is relatively uncommon compared to other cancers. Some of the risk factors for thyroid cancer include history of exposure to high doses of radiation or having a family history of thyroid cancer. It is more often seen in women than men and above 30 years of age.

Thyroid cancer in early stages may not cause any symptoms apart from neck swelling. Often, thyroid nodules are discovered incidentally on imaging tests like CT scans and neck ultrasound done for completely unrelated reasons. A fine needle biopsy of the lump can be done to determine the cause. Thyroid cancer usually has a good prognosis with early appropriate treatment. Hence, proper evaluation and timely intervention is very essential.

In conclusion, though certain individuals are predisposed to develop thyroid problems, our lifestyle choices have a huge impact on how badly they affect us. Chronic stress, smoking, dietary habits and lack of regular exercise have been known to exacerbate the thyroid gland dysfunction. Making better informed choices and seeking help when needed goes a long way in empowering us to lead a happy and healthy life.

Dr. Soumya R Shetty
Consultant ENT, Head & Neck Surgeon
Fellow in Rhinoplasty
Badr Al Samaa Medical Centre, Farwaniya