During a recent meeting of our residential society members, I was confronted with a long list of questions related to the thyroid gland in our body; its routine functions and disorders. I have tried to pen down my interactions while answering to everyone's satisfaction; a host of routine queries brilliantly put forth by some of the society members..What is the endocrine system?Our endocrine system is a network of several glands that make and release hormones.A gland is an organ that makes one or more substances, such as hormones, digestive juices, sweat or tears. Endocrine glands release hormones directly into the bloodstream.Hormones are chemicals that synchronize different functions in our body by carrying messages through our blood to our organs, skin, muscles, and other tissues. These signals tell our body what to do and when to do it.The following organs and glands make up our endocrine system:. Hypothalamus. Pituitary gland. Thyroid. Parathyroid glands. Adrenal glands. Pineal gland. Pancreas. Ovaries. Testes.What is thyroid? What does thyroid gland do?The thyroid is a small, butterfly-shaped gland located at the front of our neck under our skin. It's a part of our endocrine system and controls many of our body's important functions by producing and releasing (secreting) certain hormones namely triiodothyronine (T3) and thyroxine (T4).It is these hormones through which the gland functions and aids brain development, muscle control, mood regulation and controls the speed of our metabolism (metabolic rate), which is the process of how our body converts the food we consume into energy..How big is the thyroid?Our thyroid is about 2 inches long. A healthy thyroid usually does not stick out from our neck and one can't see it by looking at one's neck.However, certain conditions can cause the thyroid to become enlarged. This is known as goiter. If one has a goiter, one may experience the following symptoms:• Swelling in the front of the neck, just below the Adam's apple.• A feeling of tightness in the throat area.• Hoarseness of voice.What are the parts of the thyroid?There are two main parts of our thyroid: the two halves (lobes) and the connecting bridge that connects the two lobes (thyroid isthmus).The thyroid is made of thyroid follicle cells (thyrocytes), which form and store thyroid hormone (T4 and T3), and C-cells, which secrete the hormone calcitonin..Can You Please Tell Us More About the Thyroid Hormones?Thyroxine (T4): This is the primary hormone our thyroid makes and releases. Although our thyroid makes the most of this hormone, it doesn't have much of an effect on our metabolism. Once our thyroid releases T4 into our bloodstream, it can convert to T3 through a process called deiodination.Triiodothyronine (T3): Our thyroid produces lesser amounts of T3 (20per cent) than T4 (80per cent), but it has a much greater effect on our metabolism than T4.Reverse triiodothyronine (rT3): Reverse T3 is a metabolically inactive form of thyroid hormone, which is generated from T4 via an enzyme called 3 5'-deiodinaseIn cases of chronic disease such as HIV or kidney disease, starvation or extreme dieting, and bone marrow transplantation, reverse T3 can become elevatedCalcitonin: This hormone helps regulate the amount of calcium in our blood.To make thyroid hormones, the thyroid gland needs iodine, an element found in food (most commonly, iodized table salt) and water..What are levothyroxine and liothyronine? Can they be taken together?Levothyroxine and Liothyronine are drugs used to treat hypothyroidism (a condition where the body is unable to produce enough thyroid hormones due to an underlying pathological condition or removal of the thyroid gland).Liothyronine in combination with levothyroxine can be used to treat ongoing symptoms of hypothyroidism that have a significant impact on quality of life despite adequate biochemical resolution of hypothyroidism with levothyroxine monotherapy..What are the early warning signs and symptoms of thyroid problems?Different thyroid conditions have different symptoms. However, since our thyroid has a large role in certain body systems and processes, such as heart rate, metabolism and temperature control, there are certain symptoms to look out for that could be a sign of a thyroid condition, including:Slow or rapid heart rate.• Unexplained weight loss or weight gain.• Difficulty in tolerating cold or heat.• Depression or anxiety.• Irregular menstrual periods.If one is experiencing any of these symptoms, it is better to talk to a healthcare provider about getting certain blood test to check the thyroid function..What is Hypothyroidism?Hypothyroidism (underactive thyroid) happens when the thyroid doesn't produce and release enough thyroid hormones. This causes aspects of our metabolism to slow down. It's a common condition, easily treatable.Causes of hypothyroidism include:• Hashimoto's disease; an autoimmune disease.• Thyroiditis; (inflammation of the thyroid).• Iodine deficiency• A non-functioning thyroid gland (when the thyroid doesn't work correctly since birth)• Over-treatment of hyperthyroidism through medication• Surgical removal or radioactive iodine ablation of the Thyroid gland.What is Hyperthyroidism?Hyperthyroidism (overactive thyroid) happens when the thyroid produces and releases more thyroid hormones than our body needs. This causes aspects of our metabolism to speed up. It is treatable.Causes of hyperthyroidism include:• Graves' disease, an autoimmune condition.• Thyroid nodules.• Thyroiditis (inflammation of the thyroid)• Postpartum Thyroiditis (inflammation of the thyroid that happens after giving birth)• Excess iodine in our blood from diet and/or medication• Over-treatment of hypothyroidism through medication• A benign (noncancerous) tumor in the pituitary gland.What is Graves' Disease?Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism).Although several disorders may result in hyperthyroidism, Graves' disease is a leading cause. It's more common among women and in people younger than age 40..What Is Graves' Ophthalmopathy?About 30per cent of people with Graves' disease show some signs and symptoms of Graves' ophthalmopathy. In Graves' ophthalmopathy, inflammation and other immune system events affect muscles and other tissues around the affected person's eyes. Signs and symptoms may include:• Bulging eyes• Gritty sensation in the eyes• Pressure or pain in the eyes• Puffy or retracted eyelids• Reddened or inflamed eyes• Light sensitivity• Double vision• Vision loss.What is Goiter?Goiter is an enlargement of the thyroid gland. Goiters are relatively common; the prevalence of self-reported goitre in National Family Health Survey-V was 2.9 per cent.Goiters have different causes, depending on their type.Simple goiters: These goiters develop when our thyroid gland doesn't make enough hormones to meet our body's needs. Our thyroid gland tries to make up for the shortage by growing larger.Endemic goiters: These goiters occur in people who don't get enough iodine in their diet (iodine is necessary to make thyroid hormone). India has become an Iodine- replete country; hence endemic goiters are now rare in our countrySporadic goiters: These goiters have no known cause in most cases. In some cases, certain medications, such as lithium, can cause sporadic goiters..What are the different presentations of Goiters?Goiters can be classified into several categories according to the functional status of the gland (hypothyroid, hyperthyroid, or euthyroid) or to its clinical or scintigraphic appearance (diffuse or multinodular)..What are Thyroid cancers?Thyroid cancer is cancer that begins in the thyroid tissues. Over a decade (2008-2018), the incidence rate of thyroid cancer in India in women increased from 2.4 to 3.9 and in men from 0.9 to 1.3, a relative increase of 62 per cent and 48 per cent respectively. Treatments for most thyroid cancers are very successful.Thyroid cancer is classified based on the type of cells from which cancer grows.Thyroid cancer types include:Papillary: Up to 80 per cent of all thyroid cancer cases are papillary.Follicular: Follicular thyroid cancer accounts for up to 15 per cent of thyroid cancer diagnoses.Medullary: About 2 per cent of thyroid cancer cases are medullary. It's often caused by a gene mutation.Anaplastic: About 2 per cent of thyroid cancer cases are anaplastic..How dangerous do thyroid disorders get?Thyroid storm is a grave, however, rare condition that occurs when hyperthyroidism is not treated. It can get triggered by infection, trauma, or surgery. This condition can be morbid and show symptoms like delirium, very fast heart rate, diarrhea, high fever, agitation, and loss ofconsciousness.Myxedema coma is another serious, but rare condition caused due to uncorrected hypothyroidism. It is triggered by infection, cold, trauma and certain medication. Its symptoms include dropping down of blood pressure and body temperature, resulting in unconsciousness. It can be fatal if not treated..What are the indications for thyroid gland removal?Surgical removal of thyroid gland may be recommended for 4 main reasons: If a person has a nodule that might be thyroid cancer. A diagnosis of thyroid cancer is confirmed. There is a nodule or goiter that is causing local symptoms such as compression of the trachea, difficulty in swallowing or a visible or unsightly mass..How's life after thyroid gland removal?After thyroid removal, most people can get back to a normal, healthy life; for this, they will need to take all medication as prescribed.One needs to start thyroid hormone replacement (taking a pill everyday) to compensate with the lack of thyroid hormone due to thyroid removal. Blood tests (more than once a year) will be required to check whether one is on the right dose of this thyroid hormone (until the doctor finalizes the dose).Those who have only a part of the gland removed may be able to produce enough hormones not needing replacement therapy..How do experts treat Hyperthyroidism?An endocrinologist will plan the treatment. The 3 main treatment options are:. Medicine. Radioactive iodine treatment. SurgeryMedicineMedicines called thionamides are commonly used to treat an overactive thyroid. They prevent the thyroid from producing excess hormones.The main drugs used are carbimazole and propylthiouracil. These may be required to be taken for 12 to 18 months, occasionally even longer. Another medicine called a beta-blocker may also be co-prescribed to relieve some of the symptoms.Once the thyroid hormone levels are under control, the dose can be gradually reduced and even stopped.Radioactive iodine treatmentRadioactive iodine treatment is a type of radiotherapy used to destroy the cells in the thyroid gland, reducing the quantity of hormones it can produce. It's a highly effective treatment that can cure an overactive thyroid.It is administered via a drink or capsule that contains iodine and a low dose of radiation, which is absorbed by the overactive thyroid. Most people only need a single treatment.It can take a few weeks or months for the full benefits to accrue, so one may need to take medicine, such as carbimazole or propylthiouracil, for a short time.SurgeryOccasionally, surgery to remove all or part of the overactive thyroid may be recommended.This may be the best option if:• The thyroid gland is grossly swollen because of a large goiter.• A person has severe eye problems caused by an overactive thyroid• If the affected person is not a candidate for less invasive treatments• If the symptoms recur after trying other treatmentsComplete removal of the thyroid gland is usually recommended because it stops the symptoms of hyperthyroidism coming back. However, this will entail lifetime replacement with levothyroxine..What are thyroid antibodies? Why Check Your Thyroid Antibodies?Thyroid antibodies develop when our immune system mistakenly targets components of the thyroid gland. This autoimmune response, in which the immune system erroneously damages tissues in the body, can lead to chronic thyroid inflammation, tissue damage, and/or disruption of thyroid function.Laboratory tests detect the presence and measure the quantity of specific thyroid antibodies in the blood. Understanding the underlying cause of thyroid dysfunction can help doctors plan the best course of treatment.• Thyroid Peroxidase, TPO, Microsomal Antigen, Anti-TPO Antibodies• Thyrotropin Receptor Antibodies, TRAbs• Stimulating Antibodies,Thyroid-Stimulating Antibodies, Thyroid-Stimulating Immunoglobulins, TSI• Thyroid-Stimulating Hormone Receptor Antibody, TSH Receptor Antibodies• TSH Receptor-Binding Inhibitor Immunoglobulin, TBII, TBI• Thyroglobulin Antibody, TgAb, Thyroid AutoantibodiesThyroid antibody tests are used in diagnosing hypothyroidism or hyperthyroidism because of autoimmune thyroid disease.Thyroid antibody tests may also be used for the following purposes:. To diagnose an autoimmune disorder, such as Hashimoto's thyroiditis or Graves' disease. To define the best course of treatment. To determine whether your mild hypothyroidism is likely to get worse in future. To evaluate the risk to the fetus in pregnant individuals with thyroid disease. To estimate the risk of relapse after treatment for Graves' disease. To monitor if you have been previously treated for a thyroid cancer.Dr Vinod Abichandani is Diabetes & Endocrine Physician since January 1985 at Ahmedabad.
During a recent meeting of our residential society members, I was confronted with a long list of questions related to the thyroid gland in our body; its routine functions and disorders. I have tried to pen down my interactions while answering to everyone's satisfaction; a host of routine queries brilliantly put forth by some of the society members..What is the endocrine system?Our endocrine system is a network of several glands that make and release hormones.A gland is an organ that makes one or more substances, such as hormones, digestive juices, sweat or tears. Endocrine glands release hormones directly into the bloodstream.Hormones are chemicals that synchronize different functions in our body by carrying messages through our blood to our organs, skin, muscles, and other tissues. These signals tell our body what to do and when to do it.The following organs and glands make up our endocrine system:. Hypothalamus. Pituitary gland. Thyroid. Parathyroid glands. Adrenal glands. Pineal gland. Pancreas. Ovaries. Testes.What is thyroid? What does thyroid gland do?The thyroid is a small, butterfly-shaped gland located at the front of our neck under our skin. It's a part of our endocrine system and controls many of our body's important functions by producing and releasing (secreting) certain hormones namely triiodothyronine (T3) and thyroxine (T4).It is these hormones through which the gland functions and aids brain development, muscle control, mood regulation and controls the speed of our metabolism (metabolic rate), which is the process of how our body converts the food we consume into energy..How big is the thyroid?Our thyroid is about 2 inches long. A healthy thyroid usually does not stick out from our neck and one can't see it by looking at one's neck.However, certain conditions can cause the thyroid to become enlarged. This is known as goiter. If one has a goiter, one may experience the following symptoms:• Swelling in the front of the neck, just below the Adam's apple.• A feeling of tightness in the throat area.• Hoarseness of voice.What are the parts of the thyroid?There are two main parts of our thyroid: the two halves (lobes) and the connecting bridge that connects the two lobes (thyroid isthmus).The thyroid is made of thyroid follicle cells (thyrocytes), which form and store thyroid hormone (T4 and T3), and C-cells, which secrete the hormone calcitonin..Can You Please Tell Us More About the Thyroid Hormones?Thyroxine (T4): This is the primary hormone our thyroid makes and releases. Although our thyroid makes the most of this hormone, it doesn't have much of an effect on our metabolism. Once our thyroid releases T4 into our bloodstream, it can convert to T3 through a process called deiodination.Triiodothyronine (T3): Our thyroid produces lesser amounts of T3 (20per cent) than T4 (80per cent), but it has a much greater effect on our metabolism than T4.Reverse triiodothyronine (rT3): Reverse T3 is a metabolically inactive form of thyroid hormone, which is generated from T4 via an enzyme called 3 5'-deiodinaseIn cases of chronic disease such as HIV or kidney disease, starvation or extreme dieting, and bone marrow transplantation, reverse T3 can become elevatedCalcitonin: This hormone helps regulate the amount of calcium in our blood.To make thyroid hormones, the thyroid gland needs iodine, an element found in food (most commonly, iodized table salt) and water..What are levothyroxine and liothyronine? Can they be taken together?Levothyroxine and Liothyronine are drugs used to treat hypothyroidism (a condition where the body is unable to produce enough thyroid hormones due to an underlying pathological condition or removal of the thyroid gland).Liothyronine in combination with levothyroxine can be used to treat ongoing symptoms of hypothyroidism that have a significant impact on quality of life despite adequate biochemical resolution of hypothyroidism with levothyroxine monotherapy..What are the early warning signs and symptoms of thyroid problems?Different thyroid conditions have different symptoms. However, since our thyroid has a large role in certain body systems and processes, such as heart rate, metabolism and temperature control, there are certain symptoms to look out for that could be a sign of a thyroid condition, including:Slow or rapid heart rate.• Unexplained weight loss or weight gain.• Difficulty in tolerating cold or heat.• Depression or anxiety.• Irregular menstrual periods.If one is experiencing any of these symptoms, it is better to talk to a healthcare provider about getting certain blood test to check the thyroid function..What is Hypothyroidism?Hypothyroidism (underactive thyroid) happens when the thyroid doesn't produce and release enough thyroid hormones. This causes aspects of our metabolism to slow down. It's a common condition, easily treatable.Causes of hypothyroidism include:• Hashimoto's disease; an autoimmune disease.• Thyroiditis; (inflammation of the thyroid).• Iodine deficiency• A non-functioning thyroid gland (when the thyroid doesn't work correctly since birth)• Over-treatment of hyperthyroidism through medication• Surgical removal or radioactive iodine ablation of the Thyroid gland.What is Hyperthyroidism?Hyperthyroidism (overactive thyroid) happens when the thyroid produces and releases more thyroid hormones than our body needs. This causes aspects of our metabolism to speed up. It is treatable.Causes of hyperthyroidism include:• Graves' disease, an autoimmune condition.• Thyroid nodules.• Thyroiditis (inflammation of the thyroid)• Postpartum Thyroiditis (inflammation of the thyroid that happens after giving birth)• Excess iodine in our blood from diet and/or medication• Over-treatment of hypothyroidism through medication• A benign (noncancerous) tumor in the pituitary gland.What is Graves' Disease?Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism).Although several disorders may result in hyperthyroidism, Graves' disease is a leading cause. It's more common among women and in people younger than age 40..What Is Graves' Ophthalmopathy?About 30per cent of people with Graves' disease show some signs and symptoms of Graves' ophthalmopathy. In Graves' ophthalmopathy, inflammation and other immune system events affect muscles and other tissues around the affected person's eyes. Signs and symptoms may include:• Bulging eyes• Gritty sensation in the eyes• Pressure or pain in the eyes• Puffy or retracted eyelids• Reddened or inflamed eyes• Light sensitivity• Double vision• Vision loss.What is Goiter?Goiter is an enlargement of the thyroid gland. Goiters are relatively common; the prevalence of self-reported goitre in National Family Health Survey-V was 2.9 per cent.Goiters have different causes, depending on their type.Simple goiters: These goiters develop when our thyroid gland doesn't make enough hormones to meet our body's needs. Our thyroid gland tries to make up for the shortage by growing larger.Endemic goiters: These goiters occur in people who don't get enough iodine in their diet (iodine is necessary to make thyroid hormone). India has become an Iodine- replete country; hence endemic goiters are now rare in our countrySporadic goiters: These goiters have no known cause in most cases. In some cases, certain medications, such as lithium, can cause sporadic goiters..What are the different presentations of Goiters?Goiters can be classified into several categories according to the functional status of the gland (hypothyroid, hyperthyroid, or euthyroid) or to its clinical or scintigraphic appearance (diffuse or multinodular)..What are Thyroid cancers?Thyroid cancer is cancer that begins in the thyroid tissues. Over a decade (2008-2018), the incidence rate of thyroid cancer in India in women increased from 2.4 to 3.9 and in men from 0.9 to 1.3, a relative increase of 62 per cent and 48 per cent respectively. Treatments for most thyroid cancers are very successful.Thyroid cancer is classified based on the type of cells from which cancer grows.Thyroid cancer types include:Papillary: Up to 80 per cent of all thyroid cancer cases are papillary.Follicular: Follicular thyroid cancer accounts for up to 15 per cent of thyroid cancer diagnoses.Medullary: About 2 per cent of thyroid cancer cases are medullary. It's often caused by a gene mutation.Anaplastic: About 2 per cent of thyroid cancer cases are anaplastic..How dangerous do thyroid disorders get?Thyroid storm is a grave, however, rare condition that occurs when hyperthyroidism is not treated. It can get triggered by infection, trauma, or surgery. This condition can be morbid and show symptoms like delirium, very fast heart rate, diarrhea, high fever, agitation, and loss ofconsciousness.Myxedema coma is another serious, but rare condition caused due to uncorrected hypothyroidism. It is triggered by infection, cold, trauma and certain medication. Its symptoms include dropping down of blood pressure and body temperature, resulting in unconsciousness. It can be fatal if not treated..What are the indications for thyroid gland removal?Surgical removal of thyroid gland may be recommended for 4 main reasons: If a person has a nodule that might be thyroid cancer. A diagnosis of thyroid cancer is confirmed. There is a nodule or goiter that is causing local symptoms such as compression of the trachea, difficulty in swallowing or a visible or unsightly mass..How's life after thyroid gland removal?After thyroid removal, most people can get back to a normal, healthy life; for this, they will need to take all medication as prescribed.One needs to start thyroid hormone replacement (taking a pill everyday) to compensate with the lack of thyroid hormone due to thyroid removal. Blood tests (more than once a year) will be required to check whether one is on the right dose of this thyroid hormone (until the doctor finalizes the dose).Those who have only a part of the gland removed may be able to produce enough hormones not needing replacement therapy..How do experts treat Hyperthyroidism?An endocrinologist will plan the treatment. The 3 main treatment options are:. Medicine. Radioactive iodine treatment. SurgeryMedicineMedicines called thionamides are commonly used to treat an overactive thyroid. They prevent the thyroid from producing excess hormones.The main drugs used are carbimazole and propylthiouracil. These may be required to be taken for 12 to 18 months, occasionally even longer. Another medicine called a beta-blocker may also be co-prescribed to relieve some of the symptoms.Once the thyroid hormone levels are under control, the dose can be gradually reduced and even stopped.Radioactive iodine treatmentRadioactive iodine treatment is a type of radiotherapy used to destroy the cells in the thyroid gland, reducing the quantity of hormones it can produce. It's a highly effective treatment that can cure an overactive thyroid.It is administered via a drink or capsule that contains iodine and a low dose of radiation, which is absorbed by the overactive thyroid. Most people only need a single treatment.It can take a few weeks or months for the full benefits to accrue, so one may need to take medicine, such as carbimazole or propylthiouracil, for a short time.SurgeryOccasionally, surgery to remove all or part of the overactive thyroid may be recommended.This may be the best option if:• The thyroid gland is grossly swollen because of a large goiter.• A person has severe eye problems caused by an overactive thyroid• If the affected person is not a candidate for less invasive treatments• If the symptoms recur after trying other treatmentsComplete removal of the thyroid gland is usually recommended because it stops the symptoms of hyperthyroidism coming back. However, this will entail lifetime replacement with levothyroxine..What are thyroid antibodies? Why Check Your Thyroid Antibodies?Thyroid antibodies develop when our immune system mistakenly targets components of the thyroid gland. This autoimmune response, in which the immune system erroneously damages tissues in the body, can lead to chronic thyroid inflammation, tissue damage, and/or disruption of thyroid function.Laboratory tests detect the presence and measure the quantity of specific thyroid antibodies in the blood. Understanding the underlying cause of thyroid dysfunction can help doctors plan the best course of treatment.• Thyroid Peroxidase, TPO, Microsomal Antigen, Anti-TPO Antibodies• Thyrotropin Receptor Antibodies, TRAbs• Stimulating Antibodies,Thyroid-Stimulating Antibodies, Thyroid-Stimulating Immunoglobulins, TSI• Thyroid-Stimulating Hormone Receptor Antibody, TSH Receptor Antibodies• TSH Receptor-Binding Inhibitor Immunoglobulin, TBII, TBI• Thyroglobulin Antibody, TgAb, Thyroid AutoantibodiesThyroid antibody tests are used in diagnosing hypothyroidism or hyperthyroidism because of autoimmune thyroid disease.Thyroid antibody tests may also be used for the following purposes:. To diagnose an autoimmune disorder, such as Hashimoto's thyroiditis or Graves' disease. To define the best course of treatment. To determine whether your mild hypothyroidism is likely to get worse in future. To evaluate the risk to the fetus in pregnant individuals with thyroid disease. To estimate the risk of relapse after treatment for Graves' disease. To monitor if you have been previously treated for a thyroid cancer.Dr Vinod Abichandani is Diabetes & Endocrine Physician since January 1985 at Ahmedabad.
