Thyroid

The thyroid is a gland that is located around the trachea, on the lower part of your neck.  Its job is to produce hormones which help the body regulate metabolism, body temperature, heart rate, bone turnover, and much more.

Hypothyroidism

Symptoms: If your thyroid hormones are too low, you may experience symptoms such as fatigue, weight gain, dry skin, brittle hair, cold intolerance, constipation, and brain fog. 

Diagnosis: Many other things can cause these symptoms, so it is important to confirm the diagnosis of hypothyroidism through  a proper evaluation.

Etiology: If it is confirmed that you have hypothyroidism, it is important to determine WHY you have this.  Some common causes are autoimmune (Hashimoto’s disease), surgical removal of thyroid tissue, radioactive iodine treatment, thyroiditis, and certain medications (ie amiodarone, lithium, certain chemotherapy treatments).  The cause of hypothyroidism is determined by checking blood work (to check for antibodies) and a detailed patient history. 

Treatment: The treatment for hypothyroidism is to replace thyroid hormone with synthetic T4.  This comes in a pill form. It is important to take the thyroid medication on an empty stomach with just water and wait at least 30 minutes before eating food or taking any other medications.  Your response to this medication will typically be monitored every 6-8 weeks with bloodwork until the levels are stable.   

More information: thyroid.org/hypothyroidism

Hyperthyroidism

Symptoms: If your thyroid hormones are too high, you may experience symptoms such as fatigue, weight loss, tremor, anxiety, heart palpitations, shortness of breath, heat intolerance, diarrhea, insomnia, enlarged, protruding eyes, swelling in the front of your neck.

Diagnosis: The diagnosis is confirmed with blood work.

Etiology: It is important for us to determine the reason for the overactive thyroid as this will guide our treatment.  Some common causes are autoimmune (Graves’ disease), overactive thyroid nodules (toxic nodules), thyroiditis, and taking too much thyroid hormone.  In order to determine the cause, we may need to obtain imaging such as a thyroid scan or an ultrasound.  An ultrasound can be done here in the office during your appointment.

Treatment: The treatment modality we use depends on the reason for your hyperthyroidism, the severity of disease, and your personal preference based on our discussion.  Thyroiditis is a transient rise in thyroid hormones and can occur after a viral illness.  Since this is a temporary condition, treatment is not necessary unless symptoms are severe.  If your hyperthyroidism is caused by either Graves’ disease or an overactive nodule, we can treat it with medications, radioactive iodine, or surgery.  The medications used to treat an overactive thyroid are methimazole and PTU (propylthiouracil).  We monitor the response to therapy with bloodwork, usually done every 6-8 weeks until levels are stable.  If either radioactive iodine or surgery is used as a treatment modality, the thyroid function will likely decline and you will need to be put on thyroid replacement therapy.   

More information: thyroid.org/hyperthyroidism

Radioactive Iodine: Radioactive iodine can be used as treatment for hyperthyroidism from Graves’ disease and toxic nodules.  It is also occasionally used after thyroidectomy for treatment of thyroid cancer.  Iodine is used by normal thyroid cells to make thyroid hormone.  When radioactive iodine is taken in a large amount, it destroys thyroid cells.  This is a good thing if you have an overactive gland or cancer cells.  If this treatment is prescribed, you will need to have a scan done first to determine what dose you need. You may be asked to follow a low iodine diet prior to your treatment to maximize the results.  You will take the radioactive iodine by mouth (usually a small capsule or liquid form).  Afterwards, the radiologist will give you instructions on what to do.  If you have a large enough dose (usually given for thyroid cancer), you may need to stay isolated for about 24 hours to avoid exposing others to radiation, especially if you have young children at home.  Radioactive iodine is typically well tolerated without any side effects.  Occasionally, patients may get mild pain in the neck which can be treated with Tylenol or ibuprofen. 

More information: thyroid.org/radioactive-iodine

Thyroid Emergencies

Myxedema Coma: Uncontrolled hypothyroidism can rarely lead to an emergency condition called Myxedema Coma.  This typically happens when the thyroid hormone levels are very low.  Symptoms include extreme fatigue, weakness, breathing problems, a slow heart rate, low body temperature, unresponsiveness, and confusion.  To prevent this, it is important to take your thyroid medication every day, as prescribed. 

Thyroid Storm: Uncontrolled hyperthyroidism can rarely lead to an emergency condition called Thyroid Storm.  Symptoms include extremely high temperature, very high heart rate, nausea, vomiting, abdominal pain, jaundice, confusion, agitation, seizures.

Both of these thyroid emergencies can be triggered by an infection, non-compliance with medication, recent trauma, heart attack, or stroke.  If you experience any of these symptoms, you should go to the emergency department immediately.

Thyroid Cancer

Thyroid cancer is relatively uncommon; however, diagnoses has increased in recent years, likely secondary to increased imaging of the head and neck area (CT scan, ultrasound, MRI).  It is typically a slow growing cancer, and very treatable with surgery and, if needed, radioactive iodine. 

Symptoms: Thyroid cancer typically does not present with symptoms.  It can be detected by your doctor when he/she performs a neck exam, or can be found incidentally when imaging is done for an unrelated reason.  If symptoms do occur, they include difficulty swallowing, a visible lump on the neck, choking sensation, or hoarse voice.  There are no blood tests to detect thyroid cancer.

Diagnosis: Thyroid cancer can be initially diagnosed when your doctor performs and ultrasound guided fine needle aspiration of a nodule.  The diagnosis is then confirmed at the time of surgery. 

Etiology: Most cases of thyroid cancer are sporadic, so we don’t know why they occur. People who are at higher risk of thyroid cancer are those with family history of thyroid cancer and those who were exposed to high doses of radiation as a child. 

Treatment: The treatment of most thyroid cancers is taking part of the thyroid out (lobectomy) or the entire thyroid out (total thyroidectomy).  Some cancers that are considered higher risk may need additional treatment in the form of radioactive iodine (see radioactive iodine section).

Monitoring: After thyroid cancer is adequately treated, your doctor will do periodic bloodwork and neck ultrasounds to monitor for recurrence. 

At Carolina Endocrine Associates, we come up with an individualized, comprehensive treatment plan for each patient diagnosed with thyroid cancer.  We perform ultrasounds and biopsies in the office.  We are responsible for the entire treatment course, aside from the actual surgery.

Thyroid Nodules

Thyroid nodules are abnormal growths of thyroid cells that form lumps in the thyroid. 

Symptoms: Most people do not have any symptoms of thyroid nodules.  They can be detected by a routine neck exam done by your doctor, or picked up on imaging of the neck.  If the nodules are large enough to cause symptoms, they usually include difficulty swallowing, neck fullness, choking sensation, or hoarseness.

Diagnosis: Thyroid nodules are diagnosed by neck ultrasound.  An ultrasound shows the size and characteristics of each thyroid nodule in detail.  This is important because it will tell us if the nodule needs to be biopsied or not, based on how it looks.  An ultrasound is a painless test which we can perform in our office.

FNA: If we determine that the nodule needs to have a biopsy, we will schedule the patient for a fine needle aspiration (FNA).  We also perform this very simple procedure in our office.  The patient does not need to fast prior to the procedure, and there is no general anesthesia needed (patient can drive).  The doctor will administer a small amount of local anesthesia to the area.  Once numb, the doctor will use a very thin needle to get cells from the thyroid nodule.  Typically, she will do this about four times.  She does the entire procedure with ultrasound guidance.  The procedure typically lasts <10 minutes and the patient will leave with just a bandaid.  The sample will then be sent over to the lab and analyzed by pathologists for results.

Etiology: We do not know what causes thyroid nodules.  We do know that they are very common.  Approximately 50% of of people have thyroid nodules and about 95% of these nodules are benign.

Treatment: Thyroid nodules that are small or have benign features can be monitored with ultrasound every 6 months to 1 year. Thyroid nodules that are high risk should have an FNA to rule out cancer.  If a thyroid nodule is found to be cancerous, the treatment is surgery.

At Carolina Endocrine Associates, we perform the ultrasound and interpret the ultrasound results all within the same visit.  You will have the results of your ultrasound explained to you by the physician who performs the ultrasounds herself. The same physician, if needed, will perform the biopsy. 

More information: thyroid.org/thyroid-nodules