The thyroid gland, a butterfly-shaped gland situated in the front of the neck, produces the hormones thyroxine and triiodothyronine. These are both essential for a healthy body as they direct all of our cells, tissues and organs in how they use protein, fat and sugar. Thyroid problems can lead to levels of both these hormones being disrupted, which affects the entire metabolism.
Thyroid problems occur when the thyroid gland is either overactive, causing hyperthyroidism or underactive, causing hypothyroidism. Both conditions have a wide range of underlying causes but all thyroid problems can be treated.
How are thyroid problems diagnosed?
Thyroid problems are initially diagnosed using a blood test. The levels of two hormones – thyroxine and thyroid stimulating hormone are measured. Thyroid stimulating hormone is produced by the pituitary gland in the brain. When thyroid problems lead to hypothyroidism, the pituitary produces more TSH to try to restore the levels of thyroxine back to normal; when hyperthyroidism starts to develop, less TSH is produced. So, if thyroxine is low and TSH is high, this indicates an underactive thyroid; the reverse situation confirms that the thyroid problem is an overactive gland.
They can be caused by an overactive thyroid
It is possible for the thyroid gland to go into overdrive and to produce too much thyroxine or triiodothyronine. Hyperthyroidism is commonly caused by the auto-immune condition Graves’ disease in which a stimulated thyroid pumps out hormones at a greatly increased rate. People who develop benign growths – thyroid nodules – also over produce thyroid hormones.
People with thyroid problems that increase thyroid hormone production usually notice that they feel extremely restless and jumpy, unable to settle or sleep, perhaps they might even develop hand tremors. Heart rate and breathing increase, and the person affected feels very hot and is always thirsty. The thyroid gland may swell, causing a goitre and the eyes often protrude, causing a startled appearance.
Treating problems that lead to an overactive thyroid
There are several methods of treating thyroid problems that lead to hyperthyroidism:
- Carbimazole is usually used to lower the output of thyroxine by the thyroid gland but it cannot destroy thyroxine. It, therefore, takes up to 8 weeks to feel any different once treatment has started, because it takes that long for the thyroxine that has already been made to be cleared from the system. This treatment cures the underlying thyroid problems in about half of all patients, and symptoms do not recur.
- Radio-iodine treatment can be used to destroy some of the thyroid tissue, reducing thyroxine production to normal levels. This is a once-only treatment for thyroid problems and is not suitable for pregnant women, or those planning to become pregnant in the next six months or so. It is also important to avoid close contact with other people, particularly children for about 4 weeks after treatment to limit the amount of radioactivity they receive.
- Surgical removal of part of the thyroid gland is considered in people who have a large goitre and it also reduces the amount of thyroxine produced after the operation.
- Beta-blockers can also be used in combination with the above treatments during the period when you are waiting for them to take effect, or for your surgery date. Beta blockers block some of the effects of thyroxine and can help reduce symptoms.
Artificial tears, eye protectors for sleeping and dark glasses can also help relieve eye discomfort caused by protruding eyes. Steroids, radiation treatment or even surgery may be required in cases where thyroid problems are severe.
Problems caused by an underactive thyroid
Various thyroid problems can cause the thyroid gland to secrete abnormally low amounts of the two hormones it produces. Having too little iodine in the diet is still the most common reason for hypothyroidism in the world today, although it is no longer so much of a problem in most industrialised countries. Here, thyroid problems that cause an underactive thyroid usually arise because of an autoimmune condition in which the body’s own immune system attacks and destroys the tissues in the thyroid gland. This is described as Hashimoto’s thyroiditis if the thyroid problems cause the thyroid gland to swell, causing a goitre.
Solutions that lead to hypothyroidism
Treating thyroid problems caused by under production of thyroid hormones generally involves replacing the hormones that the body can no longer produce. Thyroxine can be taken easily in tablet form in the form of levothyroxine. This needs to be taken daily to keep the level of the hormone stable and is usually then required for life.
Many people report feeling a great deal better within a few days of starting levothyroxine treatment. Successful treatment reverses the usual symptoms of an under active thyroid – feeling cold and tired, gaining weight, having lifeless hair and dry skin and feeling general out of sorts over a long period of time.
Thyroid problems in pregnancy
It is not uncommon for pregnant women to develop temporary hypothyroidism during pregnancy because of the hormonal changes that are going on. Like women with a previously underactive thyroid, they can be treated safely with levothyroxine, which has been shown to have no adverse effects on the growing baby. Women diagnosed with an under active thyroid before their pregnancy will be monitored and may need to have their dose increased.
Hyperthyroidism in women of childbearing age is often overlooked, particularly if the symptoms are mild. Having an overactive thyroid can increase the risk of miscarriage so women who have lost several pregnancies should have tests to see if thyroid problems could be responsible. Some of the drugs that reduce the function of the thyroid gland can be taken safely in pregnancy but they can cause thyroid problems in the baby, so the pregnancy must be very carefully monitored. Surgery to remove part of the thyroid gland is also an option.