Know if You Have Thyroid Disease

The thyroid governs the body’s metabolism through the release of two hormones: triiodothyronine (T3) and thyroxine (T4) Thyroid disease occurs as a result of either overproduction (too much) or underproduction (too little) of the thyroid hormones. The overproduction or underproduction may lead to a thyroid disease. The most common thyroid diseases are goiter, hypothyroidism, and hyperthyroidism. Knowing whether or not you have one of these diseases will require a visit to the doctor and some tests, but you can familiarize yourself with the symptoms of each one so that you know when something might be off with your thyroid.

Steps

Identifying Goiter

1. Learn about goiter. A goiter is an abnormal enlargement of the thyroid gland. It is more common in women than in men. Under normal circumstances, an individual or physician cannot feel the thyroid gland, but if you have a goiter, then you will be able to feel it.
   • Goiter may be due to a swelling of the thyroid or multiple growths on the gland. It can also indicate hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid).
2. Check for symptoms of goiter. The main symptom of goiter is the goiter, the enlarged thyroid gland that you can feel. Most individuals with goiter have no other symptoms.The thyroid is a butterfly-shaped gland in the front portion of the neck, just below the Adam’s apple and just above the collarbone. If you can feel this gland, then you may have a goiter. If the goiter grows large enough, it may also cause the following symptoms:
   • Swelling or tightness in the neck
   • Breathing difficulties
   • Swallowing difficulties
   • Coughing
   • Wheezing
   • Hoarseness of voice
3. Consider possible causes of goiter. To help your doctor develop the best course of treatment, you should consider any preexisting conditions that you have that may have caused the goiter. Causes of goiter include:
   • Iodine deficiency. Iodine deficiency is the most common cause of goiter worldwide. However, it is rare in the United States due to the fact that table salt is supplemented with iodine.
   • Graves’ disease. Graves’ disease is an autoimmune disorder that causes hyperthyroidism (overproduction of thyroid hormones). The disease causes the body to produce a protein, thyroid-stimulating immunoglobulin (TSI), that attacks the thyroid gland. The protein attacks cause swelling of the thyroid and overproduction of thyroid hormones as TSI mimics the actions of thyroid-stimulating hormone (TSH). Other symptoms of Graves' disease include bulging eyes, anxiety, heat sensitivity, weight loss, and frequent bowel movements. Treatment for Graves' disease includes radioactive therapy that reduces thyroid activity, so you will probably need to take thyroid replacement hormones after treatment.
   • Hashimoto’s disease. Hashimoto’s disease is an autoimmune disorder that causes hypothyroidism (underproduction of thyroid hormones). The disease occurs when the body’s immune system attacks the thyroid, which leads to swelling of the gland. It progresses slowly over the years and produces chronic thyroid damage leading to low levels of thyroid hormones. The disease is also known as chronic lymphatic thyroiditis. Other symptoms of Hashimoto's disease may include fatigue, depression, joint pain, weight gain, and constipation.
   • Thyroid nodules. Thyroid nodules are lumps or abnormal masses within the thyroid gland. They may be solid or filled with fluid or blood. Individuals may have one thyroid nodule (solitary) or many. They are common and almost half of the population may have them at some point in their lives. Most thyroid nodules do not cause symptoms and 90% are benign (not cancerous). Some thyroid nodules may cause overproduction of thyroid hormones (hyperthyroidism) and an even smaller fraction masquerade as thyroid cancer.

Identifying Hyperthyroidism

1. Learn about hyperthyroidism. Hyperthyroidism, or overactive thyroid, results from the overproduction of thyroid hormones. As a result, the body’s metabolism is elevated. The disease is characterized by the production of thyroid-stimulating immunoglobulin, which causes inflammation of the thyroid and excess production of hormones.
   • Hyperthyroidism is less common than hypothyroidism.
   • The most common cause of hyperthyroidism in the United States is the autoimmune disorder Graves’ disease.
2. Check for symptoms of hyperthyroidism. Hyperthyroidism causes a wide range of symptoms, so it may be difficult to tell if you have hyperthyroidism based on symptoms alone. You will need to see your doctor for tests to determine if hyperthyroidism is the cause of your symptoms. Symptoms of hyperthyroidism may include:
   • Weight loss
   • Fatigue
   • Rapid heartbeat
   • Irregular heartbeat
   • Anxiety or nervousness
   • Irritability
   • Protruding eyes
   • Trouble sleeping
   • Trembling in the hand and fingers
   • Increased sweating
   • Feeling hot when others do not
   • Muscle weakness
   • Diarrhea
   • Change in menstrual cycles
   • Weak bones
   • Infertility
   • Enlargement of the thyroid gland (goiter)
   • Erectile dysfunction
   • Decreased sexual libido
3. Consider your risk factors. Some people are at higher risk of developing hyperthyroidism due to certain risk factors. Risk factors for hyperthyroidism include:
   • Advancing age
   • Female gender
   • Family history of hyperthyroidism
   • Iodine supplementation after deficiency
   • Autoimmune disorders such as type 1 diabetes, rheumatoid arthritis, and lupus

Identifying Hypothyroidism

1. Learn about hypothyroidism. Hypothyroidism, or underactive thyroid, results from the underproduction of thyroid hormones. As a result, the body’s metabolism is slowed. Some of the symptoms are just the opposite of what happens with hyperthyroidism.
   • The most common cause of hypothyroidism in the United States is the autoimmune disorder Hashimoto’s disease. The disease causes chronic inflammation of the thyroid gland which decreases its ability to produce hormones.
2. Check for symptoms. Symptoms of hypothyroidism usually appear slowly over months or years. Like hyperthyroidism, hypothyroidism symptoms have a wide range so you will need to see your doctor to confirm that hypothyroidism is the cause of your symptoms. Symptoms of hypothyroidism may include:
   • Fatigue
   • Feeling cold when others do not
   • Constipation
   • Weight gain
   • Poor concentration
   • Muscle weakness
   • Joint pain
   • Muscle pain
   • Depression
   • Dry, thinning hair
   • Pale, dry skin
   • Enlargement of the thyroid gland (goiter)
   • Elevated blood cholesterol
   • Infertility
   • Slow heart rate
   • Decreased sweating
   • Facial puffiness
   • Excessive menstrual bleeding
   • Hoarse voice
3. Consider your risk factors. Some people are at higher risk of developing hypothyroidism due to certain risk factors. Risk factors for hypothyroidism include:
   • Advancing age
   • Female gender
   • Family history of hypothyroidism
   • Autoimmune disorders such as type 1 diabetes and rheumatoid arthritis
   • Treatment with antithyroid medications
   • Treatment with radioactive iodine
   • Previous thyroid surgery
   • Previous exposure of the neck or upper chest area to radiation

Getting Medical Help

1. Make an appointment with your doctor. If you suspect that you have thyroid disease, make an appointment with your doctor right away to get a diagnosis and treatment if needed. Thyroid disease can be diagnosed using a variety of methods. Make sure that you tell your doctor about all of the symptoms that you are experiencing.
2. Request blood tests. Several blood tests can be used to diagnose thyroid disease. Your doctor will most likely order blood tests first because they are easy to perform and they can determine whether or not your symptoms are due to a thyroid issue. These tests include:
   • Thyroid-stimulating hormone (TSH). This test is always the first step in diagnosing a thyroid problem. The TSH blood test is the most accurate test for the diagnosis of hypothyroidism and hyperthyroidism. Low TSH correlates with hyperthyroidism, while high TSH correlates with hypothyroidism. If the results of the TSH test are abnormal, then your doctor may order additional tests to pinpoint the cause of the problem.
   • Thyroxine (T4). A blood test that reveals low levels of T4 correlates with hypothyroidism, while a test that reveals high levels correlates with hyperthyroidism.
   • Triiodothyronine (T3). A T3 blood test can also be useful for confirming hyperthyroidism. If T3 levels are elevated, it indicates that you have hyperthyroidism. A T3 blood test cannot be used for the diagnosis of hypothyroidism.
   • Thyroid-stimulating immunoglobulin (TSI). A TSI blood test can help to confirm Graves’ disease, the most common cause of hyperthyroidism.
   • Antithyroid antibody. The anti-thyroid antibody test can help to confirm Hashimoto’s disease, the most common cause of hypothyroidism.
3. Ask about imaging tests. A variety of imaging tests may also be used to diagnose and pinpoint the cause of thyroid disease. Your doctor may order one or more of these if the results of a blood test come back as abnormal. Imaging tests may include:
   • Ultrasound. Ultrasound utilizes sound waves that bounce off organs to create images of their structure. The images can help practitioners look at the tissue within the thyroid gland. It can also reveal nodules, cysts, or calcifications within the gland. However, ultrasound cannot distinguish between a benign (noncancerous) or malignant (cancerous) growth.
   • Computed tomography (CT) scan. A CT scan with or without contrast may be used to look at the tissues of a large goiter. They may also reveal thyroid nodules in individuals having the scans for unrelated reasons.
   • Thyroid scan with radioactive iodine uptake (RAIU). A thyroid scan is a type of nuclear imaging study that utilizes radioactive iodine to evaluate the structure and function of the thyroid gland. These tests may be used to assess the nature of a thyroid nodule or help diagnose hyperthyroidism.
4. Consider a fine needle aspiration (FNA) biopsy if needed. Since it is difficult or even impossible to tell if a growth is cancerous using imaging along, your doctor may order a FNA biopsy to determine whether a thyroid nodule is benign (noncancerous) or malignant (cancerous).
   • During this procedure, a small, thin needle attached to a syringe will be inserted into the thyroid nodule using ultrasound guidance.
   • Samples of the cells in the nodule will be pulled into the syringe and then sent for analysis.
   • The cells will be viewed under a microscope by a pathologist, a specialist in the study of diseases, who will determine if the cells are benign or malignant.

Warnings

• If you think that you have a thyroid disease, make an appointment with your doctor right away! Do not delay treatment, especially if your thyroid gland is enlarged or if any of your symptoms are interfering with your daily life. Waiting to get a diagnosis and treatment may cause symptoms to worse and if a growth is cancerous, delaying treatment may even be fatal.

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