Thyroid Awareness Month an opportunity to talk about common thyroid problems

by Vicky Cerino
January 22, 2016

Image with caption: Whitney Goldner, M.D.

Whitney Goldner, M.D.

What does the thyroid do?

The thyroid regulates metabolism. We have finely tuned feedback mechanisms in our bodies and if the body senses we need more or less thyroid hormone, it will send out the appropriate signals through a hormone (TSH) made in the pituitary to make those changes. If things are going well, we are not even aware that it's making those changes, but if it's not working correctly, that's when there can be problems.

What is the most common problems with the thyroid?

One of the most common problems is hypothyroidism or an underactive thyroid. This is when the thyroid is not producing enough thyroid hormone. Being hypothyroid can slow the metabolism of multiple organs in the body. Persons with hypothyroidism can have fatigue, weight gain, swelling, joint pain, disrupted sleep, changes in hair and skin, and change in ability to concentrate. If you have these symptoms it is important to talk with your doctor to have your thyroid levels checked. These symptoms are fairly non-specific and also can be caused by other disorders such as sleep apnea, anemia, etc.

Why are more people being diagnosed for thyroid cancer and should I be checked for it?

Thyroid nodules, or growths in the thyroid, are also very common and estimated to occur in nearly 50 percent of persons by the age of 60. Fortunately, only 5 to 10 percent are estimated to be thyroid cancer. Thyroid nodules are discovered either by someone noticing or feeling a lump in the thyroid or by imaging with a thyroid ultrasound. Not all nodules can be felt.

Risk factors for thyroid cancer include having a family history of thyroid cancer and having a history of exposure to radiation to the head and neck. If you have risk factors, then having a thyroid exam and ultrasound is reasonable to evaluate for nodules. If you are having symptoms that could be caused from a growth in the thyroid such as new and persistent hoarseness, difficulty swallowing, growth in the neck or lymph nodes in the neck, you should see your doctor for further evaluation.

Why is thyroid cancer on the rise?

Thyroid cancer has been on the rise and is estimated to have tripled over the last 30 years. Since imaging of the neck for other medical conditions is much more common today, some of the increase in rates of thyroid cancer may be due to increased detection of smaller thyroid nodules and cancers. However, experts feel that this is not the only reason for the rise, and there may be other factors that need to be explored that contribute to this increase.

How treatable is thyroid cancer?

It's a very treatable type of cancer. It's not uncommon to be diagnosed at a relatively young age. It's three times more common in women than men, and the average age of diagnosis is 40. If a nodule is detected, the first step is to have the nodule biopsied to evaluate for cancer if it has worrisome characteristics. If it is cancer, then primary therapy is surgical removal of all or part of the thyroid and removal of any lymph nodes involved. Depending on the pathologic features of the tumor and the stage of the tumor, some people will also receive radioactive iodine after surgery. Persons with thyroid cancer will also need lifelong thyroid hormone replacement.

What else besides TSH levels are important for making sure my thyroid condition is under control?

TSH, a hormone made by the pituitary, is our most sensitive way to detect thyroid function in the blood. Normal range is between 0.5 to 5. Sometimes we also need an additional blood test to evaluate the level of thyroid hormone secreted by the thyroid in the blood. If the thyroid exam is abnormal, then thyroid ultrasound is indicated to evaluate further.

What do I need to know about the difference between generic and brand name thyroid drugs?

It used to be that we recommended everyone to take a name brand form of thyroid hormone because we knew it would be manufactured the same way every time from the same company. With the increased requirements for patients to use generic medications, we have found that if they get the generic formulation from the same generic manufacturer every time, it will ensure patients get the correct formulation every time. This is something to discuss with the pharmacist, to make sure the pharmacist is able to provide the generic medication from the same manufacturer every time. If you cannot get the same generic manufacturer every time, that would be a reason to stay with a name brand. There also are some additional situations in which the name brand is preferred.

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