How to Detect a Thyroid Problem?

What is the Thyroid's Purpose?

The thyroid gland is a small but vital organ that regulates metabolic processes and energy consumption throughout the body by producing two hormones: thyroxine (T4) and triiodothyronine (T3).

This small, butterfly-shaped gland, weighing about twenty grams, located just below the Adam's apple, plays a key role in controlling the body's cells and tissues, significantly influencing numerous bodily functions (body weight, cholesterol, heart rate, vision, muscle mass, menstrual cycle, mental state, skin and hair).

The central nervous system, via the hypothalamus and pituitary gland (producer of the TRH or thyrotropin hormone), also plays an important role in regulating and controlling the gland's function and the production of the two essential thyroid hormones: triiodothyronine (T3) and thyroxine (T4). Thyroid hormones have two main effects: increasing basal metabolism, i.e., the amount of energy used by an individual at rest, and increasing the rate of utilization of energy-providing substances, for example, to stimulate a child's growth.

How to Detect a Thyroid Problem

A malfunctioning thyroid gland initially produces subtle symptoms that are difficult to recognize. In some cases, symptoms may not appear for months or years.

Characteristic symptoms of hypothyroidism include:

Fatigue;
Obesity;
Intolerance to cold;
Muscle or joint pain;
Constipation;
Dry skin and hair;
Heavy menstruation;
Difficulty conceiving;
Depression;
Impaired memory;
Bradycardia;

While symptoms of hyperthyroidism include:

Anxiety;
Insomnia;
Irritability;
Tachycardia or heart palpitations;
Tremor;
Weight loss;

Hyperthyroidism

When the thyroid gland overworks, there's an excess of thyroid hormones in the body. This condition is called hyperthyroidism. The effects of hyperthyroidism are: increased heart rate with possible palpitations and arrhythmias, weight loss, insomnia, anxiety, tremors, sweating, muscle weakness. Blood concentrations of FT3 and FT4 are elevated, while TSH levels are relatively low.

Causes may include:

Autoimmune processes affecting the thyroid gland (Graves' disease), which may be associated with ocular changes;
Hyperfunctioning thyroid nodules (single or multiple in a multinodular goiter);
Inflammatory processes (hyperthyroid phase of subacute thyroiditis);
Medications (e.g., amiodarone, excess iodine);

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Hypothyroidism

Hypothyroidism is the most common thyroid disease. When the thyroid gland malfunctions, blood concentrations of thyroid hormones (FT3 and FT4) are low.

In most cases, hypothyroidism is "primary", i.e., due to a primary thyroid pathology. In these cases, the blood concentration of TSH (the pituitary hormone that stimulates the thyroid gland) is increased, because the inhibitory effect that thyroid hormones exert on TSH secretion is lost. TSH is a very sensitive indicator of thyroid function and in mild forms of hypothyroidism ("subclinical hypothyroidism"), thyroid hormones are still normal and the only sign is a moderately increased TSH.

The most common causes of primary hypothyroidism in adults are autoimmune chronic Hashimoto's thyroiditis, surgical removal of the thyroid, and functional inactivation of the thyroid after iodine treatment. Severe iodine deficiency is a major cause of hypothyroidism and goiter worldwide. Other causes may be the result of external radiotherapy in the neck area and the use of certain medications that can interfere with thyroid function (such as amiodarone, lithium, interferon beta; when using these medications, thyroid function should be monitored periodically).

In rare cases, there may be a lack of thyroid development or a congenital alteration of thyroid hormone synthesis.

How to Spot Thyroid Cancer?

In the presence of signs and symptoms suggestive of thyroid cancer, the clinician can assess changes in the shape and size of the thyroid gland, and gather information on the patient's medical and family history.

The diagnostic confirmation of thyroid carcinoma requires a biopsy. However, before the clinician decides to perform a biopsy or surgical removal, the patient must undergo a series of blood tests and imaging. These tests allow the clinician to assess thyroid function and determine the type of cancer present.

Thyroid Disorder Diagnosis?

The tests available to diagnose a thyroid pathology are:

Blood tests, assessing the levels of circulating thyroid hormones. Normally, the value of TSH hormone and thyroxine T4 are measured. Sometimes T3 is also measured. High levels of T4 and low or absent levels of TSH indicate that the thyroid gland is producing too much hormone, indicating hyperthyroidism. Conversely, a low level of T4 and a high level of TSH are indications of hypothyroidism;
Ultrasound, which examines the structure and size of the thyroid gland. It can thus highlight the presence of nodules inside the gland and distinguish cysts (fluid-filled nodules) from solid nodules;
Needle aspiration and biopsy, makes it possible to distinguish between benign and malignant thyroid nodules. Needle aspiration is performed using a fine needle to collect tissue for examination under ultrasound guidance. It helps determine if cancerous cells are present in the thyroid gland and, if so, what type they are;
Scintigraphy can provide useful information on the structure and function of the thyroid gland. The examination involves introducing a small amount of radioactive iodine into a vein. The iodine accumulates in the thyroid, which can then be studied using a special machine. This examination makes it possible to distinguish hot nodules (which produce an excess of hormone and are almost always non-cancerous) from cold nodules (which do not produce hormone but may be cancerous);

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