Thyroid Diseases and Their Treatments

What is the Thyroid?

The thyroid is a butterfly-shaped gland located in the central part of the neck.

Its function is to produce and release thyroid hormones, T4 or thyroxine and T3 or triiodothyronine, which are involved in growth, the maintenance of most bodily functions, and the regulation of metabolism. The production of thyroid hormones is controlled by another hormone called TSH (thyroid stimulating hormone) which is synthesized in the pituitary gland of the brain. TSH stimulates the production of T4 and T3 and varies exponentially with small variations in T4 and T3, which explains why TSH is a very good indicator of disruptions in the production of thyroid hormones.

Thyroid diseases are five to eight times more common in women than in men, and the probability of thyroid dysfunction increases with age.

Different Symptoms of Thyroid Diseases

The symptoms of thyroid disease are very varied and depend heavily on the type of condition the thyroid is suffering from.

For example, when the thyroid malfunctions or functions poorly, among the most common symptoms we have:

• Fatigue, drowsiness and/or weakness;
• Intolerance to cold;
• Memory loss;
• Weight gain or increased difficulty losing weight (despite a reasonable diet and exercise);
• Depression;
• Constipation;
• Abnormal menstruation and/or fertility problems;
• Joint or muscle pain;
• Thin and brittle hair or nails and/or dry, scaly skin;

In parallel, when the thyroid is overactive, the symptoms that may manifest are:

• Weight loss while the person eats normally;
• Anxiety and irritability;
• Rapid heart rate;
• Prominent eyes;
• Tremors;
• Hair loss;
• Feeling weak;
• Increased frequency of bowel movements;
• Rapid nail growth;
• Thin and smooth skin;
• More sweating than normal;
• Abnormal menstruation;

Experiencing thyroid problems is unique to each person, and not everyone presents all the symptoms associated with the disease.

What tests for thyroid diagnosis?

In the presence of a thyroid nodule, the endocrinologist requests a thyreostimulin (TSH) assay to assess thyroid function.

Another test often requested in the presence of a thyroid nodule is the calcitonin assay.

Ultrasound is the method of choice for the evaluation of thyroid nodules and the initial stratification of the risk of malignancy. It is a simple, inexpensive and reliable examination that allows obtaining high-resolution images. The ultrasound examination allows documenting the size of the gland, the margins, the characteristics of the parenchyma, the number, location, size and characteristics of any nodules. The neck examination should extend to the evaluation of the other structures present there, in particular the lymph nodes.

Ultrasound-guided fine-needle aspiration of the thyroid is the most accurate, safest and most reliable diagnostic tool for the cytological diagnosis of thyroid lesions.

This is a minimally invasive procedure, performed using a fine-gauge needle (23-27), which allows the collection of a few thyroid cells from the nodule for analysis to obtain a cytological diagnosis. This is a simple procedure, without serious complications, which can be performed on an outpatient basis. Once the sample is collected, direct smear on a slide is performed, which remains the most widespread, rapid, inexpensive and widely standardized technique.

Thyroid Diseases and Their Treatments

If the thyroid functions poorly, it produces an insufficient amount of thyroid hormones, causing a condition called hypothyroidism, which slows down the metabolism of the person concerned and therefore their energy.

Some symptoms can be very vague (subclinical hypothyroidism) or appear over a long period, like other common medical problems and signs of aging, so the condition often goes unnoticed. But if left untreated, this condition can lead to serious, even fatal, complications. It is also accompanied by an increase in hypertension, high cholesterol and infertility.

However, if the thyroid is overactive, it produces too much thyroid hormone that goes into the bloodstream, causing a condition called hyperthyroidism (less frequent than hypothyroidism), which accelerates the metabolism of the person concerned.

Untreated hyperthyroidism can cause arrhythmias or heart attacks. In addition, if you are a menopausal woman, be aware that hyperthyroidism increases your risk of osteoporosis and fractures.

In cases of hypothyroidism and hyperthyroidism, the thyroid gland can become larger than normal and become visible or palpable under the skin at the front of the neck (medically called "goiter").

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Other Thyroid Diseases

Apart from hyperthyroidism and hypothyroidism, there are other common conditions of this gland:

• Any increase in the volume of the thyroid gland is called a goiter. Goiter can occur in both hyperthyroidism and hypothyroidism. It can be a single area of the thyroid gland (nodule or uninodular goiter), several areas (multinodular goiter) or a diffuse increase in the entire gland. The function of the gland may be normal (euthyroid goiter) or altered (hyperfunctional or hypofunctional goiter);
• The development of thyroid nodules is usually benign. In the case of malignant nodules, the most common carcinomas are papillary or papillary-follicular (mixed) adenocarcinomas, which account for about 60% of malignant thyroid tumors. The prognosis is exceptionally good, with a probability of cure of more than 90%. Thyroid cancer is more common in women than in men and its incidence increases with age. Among the causes, exposure to ionizing radiation in the neck region is of recognized importance. The incidence of thyroid cancer has been multiplied by 10 to 100 following the Chernobyl nuclear disaster, in areas affected by a significant increase in radioactivity;
• Other thyroid diseases. Little is known about Hashimoto's thyroiditis and other autoimmune diseases: according to autopsy analyses, it affects 5 to 15% of the female population and 1 to 5% of the male population, and its frequency increases, especially in women, with age. Another form of female disease is postpartum thyroiditis. It occurs in 5 to 9% of women shortly after delivery and is generally a transient condition;