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An overactive thyroid gland is called hyperthyroidism, with signs of increased body metabolism, along with possible swelling of the thyroid gland (known as goiter.) Hyperthyroidism is the overproduction of the thyroid hormones T3 and T4, and is most commonly caused by the development of Graves’ disease, an autoimmune disease in which antibodies are produced which stimulate the thyroid to secrete excessive quantities of thyroid hormones. The disease can result in the formation of a toxic goiter as a result of thyroid growth. Other causes of hyperthyroidism include thyroiditis and toxic nodules.
Hyperthyroidism can present with symptoms such as a thyroid goiter, protruding eyes (exophthalmos), palpitations, excess sweating, diarrhea, weight loss, muscle weakness and unusual sensitivity to heat.
Beta blockers are used to decrease symptoms of hyperthyroidism such as increased heart rate, tremors, anxiety and heart palpitations, and anti thyroid drugs are used to decrease the production and effect of thyroid hormones. These medications can take several months to take full effect and have side-effects like skin rash or a drop in white blood cell count, which decreases then ability of the body to fight off infections. These drugs often require frequent doctor visits and blood tests to monitor the treatment. Due to the possible side-effects and inconvenience of such drug regimens, some patients choose to undergo radio-iodine 131 treatment. Radio-iodine is administered in order to destroy a proportion of or the entire thyroid gland, since the radioactive iodine is selectively taken up by the gland and gradually destroys the cells of the gland. Alternatively, the gland may be partially or entirely removed surgically, though iodine treatment is usually preferred since the surgery is invasive and carries a possible risk of damage to the parathyroid glands or the nerves controlling the vocal cords. If the entire thyroid gland is removed or damaged, hypothyroidism results.
An under active thyroid, with too little secretion of thyroid hormone, is called hypothyroidism, with general symptoms of slowing down. Hypothyroidism is the underproduction of the thyroid hormones T3 and T4. Hypothyroid disorders may occur as a result of congenital thyroid abnormalities that can sometimes present later in life, autoimmune disorders such as Hashimoto’s thyroiditis, iodine insufficiency, especially in poorer countries, or the removal of the thyroid following surgery to treat severe hyperthyroidism. Typical symptoms are abnormal weight gain, tiredness, baldness, temperature intolerance (both heat and cold), and palpitation. Individuals with thyroid gland under-activity may require hormone replacement therapy, which is typically required for the rest of the patient’s life. Thyroid hormone treatment as T4 (or on occasion along with T3) is given under the care of a physician and may take a few weeks to become fully effective.
A goiter due to hypothyroidism is termed non-toxic as it does not produce toxic quantities of thyroid hormones, despite its size. Hashimoto’s is most common in women and tends to run in families.
Postpartum thyroiditis occurs in some females following delivery. The gland gets inflamed and the condition initially presents with over activity of the gland followed by under activity. In some cases, the gland does recover with time and resume its functions.
A thyroid nodule is defined as a small lump of tissue (either solid or cystic – filled with fluid), usually more than one quarter of an inch in diameter that may protrude from the neck’s surface or may form in the thyroid gland itself. The nodule can be either benign (non-cancerous) or malignant (cancerous). Many individuals may find the presence of small masses (nodules) in the neck. The majority of these thyroid nodules are benign (non-cancerous). The presence of a thyroid nodule does not mean one has thyroid disease. Most thyroid nodules do not cause any symptoms, and most are discovered on an incidental exam or imaging. Doctors usually perform a fine needle aspiration biopsy of the thyroid to determine the status of the nodules. If the nodule is found to be non-cancerous, no other treatment is required except for routine follow-up. If the nodule is suspicious then surgery is recommended. Doctors also check the thyroid blood tests since thyroid nodules can influence thyroid hormone production.
Unfortunately, cancers do occur in the thyroid gland and are more common in females. In most cases, the thyroid cancer presents as a painless mass in the neck. It is very unusual for the thyroid cancers to present with symptoms, unless it has been neglected. One may be able to feel a hard nodule in the neck. Diagnosis is made using a fine needle biopsy and various radiological studies. Most thyroid cancers are very treatable under the guidance of an endocrinologist. Surgery is usually recommended first often followed by radio-iodine and thyroid hormone replacement.
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