The thyroid gland is a small gland that is located in front of the neck just below the larynx. It is made up of two halves that are joined together by a narrow band.
What Is The Function Of The Thyroid Gland?
The function of the thyroid gland is to take iodine that is found in many foods and convert it to thyroid hormones of which there are two: Thyroxine ( T4 ) and Triiodothyronine ( T3 ). Every cell in your body depends on the thyroid hormones for regulation of your metabolism.
What Are The Common Problems That can Occur with The Thyroid Gland?
The thyroid gland is prone to many very distinct problems, some of which are very common. These problems can be broken down to include:
Problems concerning the amount of hormone (either too much or too little). If you have too much thyroid hormone being produced this can cause a condition known as hyperthyroidism.
Hyperthyroidism may cause, Fatigue, Trembling of hands, Fast or irregular heart beat, Irritability, Shortness of breath, Chest pain, Muscle weakness, Weight loss, Depression, Heat intolerance, Nervousness, Increased bowel movements, Light or absent menstrual periods, Hair loss, Staring gaze.
Hypothyroidism or too little thyroid hormone being produced. Some of the symptoms of hypothyroidism are: Fatigue, Weakness, Weight gain or increased difficulty losing weight, Dry rough pale skin, Hair loss, Cold intolerance, Muscle cramps or frequent muscle aches, Constipation, Memory loss, Irritability, Coarse dry hair, Abnormal menstrual cycles, Decreased libido.
Problems due to increased growth of the thyroid causing compression of the important structures in the neck or just appearing as a mass in the neck.
“Goiter” means an enlarged Thyroid. If it is very large, it may be easily seen as a mass in the neck.
What factors may cause goiter?
A diet deficient in iodine. This is rare in the US.
A more common cause of a goiter in America would be an increase in thyroid stimulating hormone (TSH) in response to hypothyroidism. These may be medically managed by providing thyroid hormone in the form of a pill.
When surgery may be considered for goiter?
You will more than likely be referred for surgery if the goiter continues to enlarge. A more common indication for surgical removal of a goiter is that it has enlarged enough to where it compresses on other structures in the neck such as the trachea and esophagus.
Suspicion of malignancy is also another cause for the surgical removal of the thyroid. However, it should be noted that the incidence of malignancy within a mutinodular goiter is less than 5%.
Thyroid nodules:
Nodules or lumps may occur within the thyroid gland which can be worrisome for the presence of thyroid cancer.
These abnormal growths of the thyroid often can be felt as a lump in your neck. More than 90% of all thyroid nodules are benign (non-cancerous growths).
What types of cancer occur in thyroid gland?
There are four types of Thyroid cancer with following Incidence:
- Papillary ~ 75%
- Follicular ~ 15%
- Medullary ~ 7%
- Anaplastic ~ 3 %
What is the prognosis for thyroid cancer?
In the younger patients, both follicular and papillary cancers can be expected to have a better than 95% cure rate if treated appropriately.
Medullary cancer of the thyroid is less common, but does have a worse prognosis. Treatment involves a complete removal of the thyroid gland as well a neck dissection to remove the lymph nodes of the front and sides of the neck.
Anaplastic cancer of the thyroid are not curable in most cases. Fortunately it is very rare.
Will chemotherapy be required for the treatment of thyroid cancer?
The simple answer is NO. Most thyroid cancer cells retain the ability to absorb and concentrate iodine. With this in mind, Radioactive Iodine is given to the patient. The thyroid cancer cells will concentrate the radioactive iodine and the radioactivity destroys the cell from within. Patient does not suffer sickness, hair loss, nausea, diarrhea or pain.
Not all patients who are diagnosed with thyroid cancer need radioactive iodine treatments after their surgery. It is up to the patient's endocrinologist and the surgeon who performs the thyroid surgery to determine if you will need the radioactive iodine or not.
What are some of tests for thyroid?
Thyroid Fine Needle Biopsy: This test has become the most reliable test to differentiate a nodule that is cancer from a nodule that is benign. The biopsy can provide information that no other thyroid test can provide. It is not a perfect test but it will provide definitive information in 75% of those nodules biopsied.
Thyroid Ultrasound: This is most useful radiologic imaging of thyroid for work up of thyroid nodules. A thyroid ultrasound refers to the use of high frequency sound waves to obtain an image of the thyroid gland and identify nodules. It can tell if a nodule is “solid” or a fluid-filled cyst. However, it can not detect if a nodule is benign or malignant. The ultrasound allows for accurate measurement of a nodule's size and can determine if a nodule is getting larger or smaller during treatment. Ultrasound also aids in performing thyroid needle biopsy by improving accuracy if the nodule cannot be felt easily on examination.
Iodine Uptake Scan: This is a means of measuring thyroid function. It measures how much iodine is taken up by the thyroid gland (RAI uptake). This test is performed by giving a dose of radioactive iodine on an empty stomach. The iodine is concentrated in the thyroid gland or excreted by the urine over the next few hours. The amount of iodine that goes into the thyroid can be measured by a “ Thyroid Uptake “. If you are taking thyroid medication, your thyroid gland will not take up as much of the iodine because your thyroid gland is not functioning. Other times the thyroid gland will concentrate iodine normally but will be unable to convert the iodine into thyroid hormone. This is why the interpretation of the iodine uptake is usually done in conjunction with the blood tests.
Thyroid Scan: This is taking a picture of how well the thyroid gland is functioning. This requires giving a radioisotope to the patient and letting the thyroid gland concentrate the isotope. It is very much like the iodine uptake scan and is therefore usually done at the same time. Pregnant woman should not have thyroid scans performed because the iodine can cause development troubles within the baby's thyroid gland.
Thyroid scans are used for the following reasons:
- Identifying nodules and determining if they are “hot” or “cold
- Measuring the size of the goiter prior to treatment
- Follow-up of thyroid cancer patients after surgery
- Locating thyroid tissue outside the neck, i.e. the base of the tongue or in the chest
Thyroid Antibodies: Some people are found to have antibodies against their own thyroid tissue. A condition that is known as Hashimoto's Thyroiditis is associated with a high level of these antibodies in the blood. It is not known whether it is the antibodies that cause the disease or the disease that causes the antibodies; however, the finding of a high level of thyroid antibodies is strong evidence of this disease. If Hashimoto's thyroiditis presents as a thyroid nodule rather than a diffuse goiter, the thyroid antibodies may not be present.
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