What are the main disorders of the thyroid gland?

In this article, Dr Jesse Kumar, renowned consultant endocrinologist, provides an expert insight into the most common disorders of the thyroid gland. The specialist discusses causes, symptoms and treatment, among other important points.

What are thyroid disorders?

The thyroid gland, located in the front of the neck, is an endocrine gland that secretes the hormones that regulate metabolism. Metabolism controls the way our body uses energy. If the thyroid gland is overactive (called hyperthyroidism), then metabolism speeds up, and this causes symptoms. If the thyroid gland is underactive (called hypothyroidism), then metabolism slows down, and this can also cause symptoms.

Besides thyroid gland dysfunction, which can be overactive or underactive, the structure of the thyroid gland can be an issue, as well. Any lump in the thyroid gland can be a thyroid nodule, which can be either benign, suspicious, borderline, or cancerous-looking. Thyroid nodules mostly are benign, but there are cancerous nodules, too. It is important to recognise, investigate, and remove them.

Hyperthyroidism, hypothyroidism and thyroid nodules are the main kind of disorders of the thyroid gland. In addition, there are also minor abnormalities of the thyroid gland which develop after illness, called non-thyroidal illness or thyroiditis. This illness can be a simple fever, a bacterial illness, or sometimes pregnancy itself. A thyroid disorder that presents after illness needs to be investigated to make sure that the thyroid gland is functioning properly.

How can thyroid disorders affect us?

A dysfunction of the thyroid gland can be either overactive or underactive. There can be borderline overactivity and borderline underactivity, which are technically described as subclinical states. This spectrum of underactivity to overactivity can cause a variety of symptoms, which can be at either end.

Overactive thyroid gland

An overactive thyroid gland can cause:

• Weight loss
• A fast heart rate (called palpitations)
• Tiredness and/or fatigue
• Heat intolerance and/or sweating
• Changes in the menstrual cycle

A severely overactive thyroid gland can also lead to certain medical emergencies, known as a thyroid storm, which require urgent clinical attention and treatment.

If an overactive thyroid gland is left untreated, it can lead to heart rhythm abnormalities like atrial fibrillation, bone conditions like osteoporosis, and even a stroke in the long run.

For this reason, it is important to recognise an overactive thyroid gland right from the very beginning, and check how and why the overactive thyroid gland has come about – for example, is it Graves’ disease or is it a thyroid nodule that is overfunctioning? Both of these disorders have different modalities of treatment. Likewise, it is important to recognise the effects that an overactive thyroid gland is having on the whole body. Graves’ disease, for example, can also affect the eyes, causing thyroid eye disease.

Underactive thyroid gland

An underactive thyroid gland can cause:

• Weight gain
• A slow heart rate
• Tiredness and/or fatigue
• Brain fog and/or cloudiness of memory
• Hair loss and/or brittle nails
• Constipation
• Irregular periods

It is important to investigate an underactive thyroid gland and a borderline underactive thyroid gland to correct any abnormalities that may have developed, and ensure a good, healthy outlook.

Thyroid nodules

Thyroid nodules are very common, and can happen even without the presence of an overfunctioning or an underfunctioning thyroid gland. If they do happen without any overfunction or underfunction, the nodules can be scanned to check that they are benign. If required, sometimes biopsies (called fine needle aspirations) are carried out to ensure that the nodules are not harbouring cancerous cells. Particularly, when there is a family history of thyroid nodules, it is important to recognise the presence of any thyroid nodules and remove them by thyroid surgery to prevent complications in the future.

Minor abnormalities like thyroiditis after viral illness usually recovers, but under certain circumstances, they can cause long-term underactive thyroid function. This needs to be recognised and treated appropriately.

How can thyroid disorders be managed at home?

Thyroid disorders are very common. In some occasions, they can go unrecognised if patients do not have symptoms. Other patients, in contrast, are extremely sensitive to even minor abnormalities in thyroid function, and thus, are able to receive a diagnosis.

It is important to recognise the thyroid disorders that can be managed at home and the thyroid disorders that need to be supervised by a specialist. Certain types of borderline underactive thyroid disorders can be managed at home. However, other disorders like an overactive thyroid, a severely underactive thyroid, and any kind of disorder in between involving complex thyroid nodules, need specialist advice and management.

Of course, a healthy lifestyle is important. A balanced diet with plenty of fruits and vegetables to keep gut microorganisms healthy can prevent future problems from occurring.

Still, autoimmune conditions like thyroid disorders can present at any time without warning, and they will need to be evaluated. The same occurs with thyroid nodules: they will need to be evaluated to check if they are benign or cancerous.

Most underactive thyroid glands can be managed at home under the supervision of a specialist. However, anything above this that remains symptomatic, is an overactive thyroid gland, or is a suspicious-looking thyroid nodule, will need specialist care.

How are thyroid disorders treated? How important is prompt diagnosis and treatment?

A prompt diagnosis is important, not only for a patient’s quality of life but also to prevent future complications.

Overactive thyroid gland

An overactive thyroid gland can be due to an immune disorder called Graves’ disease, which can sometimes also affect the eyes. In addition, an overactive thyroid gland can also be due to an overfunctioning thyroid nodule. On a third aspect, a transient inflammation in the thyroid gland can sometimes cause symptoms.

For this reason, it is important to determine the cause of the disorder, because a Graves’ overactive thyroid can be treated with tablets. Sometimes, it will require higher medication modalities like radioiodine therapy or thyroid surgery.

In some cases, thyroid overfunctioning nodules will remain symptomatic, and will thus need radioiodine therapy or thyroid surgery. The right modality of treatment will be determined by a specialist in conjunction with the patient, taking into account the patient’s age, pre-existing conditions, and history of complications.

Underactive thyroid gland

Treatment will depend on how underactive the thyroid gland is, what are the immune-related issues, how old the patient is, and if there are any co-existing conditions present.

Again, the right modality of treatment will be decided by a doctor in conjunction with the patient. This is because, sometimes patients can remain symptomatic and continue to feel tired and unwell despite treatment with thyroxine. When this occurs, it might be due to associated clinical disorders, such as adrenal gland problems or diabetes, that need to be checked and evaluated.

Thyroid nodules

While most thyroid nodules are benign, it is important to identify every one of them correctly. If a thyroid nodule is indeterminate, then a small biopsy called a needle aspiration cytology may need to be done. If a thyroid nodule is cancerous-looking, then it will need to be removed by surgery. Likewise, some thyroid nodules may be large and quite unsightly, and thus, a cosmetic approach may also need to be considered.

Thus, thyroid nodules require a tailored approach that is adapted to the specific thyroid gland, to the activity of the thyroid gland, and to the patient’s own preferences. All of this needs to be done with the help of a specialist and with the inclusion of good lifestyle measures like smoking cessation, a balanced diet, adequate sleep, and all the lifestyle measures that are important for our day-to-day-life.

Dr Jesse Kumar is a distinguished consultant endocrinologist with over 25 years’ experience.

If you require expert treatment and management for a known or suspected thyroid disorder, do not hesitate to book an appointment with Dr Kumar via his Top Doctors profile today.