HEALTHPLAN MAGAZINE

At the base of the neck, just below where you would find your Adam's apple, there is a small, butterfly-shaped gland located. This is the thyroid. Part of the endocrine system (a complex network of glands) the thyroid gland manufactures hormones that regulate the body's metabolism, controlling everything from digestion, to mood, and energy levels. There are a number of common disorders that affect the thyroid, when it produces too much hormone (hyperthyroidism) or not enough (hypothyroidism).

1. Hashimoto's Disease

Hashimoto's disease, a form of hypothyroidism (also known as chronic lymphatic thyroiditis) commonly occurs among middle-aged women. The body's immune system attacks and slowly destroys the thyroid gland and reduces its ability to produce hormones. In some cases, there are no symptoms and the disease remains stable for years. Common symptoms include:

• Mild weight gain
• Fatigue
• Depression
• Dry skin
• Thinning hair
• Constipation
• Pale, puffy face
• Heavy and irregular menstruation
• Feeling cold
• Poor concentration or feeling mentally "foggy"
• Enlarged thyroid (goiter)

Hashimoto's Treatment

There are blood tests for hormones that screen for any type of thyroid disorder. As Hashimoto's disease is an autoimmune disorder, any blood test would also show abnormal antibodies that might be attacking the thyroid.

While there is no cure for Hashimoto's disease, there is a hormone-replacing medication that can help relieve symptoms. In rare cases surgery removes part or all of the thyroid gland.

2. Graves' Disease

First discovered over 150 years ago, Graves' disease is the most common cause of hyperthyroidism. (overactive thyroid). Again, it is caused when the body's immune system mistakenly attacks the thyroid gland, and hormones that regulate metabolism are overproduced. Graves' Disease is hereditary and can be developed by men or women at any time. It is most common among women aged between 20 to 30, especially those who are pregnant, smoke or who are stressed.

Common symptoms include:

• Fatigue
• Anxiety
• Increased or irregular heartbeat
• Intolerance for heat or excessive sweating
• Increase in bowel movements or diarrhoea
• Irritability
• Insomnia
• Tremors
• Concentration problems
• Changes to menstrual cycle
• Enlarged thyroid (goiter)
• Bulging eyes and vision problems

Graves' Disease Treatment

A doctor can physically examine a patient to find the enlarged thyroid, or bulging eyes, and ascertain signs of increased metabolism, which may mean a rapid pulse and high blood pressure. Blood tests will provide further checks. Radioactive iodine uptake can be administered to check how rapidly the thyroid takes up iodine.

There is no effective treatment to prevent the immune system from attacking the thyroid gland but symptoms can be controlled, including:

• Beta blockers to control rapid heart rate, anxiety, and sweating
• Anti-thyroid medications
• Radioactive iodine to destroy all or part of the thyroid
• Surgery to remove the thyroid gland

Unfortunately, successful treatment for hyperthyroidism results in hypothyroidism meaning hormone-replacement medication has to be administered to the patient from then on.

3. Goiter

Goiter is a noncancerous enlargement of the thyroid gland, most commonly found in those with an iodine deficiency in the diet. Goiter affects people of any age, particularly in areas where iodine-rich foods are in short supply, although more often in women over the age of 40.

The goiter may cause one or more of the following symptoms:

• Tightness or swelling in the neck
• Swallowing or breathing difficulties
• Wheezing and coughing
• Hoarseness

Goiter Treatment

Goiter will be treated when it is severe enough to cause symptoms. Radioactive iodine can shrink the thyroid gland, or surgery will remove all or part of the gland.

4. Thyroid Nodules

Solid or fluid-filled growths on or in the thyroid gland are known as nodules. It is not certain why the nodule form but they can be due to iodine deficiency or Hashimoto's disease. Mainly benign, there is a small risk of cancer. They are more common in women than men, and the risk increases with age.

There are rarely any symptoms, although occasionally there is swelling in the neck, difficulties in swallowing or breathing or some pain. Other symptoms are similar to those of hyperthyroidism:

• Tremors
• Increased appetite
• High pulse rate
• Anxiety or nervousness
• Weight loss
• Clammy skin

Or symptoms can be similar to hypothyroidism and are the same as mentioned on the Hashimoto's disease section above.

Thyroid Nodules Treatment

Nodules can be detected during a normal physical exam or through ultrasound, CT scan, or an MRI. A blood test will check for hyperthyroidism or hypothyroidism. A biopsy can be taken to check whether the nodule is cancerous.

Benign thyroid nodules are not life threatening and therefore don't need treatment. Cancerous nodules are rare and treatment will vary. Surgery to remove the thyroid is one option, or radiation therapy is another. Chemotherapy will be required if the cancer spreads to other parts of the body.

What Is the Outlook for Thyroid Disorders?

Fortunately, in most instances and with good medical care and early intervention, thyroid disorders can be well managed and will not prove life-threatening. While some conditions may require surgery, the outlook is good, and survival rates among cancer patients are good and improving.