Thyroid Problems

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Through the hormones it produces, the thyroid gland influences almost all of the metabolic processes in your body. Thyroid disorders can range from a small, harmless goiter that needs no treatment to life-threatening cancer. The most common thyroid problems involve irregular production of thyroid hormones. Too much of these vital body chemicals results in a condition known as hyperthyroidism. Insufficient hormone production leads to hypothyroidism. The four parathyroid glands, located at the four axes of the thyroid gland, function independent of the larger gland and are responsible for regulating blood levels of calcium, necessary for the growth and maintenance of bones and teeth. Imbalances in their hormone secretion can result in hyperparathyroidism or hypoparathyroidism, which in turn can adversely affect bone development. Although the effects can be unpleasant or uncomfortable, most thyroid problems are not serious if properly diagnosed and treated.

Causes

All types of hyperthyroidism are due to an over-production of thyroid hormones, and the condition can occur in several ways: In Graves' disease, the release of excess hormones is triggered by an autoimmune disorder. At other times, nodules called toxic adenomas develop in the thyroid gland and begin to secrete thyroid hormones, altering the normal flow and upsetting the body's chemical balance; certain goiters may contain several of these nodules. In subacute thyroiditis, inflammation of the thyroid causes the gland to "leak" excess hormones, resulting in temporary hyperthyroidism. Although rare, hyperthyroidism can also develop from pituitary gland malfunctions or from cancerous growths in the thyroid gland.

Hypothyroidism, by contrast, stems from an underproduction of thyroid hormones. Since your body's energy production requires certain amounts of thyroid hormones, a drop in hormone production leads to lower energy production. A common cause of hypothyroidism is Hashimoto's thyroiditis, an autoimmune disorder in which white blood cells gradually replace thyroid tissue, which then comes under attack by immune-system proteins called antibodie. Hypothyroidism can also result when the thyroid gland has been surgically removed or chemically destroyed as treatment for hyperthyroidism. And if you are exposed to excessive amounts of iodide-perhaps from a hidden source such as cold and sinus medicines, or from certain medical tests-you may be at greater risk for developing hypothyroidism, especially if you have had thyroid problems in the past. Unlrcated for long periods of time, hypothyroidism can bring on a myxedema coma, a rare but potentially fatal condition that requires immediate hormone injections.

Hypothyroidism poses a special danger to newborns and infants, as a lack of thyroid hormones in the system at an early age can lead to the development of cretinism (mental retardation) and dwarfism (stunted growth). Most infants now have their thyroid levels checked routinely soon after birth; if they are hypothyroid, treatment begins immediately. In infants, as in adults, hypothyroidism can be due to a pituitary disorder, a detective thyroid, or lack of the gland entirely. A hypothyroid infant is unusually inactive and quiet, has a poor appetite, and sleeps for excessively long periods of time.

Although cancer of the thyroid gland is the most common endocrine malignancy other than ovarian cancer, it is still quite rare. You might have one or more thyroid nodules for several years before they are determined to be cancerous. People who have received radiation treatment to the head and neck earlier in life, possibly as a remedy for acne, tend to have a higher-than-normal susceptibility tothyroid cancer.

Diagnostic and Test Procedures

A doctor can diagnose hyperthyroidism and hypothyroidism by looking at the levels of certain hormones in your blood. Doctors usually take readings of hormones secreted by the thyroid it-self, and also of thyroid-stimulating hormone (TSH), a chemical released by the pituitary gland to trigger hormone production in the thyroid.

When you are hypothyroid, higher quantities of TSH are circulating in your blood as your body attempts to foster increased production of thyroid hormones; the reverse is true with hyperthyroidism, in which TSH levels are below normal and circulating thyroid-hormone levels are high.

To determine the cause of hyperthyroidism, doctors often use radioactive iodide uptake tests, which track the amount of iodide absorbed by the thyroid gland during a set time period. Iodide is a key ingredient in the manufacture of thyroid hormone, so the amount of iodide the thyroid absorbs is a reliable indicator of how much hormone the gland is producing. For this test, you must swallow a small amount of radioactive iodide in liquid or capsule form. After a predetermined wait, the doctor places an instrument over your neck to measure how much of the radioactive iodide has gathered in your thyroid.

If the results of this test suggest that the gland is collecting excessive amounts of iodide, the doctor may then conduct a radioactive iodide up take scan. I n this test, the physician uses a special film to create a picture that shows the exact location of the radioactive iodide in your thyroid gland. The scan will reveal, for example, if the iodide is collecting in adenomas, indicating that the nodules are responsible for the excess hormone. If the scan shows that the iodide is spread equally throughout the tissue, the whole thyroid is involved in the excess production.

Some practitioners believe that blood tests may not be sensitive enough to detect milder forms of hypothyroidism. Instead, they advocate monitoring your body's basal (resting) temperature. To track your basal temperature accurately, you must closely follow certain guidelines: Shake the thermometer below 95°F at night and place it where you can reach it without getting out of bed. The following morning, before you get out of bed, take your temperature via your armpit for 10 minutes while staying as still as possible. Keep records of your temperature for at least three days. (Women should do this during the first two weeks of the menstrual cycle, as their basal temperature may rise during the latter half.) Normal body basal temperatures fall between 97.4°F and 97.8°F. If your basal temperature is consistently low, you could be mildly hypothyroid.

If you have one or more adenomas, your practitioner will want to keep careful records of when they were first found and how they develop, since not all adenomas produce excess thyroid hormone. In fact, most of these nodules are not malignant, especially if they remain the same size over long intervals. (Cancerous tissue, by contrast, will undergo noticeable growth.) Nodules that appear suddenly are typically fluid-filled cysts and are often benign. If blood tests indicate that the nodules are producing excess thyroid hormone, and if you have other symptoms, your practitioner will treat you for hyperthyroidism.

In any case, you should receive periodic checkups if you have a nodule on your thyroid gland, since you may become hyperthyroid in the future. If your blood tests show elevated hormone levels, your doctor may recommend other tests, including radioactive iodide uptake tests and scans that indicate whether the nodules are "hot" or "cold." Hot nodules, or those that are actively trapping iodide, are rarely cancerous. But cold nodules-those showing low iodide con-centrations-indicate a possible malignancy and need to be investigated further.

One type of thyroid cancer can be diagnosed through a simple blood test that measures levels of a hormone involved in bone formation. In most cases, however, doctors check for thyroid cancer by performing a biopsy, which involves drawing cells from the suspect nodule with a fine needle to determine if the tissue is malignant.

Treatment

For thyroid disorders stemming from the over- or underproduction of thyroid hormones, both conventional and alternative treatments offer varied methods to restore hormone levels to their proper balance. Conventional treatments rely mainly on drug therapy and surgery. Alternative treatments attempt to relieve some of the discomfort associated with thyroid conditions, or to improve the function of the thyroid gland through a variety of approaches ranging from diet supplements and herbal remedies to lifestyle changes and special exercises. You should always receive a professional evaluation for any thyroid disorder; most of these conditions require a course of treatment beyond the scope of home care alone.

Conventional Medicine

Treating hyperthyroidism requires suppressing the manufacture of thyroid hormone, while hypothyroidism demands hormone replacement. Conventional medicine offers extremely effective techniques for lowering, eliminating, or supplementing hormone production. Before deciding which therapy is best for you, your doctor will make an evaluation based on your particular thyroid condition as well as your age, general health, and medical history.

Thyroid hormone production can be sup-pressed or halted completely with a radioactive iodide treatment, antithyroid medication, or surgery. If your doctor decides that radioactive treatment is best, you will be asked to swallow a tablet or liquid containing radioactive iodide in amounts large enough to damage the cells of your thyroid gland and limit or destroy their ability to produce hormones. Occasionally more than one treatment is needed to restore normal hormone production, and many patients actually develop hypothyroidism as a result of this procedure.

If you start using antithyroid medications such as propylthiouracil or methimazole, which are usually administered in tablet form, your hyperthyroid symptoms should begin to disappear in about six to eight weeks, as hormones already in your system run out and the medication starts to impair the thyroid's hormone production. However, you will need to continue taking the medication for about a year. After that time, you will also need to receive periodic medical exams to make sure that the condition has not returned.

Surgery is often recommended for people under 45 when their hyperthyroidism is due to toxic adenomas, since these nodules tend to be resistant to radioactive iodide. Once the tissue is removed surgically, hormone levels typically re-turn to normal within a few weeks.

Although subacute thyroiditis can bring on temporary hyperthyroidism, this condition usually does not require medical treatment, and any pain associated with the inflamed thyroid can generally be alleviated with acetaminophen or aspirin. If over-the-counter drugs don't help, a physician may prescribe prednisone or dexamethasone for a short period of time. Since both of these drugs may encourage the development of stomach ulcers and the loss of bone mass, however, ask your doctor it you should also be taking calcium supplements.

Hypothyroidism calls for a lifelong regimen of hormone replacement therapy. No surgical techniques or conventional drugs can increase the thyroid's hormone production once it slows down. Although hormones from animal extracts are available, doctors generally prescribe synthetic forms of thyroid hormone, such as levothyroxine. Side effects are rare, but some patients experience nervousness or chest pain while taking these drugs; usually, adjusting the levels of medication will alleviate any unpleasant effects. However, if you are also taking tricyclic antide-pressants, anticoagulant drugs, or digitalis, or if you have diabetes, make sure that you and your Practitioner discuss any possible interactions or other complications.

Thyroid cancer is usually treated by surgically removing either the cancerous tissue or the whole thyroid gland, a procedure known as a thyroidectomy. If the cancer has spread beyond the thyroid, any other affected tissue, such as the lymph glands in the neck, will also be removed.

Alternative Choices

Though the alternative choices available to you for thyroid problems will not completely suppress or replace thyroid hormones, they at e often used to strengthen the thyroid itself or to alleviate some of the unpleasant symptoms.

Chinese Herbs

Several herbal mixtures may help relieve symptoms in cases of hyperthyroidism: baked licorice (Glycyrrhiza Lit-alensis) combination, hupleurum (Bupleurum (chinense) and dragon hone combination, or hupleurum and peony combination.

Herbal Therapies

For relief from the symptoms of hyperthyroidism, try 4 parts bugleweed (Lycopus spp.), 2 parts motherwort (Leonurus carcliaca), 2 parts skullcap (Scutellaria spp.), and 1 part hawthorn (Crataegus spp.) in a tincture three times a day.

For insomnia due to hyperthyroidism, combine equal parts of valerian (Valeriana officinalis) and passionflower (Passiflora incarnata) in a tincture and take halt an hour before bedtime.

In the case of hypothyroidism, you can prepare a tea made from bladder wrack (Fucus vesiculosus) to improve thyroid function. Three times daily, pour 1 cup boiling water on 2 tsp bladder wrack and steep for 10 minutes before drinking. Bladder wrack can also betaken in cap-sule form three times daily.

Lifestyle

Aerobic exercise for 15 to 20 minutes a day is excellent for maintaining good thyroid function. Regular physical activity is especially important if you are hypothyroid. (Check with your doctor before starting an exercise program.)

Nutrition and Diet

For hypothyroidism, avoid cabbage, peaches, rutabagas, soybeans, spinach, peanuts, and radishes, as these foods can interfere with the manufacture of thyroid hormones. Supplements of vitamin C, vitamin E, riboflavin (vitamin B2), zinc, niacin (vitamin B3), pyridoxine (vitamin B6,), and tyrosine might help boost thyroid production. However, if you have hyperthyroidism, eating the foods listed above might help lower your body',, production Of thyroid hormone.

Yoga

For many people, the Shoulder Stand position, at least once daily for 20 minutes, can help improve overall thyroid function. Lie on your back and lift your legs up so your hips are oft the floor. Sup-Porting your hips with your hands, extend your legs vertically.

Slide your hands along your torso toward your shoulders, with your thumbs at the front of your body and fingers at the back. Make sure your body weight is supported by your shoulders, not your head and neck.

Symptoms

Hyperthyroidism:

weight loss despite increased appetite.
increased heart rate, higher blood pressure, and increased nervousness, with excessive perspiration.
more frequent bowel movements, sometimes with diarrhea.
muscle weakness, trembling hands. development of a goiter.

Hypothyroidism:

lethargy, slower mental processes. reduced heart rate.

increased sensitivity to cold. tingling or numbness in the hands. development of a gaiter.

Subacute Thyroiditis:

mild to severe pain in the thyroid gland.
the thyroid feels tender to the touch.
pain when swallowing or turning your head.
appearance of these symptoms shortly after a viral infection, such as the flu, mumps, or measles.

Call Your Doctor If :

you are feverish, agitated, or delirious, and have a rapid pulse; you could be having a thyrotoxic crisis, a sudden and dangerous complication of hyperthyroidism.

you feel intensely cold, drowsy, and lethargic; you could be experiencing a myxedema coma, a sudden and dangerous complication of hypothy-roidism that can cause unconscious-ness and possibly death.

Submitted By
P A Daley Md

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