Thyroid Conditions

Thyroid.  For many of us, the word conjures up a sense of curiosity, wonderment, even awe!  What is the thyroid gland and what exactly does it do?  How do you know if you’ve got a thyroid problem? 

Let’s start with the basics. The thyroid gland is a small, butterfly shaped gland that sits in the base of your neck.  It makes thyroid hormones (thyroxine and triiodothyronine) which regulate your metabolism.  Metabolism is a series of processes that control how your body creates and uses energy.  So…why do we hear so much about thyroid and thyroid dysfunction?  Well, it turns out that there are some pretty common illnesses that can affect thyroid health.   

A thyroid hormone deficiency is a state called HYPOTHYROIDISM.  You may have this if your thyroid gland is the target of an autoimmune attack (this is called Hashimoto’s disease) or if you’ve had your thyroid gland irradiated or surgically removed.  Since thyroid hormone is your source of metabolism, untreated hypothyroidism can cause a multitude of symptoms: fatigue, lethargy, weight gain, dry skin, depression,  constipation, hair loss, cold intolerance, irregular menstrual cycles in women-these are all symptoms of slowed metabolism. The solution is simple-take thyroid hormone replacement which comes as an oral supplement.

A thyroid hormone excess is a state called HYPERTHYROIDISM. You may have this if your gland is the target of an autoimmune attack (this is called Graves disease) or if you thyroid gland grows renegade chunks of thyroid tissue that lose the ability to regulate the amount of thyroid hormone they produce.  These so called “hot nodules” manufacture extra thyroid hormone without your body’s permission.  Finally, you can develop hyperthyroidism if your thyroid gland becomes acutely injured – an injured thyroid gland sheds pre-formed thyroid hormone.   This is called a thyroiditis. Medications, autoimmune attacks, viruses and pregnancy can cause thyroiditis.   Hyperthyroidism can also cause of multitude of symptoms: rapid heart rate, weight loss, tremors, palpitations, frequent and loose stools, anxiety, irregular menstrual cycles in women-these are all symptoms of accelerated metabolism.  The solution is not quite as straightforward as it is for a hypothyroid state but a hyperthyroid state can certainly be treated. Depending on the underlying cause, a hyperthyroid state can be treated with surgery (removal of the thyroid gland), medications, or irradiation. In some cases of thyroiditis, the thyroid gland heals on its own.

The thyroid gland is also prone to structural illnesses. Thyroid glands often grow NODULES – a thyroid nodule is an abnormal growth of thyroid cells that forms a lump within the thyroid gland.  While the  vast majority of nodules (probably more than 95%) are benign, some nodules do contain cancers within them so timely evaluation is important.  Thyroid ultrasound is an important tool used to assess nodule size and characteristics.  If necessary, a thyroid fine needle aspiration biopsy can be done to assess the potential for malignancy.  This is a relatively easy and straightforward procedure that can done in the physician’s office with the aid of an ultrasound machine.

Finally…a word about thyroid hormone replacement.  Oral thyroid hormone supplementation comes in various forms:

One synthetic version of thyroid hormone is called Levothyroxine-this is synthetic thyroxine also known as T4. There are several branded versions of Levothyroxine: Synthroid, Levoxyl, Unithroid, Tirosint are some common ones.  Generally speaking, branded levothyroxine preparations are usually consistent in terms of potency from batch to batch. Generic formulations may not be as consistent so your provider may specify a branded version.

Another synthetic version of thyroid hormone is called Liothyronine.  This is synthetic triiodothyronine also known as T3. The most common branded version of Liothyronine is called Cytomel.  Liothyronine is absorbed in a more rapid fashion and some patients report an increased sense of well-being when it is used in combination with Levothyroxine.  Although the guidelines published by the ATA (American Thyroid Association) conclude that Levothyroxine should remain the standard of treatment for hypothyroidism, many physicians do prescribe combination therapy with Levothyroxine and Liothyronine in patients who may not feel as well on Levothyroxine monotherapy.

The nonsynthetic version of thyroid hormone is dessicated animal thyroid extract.  This is exactly what it sounds like-it’s thyroid hormone extracted from the thyroid glands of animals-most commonly, pigs. Animal thyroid extracts were first used to treat hypothyroidism in the late 19th century but became largely replaced by synthetic versions.  One concern: animal thyroid extracts have more T3 in relation to T4 compared to the ratio produced by a healthy human gland.  T3 may place a more potent metabolic demand on the heart and in some individuals can precipitate dangerous heart rhythms. For this reason, your provider may be reluctant to prescribe this type of thyroid hormone if you are older and/or have an underlying heart condition.

In addition to thyroid health, there are numerous factors that contribute to a person’s physical and mental sense of well-being, or lack thereof.  Among these factors: diet and sleep patterns, coexisting disease states, relationships with other human beings, the quality of the surrounding environment, the ability to navigate stress, etc…. When we feel unwell, we are best served to step back and take a look at the big picture.  Because while the thyroid gland is indeed a powerful factory of thyroid hormone production and thyroid hormone itself is an incredibly capable hormone, the thyroid is only one small part of a much more complex and sophisticated piece of machinery we call the human body. 

If you have been thinking of having your thyroid levels checked out the endocrinologists at Texas Diabetes can help walk you through the process. When you trust Texas Diabetes & Endocrinology with your thyroid condition, you are assigned your own, personal team of carers who will get to know you and tailor a treatment plan that fits your individual needs.

Schedule your appointment with us today.

Hashimoto’s…What the heck is that?

Looking online about a medical diagnosis can be overwhelming. A quick Google search about your thyroid condition might lead you down a rabbit hole where things get pretty grim, pretty fast. So what is this mystery diagnosis of Hashimoto’s? Simply put, it’s the name of the condition where your immune system turns against you and attacks your thyroid. It is the most common cause for someone to need to take a thyroid supplement – hypothyroidism.
Your immune system normally does a fantastic job of keeping your body safe from foreign “attacks” like bacterias and viruses. In some individuals, their immune system is tricked into attacking their own body. As a result, the target organ can be destroyed to the point that it no longer works properly. There are a number of conditions that follow this pattern but seem different because different organs are attacked. For instance, if the immune system targets your joints, you get rheumatoid arthritis, your pancreas – type 1 diabetes. All of these “autoimmune diseases” are interrelated and often times hereditary. This is why various members of the same family can present with a variety of autoimmune diseases. Experts do not know why or how the immune system gets activated but the gradual and eventual destruction of the thyroid can lead to devastating consequences for the patient.
The thyroid gland sits in the lower, front part of your neck and its purpose is to make thyroid hormone. This hormone serves to control the metabolic rate of almost all of the organs in your body. It controls processes as diverse as the rate at which the heart beats, the stomach digests food, the brain processes memories and learning, to the condition of your skin, hair and nails. When the thyroid is partially or completely destroyed, the lack of thyroid hormone will make an individual feel tired, constipated, forgetful, have dry skin or brittle nails. Each individual will present in their own unique way. The symptoms can be subtle or get worse gradually. This makes the diagnosis difficult to come by at times.
Your doctor at Texas Diabetes and Endocrinology can run a series of blood tests to see the status of your thyroid levels. At times, we can determine if your immune system is making antibodies that are attacking your thyroid. Lastly, an ultrasound of your thyroid can sometimes be useful to see if your thyroid is healthy or if there is a problem.
Sometimes, Hashimoto’s can flare up and seemingly get worse. When this occurs, patients can experience the fatigue and other symptoms that first alerted them to the condition. Your doctor might need to increase or adjust your medication so that you can return to feeling back to normal again.

Thyroid Nodules Are Common

Depending on the reference about 7% of incidentally noted thyroid nodules are found to be from thyroid cancer. The increase in imaging procedures (MRI, CT scans, neck ultrasounds) are finding many “incidental” thyroid nodules that we might not have otherwise detected on the physical exam. The vast majority of thyroid nodules are benign, however, the risk for cancer is real. With the increased detection of thyroid nodules, it is especially important to better identify the true cancer risk of these nodules. This can help us to avoid unnecessary surgery for nodules that are likely benign but cannot be clearly designated as such on the basic pathology report, as well as help to identify nodules that are especially high risk that may warrant a different surgical approach. Here at Texas, Diabetes and Endocrinology, we can offer this genetic analysis of your thyroid cells with samples obtained during the standard thyroid biopsy. We continue to always look forward in your treatment as the science and research of thyroid nodules and thyroid cancer becomes ever more focused on genetic analysis.

American Thyroid Association Releases New Guidelines

The American Thyroid Association released their new Guidelines for managing thyroid nodules and differentiated thyroid cancer. The long-awaited guidelines incorporate new findings from a wide range of studies into 101 recommendations. Main areas that have seen major updates include role of molecular markers in diagnosis, imaging frequency for follow-up, indications for I-131 treatment, risk assessment / prognosis, and treatment of advanced disease. The guidelines are here: http://online.liebertpub.com/doi/pdfplus/10.1089/thy.2015.0020