Thyroid problems

The thyroid is a butterfly-shaped gland located near the windpipe in the neck. It plays a crucial role in metabolism and growth by producing thyroid hormones. Iodine, an important part of our diet found in iodised salt, bread, fish, and eggs, is necessary for the thyroid to function properly. This mineral is absorbed into the bloodstream and transported to the thyroid, where it is used to produce hormones. 

Thyroid hormones regulate the body's metabolism, which involves converting food into the energy needed for cells to function. This makes the thyroid a vital organ for overall health. 

Underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid conditions are relatively common. Hypothyroidism is more prevalent in women, especially as they age, while hyperthyroidism also affects many people.

Symptoms of hypothyroidism (underactivity) may include: 

• Weight gain 
• Fatigue and low energy 
• Slow heart rate 
• Feeling unusually cold 
• Constipation 
• Hair loss 
• Swollen eyelids and face 
• Enlarged thyroid 
• Hoarseness or voice changes 
• Dry, pale skin 
• Irregular menstrual cycles 
• Trouble concentrating 
• Muscle pain 

Since thyroid hormones circulate throughout the bloodstream, symptoms can appear in various parts of the body, making the condition harder to diagnose if symptoms are mild. 

Symptoms of hyperthyroidism (overactivity) may include: 

• Excessive sweating 
• Fatigue 
• Rapid heartbeat or palpitations 
• Anxiety 
• Weight loss despite normal appetite 
• Diarrhea 
• Tremors 
• Warm, moist skin 
• Bulging eyes 
• Enlarged thyroid 
• Irregular periods 
• Difficulty sleeping 

The causes of hypothyroidism and hyperthyroidism differ. Hypothyroidism is most often due to an autoimmune disorder like Hashimoto’s disease, where the body’s immune system attacks the thyroid, reducing hormone production. Other causes can include thyroid inflammation, surgery, radiotherapy to the neck, medications containing iodine or lithium, or genetic factors. 

Hyperthyroidism is frequently caused by another autoimmune disorder, Graves’ disease, which leads to excess hormone production. Other possible triggers are goitre, medications, inflammation of the thyroid, or growths on the gland itself.

Although you cannot fully prevent thyroid conditions, staying alert to symptoms can help you manage them more effectively. If you're being treated for hypothyroidism, contact your doctor if you notice symptoms such as fatigue, feeling cold, or hair loss. Similarly, if you experience signs of hyperthyroidism, such as anxiety, rapid heartbeat, or weight loss, seek medical advice. Early detection and treatment can prevent complications.

Managing a healthy lifestyle can support thyroid function, but medical treatment is necessary for both hypothyroidism and hyperthyroidism. Women with hyperthyroidism who wish to become pregnant should seek treatment beforehand to reduce risks to the baby. Maintaining a balanced diet and regular exercise can help manage symptoms and improve overall wellbeing. Smokers with hyperthyroidism may be more prone to eye problems, so quitting smoking is advisable.

Diagnosis typically involves blood tests to measure thyroid hormone levels (free T4) and thyroid-stimulating hormone (TSH). Normal free T4 levels range from 9.0 to 24.0 pmol/l, while normal TSH levels are 0.4 to 4.0 mU per litre. Low free T4 and high TSH indicate hypothyroidism, whereas the reverse suggests hyperthyroidism.

Hypothyroidism is commonly treated with Levothyroxine, a synthetic thyroid hormone. If caused by Hashimoto’s disease or treatments like surgery or radioactive iodine, lifelong medication may be necessary. The dosage is typically adjusted gradually, and it is essential to stick to one brand, as different brands can vary in strength.

Hyperthyroidism can be managed with medications, radioactive iodine, or surgery, depending on the severity and other factors like pregnancy plans. Common medications include Thiamazole or Levothyroxine, sometimes in combination with a beta-blocker to manage symptoms such as palpitations. Treatment is monitored regularly, with dosage adjustments as needed. 

Alternatively, a low-dose "titration" approach may be used, guided by a specialist. Treatment with radioactive iodine involves ingesting a solution that targets the thyroid, reducing its activity. Patients should avoid pregnancy for six months following this treatment.

Surgery to remove part of the thyroid is another treatment option for hyperthyroidism. This can relieve pressure on the windpipe and reduce swelling. However, there is a risk of developing an underactive thyroid afterwards, requiring lifelong hormone replacement. Damage to nerves during surgery can also cause permanent hoarseness. 

With both hypothyroidism and hyperthyroidism, it may take several months to adjust to the right medication dose. If you have Graves’ disease, regular blood tests are usually necessary to monitor your condition. About half of the patients who stop medication find their thyroid recovers naturally over time. If symptoms recur, treatment must resume.

Thiamazole may cause nausea, joint pain, or skin rashes, while Levothyroxine can lead to sweating, palpitations, chest pain, or diarrhoea. If you take other medications, inform your doctor, as they can interact with thyroid treatments. 

The main concern with treatments for hyperthyroidism is the potential for the thyroid to become underactive over time, necessitating ongoing hormone replacement.