Fitness and health 2.8.2016 03:47 pm

Thyroid disorders: more than an itchy throat

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

Dr Dulcy Rakumakoe. Picture: Refilwe Modise

Each individual patient may have any number of these symptoms, which will vary with the severity of the thyroid hormone deficiency.

WHAT IS A THYROID?

The thyroid gland is a butterfly-shaped gland in the front of the neck. It is located below the Adam’s apple wrapped around the trachea (windpipe). It has two lobes with a thin area of tissue in the gland’s middle, known as the isthmus, joining them on each side. The thyroid uses iodine to produce vital hormones.

Thyroxine, also known as T4, is the primary hormone produced by the gland. After delivery via the bloodstream to the body’s tissues, a small portion of the T4 released from the gland is converted to triiodothyronine (T3), which is the most active hormone. The function of the hormones is to regulate numerous metabolic processes throughout the body.

The production of these hormones is regulated by a feedback mechanism involving the brain. When thyroid hormone levels are low, the hypothalamus in the brain produces a hormone known as thyrotropin releasing hormone (TRH) that causes the pituitary gland (located at the base of the brain) to release thyroid stimulating hormone (TSH). TSH stimulates the thyroid gland to release more T4.

Since the thyroid gland is controlled by the pituitary gland and hypothalamus, disorders of these tissues can also affect thyroid function and cause thyroid problems. The most common thyroid problems involve abnormal production of thyroid hormones. Too much thyroid hormone results in a condition known as hyperthyroidism. Insufficient hormone production leads to hypothyroidism.

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 goitre (enlarged gland) that needs no treatment, to life-threatening cancer. Although the effects can be unpleasant or uncomfortable, most thyroid problems can be managed well if properly diagnosed and treated.

Hyperthyroidism, particularly Graves’ disease, tends to run in families and is more common in women than in men. If another member of your family has a thyroid condition, talk with your doctor about what this may mean for your health and whether he or she has any recommendations for monitoring your thyroid function.

SIGNS AND SYMPTOMS

1. Hyperthyroidism: The body metabolism speeds up and causes symptoms that are common to hyperthyroidism, when there’s a high level of thyroid hormone in the bloodstream.

Symptoms include:

  • Anxiety
  • Irritability
  • Fatigue
  • Hand tremors
  • Increased or irregular heartbeat
  • Excessive sweating
  • Difficulty sleeping
  • Diarrhoea or frequent bowel movements
  • Altered menstrual cycle
  • Enlarged thyroid (goitre) – seen as swelling in the front of the neck
  • Breathing or swallowing difficulties
  • Bulging eyes; vision problems
  • Increased appetite with weight loss

2. Hypothyroidism: It is now understandable that people with this condition will have symptoms associated with a slow metabolism which include:

  • Fatigue
  • Weakness
  • Weight gain or increased difficulty losing weight
  • Coarse, dry hair
  • Dry, rough pale skin
  • Hair loss
  • Cold intolerance (you can’t tolerate cold temperatures like those around you)
  • Muscle cramps and frequent muscle aches
  • Constipation
  • Depression
  • Irritability
  • Memory loss
  • Abnormal menstrual cycles

Decreased libido: Each individual patient may have any number of these symptoms, and they will vary with the severity of the thyroid hormone deficiency or excess and the length of time the body has been having the condition. As you see some of the symptoms appear in both hypothyroidism and hyperthyroidism. One may have one of these symptoms as the main complaint, while another will not have that problem at all and will be suffering from an entirely different symptom.

Most people will have a combination of these symptoms. Occasionally, some patients have no symptoms, or they are so subtle that they go unnoticed. If you have any of these symptoms, you need to discuss them with your doctor.

CAUSES

  • Hyperthyroidism: All types of hyperthyroidism are due to an overproduction of thyroid hormones, but the condition can occur in several ways:
  • Graves’ disease: The production of too much thyroid hormone by the gland.
  • Toxic adenomas: Nodules develop in the thyroid gland and begin to secrete thyroid hormones, upsetting the body’s chemical balance; some goitres may contain several of these nodules.
  • Subacute thyroiditis: Inflammation of the thyroid that causes the gland to produce excess hormones, resulting in temporary hyperthyroidism that generally lasts a few weeks but may persist for months.
  • Pituitary gland malfunctions or cancerous growths in the thyroid gland: Although rare, hyperthyroidism can also develop from these causes.
  • Hypothyroidism: This happens because of 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 levels.

Causes of hypothyroidism include:

Hashimoto’s thyroiditis: This is an autoimmune disorder where the body attacks its own thyroid tissue. The thyroid tissue eventually dies and stops producing hormones.

Removal of the thyroid gland: The thyroid may have been surgically removed or chemically destroyed.

Exposure to excessive amounts of iodide: This can happen from exposure to cold and sinus medication, the heart medicine amiodarone, or certain contrast dyes given before some X-rays may expose you to too much iodine.

Lithium: This drug used to treat mental illness has also been implicated as a cause of hypothyroidism.

A defective thyroid gland or lack of it entirely: Seen in infants and newborns. Hypothyroidism is especially a danger to newborns and infants. 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.

A hypothyroid infant is unusually inactive and quiet, has a poor appetite, and sleeps for excessively long periods of time. Cancer of the thyroid gland is quite rare and occurs in about 5% of thyroid nodules.

COMPLICATIONS

Hyperthyroidism

Untreated hyperthyroidism can lead to serious complications, mainly related to the heart. When you have hyperthyroidism, your body is, in a way, running on overdrive all the time which can greatly affect your heart. Some possible heart-related complications of uncontrolled hyperthyroidism are: arrhythmia (abnormal heart beat, such as atrial fibrillation), cardiac dilation (increase in the size of the heart cavities, which thins the heart muscle), congestive heart failure, sudden cardiac arrest and hypertension.

You may also get osteoporosis. Hyperthyroidism also puts you at risk of thyrotoxic crisis — a sudden intensification of symptoms, leading to a fever, a rapid pulse and even delirium. If this occurs, seek immediate medical care.

HypOthyroidism

Because the body is expecting a certain amount of thyroid hormone the pituitary will make additional thyroid stimulating hormone (TSH) in an attempt to entice the thyroid to produce more hormone. This constant overproduction of TSH may cause the thyroid gland to become enlarged and form a goitre (termed a “compensatory goitre”).

If not treated, the symptoms of hypothyroidism will usually progress. Rarely, complications can result in life-threatening depression, heart failure, or coma. Hypothyroidism is completely treatable simply by taking a pill once a day. However, there are several types of thyroid hormone preparations and one type of medicine is not the best for all patients. So it is important to speak to your doctor. The complications can be life threatening.

LIFESTYLE CHANGES

See your doctor so medical treatment can be started immediately. Once you begin treatment, the symptoms should subside and you should start feeling much better. The following suggestions also may help:

1. Hyperthyroidism

Diet supplements: If you’ve lost a great deal of weight or experienced muscle wasting, you may benefit from adding extra calories and protein to your diet. Your doctor or a dietitian can help you with meal planning. Treatment for hyperthyroidism can also eventually contribute to excessive weight gain, so combine with exercise.

It is important to learn how to get as much nutrition as possible from your food without eating a lot of extra calories. In addition, eating the correct amount of sodium and calcium are important dietary considerations for people with hyperthyroidism.

Get enough calcium and vitamin D: Because hyperthyroidism may contribute to thinning bones, it’s important to get enough calcium every day to help prevent osteoporosis. Talk to your doctor about appropriate dietary guidelines for you.

Eye problems: Apply cool compresses to your eyes. The extra moisture may provide relief. Wear sunglasses. When your eyes protrude, they’re more vulnerable to ultraviolet rays and more sensitive to sunlight. Wearing sunglasses helps protect them. Use lubricating eyedrops to relieve dryness and scratchiness. Be sure to use eyedrops that don’t contain redness removers.

Because your eyelids may not cover the entire eye when sleeping, a lubricating gel can be used to prevent the cornea from drying out. Elevate the head of your bed. Keeping your head higher than the rest of your body may reduce swelling and may help relieve pressure on your eyes.

Skin problems: Over-the-counter creams containing hydrocortisone may help relieve red, swollen skin on your shins and feet.

2. Hypothyroidism

  • There is no substitute for getting a proper diagnosis and starting hormone replacement treatment if you have hypothyroidism, but leading a healthier lifestyle will help you feel better faster. Try these five easy tips to implement lifestyle changes:
  • Eat a healthy diet: Eat small, nutrient dense meals throughout the day to keep your engine revved.
  • Shape-up: Regular physical activity will boost your energy, help with weight loss and lower your stress levels. Aim for 150 minutes of moderate-intensity aerobic activity every week.
  • De-stress: Stress can make hypothyroidism worse, but taking steps to change how you cope with it can make a big difference in how you feel. Yoga, meditation, deep breathing, or just chilling out to some relaxing music can all help reduce stress and anxiety.
  • Sleep more soundly: Even though you are dragging through the day, it can be hard to fall and stay asleep at night if you have hypothyroidism. Set and stick to a regular wake and bedtime, keep your bedroom cool, cold and cave-like, and avoid caffeine after 2pm.
  • Generally take care of your health: Do everything you can to stay healthy. This includes staying up to date with doctor visits and screening tests.

 

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