The thyroid is an often overlooked component of your metabolism. Yet when it is out of whack, it can cause noticeable and often troublesome problems, ranging from weight, temperature, and mood fluctuations to shifts in energy levels and hair loss.

The thyroid is a small, butterfly-shaped gland located in the front of the neck, just below the larynx (i.e., Adam’s Apple) and above the collarbone. It is made up of two lobes and a middle part known as the isthmus. The thyroid is directly responsible for the metabolism of every cell in the body, and is involved with temperature, blood pressure, and weight.

Thyroid Disorders and Their Symptoms

Abnormalities in the thyroid are referred to as nodules or goiter and often occur in the thyroid lobes, although they can also occur in the isthmus. Goiter is an enlargement of the thyroid gland. It can be smooth or nodular.

Generally, thyroid nodules are painless, but a sore throat or tenderness in the neck may be present. Swallowing may also be difficult, although this is not common.

Various complications can arise when the thyroid is not functioning properly. An underactive thyroid (hypothyroidism) causes many symptoms including fatigue, dry skin, constipation, depression, and weight gain. Hyperthyroidism (overactive thyroid) likewise causes myriad manifestations, such as irritability, racing heart with awareness of the beat (palpitation), increased perspiration, anxiety, and insomnia.

Another thyroid complication is Hashimoto’s thyroiditis, in which the body’s immune system attacks the thyroid gland, eventually destroying it. Another complication, Graves’ Disease, also causes the immune system to attack the thyroid as if it is a foreign object in the body. But rather than destroying the thyroid, Graves’ disease causes it to produce too much thyroxine, eventually resulting in hyperthyroidism.

A thyroid nodule may be classified as a “toxic nodular goiter,” in which the nodule itself causes symptoms of hyperthyroidism. Masses that appear as nodules may simply be fluid-filled cysts. Because of the problems thyroid abnormalities can cause, changes in metabolism or neck masses should be evaluated promptly by an endocrinologist.

Along with a physical exam, blood will be drawn to determine thyroid function and whether thyroid antibodies are present. The presence of thyroid antibodies can indicate Hashimoto’s thyroiditis or Graves’ disease.

According to the National Cancer Institute, more than 90 percent of thyroid nodules are non cancerous. However, cancer is still a possibility and because this form is highly treatable, it is important that all thyroid nodules be examined promptly.

Diagnosis and Treatment

Thyroid problems should be evaluated by an endocrinologist. The first step to confirming a thyroid problem is a simple external examination. This involves feeling the neck in the thyroid area to see if it is enlarged or tender, or if a nodule is present. A physician will usually feel the thyroid while standing behind the seated patient, perhaps asking the patient to swallow. If the nodule is part of the thyroid, it will move up and down along with it.

For some people, nodules are easy to detect and may be seen externally, appearing as a pronounced lump in the neck. For others, the nodules may not be apparent until an ultrasound is performed, often for an unrelated problem. Nodules can also vary in size, with some growing quite large and others staying small.

The thyroid may be diffusely, smoothly enlarged (a diffuse goiter). Size may not be an indicator of severity. However, if the lump is growing rapidly, you should immediately see an internist or endocrinologist for evaluation.

An ultrasound may be administered to determine its make-up and whether treatment is necessary. A thyroid scan and iodine uptake scan may also be used to evaluate overall thyroid functioning.

The thyroid scan makes an image of the thyroid, which is used to determine thyroid size and function. An iodine uptake scan measures how well the thyroid gland absorbs iodine over a 24-hour period, which helps in the diagnosis of hypothyroidism or hyperthyroidism.

What You can Do

In addition to regular medical checkups, consult a physician if you have significant shifts in weight, mood, energy levels or other areas that could indicate a thyroid problem. Immediately see your doctor if you have swelling or lumps in your neck.

If you have been diagnosed with a thyroid condition, gather as much information as possible, including asking for second opinions if you are concerned about treatment. Consult a physician who is knowledgeable in thyroid blood testing, causes of thyroid nodules, and conditions such as thyroiditis, hyperthyroidism, and hypothyroidism.

Diona L. Reeves
Consultant Online Health Resources

Resources

American Thyroid Association, 6066 Leesburg Pike, Ste. 550, Falls Church, Virginia 22041; 703-998-8890; www.thyroid.org

Internet Resources

Thyroid Diseases, Medline Plus, www.nlm.nih.gov/medlineplus/thyroiddiseases.html

Thyroid Tests, WebMD, www.webmd.com/a-to-z-guides/thyroid-hormone-tests

Thyroid Gland Function, www.endocrineweb.com/tests.html