Hormone, Thyroid, Diabetes, and Medicine Specialist

The thyroid gland is a vital endocrine gland located in the front part of the neck. It is the primary gland responsible for producing metabolic hormones in the human body. Another hormone called TSH (Thyroid Stimulating Hormone), secreted by the pituitary gland inside the brain, helps the thyroid gland produce its main active hormones.

One of the important functions of thyroid hormones is to increase the body's metabolic rate or basal metabolic rate. Another crucial role is the maturation of the nervous system. Therefore, a deficiency of thyroid hormone during pregnancy can result in the baby being intellectually impaired or not developing intelligence properly. Various stimuli such as puberty, pregnancy, or physical stress can cause changes in the size or function of the thyroid gland.

Thyroid gland problems mainly fall into two categories: structural and functional. These may manifest in different ways.

Structural problems include enlargement of the thyroid gland, known as goiter, which has various types. The gland may also develop nodules (thyroid nodules) or thyroid cancer.

Functional problems are mainly of two types: overactive thyroid or hyperthyroidism, and underactive thyroid or hypothyroidism. The gland can also become inflamed, a condition called thyroiditis.

Hyperthyroidism (Overactive Thyroid)

In hyperthyroidism, the thyroid gland becomes excessively active. Symptoms include:
 Feeling excessively hot and sweating in hands and feet.
 Digestive issues, weight loss despite normal or increased appetite, frequent bowel movements.
 Heart and lung problems such as palpitations, increased heartbeat, heart failure, angina, or chest pain.
 Nervous system and muscle issues like fatigue or nervousness, irritability, emotional disturbances, psychosis or depression; trembling hands and feet, muscle and eye muscle weakness.
 Additionally, bone loss (osteoporosis), menstrual problems, and even infertility may occur.

Causes of Hyperthyroidism:
a) Graves' disease: an autoimmune disorder that can also affect the eyes, causing them to bulge.
b) Multinodular goiter.
c) Autonomously functioning solitary thyroid nodule.
d) Thyroiditis (inflammation of the thyroid gland).
e) Excess thyroid hormone production from sources outside the thyroid gland.
f) TSH-related causes.
g) Follicular cancer and others.

Treatment for hyperthyroidism includes antithyroid medications that reduce thyroid function. Sometimes surgery may be necessary. Antithyroid drugs are generally used for one and a half to two years, after which the medication is stopped. If the disease recurs, radioactive iodine treatment may be used to destroy the gland.

Hypothyroidism (Underactive Thyroid)
Hypothyroidism can occur due to iodine deficiency in areas where iodine is scarce. It can also result from autoimmune hypothyroidism where antibodies attack the thyroid gland, causing it to malfunction. Medical treatment or surgery may damage the gland, causing hypothyroidism. Excessive doses of hyperthyroidism medication can also cause hypothyroidism. Congenital hypothyroidism occurs in newborns when the thyroid gland is not formed or functional.

Symptoms of Hypothyroidism:
- Fatigue, lethargy, and drowsiness.
- Rough skin.
- Slight swelling of the face.
- Loss of appetite.
- Hair loss.
- Slight weight gain of 5-6 kg.
- Memory loss.
- Feeling cold.
- Constipation.
- Irritability.
- Increased blood pressure.
- Menstrual problems.
- Infertility.
- Miscarriage during pregnancy.
- In congenital hypothyroidism, brain development is impaired.

Thyroid Cancer
When part of the thyroid gland swells like a tumor, it is called a thyroid nodule. About 1% of thyroid nodules can be cancerous. Thyroid cancer occurs when thyroid cells grow uncontrollably. However, most thyroid enlargements are not cancerous.

Signs of thyroid cancer may include:
 Swelling in the front of the neck, often hard.
 One or multiple tumors, possibly on both sides, with swollen lymph nodes.
 Weight loss and loss of appetite.
 Voice changes such as hoarseness.
 Swelling can also cause breathing difficulties due to pressure on the windpipe.

If there is a family history of thyroid cancer, consultation with an endocrinologist or hormone specialist for screening is essential.

Thyroid cancer is a disease that is curable in 95% of cases if treated promptly. If there is swelling in the front of the neck, see an endocrinologist or hormone specialist immediately. After examination, they will determine the nature of the disease.

If cancer is diagnosed or suspected, consult an ENT specialist or a surgeon experienced in thyroid surgery urgently. Surgery is the best treatment for thyroid cancer. The extent of gland removal depends on the type of cancer. Sometimes the entire thyroid gland needs to be removed.

Chemotherapy is mainly used as an adjunct treatment for poorly differentiated or undifferentiated thyroid cancers. Palliative therapy may be given in advanced cases where the disease spreads rapidly.

Frequently Asked Questions:
Q: Why is the thyroid gland and its diseases so important?
A: The thyroid gland is the primary metabolic hormone-producing gland in the human body. Timely diagnosis allows successful treatment.

During pregnancy, maternal hypothyroidism affects the baby's physical and mental development. If the baby's thyroid gland does not form or function, congenital hypothyroidism occurs, leading to cretinism characterized by poor muscle, bone, and nervous system development. The child may be deformed, mentally retarded, with a protruding tongue and umbilical hernia.

In children, thyroid hormones are critical for physical and mental growth. Untreated deficiency leads to disability and intellectual impairment.

In adults, problems include infertility, menstrual disorders in women, and miscarriage.

If hyperthyroidism is untreated for long, it may cause thyroid storm—sudden excessive hormone release leading to fever, brain dysfunction, abdominal pain, high blood pressure, rapid heartbeat, and heart failure. Immediate treatment is essential as thyroid storm can be fatal. It can be triggered by injection or stress in hyperthyroid patients.

Untreated hypothyroidism for a long time can lead to myxedema coma, a life-threatening condition where thyroid hormone levels drop sharply, affecting brain function. It can be caused by infection, illness, cold weather, or certain medications, mostly in elderly people.

Q: What other problems can occur?
A: Thyroid tumors called nodules can be single or multiple. Single nodules may be benign, such as follicular adenoma or cysts. Not all nodules cause cancer, but some may develop into thyroid cancer, which is curable in 95% of cases with timely treatment.

Q: What is the relationship between iodine and the thyroid gland?
A: Iodine is a crucial element for thyroid hormone production. When iodine is low, the gland enlarges (hypertrophy) trying to maintain hormone levels, which eventually leads to hypothyroidism.

Problems caused by iodine deficiency include:
 Enlargement of the thyroid gland.
 Mental disorders: intellectual disability, mental retardation, developmental delays in children.
 Neuromuscular weakness and spasticity.
 Stillbirth and miscarriages in pregnant women.
 Deaf-mutism and dwarfism.
 Congenital physical and mental abnormalities.
 Abnormalities in vision, hearing, and speech.

Common sources of iodine include iodized salt and foods such as:
* Eggs
* Milk
* Seaweed
* Shellfish
* Marine fish
* Seafood
* Meat
* Cereals

Q: How much iodine does an average person need daily?
A: About 150 micrograms per day.

Q: Do pregnant women need more iodine?
A: Yes, pregnant women need extra iodine because iodine deficiency can be severe for both mother and baby.

Q: Why is nuclear medicine used for thyroid disease diagnosis?
A: Patients are given a measured amount of radioactive iodine, and after a set time, the thyroid gland's uptake is measured to determine its function. A thyroid scan using radioactive technetium and a gamma camera helps detect various thyroid problems and assesses nodules' activity.

Q: Is there any harm from the radioactive substances used?
A: The amount of radioactivity used is very low and generally safe. However, it is contraindicated in pregnant or breastfeeding women.

Q: Does nuclear medicine affect hypothyroidism or hyperthyroidism treatment?
A: For hypothyroidism, treatment involves hormone replacement by a medicine specialist or endocrinologist. Nuclear medicine plays no direct role. For hyperthyroidism or cancer, nuclear medicine is important for diagnosis and gland destruction.

Summary:
 The thyroid gland is the main metabolic hormone-producing gland.
 Thyroid hormones are crucial for children's physical and mental development.
 In adults, thyroid problems can cause infertility, menstrual issues, and miscarriage.
 Thyroid cancer is curable in 95% of cases if treated timely.
 Maternal hypothyroidism during pregnancy can cause intellectual disability in the baby.

---

Doctors have at J D PATHOLOGY & CT SCAN CENTER's
Hormone, Thyroid, Diabetes, and Medicine Specialist department