In my last column we discussed the management of a thyroid tumour. Today, we will discuss another aspect of thyroid disease: under active (hypo-thyroid) and over active (hyper-thyroid) thyroid gland.
It is estimated thyroid disorders affect one in 20 Canadians and most thyroid disorders are five to seven times more common in women.
Thyroid hormones are produced in the thyroid gland from iodine and an amino acid, tyrosine. The normal function of the thyroid gland is to produce and secrete hormones. There are two hormones which are closely related: T3 (triiodothyronine) and T4 (thyroxine).
These hormones have enormous impact on our health, affecting all aspects of our metabolism. They maintain the rate at which our body uses fats and carbohydrates, help control our body temperature, influence our heart rate, and help regulate the production of protein. These hormones are important for normal growth and development of children.
Hypothyroidism causes many symptoms: weight gain, lethargy, cold intolerance, menstrual irregularities, depression, constipation, and dry skin. Deficiency of thyroid hormones in children leads to dwarfism and mental retardation.
There are many causes of hypothyroidism. Thyroid function can be diminished due to congenital development defect or acquired conditions like radiation therapy or autoimmune disease (Hashimotos’ disease).
Hashimoto’s disease is a condition in which your immune system attacks your thyroid. Inflammation from Hashimoto’s disease, also known as chronic lymphocytic thyroiditis, often leads to hypothyroidism. Hashimoto’s disease is the most common cause of hypothyroidism in North America. It primarily affects middle-aged women but also can occur in men and women of any age and in children.
Thyroid function is tested to help detect Hashimoto’s disease. Treatment of Hashimoto’s disease with thyroid hormone replacement usually is simple and effective.
Good news is accurate thyroid function tests are available to diagnose hypothyroidism. Treatment of hypothyroidism with synthetic thyroid hormone is usually simple, safe and effective. Finding an adequate replacement dosage of thyroid may take a little time.
On the other hand hyperthyroidism is not that easy to manage.
Clinically, hyperthyroidism presents with palpitations, nervousness, tremor, heat intolerance, weight loss, muscular weakness and quite often there is goitre.
Hyperthyroid gland can cause Graves’ disease that accounts for at least 90 per cent of all patients with hyperthyroidism. But the cause of hyperthyroidism is not very clear.
Graves’ disease is a condition where eyes are affected. It is called exophthalmos – protrusion of the eyeballs. Graves’ disease is an autoimmune disorder in which antibodies produced by your immune system stimulate your thyroid to produce too much thyroid hormone.
It is not clear what causes Graves’ disease, although several factors, including a genetic predisposition, are likely involved.
Unfortunately, there is no satisfactory treatment to prevent Graves’ eye disease. Because hyperthyroidism seems to affect the eyes, it is very important to treat hyperthyroidism quickly and effectively. In most patients, the eyes tend to get somewhat better when the thyroid abnormality has been treated.
Patients who are hyperthyroid are often treated with radioactive iodine or anti-thyroid medications to reduce and normalize thyroid function. However, in some cases, treatment of hyperthyroidism can result in permanent hypothyroidism.
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