Thyroid Problems

                Thyroid Problems Overview

The thyroid gland is located on the front part of the neck below the thyroid cartilage (Adam's apple). The gland produces thyroid hormones, which regulate body metabolism. Thyroid hormones are important in regulating body energy, the body's use of other hormones and vitamins, and the growth and maturation of body tissues.
Diseases of the thyroid gland can result in either production of too much (overactive thyroid disease or hyperthyroidism), too little (underactive thyroid disease or hypothyroidism) thyroid hormone, thyroid nodules, and/or goiter. All types of thyroid problems in women are much more common than thyroid problems in men.

• Production of thyroid hormones: The process of hormone synthesis begins in a part of the brain called the hypothalamus. The hypothalamus releases thyrotropin-releasing hormone (TRH). The TRH travels through the venous plexus located in the pituitary stalk to the pituitary gland, also in the brain. In response, the pituitary gland then releases thyroid-stimulating hormone (TSH) into the blood. The TSH travels to the thyroid gland and stimulates the thyroid to produce the two thyroid hormones, L-thyroxine (T4) and triiodothyronine (T3). The thyroid gland also needs adequate amounts of dietary iodine to be able to produce T4 and T3.

• Regulation of thyroid hormone production: To prevent the overproduction or underproduction of thyroid hormones, the pituitary gland can sense how much hormone is in the blood and adjust the production of hormones accordingly. For example, when there is too much thyroid hormone in the blood, TRH and TSH production are both decreased. The sum effect of this is to decrease the amount of TSH released from the pituitary gland and to reduce production of thyroid hormones from the thyroid gland to restore the amount of thyroid hormone in the blood to normal. Defects in these regulatory pathways may result in hypothyroidism (underactive thyroid problem) or hyperthyroidism  (overactive thyroid problem).
• Thyroid goiter: Thyroid goiter is any enlargement of the thyroid that can occur with hyperthyroidism or hypothyroidism but also with benign and malignant (cancerous) nodules. Worldwide, the most common cause of goiter is iodine deficiency. Although it used to be very common in the U.S., it is now less common with the use of iodized salt. Multiple nodules in the thyroid are very common, but only about 5% of the nodules are a thyroid cancer. Thyroid cancer is diagnosed after a thyroid ultrasound exam and a needle aspiration biopsy of the nodule.

Hypothyroidism in Pregnancy

Newly diagnosed hypothyroidism in pregnancy is rare because most women with untreated hypothyroidism do not ovulate or produce mature eggs in a regular manner, which makes it difficult for them to conceive.
It is a difficult new diagnosis to make based on clinical observation. The signs and symptoms of hypothyroidism (fatigue, poor attention span, weight gain, numbness, and tingling of the hands or feet) are also prominent symptoms of a normal pregnancy.
Undiagnosed hypothyroidism during pregnancy increases the chance of stillbirth or growth retardation of the fetus. It also increases the chance that the mother may experience complications of pregnancy such as anemia, eclampsia, and placental abruption.
Probably the largest group of women who will have hypothyroidism during pregnancy are those who are currently on thyroid hormone replacement. The ideal thyroxine replacement dose (for example, levothyroxine [Synthroid, Levoxyl, Levothroid, Unithroid]) during pregnancy may rise by 25% to 50% during pregnancy. It is important to have regular checks of T4 and TSH blood levels as soon as pregnancy is confirmed; and frequently through the first 20 weeks of pregnancy to make sure the woman is taking the correct medication dose.

Hyperthyroidism in Pregnancy

Newly diagnosed hyperthyroidism occurs in about 1 in 2,000 pregnancies. Grave's disease accounts for 95% of cases of hyperthyroidism newly diagnosed during pregnancy.
As with hypothyroidism, many symptoms of mild hyperthyroidism mimic those of normal pregnancy. However, anyone experiencing symptoms such as significant weight loss, vomiting, increased blood pressure, or persistently fast heart rate should have blood tests to evaluate whether hyperthyroidism is present.
Untreated hyperthyroidism does cause fetal and maternal complications including poor weight gain and tachycardia (an abnormally fast heart rate).
Treatment of hyperthyroidism during pregnancy is primarily medical. Propylthiouracil or methimazole (Tapazole) are the usual first-line agents to block the synthesis of thyroid hormone. They appear to be equally effective and have the same rate of side effects. The rate of side effects of each medication is not increased in pregnancy.
Iodine will cross the placenta, so its use in either a thyroid scan or in treatment with radioactive iodine is prohibited in pregnancy.
One positive note for women with hyperthyroidism is that those with Grave's disease or Hashimoto's thyroiditis may have improvement in their symptoms during pregnancy.

Goiter in Pregnancy

It is common for a goiter to enlarge slightly during pregnancy. It is more common when the mother lives in an area of iodine deficiency. In the United States, the average intake of iodine is adequate but can be low if someone avoids consumption of milk, eggs, and iodized salt. Not all prenatal vitamins contain iodine, but it is recommended that only prenatal vitamins that contain iodine should be used during pregnancy.

Postpartum Thyroid Disease

Some women may have thyroiditis that usually occurs within 3 to 6 months after giving birth. It also may occur after miscarriage. The classic clinical picture is a woman who will first have symptoms of hyperthyroidism, followed by hypothyroidism, culminating in normal thyroid function.
Women with type I diabetes have a 25% risk of developing postpartum thyroid dysfunction.
Consult your doctor if you have symptoms of hypothyroidism or hyperthyroidism after pregnancy or miscarriage.

Thyroiditis:

This thyroid problem is the inflammation to the thyroid gland. The treatment depends upon type of thyroiditis. For autoimmune thyroiditis, treatment is thyroid hormone replacement.
For De Quervain’s Thyroiditis, bed rest and aspirin to reduce inflammation and for silent thyroiditis, bed rest with beta-blockers to control palpitations are essential. 

hyroid Problems Causes

Hypothyroidism Causes

• Loss of thyroid tissue: Treatment of hyperthyroidism by radioactive destruction of thyroid tissue or surgical removal of thyroid tissue can result in hypothyroidism.
• Antithyroid antibodies: These may be present in people who have diabetes, lupus, rheumatoid arthritis, chronic hepatitis, or Sjogren's syndrome. These antibodies may cause decreased production of thyroid hormones.
• Congenital: Hypothyroidism can be present from birth. This is commonly discovered early with nationwide newborn screening for this disease.
• Defects in the production of thyroid hormone: Hashimoto's thyroiditis occurs when there are defects in the production of thyroid hormone, resulting in an increased amount of TSH. The increased TSH results in a goiter (enlargement of the thyroid gland itself that can be seen as an obvious swelling in the front of the neck).
• Medications: Some medications, particularly lithium (Eskalith, Lithobid), may cause a drug-induced hypothyroidism.

Hyperthyroidism Causes

• Grave's disease: This thyroid condition results from abnormal stimulation of the thyroid gland by a material in the blood termed the thyroid stimulating immunoglobulin (TSI). TSI overstimulates the thyroid causing a goiter. It also causes Grave's eye disease, including a "bug-eyed" look and "frightened stare." This can progress to severe eye pain or eye muscle weakness causing tearing and double vision. It also causes raised, thickened skin over the shins or tops of the feet.
• Toxic multinodular goiter: This occurs when part of the thyroid gland produces thyroid hormones all by itself, without regard to TSH stimulation. It usually occurs in people with a long-standing goiter, usually in the elderly. Toxic multinodular goiter is different from Grave's disease because of the general lack of eye complications and less severe signs of hyperthyroidism.
• Thyroiditis: This inflammatory disorder of the thyroid gland includes such conditions as de Quervain's thyroiditis or Hashimoto's thyroiditis. In these conditions, you may have periods of increased thyroid hormone release due to the inflammation, causing a hyperthyroid state. As thyroid failure occurs due to the inflammatory response, hypothyroidism may occur.
• Pituitary adenoma: This tumor of the pituitary gland causes independent TSH production leading to overstimulation of the thyroid gland.
• Drug-induced hyperthyroidism: This is most commonly caused the heart medication amiodarone (Cordarone). It may be prevented by monitoring this possible side effect and weighing them against the benefits of using this heart medication.