Hyperthyroidism (overactive thyroid)
Hyperthyroidism (overactive thyroid gland) is a disease of the thyroid gland characterized by overproduction of thyroid hormone (T3 and T4). It can affect the entire gland or there is one or more thyroid nodules (in the gland) that produce excessive amounts of thyroid hormones. It can be autoimmune in nature, produced by a viral infection (thyroiditis) or the cause can be obscure. This condition can be mild (sometimes asymptomatic) or can be very serious, even life threatening. Because of too much thyroid hormone the body’s metabolism is accelerated. In severe cases the symptoms are very clear: you can experience unintentional weight loss, increased hunger, hand and head tremors, rapid or irregular heartbeat, increased anxiety and/or depression, accelerated bowel movements, and hair loss/nail changes. Sometimes life threatening cardiac arrhythmias and heart attacks or strokes can happen. Other times, because the increase in thyroid hormones can stimulate production of other hormones (like insulin), patient can experience weight gain (usually the production of excessive thyroid hormone is mild in this case).
Other times the hyperthyroidism is produced by prescribing too much thyroid hormone (T4 and especially T3) or excessive iodine.
No matter how symptomatic you are, or what is the reason for overactive thyroid, if untreated for a long time hyperthyroidism can result in heart attacks, strokes, congestive heart failure, arrhythmias, osteoporosis and fractures.
Several treatments are available for hyperthyroidism. If you take too much thyroid hormone or iodine, the dose has to be adjusted. Anti-thyroid medicines and radioiodine treatment can be used to slow down the amount of thyroid hormones the thyroid gland makes. Sometimes, hyperthyroidism treatment includes surgery to remove all or part of the thyroid gland. In some cases, depending on what’s causing it, hyperthyroidism may improve without medication or other treatment.
In rare cases the hypothalamus or pituitary gland are abnormal and stimulate the thyroid gland to increase hormone production.
Hypothyroidism (low thyroid function)
Hypothyroidism (or underactive thyroid) is a disorder in which the thyroid gland cannot produce enough thyroid hormone and your entire metabolism slows down. This can be due to autoimmune conditions (most common), inflammation or viral disorders (thyroiditis), radiation or of course surgical removal of the thyroid gland. Sometimes the hypothalamus or pituitary are not functioning properly and do not send correct signals (hormones and neurotransmitters) to the thyroid gland.
When the amount of thyroid hormones decreases, it will progressively affect your entire body and all systems even though some systems are more symptomatic than others. Sometimes, in mild cases you may not notice any symptoms; other times you will experience fatigue, hair loss, palpitations, constipation, dry skin, weight gain. If the thyroid hormone levels are extremely low, this is called myxedema and can manifest by a low body temperature, heart failure, anemia, confusion and coma. We do not see this condition normally in developed countries.
Hypothyroidism can be easily treated by supplying the correct amount of thyroid hormones. It is very important to closely monitor the dosing of the thyroid medication (with frequent blood tests) in order to achieve the desired normal function of your body. The thyroid medication action can be affected by many other medications and over the counter supplements, many medical conditions, timing of taking the medication in relation to meals, interference with liver metabolism, etc.
Thyroid nodules (lumps in the thyroid gland)
Thyroid nodule is an abnormal growth of thyroid cells that forms a lump within the thyroid gland. The majority of thyroid nodules are benign (noncancerous), but a small proportion of thyroid nodules can be malignant (cancerous). Many times the nodules are very small and you cannot feel anything. You may find out you have them because of another test you have for a neck or cervical spine disorders (for example CT, US or MRI). If the nodules grow to more than 1 cm they may become palpable and your doctor or you can discover during neck palpation. Most patients over age 60 will have one or more thyroid nodules.
In order to clarify if the nodules are benign or malignant all thyroid nodules require some type of evaluation. Thyroid ultrasound is the best and least invasive modality to evaluate thyroid nodules. Depending on the ultrasound results, some of the nodules require fine needle aspiration biopsy to be able to identify or exclude malignancy.
Many times the thyroid function is normal despite having one or more thyroid nodules. Some other times, the nodule(s) may produce excessive amounts of thyroid hormone.
Depending on the type and functionality of the thyroid nodule(s), treatment will be prescribed.
Goiter (thyroid enlargement)
The term “goiter” refers to the abnormal enlargement of the thyroid gland. Not always the thyroid enlargement is associated with gland malfunctioning. Sometimes it represents just a homogeneous increase in the size of the gland as a whole; other times the gland can be large because one or more nodules are growing inside. Even when the gland is large (or enlarging) it can maintain normal function and production of thyroid hormones or can produce too much or not enough, amount of thyroid hormones. If you feel any “lump” when you palpate your neck, see your doctor for prompt evaluation and treatment. Symptoms may not give any information about the gravity of the disease.
Thyroid cancer appears in a thyroid nodule or sometimes in normal thyroid tissue. The thyroid cells receive signals to multiply uncontrollably (for known or unknown reasons). Radiation and genetics are the most common reasons for thyroid cancer. You may not have any symptoms for a long time. That’s why it is important to evaluate every thyroid ”lump” or nodule. Most of the time thyroid cancer doesn’t influence the amount of thyroid hormone produced by the gland. Occasionally thyroid cancer can be found in overactive thyroid gland or overactive thyroid nodules.
Dr Stanciu is ECNU-certified in performing and interpretation of thyroid, parathyroid and neck ultrasound studies as well as thyroid, parathyroid and lymph node biopsies. ECNU stands for Endocrine Certification in Neck Ultrasound and it is a certification provided by AACE (American Association of Clinical Endocrinology) after rigorous training and examination.
Ultrasound is a non-invasive and non-painful imaging test that can be easily done in the office by Dr Stanciu herself. Using ultrasound waves, the thyroid, parathyroid and lymph nodes of the neck can be imaged so proper evaluation of your condition can be done and adequate treatment can be recommended.
Thyroid, parathyroid and lymph node biopsies are not offered at this time but stay tuned as they will be added soon.
Make an appointment today for a thyroid, parathyroid and neck ultrasound.