Thyroid Disorders

What is thyroid disease?

Thyroid disease is an umbrella term for disorders of the thyroid gland, leading to over production or under production of the thyroid hormones.

The thyroid gland is situated below your Adam’s apple at the lower aspect of your neck. It has a shape of a ‘butterfly’ with left and right side connected in the middle. The thyroid gland produces thyroid hormone which plays a vital role in metabolism of your body cells.

Thyroid disease can be classified as hypothyroidism or hyperthyroidism.

Hypothyroidism

Hypothyroidism occurs when the thyroid gland does not produce sufficient thyroid hormone. As there are inadequate thyroid hormone, the body’s overall metabolism is slowed down.

Common causes of hypothyroidism includes

  • Immune related conditions/Autoimmune (Hashimoto’s disease)
  • Aftermath from treatment of hyperthyroidism (with radioiodine)
  • Thyroid surgical removal
  • Radiation treatment for cancer around the neck region

Hyperthyroidism

Hyperthyroidism is also known as overactive thyroid. The most common cause of hyperthyroidism is an autoimmune condition known as Graves’ disease.

What are the signs and symptoms of thyroid disease (hypothyroidism/hyperthyroidism)?

Signs and SymptomsHypothyroidismHyperthyroidism
Overall MetabolismSymptoms are associated with general low metabolism of the body.Symptoms are secondary to increase of metabolism of the body.
Weight/AppetiteIncrease weight with normal appetiteLosing weight despite increase appetite
Temperature toleranceCold intoleranceHeat intolerance
Skin/Hair/PerspirationDry skin

Dry, brittle, thin hair

Oily skin

Hair thinning/ hair loss

Sweating easily

CardiovascularSlow heart rateFast, irregular heart rate

Palpitation (heart pounding)

Bowel movementConstipationDiarrhoea, increase bowel movement
PersonalityLow mood, sluggish memory, poor attention span

Unmotivated

Anxious, Nervous, Irritable

Sleep disorders

Menstrual cycle (female)Heavy long periodLight, absent of period
MiscellaneousLethargy

Muscle aches, weakness

Increase cholesterol level

Muscle weakness

Eye irritation, blurry vision, bulging of eyes

Lady feeling her thyroid

How can I treat for hypothyroidism?

Hypothyroidism is commonly treatment with thyroid hormone pills to replace the inadequate thyroid levels. Depending on your underlying cause of hypothyroidism, your doctor may advise for long term replacement medication.

You may be advised to check your thyroid blood tests periodically to ensure the level is replaced adequately. You are advised to discuss on the benefits and risks of thyroid medication with your doctor before starting the medication — but they are for the most part safe.

How can I treat for hyperthyroidism?

Your doctor will discuss with you the treatment options for hyperthyroidism base on your underlying cause of hyperthyroidism and the symptoms that you may be experiencing.

Treatment options include;

Oral medications

  • Antithyroid medication (Carbimazole, Prophylthiouracil): These medications will block the thyroid gland from producing thyroid hormone.
  • Beta-blockers medication: Beta-blockers are useful to slow the heart rate though they do not reduce the thyroid hormones that are produced.

Radioiodine

  • This is a treatment option where you are advised to take a radioiodine capsule/drink to stops/kill the thyroid cells to produce thyroid hormones. However there is a risk of patient getting hypothyroidism.

Surgery

  • This is a permanent solution to remove thyroid tissue/gland. Surgery can lead to hypothyroidism.

How is thyroid disease diagnosed?

As there can be a wide range of thyroid disease presentation, your doctor will acquire your personal and family medical histories, followed with a clinical examination of the neck region for abnormal lumps and bumps. Depending on individual case, various diagnostic tests can be offered.

This includes:

  • Thyroid function blood tests:  Thyroid hormones (T3,T4) and TSH (thyroid stimulating hormone)
  • Thyroid antibodies blood tests
  • Ultrasound of the thyroid

Specialized tests such as radioactive iodine update test, thyroid, biopsy etc.

Your doctor will guide you on the suitable tests for evaluation of your thyroid condition.

FAQS

Thyroiditis is an inflammation of the thyroid gland.

Commonly inflammation of the thyroid gland can be due to:

  • Autoimmune conditions (body’s immune system attacking onto the thyroid gland) such as Graves’ disease, Hashimoto disease, type 1 diabetes and etc
  • After childbirth/ delivery
  • Infection due to bacteria/ virus
  • Medications
  • Hereditary causes

As every patient may have a different cause for thyroid disease/ thyroiditis, you are advised to speak to your doctor to understand more about your thyroid disease and how to manage the condition.

Goiter is the enlargement of thyroid gland. In some patients, the prominence of the thyroid gland can be seen with naked eyes. Goiter can be a symptom with an underlying thyroid diseases such as Graves’ disease, Hashimoto’s disease, thyroiditis, thyroid benign lumps (nodules) or even thyroid disease.

You are advised to seek medical attention if you have goiter. Your doctor may offer thyroid blood tests and imaging tests such as ultrasound to evaluate further the thyroid gland.

The treatment of goiter will be dependent on the underlying cause. Your doctor may want to evaluate further the thyroid gland with blood tests, ultrasounds or even CT scan of the thyroid/neck before discussing on treatment options for the management of the goiter.

Thyroid nodules are benign solid lumps that are present on the thyroid gland. Your doctor may advise you to follow up the thyroid nodules with a repeat ultrasound in 4 to 6 months to ensure stability of the nodules.

Thyroid nodules are common, and seen more frequently in females.

Most patients with thyroid nodules do not have any symptoms. However if the thyroid nodules size are enlarged, the airway or the throat can be affected and patients can develop compressive symptoms such as difficulty swallowing or breathing. In thyroid nodules which are ‘active’, patients can present with excessive thyroid hormone production (hyperthyroidism). Do speak to your doctor if you do experience any abnormal thyroid symptoms.

Thyroid cancer symptoms may present differently in different individuals. One can present with no symptoms, an unusual lump over the neck, difficulty swallowing, hoarseness of voice, or weight loss. As the symptoms can be insidious, early screening and detection of thyroid cancer is important. You can discuss further with your doctor on thyroid screening tests.

Thyroid cancer appears more frequently in female who

  • In the adult group between 25- 65 years old
  • Smoker
  • Has family history of thyroid cancer
  • History of a thyroid lump/goiter
  • Has radiotherapy done over the head and neck in the past

You can self-examine your thyroid gland. First, lift up your chin and stand in front of a mirror. Locate your Adam’s apple, palpable the thyroid gland which is situated  at either side of the windpipe just below the Adam’s apple. You can also attempt the fell the thyroid gland when you make an act of ‘swallowing’. If you notice abnormal lumps on either side, do let your doctor know to evaluate further.

Yes, as thyroid disease can disrupt the menstrual cycle, it can reduce a person’s fertility ability. Furthermore, uncontrolled thyroid disease is associated with pregnancy complications such as

  • Miscarriage
  • Premature birth
  • Still birth
  • Preeclampsia (high blood pressure affecting the kidney and vital organs during pregnancy)
  • Low birth weight
  • Failure to thrive, and brain developmental disorder in babies
  • Heart failure in babies

If you are contemplating to conceive and have thyroid disease, you are encouraged to discuss with your doctor to manage the thyroid disorder in order to have a safe pregnancy.

In general, women are more predisposed towards thyroid disease.

Approximately 5-10% of Singapore population experience thyroid disease. Among patients with thyroid lump, 90% are benign, whilst the remaining 10% of thyroid lumps/nodules can be dangerous. You are advised to speak to your doctor on screening of thyroid disease.

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