Thyroid disorders are common medical issues that can range from a small, harmless goiter (enlarged thyroid) that needs no treatment to life-threatening cancer. The thyroid is a butterfly-shaped gland located at the base of the neck below the Adam’s apple. It produces thyroid hormones that regulate metabolism. A thyroid problem develops when the gland produces too much or too little hormones.
What are the different types of thyroid disorders?
There are several types of thyroid disorders:
Hypothyroidism
This is when the thyroid gland does not produce enough thyroid hormone. Symptoms include fatigue, weight gain, dry skin, hair loss, feeling cold, constipation, depression, and muscle weakness. It is most often caused by Hashimoto’s disease, an autoimmune disorder where the body attacks the thyroid. Treatment is daily thyroid hormone replacement medication.
Hyperthyroidism
This is when the thyroid is overactive and produces too much thyroid hormone. Symptoms include unexplained weight loss, rapid heartbeat, nervousness, sweating, feeling hot, diarrhea, tremors, and irregular menstrual cycles. Graves’ disease, another autoimmune disorder, is the most common cause. Treatment options include antithyroid medications, radioactive iodine, and thyroid surgery.
Goiter
A goiter is an abnormally enlarged thyroid gland. It may be caused by iodine deficiency, Hashimoto’s disease, or Graves’ disease. Many goiters cause no symptoms and need no treatment. Large goiters may cause coughing, breathing difficulties, and throat tightness. Treatment depends on the underlying cause and may include thyroid hormone medication, radioactive iodine, or surgery.
Thyroid nodules
These are lumps that form within the thyroid. Most are benign but around 5% are cancerous. Symptoms depend on the size. Small nodules cause no symptoms. Large nodules may lead to throat tightness and difficulty swallowing or breathing. Treatment depends on whether it is cancerous. Benign nodules may just be monitored. Cancer is treated with surgery and radioactive iodine.
Thyroid cancer
This is fairly uncommon cancer that develops in the thyroid gland. It is usually treatable with high survival rates if caught early. Symptoms include a lump or swelling in the neck, hoarseness, swollen lymph nodes, and difficulty swallowing and breathing. Treatment involves surgery to remove the thyroid followed by radioactive iodine therapy.
Thyroiditis
This is inflammation of the thyroid gland. It can be caused by a viral infection or an autoimmune disorder like Hashimoto’s disease. Symptoms include pain and tenderness in the thyroid, fever, fatigue, and temporary hyperthyroidism or hypothyroidism. Most cases resolve on their own with pain relievers. Severe cases may require steroid treatment.
What tests diagnose thyroid disorders?
| Test | What it measures |
|---|---|
| TSH test | Levels of thyroid-stimulating hormone (TSH) to evaluate for hypo or hyperthyroidism |
| T3 and T4 tests | Levels of thyroid hormones T3 and T4 to confirm hypo/hyperthyroidism |
| Thyroid antibodies test | Presence of antibodies to diagnose autoimmune disorders like Hashimoto’s and Graves’ |
| Thyroid ultrasound | Looks for nodules, goiter, tumors, and inflammation |
| Radioactive iodine uptake | Measures how much iodine the thyroid takes up to evaluate hyperthyroidism |
| Thyroid biopsy | Takes a sample to test for cancer |
The main test to initially screen for thyroid problems is the TSH test. This measures your levels of thyroid-stimulating hormone. Elevated TSH indicates hypothyroidism, while low levels indicate hyperthyroidism. Your doctor may order additional tests like T3, T4, antibodies, ultrasound, or biopsy to confirm a diagnosis.
What causes thyroid disorders?
Hashimoto’s disease
This is an autoimmune disorder and the most common cause of hypothyroidism. The body’s immune system attacks and destroys the thyroid gland. People with family history are at higher risk. Hashimoto’s is more common in middle-aged women.
Graves’ disease
This autoimmune disorder results in hyperthyroidism. It causes the body to produce antibodies that overstimulate the thyroid. Genetics and family history increase risk. It most often affects women under 40.
Thyroiditis
Inflammation of the thyroid can be caused by an infection, pregnancy, or an autoimmune disorder. Postpartum thyroiditis occurs after giving birth. Silent thyroiditis is painless inflammation that resolves on its own.
Iodine deficiency
Consuming too little iodine causes hypothyroidism and may lead to goiter. Most people get enough iodine from foods like seafood, dairy, eggs, and bread.
Thyroid nodules and cancer
The cause is unknown but risk rises with age, family history, and radiation exposure. Nodules are more common in women. Only about 5% of nodules are malignant.
Medications
Certain drugs like lithium, interferon alpha, and interleukin-2 can impact thyroid function. Amiodarone, used for heart disease, can cause both hyper and hypothyroidism.
Pregnancy
Hormone changes during pregnancy can cause thyroid issues. Hyperthyroidism in pregnancy is usually Graves’ disease. Hypothyroidism is often Hashimoto’s thyroiditis. Postpartum thyroiditis can occur after delivery.
Pituitary gland disorders
The pituitary produces TSH, which controls the thyroid. Tumors and other pituitary problems may disrupt TSH production and cause hypothyroidism.
Are thyroid disorders serious?
For the most part, thyroid problems are very treatable, especially when caught early. However, they can potentially be serious if left untreated.
Hypothyroidism
Untreated hypothyroidism can lead to a myxedema coma, which is a rare, life-threatening condition. It is caused by extremely low thyroid hormone levels. Symptoms include drowsiness, cold intolerance, slurred speech, slowed breathing, low blood pressure, and hypothermia. Immediate medical treatment is needed.
Pregnant women with untreated hypothyroidism are at a higher risk for preeclampsia, premature birth, low birth weight, and other complications. Infants born with congenital hypothyroidism can have intellectual disabilities and growth problems if not treated quickly.
Hyperthyroidism
Serious complications from untreated hyperthyroidism include thyroid storm, irregular heartbeat and cardiac arrhythmias, osteoporosis from excessive calcium loss, and thinning skin. Thyroid storm causes fever, racing pulse, nausea, diarrhea, and other severe symptoms. It results from a major hormonal surge and requires emergency care.
Thyroid nodules and cancer
Most thyroid cancers are highly treatable. However, if left undiagnosed and untreated, all types can spread to lymph nodes and other organs. Anaplastic thyroid cancer is rare but spreads rapidly and is difficult to treat. The 5-year survival rate is less than 10% if it has spread widely.
Goiter
A large goiter can cause a cough, difficulty swallowing and breathing, sleep apnea, and swelling of neck veins. Although extremely rare, an untreated, benign goiter could potentially block the trachea and become life-threatening.
When should you see a doctor?
See a doctor if you experience any of these symptoms:
- Weight gain or loss
- Fatigue
- Constipation or diarrhea
- Feeling cold or hot
- Sweating, trembling, shakiness
- Changes in heart rate
- Changes in menstrual cycles
- Muscle weakness
- Dry skin and hair
- Difficulty concentrating
- Depression
- Neck swelling
- Hoarse voice
- Difficulty swallowing
- Pain or fullness in the neck
Tell your doctor about any family history of thyroid disease. Be sure to mention if you have been exposed to radiation from previous scans or cancer treatment. Request screening tests if you feel you may be at risk. Thyroid disorders are highly treatable when identified early.
What is the treatment for thyroid problems?
Treatment depends on the specific thyroid disorder and its severity:
Hypothyroidism
Replacing missing thyroid hormone daily by taking levothyroxine pills. Most people need to continue medication lifelong. Dose is adjusted based on regular TSH testing.
Hyperthyroidism
Antithyroid medications to block excess hormone production. Radioactive iodine to damage and shrink the thyroid gland. Thyroid surgery as a last resort.
Goiter
Small, symptomless goiters may just need monitoring. Large goiters can be treated with radioactive iodine, surgery, or hormone therapy.
Thyroid nodules
Benign nodules are observed or treated with surgery or radioactive iodine. Cancerous nodules require surgery followed by radioactive iodine to destroy any remaining thyroid tissue.
Thyroid cancer
Surgery to remove thyroid followed by radioactive iodine therapy to eliminate any remaining cells. Thyroid hormone treatment replaces removed gland. Radiation therapy or chemotherapy may be used in some cases.
Thyroiditis
Usually resolves on its own. Pain relievers and anti-inflammatories to manage symptoms. Beta blockers for temporary hyperthyroid phase. Cortisol for severe cases.
What is the prognosis for thyroid disorders?
With proper treatment, most people with thyroid problems can manage their condition and have an excellent prognosis:
Hypothyroidism
Taking thyroid hormone replacement daily allows people to completely manage their hypothyroidism. Most are able to live normal, healthy lives with typical life expectancy.
Hyperthyroidism
Antithyroid medications, radioactive iodine ablation, and thyroid surgery are usually able to successfully treat hyperthyroidism. Relapse is possible and ongoing monitoring is needed.
Goiter
Most goiters respond well to treatment with radioactive iodine or surgery if they become problematic. Prognosis is good once treated, though goiter may recur over time.
Thyroid nodules
The prognosis for benign thyroid nodules is typically very good. Cancerous nodules have a favorable outlook when caught early before spreading. 10-year relative survival rates by stage:
- Localized (confined to thyroid) – near 100%
- Regional spread to lymph nodes – 98%
- Distant metastases – 57%
Thyroid cancer
Overall 5-year survival rates:
- Papillary – over 97%
- Follicular – over 95%
- Medullary – 79%
- Anaplastic – 7% (rare type)
Thyroiditis
Most cases of thyroiditis resolve on their own over weeks to months. With treatment for symptoms and thyroid hormone therapy as needed, prognosis is excellent.
What is the impact of living with a thyroid disorder?
With proper treatment, most people with thyroid conditions are able to live normal, active lives. However, there can be some ongoing impacts:
- Need for regular medication and doctor monitoring
- Possible ongoing fatigue, weight changes, and other symptoms
- For hyperthyroidism, potential for relapse requiring repeat treatment
- Lifelong hormone therapy for those who have thyroid removed
- Possible dietary changes (goiter avoidance of cruciferous vegetables)
- Increased medical costs for doctor visits, lab tests, and medication
- Emotional impact – anxiety, depression, relationship strain
Support groups and mental health counseling can help people cope with thyroid disorders. Most patients are able to adapt and live full lives with minimal long-term impact from the condition.
Conclusion
Thyroid disorders range from benign to serious, but most are very manageable with modern treatment. Hypothyroidism and hyperthyroidism can typically be well-controlled with medication and monitoring. Goiters, nodules, and thyroiditis often resolve with treatment or monitoring. Thyroid cancers have high survival rates when detected early before spreading. Seeking prompt medical care for symptoms allows for early treatment and an excellent prognosis in most thyroid problems. With treatment, patients can manage their disorder and experience minimal impact on their daily life.