Thyroid gland is a butterfly shaped gland located infront of the neck. It mainly produces the Thyroid hormones T3 and T4 which controls our energy requiring processes and metabolism. Thyroid disorders can involve either the functioning of the gland or structural lesions.
1. Functional disorders
a. Hypothyroidism
Hypothyroidism is a very prevalent hormonal disorder where there is less production of the thyroid hormones. This can be due to a primary problem in the thyroid gland itself ( Primary Hypothyroidism) or can be due to pituitary/hypothalamic disease( Secondary Hypothyroidism)
Symptoms of hypothyroidism include excessive fatigue, lethargy , weight gain, cold intolerance, constipation, menstrual irregularities etc.
Diagnosisis mainly by doing a Thyroid Function test (TSH,T3 and T4)
Treatment is mainly by substituting with Thyroxine and adjusting the dose every 4 to 6 weeks initially so that the Thyroid function normalizes and patients symptoms improve
b. Hyperthyroidism
Hyperthyroidismstands for overproduction of thyroid hormones by the Thyroid gland. It can be due to Graves disease or secretion from a solitary functioning nodule(AFTN) or from multiple nodules(MNG).
Symptoms include weight loss, weakness and fatigue, heat intolerance, increase frequency of stools, tremors, increased heart beat etc
Diagnosisis is mainly by doing a Thyroid Function test(TSH,T3 and T4). Once the thyroid hormones are documented to be excessive further investigation is required for assessing the cause for overproduction. The best test includes a Tecnitium 99 Thyroid scan which is a nuclear scan. This is a bit costly but is very valuable. In the absence of nuclear scan one can go for Thyroid receptor antibody test(TRAb), ESR, Anti TPO antibody, Ultrasound of thyroid etc to determine the etiology.
Treatment includes three modalities which include Anti Thyroid medications, Radioactive Iodine ablation or surgery depending on the clinical situation
c. Thyroiditis
This is usually due to Inflammation, infections or autoimmune conditions. They can present with thyrotoxicosis (Symptoms of increased thyroid hormones) and hypothyroidism
2. Structural disorders
a. Thyroid nodules
b. Thyroid cancers
These usually present as painless swelling infront of neck which moves up with swallowing. These nodules can compress on the surrounding structues like food pipe, windpipe or nerve to the vocal cords resulting in difficulty swallowing, breathlessness or change in voice.
Diagnosisis involves doing a TSH and an ultrasound scan of the Thyroid. If any suspicious features are present on Ultrasound scan , then FNAC(needle aspiration) of the suspicious region is done
Treatment involves reassurance and serial 6 monthly ultrasound scan for benign nodules. Surgery is recommended based on biopsy report for suspected/malignant nodules
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