So, Your Doctor Thinks You May Have a Thyroid Disorder -- Now What?

An Overview of Common Thyroid Tests

Finding out that your thyroid may not be functioning properly can be a disorienting and emotionally draining experience. This sense of feeling overwhelmed and confused can sometimes be made even worse by the battery of tests, lab procedures, and other diagnostic assessments that follows a preliminary diagnosis of thyroid-related problems.

Once your doctor has determined that the signs and symptoms you’ve been experiencing may be linked to your thyroid, the next step will be assessing the health and performance of your thyroid gland using a number of advanced diagnostic procedures.

Because thyroid disorders can encompass such a broad range of illnesses, diseases, and conditions, it is likely that you will be subjected to a sizable number of diagnostic tests. In order to pinpoint the precise nature and extent of the problem, your doctor may arrange a full slate of procedures, ranging from blood work to advanced imaging of the thyroid gland.

It’s likely that the less that your doctor knows about your thyroid disorder, the more tests he or she will schedule. This week, we’ll take a look at some of the most common tests that are used to gauge thyroid health, function, and disorders.

Blood Tests

Because a dysfunctional thyroid gland can impact the level of hormones in your blood, blood tests are often an important component of the diagnostic process. Here are some common blood tests used to help identify possible thyroid problems.

• T3 levels - Blood tests are often used to determine the level of thyroid hormone triiodothyronine in the bloodstream.

• FTI or FT4 - These tests are performed in order to determine the level of the thyroid hormone thyroxine that is in the bloodstream. Specifically, these tests focus on quantifying the small amount of the T4 hormone that is unattached to blood cells.

• Total T4 - This blood test shows the total level of thyroxine in the bloodstream, quantifying both attached and unattached cells.

• Thyroid antibodies test - If an autoimmune disorder such as Grave’s disorder is suspected, this blood test is used to determine whether the body’s immune system is attacking the thyroid gland.

• Thyroglobulin levels - This procedure is typically used in the diagnosis and management of thyroid cancer.

Radioactive Iodine Testing

These tests make use of the unique iodine-absorbing properties of the thyroid gland to measure thyroid function. They are usually only performed on patients who are suspected to be hyperthyroid, or when a preliminary diagnosis of thyroid cancer has been made. They involve ingesting a very small dose of radioactive iodine and viewing its path in the body using advanced imaging techniques.

• Radioactive Iodine Uptake Test - This test is used to help doctors achieve a clearer understanding of the source of your thyroid-related symptoms. It can help them to determine whether you are hyperthyroid and the degree of thyroid hyperactivity. It can also allow doctors a closer look at a nodule or growth on the thyroid gland. Lastly, in patients who have been diagnosed with thyroid cancer, this test can show whether the cancer has spread beyond the thyroid gland.

• Thyroid Scan - In some cases, thyroid scans are performed as part of a radioactive iodine uptake test, but they can also be performed as stand-alone assessments. If it is not done in tandem with a radioactive iodine uptake tests, thyroid scans are usually used to observe and diagnose thyroid nodules or growths.

Other Thyroid Imaging Procedures

If a growth or nodule has been detected on your thyroid, your doctor may choose to order several imaging procedures to get a better look at the abnormal tissue and better determine its origins.

• Ultrasound - This painless, non-invasive imaging procedure will provide doctors with a highly detailed snapshot of your thyroid, allowing them to get a closer look at any suspect growths and nodules. The ultrasound, also known as a sonograph, uses sound waves to produce images of internal organs.

• Computerized tomography - More commonly known as CAT scans or CT scans, this imaging technique relies on the same basic technology that powers standard x-rays, although it is applied in a slightly different way. These images can help doctors get a wider look at the entire neck area, which can sometimes be helpful in diagnosing the size and extent of thyroid cancers and malignant growths.

• Magnetic resonance imaging - This relatively newly developed imaging technique draws on the power of magnetism to produce crystal-clear images of internal organs, tissues, and musculoskeletal structures. This test is typically used only if thyroid growths or tumors are believed to be present.

They say that knowledge is power, and when it comes to medical procedures, having a basic understanding of the nature of the tests that are being performed can make all the difference in the world. If you are unclear about the purpose or nature of any of the diagnostic procedures your doctor has arranged, don’t hesitate to request more information. Remember, the only stupid question is the one that remains unasked!

For Further Reading

• http://www.endocrineweb.com/tests.html

• http://thyroid.about.com/cs/newsinfo/l/bltest_values.htm

The Truth About Thyroid Growths: Origins, Symptoms, and Outcomes

In this day and age, cancer awareness is at an all-time high. More than ever before, men and women alike are increasingly vigilant about the necessity of checking their bodies for any unusual lumps, polyps, or growths. However, amidst all of the focus on more common forms of cancer and other growth-producing diseases, some lesser-known health risks can tend to get lost in the shuffle.

One example of this phenomenon is the public’s general lack of awareness of thyroid growths. In some cases, these growths can be indicative of serious health problems, while in other cases, they are simply harmless annoyances. This week, we’ll talk about the different types of thyroid growths and the underlying illnesses that their presence can sometimes indicate.

What Are Thyroid Growths?

On the most basic level, thyroid growths are unusual tissue masses that appear on the thyroid gland. In most cases, they often cannot be detected with the naked eye. Some people with thyroid growths may experience a feeling that is akin to having a “lump” in the throat. In severe cases, these growths may interfere with speaking, swallowing, or breathing.

In the vast majority of cases, thyroid growths are simply normal thyroid tissue that has grown too much, or has expanded into an unusual shape. Only about five percent of all thyroid growths are caused by cancer-related cell activity.

Depending on the cause of the thyroid growth, these growths can take one of several different forms:

• Colloid nodules. These benign growths are responsible for most cases of thyroid nodules. Colloid nodules occur when the thyroid, for reasons that are often unknown, begins to generate extra tissue that is non-cancerous. These growths are often undetectable without the use of advanced imaging techniques.

• Follicular adenomas. Another benign type of thyroid nodule, follicular adenomas are growths ranging from one to ten centimeters in size that are filled with colloid tissue and epithelial cells. They are usually detected by physicians in routine medical examines, although they can also be viewed on x-rays or using other imaging techniques.

• Inflammatory nodules. These benign nodules are commonly seen in patients who suffer from chronic inflammation of the thyroid gland. Most inflammatory nodules do not cause noticeable symptoms, although one rare form of these nodules can result in extreme neck and throat pain. Patients with a history of thyroiditis and postpartum women are at greatest risk for developing inflammatory nodules.

• Hyperfunctioning Thyroid Nodules. These growths occur when a thyroid nodule begins producing thyroid hormones of its own, acting as if it were a mini-thyroid gland. As a result, patients with these types of growths often experience a form of hyperthyroidism, because they have elevated levels of thyroxine in the bloodstream. Although the cause of these nodules remains unclear, researchers believe that genetic factors may play a role in their development. In other cases, they may be a sign of a condition known as Plummer’s disease.

• Thyroid cysts. These growths occur when areas of fluid develop within the thyroid gland, forming small, blister-like growths ranging from one-quarter inch to over an inch in diameter. In most cases, the origins of the cysts are unclear, and tests indicate that the cysts are harmless. However, a rare type of thyroid cyst that contains both fluid and solid tissue is often cancerous. Symptoms can include throat and neck pain and changes in the patient’s speaking or singing voice.

• Multinodular goiters. Strictly speaking, goiters are not growths on the thyroid, but rather, an abnormal enlargement of the entire thyroid gland. However, in the early stages of goiter growth, patients often experience a lump-like sensation in their throat or neck. This is particularly common with multinodular goiters, which are often caused by the presence of multiple benign nodules on the thyroid gland. Patients who detect a neck lump or experience difficulty breathing or swallowing should be evaluated for this condition.

• Thyroid cancer. As mentioned previously, more than 95% of all thyroid growths are benign. However, in some rare cases, the presence of a thyroid lump or growth may be a sign of thyroid cancer. You are at greater risk for developing the disease if you have a family history of thyroid or endocrine system disorders. Adolescents and young adults under the age of 20 and individuals over the age of 60 are at higher risk for thyroid cancer, and although women develop most types of thyroid disorders more frequently than men, men are at greater risk of developing cancer of the thyroid than women. If you notice a neck or throat lump that is hard and painful, it is particularly important to seek immediate medical attention.

  Visit ThyroidCancer.com for more information about Thyroid Cancer.

For Further Reading

• http://cpmcnet.columbia.edu/dept/thyroid/NodulesHP.html

• http://www.umm.edu/endocrin/thytum.htm

• http://www.nlm.nih.gov/medlineplus/ency/article/007265.htm

The Body Divided: Understanding Autoimmune Thyroid Disorders

Despite all of the significant medical advances that have been made in recent years, the mystery of autoimmune disorders continues to confound researchers. For reasons that are still largely unknown, autoimmune disorders cause the body literally to attack itself as if it were an invading germ, bacteria, or virus.

Although not all thyroid disorders follow this pattern, several of the most common thyroid-related illnesses have autoimmunological components. This week, we’ll take a deeper look at these puzzling illnesses and the way that they negatively impact the thyroid health of millions of men and women.

What are Autoimmune Disorders?

The immune system is a complex, sophisticated defense against outside invaders that could cause illness, injury, or disease. If our body is attacked by anything that might imperil our health, whether it’s the common cold or a splinter, the immune system springs into action. In most cases, the body fights back against germs with strategies such as fever and dispatching white blood cells and other helper cells.

However, for reasons that have not yet been fully explained, the immune systems of some individuals lose the ability to differentiate between the body’s cells and invading outside germs, bacteria, and viruses. In these cases, the body’s immune system may begin to attack its own cells, tissues, or organs, just as it would a cold virus or a bacterial infection. Some of the most common autoimmune disorders include rheumatoid arthritis, lupus, Sjogren’s syndrome, scleroderma, Guillain-Barre syndrome, celiac disease, Type 1 diabetes, and multiple sclerosis.

What is not as widely known is that two of the most common causes of thyroid disorders -- namely, Hashimoto’s thyroiditis and Graves’ disease -- are also classified as autoimmune disorders.

Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis is an autoimmune disorder that is believed to be the leading cause of hypothyroidism in North America. Women between the ages of 45-65 are at greatest risk of developing thyroid disorders as a result of Hashimoto’s thyroiditis.

In this disorder, the immune system somehow loses the ability to recognize the thyroid as part of the body. Instead, the immune system begins to attack the thyroid as if it were an invading pathogen. As a result of this immunological response, the follicles on the thyroid gland sustain damage. This, in turn, impedes the thyroid gland’s ability to function at a normal rate, which in turn can result in a wide variety of other adverse health outcomes.

Although this disorder was first identified by Japanese physician Hakaru Hashimoto in 1912, its origins and causes remain mysterious. However, recent research has indicated that there may be a strong genetic component linked to a patient’s risk of developing Hashimoto’s thyroiditis. Individuals with a family risk of chromosomal disorders such as Turner's syndrome, Down syndrome, and Klinefelter's syndrome are at greater risk of developing this thyroid disorder.

Graves’ Disease

Although Graves’ disease is also an autoimmune thyroid disorder, it is linked to hyperthyroidism, rather than hypothyroidism. Because patients with Graves’ disease suffer from an unnaturally rapid rate of thyroid functioning, they also experience many of the classic symptoms associated with hyperthyroidism, including increased appetite, weight loss, anxiety, nervousness, hot flashes, excessive perspiration, tremors, palpitations, weakness, vision problems, digestive difficulties, and menstrual dysfunction.

In Graves’ disease, the immune’s system inappropriate response to the thyroid gland is different than the pattern which is associated with Hashimoto’s thyroiditis. Most significantly, it results in the inflammation and enlargement of the thyroid gland, which in turn prompts the thyroid to produce an excess amount of the hormone thyroxine. This hormonal surplus sets into motion the classic symptoms of hyperthyroidism.

Although the precise causes of Graves’ disease have not yet been uncovered, researchers suspect that a genetic component may be involved. Like Hashimoto’s thyroiditis, women appear to be at greater risk for developing the condition than their male counterparts. However, Graves’ disease is much rarer than Hashimoto’s thyroiditis, affecting only an estimated five out of every 10,000 men and women.

Prognosis

Because scientists still have not unraveled the mysterious origins, causes, and mechanisms of autoimmune thyroid disorder, no “cure” exists for either Hashimoto’s thyroiditis or Graves’ disease. However, most of the thyroid-related symptoms associated with these disorders can be reduced or eliminated with a prescribed regimen geared to correct the rate of thyroid function. As a result, the overall prognosis for both disorders is good, although patients must be prepared to comply with a life-long course of treatment in order to keep symptoms at bay.

For Further Reading

• http://www.aarda.org/women.html

• http://www.4woman.gov/faq/graves.htm

• http://www.mayoclinic.com/health/hashimotos-disease/DS00567

Thyroid Eye Disease: A Serious Health Concern for Hyperthyroid Patients

Patients with thyroid disorders are often all too aware of the fact that these conditions can cause a broad spectrum of physical and mental symptoms. From anxiety attacks to coarse hair, the consequences of even slight dysfunction of the inch-long thyroid gland can be severe and wide-ranging.

Still, many thyroid patients remain unaware of a relatively rare but potentially dangerous side effect of excessively fast thyroid function: an eye disorder known to doctors as Graves' orbitopathy, more commonly referred to as thyroid eye disease. We’ll take a look at the causes and origins of this disorder, its chief symptoms, and traditional and emerging treatment options.

What is Thyroid Eye Disease?

Thyroid eye disease is a condition that affects as many as half of all patients with the type of hyperthyroidism known as Graves’ disease. In some cases, patients who develop thyroid eye disease do not meet all of the diagnostic criteria for hyperthyroidism; however, these stand-alone cases of thyroid eye disease are relatively rare.

Researchers have not yet been able to uncover the reason why so many patients with Graves’ hyperthyroidism also develop thyroid eye disease. At the current juncture, the persistent link between Graves’ disease and thyroid eye disease has not yet been explained.

Thyroid eye disease is an autoimmune disorder that impacts the tissues of the eyes and the eyelids. Like other autoimmune disorders, thyroid eye disease causes the body to attack itself. In this disease, there is an adverse reaction that occurs between the fatty tissues of the eye and a specific class of white blood cells known as lymphocytes. As a result, the eyeballs are literally pushed out of their sockets.

Patients with thyroid eye disease often experience chronic, painful inflammation of the eyelids. This can also result in the characteristic “bug-eyed” appearance that is one of the chief hallmarks of the disease. Patients often report extreme sensitivity to conditions such as wind or sun.

The constant pain and irritation experienced by patients with thyroid eye disease can be difficult to cope with. In addition, some patients feel self-conscious about their altered appearance in the wake of the eye bulging that is the most common physical sign of the disease.

For some patients who have been more severely impacted, thyroid eye disease can result in impaired vision. This occurs when the inflammation of the eyes results in double vision or blurred vision. Although this symptom does not impact all patients with thyroid eye disease, it can seriously limit the mobility and independence of those who experience it.

At the current juncture, no reliable test exists to check for thyroid eye disease. Instead, physicians typically rely on the identification and analysis of the presenting symptoms in order to make a diagnosis. However, progress is being made towards developing a reliable clinical test for the disease, which could prove to be useful in prevention efforts.

Treatment and Prognosis

Although no “cure” exists for thyroid eye disease, doctors have developed a wide array of methods for managing the disorder and treating the most challenging symptoms. Like many other disorders that are associated with an underlying diagnosis of thyroid disease, the single most important aspect of treating thyroid eye disease is ensuring that patients adhere strictly to their prescribed treatment regimen. If the underlying hyperthyroidism is not well controlled, it is more likely that the symptoms of thyroid eye disease will be severe.

Increasing numbers of patients with serious cases of thyroid eye disease are opting for surgical treatment options. New procedures can eliminate much of the eye bulging that many patients find disagreeable. This eliminates the aesthetic problems associated with the disorder, but it also eliminates some of the pain and irritation, as well. Surgical intervention is a good option in cases in which patients suffer from severe inflammation.

Despite the seriousness of the disorder, the prognosis for thyroid eye disease is typically fairly good. If the underlying hyperthyroidism is well-controlled with adherence to a prescription regimen, and no further complications occur, the worst of the symptoms of the disorder will usually recede within two years.

If you have hyperthyroidism and you have experienced dryness, itching, or inflammation of the eyes, talk to your doctor about the possibility that you may be developing thyroid eye disease.

For Further Reading

• http://www.ithyroid.com/thyroid_eye_disease.htm

Thyroid Disorders, the Menstrual Cycle, and Fertility: What You Need to Know to Protect Your Reproductive Health

Women with thyroid disorders know that the effects of these health problems can be widespread. However, many newly-diagnosed patients are surprised to find out that thyroid dysfunction can interfere with the menstrual cycle, and, by extension, with reproduction and fertility. Conversely, more and more women who report menstrual difficulties and irregularities to their doctors are subsequently being diagnosed with thyroid disorders.

So, what does the little butterfly-shaped gland in your neck have to do with your menstrual cycle? Well, odd as it may initially sound, both are intimately intertwined with the endocrine system, which regulates the creation and distribution of hormones within the body. As a result of this relationship, problems with the menstrual cycle could indicate problems with the thyroid gland -- or vice versa.

Thyroid Disorders and the Menstrual Cycle

Patients with either hyperthyroidism or hypothyroidism may experience menstrual irregularities related to their disorders, although each tends to be associated with a unique pattern of symptoms. This is due to the fact that the variations in the level of thyroid hormone associated with each form of thyroid disease -- either too little or too much -- results in a different outcome in the body.

Women with hypothyroidism produce insufficient levels of thyroid hormones. Menstrual irregularities associated with hypothyroidism include:

• Early onset of menstruation (typically before the age of 10)

• Heavy or prolonged menstruation, also known as menorrhagia

• Irregular menstrual cycles

• Dysmenorrhea, or painful menstruation, including symptoms such as excessive cramps, headache, backache, nausea, aches in the limbs, a bloated sensation, and bowel irregularities

• Amennorhea, or an absence of menstrual periods

On the other hand, women with hyperthyroidism produce too much thyroid hormone and experience problems associated with excessive metabolic rates as a result. They are often faced with a different set of menstruation-related symptoms, including:

• Early or late onset of menstruation, depending on the age at which hyperthyroidism develops

• Unusually light or scant flow during menstrual period

• Sporadic or irregular periods, with long stretches of time between periods

In addition, if women with hyperthyroidism receive excessive doses of pharmaceutical treatment, they may enter into a false hypothyroid state, and begin experiencing the type of menstrual symptoms that are typically associated with hypothyroidism.

Thyroid Disorders and Fertility

Clearly, the extent to which thyroid problems can impact the menstrual cycle has grave implications for a woman’s fertility and ability to carry a pregnancy to term. The menstrual irregularities associated with both hyperthyroidism and hypothyroidism can make ovulation rare and conception difficult, and women with underactive and overactive thyroids have a greater risk of miscarriage, premature birth, and slowed prenatal development.

Often, women suffering from thyroid disorders do not ovulate regularly, if at all. Experts recommend the use of over-the-counter ovulation tests to determine if this might be a problem for you. If it is difficult or impossible for you to pinpoint the time of ovulation, consult with your physician to schedule more detailed medical tests.

In other cases, thyroid disorders can shorten the cycle of fertility. Specifically, the luteal phase of the menstrual cycle can often be truncated in women with thyroid dysfunction. This can make it difficult to determine the optimal time frame for conception, as well as making it more likely that the body will reject an early pregnancy.

Hypothyroidism has been linked with the production of excess amounts of the hormone prolactin, which has been shown to diminish the chances of conception by suppressing ovulation, similar to the way that breastfeeding tends to impede menstruation in the months following childbirth.

What Can You Do?

Although thyroid disorders have been linked to both menstrual irregularities and fertility problems, both of these issues can be addressed with a comprehensive treatment and prevention plan. Here are some guidelines to help you devise a strategy for optimal reproductive health:

• Adhere strictly to your prescribed treatment regimen. In order to minimize menstrual irregularities and stabilize your fertility cycle, it is vital that your thyroid hormone levels remain within the normal range. The single best thing you can do to make this happen is to stick to the treatment plan prescribed by your doctor.

• Keep tabs on your cycle. Recording the start and end date of your period each month can be tedious, but it’s the best way to monitor your regularity and overall reproductive health. In addition to dates and times, also jot down brief notes about the type and amount of flow you observe. That way, if you notice any irregularities, you’ll have all the documentation you need to offer a full description to your doctor.

• When in doubt, consult a specialist. If, after a year or more of following these guidelines, you are still experiencing difficulties with menstrual irregularity or infertility, it may be best to consult with an expert trained in treating reproductive problems in women with endocrine disorders. If fertility is your concern, there may be other health factors that are standing in the way of conception.

For Further Reading

• http://cpmcnet.columbia.edu/dept/thyroid/women.html

• http://www.nlm.nih.gov/medlineplus/ency/article/003149.htm

• http://www.emedicine.com/ped/topic2781.htm