Victor J. Bernet, M.D., FACP, FACE
Secretary & Chief Operating Officer, American Thyroid Association; Chair, Division of Endocrinology, Mayo Clinic, Jacksonville, Florida, Mayo Clinic Florida
The thyroid gland plays an important role in one’s health and metabolism.
The thyroid resides in the lower front of your neck and secretes thyroid hormone. Too much or too little thyroid hormone can result in symptoms like fatigue, nervousness, and fluctuations in weight.
The thyroid gland is also susceptible to developing growths called nodules. Between 35-50 percent of Americans are thought to have thyroid nodules and about 5 percent of these nodules are cancerous.
A goiter is a thyroid enlargement that may or may not contain any thyroid nodules. While women definitely have a higher risk of developing thyroid issues, nodules can also develop in men and even in some children. In certain instances, thyroid disorders can run in families. Thyroid disorders, particularly those that affect thyroid hormone levels, may also be associated with infertility.
On the rise
Research has found a general increase in the rate of thyroid cancer in children and adults since the 1970s.
While the full explanation for the increase is yet to be fully understood, theories for the rise include increased radiation exposure, or exposure to some substance or chemical present in our diet or the environment. In addition, methods to detect thyroid nodules, including those that contain thyroid cancer, have improved, allowing for more nodules to be detected.
Interestingly, screening programs to identify thyroid nodules and cancer in otherwise healthy individuals have not been found to be effective. Many benign thyroid nodules are detected in these screenings, and identifying thyroid cancers has not been linked to improving patient health.
Difficult to detect
Thyroid disorders can go unrecognized for some time because the symptoms can vary greatly. An overactive thyroid may present as increased nervousness, sweating, difficulty sleeping, and weight loss, which are linked to many other more common conditions. The most common type of thyrotoxicosis, or hyperthyroidism, is called Graves’ disease, which can occasionally result in a bulging appearance of the eyes.
When the thyroid gland fails to make enough thyroid hormone, this is referred to as hypothyroidism. Common symptoms include feeling tired and cold. Reasons for reduced thyroid hormone levels include autoimmune disease like Hashimoto’s disease or surgical removal of the thyroid gland.
Getting tested
Fortunately, once suspected, the blood test known as thyroid stimulating hormone (TSH) is a sensitive test for determining whether or not thyroid function disorders are present. A low TSH level usually indicates an overactive thyroid, while a high TSH usually indicates low, insufficient thyroid hormone levels.
There are, however, exceptions to these rules, so the test should be ordered and interpreted by a qualified healthcare expert (i.e., your doctor). Additional testing may be required to determine the diagnosis.
Once confirmed, your healthcare provider can recommend treatments to restore your thyroid health and make you feel better. In many instances, your primary care provider can guide the diagnosis and treatment of uncomplicated thyroid issues, whereas the training and experience of a thyroid specialist, such as an endocrinologist, is often necessary for more complicated situations. The American Thyroid Association (ATA) website provides more detailed information about various thyroid disorders, including lists of symptoms, and diagnosis and management options. The ATA is dedicated to transforming thyroid care through clinical excellence, education, scientific discovery, and advocacy in a collaborative community.