Thyroid gland is an endocrine gland situated in the front of the neck.Thyroxine (T4) and triiodothyronine (T3) are hormones produced.They play a pivotal role in metabolism , temperature control, growth ,memory ,reproduction and various important physiological functions .The hall mark of thyroid disorders are they have subtle clinical manifestations and patients seek help only after months of onset of illness. Hereditary predispositions and genetic factors contribute to the autoimmune thyroid disorders. These disorders should be detected early and treated adequately as the results are good .But if gone undiagnosed for a long time ,may result in irreversible damage to growth and nervous system.   Thyroid disorders are broadly classified as  

• HYPOTHYROIDISM
• HYPERTHYROIDISM
• GOITRE
• THYROID CANCER

HYPOTHYROIDISM

  Endocrine disorder characterised by lack of thyroid hormones .Worldwide iodine deficiency is most common cause .Hashimotos thyroiditis and post surgical hypothyroidism are other common causes .Hypothyroidism is seven times more common among females . Clinical features:-Lethargy, feeling cold ,hair loss, dry skin, lack of concentration, constipation, weight gain inspite of poor appetite ,menstrual irregularities Investigations: TSH, Free T3,freeT4 ,Anti TPo, Antithyroglobulin antibodies and Ultrasound of neck are done to completely evaluate the patient .Besides Complete Blood Count, Liver function tests and lipid profile also should be checked. Treatment  is individualised according to age, weight, gender and various co-morbid conditions. Levothyroxine is prescribed and TSH is monitored periodically. Adequate iodine intake in the form of iodized salt and avoidance of goitrogens(broccoli,cauliflower,cabbage,kale,soy) are recommended.

HYPERTHYROIDISM

  Excessive presence of thyroid hormones commonly due to increased production of the hormones is hyperthyroidism.Graves disease, an autoimmune condition is most common cause.It mostly affects middle aged females.Multinodular toxic goitre,single toxic nodule, certain medicines also cause this condition. Clinical features:- Abnormal weight loss, heat intolerance,  anxiety, insomnia, palpitations, tremors, eye problems, menstrual disorders, fatigue,sweating Treatment includes drugs, radioactive iodine and surgery depending on eitiology, patient profile, severity of thyrotoxicosis and treatment response.

Thyroid nodule and cancer

  Nodules in the thyroid are quite common. If random ultrasound neck is done of a group of people around 20 to 70% will have thyroid nodules.The good news is that only 7 to 15% shall turn out to be malignant.   RED FLAGS

• AGE LESS THAN 20 YEARS ANDMORE THAN 70 YEARS
• RAPIDLY GROWING MASS
• MALES
• FIRM HARD IRREGULAR MASS

 

GOITRE

  IT IS ENLARGMENT OF THYROID GLAND.It poses cosmetic problems,swallowing, speech and breathing difficulties if too large. Clinical features:-Patient usually presents with neck swelling and in advanced cases compression symptoms Any neck swelling should be evaluated by Ultrasound of the neck,FNAC-fine needle aspiration biopsy and if needed Nuclear Scan. Complete thyroid profile to be checked. Treatment usually is surgery depending on the clinical scenario. Early and appropriate treatment yields good results.   Dr Sonia Paul Nilayattingal SPECIALIST INTERNAL MEDICINE