Understanding Thyroid Disease

October 02, 2023

Close-up of a female doctor checking thyroid of a young female patient

It’s estimated that 20 million people in the U.S. have thyroid disease, but more than half don’t know it. Unlike heart disease and cancer, thyroid disease often flies under the radar.

“Thyroid problems can cause significant health issues, so it’s important to recognize the symptoms and get a medical diagnosis and treatment. There is no known cure for thyroid disease, but the great news is that there are effective treatments to restore the right balance of hormone for good health and thyroid function,” says University Hospitals otolaryngologist and head and neck surgeon Nicole Fowler, MD.

What Is the Thyroid?

The thyroid gland, located near the base of your neck, produces hormones that are vital for good health. Those hormones control your metabolism and affect a host of critical body functions including heartrate, energy, temperature, mood and more. Thyroid diseases and conditions can cause the thyroid to be underactive (make too little hormone) or overactive (make too much hormone), resulting in a wide range of symptoms and health problems.

Women Are at Much Higher Risk

Thyroid disease is common, but women are five to eight times more likely to have thyroid problems than men. Women’s reproductive cycles and robust immune system responses may play a role.

Thyroid disease risk also increases if you are over age 60, have a personal or family history of thyroid problems, have type 1 diabetes or another autoimmune condition, consume too much or too little iodine, are pregnant or recently gave birth, or have had radiation therapy to the neck.

Underactive Thyroid Conditions and Symptoms

Hypothyroidism. An underactive thyroid doesn’t produce enough hormone. This results in a slowed metabolism. Common symptoms include low energy, weakness, fatigue, muscle and joint pain, fluid retention, weight gain, constipation, hair loss, sensitivity to cold, heavy or irregular menstrual cycles, and difficulty thinking and focusing. To diagnose the condition, blood tests will show low thyroid hormone levels. Thyroid hormone replacement drugs, such as Synthroid, are typically effective at restoring normal hormone levels.

Hashimoto’s Thyroiditis is an autoimmune condition. The body produces antibodies that attack the thyroid and cause inflammation. This can lead to hypothyroidism and swelling (goiter). To confirm the condition, blood tests look for thyroid antibodies and low hormone levels. Goiters are evaluated with imaging. The symptoms and treatment are the same as for hypothyroidism.

Overactive Thyroid Conditions and Symptoms

Hyperthyroidism. An overactive thyroid produces too much hormone. This results in a hyped-up metabolism, although you won’t feel energized. Common symptoms include weakness, fatigue, irritability, a fast heartbeat or palpitations, weight loss, diarrhea, problems sleeping, hair loss, heat sensitivity and excessive sweating, hand tremors, thyroid eye disease, an enlarged thyroid (goiter), and light or irregular menstrual cycles. To diagnose this condition, blood tests will show high hormone levels.

Several treatment options can reduce the thyroid hormone to a safe and proper level. Medication to reduce TSH, the thyroid-stimulating hormone produced by the pituitary gland, can slow thyroid activity. Beta blockers may be prescribed to help block the effects of too much thyroid hormone on the heart. In addition to medication, the function of the gland can be reduced with oral radioactive iodine that destroys thyroid tissue or with surgery to remove all or part of the thyroid.

Grave’s Disease is a genetic autoimmune condition that leads to hyperthyroidism. Thyroid eye disease (TED) and bulging eyes are signs of Grave’s disease. Symptoms and treatments are the same as for hyperthyroidism, with additional treatment for TED.

Structural Abnormalities of the Thyroid

Thyroid nodules, cysts or lumps can develop on or in thyroid tissue. Nodules, cysts and lumps can be caused by iodine deficiency, fluid in the gland, extra tissue growth, goiter, Hashimoto’s disease or thyroid cancer.

Small nodules may go undetected and may not cause symptoms or affect your health. Larger ones can interfere with your voice and swallowing. Large nodules can be treated with anti-inflammatory drugs or removed surgically. While most nodules are benign, some can be cancerous. Cancerous nodules require surgery to remove the affected gland and surrounding tissues. If part or all of the gland is removed and hormone levels are affected, supplemental hormone is prescribed to maintain healthy levels.

Diagnosing Thyroid Conditions

Thyroid problems often cause a hormone imbalance. Other less common symptoms include swelling (goiter), nodules on the thyroid or cancer of the gland.

Diagnosis begins with a review of your symptoms, your medical history and a physical exam of your neck. Bloodwork often tests for thyroid stimulating hormone (TSH) and thyroid hormone (T4 and T3) levels, and for the presence of thyroid antibodies. Ultrasound imaging, CT or MRI scans help evaluate nodules and goiters.

Whether hormonal or structural, thyroid conditions can be effectively managed. With symptom recognition followed by a proper diagnosis and treatment, you can live a healthy life.