Thyroid Gland Problems
The thyroid gland sits in the front of the neck, shaped like a butterfly, astride the windpipe (trachea). The thyroid’s job is to make thyroid hormone. This hormone controls the metabolic rate of every cell in our body, that is, it controls how fast we burn up energy.
Thyroid problems can be divided into 2 groups:
- Swellings of the thyroid gland (also known as goitre).
- Problems with the hormone level – either too much or too little.
Sometimes, you can get a mixture of both types of problems – example, an enlarged gland with too much hormone.
Symptoms of thyroid problems can also be divided into 2 groups
- Symptoms due to swelling of the thyroid gland and the pressure effects of those swellings.
- Symptoms due to thyroid hormone imbalance.
Swelling In The Neck – Goitre
Patients often come to see me with swellings in the neck.
Thyroid swellings are situated in the front of the neck and move when you swallow. Look at yourself in the mirror, then swallow. If you have a lump and it moves on swallowing, it may be that your thyroid gland is enlarged.
Common causes of thyroid swellings include:
- Thyroid cysts
- Multinodular goiter
- Graves disease
- Colloid nodules
- Thyroid adenomas
- Thyroid cancer
Sometimes, you may also have difficulty breathing or discomfort in the neck when swallowing. This could be due to the enlarged thyroid gland pressing on the windpipe (trachea) or gullet (oesophagus).
Too Much Hormone – Hyperthyroidism
You can also have symptoms of too much or too little hormone.
Common symptoms of too much hormone (hyperthyroidism):
- Sensation of heart beating too fast (palpitations)
- Shortness of breath
- Weight loss (despite good appetite)
- Anxiety and nervousness
- Lack of energy
- Tremor in the hands
- Irregular periods
- Both eyes protruding out (exophthalmos)
Too Little Hormone – Hypothyroidism
Common symptoms of too little hormone (hypothyroidism):
- Lack of energy
- Slow heart rate
- Irregular periods or infertility
- Increase in weight
- Dry skin
- Inability to tolerate cold
If you believe the above symptoms mirror what you suffer from and you suspect you have thyroid disease, make an appointment to see me.
I will usually arrange 2 tests: a simple blood test to check the hormone level and an ultrasound scan of the neck.
Occasionally we may have to proceed to a CT (Computer Tomography) scan of the neck and other tests. Once these tests and scans are done I will be able to advise you about your thyroid gland.
Treatment For Thyroid Problems
Treatment depends on the nature of your thyroid illness.
If you have a thyroid swelling, you may need surgery to remove it. Not all swellings require surgery so do not worry!
Most thyroid swellings are benign (not cancerous). However some thyroid swellings do turn out to be cancer. This is very important because most types of thyroid cancer are treatable and some have a very good prognosis.
If you think you have a thyroid swelling, you should see a doctor urgently. We may need to remove the thyroid swelling if there is a risk of the swelling being cancerous.
Some thyroid swellings need to be removed even if they are benign because they are pressing on some vital structure (like the windpipe / trachea or gullet / oesophagus) causing difficulty breathing or swallowing. If your thyroid gland is causing severe narrowing of the windpipe, you may be at risk of suffocation.
If you are worried about the swelling in your neck, come to see me and we will arrange a scan and some blood tests. ?I can better advise you once I have more information about the swelling in your neck.
If you have too much hormone, you may need medication to bring down the hormone levels.
If, on the other hand you have too little hormone, we need to do the exact opposite – you need to take hormone tablets to replace the missing hormone.
Tips For Thyroid Hormone Imbalance
If you have problems with your thyroid hormone levels (too much or too little), here’s what you can do.
- Take your medicines regularly without missing doses. If you do not take them properly, it can be difficult for your doctor to adjust your medicines so that your hormone levels are just right. For example, if you missed a week of medicines and your hormone levels are still high, I won’t know if I gave you too low a dose or if it was because you missed your medicines.
- Choose and then stick with the same doctor (it doesn’t matter if it’s me or not). I’ve known of patients who consult with many doctors and take medicines from all of them. They then mix up all the medicines from doctors A, B & C. Even though the medicines look different, they may actually be the same drug made by different companies, example one pink, another white etc.
- When you choose a doctor, pick one who is going to check and monitor your thyroid levels carefully with regular blood tests. Careful monitoring is just as important as taking medication regularly. When seeing a new patient with too much thyroid hormone, I usually monitor patients once a month at the start. When the levels become normal, I adjust the dose and lengthen the periods between check-ups to maybe 3 to 6 months.
- Be aware of the potential side effects of medication. Your doctor should be able to advise you what to look out for.
- If surgery is planned and you have too much thyroid hormone, it is important to bring the hormone levels down to normal before surgery to avoid getting a complication known as thyroid storm. This is a rare but potentially serious condition caused when a large amount of thyroid hormone is suddenly released into the circulation.
Treating Thyroid Problems Without Medication
Many patients ask me if they can treat thyroid problems without medication.
If your thyroid hormone levels are too low, the answer is no.
If your thyroid hormone levels are too high, there are 2 alternatives – surgery to remove the gland, and radioactive iodine treatment. Come to see me for further advice on this. In any case, treatment always begins with medicines first.
Hyperthyroidism & Pregnancy
I have hyperthyroidism (too much hormone). Can I get pregnant and should I stop my thyroid medicines during pregnancy?
Yes, you most certainly can get pregnant. However, if your hormones are very high, it may be a little more difficult to get pregnant.
If you are already pregnant you most certainly should continue your medication. Without your antithyroid medication, your hormones will become uncontrolled during pregnancy. That will make you ill.
Remember, if the mother is unwell, the baby will suffer too!
I advise women with hyperthyroidism during pregnancy to be especially careful about controlling their thyroid levels during pregnancy – maybe more frequent checks etc.
You should also inform your Obstetrician – it is possible the hyperthyroidism could affect the baby (not the medicines). I usually try to give patients the lowest dose possible during pregnancy.
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