Thyroid Gland Problems

Thyroid-02

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:

  1. Swellings of the thyroid gland (also known as goitre).
  2. 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
  1. Symptoms due to swelling of the thyroid gland and the pressure effects of those swellings.
  2. 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
  • Sleepiness
  • Dry skin
  • Constipation
  • 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.

  1. 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.
  2. 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.
  3. 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.
  4. Be aware of the potential side effects of medication. Your doctor should be able to advise you what to look out for.
  5. 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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Rectal Bleeding: Should You Be Worried?

Rectal Bleeding… Beware That Which Is Concealed!

Passing blood in the stools is a common problem. For some patients, the sight of blood in the toilet bowl is alarming but others simply blame it on piles and brush it off.

Rectal bleeding is always significant and requires further investigation and assessment by a specialist.

Why?

Well, though the commonest cause is probably piles (which are usually just troublesome rather than serious) rectal bleeding can also be due to other diseases in the large bowel.

Even if you DO have piles – (because piles are so common) it is possible for someone to have piles but be bleeding from Something Else in the large bowel.

And that Something Else could be serious….

 

Possible Causes of Rectal Bleeding
  • Anal fissure
  • Anal fistula
  • Diverticular disease
  • Colitis & Inflammatory bowel disease
  • Angiodysplasia
  • Polyps
  • Cancer

Notice the last two?

Polyps & Cancer.

You certainly do NOT want to miss picking up a hidden colon cancer, just because someone called it piles without checking out your bowel.

And as for polyps, there is quite a lot of evidence to link polyps to cancer.

So, if you have polyps, you wouldn’t want to be keeping those either.

As for the other things, Diverticular Disease can cause massive serious bleeding as well as perforation or obstruction but at the end of the day, it is totally benign and does not keep getting worse with time, like polyps and cancer.

 

What To Do If You Have Rectal Bleeding

So if you’re thinking: does rectal bleeding have anything to do with cancer?

First, don’t scare yourself unnecessarily. We won’t know until we conduct a thorough examination.

Make an appointment to see me.

I would probably advise a scope examination of the large bowel, called a colonoscopy.

If after the scope examination everything inside you is normal, we can then blame the bleeding on piles and be certain that we are not missing something potentially dangerous inside.

Then we can both breathe a sigh of relief!

 

You might also want to read:

 

All You Ever Wanted To Know About Polyps

What Are Polyps?

Polyps are growths in the bowel.

They can have a stalk, like a cauliflower, or be flat like moss. Polyps can cause bleeding or mucus in the stools, and on rare occasions it can cause bowel obstruction.  There are 2 types of polyps: malignant as well as benign polyps.

However, evidence suggests that polyps kept for a long time in the body can turn cancerous.

Hundreds of Polyps In The Bowel?
Polyp as seen on colonoscopy
Polyp as seen on colonoscopy

Yes, some patients have a rare condition called Familial Adenomatous Polyposis (FAP).

Patients with this condition have hundreds of polyps in the bowel.

These patients have a risk of cancer approaching 100%, mostly before the age of 40 years. If you suffer from FAP, the best course of action is to remove the entire large bowel leaving the small bowel, preferably before it becomes cancerous.

Do I Have Polyps and If So, How Do I Get Rid of Them?

If you do not have any symptoms, we can screen you to see if you might have polyps using a test called Faecal Occult Blood test to see if there is any blood mixed in the stool.

If it is positive, you should have a colonoscopy. A colonoscopy is the best way to find out if you have polyps or not.

If we find polyps during the colonoscopy examination, we can remove them with a special snare.

If you are on “blood thinning medicines” (Aspirin, Clopidogrel, Ticlodipine, Xarelto or Warfarin) you need to stop taking these medicines at least 5 days before removal of a polyp to avoid bleeding from the stalk afterwards.

Colon Cancer: Symptoms & Treatment

What Is Colorectal Cancer?

Colorectal cancer is cancer of the large bowel. In Malaysia, it is one of the top 3 most common cancers for men and women.

Like all cancers, it is dangerous because it can spread to involve other organs in other parts of the body. Once the cancer has spread, it may not be possible to remove it completely with surgery.

 

Colorectal cancer causing obstruction
Colorectal cancer causing obstruction
Symptoms of Colorectal Cancer

Colorectal (large bowel) cancer may be silent and display no symptoms. However, most patients would have had some symptoms at one time or other.

Here are some symptoms to check for:

  • Passing blood in the stools
  • Recent change in bowel habit – constipation or diarrhea
  • Difficulty passing motions
  • Passing slime or mucus in the stools
  • Unexplained abdominal pain
  • Abdominal mass

If you have any of these symptoms, or if you have a strong family history of bowel cancer you should have your bowel checked with a colonoscopy.

What If I Don’t Have Pain?

If you don’t experience pain that does not mean you are OK.

Although cancers can cause pain, very often we see cancers without any pain at all. In fact, painless rectal bleeding is often a sign of colorectal cancer.

Am I At Risk For Colorectal Cancer?
  • Age – more common in middle aged & elderly
  • Gender – more common in males
  • Diet – more common if diet is rich in red meats or in low fibre diets
  • Genetic – family history of colorectal cancer
  • Polyps – Polyps are now regarded as having the potential to become cancerous (see my explanation on polyps)
  • Inflammatory bowel disease – ulcerative colitis & Crohn’s disease (uncommon in Malaysia)
How Should I Change My Diet?

I get this question all the time. My advice is, take less red meat and consume more fruits and vegetables.

However, diets are weak risk factors for colorectal cancer. In other words, changing your diet may not necessarily prevent you from getting colorectal cancer.

Can I Take Preventive Medicine?

You can.

Some studies suggests that Aspirin and Celecoxib can reduce the risk of getting colorectal cancer but this is only recommended for those who are at high risk.

Colorectal Cancer Treatment

Colorectal cancer treatment depends on several things including what stage the cancer has reached as well as whether other organs are involved.

Surgery is one of the main ways of treating colorectal cancer and if it can be removed safely, it should be removed. Surgery is often combined with radiotherapy and chemotherapy.

This is not a one-size-fits all treatment plan. The treatment plan can be complicated and varies from patient to patient, especially if other organs are involved. On the whole, as doctors, we do tailor the treatment according to your needs as a patient.

If you suspect something amiss or have been diagnosed with colorectal cancer and need someone to advise or discuss your options either for medication, management plan or surgery, I may be able to help.

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A Thank You is Simply Inadequate

Yes, I did not forget to thank Mr. Khoo Saye Thiam who effectively removed the cancerous colon bothering me. Yes, I repeated that each time I bumped into him subsequent to my operation. Mr. Khoo is a surgeon who listens and understands his patients well. He has done all he could to put away the first huge problematical part of my medical journey to provide me with the necessary foundation and confidence to engage with my other medical challenges.

Dr. P. S. Yeoh
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Cancer In The Colon

Madam T was a 78 year old Chinese lady who was referred to me with blood in her stools. She also had diabetes, high blood pressure and had previously suffered a stroke.

When I met her, I advised her to undergo a colonoscopy.  During this procedure I found she had small polyps in her rectum and left colon which I removed with the colonoscope.

However, this was not the last of her problems.

Cancer In The Colon

The colonoscopy also showed a cancer of the left colon as well as a huge polyp in the right colon which looked very suspicious. The right colon polyp was too large to remove safely with the colonoscope and could only be removed surgically.

colon cancer and polyp removal
Madam T’s Colon Cancer and Polyp

I decided to do a CT scan of the chest, abdomen and pelvis just to be sure the cancer had not spread elsewhere.

As polyps can become cancerous over time, I could not leave the polyp alone especially as she had already developed a cancer in the left colon.

To remove the cancer in the left colon as well as the polyp on the opposite side, undergoing open surgery would have meant a long incision from the upper to lower abdomen.

I recommended laparoscopic surgery as this would mean a much smaller scar, less pain and faster healing. Nevertheless, the operation still had some risks due to her age, diabetes, high blood pressure and previous stroke.

She was also on blood thinning medication (antiplatelet drugs) which would increase the risk of bleeding during surgery.

But the biggest obstacle was yet to come.

She Refused Surgery

Madam T was completely against surgery. She was understandably worried and frightened.

She firmly refused surgery although I told her that this could be an early cancer. Her best hope was to remove the cancer through surgery. Untreated, it would most certainly progress, possibly to obstruction or spread elsewhere beyond the reach of any medical help.

Sensing her fear, I decided to keep my silence as I completed her tests including a thorough cardiac assessment.

Finally, I drew her family aside and explained the situation clearly to them. Yes, there were risks including leaks, bleeding and another stroke.

No, I could not promise to deliver an operation without complications but I did promise I would leave no stone unturned and would try my very best to make it as safe as humanly possible. It helped that the daughter had seen me as a patient on an earlier occasion and I had already won her trust.

Madam T finally agreed to proceed after much cajoling from her family, signing the consent form dejectedly.

The laparoscopic surgery was a success. We managed to remove both the cancer and polyp using just a 6 cm long incision. During the operation, we noticed there was no visible spread of the cancer which was a relief!

Soon after, Madam T had a good recovery post-operation without any complications. She was relieved that her surgery went well and was glad she was persuaded to undergo it, despite her earlier misgivings.

She is presently on chemotherapy and there are presently no signs of recurrent cancer.