You Asked: Do I have a thyroid problem?

Are you always feeling hot, awake and hungry? Or perhaps you are always feeling cold, sleepy and gaining weight. The problem could be in your neck.

The thyroid is a butterfly-shaped gland situated below the Adam’s apple near the base of the neck. The thyroid secretes hormones essential to a wide array of bodily functions, including metabolism.

“A thyroid hormone imbalance, which is more prevalent in women, may be the cause of a multitude of health issues,” said Ronald Kuppersmith, MD, FACS, a head and neck surgeon and professor of surgery at the Texas A&M College of Medicine.

The scope of the thyroid’s influence within the body can make diagnosing a disorder highly difficult. “Often the symptoms of a thyroid disorder are subtle and gradual, but their effects can be significant,” Kuppersmith said. “Functional changes of the thyroid, like hormonal production, and structural changes of the thyroid, like abnormal cell growth and cancer, can be independent of one another.”

The expertise of a health care provider is necessary to determine what type of thyroid problem may be the culprit of any symptoms. Genetics, iodine deficiency, pregnancy, toxins, stress and autoimmune diseases are thought to be contributing factors to thyroid disease, but the underlying causes are not well understood. Treatments can be effective in managing the symptoms, but they tend to demand life-long monitoring by patients and their health care providers.

Functional changes of the thyroid tend to stem from autoimmune diseases, in which the body attacks itself.

“In this case, the body produces antibodies that target the thyroid and its hormone products, resulting in a hormonal imbalance that could hamper or hasten the body’s productivity,” Kuppersmith said.

There are three hormone products that the body may attack. First is the thyroid stimulating hormone (TSH), which is released by the pituitary gland in the brain. The other two hormones are produced by the thyroid: triiodothyroinine (T3) and its prohormone, or inactive hormone form, thyroxine (T4). These hormones are created from iodine and largely regulate metabolism. Typically, functional problems of the thyroid—including hypothyroidism and hyperthyroidism—manifest through symptoms linked to systems of the body.

Hypothyroidism

Hypothyroidism means the thyroid is underactive and produces too little thyroid hormone. This underproduction hinders signals and slows many operations within the body that could leave a person and their insides feeling less energized.

Below are some common symptoms of hypothyroidism:

• Fatigue
• Depression from low serotonin levels, the “feel-good” hormone
• Loss of appetite
• Weight gain
• Forgetfulness
• Low libido, potentially linked to weight gain, low energy and body pains
• Weak heartbeat
• Dry, itchy skin from decreased skin moisture and lack of sweat
• Constipation
• Longer, heavier and more frequent menstrual periods, leading to fertility issues
• Muscle weakness and pains from damaged nerves
• High blood pressure from slowed heartbeat, curbing pump strength and blood vessel flexibility
• Feeling cold
• Dry hair and hair loss, sometimes all over the body
• High cholesterol, potentially leading to heart problems

Hypothyroidism is typically treated with a synthetic thyroid hormone replacement to help increase and balance the thyroid hormone levels. The thyroid medicine levothyroxine can begin improving symptoms in two to four weeks once the body begins metabolizing the medication, Kuppersmith explained. At six to eight weeks, the body’s thyroid hormone levels should be recalibrated, and the health care provider can reassess the medication dosage.

Hyperthyroidism

Hyperthyroidism results from an overactive thyroid, meaning it produces too much thyroid hormone. This can push the body into overdrive by excessively activating the energy-producing cells.

Below are some common symptoms of hyperthyroidism:

• Difficulty sleeping
• Anxiety or heightened nervousness
• Increased appetite
• Weight loss
• Difficulty concentrating
• Rapid heartbeat
• Excessive sweating
• Diarrhea or frequent bowel movements
• Shorter, lighter and less frequent menstrual periods, leading to fertility issues
• High blood pressure from a rapid heartbeat
• Feeling warm
• Thinning hair on the head

Hyperthyroidism can be treated with radioactive iodine therapy, which is swallowed in a liquid or capsule form and generally requires only one treatment. It can help shrink the gland, causing the symptoms to diminish in three to six months.

Anti-thyroid medications can help the prevent overproduction of hormones temporarily, with results in six to 12 weeks, but these medications can be harmful to the liver. A surgical procedure called a thyroidectomy can remove all or part of the thyroid to prevent excessive hormone production. After radioactive iodine therapy or thyroidectomy, thyroid hormone replacement is typically required for life as the body no longer produces thyroid hormones.

Thyroid nodules or cancer

Structural changes, on the other hand, may not cause problems throughout the body, but people may show other symptoms. These changes derive from growths, or nodules, and cancerous tumors of the thyroid. Thyroid nodules are solid or fluid-filled lumps from cell changes of the thyroid that are common and typically very treatable.

“Approximately 60 percent of people have these nodules, and more than 90 percent of the nodules are benign,” Kuppersmith said, “but some can be cancerous.”

Thyroid cancer is also usually treatable and typically shows itself as a painless lump or swelling in the neck. If a thyroid mass becomes large enough that can make it difficult to swallow or breathe.

“Thyroid cancer is becoming more common, and it is unclear why. Some postulate that medical advancements have made it easier to detect, while others are concerned that environmental radiation exposure may be culpable,” Kuppersmith said. “Fortunately, we haven’t experienced an increase in the mortality rate.”

Below are some common symptoms of thyroid nodules or cancer:

• Painless lump or swelling in the neck
• Trouble breathing
• Trouble swallowing
• Hoarse voice

As for structural changes, the course of action depends on the size.

“When thyroid nodules are less than a centimeter wide, treatment is not typically necessary, and they need to be observed,” Kuppersmith said. “When they exceed one centimeter, a needle biopsy will be administered to test the cells for the presence of cancer in the thyroid.”

Thyroid cancer can be treated surgically with a thyroidectomy to remove all or part of the thyroid. Radioactive iodine therapy that destroys remaining cancerous thyroid cells following surgery may be necessary in high-risk cases. Patients who no longer have a working thyroid are often prescribed levothyroxine to balance their hormones.

“That small butterfly-like gland in our neck supports so many of our involuntary body functions that we aren’t aware of until they’re thrown out of whack,” Kuppersmith said. “Despite the impetus of the imbalance remaining a mystery, it is important to work with your health care provider, who can help bring your hormone levels back to normal.”