What Is Thyromegaly?
Thyromegaly is a rare genetic disorder which causes the body’s thyroid gland to produce too much thyroid hormone (hyperthyroidism). Hyperthyroidism leads to a number of health problems such as high blood pressure, heart attack, stroke, kidney failure and cancer. Thyroid hormones are involved in regulating metabolism and controlling many bodily functions including growth and development. Thyroid hormones play a vital role in energy production, nerve function, and muscle contraction.
The most common form of hyperthyroidism is known as congenital hyperthyroidism or Cushing’s syndrome. A child with Cushing’s syndrome will have elevated levels of both thyroxine (T4) and triiodothyronine (T3), which means they will develop symptoms when their TSH level falls below certain thresholds.
A second type of hyperthyroidism is called idiopathic hyperthyroidism. Idiopathic refers to the fact that it does not occur naturally in any individual. These cases usually arise from genetic defects or environmental factors.
Hyperthyroidism is also known as thyrotoxicosis and is caused by excessive amounts of thyroid stimulating hormone (TSH). TSH stimulates the pituitary gland to release additional hormones into the bloodstream. TSH causes the thyroid gland to produce and release more hormones.
The thyroid is a butterfly-shaped organ located in the neck that produces hormones that control the body’s metabolism.
Why Do You Need Thyromegaly?
More than 65% of people with hyperthyroidism have Graves’ disease. Graves’ disease is an autoimmune disorder that causes the body to produce antibodies that stimulate the thyroid. This stimulation causes the thyroid to produce and release excessive amounts of thyroid hormones. Graves’ disease is typically diagnosed using blood tests to measure the level of thyroid hormones in the blood. In some cases, an ultrasound or a nuclear scan of the thyroid may be used to confirm the diagnosis and rule out tumors.
A doctor may prescribe antithyroid medication to block the effects of excess thyroid hormones, radioactive iodine (RAI) to destroy part of the thyroid, or surgery to remove all or part of the thyroid. Radioactive iodine is the most common treatment for hyperthyroidism, but there are some risks involved with this method. For example, a small percentage of people develop hypothyroidism as a side effect of RAI treatment.
However, antithyroid drugs can cause serious side effects in some people such as high blood pressure and diabetes.
What Is Goiter?
Goiter refers to enlargement of the thyroid gland in the neck. Goiters can be caused by a number of factors, including autoimmune diseases, dietary deficiencies, and exposure to toxins. The most common form of goiter is known as simple goiter. Goiters may also result from an overproduction of thyroid hormones (hyperthyroidism). Simple goiters can be a temporary or permanent condition. If the thyroid enlargement is temporary, it will usually go away on its own. Permanent goiters may require treatment.
What Is a Thyroid Storm?
A thyroid storm is among the most serious complications of hyperthyroidism. It is most common in people with Graves’ disease and it can lead to life-threatening complications such as congestive heart failure and arrhythmias. A thyroid storm is a medical emergency and immediate treatment is necessary to avoid death. Patients experiencing a thyroid storm will undergo treatment for their underlying disease. They may also require a beta-blocker or diuretic to control heart or blood pressure issues.
What Is Myxedema?
Myxedema is a rare complication of hypothyroidism and occurs when a patient’s body fails to produce enough thyroid hormones. It is also known as myxedema coma and it is a medical emergency. Myxedema coma can lead to severe complications such as hypothermia, respiratory failure, and heart problems. It is most common in elderly people. A patient with myxedema will undergo treatment to stimulate the thyroid and replace hormones. They may require intravenous fluids, oxygen, and other supportive care.
What Is Cretinism?
Cretinism is a rare condition that affects children born to mothers who have untreated hypothyroidism during pregnancy. Women with untreated hypothyroidism are less likely to become pregnant and if they do, they are more likely to have miscarriages. Cretinism in newborns can cause a number of serious health issues such as growth problems, intellectual disability, deafness, and delayed development. The condition can be avoided if mothers with hypothyroidism receive the proper treatment before and during pregnancy.
What Is Myxedema Coma?
Myxedema coma is a rare but life-threatening complication of severe hypothyroidism. It most commonly occurs in people over the age of 60 and it can lead to heart failure, respiratory failure, and coma. People with myxedema coma will be admitted to the hospital and undergo thyroid hormone replacement therapy. They may also require intravenous fluids and oxygen to support the organs affected by the coma.
Hypothyroidism Treatment
People with either form of hypothyroidism can benefit from taking synthetic thyroid hormones. The thyroid hormones T3 and T4 need to be taken for life in order to reap the benefits of proper thyroid function. Most patients take tablets that are ingested, however, some patients may be prescribed injections instead.
Patients will undergo routine lab tests to ensure that they are getting the proper dose of medication.
Thyroid Hormone Replacement
Patients with either underactive thyroid will require lifelong treatment with synthetic thyroid hormones, also known as thyroid replacement therapy. These patients will need to take either levothyroxine (levothroid, levoxyl, others) or synthetic liothyronine sodium (synthetic triiodothyronine) daily for the rest of their lives. Taking levothyroxine or liothyronine is necessary for the body to produce normal levels of the thyroid hormones triiodothyronine (T3) and thyroxine (T4).
Patients with hypothyroidism will be started on levothyroxine sodium tablets. The starting dose will be based on the patient’s age, current thyroid hormone blood levels, and other medical problems. Doses are adjusted according to blood tests that measure thyroid hormone levels.
Liothyronine (T3) is another thyroid hormone that is taken by some patients. It may be preferred by patients who still feel symptomatic on levothyroxine. Liothyronine is not favored however, as there is some evidence that liothyronine may accelerate the growth of different types of cancer.
Patient’s families and caregivers should learn how to give the patient’s injections in case they are needed. Caregivers should make sure patients continue taking their medication even if they feel good, as this can prevent a relapse of the disease.
Natural Treatment for Hypothyroidism
Some natural treatment options for underactive thyroid may be used in addition to a synthetic thyroid hormone. Some patients find that dietary changes are enough to help them feel better.
Vitamin and Mineral Supplements
Certain vitamin and mineral supplements may be useful for hypothyroidism. These include:
Iodine: A small amount of iodine is needed for making thyroid hormones. Some experts recommend that people take small amounts of iodine as a supplement. However, people who have had radiation exposure, have lung or kidney disease, or have certain types of allergies should not take iodine supplements.
Selenium: Selenium is an antioxidant, and it may help reduce the amount of thyroid antibodies in people with hypothyroidism.
Zinc: Zinc is needed to make the hormone that tells the thyroid to release hormones. Good food sources of zinc include beef and oysters.
Watching the Sodium (Salt) Intake: Some patients find that eating too much salt makes their hypothyroidism worse. So they try to cut down on salt.
Stress Reduction: Some patients find that stress makes their hypothyroidism worse. As such, they try to take measures to reduce their stress levels in order to feel better. These include meditation, yoga, tai chi and getting more exercise.
Surgery for Graves’ Disease
Surgery may be recommended as a treatment option for patients with Graves’ disease whose thyroid is affected by the condition. This can be performed by a thyroidectomy, which involves the surgeon removing the entire thyroid.
A partial thyroidectomy may also be used to treat the Graves’ disease. In this procedure, an area of the thyroid is removed in order to reduce disease activity.
Removing the thyroid and/or part of the organ eliminates the overproduction of hormones that cause the symptoms of Graves’ disease. The patient’s remaining healthy thyroid tissue will then produce enough hormones to maintain a normal body metabolism.
Surgery may also be recommended as a treatment for patients with Graves’ ophthalmopathy. In this case, the surgeon will sometimes remove only the affected eye.
Some patients may experience postoperative complications after surgery, including:
Hoarseness: A change in the voice that makes it sound raspy or strained may develop. This is most likely to occur in women.
Paralysis: Temporary paralysis of the vocal cords is possible, especially in patients who have had a thyroidectomy. This can cause hoarseness or difficulty breathing.
Swelling: Swelling of the neck may occur after surgery, which may cause compression of the airway or interfere with swallowing.
Bleeding: Light bleeding may occur after the surgery, and a gauze pad or bandage may be needed to stop it. Heavy bleeding that cannot be stopped by direct pressure requires a return to the operating room for clot removal.
Infection: Rarely, an infection may develop at the surgical site. Signs of infection include redness, swelling, pain and fever.
If any of these complications occur, the patient’s doctor will likely recommend taking antibiotics.
Living With Hypothyroidism
While there is no cure for hypothyroidism, the condition can be managed with a synthetic thyroid hormone replacement medication. While some patients may choose to take the synthetic T4 hormone and add T3 (either as a standalone tablet or a combination medicine), others prefer to take the T4-only pill because it has been shown to be just as effective and causes fewer side effects. It’s a matter of personal preference.
The hypothyroidism patient may have to take thyroid hormone replacement medication for the rest of their life. This will prevent any symptoms from reappearing. The dose of the medicine must be adjusted over the years, however, as the body’s need for thyroid hormone decreases with age.
A lifestyle change may also help patients with hypothyroidism. This involves making healthy food choices and getting more exercise. This can help with a number of the health risks that come with having an underactive thyroid.
Living With Graves’ Disease
The goal of treatment for patients with Graves’ disease is to reduce the thyroid hormone production to normal levels. This can be achieved through a number of ways, including:
Surgery: The most common treatment for Graves’ disease is radioiodine ablation, also known as radioactive iodine therapy. In this procedure, a patient is given a concentrated amount of radioactive iodine. The iodine then goes on to destroy the thyroid cells that produce the excess hormones.
The effects of the treatment become evident within a few days as the overproduction of thyroid hormones is reduced. This is a permanent solution to the condition.
Drugs: Patients may also take drugs to reduce thyroid hormone production. Such drugs include Propylthiouracil (PTU) and Methimazole (MMI). The use of these drugs can lead to liver and kidney complications.
While the goal of treatment for patients with Graves’ disease is to reduce the production of thyroid hormones to normal levels, this doesn’t always happen. For some patients, the hyperthyroid state will become permanent. This is known as permanent pathological hyperthyroidism.
For others, the condition may become permanent due to the body’s inability to absorb the medication. This is known as drug resistance.
Living With Pseudothyroidism
Pseudothyroidism is a condition in which the patient has an enlarged thyroid gland but does not produce excess thyroid hormones. It is diagnosed by performing a physical examination and measuring the level of the patient’s TSH (thyroid-stimulating hormone). A high TSH level and an enlarged thyroid are telltale signs of the condition.
There is no known cure for pseudothyroidism, and the condition does not cause any major health problems for the patient. However, medication can be taken to reduce the size of the thyroid and block the production of thyroid hormones. This process is known as ablative therapy, in which the size of the thyroid is reduced with the use of X-rays.
The TSH level can then be monitored over time to see if the patient’s condition has improved.
Living With TSH Levels Above Normal
Pseudothyroidism is not the only condition that causes an elevated TSH level. Some patients with a lower than normal TSH level are found to have an enlarged thyroid. This may be due to a condition known as subclinical hyperthyroidism.
In some cases, the patient may have an even lower TSH level but show no signs of an enlarged thyroid. This is known as subclinical hypothyroidism. A low TSH level in the presence of normal thyroid hormone levels is not an illness and does not cause any health problems.
It should be monitored regularly with further testing to ensure that the patient’s condition doesn’t change.
Living With TSH Levels Below Normal
In some rare cases, a patient may have a low TSH level and an underactive thyroid. This is known as subclinical hypothyroidism and can be treated in the same way as a patient who has been diagnosed with permanent hypothyroidism. The treatment involves replacing the missing hormone with a synthetic version called levothyroxine.
Diagnosis
A diagnosis of hypothyroidism or hyperthyroidism can be made by testing the levels of thyroid hormones in the blood. The most commonly tested thyroid hormone is TSH (Thyroid-Stimulating Hormone), which is secreted from the pituitary gland and tells the thyroid to produce hormones.
Measuring the levels of TSH, free T4 and free T3 can help doctors determine whether the thyroid is overactive (producing too much hormone), underactive (not producing enough hormone) or whether the cause of the condition is due to the pituitary gland.
The patient’s age, weight, medical history and symptoms can also be taken into account when diagnosing a thyroid disorder.
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