Understanding Thyroid Problems -- Diagnosis and Treatment

How Do I Know If I Have a Thyroid Problem?

Your doctor can diagnose hyperthyroidism and hypothyroidism by testing the levels of thyroid hormones in your blood. Doctors measure hormones secreted by the thyroid itself, as well as thyroid-stimulating hormone (TSH), a chemical released by the pituitary gland that triggers hormone production in the thyroid.

When you are hypothyroid, higher quantities of TSH are circulating in your blood as your body attempts to increase production of thyroid hormones. The reverse is true with hyperthyroidism, in which TSH levels are below normal and circulating thyroid-hormone levels are high.

To identify the cause of hyperthyroidism, doctors often use radioactive iodide uptake tests, which track the amount of iodide absorbed by the thyroid gland. Iodide, obtained from the foods we eat, is a key ingredient in the manufacture of thyroid hormone, so the amount of iodide the thyroid absorbs is a reliable indicator of how much hormone the gland is producing. For this test, the doctor places an instrument over your neck to measure how much background radioactivity there is. Then, you must swallow a small amount of radioactive iodide in liquid or capsule form. After a predetermined time (usually 4-6 hours and at 24 hours), the doctor again places an instrument over your neck to measure how much of the radioactive iodide has gathered in your thyroid.

If the test suggests that the gland is collecting excessive amounts of iodide, the doctor may then conduct a radioactive iodide uptake scan. In this test, the doctor uses a special film to create a picture that shows the exact location of the radioactive iodide in your thyroid gland. The scan will reveal, for example, if the iodide is collecting in nodules, indicating that the nodules are responsible for the excess hormone production. If the scan shows that the iodide is spread equally throughout the tissue, the whole thyroid is involved in the excess production.

Nodules that appear suddenly are typically fluid-filled cysts and are often benign. They can be evaluated with a noninvasive ultrasound exam. If blood tests indicate that the nodules are producing excess thyroid hormone, your doctor may treat you for hyperthyroidism.

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In any case, you should receive periodic checkups if you have a nodule on your thyroid gland. Further tests will show if the nodule has the potential to become cancerous.

Depending on the size of the nodule, how it looks on ultrasound and other risk factors your doctor may check for thyroid cancer by performing an aspiration, or biopsy, in which a tissue sample of the nodule is taken and examined. One uncommon type of thyroid cancer can be diagnosed through a blood test that measures levels of a hormone involved in bone formation called calcitonin.

What Are the Treatments for Thyroid Problems?

For thyroid disorders stemming from the over- or under-production of thyroid hormones, both conventional and alternative treatments offer varied methods to try to restore hormone levels to their proper balance. Conventional treatments rely mainly on drugs and surgery. Alternative treatments attempt to relieve some of the discomfort associated with thyroid problems, or to improve the function of the thyroid gland through approaches ranging from diet supplements and herbal remedies to lifestyle changes and special exercises.

You should always receive a medical evaluation from your doctor for any thyroid disorder; most of these conditions require treatment beyond the scope of home care alone.

Treating hyperthyroidism requires suppressing the manufacture of thyroid hormone, while hypothyroidism demands hormone replacement. Conventional medicine offers extremely effective techniques for lowering, eliminating, or supplementing hormone production. Before deciding which treatment is best for you, your doctor will make an evaluation based on your particular thyroid condition, as well as your age, general health, and medical history.

Treatments for Hyperthyroidism

Thyroid hormone production can be suppressed or halted completely in these ways:

  • Radioactive iodide treatment
  • Anti-thyroid medication
  • Surgery

If your doctor decides that radioactive treatment is best, you will be asked to swallow a tablet or liquid containing radioactive iodide in amounts large enough to damage the cells of your thyroid gland and limit or destroy their ability to produce hormones. Occasionally, more than one treatment is needed to restore normal hormone production, and many patients actually develop hypothyroidism as a result of this procedure. 

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If you start using anti-thyroid medications, your hyperthyroid symptoms should begin to disappear in about six to eight weeks. However, you will need to continue taking the medication for about a year. At that time, your doctor will check to see if the medicine can be stopped. You will need to receive periodic medical exams once you are off the medicine to make sure that the condition has not returned.

Surgery is usually reserved for pregnant women who can’t take anti-thyroid medicine, or people with large goiters or cancerous nodules.

Treating Subacute Thyroiditis

Although subacute thyroiditis can bring on temporary hyperthyroidism, this condition usually does not require medical treatment. Any pain associated with the inflamed thyroid can generally be relieved with acetaminophen (Tylenol or Anacin) or aspirin. Do not use aspirin in children under the age of 19 because it increases the risk of Reye Syndrome. If over-the-counter drugs don't help, a doctor may prescribe prednisone or dexamethasone -- powerful anti-inflammatory drugs -- for a short period of time.

Treating Hypothyroidism

Hypothyroidism calls for a lifelong regimen of thyroid replacement. No surgical techniques, alternative medicine, or conventional drugs can increase the thyroid's hormone production once it slows down. Doctors generally prescribe synthetic forms of thyroid hormone, such as levothyroxine. Side effects are rare, but some people experience nervousness or chest pain while taking these drugs; usually, adjusting the levels of medication will alleviate any unpleasant effects. Tell your doctor if you are also taking tricyclic antidepressants, estrogens, the blood-thinning drug warfarin, the heart drug digitalis, or if you have diabetes, to make sure medications don't interfere with the thyroid treatment. Magnesium, aluminum, iron and even soy may interfere.

Treating Thyroid Cancer

Thyroid cancer is usually initially treated by surgically removing either the cancerous tissue or the whole thyroid gland, a procedure known as a thyroidectomy. If the cancer has spread beyond the thyroid, any other affected tissue, such as the lymph glands in the neck, will also be removed.

What About Alternative Medicine for Thyroid Problems?

Thyroid problems are usually easily corrected with conventional medicine. Consult your endocrinologist about using alternative therapies, which aim to cleanse the system, restore immune function, and balance hormone production and release.

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Naturopathy and TCM

A naturopath may treat your thyroid condition with homeopathic mixtures, herbs, preparations based on traditional Chinese medicine (TCM), which attributes thyroid disease to emotional distress, and acupuncture. Both methods aim to remove blocks to one's ''life force energy.''

Naturopaths are authorized to treat thyroid disease in some states; in others, it is illegal. Before seeking naturopathic treatment, check with your doctor or local health authority to see if your state allows naturopathic interventions. In addition, it is important to discuss with your doctor if these methods are working to treat your thyroid problem and not just treating the stress associated with thyroid disease.

There are no good studies showing the effectiveness of these methods in treating thyroid disorders.

Body Work and Nutrition

Chiropractors use spinal manipulation to treat symptoms of thyroid disorders by reducing muscle tension and improving blood circulation.

A diet rich in protein, calcium, magnesium, and iodine supports thyroid function. You want to be sure you are receiving enough of all the B vitamins, vitamin A, and vitamin C Check with your doctor before taking selenium which can cause hypothyroidism in someone with an iodine deficiency.

Avoid these products if you suffer from thyroid disease:

 

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on March 23, 2015

Sources

SOURCES:

American Academy of Family Physicians.

The American Thyroid Association.

EndocrineWeb.com.

The Norman Endocrine Surgery Clinic.

Community Health Care Medical Library.

Johns Hopkins University.

FDA Center for Food Safety and Applied Nutrition.

Mary Shoman, patient advocate - About.com.

WebMD Drug Reference from MedicineNet: "Levothyroxine Oral."

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