Thyroid Disease


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Thyroid Disease

  1. 1. Frequently Asked questions Thyroid Q: What is hyperthyroidism? A: Some disorders cause the thyroid to make more thyroid hormones than the body needs. This is called hyperthy- Disease roidism (hy-pur-THY-roi-diz-uhm), or overactive thyroid. The most common cause of hyperthyroidism is Graves' dis- ease. Graves’ disease is an autoimmune Q: What is the thyroid? disorder, in which the body's own A: Your thyroid (THY-roid) is a small defense system, called the immune sys- gland found at the base of your neck, tem, stimulates the thyroid. This causes just below your Adam's apple. The it to make too much of the thyroid 1-800-994-9662 thyroid produces two main hormones hormones. Hyperthyroidism can also be TDD: 1-888-220-5446 called T3 and T4. These hormones caused by thyroid nodules that prompt travel in your blood to all parts of your excess thyroid hormones to be made body. The thyroid hormones control (see What are thyroid nodules?). the rate of many activities in your body. These include how fast you burn calo- ries and how fast your heart beats. All Q: What are the symptoms of of these activities together are known as hyperthyroidism? your body's metabolism. A thyroid that A: At first, you might not notice symp- is working right will produce the right toms of hyperthyroidism. They usually amounts of hormones needed to keep begin slowly. But over time, a speeded your body’s metabolism working at a up metabolism can cause symptoms rate that is not too fast or too slow. such as: • Weight loss, even if you eat the same Q: What kinds of thyroid problems or more food can affect women? • Eating more than usual A: Women are more likely than men to • Rapid or irregular heartbeat or develop thyroid disorders. Thyroid dis- pounding of your heart orders that can affect women include: • Anxiety • Disorders that cause hyperthyroidism • Irritability • Disorders that cause hypothyroidism • Trouble sleeping • Thyroid nodules • Trembling in your hands and fingers • Thyroiditis • Increased sweating • Thyroid cancer • Increased sensitivity to heat • Goiter • Muscle weakness • More frequent bowel movements • Less frequent menstrual periods with lighter than normal menstrual f low page U.S. Department of Health and Human Services, Office on Women’s Health
  2. 2. Frequently Asked questions In addition to these symptoms, people • Constipation with hyperthyroidism may have osteo- • Muscle weakness porosis, or weak, brittle bones. In fact, hyperthyroidism might affect your bones • Joint or muscle pain before you have any of the other symp- • Depression toms of the disorder. This is especially • Fatigue (feeling very tired) true of postmenopausal women, who are already at high risk of osteoporosis. • Pale dry skin • A puffy face Q: What is hypothyroidism? • A hoarse voice A: Hypothyroidism (hy-poh-THY-roi- • Excessive menstrual bleeding 1-800-994-9662 diz-uhm) is when your thyroid does TDD: 1-888-220-5446 not make enough thyroid hormones. It In addition to these symptoms, people is also called underactive thyroid. The with hypothyroidism may have high most common cause of hypothyroid- blood levels of LDL cholesterol. This ism in the United States is Hashimoto's is the so-called bad cholesterol, which thyroiditis. Hashimoto’s thyroiditis is can increase your risk for heart disease. an autoimmune disease, in which the immune system mistakenly attacks the Q: What are thyroid nodules? thyroid. This attack damages the thy- A: A thyroid nodule (NAHD-yool) is a roid so that it does not make enough swelling in one section of the thyroid hormones. Hypothyroidism also can be gland. The nodule can be solid or filled caused by: with f luid or blood. You can have just • Treatment of hyperthyroidism one thyroid nodule or many. • Radiation treatment of certain can- Most thyroid nodules do not cause cers symptoms. But some thyroid nod- • Thyroid removal ules make too much of the thyroid hormones, causing hyperthyroid- In rare cases, problems with the pitu- ism. Sometimes, nodules get to be big itary gland can cause the thyroid to be enough to cause problems with swal- less active. lowing or breathing. In fewer than 10 percent of cases, thyroid nodules are Q: What are the symptoms of cancerous. hypothyroidism? Thyroid nodules are quite common. By Symptoms of hypothyroidism tend to the time you reach the age of 50, you develop slowly, often over several years. have a 50 percent chance of having a At first, you may just feel tired and thyroid nodule larger than a half inch sluggish. Later, you may develop other wide. We do not know why nodules symptoms of a slowed down metabo- form in otherwise normal thyroids. lism, including: You can sometimes see or feel a thyroid • Weight gain, even though you are nodule yourself. Try standing in front not eating more food of a mirror and raise your chin slightly. • Increased sensitivity to cold Look for a bump on either side of your page U.S. Department of Health and Human Services, Office on Women’s Health
  3. 3. Frequently Asked questions windpipe below your Adam's apple. If Silent or painless thyroiditis the bump moves up and down when Symptoms are the same as in postpar- you swallow, it may be a thyroid nod- tum thyroiditis, but they are not related ule. Ask your doctor to look at it. to having given birth. Subacute thyroiditis Q: What is thyroiditis? Symptoms are the same as in post- A: Thyroiditis (thy-roi-DY-tiss) is inf lam- partum and silent thyroiditis, but the mation, or swelling, of the thyroid. inf lammation in the thyroid leads to There are several types of thyroiditis, pain in the neck, jaw, or ear. Unlike the one of which is Hashimoto's thyroiditis. other types of thyroiditis, subacute thy- Other types of thyroiditis include: roiditis may be caused by an infection. 1-800-994-9662 Postpartum thyroidits TDD: 1-888-220-5446 Like Hashimoto's thyroiditis, postpar- Q: What are the symptoms of thy- tum thyroiditis seems to be caused by roid cancer? a problem with the immune system. Most people with thyroid cancer have In the United States, postpartum thy- a thyroid nodule that is not causing roiditis occurs in about 5 to 10 percent any symptoms. If you have a thyroid of women. The first phase starts 1 to 4 nodule, there is a small chance it may months after giving birth. In this phase, be thyroid cancer. To tell if the nodule you may get symptoms of hyperthy- is cancerous, your doctor will have to roidism because the damaged thyroid is do certain tests (see How are thyroid leaking thyroid hormones out into the diseases diagnosed?). A few people with bloodstream. The second phase starts thyroid cancer may have symptoms. If about 4 to 8 months after delivery. In the cancer is big enough, it may cause this phase, you may get symptoms of swelling you can see in the neck. It may hypothyroidism because, by this time, also cause pain or problems swallowing. the thyroid has lost most of its hor- Some people get a hoarse voice. mones. Not everyone with postpartum Thyroid cancer is rare compared with thyroiditis goes through both phases. other types of cancer. It is more com- In most women who have postpartum mon in people who: thyroiditis, thyroid function returns to normal within 12 to 18 months after • Have a history of exposure of the symptoms start. thyroid to radiation (but not routine X-ray exposure, as in dental X-rays Risk factors for postpartum thyroiditis or mammograms) include having: • An autoimmune disease, like type 1 • Have a family history of thyroid can- diabetes cer • A personal history or family history • Are older than 40 years of age of thyroid disorders • Having had postpartum thyroiditis after a previous pregnancy page U.S. Department of Health and Human Services, Office on Women’s Health
  4. 4. Frequently Asked questions Q: What is a goiter? Blood tests A: A goiter is an abnormally enlarged thy- Testing the level of thyroid stimulating roid gland. Causes of goiter include: hormone (TSH) in your blood can help • Iodine deficiency. Iodine is a min- your doctor figure out if your thyroid eral that your thyroid uses for mak- is overactive or underactive. TSH tells ing thyroid hormones. Not getting your thyroid to make thyroid hor- enough iodine in your food and mones. Depending on the results, your water can cause your thyroid to doctor might order another blood test get bigger. This cause of goiter is to check levels of one or both thyroid uncommon in the United States hormones in your blood. If your doctor because iodine is added to table salt. suspects an immune system problem, 1-800-994-9662 your blood may also be tested for signs • Hashimoto's thyroiditis of this. TDD: 1-888-220-5446 • Graves' disease Radioactive iodine uptake test • Thyroid nodules For this test, you swallow a liquid or • Thyroiditis capsule containing a small dose of radio- active iodine (radioiodine). The radio- • Thyroid cancer iodine collects in your thyroid because Usually, the only symptom of a goiter is your thyroid uses iodine to make thyroid a swelling in your neck. But a very large hormones. Then, a probe placed over or advanced goiter can cause a tight your thyroid measures the amount of feeling in your throat, coughing, or radioiodine in your thyroid. A high problems swallowing or breathing. uptake of radioiodine means that your Having a goiter does not always mean thyroid is making too much of the thy- that your thyroid is not making the right roid hormones. A low uptake of radioio- amount of hormones. Depending on the dine means that your thyroid is not mak- cause of your goiter, your thyroid could ing enough of the thyroid hormones. be making too much, not enough, or the Thyroid scan right amount of hormones. A thyroid scan usually uses the same radioiodine dose that was given by Q: How are thyroid disorders diag- mouth for your uptake test. You lie on nosed? a table while a special camera creates A: Thyroid disorders can be hard to diag- an image of your thyroid on a com- nose because their symptoms can be puter screen. This test may be helpful linked to many other health problems. in showing whether a thyroid nodule is Your doctor will start by taking a medi- cancerous. Three types of nodules show cal history and asking if any of your up in this test: family members has a history of thyroid • Thyroid nodules that take up excess disorders. Your doctor will also give radioiodine are making too much you a physical exam and check your of the thyroid hormones, causing neck for thyroid nodules. Depending hyperthyroidism. These nodules on your symptoms, your doctor may show up brightly on the scan and are also do other tests, such as: called hot nodules. page U.S. Department of Health and Human Services, Office on Women’s Health
  5. 5. Frequently Asked questions • Thyroid nodules that take up the • Antithyroid medicines block the same amount of radioiodine as nor- thyroid's ability to make new thyroid mal thyroid cells are making a nor- hormones. These drugs do not cause mal amount of thyroid hormones. permanent damage to the thyroid. These are called warm nodules. • Radioiodine damages or destroys • Thyroid nodules that do not take up the thyroid cells that make thyroid radioiodine are not making thyroid hormones. For this treatment, your hormones. They appear as defects or doctor will give you a higher dose of holes in the scan and are called cold a different type of radioiodine than is nodules. used for the radioiodine uptake test Hot nodules are almost never cancer- or the thyroid scan. 1-800-994-9662 ous. A small percentage of warm and • Surgery to remove most of the thy- TDD: 1-888-220-5446 cold nodules are cancerous. roid. Thyroid fine needle biopsy • Beta (BAY-tuh)-blockers are medi- This test is used to see if thyroid nod- cines that block the effects of thyroid ules have normal cells in them. Local hormones on the body. These medi- anesthetic may be used to numb an area cines can be helpful in slowing your on your neck. Then, a very thin needle heart rate and reducing other symp- is inserted into the thyroid to withdraw toms until one of the other forms some cells and f luid. The withdrawal of treatment can take effect. Beta- of cells and f luid is called a biopsy (BY- blockers do not reduce the amount op-see). A special type of doctor called of thyroid hormones that are made. a pathologist (path-ol-uh-jist) examines If your thyroid is destroyed by radioio- the cells under a microscope to see dine or removed through surgery, you if they are abnormal. Abnormal cells must take thyroid hormone pills for the could mean thyroid cancer. rest of your life. These pills give your Thyroid ultrasound body the thyroid hormones that your The thyroid ultrasound uses sound thyroid would normally make. waves to create a computer image of the thyroid. This test can help your doctor Q: How is hypothyroidism treated? tell what type of nodule you have and A: Hypothyroidism is treated with medi- how large it is. Ultrasound may also cine to supply the body with the thyroid be helpful in detecting thyroid cancer, hormones it needs to function right. although by itself it cannot be used to The most commonly used medicine is diagnose thyroid cancer. You may have levothyroxine (le-voh-thy-ROK-suhn). repeat thyroid ultrasounds to see if your This is a man-made form of T4. It is nodule is growing or shrinking. exactly the same as the T4 that your thyroid makes. When you take T4, your Q: How is hyperthyroidism treated? body makes the T3 it needs from the T4 A: Your doctor's choice of treatment will in the pills. A man-made form of T3, depend on the cause of your hyperthy- called liothyronine (ly-oh-THY-roh- roidism and how severe your symptoms neen), is also available. Some doctors and page are. Treatments include: patients prefer a combination of T4 and U.S. Department of Health and Human Services, Office on Women’s Health
  6. 6. Frequently Asked questions T3 or T3 by itself. Most patients with Q: How is thyroid cancer treated? hypothyroidism will need to be on thy- • Surgery. The main treatment for roid hormone treatment for the rest of thyroid cancer is to remove the their lives. entire thyroid gland, or as much of it as can be safely removed. Often, sur- gery alone will cure the thyroid can- Q: How are thyroid nodules treat- cer, especially if the cancer is small. ed? A: Treatment depends on the type of • Radioiodine. A large dose of radio- nodule or nodules that you have. iodine will destroy thyroid cancer Treatments include: cells with little or no damage to other parts of the body. • Watchful waiting. If your nodule 1-800-994-9662 is not cancerous, your doctor may TDD: 1-888-220-5446 decide to simply watch your condi- Q: How is goiter treated? tion. This involves giving you regu- A: The treatment for goiter depends on lar physical exams, blood tests, and the cause of the goiter. If your goiter is perhaps thyroid ultrasound tests. If caused by not getting enough iodine, your nodule does not change, you you may be given an iodine supplement may not need further treatment. to swallow and T4 hormone, if need • Radioiodine. If you have nodules be. Other treatments include: that are making too much of the • Radioiodine to shrink the goiter, thyroid hormones, radioiodine treat- especially if parts of the goiter are ment may be used. The radioiodine overactive is absorbed by the thyroid nodules, • Surgery to remove part or almost all and it causes them to shrink and of the thyroid make smaller amounts of thyroid hormones. • Alcohol ablation (uh-BLAY- Q: Are there any complementary shuhn). In this procedure, your doc- or alternative treatments for tor injects alcohol into thyroid nod- thyroid problems? ules that make too much of the thy- A: To date, we don’t know enough about roid hormones. The alcohol shrinks alternative treatments for thyroid prob- the nodules and they make smaller lems. Your doctor can explain which amounts of thyroid hormones. treatment options are best for you. • Surgery. All nodules that are cancerous are surgically removed. Q: Can thyroid disorders cause Sometimes, nodules that are not problems with pregnancy? cancerous but are big enough to A: Both hyperthyroidism and hypothy- cause problems breathing or swal- roidism can make it more difficult for lowing are also surgically removed. you to become pregnant. Hyperthyroidism that is not properly treated during pregnancy can cause: • Early labor and premature babies page U.S. Department of Health and Human Services, Office on Women’s Health
  7. 7. Frequently Asked questions • Preeclampsia (pre-ee-CLAMP-see- Q: Can I exercise if I have a thyroid uh), a serious condition starting after problem? 20 weeks of pregnancy that causes A: Some people with thyroid problems may high blood pressure and problems find exercise difficult. It is important with the kidneys and other organs to talk to your doctor about the right • Fast heart rate of the developing amount of physical activity for you. baby • Smaller babies Q: Should I get tested for thyroid • Stillbirths diseases? A: Ask your doctor or nurse if you need Women who have hypothyroidism that to have a thyroid test. This is especially 1-800-994-9662 is not diagnosed or properly treated important if you are of childbearing age, TDD: 1-888-220-5446 during pregnancy may be at increased have already had a thyroid problem, or risk for: have had surgery or radiotherapy affect- • Anemia (lower than normal number ing the thyroid gland. You may also be of healthy red blood cells) at higher risk if you have: • Preeclampsia • Goiter • Low-birth-weight babies • Pernicious anemia • Problems with brain development in • Type 1 diabetes the baby • Vitiligo • Abnormal bleeding after giving birth • Prematurely gray hair If you are pregnant or are thinking At any age, be sure to ask your doctor about becoming pregnant, ask your about any thyroid disorder symptoms doctor if you need a thyroid test. This is you might have. n especially true if you or a family mem- ber has a history of thyroid problems or conditions related to thyroid disorders, including: • Prematurely gray hair • White patches on the skin • Type 1 diabetes page U.S. Department of Health and Human Services, Office on Women’s Health
  8. 8. Frequently Asked questions For more information For more information on thyroid diseases, call at 1-800-994-9662 or contact the following organizations: The American Thyroid Association National Cancer Institute Phone number: (703) 998-8890 Phone number: (800) 422-6237 Internet address: Internet address: cancertopics/wyntk/thyroid The Hormone Foundation 1-800-994-9662 Phone number: (800) 467-6663 Thyroid Cancer Survivors, Inc. Internet address: http://www.hormone. Phone number: (877) 588-7904 TDD: 1-888-220-5446 org/thyroid/ Internet address: National Endocrine and Metabolic Diseases Information Service National Institute of Diabetes and Digestive and Kidney Diseases Phone number: (888) 828–0904 Internet address: http://endocrine.niddk. Reviewed by: Jacqueline Jonklass, MD, PhD, MPH Assistant Professor Division of Endocrinology and Metabolism Department of Medicine Georgetown Univeristy Mark Helfand, MD, MS, MPH Director, Oregon Evidence-Based Practice Center Assistant Professor, School of Medicine Oregon Health and Science University All material contained in this FAQ is free of copyright restrictions, and may be copied, reproduced, or duplicated without permission of the Office on Women's Health in the Department of Health and Human Services. Citation of the source is appreciated. Content last updated April 9, 2009. Screening recommendation updated January 14, 2010. page U.S. Department of Health and Human Services, Office on Women’s Health