The mere mention of the word Thyroid conjures up images of a swollen neck and lifelong medication. There are many myths, misconceptions and mysteries that surround this important gland. The truth is that thyroid problems are common, easy to diagnose and treat. A person with a thyroid problem can grow, marry, have children and lead a very normal productive, and long life.
What does the thyroid gland do?
The Thyroid is a butterfly-shaped gland in the front of our neck. Everyone has a thyroid gland. (Some children are born with no thyroid. Sometimes it is in an unusual location like the tongue or elsewhere in the neck).
The thyroid produces two important hormones - T4 and T3 (thyroid hormone) - which circulate in the blood. The Thyroid gland is controlled by the pituitary gland in the brain by producing a hormone called TSH (Thyroid stimulating hormone).
How important is the thyroid hormone?
Extremely important. The hormone controls our metabolism and has an impact on all our cells and all our body functions. It is necessary for memory, energy levels, bone marrow function, proper functioning of the heart, proper movement of our intestine and many such vital functions. People who have an under-active thyroid (hypothyroidism) feel tired, have poor memory, have a poor appetite, feel constipated and gain weight. They have a slow heart rate and feel puffy and sleepy.
What is hypothyroidism and how can it be diagnosed?
The most common reason is autoimmune thyroid problem. The body produces antibodies against its own gland that make the gland function less.
Sometimes the gland under functions temporarily and recovers a few months later. The gland may not have formed well at birth or may have been removed surgically.
Another reason is when the Pituitary gland is under active and produces insufficient TSH. Diagnosing thyroid problems requires just a simple blood test in most people.
Can an under-active thyroid be made to work normally?
We cannot make the thyroid work normally but we can easily do what the normal gland does. Thyroid hormone supplements are now available in multiple doses and in most places.
Thyroxine tablets should be taken on an empty stomach (preferably first thing in the morning). No food or beverages should be consumed for about 30 minutes. Iron supplements, calcium, fibre laxatives and antacids can interfere with proper absorption so they should be taken after lunch or dinner.
Most people have to take their supplements lifelong but one in five may have only a temporary problem.
Can women with hypothyroidism have children?
Women tend to have thyroid problems more often than men. If untreated, this can lead to difficulty with conception and miscarriages. The hormone is also important for the baby's growth and development.
The good news is that testing is simple and the problem can be effectively treated. Some women develop a transient thyroid problem after delivery.
Is taking medication during pregnancy safe for the baby?
All medications are not safe. But Thyroid hormone is not only safe; it is good for the baby. Most women with hypothyroidism need to be checked every six weeks during pregnancy and their dosage increased or adjusted. It is important that they do not to stop the thyroid supplement.
On the contrary, medication used to treat an overactive thyroid has to be discussed with the doctor and only the minimum required dose taken.
Children can also develop thyroid problems. In fact some may be born with it. They should be given thyroid supplements and attain normal growth and puberty if their levels are maintained within the normal range.
Can food supplements or yoga help?
Patients with thyroid disorders usually avoid foods like cabbage, cauliflower, radish and lady's finger. There is no real scientific basis or recommendation. Soya can be consumed in moderation. All these concerns do not matter as long as there is adequate dietary iodine intake (from iodised salt and some grains and cereals and seafood). There are no dietary supplements that help with improving thyroid function.
Yoga is good for many things but there is no clear scientific evidence regarding its role as the definitive therapy for thyroid dysfunction.
Can the thyroid ever be overactive?
Yes. This condition, called hyperthyroidism, is also frequently caused by the auto immune process. A more unusual cause is a nodule or nodules in the thyroid overproducing the hormone. In rare cases it may also be due to a tumour in the pituitary.
The usual symptoms are weight loss, anxiety, sweating, palpitations, sleeplessness, excessive hunger and bulging of eyes. The diagnosis is again simple and treatment is with medication or, in rare cases, radioactive iodine or surgery.
Should people worry about a swelling in the neck?
Not all swellings in the neck region are due to a thyroid problem. Examination and simple tests (blood test, Ultrasound and Fine needle aspiration) will shed light on the nature of the swelling.
While the vast majority are benign, about five per cent can be due to thyroid cancer. It is important not to ignore any neck swelling at any age. Surgery cures most patients with cancer.
Who should have a check-up?
Those with a thyroid swelling
Pregnant women or women planning a pregnancy
People with autoimmune problems like Type 1 diabetes, Vitamin B12 deficiency, premature menopause, vitiligo
People with symptoms of an under-active or over-active thyroid
Special situations like Down's syndrome or Turner syndrome
People taking medication known to cause thyroid dysfunction
People with a family history of thyroid dysfunction
The writer is a Chennai-based endocrinologist.
Keywords: thyroid problems