The thyroid is a small but mighty gland, helping regulate body temperature and heart rate and supporting how your body uses energy.  An estimated 20 million people in the United States have thyroid diseases, but up to 60 percent don’t know about their condition.

“Most of the time, people are unaware of this butterfly-shaped gland, as it’s quietly doing its work underneath the surface, producing thyroid hormones to help control the body’s metabolism,” says Dr. Hyesoo Lowe, endocrinologist at NewYork-Presbyterian/Columbia University Irving Medical Center and the medical director of the Columbia Thyroid Center.

“Many thyroid diseases, such as when the gland produces too much or too little hormones, are autoimmune conditions, but very treatable.”

Dr. Lowe shares more with Health Matters on how the thyroid functions, common thyroid diseases and conditions, and when it’s time to see a doctor about thyroid health.

What purpose does the thyroid have in the body?
Dr. Lowe: The purpose of the thyroid gland, which sits in the lower central neck, is to make hormones, the main two being thyroxine (T4) and triiodothyronine (T3), which are released into the bloodstream and used in a variety of body processes. It’s crucial in things like maintaining your metabolic rate and how you burn calories, cardiac and digestive function, and even your mood.

What are some common thyroid diseases and conditions?
When there’s a problem with the thyroid, the most common issues are functional problems where the thyroid slows down and becomes underactive, or the opposite, where it’s overactive.

There tends to be a higher prevalence of thyroid diseases in women compared to men, particularly related to autoimmune conditions. Women are five to eight times more likely than men to have thyroid problems, according to the American Thyroid Association (ATA).

Hypothyroidism

Hypothyroidism is when the thyroid gland doesn’t produce enough hormones. Generally, this is a gradual process, not a sudden onset.

• Hashimoto’s Thyroiditis
  The most common cause of hypothyroidism, or an underactive thyroid gland, is Hashimoto’s thyroiditis, named after the doctor who first described the disease. Hashimoto’s is a common issue that occurs when the body’s immune system attacks the thyroid cells and eventually causes underactivity. Hypothyroidism can also be caused by certain medications, or thyroid surgery to remove the gland due to cancer or nodules.
  
  
• Hypothyroidism symptoms
  • Fatigue
  • Swelling and puffiness of the face, hands and feet
  • Weight gain
  • Constipation
  • Cold intolerance
  • Depressed mood
  • Heavy periods

Hyperthyroidism

Hyperthyroidism, or an overactive thyroid, occurs when the gland produces too much of the thyroid hormone.

• Graves’ Disease
  While Hashimoto’s is caused by an autoimmune formation of an antibody that attacks the thyroid cells, Graves’ disease occurs when a different thyroid antibody stimulates the thyroid cells, causing hormone overproduction.
  
  Think of it like turning the switch on in a factory and causing the machinery to speed up in an unregulated manner.
  
  
• Hyperthyroidism symptoms
  • Feeling anxious or moody
  • Increased appetite or hunger, coupled with weight loss
  • Feeling hot or sweaty
  • Frequent bowel movements
  • Insomnia
  • Palpitations
  • Shortness of breath with exercise

Nodules and Thyroid Cancer

Nodules are small lumps that can grow on the thyroid gland. By age 60, about half of all people have a thyroid nodule that can be found through examination or with imaging, according to the ATA

Many times, people have no idea they have them and they’re often found incidentally during a CT scan or an unrelated examination.

The nodules can range from the size of a pea to about two centimeters, or the size of an almond. Majority of these, up to 90 percent, are benign, or noncancerous.

For cancerous nodules, exposure to radiation can increase risk, as well as family history of thyroid cancer if a first-degree relative has been diagnosed. 

• Symptoms
  Typically, thyroid cancer may not present with symptoms in the early stages. Later symptoms can include:
  • Changes in voice
  • Lymph node enlargement in the neck
  • Trouble swallowing

How is thyroid disease diagnosed?
A blood test requested from your primary care physician is very accurate in diagnosing hypo and hyperthyroidism based on levels of TSH, or Thyroid Stimulating Hormone.

For nodules, patients usually obtain a non-invasive ultrasound of the thyroid gland. Based on certain ultrasound characteristics and size of the nodule, we decide whether to investigate further or just monitor.

What’s the treatment for thyroid diseases?
Thyroid conditions are very treatable.

Medication, in the form of pills, can replete low levels of thyroid hormones or decrease production in an overactive condition.

Nodules, if cancerous, are typically managed with surgical removal depending on size.

If left untreated in extreme cases, such as a patient not visiting a doctor in many years, hypothyroidism can cause fluid to accumulate around the lungs and heart. An individual may be able to live their life untreated for several years, but if a sudden illness such as pneumonia occurs, their body may not be able to handle these additional stressors.

In hyperthyroidism, without treatment, the heart can become overstimulated to the point of an arrhythmia, or irregular heartbeat.

How can you take care of your thyroid health?
Knowing your family history is essential, since many thyroid conditions tend to be more prevalent within family members. Overall healthy lifestyle behaviors can impact thyroid health, including reducing excess weight, increasing physical activity, and getting more sleep.

Iodine is also very important in thyroid health, because it’s the backbone of the thyroid hormone. We need enough iodine, which we typically get through foods like fish, seaweed, and shellfish. In general, one half to three quarters teaspoon a day of regular, iodized table salt is sufficient. But not all regular or specialty salts are iodized, such as sea salt, kosher salt, and Himalayan salt.