January is National Thyroid Awareness Month. The thyroid gland is a butterfly shaped organ located in the base of your neck. It releases hormones that control metabolism— or the way your body uses energy.
What is thyroid disease?
Any condition that affects the normal function of the thyroid gland, causing too little or too much production of thyroid hormone. Thyroid disease can also include enlargement of the gland, called a goiter, or development of lumps in the gland, called thyroid nodules.
Why is the thyroid important?
It produces thyroid hormones that are critical in controlling the body’s metabolism by impacting every organ. Thyroid hormones help the body use energy, stay warm, and keep the brain, heart, muscles, and other organs functioning properly.
What is a thyroid nodule and how common are they?
It is an abnormal growth of thyroid cells causing a lump in the thyroid gland. They are common and increase with age.
Why is it important for African-Americans to have thyroid nodules detected and biopsies early?
The majority of thyroid nodules are benign and do not cause symptoms; however, some thyroid nodules contain cancer. While thyroid cancer rates are similar in Blacks compared to whites; however, we are more likely to have larger tumors that have a less favorable pathology; lower 5-year survival, and higher overall thyroidectomy complication rates. It is therefore crucial to have nodules detected earlier before they enlarge from cancer, which can spread to lymph nodes in the neck.
Can thyroid disease be prevented?
Most thyroid disease in the United States (both hypothyroidism and hyperthyroidism) is caused by autoimmune disease where the body makes proteins against its own thyroid cells, either destroying them (as in hypothyroidism) or stimulating them (as in hyperthyroidism/graves’ disease). We do not yet know how to prevent the development of antibodies against the thyroid.
Is thyroid disease hereditary?
Some autoimmune diseases of the thyroid, like Hashimoto’s thyroiditis and graves’ disease does run in families. Certain types of thyroid cancer can run in families as well.
What are different types of thyroid disease and their symptoms?
There are two primary categories of thyroid disease.
- hypothyroidism, where the thyroid gland is underactive and not making enough thyroid hormone—so everything slows down. Symptoms include feeling cold, fatigue, dry skin, forgetfulness and depression, and constipation.
- hyperthyroidism, where the thyroid gland is overactive and making too much thyroid hormone—so everything speeds up. Symptoms include racing heart, nervousness and irritability, sweatiness, tremors, anxiety, warm skin, difficulty sleeping, thinning of hair and skin, muscle weakness, weight loss, and menstrual irregularities.
How often should you get your thyroid checked?
Everyone should have their thyroid physically examined by a physician once/year and have a tsh checked. This hormone stimulates the thyroid gland and if it is too low or too high, it can be an indication of thyroid disease.
If thyroid disease goes undetected what other health issues can it cause?
Severe hypothyroidism can cause severe swelling, impaired mental function, electrolyte abnormalities, hypothermia (low body temperature), and an extremely low heart rate.
Severe hyperthyroidism can cause severe weight loss and muscle wasting, heart failure, and life-threatening abnormal heart rhythms.
Both extreme conditions require hospitalization and immediate treatment.
Does most insurance cover the cost for treatment?
Insurance covers thyroid hormone replacement for individuals with hypothyroidism (underactive thyroid). Insurance also covers the treatments for hyperthyroidism (overactive thyroid)—medications, radioactive iodine treatment, and/or surgery.
What causes a goiter?
In the United States, the most common cause is Hashimoto’s thyroiditis, which causes autoimmune destruction of the thyroid gland, resulting in hypothyroidism. Another common cause is Graves’ disease, another autoimmune condition in which the body produces a protein (antibody) that stimulates the thyroid gland and causes it to enlarge and produce too much hormone, resulting in hypothyroidism.
Dr. Golden answers your ‘Text Tom’ questions on the next page.
QUESTIONS TEXTED FROM LISTENERS:
Dear doctor, speak on goiters I have small ones do I need to be concerned also how does cruciferous vegetables affect your thyroid?
Goiters, or an enlarged thyroid gland, can have several causes. The most common cause worldwide is iodine deficiency. This is not much of a problem in the United States because many of our foods are fortified with iodine.
In the United States the most common cause of goiter is Hashimoto’s thyroiditis, which causes autoimmune destruction of the thyroid gland, which can lead to hypothyroidism (underactive thyroid).
The pituitary gland senses a low thyroid hormone level and secretes another hormone (TSH) to stimulate the thyroid to make more thyroid hormone, which may cause the thyroid to increase in size. For more information about goiters, click HERE.
In your case, I would make sure that your doctor checks your thyroid blood tests regularly (every 6 to 12 months) to make sure that your actual thyroid function and hormone levels remain normal.
Cruciferous vegetables, such as broccoli, cauliflower, cabbage, kale, arugula, and collards, do not affect the thyroid directly; however, they are an excellent source of vitamins, minerals, antioxidants, and fiber, all of which are important for overall good health.
I have nodules on my thyroid. What causes that?
The cause of most thyroid nodules is not known, although they are common and increase with age. Hashimoto’s thyroiditis, the most common cause of hypothyroidism in the United States, can cause thyroid nodules. For more information about thyroid nodules, click HERE.
Can a hyperthyroid cause psychotic episodes?
In rare cases hyperthyroidism (an overactive thyroid) can be associated with psychosis. Most individuals who develop psychosis in this setting have a prior history of mania or other psychiatric disorder.
Online there are websites that tell you there are foods you can eat to get rid of thyroid nodules. My doctor said that is not true. What does Dr. Golden say?
Your doctor is correct. There is no special diet or vitamin that can eliminate thyroid nodules or thyroid disease.
My niece is 8 and she’s gained a lot of weight since the summer. What’s the best way to treat younger people with thyroid disease?
In order to determine if thyroid disease is contributing to the weight gain, the first step is to have her pediatrician check her thyroid blood tests. If the blood tests are abnormal then she should be referred to a pediatric endocrinologist for further evaluation and treatment.
My thyroid is enlarged. The blood tests are always OK. FNA, was OK, however, it’s getting larger. Should I be concerned?
It is encouraging that your blood tests and FNA (fine needle aspiration) have been normal. If the thyroid/nodule is increasing in size, we generally recommend that it be followed with a yearly thyroid ultrasound and if there is significant interval growth, the nodule should be re-biopsied.
Is it necessary to have your thyroid removed if you have swollen nodule? Even though no cancer is detected?
It is not necessary to have your thyroid removed if you have a benign nodule. If the nodule is causing symptoms, such as trouble swallowing, then the portion of the thyroid containing the nodule is sometimes removed to relieve the symptoms. Since most thyroid nodules do not cause symptoms, surgery is rarely needed for benign nodules.
I have thyroid now for more than 18 years and I am 40 years of age and a healthy woman. I noticed a few years now that the palms of my hands and soles of my feet get really red, puffy with a burning sensation. Is this the thyroid and what can I do? I take 175mcg Levothyroxine daily.
If you are taking levothyroxine daily and your thyroid blood tests are normal, your symptoms are not related to your thyroid. I would discuss these symptoms with your primary care doctor as they are not symptoms typical for thyroid disease.
Sometimes my tongue feels too big for my mouth, I get teeth prints on my tongue is this related to thyroid disease? I’m extremely overweight, I eat healthy most of the time, and exercise approximately 3 times per week. I have my thyroid checked often but this runs in both sides of my family.
There are many hormones that contribute to our body weight and thyroid hormone is just one of them. It is good that you have your thyroid checked regularly since thyroid disease runs on both sides of your family. An enlarged tongue is not typically associated with thyroid disease; it may be caused by another hormone disorder in which the body makes too much growth hormone (acromegaly). You can ask your doctor to check a hormone lab test called IGF-1.
Can thyroid issues be hereditary?
Some autoimmune diseases of the thyroid, like Hashimoto’s thyroidits and Graves’ Disease, does run in families. Certain types of thyroid cancer can run in families as well.
Is a blood test the only way to detect thyroid disease, if not what are the other tests?
Yes, a blood test is the only way to detect thyroid disease.
I have had thyroid Disease for 34 years and I was treated with liquid iodine. I am taking Armour Thyroid and has been for the duration. Is it time to change to a different med? My pharmacist said the side effects have changed. What do you suggest?
I would get specific medical advice from your doctor but generally endocrinologists prefer to replace thyroid hormone using levothyroxine.
Is there any way to improve your health if you’ve been diagnosed with hypothyroidism?
It is important to take your thyroid hormone replacement daily (levothyroxine). A regular exercise routine (3-5 days/week for at least 30 minutes) and healthy diet (getting 5 servings of fresh fruits and vegetables daily) are important components for supporting your overall health.
I have a goiter. Can I have it removed?
Yes, a goiter can be removed if it is causing symptoms, especially trouble breathing or swallowing.
Can thyroid problem cause hair loss? I am a woman and my hair is thinning. I find hair, on my pillow, in the sink, all over my house.
Yes, an overactive or underactive thyroid can cause the hair to become brittle and contribute to hair loss. You should have your thyroid hormone levels checked.
If your thyroid hormone levels are normal, then the hair loss may be from other causes which can be evaluated by a dermatologist.
I’ve had a biopsy, nuclear medicine test as well as an ultra sound. All were negative for cancer yet I have a goiter lump. Is surgery the only option?
If the nodule is still bothering you and causing symptoms then surgical removal is the only option.
For additional information, please visit the American Thyroid Association website:
Dr. Sherita Hill Golden is the Hugh P. McCormick Family Professor of Endocrinology and Metabolism and Executive Vice-Chair of the Department of Medicine at the Johns Hopkins University School of Medicine.
She holds joint appointments in the Welch Center for Prevention, Epidemiology, and Clinical Research, in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, and in the Armstrong Institute for Patient Safety and Quality.
She was Director of the Johns Hopkins Hospital Inpatient Glucose Management Program from 2003-2018. In the community, Dr. Golden is a proud member of Delta Sigma Theta Sorority, Inc. and Co-Directs the Health Ministry with her husband at Clearview Baptist Church in Woodlawn, MD.
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