By Dee Duren
The thyroid is a small organ with a huge impact on the human body. A butterfly-shaped gland located in the base of the throat just above the collarbone, the thyroid produces hormones that affect the way every other organ in the body works. For an estimated 27 million Americans, malfunctions in this little gland cause a wide range of problems ranging from mild to severe. According to the American Association of Endocrinologists, about half of those Americans have not yet been diagnosed.

About The Thyroid
Part of the endocrine system, the thyroid secretes two main hormones — tri-iodothyronine (T3) and thyroxine (T4) — that regulate the body’s metabolism, or the way it stores and uses energy, grows and heals. Imbalances in the production of these hormones can cause a personal energy crisis. The way the body uses fats and carbohydrates, controls temperature, heart rate, mental functioning and more can all suffer from thyroid disease.
“Through its production of the two thyroid hormones T4 and T3, the thyroid controls the metabolism of every cell and organ system in the body, especially the heart, liver muscle and brain,” said Dr. Irwin Klein, American Thyroid Association Research Committee chairman and Thyroid Disease Program director at North Shore University Hospital in Manhasset, N.Y. “The diseases of over- and underactive thyroid disease — hyper- and hypothyroidism — have many symptoms relating to energy, weight, heart, cholesterol, muscle strength, skin and hair.”
Studies show that women are five to eight times more likely to have thyroid disease than men, and thyroid imbalances can be especially harmful for women who are or want to become pregnant. Men, infants and children are also at risk of thyroid disease.

Types Of Thyroid Disease
Hypo- and hyperactive thyroid disorders are the most common forms of thyroid disease. Other forms of thyroid disease include goiter, or enlarged thyroid gland. Goiter is usually harmless but can become uncomfortably large and affect breathing and swallowing. Thyroid nodules are lumpy growths within the thyroid and are usually benign. Thyroid cancer is found in about 8 percent of nodules in men and in about 4 percent of nodules in women, according to The Hormone Foundation.
Thyroiditis is a condition in which the thyroid becomes inflamed. Depending on the nature of the inflammation, thyroiditis can cause the same symptoms as hypo- or hyperthyroidism. Women who experience metabolism problems after giving birth may be suffering from a condition known as postpartum thyroiditis. About 8 percent of women are believed to develop postpartum thyroiditis within a few months of giving birth. According to the National Endocrine and Metabolic Diseases Information Service, these women will probably experience thyroiditis with each pregnancy. If the thyroid gland doesn’t recover, they may need to be placed on lifelong thyroid medication.

Hypothyroidism
The most common thyroid disorder is hypothyroidism, or underactive thyroid. It occurs most often in women over the age of 50, and its effects increase with time.
“Hypothyroidism often causes symptoms that are mild like mild fatigue and weight gain,” said Dr. Alan P. Farwell, director of endocrine studies at Boston Medical Center and an associate professor at Boston University School of Medicine.
“It can also cause severe symptoms such as severe fatigue, constipation, very low body temperature, heavy menstrual periods, confusion and memory loss.”
If left untreated, hypothyroidism can cause high blood cholesterol levels that can lead to heart disease, joint pain, obesity and infertility. In infants and children, untreated hypothyroidism can result in developmental problems. Infants with underactive thyroid glands may show signs of jaundice, frequent choking, an enlarged tongue and puffy face. Constipation, poor muscle tone and excessive sleepiness may develop as the disorder progresses. Children whose hypothyroidism remains untreated may have delayed and stunted mental and physical development.

Hyperthyroidism
“Hyperthyroidism often has the most dramatic symptoms with racing or pounding heart beats, shakes and tremors, severe weight loss, insomnia and marked sweating,” Farwell said. Hyperthyroidism occurs when the body produces too much of the hormones that regulate the metabolism. Other symptoms include nervousness or irritability, muscle weakness, mood swings, diarrhea and heat intolerance.
Hyperthyroidism is sometimes caused by the presence of nodules, goiter or thyroiditis. Graves’ disease, the most common form of hyperthyroidism in the U.S., is an autoimmune disease where the body’s defense system acts against itself. Graves’ Disease is most common in women starting in their 20s. In addition to the usual symptoms of hyperthyroidism, Graves’ Disease sufferers also may have swelling of the tissues and muscles behind the eyes that cause the eyes to bulge. A less common symptom is patchy, puffy red skin on the shins and tops of the feet.
Older adults with hyperthyroidism can be misdiagnosed with depression or even dementia if their symptoms remain untreated. Overactive thyroid also speeds up the development of osteoporosis and causes heart problems that may lead to heart failure or stroke.

Testing Is Key
Fortunately, testing for thyroid disease is a well-established practice for family physicians during an annual physical. It is especially important that women have their thyroid functions tested.
A simple blood test can be done to determine if the thyroid is functioning normally,” Farwell said. Levels of thyroid-stimulating hormone (TSH) tell physicians whether the gland is working properly or not. It is the first step your physician will take if thyroid problems are suspected.
“Know your TSH,” Klein said. “TSH levels can make a diagnosis in all cases. Treatment cures the symptoms; untreated symptoms usually get worse. In pregnancy, treatment is critical for mother and child.”
John Baldridge, an endocinologist for Northwest Health System, noted that lab tests can be confusing when dealing with thyroiditis. Sometimes a good clinical assessment of the patient and the lab results require an endocrinologist.
“When there is confusion about the lab tests, we’re often asked to sort out what this means,” Baldridge said. “It’s not unusual to have confusing lab tests come back unexpectedly abnormal in a pattern that doesn’t quite fit a diagnosis.”
Ultrasound is another useful device for physicians dealing with the thyroid.
“Ultrasound is today’s best assessment of abnormalities in size and description of the gland itself, ideally done before any biopsies are attempted,” Baldridge said.
When testing for thyroid problems, sometimes it’s a matter of repeating tests over a period of time in order to gain an accurate evaluation.
“Treatment of thyroiditis may be ‘tincture of time,’ meaning it can be better if physician and patient simply repeat laboratory testing, or even ultrasound evaluation, at a later date: blood tests and even the anatomy often change with time, usually confirming a clinical suspicion when treatment is best,” Baldridge said. “Like the old adage, ‘timing is everything.’”

Treatment
Hypothyroidism is treated with a thyroid hormone pill once a day. It’s important to take thyroid medication on an empty stomach because some minerals including calcium interfere with absorption. Some patients tend to stop taking their medication when their symptoms clear up which may cause long-term problems as the disease tends to get worse over time.
Hyperthyroidism can be treated with antithyroid pills, surgery or a treatment with radioactive iodine. Nodules that are large enough are usually biopsied to see if there is cancer present. If malignant cells are found, it is usually treated by surgery to remove the affected tissue, often followed by a radioactive iodine treatment. Patients will then have to take thyroid medication to replace the thyroid no longer manufactured by the missing gland.
In recent years, research has focused on the importance of detecting and managing thyroid disease during pregnancy. Pregnant mothers with hypothyroidism, even mild cases, are at an increased risk for premature delivery. Women being treated for underactive thyroid often need a 30 to 50 percent increase in their dose of thyroid hormone replacement. Women with undiagnosed hyperthyroidism are at added risk for miscarriage.
The exact cause of a malfunctioning thyroid is unknown, but Baldridge noted that altered thyroid function can be found in iodine deficient as well as iodine rich areas of the world. However, he cautions that whether it is “a true disease state or simply an environmental hazard is another matter.”
There is no precise method for prevention, but Baldridge suggested having iodine in one’s diet.
“I suppose to have a level amount of iodine in the diet is the best prevention we can recommend for people,” he said. “We get that from our standard foods, in the United States at least, from bread, milk and salt.”
It’s important to remember that thyroid disease is almost always a lifelong disease. With the proper treatment, however, it is a disease that can be managed.

Antoinette Grajeda contributed to this report.