Understanding Thyroid Disorders - Symptoms And Treatment Options
Overview
The thyroid is a small gland that’s located at the front of your neck and produces T3 and T4 (e.g., thyroid hormones).
Thyroid hormones control numerous physiological functions, including metabolism, body temperature, and mood fluctuations. However, the production of these hormones may be disrupted.
According to the American Thyroid Association (ATA), approximately 20 million Americans have some form of thyroid disease. Another staggering statistic is that about 12% of the U.S. population will develop a thyroid condition during their lifetime.
For instance, patients with low thyroid hormone levels often complain of experiencing apathy, mood swings, and psychomotor dysfunction. Conversely, when the gland produces excessive amounts of thyroid hormones, the body shifts into hyperthyroidism, which may present with tachycardia (rapid heartbeat), anxiety, weight loss, and restlessness.
In this article, we will discuss the clinical presentation of thyroid disorders, including hyperthyroidism and hypothyroidism. We will also list the available treatment options for these conditions.
Thyroid testing
To comprehensively address thyroid hormone issues, we need sensitive and specific testing of thyroid hormones. Once a diagnosis has been made, your healthcare provider will come up with an appropriate treatment plan that includes pharmacological drugs, diet, and other measures.
A full thyroid panel must test for:
TSH
fT4
fT3
rT3
Anti-TPO antibodies.
Anti-TG antibodies.
SHBG.
Note that thyroid hormone production is linked with several other functions, including inflammation, methylation, nutritional status, toxins in the blood, and the presence of cardiovascular risk factors. So, if your thyroid issues are caused by other underlying conditions, your doctor may need to request more tests.
Sometimes, it may be necessary to check the function of the adrenal glands (e.g., cortisol production). Other tests may also include estrogen, progesterone, testosterone, full blood sugar panel, and food intolerances.
What is hyperthyroidism?
Hyperthyroidism refers to elevated levels of thyroid hormones in the blood. Because these hormones play a role in virtually every cell of the body, you can expect all sorts of signs and symptoms. About 1.2% of the U.S. population (about 1 out of every 100 people) has hyperthyroidism.
The symptoms of hyperthyroidism
Common signs and symptoms of hyperthyroidism include:
Increased appetite
Tachycardia (i.e., fast heartbeat)
Difficulty sleeping
Brittle hair
Restlessness
Distractibility
Weakness
Itching
Hair loss
Nausea and vomiting
The diagnosis of hyperthyroidism
The diagnosis of this condition relies on measuring the levels of thyroid hormones in the blood. When T3 and T4 are elevated, the diagnosis is straightforward.
The treatment of hyperthyroidism
The treatment of hyperthyroidism consists of:
Medication – Antithyroid drugs, such as methimazole, which stop the thyroid from making T3 and T4.
Radioactive iodine – This treatment is given to the vast majority of Americans with hyperthyroidism. It neutralizes the action of the cells that produce large amounts of thyroid hormones.
Surgery – The removal of a section of your thyroid can be an option, especially if you fail to respond to other treatment measures. However, it is left as a last-resort treatment.
What is hypothyroidism?
Hypothyroidism is the exact opposite of hyperthyroidism. In this case, the thyroid gland is not secreting enough hormones, which disrupts the functions of your cells.
Since T3 and T4 provide energy to the body, regulate blood pressure and digestion, and control your metabolism, expect all these functions to get disrupted in case of hypothyroidism.
Most commonly, this condition affects people over the age of 60. However, it could occur at any age, especially when there is an underlying immune disease.
In a 2019 meta-analysis, researchers found that subclinical hypothyroidism is actually linked to depression. In other words, many cases of depression may be caused by asymptomatic hypothyroidism. This is no surprise when you learn that up to 60% of individuals with thyroid disease are unaware of their condition.
Moreover, another link between hypothyroidism and low levels of serotonin was established, which was quickly reversed after the administration of synthetic thyroid hormones.
The symptoms of hypothyroidism
Hypothyroidism affects all organ systems. About 4.6% of the U.S. population (about 5 out of every 100 people) has hypothyroidism (including subclinical cases).
Here are the most common signs and symptoms of hypothyroidism:
Feeling tired all the time
Dry hair and skin
Hypersomnia (i.e., sleeping long hours)
Muscular atrophy
Cold extremities
Mood swings and depression
Bulged eyes
Hoarseness
Constipation
Brittle hair
Decreased libido
Myalgia and arthralgia
Peripheral edema (swelling)
Unexplained weight gain
Carpel Tunnel Syndrome
Irregular menses
Heart palpitations
The diagnosis of hypothyroidism
The diagnosis of hypothyroidism is suspected when a patient presents with the symptoms listed above. To confirm this diagnosis, blood tests of thyroid hormones are necessary.
The treatment of hypothyroidism
The management of hypothyroidism mostly focuses on levothyroxine. The latter is a synthetic T4 hormone that restores normal levels and resolves most symptoms. Some individuals may also benefit from a combination T4/T3 therapy if they remain symptomatic.
It is also vital to address nutritional deficiencies (e.g., iodine, selenium) as they may impede the production of thyroid hormones.
Finally, lifestyle modifications, such as stress management, healthy eating, and regular exercise, can all improve your outcome.
The following table summarizes the major aspects of thyroid disorder:
| Feature | Hypothyroidism | Hyperthyroidism |
|---|---|---|
| Definition | Under-active thyroid gland (insufficient T3 & T4 production). | Overactive thyroid gland (excessive T3 & T4 production). |
| Prevalence (US) | 4.6% of the population. | 1.2% of the population. |
| Common Causes | Autoimmune (Hashimoto’s thyroiditis). Iodine deficiency. Post-thyroid surgery or radioactive iodine treatment. Certain medications. | Autoimmune (Graves’ disease). Thyroid nodules. Excessive iodine intake. Thyroiditis (inflammation). |
| Typical Symptoms | Fatigue and weight gain. Cold intolerance. Dry skin/hair. Constipation. Depression and mood swings. Bradycardia (slow heart rate). | Weight loss and increased appetite. Heat intolerance. Palpitations/tachycardia. Anxiety and restlessness. Insomnia. Brittle hair/hair loss. Tremors. |
| Diagnosis | Elevated TSH, low T4/T3. Check for anti-TPO and anti-Tg antibodies. | Low TSH and high T3/T4. Check for TRAb (TSI in Graves’ disease). Thyroid uptake scan. |
| Treatment | Synthetic T4 (Levothyroxine). Possible combination T4/T3. Lifestyle and nutritional support. | Antithyroid drugs (e.g., methimazole). Radioactive iodine therapy. Surgery (last resort). |