Dr Asjid Qureshi
MB ChB (Edin), MD (Lon), MRCP (Edin)
London Diabetes and Endocrinology
Consultant
Wellington Hospital and Clementine Churchill Hospital

 
 

London, UK

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THYROID DISORDERS

To arrange a consultation, please call 07733 595 617 or
 
e-mail: nazima.sardar@hcaconsultant.co.uk

 

Do you have hypothyroidism, hyperthyroidism or a thyroid swelling?

HYPOTHYROIDISM

Who it affects
Hypothyroidism is a common disorder affecting 5% of the general population.

What gland is involved
The thyroid gland lies in the front part of the neck just under skin and below the thyroid cartilage (see picture above).

Symptoms
Patients with hypothyroidism may experience symptoms such as tiredness, lethargy, weight gain, constipation, dry skin and hair loss.

Diagnosis
Hypothyroidism is diagnosed with blood tests including TSH, free T4 +/- free T3.

Treatment
Treatment is with Levothyroxine tablets. The dose is usually titrated over many months whilst monitoring blood tests.

Prognosis
An under active thyroid is usually a lifelong disorder. Blood test are performed at intervals to ensure the correct dose of Levothyroxine is taken. Patients with hypothyroidism are entitled to free prescriptions in the NHS.

HYPERTHYROIDISM

 

 

 

 

 

 

 

Who it affects
Hyperthyroidism is also known as thyrotoxicosis or an over active thyroid and is a relatively common disorder. An over active thyroid may result from various causes. Patients with Graves disease are usually younger, female and may have a history or family history of diseases such as rheumatoid arthritis, pernicious anaemia or Addison`s disease. Patients with Graves disease may develop Graves ophthalmopathy (picture above).  Multiple benign overactive thyroid nodules is another cause. This is called a toxic multi-nodular goitre. More rarely an overactive thyroid can be due to drugs such as Amiodarone or a single hyperactive thyroid nodule (toxic nodule). Postpartum thyroiditis refers to abnormal thyroid function following the delivery of a child.

What gland is involved
The thyroid gland lies in the front part of the neck just under skin and below the thyroid cartilage (Adam`s apple).

Symptoms
Hyperthyroidism may cause symptoms such as weight loss, increased appetite, tremor of the hands, palpitations, loose motions or menstrual irregularity.

Diagnosis
The blood tests used to diagnose an overactive thyroid are Thyroid Stimulating Hormone (TSH), free T4 and sometimes free T3. Free T4 is produced by the thyroid in response to TSH stimulation. Free T4 is converted to free T3, the more active form of the hormone. TSH is produced by the pituitary and because of thyroid hormone feedback, levels are low or undetectable in hyperthyroidism. The tests used to determine what caused thyroid over activity may include blood tests (thyroid anti-bodies), ultrasound scans or thyroid isotopes scans.

Treatment
The treatment of an overactive thyroid is dependent on the cause. Graves` disease is typically treated with anti-thyroid medication (Carbimazole or Propylthiouracil) for 6-18 months. Once discontinued, about 50% of patients may remain off medication. In those whom an over active thyroid re-occurs (relapse), treatment with radioiodine or surgery may be considered.
Anti-thyroid medication may be titrated to control thyroid function or used in a "block and replace" fashion. Block and replace therapy entails using anti-thyroid medication to block thyroid hormone production and levothyroxine replacement to normalise TFTs.
Hyperthyroidism due to a multinodular goitre is usually treated with radioiodine or surgery, although medication is usually prescribed initially.

Outlook
About half of patients with Graves` disease are able to successfully discontinue all medication after a closely monitored course of anti-thyroid medication.
Patients treated with surgery (total thyroidectomy) or radioiodine (ablative doses) usually become hypothyroid and require lifelong thyroxine therapy.
Thyroid surgery is arranged by referring to a surgeon.
Surgical removal of the entire thyroid gland will result in hypothyroidism and require lifelong levothyroxine therapy. The parathyroid glands lie behind the thyroid and although efforts are made to avoid it, these may also be removed during total thyroidectomy surgery. Such patients may require lifelong vitamin D therapy.
Some surgeons aim to achieve normal thyroid function off medication by removing part of the thyroid gland. With this approach, there is however a chance that the thyroid remains overactive or becomes overactive at a later time.
Radioiodine is a popular alternative to surgery. It involves the administration of the isotope I131 that is administered in the form of a liquid or tablet. Patient will be advised to take certain precautions e.g. avoiding contact with young children and pregnant women for a period of time after treatment. The main side-effect of radioiodine therapy (ablative dose) is to render the patient`s thyroid under active. Life-long levothyroxine therapy is required in this case. It is important that if you are considering radioiodine therapy, you mention to your endocrinology specialist if:

1. you come into contact with children or pregnant women
2. you suffer from urinary incontinence
3. plan to conceive
4. you are a carer for someone
 

THYROID SWELLINGS

 

 

 

 

 

 

 

Thyroid swellings
Thyroid swellings (see picture above) may be caused by a diffuse enlargement of the thyroid itself or because of nodule(s) or cyst(s) within the thyroid.  The thyroid can enlarged normally during pregnancy and puberty.  It may also be a feature of conditions that cause hypo- or hyperthyroidism. 

Endocrinologists focus on thyroid nodules and cysts because these often require additional investigations.  Thyroid nodules and cysts are very common and usually benign. They are increasingly being detected because of the widespread availability of ultrasound and CT scanning.

Who it affects
Thyroid nodules and cysts are very common and usually benign. They are increasingly being detected because of the widespread availability of ultrasound and CT scanning.

What gland is involved
The thyroid gland lies in the front part of the neck just under skin and below the thyroid cartilage (Adam`s apple).

Symptoms
Thyroid nodules or cysts are detected increasingly commonly during routine scanning for other reasons. These may cause no symptoms. In other patients a visible swelling below the skin may be seen and may change in size over time.

Diagnosis
A thyroid nodule or cyst can be detected on examination or using an ultrasound scan. To clarify whether such a lesion is benign or malignant requires further investigation; tests that are used to help clarify include fine needle aspiration, ultrasound and isotope scanning.

Treatment
Treatment depends upon the nature of the suspected thyroid nodule or cyst. Benign lesions are generally observed. Malignant lesions are removed surgically. Indeterminate lesions are also generally removed surgically. Large lesions, whether benign on FNA or not, are often removed surgically. It is important to inform your doctor if you feel the lesion is changing in appearance.

Prognosis
Benign thyroid lesions are of little consequence and do not adversely affect a patients long-term health.
 

 
     
 

 
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