Thyroid Gland Disorders

Hypothyroidism is a common endocrine disorder in which the thyroid gland fails to produce enough thyroid hormones — T3 (triiodothyronine) and T4 (thyroxine). These hormones play a critical role in regulating the body’s metabolism, energy levels, and many other physiological functions.

The condition may result from autoimmune destruction of the thyroid (as in Hashimoto’s thyroiditis), surgical removal of the gland, radiation therapy, certain medications (like lithium), or iodine deficiency. It can also be congenital in newborns. Symptoms develop gradually and may be subtle at first. They include fatigue, weight gain, cold intolerance, constipation, dry skin, hair thinning, hoarseness, slow heart rate, menstrual irregularities, depression, and impaired memory. In children, it can result in poor growth and developmental delays.

If untreated, hypothyroidism can lead to severe complications such as myxedema — a lifethreatening condition marked by extreme drowsiness, hypothermia, and coma. Long-term hypothyroidism increases the risk of high cholesterol, heart disease, infertility, and miscarriage in pregnant women.

Diagnosis is confirmed through blood tests showing elevated TSH (thyroid-stimulating hormone) and low free T4 levels. Treatment involves daily use of synthetic thyroid hormone (levothyroxine), with dosage adjusted according to blood levels and symptoms. With proper treatment and monitoring, most individuals can lead completely normal lives.

Hyperthyroidism is a condition in which the thyroid gland becomes overactive and produces excessive amounts of thyroid hormones (T3 and T4). This leads to an accelerated metabolism, affecting virtually every system in the body. The most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies stimulate the thyroid gland. Other causes include toxic multinodular goiter, thyroid adenomas, thyroiditis, and excessive intake of iodine or thyroid hormones. Symptoms of hyperthyroidism can be quite dramatic and include weight loss despite increased appetite, palpitations, anxiety, irritability, heat intolerance, tremors, sweating, frequent bowel movements, menstrual irregularities, and fatigue. Patients may also experience thinning of hair, bulging eyes (in Graves’ disease), and muscle weakness. If not treated, hyperthyroidism can lead to serious complications such as atrial fibrillation, osteoporosis, heart failure, and a rare but dangerous condition called thyroid storm — a sudden, severe worsening of symptoms that can be life-threatening. Diagnosis is made through suppressed TSH levels and elevated free T4 and/or T3 levels. Additional tests such as thyroid antibodies and radioactive iodine uptake scans help determine the underlying cause. Treatment options include antithyroid medications (like methimazole), radioactive iodine therapy, and in some cases, thyroid surgery. Beta-blockers are often used to control symptoms like palpitations until thyroid levels normalize. With appropriate management, patients can return to a balanced and symptom-free life.

Thyroid nodules are abnormal growths or lumps that form within the thyroid gland, a butterfly-shaped gland located in the front of the neck. They are quite common, especially in older adults and women, and most are benign (non-cancerous). However, a small percentage may be malignant or cause hormonal imbalance. Many thyroid nodules are discovered incidentally during imaging for other health issues or on routine neck examination. They may also be noticed as a visible lump in the neck. While most nodules do not cause symptoms, some may result in difficulty swallowing, hoarseness, neck discomfort, or cosmetic concerns. Nodules that produce excess thyroid hormone (autonomous or “hot” nodules) can lead to symptoms of hyperthyroidism like weight loss, palpitations, and anxiety. Evaluation includes a physical exam, thyroid function tests (TSH, free T4), ultrasound imaging, and fine-needle aspiration (FNA) biopsy when indicated. The ultrasound helps assess features suggestive of malignancy, such as irregular margins, microcalcifications, or increased blood flow. Treatment depends on the size, type, and function of the nodule. Benign and non-functional nodules are usually monitored with periodic ultrasound. Hyperfunctioning nodules may require radioiodine therapy or surgery. Cancerous nodules typically require surgical removal and further oncologic evaluation. Early detection and appropriate workup ensure effective management and peace of mind.

Goiter refers to an abnormal enlargement of the thyroid gland. It may be diffuse (uniformly enlarged) or nodular (containing lumps), and can occur with normal, increased, or decreased thyroid hormone levels. Goiter is a visible sign of underlying thyroid dysfunction and may have a variety of causes. The most common global cause of goiter is iodine deficiency, especially in regions with low iodine intake. In iodine-sufficient areas, goiters are more commonly due to autoimmune conditions like Hashimoto’s thyroiditis or Graves’ disease, multinodular goiter, thyroid nodules, or certain medications like lithium. Clinically, a goiter may present as a visible or palpable swelling in the neck. Small goiters are often asymptomatic, while larger ones may cause a sensation of tightness, difficulty swallowing, hoarseness, or even breathing issues due to compression of nearby structures like the trachea or esophagus. The overactive or underactive thyroid hormone state may produce symptoms of hyperthyroidism or hypothyroidism, respectively. Diagnosis involves thyroid function tests, ultrasound imaging, and sometimes radioactive iodine uptake scans or CT scans to evaluate the size and impact on surrounding structures. In some cases, fine-needle aspiration biopsy is needed to rule out malignancy. Treatment depends on the cause and severity. Mild, asymptomatic goiters may require only observation. Iodine supplementation helps in deficiency-related goiters. In cases of dysfunction or cosmetic concern, thyroid hormone therapy, radioactive iodine, or surgical removal (thyroidectomy) may be recommended. Early evaluation helps prevent complications and improves patient outcomes.

Thyroid cancer is a malignancy of the thyroid gland and is generally considered one of the more treatable forms of cancer. It is often detected early, and most types have excellent outcomes, especially when diagnosed before they spread beyond the gland. The most common types include papillary thyroid carcinoma (most prevalent and least aggressive), follicular carcinoma, medullary carcinoma, and the rare but aggressive anaplastic thyroid carcinoma. Risk factors include radiation exposure, family history, certain genetic syndromes (like MEN2), and iodine deficiency. Many patients with thyroid cancer present with a painless neck lump, noticed incidentally. Others may experience hoarseness, difficulty swallowing, or neck swelling. Some nodules are discovered during imaging or evaluation for unrelated thyroid issues. Suspicious features on ultrasound, such as microcalcifications or irregular margins, prompt further testing through fine-needle aspiration biopsy (FNA). Treatment typically involves surgical removal of part or all of the thyroid (thyroidectomy), often followed by radioactive iodine ablation to destroy remaining cancerous cells. Lifelong thyroid hormone replacement is necessary if the entire gland is removed. In more aggressive or metastatic cancers, external radiation or chemotherapy may be used. Prognosis is excellent for papillary and follicular types, with survival rates exceeding 95% over 10 years. Regular monitoring through imaging and thyroglobulin levels helps ensure long-term control and recurrence detection.

Hashimoto’s Thyroiditis is an autoimmune disorder in which the body’s immune system mistakenly attacks the thyroid gland, leading to chronic inflammation and gradual destruction of thyroid tissue. It is the most common cause of hypothyroidism in iodinesufficient regions and is significantly more prevalent in women than men. In Hashimoto’s, the immune system produces antibodies — such as anti-thyroid peroxidase (anti-TPO) and anti-thyroglobulin — that damage the thyroid cells, impairing their ability to produce hormones. This process unfolds slowly, and many individuals remain asymptomatic for years. When symptoms do occur, they reflect declining thyroid function and include fatigue, weight gain, constipation, cold intolerance, depression, dry skin, hair thinning, and menstrual irregularities. Some patients may initially experience a transient hyperthyroid phase (Hashitoxicosis) before settling into a long-term hypothyroid state. The thyroid gland may become enlarged (goitrous Hashimoto’s), firm, and irregular, but not usually painful. Diagnosis is based on elevated TSH, low free T4, and the presence of thyroid autoantibodies in the blood. There is no cure, but Hashimoto’s is easily managed with levothyroxine, a synthetic thyroid hormone. Regular follow-up is essential to adjust the dose and monitor for symptom control and antibody levels. Early diagnosis and treatment prevent complications such as myxedema, cardiovascular issues, infertility, and miscarriage. With appropriate care, patients can maintain excellent quality of life.