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 Women's Health

April 2010
Let’s Talk About Thyroid
Dr Akhter Jawade
 
Manisha* was losing weight, having palpitation and excessive sweating for a couple of months. Her mother put it down to anxiety. After all, she was to get married the next month and it was an arranged marriage! Manisha knew that it was not all anxiety when she had a casual chat with a patient at a clinic lounge, while waiting for her father’s diabetic check up.

Rafikul* came all the way from Bangladesh with a hard lump in front of his neck. It was getting bigger, in spite of the homeopathic medicine he had been taking. Shanti* was gaining weight and she was feeling very tired. Payel* was experiencing heavy periods, while Mrs. Ghosh* had severe pain in her neck radiating to the angle of her jaw. Her dentist initially suggested a tooth extraction!

What is the common link between Manisha, Rafikul, Shanti, Payel and Mrs. Ghosh?
All of them have different types of thyroid disorders. Thyroid disorders are extremely common, making up more than 70 percent of the patients in general endocrinology clinics. Despite this fact, awareness regarding common thyroid ailments is strangely missing and the diagnosis is often by chance.

What does the thyroid gland do?
The thyroid gland is an endocrine gland. It manufactures thyroid hormones. Hormones are chemical substances secreted into the blood stream, which act as messengers to affect cells and tissues in distant parts of the body. The function of the thyroid gland is controlled by another gland called the pituitary. The thyroid gland lies in front of the neck, just below the Adam’s apple. Thyroid hormones influence the metabolism of the body cells. In other words, they regulate the speed with which the body cells work.

What are the common thyroid disorders?
Thyroid problems can be divided into two categories: functional (over or under activity), and structural (enlargement of the gland/lumps / bumps which could be benign or cancerous).

What are hyperthyroidism and hypothyroidism?
If too much of the thyroid hormones are secreted, the body cells work faster than normal, and the condition is called hyperthyroidism. On the other hand, if too little of the thyroid hormones are produced, the condition is known as hypothyroidism where the cells and organs of the body slow down.

What are the causes of hypothyroidism?
The most common cause is autoimmunity, where the body produces chemicals that act against its own organs. Other causes are damage of the gland after infection, inflammation or radiation, birth defect, medicines, postsurgery, etc.

What are the symptoms of hypothyroidism?

The common symptoms are lethargy, fatigue, constipation, cold intolerance, aches, pains, cramps, weight gain, dry skin, hair loss, heavy periods etc. Thyroid blood test shows low thyroid hormones and high TSH (a pituitary hormone).

How is hypothyroidism treated?
One needs to take Thyroxin tablet daily in the morning on an empty stomach, practically for the rest of their life. Periodic blood test is required to adjust the dose.

What are the symptoms of hyperthyroidism?
Weight loss in spite of good appetite, fatigue, sweating, palpitation, frequent loose motions, tremors and protrusion of eyes (only in Graves’ disease) are the usual features. The cause of over activity can be established by thyroid blood test, with or without a thyroid scan.

How is hyperthyroidism treated?
Hyperthyroidism is treated by either antithyroid medication or radiation therapy. Surgery is rarely required. Antithyroid medications mainly act by blocking thyroid hormone production. They need to be taken for a long time and are occasionally associated with some serious, but unpredictable side effects. Patients should report to their doctors immediately if they develop a sore throat with fever and skin rashes. Radio-iodine therapy is comparatively a much safer option and the cure rate is much higher. It is not indicated in young children, pregnant women or lactating mothers. Women should avoid pregnancy for six months and men should avoid fathering a child within the next four months following radioiodine therapy.

What is the effect of thyroid disorders in pregnancy?
Underactive thyroid can cause sub fertility. Thyroid hormone requirement goes up during pregnancy. Under treated hypothyroidism may have some detrimental effects on pregnancy and the growing foetus. Treatment of hyperthyroidism during pregnancy is slightly difficult as both the commonly used medicines can cross the placenta, though both of them can be used effectively.
Dr Akhter Jawade is Consultant, Radiation Oncology at Apollo Gleneagles Hospitals, Kolkata

    
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