All about thyroid problems

It’s a small gland that we’re barely aware of. But when it’s not working properly it can wreak havoc on our health

The thyroid, situated in the neck, is an endocrine gland that secretes hormones that regulate your metabolism.

IT SITS low in your neck, across your windpipe, and is shaped a like a butterfly. Most of us don’t give this humble little gland a second thought. Because when it’s working, you have no reason to think about it. But when your thyroid isn’t functioning as it should, it can create chaos in your body in ways you’d could never imagine. It could be the culprit behind symptoms such as unexplained weight gain, an inability to focus, depression and even dementia.

The thyroid can sometimes work overtime – called an overactive thyroid – or be underactive, with each of these conditions causing a specific range of problems.

“It’s important to get your thyroid hormone levels checked regularly to ensure you don’t have too much or too little of it,” says Wimpie de Lange, an endocrinologist from Bloemfontein.

Just what does this gland do that can cause so much trouble? Here’s what you need to know and why it’s important to seek medical help for an under- or overactive thyroid.

What does the thyroid do?

“It’s an endocrine gland, which means it produces and secretes hormones,” explains Dr Jacomien de Villiers, an internist from Pretoria.

“These hormones act as chemical messengers responsible for regulating certain functions in the body.”

The thyroid secretes two types of hormones: triiodothyronine (T3) and thyroxine (T4). These regulate the body’s metabolism, in other words how quickly or slowly your body converts fuel into energy.

The working of the thyroid itself is regulated by hormones secreted by glands in the brain, and the levels of all these hormones can be measured with a blood test. Doctors can analyse these results to determine whether the thyroid is functioning properly.

If your thyroid produces too little T3 and T4, you might have an underactive thyroid, which is called hypothyroidism, Dr de Villiers says.

If it produces too much, you might have an overactive thyroid, called hyperthyroidism. Both conditions can cause all kinds of problems.

Who is prone to thyroid problems?

Anyone can develop a thyroid problem, and in rare cases even children might struggle with it, Dr de Lange says. It seems to be more prevalent among women, but experts aren’t sure why.

Thyroid problems can also be caused by autoimmune conditions such as Graves’ disease or Hashimoto’s disease.

Dr de Lange says some medications, such as those containing lithium, which are prescribed for certain mental illnesses, can also cause thyroid problems. “But psychiatrists will monitor hormone levels to ensure there’s no imbalance.”

What are the symptoms of a dysfunctional thyroid?

It can be difficult to isolate and identify the symptoms, says Dr Michael Heyns, a Pretoria surgeon who treats thyroid problems.

“Symptoms are usually subtle and slow to develop – only extreme symptoms are easily detected,” he explains.

Dr Heyns recommends an annual blood test to check the level of thyroid hormones, regardless of whether you have symptoms or not.

“Since thyroid problems are so common and so easy to diagnose with basic blood tests, it’s best to ask your GP to

test your thyroid when you have your other annual blood tests.”

It’s easy to miss the symptoms in the early stages because they develop slowly. These are the symptoms of thyroid irregularities to watch out for, says Dr de Villiers:

Overactive thyroid (hyperthyroidism)

Struggling to gain weight A tendency to overheat Increased pulse and breathing Insomnia Anxiety and chronic fatigue Eyes appear to bulge Enlarged thyroid gland

Underactive thyroid (hypothyroidism)

Inexplicable weight gain A tendency to feel chilly Slower pulse and breathing Reduced appetite Constipation Hair loss or decreased hair growth Inability to focus Chronic fatigue Depression Eyes appear swollen

“In extreme cases of hypothyroidism, the patient’s reactions become lethargic, and they might slip into a coma,” says Dr de Villiers.

“The face might appear swollen and the skin and hair dry.”

Dr de Lange says psychiatrists, neurologists and other specialists will often first test the thyroid levels of patients presenting with dementia symptoms as both hyper- and hypothyroidism can cause similar symptoms.

“It really seems as if the person has dementia,” Dr de Lange says. “They’ll struggle to speak and there’s extreme cognitive shrinkage. But if the thyroid is causing it, most of those symptoms disappear with the right treatment.”

Left untreated, a dysfunctional thyroid gland can lead to serious health issues in the long term, including heart problems, mental illness, osteoporosis, vision problems and long-term nerve damage.

How is it treated?

Once hyper- or hypothyroidism has been diagnosed, it’s usually treated with hormone therapy. Depending on the problem, the medication either suppresses or stimulates the production of thyroid hormones. This medication will need to be taken for the rest of the patient’s life.

It’s crucial that thyroid patients use their medication correctly, Dr de Villiers says. “It’s usually one small tablet to be taken daily with water on an empty stomach. You need to wait an hour after taking it before eating or taking any other medications. It’s important to ensure optimal absorption of the medication or the treatment won’t be as effective.”

Anyone who’s been diagnosed with a dysfunctional thyroid needs their hormone levels checked more than once a year, Dr de Lange says.

“Changing seasons influence your thyroid hormones, and you need to always ensure your levels are correct.”

It’s extremely important for pregnant women with an underactive thyroid to take their medication, Dr de Lange adds.

“If an expectant mother with hypothyroidism doesn’t take her pills, it can lead to miscarriage or deformity in the foetus because the foetus only starts developing its own thyroid hormones in the third trimester.”

It can even be fatal, he says, so it’s vital that pregnant women with hypothyroidism take their medication religiously and have their hormone levels tested monthly.

When is removal of the thyroid gland necessary?

Surgical removal of the thyroid should be a last resort, Dr de Lange says.

“This is only done when the gland is greatly enlarged, making it difficult for the patient to swallow or breathe properly.

“It’s also done if there’s a malignant tumour on the thyroid, and is sometimes done for cosmetic reasons because the gland has grown to the size of a cricket ball.”

Patients whose thyroid gland has been removed need life-long hormone therapy.

As the gland also aids in the absorption of calcium, these levels, as well as iron levels, should be regularly monitored if the thyroid has been removed, Dr De Lange says.

’It’s best to ask your GP to test your thyroid when you have your other annual blood tests’