The term thyroid nodule refers to any abnormal growth of thyroid cells into a lump within the thyroid. Majority of thyroid nodules are benign (noncancerous), a small proportion of thyroid nodules do contain thyroid cancer. Because of this possibility, the evaluation of a thyroid nodule is aimed at discovering a potential thyroid cancer. Some Thyroid nodules could be over functioning by producing too much of Thyroid hormones. There are long term complications of overproducing thyroid nodules if not addressed earlier on. For more information please check the following links:
Thyroid cancer is the most common endocrine-related cancer. In the United States there are about 20,000 new patients annually. The outlook for patients with thyroid cancer is usually excellent if diagnosed and evaluated on time. Most thyroid cancer is easily curable with surgery and they rarely cause pain or disability. Effective and well-tolerated treatment is available for the most common forms of thyroid cancer.
What is Thyroid Cancer?
Thyroid cancer occurs in the cells of the thyroid — a butterfly-shaped gland located at the base of your neck, just below your Adam's apple. Your thyroid produces hormones that regulate your heart rate, blood pressure, body temperature and weight.
Thyroid cancer might not cause any symptoms at first. But as it grows, it can cause pain and swelling in your neck.
Several types of thyroid cancer exist. Some grow very slowly and others can be very aggressive. Most cases of thyroid cancer can be cured with treatment.
Thyroid cancer rates seem to be increasing. Some doctors think this is because new technology is allowing them to find small thyroid cancers that may not have been found in the past.
What are symptoms of Thyroid Cancer?
Thyroid cancer typically doesn't cause any signs or symptoms early in the disease. As thyroid cancer grows, it may cause:
A lump (nodule) that can be felt through the skin on your neck
Changes to your voice, including increasing hoarseness
Pain in your neck and throat
Swollen lymph nodes in your neck
What are the causes of Thyroid Cancer?
The exact cause of thyroid cancer is not known. Thyroid cancer occurs when cells in your thyroid undergo genetic changes (mutations). The mutations allow the cells to grow and multiply rapidly. The cells also lose the ability to die, as normal cells would. The accumulating abnormal thyroid cells form a tumor. The abnormal cells can invade nearby tissue and can spread (metastasize) to other parts of the body.
What are the types of thyroid cancer?
Thyroid cancer is classified into types based on the kinds of cells found in the tumor. Your type is determined when a sample of tissue from your cancer is examined under a microscope. The type of thyroid cancer is considered in determining your treatment and prognosis.
Types of thyroid cancer include:
Papillary thyroid cancer. The most common form of thyroid cancer, papillary thyroid cancer arises from follicular cells, which produce and store thyroid hormones. Papillary thyroid cancer can occur at any age, but most often it affects people ages 30 to 50. Doctors sometimes refer to papillary thyroid cancer and follicular thyroid cancer together as differentiated thyroid cancer.
Follicular thyroid cancer. Follicular thyroid cancer also arises from the follicular cells of the thyroid. It usually affects people older than age 50. Hurthle cell cancer is a rare and potentially more aggressive type of follicular thyroid cancer.
Anaplastic thyroid cancer. Anaplastic thyroid cancer is a rare type of thyroid cancer that begins in the follicular cells. It grows rapidly and is very difficult to treat. Anaplastic thyroid cancer typically occurs in adults age 60 and older.
Medullary thyroid cancer. Medullary thyroid cancer begins in thyroid cells called C cells, which produce the hormone calcitonin. Elevated levels of calcitonin in the blood can indicate medullary thyroid cancer at a very early stage. Certain genetic syndromes increase the risk of medullary thyroid cancer, although this genetic link is uncommon.
Other rare types. Other very rare types of cancer that start in the thyroid include thyroid lymphoma, which begins in the immune system cells of the thyroid, and thyroid sarcoma, which begins in the connective tissue cells of the thyroid.
What are risk factors for Thyroid Cancer?
While anyone can develop thyroid cancer, certain factors put an individual at higher risk. Thyroid cancer risk is approximately three times higher in women than men, and most cases occur in patients under age 55
Other risk factors include:
Being between ages 25 and 65
Having a family member who has had thyroid disease
Having had exposure to radiation, especially as a child. The radiation exposure could come from exposure to a nuclear reactor accident (such as Chernobyl or Fukashima) or from radiation treatments for another cancer. Survivors of childhood cancer who were treated with high dose radiation have the greatest risk of thyroid cancer from radiation
Certain inherited genetic syndromes. Genetic syndromes that increase the risk of thyroid cancer include familial medullary thyroid cancer, multiple endocrine neoplasia, Cowden's syndrome and familial adenomatous polyposis.
What are the expected complications of thyroid cancer?
Despite treatment, thyroid cancer can return, even if you've had your thyroid removed. This could happen if microscopic cancer cells spread beyond the thyroid before it's removed.
Thyroid cancer may recur in:
Lymph nodes in the neck
Small pieces of thyroid tissue left behind during surgery
Other areas of the body, such as the lungs and bones
Thyroid cancer that recurs can be treated. Your doctor may recommend periodic blood tests or thyroid scans to check for signs of a thyroid cancer recurrence.
Adults and children with an inherited gene mutation that increases the risk of medullary thyroid cancer may consider thyroid surgery to prevent cancer (prophylactic thyroidectomy). Discuss your options with a genetic counselor who can explain your risk of thyroid cancer and your treatment options.
What are the tests and procedures used to diagnose thyroid cancer?
History & Physical exam. Need to identify risk factors like family history or history of exposure to radiation. Examination of neck to feel for physical changes in your thyroid, such as thyroid nodules. He or she may also ask about your risk factors, such as .
Blood tests. Blood tests help determine if the thyroid gland is functioning normally.
Ultrasound imaging. Ultrasound uses high-frequency sound waves to create pictures of body structures. The appearance of your thyroid on the ultrasound helps your doctor determine whether a thyroid nodule is likely to be noncancerous (benign) or whether there's a risk that it might be cancerous.
Removing a sample of thyroid tissue. During a fine-needle aspiration biopsy, your doctor inserts a long, thin needle through your skin and into the thyroid nodule. Ultrasound imaging is typically used to precisely guide the needle into the nodule to remove samples of suspicious thyroid tissue. The sample is analyzed in the laboratory to look for cancer cells.
Other imaging tests. You may have one or more imaging tests to help your doctor determine whether your cancer has spread beyond the thyroid. Imaging tests may include CT, MRI and nuclear imaging tests that use a radioactive form of iodine.
Genetic testing. Some people with medullary thyroid cancer may have genetic changes that can be associated with other endocrine cancers. Your family history may prompt your doctor to recommend genetic testing to look for genes that increase your risk of cancer.
How is thyroid cancer treated?
Once the diagnosis is confirmed, you will likely need to have your thyroid gland removed. If the thyroid cancer is contained within the gland, this may be the only treatment needed. However, some patients need one-time radioactive iodine pill as part of their thyroid cancer treatment protocol. Advanced cancers, which are found in fewer than 5% of patients, may require chemotherapy. Because the thyroid gland is removed during treatment, patients need thyroid hormone therapy for the rest of your life.
Thyroid cancer treatment options depend on the type and stage of your thyroid cancer, your overall health, and your preferences. Most thyroid cancers can be cured with treatment. Very small thyroid cancers that have a low risk of spreading in the body might not need treatment right away. Instead, you might consider active surveillance with frequent monitoring of the cancer. Your doctor might recommend blood tests and an ultrasound exam of your neck once or twice per year.
In some people, the cancer might never grow and never require treatment. In others, growth may eventually be detected and treatment can be initiated.
Most people with thyroid cancer undergo surgery to remove the thyroid. The type and extent of surgery depends on the type of thyroid cancer, the size of the cancer, whether the cancer has spread beyond the thyroid and the results of an ultrasound exam of the entire thyroid gland. Surgery may require removing all or most of the thyroid (Near total or total thyroidectomy) or part of the gland (Partial thyroidectomy or lobectomy) The procedure may require removing lymph nodes in the neck (lymph node dissection).
Thyroid surgery carries a risk of bleeding and infection. Damage to your parathyroid glands also can occur during surgery, which can lead to low calcium levels in your body.
There's also a risk that the nerves connected to your vocal cords might not work normally after surgery, which can cause vocal cord paralysis, hoarseness, voice changes or difficulty breathing. Treatment can improve or reverse nerve problems.
Patients are encouraged to discuss all possible complications and procedure including recovery time with their surgeon before the procedure. We usually work with ENT surgeons at Sacramento ENT ( https://sacent.com 1561 Creekside Drive, Suite 180 Folsom, CA 95630 (916) 984-8830)
but we do take in consideration patients insurance, convenience and other factors and work with other surgeons as well.
Thyroid hormone therapy
After thyroidectomy, you may take the thyroid hormone medication levothyroxine (Synthroid, Levoxyl, Tirosint and others) for life.
This medication has two benefits: It supplies the missing hormone your thyroid would normally produce, and it suppresses the production of thyroid-stimulating hormone (TSH) from your pituitary gland. High TSH levels could conceivably stimulate any remaining cancer cells to grow.
Radioactive iodine treatment uses large doses of a form of iodine that's radioactive.
Radioactive iodine treatment is often used after thyroidectomy to destroy any remaining healthy thyroid tissue, as well as microscopic areas of thyroid cancer that weren't removed during surgery. Radioactive iodine treatment may also be used to treat thyroid cancer that recurs after treatment or that spreads to other areas of the body.
Radioactive iodine treatment comes as a capsule or liquid that you swallow. The radioactive iodine is taken up primarily by thyroid cells and thyroid cancer cells, so there's a low risk of harming other cells in your body.
Side effects may include:
Altered sense of taste or smell
Most of the radioactive iodine leaves your body in your urine in the first few days after treatment. You'll be given instructions for precautions you need to take during that time to protect other people from the radiation. For instance, you may be asked to temporarily avoid close contact with other people, especially children and pregnant women. Patients are encouraged to discuss the expected procedure, dose and expected complications with the nuclear medicine doctor at the time of initial consultation before the procedure.
External radiation therapy
External beam radiation therapy may be recommended if surgery isn't an option and your cancer continues to grow after radioactive iodine treatment. Radiation therapy may also be recommended after surgery if there's an increased risk that your cancer will recur.
Chemotherapy is a drug treatment that uses chemicals to kill cancer cells. Chemotherapy is typically given as an infusion through a vein. The chemicals travel throughout your body, killing quickly growing cells, including cancer cells.
Chemotherapy isn't commonly used in the treatment of thyroid cancer, but it's sometimes recommended for people with anaplastic thyroid cancer. Chemotherapy may be combined with radiation therapy.
For suspicious thyroid nodules we usually refer patients to Precision Pathology for ultrasound guided Fine Needle Aspiration Cytology (FNAC or Needle Biopsy) https://www.ypmg.com/contact/ We usually are sensitive to patients convenience and restrictions of driving and if they wish to go to a closer facility then try to work with facilities that are convenient to them.
PRECISION PATHOLOGY MEDICAL GROUP
7750 College Town Dr.
Sacramento, CA 95826
Phone: (855) 577.PPMG
Fax: (855) 677.9564
For appointment inquiries, please contact:
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Hyperthyroidism is a condition in which the thyroid gland is overactive and produces too much thyroid hormone. If left untreated, hyperthyroidism can lead to other health problems. Some of the most serious involve the heart (rapid or irregular heartbeat, congestive heart failure) and the bones (Osteoporosis) People with mild hyperthyroidism or the elderly may not have any symptoms at all.
Graves Disease is the most common cause of hyperthyroidism. It occurs when the immune system attacks the thyroid gland, causing it to enlarge and make too much thyroid hormone. It is chronic (long-term) and typically runs in families with a history of thyroid disease or other autoimmune conditions. Some people with Graves' disease also develop swelling behind the eyes that causes the eyes to bulge outward. Less common causes of hyperthyroidism include Thyroid Nodules, Subacute Thyroiditis, Lymphocytic thyroiditis,, Postpartum thyroiditis: Thyroiditis that develops shortly after pregnancy. Condition is best diagnosed with examination, blood test and a special imaging test (Thyroid Uptake & Scan) Treatment for hyperthyroidism will depend on its cause, your age and physical condition, and how serious your thyroid problem is. Available treatments include Anti thyroid Medications, Radioactive iodine, Surgery and beta blockers. All of these therapies have risks. Your doctor will work with you to decide which treatment option is best for you.
Hypothyroidism means you have too little thyroid hormone. Another term is an “under-active thyroid.” Hypothyroidism is the most common thyroid disorder. It occurs more often in women and people over age 60. Hypothyroidism tends to run in families. Typical symptoms include tiredness/sluggishness, mental depression, feeling cold, weight gain, dry skin and hair, hair loss, constipation, menstrual irregularities. These symptoms are not unique to hypothyroidism. A simple blood test can tell whether the symptoms are due to hypothyroidism or some other cause. People with mild hypothyroidism may not have any symptoms at all. In adults, Hashimoto's disease is the most common cause of hypothyroidism in industrialized countries (iodine deficiency is the most common cause in the rest of the world). In Hashimoto, your immune system attacks and damages your thyroid, so it can't make enough thyroid hormone. Hypothyroidism can also be caused by radioactive iodine treatment or surgery on the thyroid gland, which are used to treat other types of thyroid disorders. A problem with the pituitary gland is another rare cause. Congenital hypothyroidism is present from birth and occurs when the thyroid gland does not develop properly. In adults, untreated hypothyroidism leads to poor mental and physical performance. It also can cause high blood cholesterol levels that can lead to heart disease. A life-threatening condition called myxedema coma can develop if severe hypothyroidism is left untreated. Diagnosis of hypothyroidism is especially important in pregnancy. Untreated hypothyroidism in the mother may affect the baby's growth and brain development. All babies are tested at birth for hypothyroidism. If not treated promptly, a child with hypothyroidism could have an intellectual disability or fail to grow normally. Blood tests can measure your levels of thyroid-stimulating hormone (TSH) and thyroid hormone (T4). You have hypothyroidism when you have high TSH and low T4 levels in your blood. In very early or mild hypothyroidism, TSH will be high but T4 may be normal. In this case, your doctor may measure the thyroid levels more frequently to determine if hypothyroidism develops over time. When the cause of hypothyroidism is Hashimoto disease, blood tests can detect anti-thyroid antibodies that attack the thyroid.
How is hypothyroidism treated?
Hypothyroidism is treated with thyroid hormone medication, taken as a pill. Levothyroxine is the drug of choice. It is a synthetic (laboratory-made) form of T4 that is identical to the T4 the thyroid naturally makes. Levothyroxine comes in brand-name and generic versions. Changing the manufacturer of the medication could alter the amount of medicine your body gets; so preferably, try to consistently take the same dose, made by the same company at all times. Often, this might be resolved by using a branded levothyroxine product. Most people need thyroid hormone replacement for life.
What is Graves’ disease?
Graves' disease is an immune system disorder that results in the overproduction of thyroid hormones (hyperthyroidism). Although a number of disorders may result in hyperthyroidism, Graves' disease is a common cause.
Because thyroid hormones affect a number of different body systems, signs and symptoms associated with Graves' disease can be wide ranging and significantly influence your overall well-being. Although Graves' disease may affect anyone, it's more common among women and before the age of 40.
What causes Graves’ Disease?
Graves’ disease is an autoimmune disorder. This means that the patient’s own immune system produces antibodies that bind to the surface of thyroid cells and then stimulate those cells to overproduce thyroid hormones.
How is the diagnosis of Graves’ disease made? A physical examination and laboratory tests that measure the amount of thyroid hormone (thyroxine, or T4, and triiodothyronine, or T3) and thyroid-stimulating hormone (TSH) in your blood are necessary. Your doctor may choose to obtain a picture of your thyroid (a thyroid scan).
What are common signs and symptoms of Graves' Disease?
Some of the possible symptoms are
Anxiety and irritability
A fine tremor of your hands or fingers
Heat sensitivity and an increase in perspiration or warm, moist skin
Weight loss, despite normal eating habits
Enlargement of your thyroid gland (goiter)
Change in menstrual cycles
Erectile dysfunction or reduced libido
Frequent bowel movements
Bulging eyes (Graves' ophthalmopathy)
Thick, red skin usually on the shins or tops of the feet (Graves' dermopathy)
Rapid or irregular heartbeat (palpitations)
Difficulty with sleep
The diagnosis of Graves' disease may include:
Physical exam. Your doctor examines your eyes to see if they're irritated or protruding and looks to see if your thyroid gland is enlarged. Because Graves' disease increases your metabolism, your doctor will check your pulse and blood pressure and look for signs of tremor.
Blood sample. Your doctor will order blood tests to determine your levels of thyroid-stimulating hormone (TSH), the pituitary hormone that normally stimulates the thyroid gland, as well as levels of thyroid hormones. People with Graves' disease usually have lower than normal levels of TSH and higher levels of thyroid hormones.
Another laboratory test measures the levels of the antibody known to cause Graves' disease. This test usually isn't necessary to make a diagnosis, but a negative result might indicate another cause for hyperthyroidism.
Radioactive iodine uptake. Your body needs iodine to make thyroid hormones. By giving you a small amount of radioactive iodine and later measuring the amount of it in your thyroid gland with a specialized scanning camera, your doctor can determine the rate at which your thyroid gland takes up iodine. The amount of radioactive iodine taken up by the thyroid gland helps determine if Graves' disease or another condition is the cause of the hyperthyroidism. This test may be combined with a radioactive iodine scan to show a visual image of the uptake pattern.
Ultrasound. Ultrasound uses high-frequency sound waves to produce images of structures inside the body. Ultrasound can show if the thyroid gland is enlarged, and is most useful in people who can't undergo radioactive iodine uptake, such as pregnant women.
Imaging tests. If the diagnosis of Graves' ophthalmopathy isn't clear from a clinical assessment, your doctor may order an imaging test, such as CT scan, a specialized X-ray technology that produces thin cross-sectional images. Magnetic resonance imaging (MRI), which uses magnetic fields and radio waves to create either cross-sectional or 3-D images, also may be used.
The treatment goals for Graves' disease are to inhibit the production of thyroid hormones and to block the effect of the hormones on the body. Some treatments include:
Radioactive iodine therapy
With this therapy, you take radioactive iodine, or radioiodine, by mouth. Because the thyroid needs iodine to produce hormones, the radioiodine goes into the thyroid cells and the radioactivity destroys the overactive thyroid cells over time. This causes your thyroid gland to shrink, and symptoms lessen gradually, usually over several weeks to several months.
Radioiodine therapy may increase your risk of new or worsened symptoms of Graves' ophthalmopathy. This side effect is usually mild and temporary, but the therapy may not be recommended if you already have moderate to severe eye problems.
Other side effects may include tenderness in the neck and a temporary increase in thyroid hormones. Radioiodine therapy isn't used for treating pregnant women or women who are breast-feeding.
Because this treatment causes thyroid activity to decline, you'll likely need treatment later to supply your body with normal amounts of thyroid hormones.
Anti-thyroid medications interfere with the thyroid's use of iodine to produce hormones. These prescription medications include propylthiouracil and methimazole (Tapazole).
Because the risk of liver disease is more common with propylthiouracil, methimazole is considered the first choice when doctors prescribe medication.
When these two drugs are used alone, a relapse of hyperthyroidism may occur at a later time. Taking the drug for longer than a year, however, may result in better long-term results. Anti-thyroid drugs may also be used before or after radioiodine therapy as a supplemental treatment.
Side effects of both drugs include rash, joint pain, liver failure or a decrease in disease-fighting white blood cells. Methimazole isn't used to treat pregnant women in the first trimester because of the slight risk of birth defects. Therefore, propylthiouracil is the preferred anti-thyroid drug during the first trimester for pregnant women. After the first trimester, methimazole use is generally resumed and propylthiouracil is no longer prescribed.
These medications don't inhibit the production of thyroid hormones, but they do block the effect of hormones on the body. They may provide fairly rapid relief of irregular heartbeats, tremors, anxiety or irritability, heat intolerance, sweating, diarrhea, and muscle weakness.
Beta blockers include:
Metoprolol (Lopressor, Toprol-XL)
Beta blockers aren't often prescribed for people with asthma, because the drugs may trigger an asthma attack. These drugs may also complicate management of diabetes.
Surgery to remove all or part of your thyroid (thyroidectomy or subtotal thyroidectomy) also is an option for the treatment of Graves' disease. After the surgery, you'll likely need treatment to supply your body with normal amounts of thyroid hormones.
Risks of this surgery include potential damage to the nerve that controls your vocal cords and the tiny glands located adjacent to your thyroid gland (parathyroid glands). Your parathyroid glands produce a hormone that controls the level of calcium in your blood. Complications are rare under the care of a surgeon experienced in thyroid surgery.
Treating Graves' ophthalmopathy
Mild symptoms of Graves' ophthalmopathy may be managed by using over-the-counter artificial tears during the day and lubricating gels at night. If your symptoms are more severe, your doctor may recommend:
Corticosteroids. Treatment with prescription corticosteroids, such as prednisone, may diminish swelling behind your eyeballs. Side effects may include fluid retention, weight gain, elevated blood sugar levels, increased blood pressure and mood swings.
Prisms. You may have double vision either because of Graves' disease or as a side effect of surgery for Graves' disease. Though they don't work for everyone, prisms in your glasses may correct your double vision.
Orbital decompression surgery. In this surgery, your doctor removes the bone between your eye socket (orbit) and your sinuses — the air spaces next to the orbit. This gives your eyes room to move back to their original position.
This treatment is usually used if pressure on the optic nerve threatens the loss of vision. Possible complications include double vision.
Orbital radiotherapy. Orbital radiotherapy was once a common treatment for Graves' ophthalmopathy, but the benefits of the procedure aren't clear. Orbital radiotherapy uses targeted X-rays over the course of several days to destroy some of the tissue behind your eyes. Your doctor may recommend orbital radiotherapy if your eye problems are worsening and prescription corticosteroids alone aren't effective or well-tolerated.
Graves' ophthalmopathy doesn't always improve with treatment for Graves' disease. Symptoms of Graves' ophthalmopathy may even get worse for three to six months. After that, the signs and symptoms of Graves' ophthalmopathy usually stabilize for a year or so and then begin to get better, often on their own.
How is Graves’ disease treated?
The treatment of hyperthyroidism may include antithyroid drugs (methimazole or propylthiouracil [PTU]), Radioiodine, or Surgery . The primary treatment goals are to inhibit the overproduction of thyroid hormones and lessen the severity of symptoms.
What is Graves' ophthalmopathy?
About 30 percent of people with Graves' disease show some signs and symptoms of a condition known as Graves' ophthalmopathy. In Graves' ophthalmopathy, inflammation and other immune system events affect muscles and other tissues around your eyes. The severity of the eye problems is not related to the severity of the hyperthyroidism. Problems with the eyes occur much more often in people with Graves’ disease who smoke cigarettes.
The resulting signs and symptoms may include:
Bulging eyes (exophthalmos)
Gritty sensation in the eyes
Pressure or pain in the eyes
Puffy or retracted eyelids
Reddened or inflamed eyes
What is Graves' dermopathy?
An uncommon manifestation of Graves' disease, called Graves' dermopathy, is the reddening and thickening of the skin, most often on your shins or the tops of your feet
The texture of the affected skin may be similar to that of an orange peel. Doctors may also refer to the condition as pretibial myxedema.
Graves' dermopathy results from a buildup of certain carbohydrates in the skin — the cause of which isn't known. Carbohydrate buildup also causes the eye problems associated with Graves' disease. The vast majority of people who develop Graves' dermopathy also have Graves' ophthalmopathy.
Milder cases of Graves' dermopathy often improve over time without treatment. Treatment of Graves' dermopathy is usually aimed at correcting the overactive thyroid responsible for Graves' disease. You'll also be advised to quit smoking and to avoid trauma to the skin as much as possible.
Even with successful treatment of the underlying Graves' disease, you may still have cosmetic issues and have a hard time getting shoes to fit well.
Autoimmune Thyroid Disorder
Autoimmune diseases arise when the immune system mistakes parts of the body as being foreign or ‘non-self’ and mounts an immune response against the body’s healthy cells, tissues, and organs. According to the National Institute of Health, 23.5 million Americans have autoimmune disease.
The role of the immune system is to protect the body against invasion (infection). White blood cells recognize infectious organisms such as viruses, bacteria, fungus, etc. as ‘non-self’ or foreign, and mount an immune response to attack and eliminate them from your body. This means the immune system is ‘educated’ to know ‘self’ (i.e., lung, liver, heart, skin), and what is foreign to the body, or ‘non-self’.
Autoimmune diseases can manifest anywhere in the body. Some of the more well-known autoimmune diseases are:
Type 1 Diabetes Mellitus
Inflammatory bowel disease (IBD)
Multiple sclerosis (MS)
Others are rare and can be difficult to diagnose
Currently, scientists are not sure what causes autoimmune diseases, but have identified several contributors such as genetics, environmental factors, and sex (female vs male).
Who is at risk for Autoimmunity ?
Having a family history of autoimmune diseases such as lupus or multiple sclerosis raises your risk of developing autoimmunity. Moreover, some families have multiple members affected by different autoimmune diseases, while others never manifest (develop) such diseases.
Other factors in combination to genetic susceptibility have been associated with autoimmunity. These include some viral and bacterial infections, traumatic experiences and chronic stress, some medications, drug abuse and acute chemical exposures.
Smoking and obesity may worsen some autoimmune disorders and their symptoms by contributing to chronic systemic inflammation.
Autoimmune diseases are more common in certain ethnic backgrounds than others. Type 1 diabetes is more common in Caucasians while Lupus is most severe in African American and Hispanic people.
The hormones and endocrine system may contribute to the autoimmune conditions. Sex-hormones, Cortisol, vitamin D and other hormones that affect how your immune system functions may also contribute to autoimmunity, but more research is needed to establish a causative link.
Women are more likely than men to develop most autoimmune diseases. These sex differences vary by condition and range from women being twice as likely to develop autoimmunity, to women being nine times more likely, as is the case with lupus. Usually, the autoimmunity starts during a woman’s childbearing years (ages 15 to 44). Other autoimmune diseases which are more common in women include systemic lupus erythematosus (SLE), multiple sclerosis, rheumatoid arthritis, Graves' Disease, Hashimoto’s thyroiditis, and Sjogren's syndrome. Several factors are likely responsible for these sex-differences in autoimmunity. Differences in Estrogen and Testosterone between men and women are thought to be contributors, but this hasn’t been proven.
Birth control, especially contraceptives with high estrogen content, have been linked to higher risk of developing autoimmune conditions including Crohn’s disease and lupus, or may increase their severity, but more research is needed to support these links.
Vitamin D deficiency is often observed in people with autoimmune diseases. However, whether vitamin D supplementation protects against autoimmune disorders is not certain. Some report that low vitamin D levels result from autoimmune disorders, and supplementing with vitamin D may exacerbate these disorders.
What is the general presentation of Autoimmune Diseases?
Autoimmune diseases share many symptoms in common. Inflammation is the central mechanism by which the immune system damages organs and tissues, which is associated with tenderness and pain. Other symptoms include swelling and redness at site of inflammation, fatigue, fever, unexplained weight loss, rashes, muscle pain, joint stiffness that improves with activity and gets worse with rest, back pain at night that gets worse with rest and immobility
Most autoimmune diseases are episodic (occurring occasionally) in nature, meaning some will experience times of intense debilitating pain and other times of low-grade pain that is more manageable and may not interfere with daily tasks. Patients have also described hair loss in localized areas, and recurrent oral or nasal ulcers.
Since many autoimmune diseases share many symptoms, getting to a diagnosis can be a long, difficult, and stressful. Many symptoms of autoimmune diseases are the same for other types of health problems too. This makes it difficult for doctors to settle on a specific diagnosis. It is important not get frustrated and feel defeated by this process. Keep good notes on symptoms as they appear, pain level associated and how long these symptoms last.
What's the best treatment for autoimmune Conditions?
Most autoimmune conditions are chronic and cannot be cured, but they can be controlled with treatment. Treatments will depend on the disease and symptoms. The goal of treatment is to control the autoimmune process, reduce symptoms, and maintain the body's ability to fight diseases.
Autoimmune diseases that damage glands in our body that produce hormones may require lifetime hormone replacement. These include Type 1 Diabetes Mellitus, Addison's Disease, Hashimoto’s Thyroiditis & Graves’ Disease. For these diseases, hormone replacement therapy is needed to replace the hormones that a person can no longer make. In Graves’ Disease, medication is given to destroy the thyroid gland, and the patient will then take thyroid hormone replacement for the rest of their lives.
Certain lifestyle changes can significantly improve the efficacy of physician prescribed medication. Smoking can have significant impact on the success of treatment. Smoking has been associated with increased risk for many autoimmune diseases including lupus, psoriasis, and rheumatic arthritis.
While there is no causal link between obesity and development of autoimmune diseases, physicians recommend maintaining a healthy body weight. Studies have linked high body weight and a poor prognosis in rheumatoid arthritis patients.
Autoimmune diseases such as rheumatoid arthritis can make simple daily tasks such as removing the lid on a jar or turning a doorknob difficult due to the pain and deformation that can occur to the inflamed joints. Some patients have described changes in mood and depression because of changes to normal routines due to their autoimmune disease. People recently diagnosed with an autoimmune disease should seek professional help from therapist to help come to terms with their diagnosis and the possible lifestyle changes to come. Physicians also recommend working with physical and occupational therapist to learn how to use assistive devices.
While there is no definitive diet to prescribe for patients with autoimmune diseases, some foods have been shown to have anti-inflammatory effects for some autoimmune conditions. Most of the research investigating the association between diet and autoimmunity are currently being conducted in mouse models of lupus.
Apart from maintaining a healthy body weight, the use of the polyunsaturated fatty acid Omega-3 has been shown to have a mild anti-inflammatory effect in randomized trials. Omega-3 fatty acids can be found in fish, canola oil, flaxseeds, soybeans and walnuts otherwise known as the Mediterranean diet. Nutritional supplements are an attractive therapeutic option that have shown some promise in early research for lupus therapy, but more research is needed.
Autoimmune disease and conditions are some of the most complex and hard-to-treat immune system-related diseases. Management of stress is highly encouraged to deal with autoimmune conditions as well.
Pregnancy & thyroid
PREGNANCY & THYROIDITIS
Postpartum thyroiditis is an inflammation of the thyroid gland that occurs after pregnancy. It usually occurs within a year after a woman gives birth. It affects five to ten out of every 100 women after they deliver a baby. There are usually two phases of the disease, Hyperthyroidism (too much thyroid hormone) and Hypothyroidism (too little thyroid hormone)
In the usual first phase, hyperthyroidism, the inflamed thyroid gland leaks stored thyroid hormone (which consists of T3 and T4) into the blood. This phase usually lasts two to four months. Too much thyroid hormone in your blood causes your metabolism to speed up. Usual symptoms include:
Losing weight suddenly
Sensitivity to heat
The inflammation can damage the thyroid, making it less able to produce thyroid hormone. This can lead to the second phase, hypothyroidism, too little thyroid hormone in the blood. This phase may last up to a year. Too little thyroid hormone in your blood slows your metabolism. Many women with hypothyroidism have a goiter, an enlarged thyroid gland that causes swelling in the front part of the neck. Other symptoms of hypothyroidism can include:
Unexplained weight gain or inability to lose weight
Feeling tired or fatigued
Dry skin and brittle nails
Sensitivity to cold
You are at greater risk of developing postpartum thyroiditis if you have an immune system disorder such as Type 1 Diabetes, a personal or family history of thyroid disease, or have had postpartum thyroiditis before.
For some women who develop hyperthyroidism after giving birth, the thyroid levels return to normal within a few months without going through the second phase (hypothyroidism). However, most women do experience the second phase. Of these women, about one out of five develops permanent hypothyroidism. They require life-long treatment with thyroid hormone. If left untreated, hypothyroidism can cause serious problems such as heart disease.
Diagnosis depends on the phase of the disease and is based on your symptoms and laboratory test results. These tests help determine if you are in the hyper- or hypothyroid phase:
Level of T4 in the bloodstream.
Level of thyroid-stimulating hormone (TSH) in the bloodstream. This hormone is produced by the pituitary gland (located at the base of the brain), TSH tells the thyroid to produce T3 and T4.
Radioactive iodine uptake values. The thyroid uses iodine to make thyroid hormone. This test requires you to swallow a small dose of radioactive iodine and then measures the amount that builds up in the thyroid gland. It is not recommended for women who are nursing.
Levels of anti-thyroid antibodies. Inflammation of the thyroid causes your immune system to release antibodies into the bloodstream.
In the first phase (hyperthyroidism), you usually don't need treatment because symptoms are mild and brief. If your symptoms are extreme, however, your doctor might give you a beta blocker drug to slow your heart rate and lessen nervousness.
In the second phase (hypothyroidism), you will receive thyroid hormone therapy if you develop symptoms. Levothyroxine is the most commonly used thyroid hormone medication. It is a synthetic (laboratory-made) form of T4 that is the same as the T4 the thyroid gland naturally makes. After 6 to 12 months, the medication is stopped to see whether your thyroid will function normally on its own. In most cases the thyroid returns to normal, but some women develop long-term hypothyroidism and need lifelong thyroid hormone replacement therapy.
PREGNANCY & HYPOTHYROIDISM
Pregnancy causes major changes in the levels of hormones made by the thyroid gland, located in the front of the neck. For that reason, thyroid problems sometimes can start or get worse during pregnancy or after childbirth. Hypothyroidism during pregnancy is not common. However, the symptoms can be overlooked because some mimic the hormonal changes of a normal pregnancy, such as tiredness and weight gain.
If left untreated, maternal hypothyroidism poses a risk for both mother and baby. A pregnant woman’s thyroid hormones are vital not only for her but also for the development of her baby. Pregnant women with uncontrolled hypothyroidism can get high blood pressure, anemia (low red blood cell count), and muscle pain and weakness. There is also an increased risk of miscarriage, premature birth (before 37 weeks of pregnancy), or even stillbirth.
A common cause of under active thyroid in pregnant women is Hashimoto Disease, sometimes called Hashimoto thyroiditis. This autoimmune disease occurs when your immune system forms antibodies (immune proteins) that attack the thyroid. This, in turn, causes the gland to make too little thyroid hormone. People with this disease may have symptoms of hypothyroidism or they may notice no effects.
Other causes of hypothyroidism include iodine deficiency, prior treatment for hyperthyroidism (when the thyroid makes too much thyroid hormone) and surgery to remove thyroid tumors.
The thyroid also can become under active after childbirth. About 7% of women get postpartum thyroiditis (inflammation of the thyroid) in the first year after giving birth. This problem starts with hyperthyroidism, which most often clears up without treatment in a few weeks or months. But sometimes the inflammation leads to hypothyroidism. In most cases, the hypothyroidism goes away on its own. In countries where there is not enough iodine in the diet, iodine deficiency is a chief cause of hypothyroidism. The thyroid gland needs iodine to make thyroid hormones. In the United States, iodine is not lacking in the diet because of the use of iodized salt. However, women who are pregnant or breast-feeding need more iodine than usual and should increase their intake of this important mineral.
Pregnant women at high risk of thyroid problems should have a thyroid function test even if they do not have symptoms of an under active thyroid. Ideally, this screening blood test should take place by the ninth week of pregnancy or at the first prenatal visit.
Because of the dangers of untreated thyroid disease, some experts advise screening all newly pregnant women for abnormal thyroid function. You should ask your health care provider early in your pregnancy whether you need thyroid function blood tests.
Women who have known high levels of TPO antibodies need extra thyroid function screening. They are at increased risk of hypothyroidism and pregnancy problems such as miscarriage. Therefore, they should get a TSH blood test before they try to become pregnant, and again during the first and second trimesters of pregnancy (first six months).
The treatment for hypothyroidism is thyroid hormone replacement with a form of T4 called levothyroxine. This drug is the same as the T4 your body makes and is safe for pregnant women.
Before pregnancy. It is important that thyroid hormone levels are normal both before and during pregnancy. If you are already receiving levothyroxine to treat hypothyroidism, you should have your thyroid hormone levels checked before you try to conceive. If your TSH levels are too high, you may need an increase in your dose of levothyroxine. You should delay pregnancy until your disease is well controlled.
During pregnancy. Once a hypothyroid woman becomes pregnant, the levothyroxine dose often must increase. Possibly the dose must go up by as much as 30% or more in the first 4 to 6 weeks of pregnancy. Contact your doctor soon after you know you are pregnant, so you can get a thyroid function blood test and discuss your treatment plan.
If you receive a new diagnosis of hypothyroidism during pregnancy, you will need your T4 levels brought to normal as quickly as possible. Your doctor may give you increasing doses of levothyroxine until your T4 levels become normal. About 30 to 40 days after you start treatment, you should have your thyroid function retested.
Also, your thyroid testing should be done often during pregnancy, usually every 4 to 6 weeks until delivery.
The Endocrine Society’s expert panel recommends that expectant mothers with sub clinical hypothyroidism also receive levothyroxine treatment. Some studies show that thyroid hormone replacement improves pregnancy outcomes in these women.
After pregnancy. After delivery, most hypothyroid women need to decrease the levothyroxine dose they received during pregnancy.
You can help ensure your baby’s health and your own health. Work with your pregnancy care provider and your endocrinologist, a specialist who treats hormone-related conditions, to receive proper medical care before, during, and after pregnancy. Take your medication as prescribed and tell your doctor about any side effects.
To make sure you get enough iodine, take daily prenatal vitamins that include 150 to 250 micrograms (mcg) of potassium iodide or iodate. Breast-feeding mothers should supplement with 250 mcg per day of iodine, to make sure their breast milk provides the iodine that their nursing babies need.
Do not take thyroid medicine at the same time as prenatal vitamins or supplements containing calcium and iron. These nutrients can interfere with the absorption of thyroid hormone. Take these vitamins at least 2 or 3 hours before or after taking your levothyroxine.
PREGNANCY & THYROID NODULES
Thyroid Nodules are very common. They are lumps in the thyroid gland, which is located in the front of your neck. These lumps can be solid growths of thyroid tissue or fluid-filled cysts. Thyroid nodules occur more often in women than men, and the chance of getting one or more nodules increases as you age.
Most nodules do not cause problems during pregnancy. Yet, pregnancy does cause major changes in the levels of hormones made in the thyroid gland. For this reason, thyroid dysfunction (changes in how well your thyroid gland works) can start during or after pregnancy in women who never had thyroid problems before.
Some thyroid nodules can trigger hyperthyroidism (when the thyroid makes too much thyroid hormone). Thyroid nodules also may occur in people with hypothyroidism (too little thyroid hormone). These thyroid problems can affect the health of a pregnant woman and her baby. It is important to know if you have either problem, so you can receive treatment. Doctors also are concerned about thyroid nodules because some can be malignant (cancerous). Most, though, are benign (not cancerous).
The cause of most thyroid nodules is unclear. They tend to occur more often in Women, Older adults, those with a family history of nodules, those whose diet lacks iodine (which the thyroid uses to make thyroid hormones), a rare problem in the United States
Less than 10% of thyroid nodules are cancerous. Certain risk factors make people more likely than others to get thyroid cancer. Having a risk factor, however, does not mean you will get thyroid cancer, and it is still possible to get this cancer if you have no risk factors. Risk factors include past radiation treatments (but not tests like X-rays) to the head, neck, or chest, mainly as an infant or child. Other risk factors are similar to those for thyroid nodules: age over 40 and low iodine intake. Some types of thyroid cancer have their own risk factors. For example "Medullary” thyroid cancer (an uncommon type) can run in families.
A nodule is more likely to be cancerous if it is large or growing quickly. There is no proof that pregnancy causes thyroid cancer to recur (come back) in women who had successful treatment for thyroid cancer before becoming pregnant. Most thyroid nodules cause no symptoms. You may not even know you have one unless it starts to grow. A large nodule may sometimes cause the following symptoms: lump in the front of the neck, hoarseness, trouble swallowing or breathing difficulty
Many thyroid nodules that cause no symptoms are found during a routine physical exam, when your health care provider feels your neck. Others may be found during an imaging test done for another reason, or you may find a nodule yourself.
Even though most thyroid nodules are benign, the possibility of cancer is concerning to a woman expecting a baby. To know if you have cancer or to rule it out, you will need more tests. For pregnant women, diagnosis and decision-making about the treatment of thyroid nodules relies mainly on the results of thyroid ultrasound imaging and fine-needle aspiration biopsy. A biopsy is the removal of a small sample of the nodule for further testing.
Though ultrasound alone cannot tell if a nodule is cancerous, it can show its size and whether it is solid, filled with fluid, or both (called complex nodules). This helps your doctor know whether to biopsy the nodule.
Fine-needle aspiration biopsy involves inserting a thin needle into the nodule to remove cells and/or fluid from it, for inspection under a microscope. This test is highly accurate for detecting cancerous nodules or “suspicious” ones that might be cancerous. Ultrasound often is used to guide the needle, especially when the nodules are very small.
According to the guidelines from the Endocrine Society, pregnant women should have a fine-needle aspiration biopsy when their thyroid nodules are one of the following:
Mostly solid and larger than 1 centimeter (about half an inch)
Complex and a size of 1.5 to 2 centimeters (0.6 to 0.8 inch)
Nodules that do not fall into one of these groups are unlikely to be cancerous and thus do not usually need a biopsy. When a nodule needing biopsy is found during your last months of pregnancy, you may choose to wait until after you deliver the baby to have the biopsy.
If the biopsy results show cancer, the pathologist (a medical expert who examines the cells under the microscope) will decide what type of thyroid cancer it is. The types, in order from most common to least common, are papillary, follicular, medullary, and anaplastic. Treatment depends on the type of cancer.
Treatment depends on the type of nodule and whether it is cancerous. Surgery to remove part or all the thyroid gland (called a thyroidectomy) may be recommended for nodules that:
Are cancerous or look highly suspicious on biopsy
Occur with enlarged lymph nodes in the neck (a possible sign of spread of cancer)
If you need surgery, you should have it late in the second trimester (pregnancy months 4–6), when it is safest for the baby.
Women who are hesitant to have surgery during pregnancy can postpone it until after delivery if their thyroid cancer is slow growing (papillary or follicular cancer) and not advanced. Most thyroid cancers are slow growing. Thus, in most cases, waiting to have surgery until soon after childbirth will not affect your prospects of living cancer free.
After giving birth, some women with thyroid cancer may need more treatment. This can include radioactive iodine therapy (to destroy thyroid tissue not removed by surgery or to treat advanced cancer), external radiation (mainly for advanced cancer), or chemotherapy (mainly for anaplastic thyroid cancer). Pregnant and breast-feeding women cannot have these treatments because of the risk to the baby.
People who had their whole thyroid removed will need to take thyroid medication for the rest of their lives.
You can help ensure the health of your baby and your own health. Work with your pregnancy care provider and your endocrinologist, a specialist who treats hormone-related conditions, to receive proper medical care. If your doctor recommends thyroid surgery, discuss when to have the operation.
Any woman who had radioactive Iodine treatment before or after pregnancy should wait 6 to 12 months before trying to become pregnant again.
To make sure you get enough iodine while pregnant, take daily prenatal vitamins that include 150 to 250 micrograms (mcg) of potassium iodide or iodate. Breastfeeding mothers need to supplement with 250 mcg per day of iodine.
Special Tests for Thyroid Disorders
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Why is iodine used in some thyroid gland treatment?
Iodine is essential for proper function of the thyroid gland, which uses it to make the thyroid hormones. The thyroid is equipped with an active system or “pump” for moving iodine into its cells, where it is concentrated as iodide.
What is Radioactive Iodine (RAI)?
Iodine, in the form of iodide, is made into two radioactive isotopes that are commonly used in patients with thyroid diseases: I-123 (harmless to thyroid cells) and I-131 (destroys thyroid cells. RAI is safe to use in individuals who have had allergic reactions to seafood or X-ray contrast agents. RAI is given by mouth in pill or liquid form.
Does RAI for thyroid imaging provide the best results?
I-123 is the usual isotope used to take pictures and determine the activity of the intact thyroid gland (Thyroid scan and Radioactive Iodine uptake, RAI UPTAKE), since it is harmless to thyroid cells. No special radiation precautions are necessary after a thyroid scan or RAI UPTAKE with I-123.
When is RAI used for treatment of thyroid disorders?
Normal Thyroid Tissue – I-131 is given to destroy overactive thyroid tissue or to shrink thyroid glands that are functioning normally but are causing problems because of their size. I-131 may occasionally cause mild pain in the neck that can be treated with aspirin, ibuprofen or acetaminophen. The RAI treatment may take up to several months to have its effect.
Thyroid Cancer – Large doses of I-131 are used to destroy thyroid cancer cells. This is performed after the remaining thyroid tissue (including any cancer cells) is stimulated by raising TSH levels by either withdrawing thyroid hormone or by treating with recombinant human TSH. Depending on state regulations, patients may have to stay isolated in the hospital for about 24 hours to avoid exposing other people to radiation, especially if there are young children living in the same home.
What are the radiation safety precautions after treatment with I-131 RAI?
Since RAI produces radiation, patients must do their best to avoid radiation exposure to others, particularly to pregnant women and small children. The amount of radiation exposure markedly decreases as the distance from the patient increases. Patients who need to travel in the days after I-131 RAI treatment are advised to carry a letter of explanation from their physician since radiation detection devices used at airports or in federal buildings may pick up even very small radiation levels.
Are there long term risks of I-131 RAI?
In general, RAI is a safe and effective treatment. Hypothyroidism is a common side effect of RAI for hyperthyroidism and always seen after RAI for thyroid cancer (see Hypothyroidism brochure). some studies suggest a slight increase in thyroid cancers after RAI treatment for hyperthyroidism.
Loss of taste and dry mouth due to salivary gland damage may be seen. The use of lemon drops, vitamin c or sour stimulation to potentially decrease the exposure of the salivary glands to RAI is controversial and should be discussed with your physician. Importantly, once you have been treated with RAI, regular medical follow-up is lifelong.
What are the special concerns for women? RAI, whether I-123 or I-131, should never be used in a patient who is pregnant or nursing. Pregnancy should be put off until at least 6 - 12 months after I-131 RAI treatment since the ovaries are exposed to radiation after the treatment and to ensure that thyroid hormone levels are normal and stable prior to pregnancy. There is no clear evidence that RAI leads to infertility. are there special concerns for men? Men who receive RAI treatment for thyroid cancer may have decreased sperm counts and temporary infertility for periods of roughly two years. sperm banking is an option in a patient who is expected to need several doses of RAI for thyroid cancer.
More info about Thyroid
THYROID & AGING
The thyroid makes hormones that travel through your bloodstream and regulate how your body breaks down food and uses it for energy. Learn more about what can occur when thyroid releases too many (overactive) or too few (under active) hormones. The thyroid is a butterfly shaped gland located in the front of the neck. This gland makes hormones that travel through your bloodstream and regulate how your body breaks down food and uses it for energy. Thyroid disorders typically occur when this gland releases too many or too few hormones. An overactive or underactive thyroid can lead to a wide range of health problems in both men and women.
Newborn babies who are unable to make enough thyroid hormone have congenital hypothyroidism, also known as neonatal hypothyroidism, meaning they are born with an underactive or absent thyroid gland. About 1 in every 2,000 to 4,000 babies is born with congenital hypothyroidism. It is twice as common in girls as in boys. The most common causes are an underdeveloped thyroid gland, a thyroid gland that's not located where it should be (in the neck below the voice box or larynx) a missing thyroid gland. These abnormalities are not inherited from the parents.
Other possible causes include defective production of thyroid hormone (an inherited condition) Problems with the pituitary gland (located at the base of the brain), which tells the thyroid to make thyroid hormone. Less commonly, a mother's thyroid disease or medicines taken during pregnancy can cause congenital hypothyroidism.
Many babies with congenital hypothyroidism appear normal at birth or for several months after birth. But others may have these signs and symptoms which include Jaundice (yellowing of the skin and eyes) Constipation, Poor muscle tone, Sluggishness, A hoarse cry, Feeding problems, A thick, large tongue, A puffy-looking face, swollen abdomen, sometimes with “outpouching” of the belly button and large soft spots of the skull
Thyroid hormone deficiency can also occur in older babies or young children, even if test results at birth were normal. If your child shows signs and symptoms of hypothyroidism, contact your doctor right away.
Most newborns in the United States are tested a few days after birth for congenital hypothyroidism as part of standard screening tests. These tests detect almost all cases of congenital hypothyroidism. If the condition is not found and treated, it can result in irreversible neurological problems and poor growth. The good news is that early diagnosis and proper treatment can prevent these problems. In most cases, the condition is permanent and your child will need lifelong treatment.
All YOU NEED TO KNOW ABOUT YOUR THYROID