Your thyroid gland is a small, butterfly-shaped gland located just below your Adam's apple. The thyroid produces hormones that affect your body's metabolism and energy level. Thyroid problems are among the most common medical conditions but, because their symptoms often appear gradually, they are commonly misdiagnosed. The three most common thyroid problems are the underactive thyroid, the overactive thyroid , and thyroid nodules.

HYPOTHYROIDISM (Underactive thyroid)

The most common cause of hypothyroidism is Hashimoto's thyroiditis. In this condition, the body's immune system mistakenly attacks the thyroid gland. Common symptoms of hypothyroidism are:

Fatigue or lack of energy
Weight gain
Feeling cold
Dry skin and hair
Heavy menstrual periods
Slowed thinking

DIAGNOSIS of hypothyroidism is usually straightforward, once it is suspected. Patients with hypothyroidism due to Hashimoto's thyroiditis have an elevated level of serum TSH (thyroid stimulating hormone). However, the rare patient with hypothyroidism due to a pituitary or hypothalamic condition may have a normal or low serum TSH.

TREATMENT of hypothyroidism consists of taking thyroid hormone in pill form on a daily basis. Symptoms of hypothyroidism should clear up within a few months of starting treatment. Adjustment of the dose of thyroid pills is based upon measurements of serum TSH. Most patients need to take thyroid hormone for life.  

HYPERTHYROIDISM (Overactive Thyroid)

The most common cause of hyperthyroidism is Graves' disease. This occurs when the body's immune system overstimulates the thyroid. Common symptoms of hyperthyroidism are:

Jitteriness, shaking, increased nervousness, irritability
Rapid heart beat or palpitations
Feeling hot
Weight loss
Fatigue, feeling exhausted
More frequent bowel movements
Shorter or lighter menstrual periods

In addition to symptoms of hyperthyroidism, some patients with Graves' disease develop eye symptoms such as a stare, eye irritation, bulging of the eyes and, occasionally, double vision or loss of vision. Involvement of the eyes is called Graves' Ophthalmopathy.

DIAGNOSIS is straightforward if suspected. However, patients are sometimes evaluated for other conditions, such as cancer or heart problems, if the doctor doesn't think of hyperthyroidism. The diagnosis is best made by finding an elevated level of Free T4 and low level of TSH in the blood. A thyroid scan should then be performed to determine whether the hyperthyroidism is due to Graves' disease or another condition such as toxic multinodular goiter, hot nodule, subacute thyroiditis, or silent thyroiditis. There are other, rare, cases of hyperthyroidism that usually require the expertise of an endocrinologist for diagnosis. Several methods of

TREATMENT are available for hyperthyroidism. The most popular method is radioactive iodine.Because the thyroid is the only organ in the body that takes up and uses iodine, when a dose of radioactive iodine is given the radiation enters the thyroid and destroys part of it. The main side effect is the development of an underactive thyroid which is treated as discussed above. Medications can also be used for treatment. These drugs slow down the working of thyroid and restore normal levels. However, they usually need to be taken for 6-12 months and 60-80% of patients have a relapse when they stop taking them. These drugs are associated with serious side effects in a small percentage of patients taking them. Surgical removal of part of the thyroid is occasionally used as a treatment. Consultation with a thyroid specialist is highly recommended to determine which treatment is best for you!


Thyroid nodules are fairly common and usually harmless. However, about 4% of nodules are cancerous, so further testing needs to be done. This is usually best accomplished by fine needle aspiration biopsy. This is a quick and simple test that takes just a few minutes to perform in the doctor's office. If the biopsy does not raise any suspicion of cancer, the nodule is usually observed. Some thyroid specialists recommend treatment with thyroid hormone to try to decrease the size of the nodule. A second biopsy is usually recommended 6-12 months later, to make sure there continues to be no evidence of cancer. If a nodule is cancerous, suspicious for cancer, or grows large enough to interfere with swallowing or breathing, surgical removal is advised.

Further reading. We highly recommend the following book written by three endocrinologists for patients with thyroid problems: Your Thyroid: A Home Reference by Woods, L.C., Cooper, D.S., and Ridgway, E.C., published by Ballantine Books. 0-345-39170-5

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