Diseases of the thyroid gland disrupt the work of the whole organism, hence there are often problems with the correct diagnosis. Hypothyroidism, hyperthyroidism, goiter, nodular thyroid tumors are diseases that endocrinology deals with. How does an endocrinologist recognize thyroid disease? What might indicate that your thyroid is not working properly?

About howthyroidaffects our well-being, what is hypothyroidism and how hyperthyroidism manifests itself, we talk to Dr. Anna Lewandowska, an endocrinologist.

What functions does the thyroid gland play and why is it so important for our he alth?

Anna Lewandowska, MD, PhD : The thyroid gland produces the hormones thyroxine (T4) and triiodothyronine (T3), which are essential for the proper functioning of all tissues and cells in the body. Thyroid hormones affect metabolism and growth processes, and in the fetus and newborns they determine the proper development of the nervous system, including the central nervous system, i.e. the brain. More figuratively speaking, from the hair to the heels, thyroid hormones are needed everywhere. Without them, tissues and cells cannot function properly.

Important

The thyroid glandis located at the bottom of the neck, below the larynx. It is made of two lobes. This gland is small - about 5 cm long, about 3 cm wide and about 2 cm thick. In women, the thyroid weighs from 15 to 30 g, and in men, from 30 to 60 g. The thyroid is an important endocrine gland of little impressive size. It is shaped like a butterfly. But it is not size that determines its role in the body and its special importance for a woman's he alth. Hormones produced by the thyroid protect a slim figure, take care of our mood, skin and hair.

What happens when the thyroid is working poorly?

A.L.:It all depends on whether the thyroid is producing too little or too much hormones. Generally speaking, things are not going well. When your thyroid hormones are depleted, the first symptoms may not be very specific. A person whose thyroid is working poorly feels that something is happening, but is unable to define or define what the malaise is. Such conditions are especially dangerous in the elderly, when indisposition is attributed to the aging processthe body. As a consolation, it is worth adding that the social awareness of thyroid diseases is increasing, the methods of diagnosing these diseases are more perfect, so when something bothers the patient, he often asks the doctor himself to check the thyroid gland. At the beginning of my career, diagnosis was based on indirect tests that determined the level of protein bound iodine. Today, doctors have at their disposal simple tests that determine TSH, free hormones, i.e. T3 and T4.

What causes thyroid disease?

A.L.:The thyroid gland works in the body in a feedback system - the thyroid gland, pituitary gland, hypothalamus. The thyroid gland is regulated by tropic hormones, the so-called upper floor. Therefore, diseases of the thyroid gland may result from disorders of the pituitary or hypothalamus, or from deficiencies of the thyroid gland itself. The latter are the most numerous. For many years, Poland has been in the area of ​​iodine deficiency. Compensation mechanisms developed in our bodies, which means that the thyroid gland, wishing to keep up with the needs of the body, was pathologically growing. Not only was the goiter formed, that is, there was a simple hypertrophy of the thyroid gland, but also nodules. According to estimates, about 9 million people have an abnormally developed thyroid due to iodine deficiency. It's a lot. Fortunately, this applies to the young generation to a small extent, and more often to people around 50 or 60 years of age. Most of them are not aware of it, because thyroid disorders do not have to go hand in hand with the appearance of the thyroid gland. Even with a lot of goiter, hormone production can be normal, so it is even difficult to determine whether it is a disease or not.

Hyperthyroidism and hypothyroidism - we often confuse these diseases. What causes them, what is the difference?

A.L.:Excessive hormone production is an overactive thyroid. It can be due to the presence of nodules that get out of control of the pituitary and hypothalamus and produce as many hormones as they want. It's autonomy. Each of us has about 10 percent of the thyroid. autonomic cells, but in the mass of normal cells they are not dangerous. When a tumor is formed with a specific mass and composed of autonomic cells only, hormone production occurs without feedback control. The second cause of hyperthyroidism is autoimmune disorders. Graves' disease may develop, or more rarely, Hashimoto's disease is the cause of hyperthyroidism. Hypothyroidism may be primary (idiopathic), which in Poland is usually the result of chronic inflammation of the gland. Hypothyroidism can develop after surgery or treatment with radioactive iodine. Maybegive way or last for the rest of your life.

What are the symptoms of the gland malfunctioning?

A.L.:Full-blown hyperthyroidism is characterized by nervousness, weight loss, increased heart rate, and sometimes cardiac arrhythmias. There are problems with concentration, insomnia, diarrhea, increased body temperature, muscle weakness. Another symptom is constantly wet skin. The symptoms are atypical in the early stages of the development of the disease. For example, someone is constantly nervous, but it is not known whether it is the result of stress or the onset of an illness. The same is true of hypothyroidism, which usually affects elderly people. The first symptoms are not very characteristic - concentration disorders, hearing loss, slowness, forgetfulness. However, developed hypothyroidism is manifested by a feeling of cold, even in a warm environment, fatigue, poor exercise tolerance, joint pain, constipation, menstrual disorders in young women, hair loss, eyelashes, eyebrows, dry skin. In addition, weight gain, metabolic disorders, and anemia often appear.

Are these conditions difficult to recognize?

A.L.:No. Fully symptomatic hypothyroidism or hyperthyroidism can be easily identified. Hypothyroidism is treated quite simply, but in the case of hyperthyroidism, the patient needs patience to be successful. The clinical diagnosis is confirmed by measuring the thyroid hormones. The first test is TSH, which stimulates the thyroid gland to synthesize and release hormones, enhances iodine uptake by the thyroid gland. However, it is worth adding here that low TSH does not always mean pathology. So every doctor should remember that it is not the results that are being treated, but the patient.

Is it true that the number of patients with thyroid cancer is increasing?

A.L.:It's hard to say. Malignant neoplasms of the thyroid gland develop slowly. Their incidence is greater than the number of neoplasms diagnosed during the lifetime of patients. We don't know if there are more thyroid cancers today than before, but we do have more patients - possibly because of higher detection rates. High social awareness and easy access to tests, including ultrasound, are one of the reasons for earlier cancer detection. A real answer to this question will be provided in 15-20 years, after analyzing the currently collected data.

When is it necessary to operate the thyroid gland?

A.L .:There are two indications for surgery - the suspicion of a malignant neoplasm or the assumption that nodules present in the thyroid gland may evolve into a malignant lesion, and a goiter that oppresses the trachea, making it difficult to breathe orlimiting airway patency. It is rarely operated because of hyperthyroidism.

What tests help diagnose thyroid diseases?

A.L.:The basic test is the determination of TSH. When the thyroid gland is enlarged, an ultrasound is performed (an endocrinologist's referral is needed). Many people over 50 have benign changes in the thyroid gland that do not require further diagnosis and treatment. But the word "lump" is scary. The result must be shown to the specialist who will decide what to do next. If the nodule is suspicious, a biopsy is performed and material is collected for histopathological examination. If the cells are normal, only observation is recommended. Anyone over the age of 55-60, to be on the safe side, should have their TSH levels checked from time to time to check that their thyroid is in good condition and that there is nothing wrong with it.

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