By

Graves’ Disease Causes

Graves’ disease is an autoimmune disease that leads to a generalized overactivity of the thyroid gland. It is the most common cause of hyperthyroidism and is named after an Irish Physician, Robert J. Graves MD, circa 1830s. He first described this form of hyperthyroidism. It is 7-8 times more common in women than men. Graves’ disease occurs when your own immune system attacks your thyroid gland. This causes an overproduction of its normal hormone, thyroxine. The hormones from the thyroid gland help in regulating growth and in controlling your body’s metabolism. This is only one form of hyperthyroidism, and its resulting high thyroxine levels may affect your moods and appearance.

Graves’ disease can occur in any age group. There are no current medications that can stop your immune system from continuing to attack your thyroid gland. However, for patients who have hyperthyroidism, there are treatments that will lower the thyroid glands thyroxine production and ease symptoms.

Graves’ Disease Symptoms

There are a number of symptoms common to people affected with Graves’ disease. According to Medical News Today, they include:

  • Irritability and moodiness
  • Anxiety
  • Tiredness
  • Insomnia
  • Accelerated heartbeat – tachycardia
  • Irregular heartbeat – arrhythmia
  • Heat sensitivity
  • Tremor in fingers and hands
  • Hair that feels brittle
  • Weight loss without dieting
  • Changes in menstrual cycle
  • Enlarged thyroid gland – goitre
  • Frequent bowel movements

People with Graves’ disease may have mild signs of Graves’ ophthalmopathy. They include a bulging of the eyes, caused by a swelling of the muscles and tissues behind the eyes. If you smoke and have Graves’ disease, you are more likely to be affected by Graves’ ophthalmopathy. In cases that are severe, your eyelids may not close properly, and they will likely become very dry.

How is Graves’ Disease Diagnosed?

The diagnosis of Graves’ disease. People with the disorder may have a goitre and eye signs, plus any of the multiple symptoms of hyperthyroidism. If, on the other hand, you show only mild symptoms, it may be mistaken for something else. The diagnosis is usually made by thorough clinical assessment, blood tests and medical imaging.

Treatment for Graves’ Disease

There are three main commonly used ways to treat Graves’ disease.

One option is the use of radioactive iodine 131-l. This option is relatively straightforward and usually avoids the need for surgery. There are minimal significant health risks to adults given this treatment. Occasionally patients may require re-treatment. Treating Graves’ disease with iodine 131-l is common in people over the age of 40 and in cases where anti-thyroid drugs don’t properly control the illness, according to ThyroidManager.com.

Anti-thyroid drugs are also used in treating Graves’ disease. By itself, an anti-thyroid drug can treat Graves’ disease without inducing thyroid damage. There may not be a high permanent remission rate, however.

When Is Surgery a Viable Option?

Surgery is an excellent treatment for patients with Graves’ disease. Surgery to remove the thyroid has the advantage of managing the disease quickly. The disadvantages to surgery include the normal risks of thyroid surgery.

If a thyroid surgeon performs the thyroidectomy, this is usually a curative treatment option for people with Graves’ disease. It can also be offered for patients who are not able to be managed with antithyroid drugs. Surgery is also a good option for women who a planning pregnancy – where radioactive iodine therapy is not a recommended treatment option.

The total removal of the thyroid gland is sometimes used for patients where other treatment methods have failed to improve their condition. Surgery is often the chosen treatment in patients who have a large goitre.

If you have questions or concerns about thyroid problems see your local doctor who will arrange for you to see a thyroid surgeon.

For more information about Graves’ disease click here.

References

  • Medical news today: link
  • Thyroid manager: link

The post What is Graves’ Disease and How is it Treated? appeared first on Thyroid Clinic Sydney.

By

Healthy Diet for Your Thyroid

Your thyroid gland governs your metabolism. It does this by producing the thyroid hormones T3 and T4 and releasing them into your bloodstream. If your thyroid is underactive, you are said to have hypothyroidism, whilst having an overactive thyroid is referred to as hyperthyroidism. Before we get into food you should be seeking out to keep your thyroid healthy, let us discuss what can happen if your thyroid is not functioning properly.

Hypothyroidism

When your thyroid is not producing enough T3 and T4, your metabolism will slow down. At first, you will probably only experience a few mild symptoms, but as time progresses, they will most likely get worse and worse. You may notice one or more of these symptoms:

  • Weight gain
  • Anxiety / Depression
  • Fatigue
  • Joint pain
  • Dry skin
  • Heavy menstrual bleeding
  • Cold sensitivity

Hyperthyroidism

An overactive thyroid can be just as dangerous to your health as an underactive one, perhaps even more so. Hyperthyroidism is marked by such symptoms as:

  • Weight loss
  • Heightened anxiety and/or irritability
  • Sensitivity to heat
  • Sweating
  • Infrequent, light menstrual periods

The first item on this list might seem like a benefit, rather than a symptom, but don’t let it fool you. Untreated hyperthyroidism can have serious consequences.

Whether you are concerned that your thyroid gland might be overactive or underactive, you can help yourself out by getting the right nutrients and avoiding certain foods. Let us take a closer look at what you should (and should not) be eating to maintain a healthy thyroid and balanced metabolism.

Foods required to ensure adequate thyroid hormone production

Make sure that you are getting enough iodine in your diet. Iodine is essential for producing thyroid hormones, T3 and T4. An iodine deficient diet can lead to hypothyroidism, or at the very least exacerbate it.

If you want to give your thyroid a kick, eat foods like shellfish, seaweed, and coconut oil, and avoid simple sugars. Overall a healthy diet should include complex carbohydrates and get plenty of fibre. Also, make sure that you are drinking plenty of water every day. Good hydration is key to proper metabolic function.

Foods which can inhibit thyroid hormone production

You may be surprised to find that you can slow down thyroid hormone production by eating certain vegetables. It may sound odd to hear that they could actually slow your metabolism, because vegetables are so healthy. By eating cruciferous vegetables, that’s exactly the case. Raw cabbage, turnips, broccoli, Brussels sprouts, and other cruciferous vegetables have high goitrogen content. Goitrogen interferes with the body’s ability to uptake iodine, and it tends to slow the production of thyroid hormones. Foods containing fermented soy, and millet also slow thyroid hormone production. If your thyroid is underactive, you want to avoid these foods.

Whether your thyroid is producing too much or too little in the way of T3 and T4 hormones, this information should help you understand a bit more on how to adjust your diet to improve your thyroid function and metabolism. You will still need to go to see your local doctor or endocrinologist for specific treatment for hypothyroidism or hyperthyroidism. For patients who have a thyroid condition, eating the right diet can be hugely beneficial, as part of a comprehensive treatment plan.

If you have questions about a good diet for thyroid health, make an appointment to see one of our dietitians and nutritionists. We’ll provide you with personalised and effective advice targeted to your concerns. Contact us today.

Reference

The post How to Eat a Healthy Diet for Your Thyroid appeared first on Thyroid Clinic Sydney.

By

What Is Hypothyroidism

Hypothyroidism is caused by low hormone production in the thyroid gland. Some disorders can lead to hypothyroidism. They may involve your thyroid gland, either directly or indirectly. Hypothyroidism causes a slowing down of the body’s metabolic rate and you’ll need help from a physician to get back on track.

Thyroid hormones affect cellular processes, along with growth and development, so a thyroid gland that is under-producing can have serious ramifications for your whole body.

What are Thyroid Hormones

Thyroid hormones are, of course, those produced by your thyroid gland. The gland is found in the lower part of your neck. This gland uses iodine, usually from the foods you eat, to produce proper levels of thyroid hormones.

Hypothyroidism Symptoms

You may find that hypothyroidism symptoms are subtle. They can look like the symptoms of many other health conditions. They may even be attributed to aging.

If your hypothyroidism is mild, you may have no symptoms. They will become more easily seen as your condition worsens. Most of these signs are related to the slowing down of your metabolism.

Common symptoms of hypothyroidism include:

  • Depression
  • Fatigue
  • Intolerance of cold
  • Modest weight gain
  • Coarse, dry hair
  • Dry skin
  • Constipation
  • Excessive sleepiness
  • High cholesterol levels
  • Muscle cramps
  • Aches and pains
  • Leg swelling
  • Decreased levels of concentration

As this disease increases in its severity, you may also experience lowered body temperature, a slowing heart rate, puffiness around your eyes and heart failure. The most severe form of hypothyroidism can lead to coma and even death, according to MedicineNet.

If your thyroid is severely under-producing, a coma may be triggered by traumatic injury, stress, surgery or a severe illness. In this situation hospitalisation will be needed for acute management.

Treatment of Hypothyroidism

Hypothyroidism, if properly diagnosed, can be fully treated with replacement thyroid hormones. Left untreated, it can lead to fluid accumulation around the lungs, an enlarged heart and worsening heart failure.

Man-made synthetic hormones are most often used for the management of hypothyroidism, states WebMD. Once your treatments have begun, you will need to schedule regular appointments with your physician to make sure the dosage is correct.

Symptoms of hypothyroidism usually begin to improve within days of the onset of treatment. All of your symptoms should be gone within several months. Children and infants who have hypothyroidism must always receive treatment. People in poor general health and older adults sometimes take a longer time period to respond to the medications.

Treatment Duration

If you have had your thyroid gland removed or have been treated with radiation and develop hypothyroidism, you will usually need treatment for the remainder of your life. The same is true if your condition was caused by Hashimoto’s thyroiditis. 

If your hypothyroidism was triggered by a serious infection or illness, your thyroid levels will probably return to normal after you have recovered.

Some medications can cause hypothyroidism. If this is the case, your thyroid hormone production should return to normal when you stop taking those medications.

Mild Hypothyroidism

Mild cases of hypothyroidism may not initially need treatment. However, you should watch closely for any signs that your hypothyroidism may be getting worse. You and your physician will discuss the positives and negatives of using medications to treat mild hypothyroidism.

Medication doses for hypothyroidism must be carefully watched if you have heart disease as well, since too much thyroid hormone replacement medication will increase the risk for irregular heartbeats and chest pain.

Ongoing Treatments

You will probably need some sort of treatment for your hypothyroidism for the remainder of your life. Be sure to take your medicine as directed. Hypothyroidism may worsen with age and your dosage may need to be increased.

If you have questions or concerns about thyroid problems see your local doctor who will arrange for you to see thyroid specialist.

References

The post Successfully Treating Hypothyroidism appeared first on Thyroid Clinic Sydney.

By

By Ashleigh Elkins

There are many different tests that can be used to help confirm the diagnosis of a thyroid problem. Based on taking a history and performing a physical examination, if your doctor suspects you have a problem with your thyroid gland, he or she will most likely order one or more tests to help confirm or rule out the diagnosis of a thyroid disorder.

Common tests include blood tests to check the thyroid function, fine needle aspiration biopsy to evaluate lumps and nodules, and scans to obtain imaging of the thyroid gland.

Thyroid Function Tests

Thyroid function tests are a very common investigation performed when a thyroid problem is suspected. Thyroid function tests require a blood test. They are also used to monitor the effectiveness of treatment. Thyroid function tests assess the levels of thyroid stimulating hormone (TSH) and the two thyroid hormones – thyroxine (T4) and v (T3). These tests can be used to determine if the thyroid has a normal level of activity (euthyroid), if the thyroid is underactive (hypothyroid) or if the thyroid is over-active (hyperthyroid). The table below shows the results for the different states of thyroid activity:

Thyroid State TSH Free T4 Free T3
Euthyroid Normal Normal Normal
Hyperthyroid Decreased Increased Increased
Hypothyroid Increased Decreased Decreased

Due to Medicare restrictions in Australia, TSH needs to be tested alone first. If the TSH is found to be abnormal, then levels of thyroid hormone can be tested. This restriction does not apply to people who have already been diagnosed with a thyroid problem.

Thyroid Autoantibodies

Thyroid autoantibodies are another type of blood test that can be ordered in the investigation of thyroid problems. This test is used to rule in or rule out an autoimmune disease as the cause of thyroid problems. There are three main autoantibodies that can be tested for:

  1. Thyroid peroxidase antibodies (TPO); these are antibodies towards thyroid peroxidase, an enzyme that is needed in the process of producing T3 and T4. TPO antibodies are positive in most patients with Hashimoto’s thyroiditis and in most patients with Graves’ disease. TPO antibodies may also be elevated in patients with other autoimmune diseases, such as rheumatoid arthritis.
  2. Thyroglobulin antibodies; these antibodies are markers of autoimmune thyroid diseases. They are positive in almost all patients with Hashimoto’s thyroiditis and are positive in most people with Graves’ disease
  3. TSH receptor autoantibodies; these are antibodies that bind to the TSH receptor and cause it to activate. TSH receptor autoantibodies are positive in the majority of people with Graves’ disease.

Other Thyroid Blood Tests

There are a few other blood tests that may be ordered to investigate suspected thyroid disease. Calcitonin is a hormone made by the C cells of the thyroid and is released when levels of blood calcium are high. Calcitonin levels may be ordered in the investigation of people with thyroid nodules or suspected medullary thyroid cancer. Blood levels of calcitonin may be elevated in medullary thyroid cancer, and may be used in monitoring following treatment for medullary thyroid cancer. In addition, another blood test called carcinoembryonic antigen, or CEA, is also used in addition to calcitonin for monitoring and follow up after treatment of medullary thyroid cancer. CEA is also used for monitoring following treatment of other types of tumours, such as colorectal cancers.

Fine Needle Aspiration Biopsy

Fine needle aspiration biopsy is most commonly used in the investigation of thyroid nodules. The procedure involves inserting a needle into the nodule in order to remove a sample of cells which can then be analysed under a microscope to assist in diagnosis. There are usually several samples taken from different parts of the nodule to ensure that the samples that are taken are representative of the cells and tissues within the nodule. This test helps to determine whether or not the nodule requires surgical removal or further monitoring.

Fine needle aspiration can also be used to help evaluate thyroid cysts. This involves inserting a needle into the cyst and draining the fluid within the cyst. The fluid that is collected can be evaluated in the lab to see if there are any suspicious changes.

Fine needle aspiration biopsy is used to guide the treatment and management of patients with thyroid nodules. Thyroid fine needle aspiration cytology results are classified according to the Bethesda classification system which is a six-category system used to guide management of thyroid nodules.

The six categories of this system are:

  1. Unsatisfactory sample/Non-diagnostic
  2. Benign
  3. Atypia of undetermined significance
  4. Follicular neoplasm/suspicious for follicular neoplasm
  5. Suspicious for malignancy
  6. Malignant

Fine needle aspiration cytology cannot help to differentiate between benign and malignant follicular neoplasms. Ultrasound guidance can be used to visualise the nodule when performing the fine needle biopsy to make sure that the samples are being taken from within the nodule and not the surrounding thyroid tissue.

Nodules that are removed surgically undergo histopathological analysis to provide a definitive diagnosis.

Thyroid Imaging

Thyroid Ultrasound

Ultrasound is a safe, accurate, non-invasive, inexpensive and readily available imaging modality that can be used to assess the thyroid gland. Ultrasound is usually the first type of imaging ordered for the investigation of thyroid problems. Ultrasound uses sound waves transmitted through a hand-held transducer probe. A gel is placed over the neck which helps to transmit the ultrasound waves from the probe. There is no radiation used in an ultrasound. Thyroid ultrasounds are particularly useful for imaging thyroid cysts, nodules, goitre (enlargement of the thyroid gland) and suspected tumours. Ultrasounds can also be used to assess the blood flow in the thyroid. Ultrasound can also be used to guide fine needle aspiration biopsy of nodules or growths in the thyroid.

There are several ultrasound features which suggest that a thyroid nodule is likely to be benign. These include:

  • Sharp, well-defined borders around the entire nodule
  • Fluid within the nodule is indicative of the nodule being a cyst
  • Numerous nodules throughout the thyroid; this generally indicates a benign multinodular goitre
  • Minimal or no blood flow through the nodule indicates that the nodule is likely to be a cyst

Thyroid Scan/Thyroid Isotope Scans

An isotope scan of the thyroid is used to determine thyroid function because the scan measures how much of a substance similar to iodine is taken up by the gland. The thyroid uses iodine to produce thyroid hormones, so the thyroid normally absorbs iodine. For the scan, technetium (Tc- 99m) pertechnetate is injected. This is a substance that behaves similarly to iodine. Radioactive iodine has been used in the past, but technetium pertechnetate is now preferred because there is less radiation exposure and it is more cost-effective than radioactive iodine. After about 20 minutes, a scan is performed to identify the pattern of uptake in the thyroid.

This type of thyroid scan is particularly useful in helping to determine if the thyroid is over-active, such as in conditions like Graves’ disease, subacute thyroiditis and toxic multinodular goitre. All three conditions have different patterns of uptake:

Graves’ disease

  • Diffuse increased uptake

Subacute Thyroiditis

  • Low iodine uptake

Toxic Multinodular Goitre

  • Patchy uptake; areas of increased uptake and areas of decreased uptake

Thyroid isotope scans are helpful in the investigation of thyroid nodules. Thyroid nodules are generally classified as cold, warm or hot. A cold nodule does not take up any pertechnetate and is non-functioning, a warm nodule is functioning normally, and a hot nodule takes up more pertechnetate than the surrounding thyroid tissue and is said to be hyper-functioning. Isotope scans are particularly helpful for investigating patients with low levels of TSH. If a patient has low TSH and the isotope scan identifies a hot nodule, it is likely that the nodule is benign. Overall, the majority of thyroid nodules scanned are cold nodules, approximately 80%. However, only about 20% of cold nodules are found to be malignant after further investigation.

Thyroid CT Scan

Computed tomography, or CT scans can also be used to investigate suspected thyroid pathologies. It is not as good as ultrasound for identifying pathology within the thyroid gland itself, but CT is useful for investigating lymph nodes in the neck, chest and thyroid region. It is also used in the investigation of goitre to determine if the goitre has extended behind the sternum and into the mediastinum (retrosternal extension). CT may also be used if thyroid cancer is suspected to see if the tumour has spread to other surrounding organs. CT scans use x-rays to create cross-sectional images of the thyroid and surrounding structures. In some cases, a contrast medium may be injected to help define anatomical structures more clearly. A limitation of CT scans is that there is radiation exposure associated with the scan, unlike MRI and ultrasound.

Thyroid MRI Scan

Another type of investigation which may be ordered to investigate problems with the thyroid is a magnetic resonance imaging (or MRI) scan. Just like a CT scan, MRI is also not as good as ultrasound for detecting pathology within the thyroid gland itself. MRI scans might be ordered to assess surrounding lymph nodes and other neck and chest structures. It is useful to help determine if a suspected thyroid cancer has spread to surrounding organs. MRI can also be used to evaluate retrosternal goitre extension. MRI is also helpful to determine the size and shape of the thyroid. MRI may be recommended instead of a CT scan because there is no radiation exposure associated with an MRI, and an MRI scan of the thyroid does not usually require the administration of a contrast medium. CT and MRI are similar in terms of evaluating lymph nodes and spread to the surrounding tissues.

The post Diagnostic Tests for the Thyroid Gland appeared first on Thyroid Clinic Sydney.

By

Historically, fluoride was used as a treatment for hyperthyroidism; however, it is not a treatment that is currently used. Fluoride is thought to be an antagonist of iodine, impacting upon the ability of body tissues, such as the thyroid gland, to utilise iodine. However, this is only important if iodine levels are low. Fluoride is commonly added to drinking water supplies as a public health intervention in industrialised countries. This is because fluoride is an important component of the defence against tooth decay, and carries significant benefits for oral health. But is there an association between fluoridated water supplies and increased rates of hypothyroidism?

Recently, an English observational study was published. This study compared the levels of fluoride in the water in different regions of London with the prevalence of diagnosed cases of hypothyroidism at GP practices in the same region.

The authors of the study claimed that there was an increase in the prevalence of hypothyroidism in areas with higher levels of fluoride in the water¹.

However, this study has been criticised in the media by experts for flaws in the study’s methodology². Firstly, the study employs a very simplistic design to investigate whether or not there is an association. The authors do not take into account the numerous other potential confounding factors, which may influence the results of the study. This type of study design makes it virtually impossible to prove a cause-and-effect relationship between fluoridated water supplies and hypothyroidism because there are so many other factors that can influence the rates of hypothyroidism, for example iodine intake, beyond just the levels of fluoride in the water.

Furthermore, the levels of fluoride in the water are at a very low level in the water supply. These levels are significantly below the amount of fluoride needed to have an inhibitory effect on the thyroid gland. Experts quoted in the article in The Conversation² are critical of how the authors of the paper exaggerate the potential effect of fluoride on the thyroid gland, and do not give sufficient recognition to the potential influence of iodine deficiency on the results.

Due to the flaws in the methodology of this study, the results of this study should be interpreted with a degree of scepticism. Further studies with a better design are required to determine if there is a cause and effect relationship between fluoride in the water and hypothyroidism.

References

  1. Peckham S, Lowery D, Spencer S. Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water. J Epidemiol Community Health, 2015. Published online 24 February 2015. http://jech.bmj.com
  2. Rattan R. Flawed study overstates link between fluoride and ill health: experts. The Conversation. http://theconversation.com

The post Is there an association between fluoridated water and increased rates of hypothyroidism appeared first on Thyroid Clinic Sydney.

Call (02) 8188 2570
or our local call number 1300 123 368

Stay Connected

Contact Us

    Your Name (required)

    Your Email (required)

    Your Message

    [recaptcha]

     

    Translate

    ENT Clinic Sydney - Suite 70B, Royal Randwick Shopping Centre, 73 Belmore Road, Randwick, Sydney, Australia

    FRACS
    ASOHNS
    DAA
    MUH
    university-of-newcastle
    university-of-sydney
    university-of-queensland
    university-of-oxford
    australasian-college-of-dermatologists
    nutrition-blog-network
    speech-pathology-australia