Thyroid Problems: Hormones, Autoimmune Traits, Cancer

Thyroid problems occur when your thyroid gland (a small organ in the front of your neck) does not produce normal levels of thyroid hormones. Because these hormones control many vital functions in your body, problems can result when levels are disrupted. These hormones affect your brain and organ function, bone growth, heart rate, and muscle function.

Thyroid problems can be linked to too much thyroid hormone. This can cause symptoms like higher metabolism, weight loss, fatigue, racing heartbeat, hair loss, and nervousness.

Thyroid problems can also involve disorders that cause too little thyroid hormone. This can trigger symptoms like weight gain, slow heart rate, slow movement, and depression.

This article describes the many thyroid problems, their causes, symptoms, and treatments.

Most Common Thyroid Problems

The most common thyroid problems include the following:

Graves’ Disease

Graves’ disease is an autoimmune disease in which your immune system attacks your thyroid. This causes hyperthyroidism (producing more thyroid hormones than your body needs). Graves’ disease is the most common cause of hyperthyroidism.

Having the following risk factors can increase your chances of developing Graves’ disease:

Thyroiditis

Thyroiditis (inflammation of the thyroid gland) can occur as a result of the following factors:

• Viral infections
• Some medicines
• Post-pregnancy reactions (postpartum thyroiditis)
• Reaction to treatment with radioiodine therapy for Grave’s disease

Depending on the cause of thyroiditis, either hyperthyroidism or hypothyroidism (too little thyroid hormone) will result.

Hashimoto’s Disease

Hashimoto’s disease (or Hashimoto’s thyroiditis) is an autoimmune disease in which your immune system attacks your thyroid. It causes your thyroid to become inflamed.

Hashimoto’s disease is the most common cause of hypothyroidism. The inflammation makes your thyroid incapable of generating enough thyroid hormones to support your bodily functions.

People with Hashimoto’s disease tend to have the following risk factors:

Congenital Hypothyroidism

A baby can be born without a thyroid or with only a partly formed thyroid. Some babies are born with ectopic thyroid (a thyroid in the wrong place). Hypothyroidism can also occur in babies born with thyroid cells or enzymes that are defective and hinder the production of thyroid hormones.

Risk factors for congenital hypothyroidism include the following:

• Advanced maternal age
• Gestational thyroid disease
• Gestational diabetes mellitus
• Gestational anxiety
• Gestational drugs
• Radiation exposure during gestation
• Family history of thyroid disease
• Low birth weight
• Macrosomia (high birth weight)
• Premature birth
• Post-term birth
• Birth to twins or other multiples

Thyroid Cancer

Thyroid cancer is a cancer that starts in the cells of your thyroid gland. It is often curable if it is treated before it spreads to other areas.

Thyroid cancer risk factors include:

• Being a woman
• Being of Asian descent
• Being between 25 and 65 years old
• Having a family history of thyroid cancer
• Having prior exposure to radiation of the neck and head
• Having certain genetic conditions, including the following: multiple endocrine neoplasia, type 2A syndrome, multiple endocrine neoplasia, type 2B syndrome, and familial medullary thyroid cancer
• Being obese or overweight
• Consuming too much or too little iodine in your diet

Least Common Thyroid Problems

Some of the least common thyroid problems include the following:

Overactive Thyroid Nodules

While thyroid nodules, or lumps in your thyroid are very common and usually benign (noncancerous), a minority of these lumps can cause problems. Issues occur when one of these lumps becomes overactive and produces too much thyroid hormone, causing hyperthyroidism.

The cause of thyroid nodules is unknown. The most significant risk factors for overactive thyroid nodules include the following:

• Increasing age
• Living in areas of iodine deficiency
• Smoking

Noncancerous Tumor of the Pituitary Gland

Rarely, a benign tumor of your pituitary gland (a gland located at the base of your brain) can cause hyperthyroidism.

The following risk factors are linked to the development of noncancerous tumors of the pituitary gland:

• Family history of tumor of the pituitary gland
• Certain genetic syndromes: multiple endocrine neoplasia, type 1 (MEN1), multiple endocrine neoplasia, type 4 (MEN4), McCune-Albright syndrome, Carney complex, and familial isolated pituitary adenoma (FIPA)

Consuming Excess Iodine

Most healthy people can tolerate high iodine intake. However, it is possible to develop thyroiditis as a result of eating too many foods that contain iodine. This type of reaction is very rare.

A reaction to excess iodine is typically limited to people who already have a problem with their thyroid.

Symptoms Associated With Thyroid Problems

Graves’ Disease Symptoms

Symptoms of Graves’ disease include the following:

• Weight loss despite an increased appetite
• Irregular or rapid heartbeat
• Irritability or nervousness
• Fatigue or trouble sleeping
• Muscle weakness or shaky hands
• Abnormal sweating or trouble tolerating heat
• Diarrhea or frequent bowel movements
• Goiter (an enlarged thyroid gland)

Thyroiditis Symptoms

Thyroiditis symptoms can vary because the condition includes several types of disorders from too much or too little thyroid hormone. When thyroiditis leads to hyperthyroidism, possible symptoms include the following:

• Weight loss
• Nervousness, anxiety, or irritability
• Trouble sleeping
• Fatigue
• Rapid heart rate
• Muscle weakness
• Tremors
• Loose stools or diarrhea

When thyroiditis leads to hypothyroidism, possible symptoms include the following:

• Weight gain
• Fatigue
• Dry skin
• Muscle aches
• Constipation
• Depression

Hashimoto’s Disease Symptoms

Symptoms of Hashimoto’s disease may not occur until the disease progresses. They can include the following:

• Fatigue
• Weight gain
• Difficulty tolerating cold
• Constipation
• Joint and muscle pain
• Dry skin
• Dry, thinning hair
• Irregular or heavy menstrual problems
• Fertility problems
• Slowed heart rate

Congenital Hypothyroidism Symptoms

Symptoms of congenital hypothyroidism include the following in babies:

• Neonatal jaundice (yellow eyes or skin)
• Constipation
• Sleeping more often or longer than usual
• A large fontanelle (soft spot) on the baby’s head
• Large belly with protruding navel
• Weak or floppy muscle tone
• Cool, pale skin
• Swelling around the eyes

Thyroid Cancer Symptoms

Common signs of thyroid cancer include the following:

• A fast-growing lump in your neck
• Swelling in your neck
• Pain that originates in the front of your neck and goes up to your ears
• Trouble breathing and/or swallowing
• Voice changes, including hoarseness, that do not improve
• A persistent cough unrelated to a cold

Thyroid Nodule Symptoms

Symptoms of thyroid nodules are uncommon. They may occur when a nodule grows large and causes the following problems:

• Pain
• Hoarseness
• Interference with normal swallowing or breathing

Noncancerous Pituitary Tumor Symptoms

Symptoms of pituitary tumors that produce too much thyroid hormone may cause the following symptoms:

• Irregular heartbeat
• Weight loss
• Shakiness
• Trouble sleeping
• Frequent bowel movements
• Sweating

Excess Iodine Symptoms

Symptoms of consuming too much iodine include the following:

• Goiter
• Increased metabolism
• Weight loss
• Fast or irregular heartbeat
• Hand tremors
• Irritability
• Fatigue
• Sweatiness

How Do You Know If You Have Thyroid Problems?

You can only know you have thyroid problems by consulting with your healthcare provider about symptoms. It is not possible to diagnose thyroid problems yourself because many symptoms caused by thyroid problems also occur in other medical conditions.

Your healthcare provider can determine whether you have thyroid problems by using the following diagnostic tools:

A thorough clinical evaluation with a medical history of risk factors and a physical exam that includes feeling the area around your thyroid for lumps, bumps, or enlarged lymph nodes in your neck.

One or more of the following blood tests that measure thyroid hormone levels in their different forms may be performed:

Imaging tests to identify thyroid deterioration, enlargement, or nodules include:

• Thyroid ultrasound uses sound waves to create images of your thyroid and identify whether a nodule is a cyst filled with fluid or a mass of solid tissue.
• Thyroid scan uses a small amount of radioactive iodine or a similar substance while a special camera makes images of your thyroid on a computer screen showing the pattern of iodine uptake in your thyroid.
• Radioactive iodine uptake test (RAIU) uses a radioactive iodine tracer and camera to examine your thyroid health and functioning by observing how much radioactive iodine your thyroid absorbs over a certain time (may be done with a thyroid scan).

Thyroid fine needle aspiration biopsy uses a very thin needle to remove cells and fluid from your thyroid, which are observed under a microscope to identify thyroid cancer.

Short-Term Treatment for Thyroid Problems

Short-term treatments generally involve thyroid medication. They may be used to treat temporary cases of hyperthyroidism or to achieve immediate results. During treatment, your healthcare provider monitors your progress to determine whether to continue with medication long-term, discontinue it, or pursue more permanent treatments.

The type of short-term treatment your healthcare provider advises depends on the type of thyroid problem present, its severity, and other factors like your age and medical conditions.

Hyperthyroidism

The goal of hyperthyroidism treatment, which is usually linked to Graves’ disease or thyroid nodules, is to prevent your thyroid from producing too much thyroid hormone. Short-term treatments for hyperthyroidism involve the following:

• Antithyroid drugs: Antithyroid drugs increase the ability of your thyroid cells to make new thyroid hormones. There are two antithyroid drugs used in the United States: Propycil (propylthiouracil) and Tapazole (methimazole), which is preferred because it works faster and has fewer side effects than Propycil.
• Beta-blockers: Beta-blockers help control symptoms of hyperthyroidism like rapid heart rate, nervousness, and shakiness. The following beta-blockers, among others, may be used: Inderal (propranolol), Corgard (nadolol), and Lopressor (metoprolol).

Hypothyroidism

The goal of hypothyroidism treatment, which can be linked to Hashimoto’s disease or iodine deficiency, is to produce the hormones thyroxine (T4) and triiodothyronine (T3). Short-term treatments for hypothyroidism include the following:

• Synthroid, Levoxyl, Unithroid, Tirosint (levothyroxine): regarded as first-line treatment for hypothyroidism
• Cytomel, Triostat (liothyronine)

In subclinical hypothyroidism or mild thyroid failure, a course of watchful waiting (a postponement of treatment while your condition is monitored) may be advised to see if thyroid hormone levels normalize without treatment.

Thyroid Cancer

Thyroid cancer treatment depends on the stage of your cancer and other characteristics concerning your health and medical condition. Short-term treatment for thyroid cancer includes the following:

• Watchful waiting: Watchful waiting postpones treatment while your condition is monitored for changes by a healthcare provider.
• Thyroid hormone therapy: Thyroid hormone therapy may be used to remove or block thyroid hormones to stop the growth of cancer cells.
• Targeted therapy: Targeted therapy uses drugs that identify and attack cells that promote the growth of thyroid cancer tumors. These medications include: Caprelsa (vandetanib), Cometriq (cabozantinib-S-malate), Gavreto (pralsetinib), Lenvima (lenvatinib mesylate), Mekinist (trametinib dimethyl sulfoxide), Nexavar (sorafenib tosylate), Retevmo (selpercatinib), and Tafinlar (dabrafenib mesylate).
• Chemotherapy: Chemotherapy drugs can be administered orally or by injection. They are used to slow or kill cancer cells in your thyroid and other areas.

How to Manage Chronic Thyroid Problems

Managing chronic thyroid problems varies based on the cause of your problems, the severity of your condition, and factors like your age and other medical conditions. For most people, it is possible to lead a normal, healthy life with proper treatment of chronic thyroid problems.

Chronic thyroid problems can be treated with long-term use of thyroid medication to restore normal function. The following treatments may also be used to treat these problems:

• Radioactive iodine treatment (RAI): RAI, also known as radioiodine ablation, involves taking a dose of iodine 131 (radioactive iodine) to ablate, or destroy, all or part of your thyroid’s ability to make thyroid hormone when the iodine is absorbed by your thyroid.
• Thyroidectomy: A thyroidectomy is the surgical removal of all or part of your thyroid gland. It is the main treatment for most thyroid tumors and may be appropriate for pregnant or nursing people or those who have young children and want to avoid radiation exposure from RAI for their family members.

Lifestyle changes to avoid inflammation and stress include:

• Get quality sleep nightly.
• Engage in light to moderate exercise daily.
• Reduce refined sugars and processed foods.
• Limit your intake of cruciferous vegetables like cabbage and broccoli, which can interfere with thyroid hormone production.
• Reduce stress.
• Maintain a healthy body weight.

Summary

Thyroid problems affect more than your thyroid. Because thyroid hormones control so many functions in your body, any problem that affects your thyroid gland can have an impact on your general health.

Know your risk factors and whether you are more likely to have these problems based on family history or other factors. Symptoms of thyroid problems can often be confused with symptoms of other health problems. This can lead to a delay in treatment.

Getting annual exams can help your healthcare practitioner assess your thyroid for signs of problems that you may miss. With the right treatment, most thyroid problems can be treated so you can live a normal life.