Disorders of the Thyroid
Disorders of the thyroid fall under two main categories: functional disorders and growth disorders.
Functional disorders are related to thyroid hormone production. If the thyroid is making too little hormone, this is known as hypothyroidism. If the thyroid makes too much thyroid hormone, this is known as hyperthyroidism. A person whose thyroid is producing adequate or normal hormone is known as euthyroid.
Growth disorders including Thyroid Cancer occur when nodules appear within the thyroid and cause problems in a variety of ways.
The most common cause of hypothyroidism is Hashimoto’s thyroiditis. This is an autoimmune disease in which a person makes antibodies against the thyroid resulting in inflammation of the thyroid. Patients with Hashimoto’s thyroiditis initially often suffer from hyperthyroidism. As the gland begins to burn out, the patient becomes euthyroid and then ultimately results in hypothyroidism, with inability to produce thyroid hormone.
Symptoms of hypothyroidism vary but can include weight gain, cold intolerance, skin and hair changes, menstrual changes, depression among other symptoms. This disorder is often treated medically with thyroid hormone replacement therapy.
There are several causes for hyperthyroidsim. Graves’ disease is an autoimmune disorder which results in the overproduction of thyroid hormone leading to hyperthyroidism. Patients suffering from hyperthyroidism can experience weight loss, heat intolerance, palpitations, tremor, anxiety, skin and hair changes, menstrual changes, eye problems know as Graves’ opthalmopathy, and other problems. Other disorders resulting in hyperthyroidism include toxic multinodular goiter (Plummers Syndrome) and solitary toxic nodule. Both of these disorders are due to nodules (growths) within the thyroid that result in excessive production of thyroid hormone.
For more information on treatment of thyroid disorders at White Plains Hospital, or to schedule a consultation, call 914-681-1010.
Nodules are growths within the thyroid which can cause difficulties for patients in several ways.
The majority of thyroid nodules (90%) are benign, however benign nodules can also cause trouble if they continue to grow and begin to push on surrounding structures such as the food pipe (esophagus) and wind pipe (trachea) resulting in what are known as compressive symptoms. These include discomfort or pain; trouble swallowing liquids, solids or pills (dysphagia); trouble breathing with shortness of breath or wheezing; or symptoms of cough and hoarse voice. Thyroid nodules can also produce excessive thyroid hormone resulting in hyperthyroidism. Lastly, nodules can grow to the point that they become cosmetically displeasing for patients resulting in a goiter (general term for an enlarged thyroid).
While the vast majority of thyroid nodules are benign, there are about 30,000 new cases of thyroid cancer diagnosed each year, making it one of the more commonly diagnosed cancers in the United States. The two main risk factors for thyroid cancer include radiation exposure and family history. The diagnosis is often made by a needle biopsy, and ultrasound-guided fine needle aspiration (FNA) is the most reliable technique. There are four broad categories that result from a fine needle aspiration (FNA):
Benign: does not require any further intervention except follow up ultrasound in 6-12 months.
Suspicious for cancer or papillary thyroid cancer: often requires total thyroidectomy (removal of the thyroid) and possible lymph node dissection for adequate treatment.
Follicular Neoplasm: usually requires partial thyroidectomy to rule out the diagnosis of follicular thyroid cancer which cannot be diagnosed solely on FNA. The treatment for follicular thyroid cancer is a total thyroidectomy and patients may require a second operation to remove all thyroid tissue once the diagnosis is made.
Non-diagnostic: the biopsy did not have enough cells for evaluation or was too bloody to make an adequate diagnosis. A repeat biopsy is often required to make a diagnosis.
The vast majority of thyroid cancers are known as well-differentiated thyroid cancers. These include both papillary thyroid cancer and follicular cancer. Most thyroid cancers respond to surgery. Thyroid cancer usually remains confined to the neck, however can spread to distant sites. About 20% of patients with papillary thyroid cancer can have spread to the lymph nodes with a much smaller number spreading to sites such as bone, lung, or liver. Follicular cancers usually spread via the blood stream (hematogenously) to distant sites. Chemotherapy is usually not required and oncologists (cancer doctors) are frequently not involved in the treatment of these cancers. If any additional treatment is required, it is usually in the form of a pill called radioactive iodine, administered by nuclear medicine experts.
A much less common type of thyroid cancer is known as Medullary thyroid cancer. Lymph node involvement is common and surgery is the main treatment. This type of cancer does not respond to radioactive iodine, is often inherited and requires genetic counseling and early diagnosis. This cancer can be seen in patients diagnosed with familial medullary thyroid cancer or Multiple Endocrine Neoplasia syndrome.
For more information on treatment of endocrine growth disorders at White Plains Hospital, or to schedule a consultation, call 914-681-1010.