Everything About Thyroid Diseases, Thyroid Cancer, and Goiter!

It is a butterfly-shaped organ located in the thyroid gland neck. It regulates many functions in the body thanks to the hormones it secretes. In case of deficiency or excess, it may cause very serious discomfort and complaints. Thyroid gland problems, which are more common in women than in men, may also form the basis for many disorders. Thyroid gland functions are also very important for general body health. Because imbalance in thyroid hormone level negatively affects the functioning of other organs and systems. Irregularities in thyroid hormone, which occur with complaints such as weakness, weight loss, and inability to lose weight, also reduce the quality of life of the person. Experts from the Endocrinology Department of the Memorial Health Group gave information about thyroid diseases and their treatment.

What is a Thyroid Gland?

The name thyroid originated in Latin and was taken as a shield used in wars. In this context, although it is also called "shield gland" in some dictionaries, it can be said that its shape rather evokes a butterfly.

When the thyroid gland is viewed from the front of the neck, it is located in the area just below a cartilage protrusion called the Adam's apple, which is located under the lower jaw and is more prominently seen in men.

It is an organ located on both sides and partially in front of the trachea. The parts of the trachea placed on both sides are called the right and left part (right lobe, left lobe or right thyroid, left thyroid). The thyroid is an internal gland. Its function is to produce a hormone called T3 and T4 and release them into the blood. The main task of these hormones, which should be at an adequate level in the blood, is to control all processes related to the metabolism of the body and to ensure that it works correctly.

Thyroid Diseases

Thyroid diseases can be classified differently. This is due to the fact that different diseases can be together from time to time.

Benign Thyroid Diseases

The first group of benign diseases involves the growth of the thyroid and is generally known as "goiter". This growth may be in the form of lumping (budding) in one or more areas of the thyroid, inside or outside the thyroid. The nodule is called nodular goiter in the enlarged thyroid.

Goiter containing a single nodule is called a single nodule goiter and those containing more than one nodule are called multinodular goiter. A goiter growing into the chest cavity may also be encountered (substernal goiter).

The second group of benign diseases are functional disruptors of the thyroid. In other words, if the thyroid produces excess hormone, there is an overworked thyroid. These are also called toxic goiter or hyperthyroidism. However, if the thyroid produces less hormone for any reason, a condition called underactive thyroid or hypothyroidism occurs. While functional impairment does not occur in the majority of patients with goiter, goiter and functional impairment can be seen together in some patients.

The third group of benign diseases may be inflammatory diseases of the thyroid and some of them may be goiter. Hashimato (link-hashimato) disease is a thyroid disease that occurs when the thyroid gland is autoimmune; that is, when the person recognizes his own protection mechanism, thyroid tissue as a foreigner. In addition, functional disorders of the thyroid are more common in this group.

Benign Thyroid Diseases

Malignant diseases are examined under the heading of thyroid cancer. When it comes to the cancers of the thyroid, it is generally understood that the cancers originate from the cells in the basic structure of the thyroid. There are four types of thyroid cancer, and these two types often come to mind when it comes to thyroid cancer, as the two most common types are seen. These are "papillary" and "follicular" thyroid cancers.

What is Goiter?

The growth of the thyroid gland is called goiter. Goiter can be found in different forms. In the nodule-free goiter, both thyroid glands are symmetrically enlarged and the thyroid face is flat and soft. In the nodular goiter, although the thyroid gland grows, there is one or more nodules in it. Its face consists of knots and bumps.

What are the causes of goiter without nodes?

Nodule-free goiter occurs when the thyroid gland does not produce enough thyroid hormone for the body. When the thyroid hormones made in the body fall, the thyroid gland cells are stimulated by the brain to make more hormones. The stimulated thyroid cells multiply and grow to produce more hormones.

How does nodular goiter form?

The stimuli from the brain are sometimes perceived more by some cells in the thyroid, and as a result, they multiply more than other cells. These proliferating cells form the nodules in the thyroid called nodules.

 

What is the importance of thyroid nodules?

Thyroid nodules are very common, but 4-20% of them are at risk of thyroid cancer. Especially the gradual growth of a small single nodule, its hardness and adherence to its surroundings increase the suspicion of cancer. In a multi-nodule goiter, the risk of cancer is lower.

How are thyroid nodules evaluated?

Endocrinology, Radiology, Nuclear Medicine and Pathology units work with the surgical team in the evaluation of thyroid nodules. While the thyroid nodules are examined by ultrasonography to determine whether they pose a cancer risk, the scintigraphic examination performed by the Nuclear Medicine Unit and the hormone values examined in the blood are distinguished from their function. In small nodules with no risk, drug treatment and follow-up options are applied instead of unnecessary surgery. Thin needle biopsy has been standardized in cancer research in thyroid nodules. This procedure is performed by an experienced general surgeon and interventional radiologist together with the pathologist. In necessary cases, these units come together at the time of surgery and give an example of teamwork.

What is Overwork of the Thyroid Gland (Hyperthyroidism)?

It is called hyperthyroidism that the thyroid gland produces more thyroid hormone than the body needs, on its own, unrelated to the level of thyroid hormone in the blood. Hyperthyroidism is also a common condition. In this case, the functions of the organs are accelerated. As a result, eye findings such as tremors, palpitations, intolerance to heat, irritability, excessive excitement, emotionality, weight loss, excessive sweating, hair loss, diarrhoea, eyes moving forward, decreased strength, menstrual irregularities in women are seen. Hyperthyroidism, which is relatively common during the menopause period, increases the risk of osteoporosis, which is already increased during this period.

How is hyperthyroidism treated?

In the treatment of hyperthyroidism, it is necessary to balance the excess hormone produced in the body in the first place. For this, drugs that eliminate the effect of thyroid hormones on tissues can be used. But the ideal treatment method is with drugs that reduce hormone production. After balancing excessive hormone production in non-nodular hyperthyroidism, definitive treatment is performed with Surgical treatment or with radioactive iodine, known as atomic treatment, in the Nuclear Medicine Unit. In cases with nodules, definitive treatment is performed surgically.

What is the Underwork of the Thyroid Gland (Hypothyroidism)?

The underworking of the thyroid is called "hypothyroidism". Symptoms of hypothyroidism are weakness, fatigue, difficulty concentrating, constipation, rapid chill and intolerance to cold. Skin dryness, skin roughness, colour changes that turn orange, which are sometimes thought to be caused by dermatological diseases, may also develop due to the underworking of the thyroid gland. In this case, it is useful to consult an endocrinologist.

The most common cause of hypothyroidism is the unknown Hashimato disease. In this disease, there is first goiter, then the thyroid gland shrinks and becomes unable to secrete hormones.

Another factor that causes hypothyroidism is thyroid gland surgery. The thyroid gland, most of which is removed by surgery, cannot secrete enough hormones. Since the thyroid gland is damaged in patients undergoing radioactive iodine therapy, hormone secretion is reduced and hypothyroidism develops. Some drugs may also cause hypothyroidism. Note (Atom) Therapy

Iodine therapy, also known as atomic treatment, is applied after thyroid gland overwork and thyroid cancer surgeries. Radioactive iodine taken orally is retained by thyroid cells after being absorbed in the gastrointestinal tract. The iodine intake diminishes the growth ability of thyroid cells by destroying them. Iodine therapy is generally the most appropriate treatment in goiter and Basedow-Graves disease caused by overwork of the thyroid gland. Since the dose of radioactive iodine used is low, there is no problem for the patient to go home.

Patients who will receive low-dose radioactive iodine therapy should come to the hospital without taking thyroid medications and on an empty stomach. Patients should not consume fish, shellfish, iodinated salt-containing foods or cola drinks in order to prevent the effectiveness of the treatment before radioactive iodine application. In addition, drugs containing iodine are also discontinued before treatment. After the effects of the treatment are over, the patient does not need to go to any restrictions in terms of nutrition.

Although no side effects are usually seen in patients receiving treatment, rarely, nausea or temporary inflammation of the salivary glands may occur. The side effects of drinking plenty of water, consuming nutrients such as lemons and chewing gum can return to normal in a short time.

It is not appropriate for pregnant women and dialysis patients who have difficulty in removing iodine from the body to receive radioactive iodine treatment.

Thyroid Surgery

Thyroid-oriented surgeries are performed in the form of the removal of the thyroid, known in medicine as "thyroidectomy".

This procedure can be performed unilaterally (right or left thyroid) or bilaterally depending on the type of disease and the condition of the thyroid. In unilateral surgery, all thyroid tissue in that part is removed, and in a surgery involving the thyroid gland in general, all thyroid tissue on both sides is removed. Sometimes, the lymph nodes in the neck are also removed during the surgery for thyroid cancer.

Auxiliary Techniques in Thyroid Surgeries

One of the most important problems that may occur in thyroid surgeries is the problems that may occur in the voice (speech) due to the injury or injury of the nerves to the vocal cords.

They may be temporary or permanent. While temporary problems improve between a few weeks and a few months, permanent problems continue throughout life. There are two nerves adjacent to the thyroid. The main problem that develops due to upper nerve injury is the fatigue of the voice while talking and the inability to make loud sounds.

While this problem is more noticeable in people who use their voice professionally (such as voice artists, teachers), it creates less problems in people other than them.

As a result of damage to the lower nerve, which is the second nerve, a wide range of problems may occur, from mild hoarseness to insufficient sound. After thyroid surgery performed in experienced centres, vocal cords are preserved at a rate of almost 100%. The most important approach to prevent damage to thyroid-related nerves is the visual protection of these nerves with a careful surgical technique. In recent years, a technique called nerve monitoring, which allows the upper and lower nerves to be controlled with special devices during surgery, has been used.

Nerve Monitoring Technique

Monitoring of the Lower Nerves: A tube is placed in the trachea after the patient is anesthetized in order to provide controlled breathing of the patient during surgery in a significant part of the patients who are given general anaesthesia. The tubes used in patients undergoing nerve monitoring technique are different from the standard tubes and there is a sensor wire (electrode) in the part corresponding to the vocal cords. This wire in the tube senses the movement of the vocal cords and turns it into an audio and graphical image on a screen. When the lower nerve leading to the vocal cords during surgery is stimulated by a stimulus, if the nerve is intact, the flood wires move, this movement is visually reflected on the screen and can be heard as sound. In other words, as a result of the stimulation of the nerve, the surgeon can conclude that the nerve is intact if it receives a visual and audio response. Thus, by stimulating the nerve at various stages of the surgery, the patient can realize whether there is a problem during the surgery and predict whether the patient will encounter a sound problem after the surgery, while the patient is still asleep on the operating table.

Monitoring of the upper nerves: As in the lower nerves, the upper nerves are stimulated during the surgery to determine whether there is damage to the nerve. For this, when the nerve is stimulated, it is observed whether there is a contraction in a muscle that is activated by this nerve and located near the thyrotin. If contraction is detected in the muscle, it is concluded that there is no damage or damage to the nerve.

This technique has several important benefits. The first of these is that it can make the surgery safer and therefore faster. Because when a formation that cannot be decided visually is stimulated, if the voice and image response can be obtained, it shows that that formation should not be interrupted, and when there is no response, that structure can be easily interrupted.

The second important benefit of the technique is to estimate whether the patient will encounter a sound problem after the surgery while under anaesthesia. Finally, the technique is related to the surgical method and can give the surgeon important clues about the width of the surgery.

 

Protection of Parathyroids

The parathyroid glands, which are very closely adjacent to the posterior side of the thyroid, are 4 in total and each is about the size of a lentil.

These glands have an important role in ensuring the calcium balance of the body. If all four of these glands are injured or accidentally removed during surgery for both thyroid lobes, some problems may occur because blood calcium levels may decrease (hypocalcaemia). Therefore, the care given to the nerves during the surgery is also valid for these glands and at least one gland of the patient should be protected without damage.

Blood calcium deficiency usually develops 24¬48 hours after surgery, manifests itself with numbness and sometimes contractions in the patient's mouth circumference, fingers and toes. These problems, which often develop due to injury, often resolve with short-term calcium administration. However, some patients may need to be given vitamin D treatment together with calcium. The aim is to keep the calcium level of the patient within normal limits.

Thyroid Cancer

Thyroid cancer is an uncommon disease and most of it progresses very well compared to other cancers. The first step after detecting thyroid cancer is surgery. After surgery, treatment is continued with radiation therapy and hormone drugs. In thyroid cancer surgery, if the cancer has spread to the lymph node, the entire thyroid gland is usually removed. If it has spread to the lymph nodes, the lymph nodes can also be removed. It is generally preferred to remove the entire thyroid gland. This method is the most preferred treatment because it reduces the risk of recurrence of the disease, allows radioactive treatment, and facilitates the control of the disease by physicians. Radioactive iodine therapy begins six weeks after the surgical operation. The aim of administering high doses of radioactive iodine to patients with thyroid cancer is to eliminate the remaining thyroid tissue and possible cancer spreads after surgery.

This treatment can only be given in centres with specially equipped treatment rooms. The reason for the need for such a room is to prevent the uncontrolled contamination of radioactivity to the environment through patients receiving treatment. Patients can continue their normal lives as long as they stay in this room. The amount of radioactivity in the patients' bodies is measured every day, and patients can go home when they reach a level that does not prevent them from being discharged.

However, they also organize their lives by following the precautions to be taken in their homes for another week. Patients are called for follow-up at regular intervals, and a follow-up method is planned according to the results of the examinations. All patients whose thyroid glands have been destroyed by surgical and radioactive iodine treatment receive the thyroid hormone, which is the regulator of vital functions in our body, from the outside (in the form of pills) throughout their lives. A multidisciplinary approach is required to accurately diagnose, treat and monitor thyroid diseases (various forms of goiter and thyroid cancer). Therefore, patients are primarily treated by an endocrinologist.

Measure Your Risk of Thyroid Disease

• Have you found that your heart rate is too high or too low? (Under 60 or over 100)

• Is there a feeling of tightness and tension in your neck?

• Do you often experience sweating and hair loss?

• Have you suddenly gained or lost weight recently?

• Do you have skin shedding, drying or a matte appearance?

• Are you experiencing sudden nervous attacks or daytime drowsiness?

• Do you have swelling in your legs?

• Has your intolerance to cold or heat increased recently?

• Do you experience constipation, diarrhoea or abdominal pain attacks?

• Do you have amnesia? Or do you feel prone to depression?

If you experience some of these conditions, you should definitely consult a specialist doctor.

Don't Neglect Your Thyroid Controls

There is a risk of developing thyroid cancer in some of the thyroid nodules. For this reason, it is vital to perform thyroid examinations and scans especially in regions where thyroid diseases are common, such as our country. In the presence of these nodules, an endocrinologist should be consulted immediately. Especially people with a history of thyroid cancer in their first-degree relatives should have thyroid tests and examinations at regular intervals.

Thyroid Values Before Pregnancy Should Be Considered

The main treatment in a group of diseases called "thyroiditis", especially "Hashimato Thyroid", which causes the hypothyroidism, that is, the thyroid gland, to be unable to produce enough hormones, is the follow-up of the patient with regular drug use. Because the "thyroid hormone", which is not produced by the thyroid gland, is given as a pill from the outside to patients whose thyroid gland does not work enough.

Thyroid functions of patients who want to have children should be evaluated before pregnancy. Thyroid hormone deficiency negatively affects the intelligence and physical development of the baby in the womb.

Does Thyroid Hormone Affect Sexual Life?

Thyroid diseases affect reproductive functions and sexual life. The healthy functioning of the thyroid is necessary to maintain reproductive functions in both genders. The presence of hyperthyroidism or hypothyroidism in both genders affects sex hormones and the levels of sex hormones by causing changes in the proteins (SHBG) that carry these hormones in the blood.

Male reproductive functions are affected by both thyroid hormone excess and insufficiency. Thyroid hormone excess (hyperthyroidism) may lead to growth in the breasts (gynecomastia) and decreased libido in male patients. While hyperthyroidism can lead to impairments in sperm motility, hypothyroidism leads to sperm deformities that can be corrected by correction of thyroid hormone deficiency. On the other hand, hyperthyroidism affects the quality of sexual life by causing erectile dysfunction in up to 70% of men. These findings may be accompanied by other disorders such as sexual reluctance, premature ejaculation and late ejaculation. The erectile dysfunctions seen with the treatment of hyperthyroidism improve, as well as early ejaculation regresses from 50% to 15%.

Both excess and scarcity of thyroid hormones can lead to menstrual periods deterioration in women. Menstrual disorders are 2.5 times more common during hyperthyroidism. It is known that smoking in the hyperthyroid period increases menstrual deterioration. Infertility; that is, infertility is seen in approximately 5.8% of women with hyperthyroidism. In hypothyroidism, globulin, which binds sex hormones, decreases and the free levels of sex hormones increase in women. This situation is improved by thyroid hormones treatment. Approximately 68% of women with hypothyroidism have menstrual irregularities. Hypothyroidism is associated with oligomenorrhea (more than 35 days of menstrual bleeding cycles). Hypothyroidism can also cause disorders and excessive menstrual bleeding in the coagulation system that provides control of bleeding.

The Place and Importance of Iodine in Thyroid Diseases

Iodine is a vital element. Iodine, a vital element for metabolism, plays a role in most of the physical and mental functions. It must be taken from the outside for many metabolic processes, especially for the thyroid gland to work well and produce sufficient hormones, from burning excess fat to maintaining the immune system and the energy level needed by the body.

Iodine is mostly found in soil and sea water in nature. Since its mineral form is dissolved in water, it is lost with erosion. Iodine in seawater is accumulated in seaweed/plants and fish/shellfish. Long-term rainfall removes iodine in the soil and may cause iodine deficiency in growing vegetables and fruits. This can also lead to the formation of goiter in people who feed on food.

How Much Iodine Do I Need Daily?

Daily iodine needs determined by the World Health Organization (WHO):

• 0-5 years: 90 micrograms/day
• Between 6-12 years: 120 micrograms/day
• In young adults and adults:150 micrograms/day
• Pregnant and breastfeeding: 200 micrograms/day

Daily need increases 1.5 times in pregnant women and 2 times in breastfeeding mothers. Apart from the thyroid gland, the breast tissue also has the ability to retain iodine (to pass into milk).

The amount of iodine in food and drinking water other than milk is insufficient for humans and the amount of iodine in the natural feed of livestock is insufficient for animals. On the other hand, industrial fattening (iodine solutions used both to supplement dairy animals and to process products obtained from these animals and during hygiene techniques) may indirectly lead to excess iodine in humans. Milk and dairy products are the most important source of iodine. Those containing natural iodine are unprocessed sea salt and rock salt.

In organic milk and dairy products, iodine may be lower since it is not added. Seasonal and geographical differences are also effective on the amount of iodine in milk. It is usually twice as much in winter. Heat treatment and pasteurization also reduce the amount of iodine in milk by up to 25%.

It has been shown that oedema, chills, weight gain, chronic fatigue, decreased libido/subfertility (difficulty getting pregnant), decreased intellectual skills/capacity and frequent illness, as well as iodine deficiency may be associated with breast cancer. The low level of iodine in urine despite adequate intake suggests a problem related to absorption such as gluten intolerance and intestinal flora disorder if it is accompanied by the lack of other vitamins and minerals.

Iodine, a vital element for metabolism, plays a role in most of the physical and mental functions. It must be taken from the outside for many metabolic processes, especially for the thyroid gland to work well and produce sufficient hormones, from burning excess fat to maintaining the immune system and the energy level needed by the body.

Iodine is mostly found in soil and sea water in nature. Since its mineral form is dissolved in water, it is lost with erosion. Iodine in seawater is accumulated in seaweed/plants and fish/shellfish. Long-term rainfall removes iodine in the soil and may cause iodine deficiency in growing vegetables and fruits. This can also lead to the formation of goiter in people who feed on food.

Prepared by the Medical Editorial Board. Our health library contents have been prepared for informational purposes only and with the scientific content on the registration date. For all your questions, concerns, diagnosis or treatment about your health, please consult your doctor or health institution.