Thyroid Disease Requires Lifelong Management

Glands are small organs that make substances such as hormones. These substances are released into the body to perform specific functions. The thyroid gland, located at the base of the neck, is small and shaped like a butterfly.

The thyroid might be a small gland in the neck, but it plays a large role in maintaining the body's metabolism, said Kecia Gaither, M.D., who is board-certified in OB-GYN and maternal fetal medicine and the director of perinatal services/maternal-fetal medicine at NYC Health + Hospitals/Lincoln in the Bronx, New York.

She added that the thyroid produces three hormones:

1. Thyroxine (T4), also known as tetraiodothyronine
2. Triiodothyronine (T3), which, with T4, makes up the thyroid hormone
3. Calcitonin, which is responsible for regulating the calcium levels in the blood

Gaither said the thyroid works in conjunction with other organs in the body to effectively:

• Control muscle contraction
• Impact brain development (particularly during the fetal period)
• Influence the speed of digestion
• Regulate heart rate
• Regulate body temperature
• Affect weight loss/gain (metabolic rate)

So when your thyroid doesn't work correctly, it can impact your whole body.

Thyroid dysfunction manifests in two primary ways:

1. Hypothyroidism. The thyroid doesn't produce enough thyroid hormone.
2. Hyperthyroidism. The thyroid produces too much thyroid hormone.

The leading causes of hypothyroidism include:

• Hashimoto's thyroiditis is an autoimmune disease and the most common cause of hypothyroidism.
• Thyroiditis is inflammation (swelling) of the thyroid gland that can be triggered by a viral infection. Acute or infectious thyroiditis is rare and caused by a bacterial infection.
• A nonfunctioning thyroid gland is a congenital abnormality that affects about 1 in 3,000 to 4,000 newborns.
• Postpartum thyroiditis is a rare type of thyroiditis that can affect women after they give birth.
• Iodine deficiency leads to problems because iodine is needed to make the thyroid hormone.
• Radiation treatment for certain cancers.
• Drug-induced thyroiditis is caused by certain cancer medications or lithium, which some clinicians use to treat bipolar disorder.
• Thyroid removal.

The primary causes of hyperthyroidism include:

• Graves' disease is an autoimmune disease and the most common cause of hyperthyroidism.
• Nodules. Noncancerous nodules on the thyroid can cause it to be overactive.
• Thyroiditis is inflammation (swelling) of the thyroid gland that can cause either hypothyroidism or hyperthyroidism.
• Excessive iodine can make your thyroid overactive. Certain types of medications that contain iodine can cause hyperthyroidism. An example is amiodarone, which clinicians use to treat irregular heart rhythms.
• A pituitary adenoma is a noncancerous tumor of the pituitary gland that affects the level of hormone production.
• Thyroid cancer is rare but can affect the level of thyroid hormone produced.

High levels of human chorionic gonadotropin (hCG) are sometimes due to early pregnancy, a multiple-birth pregnancy or a molar pregnancy, and can lead to hyperthyroidism.

Depending on the cause of hypothyroidism or hyperthyroidism, the symptoms may differ. Gaither explained the most common symptoms for each type of thyroid dysfunction.

For hypothyroidism, they include:

• Slowed heart rate
• Slowed metabolism
• Low libido
• Increased weight gain
• Fatigue
• Anemia
• Heart failure
• Low body temperature
• Constipation
• Muscle aches, cramps and weakness
• Dry scaly skin
• Brittle hair and nails
• Irregular or heavy periods

If left untreated, hypothyroidism may lead to heart problems, goiters (abnormal swelling of the thyroid gland), pregnancy complications and, in rare circumstances, a myxedema coma, which can be life-threatening.

The symptoms of hyperthyroidism can include:

• Weight loss
• Rapid heartbeat
• Anxiety
• Increased appetite
• Bulging eyes
• Heat intolerance
• Goiter
• Hair loss
• Pretibial myxedema (a type of skin lesion)
• Thyroid storm (increased heart rate, blood pressure and temperature)
• Hyperactivity (nervous energy)
• Persistent thirst
• Mood swings
• Diarrhea
• Itching
• Fatigue

When left untreated, hyperthyroidism can lead to osteoporosis, eye problems, pregnancy complications, heart problems or a thyroid storm (a medical emergency.) However, certain treatments for hyperthyroidism can lead to hypothyroidism.

"It's imperative to see your doctor if any of the above symptoms are present, particularly if there is a family history," Gaither said.

Your doctor can take a full medical, symptom and family history. If they suspect your thyroid is the problem, they may order a thyroid function blood test. This checks the levels of the main thyroid hormones (T3 and T4) and thyroid-stimulating hormone (TSH) produced by the pituitary gland.

Further tests might include more blood tests to look for antithyroid antibodies and inflammation in your body. A thyroid scan to look for lumps (nodules) on your thyroid or pituitary gland is another option.

Most commonly, your healthcare provider can treat hypothyroidism with a medication called levothyroxine. This is a thyroid replacement medication that gives your body the extra thyroid hormone it needs. It can take some time, and several blood tests, to get the dosage right. But it can help improve the symptoms so you can live a normal life. You need to take this medication for the rest of your life.

For hyperthyroidism, there are various treatment options depending on the cause. Medication is a primary one. Drugs called thionamides help prevent your thyroid from producing too much thyroid hormone. The most common types are methimazole and propylthiouracil.

Radioactive iodine treatment is a type of radiation therapy to destroy thyroid gland cells, which reduces the amount of thyroid hormone produced. Finally, surgery may be necessary to remove the thyroid. This could be necessary in the case of large goiters, cancer or nodules, or if you are unresponsive to other thyroid treatments.

If the thyroid is removed, you'll have to take medication for an underactive thyroid for the rest of your life.

When thyroid disease is well managed, its effects on sexual function are minimal. Untreated, however, thyroid disease can cause diminished libido in men and women. Low libido can affect relationships and mental health.

Men with uncontrolled hypothyroidism may experience erectile dysfunction (ED), ejaculatory disorders, and semen and sperm quality issues. Infertility is even a possibility. Untreated hypothyroidism causes similar sexual dysfunction in women.

A meta-analysis published in 2019 found 59 percent to 63 percent of men with hypothyroidism and 48 percent to 77 percent of those with hyperthyroidism experienced sexual issues. The study put the numbers at 22 percent to 46 percent (hypo) and 44 percent to 60 percent (hyper) in women.

Women's sexual issues attributed to thyroid disease include diminished arousal and lubrication, painful intercourse, difficulty achieving orgasm and lower sexual satisfaction. As is the case with men, female fertility can be affected by an out-of-balance thyroid.

Thyroid diseases are usually lifelong medical conditions that you need to learn to manage with support from your healthcare provider. The symptoms can be varied and have a significant impact on your everyday life.

The most critical first step is to see your doctor to determine if your symptoms are caused by thyroid disease and to help identify the underlying cause. Once they have found the cause, your healthcare provider can discuss treatment options and guide you through thyroid management and a coping plan.

Finding the correct medication dosage or treatment plan for yourself can be frustrating. But once you do, it can help relieve your symptoms, and you can live a normal life.

Some professional organizations that provide support and information for patients with thyroid diseases include:

• The American Thyroid Association
• The American Association of Clinical Endocrinology
• Thyroid Cancer Alliance
• Thyroid Cancer Survivors' Association
• Smart Patients. This is an online community for patients and families affected by various illnesses. There are online support groups for Hashimoto's thyroiditis and Graves' disease.