THE THYROID BOOK Medical and Surgical Treatment of Thyroid Problems
Trouble with Your Thyroid Gland The thyroid is a small gland in your neck that plays a big role in how your body functions. It impacts everything from your heart rate to your energy level. So, if the thyroid isn t working properly, this can affect your entire body. There are different types of thyroid problems. This booklet will help you learn more about them and how they can be treated. People can have symptoms, such as tiredness, for years before learning they have a thyroid problem. Who Gets Thyroid Problems? Anyone can get a thyroid problem. But certain factors make them more likely. These can include: Being a woman Older age A family history of thyroid problems Previous thyroid surgery Radiation therapy to the head or neck Do You Have a Thyroid Problem? Symptoms of thyroid problems vary from person to person. They also vary depending on the type of thyroid problem. Some problems cause you to feel tired, be forgetful, or get cold easily. Others cause you to lose or gain weight, have an irregular heartbeat, or get a lump in your neck. And some problems have no symptoms at all. Thyroid symptoms can be easy to confuse with symptoms of other conditions. For this reason, it can take a long time to diagnose thyroid problems. 2
Why Treatment Is Needed A thyroid problem should be treated even if it doesn t cause symptoms. This is because without proper care, a thyroid problem can cause other health issues. These include heart problems, bone loss, cholesterol problems, or infertility. In rare cases, a thyroid problem could even be due to cancer. Your Treatment Plan You and your doctor can work together to form the best treatment plan for your thyroid problem. This plan can help you manage your condition and prevent other problems from developing. Possible treatments include medications, nonsurgical procedures, or surgery. Your doctor will discuss your options with you. He or she will also explain their benefits and risks. If you have any questions, be sure to get them answered. 3
The Role of the Thyroid The thyroid is located in the neck, just below the voice box. It is a type of gland known as an endocrine gland. Endocrine glands make hormones (chemicals that carry messages through the bloodstream). The thyroid gland makes thyroid hormone. It does this with help from a gland in the brain called the pituitary. Keeping the Body Working Right Thyroid hormone helps control the body s metabolism. This is the rate at which every part of the body functions. Thyroid hormone keeps the metabolism at a healthy pace: not too fast or too slow. This helps the brain, heart, muscles, and other organs work well. This also helps maintain healthy skin, hair, and nails. In addition, a balanced metabolism helps ensure a normal temperature, heart rate, energy level, and growth rate. Larynx (voice box) Thyroid gland Trachea (windpipe) The parathyroid glands are located behind the thyroid. Recurrent laryngeal nerve Parathyroid glands Digestive tract Brain Bone Skin Heart Muscle Thyroid hormone affects all the tissues in the body. 4
The Thyroid Cycle Thyroid hormone must be kept at a specific level. A complex cycle maintains this level. The cycle starts with the pituitary gland. This gland constantly checks how much thyroid hormone is in the blood. The pituitary then sends a certain amount of TSH (thyroid stimulating hormone) through the bloodstream to the thyroid gland. TSH tells the thyroid how much thyroid hormone to make. The thyroid gland uses iodine in the blood to make the specified amount of thyroid hormone. The thyroid then sends this thyroid hormone into the bloodstream. The pituitary senses the hormone level, adjusts the TSH level, and the cycle continues. The thyroid gland sends thyroid to the rest of the body. hormone through the bloodstream TSH thyroid gland to make stimulates the thyroid hormone. The pituitary gland the level of thyroid hormone in the bloodstream. The pituitary through senses 2 sends TSH the bloodstream to the thyroid gland. 5
Functional Thyroid Problems Most thyroid problems are related to issues with thyroid function. There is an imbalance between the body s levels of TSH and thyroid hormone. This often causes symptoms. The two types of functional thyroid problems are hypothyroidism and hyperthyroidism. Hypothyroidism can cause extreme tiredness and loss of energy. Hypothyroidism With hypothyroidism, the thyroid gland is underactive. This means it makes less thyroid hormone than the body needs. The pituitary gland responds by making more TSH. This results in a high level of TSH and a low level of thyroid hormone. A common cause of hypothyroidism is Hashimoto disease. This condition causes the body s own immune system to destroy part or all of the thyroid. Hypothyroidism can also result from surgical removal of the thyroid, radiation therapy, or damage to the pituitary gland. A lack of iodine in the blood is a rare cause. A person can also become hypothyroid if he or she has a nodule or goiter (see page 8). Symptoms of Hypothyroidism Having a low level of thyroid hormone slows the body s metabolism. This can cause symptoms that include the following: Tiredness, loss of energy Weight gain Feeling cold Puffiness in the face, Hypothyroidism TSH hands, ankles, or feet People with hypothyroidism have Hair loss THYROID HORMONE a high level of TSH Heavier menstrual periods and a low level of Dry skin thyroid hormone. Depression Constipation 6
Hyperthyroidism With hyperthyroidism, the thyroid gland is overactive. This means it makes more thyroid hormone than the body needs. The pituitary gland responds by making less TSH. This results in a low level of TSH and a high level of thyroid hormone. The most common cause of hyperthyroidism is Graves disease. This occurs when the body s immune system causes the thyroid to grow and make more thyroid hormone. A person can also become hyperthyroid if he or she has a nodule or goiter (see page 8). Symptoms of Hyperthyroidism Having a high level of thyroid hormone speeds up the body s metabolism. This can cause symptoms that include the following: Feeling anxious or shaky Fast or irregular heart rate Weight loss Feeling hot and sweaty Shortness of breath Tiredness or sleeplessness Lighter or irregular menstrual periods Vision changes Bulging of the eyes (exophthalmos) THYROID HORMONE TSH Hyperthyroidism can cause a person to feel hot and sweaty when others are comfortable. Hyperthyroidism People with hyperthyroidism have a low level of TSH and a high level of thyroid hormone. 7
Structural Thyroid Problems Some thyroid problems involve changes in the structure of the thyroid. A thyroid gland that changes in size or shape may still work normally. Other than enlargement, symptoms may not occur. But, if functional thyroid problems are also present, this may result in symptoms. The two types of structural thyroid problems are nodules and goiters. Nodules A nodule is a lump in the thyroid gland. It can be a solid mass, a cyst filled with fluid, or both. You can have one or more nodules. What causes them is not always clear. Most nodules are benign (not cancerous). If a malignant (cancerous) nodule is found, it may be linked to family history or previous exposure to radiation. Hyperthyroidism or hypothyroidism sometimes occurs along with a nodule. Nodules can be lumps that may be seen and felt. They may also cause pain or pressure in the neck, trouble swallowing, or breathing issues. Goiter A goiter is an enlarged thyroid gland. Some goiters are large and visible. Others are hard to see or feel. A common type of goiter is made up of many nodules (multinodular goiter). A goiter can occur along with hyperthyroidism or hypothyroidism. In some cases of goiter, though, thyroid hormone levels remain normal. Goiters may cause a large lump that can be seen and felt. They may also cause pain or pressure in the neck, trouble swallowing, or breathing issues. Thyroid nodule Goiter 8
Your Evaluation Thyroid problems are diagnosed by examination and testing. Based on the test results, you may be referred to an endocrinologist (thyroid specialist) or a surgeon for further evaluation and treatment. Health History and Exam Tell the doctor about your symptoms, such as changes in weight, energy level, or body temperature. Mention past health problems and treatments, and if you have a family history of thyroid problems or thyroid cancer. During the physical exam, the doctor will feel for changes in the size and shape of your thyroid gland. The doctor may also check for changes in your heart rate, reflexes, muscle strength, or skin texture. Blood Tests Blood tests may be done to check the levels of hormone in your blood. A TSH test determines how much TSH is being made by the pituitary gland. This test is used to help diagnose most thyroid problems. A T4 test determines how much thyroid hormone (T4) is available in the blood. This test is most often used to help diagnose hyperthyroidism. Other Tests Based on your exam and blood tests, you may have other tests, including: Thyroid antibody tests to check the blood for problems with the immune system, such as Hashimoto disease or Graves disease. An ultrasound, which uses sound waves to produce images of the thyroid. This helps check the size and shape of the thyroid. A radioactive iodine uptake test to measure how much iodine the thyroid gland takes in from the blood. This test is often done along with a thyroid scan. The scan can show if certain areas of the thyroid gland are working too hard and making too much thyroid hormone. 9
Treatment for Thyroid Problems Your doctor or thyroid specialist will work with you to create a treatment plan for your thyroid problem. The most common treatments are outlined here. If you have a goiter, your care could include any of these treatments. Treating Hypothyroidism Hypothyroidism can t be cured. So, treatment focuses on relieving your symptoms. Treatment for hypothyroidism involves taking thyroid hormone pills daily. These replace the hormone your thyroid no longer makes. Chances are, you ll need to take a daily hormone pill for the rest of your life. Your doctor will prescribe a starting dosage. You ll have a TSH test a few weeks later. Your dosage may then be adjusted. After that, regular blood tests help ensure the dosage remains right for you. Treating Hyperthyroidism Treatments for hyperthyroidism are discussed below. In some cases, medications called beta-blockers may be used along with another treatment to help manage hyperthyroid symptoms. Antithyroid medication can reduce the amount of thyroid hormone made by the thyroid gland. It may help reduce hyperthyroid symptoms. Radioiodine ablation is a common treatment for hyperthyroidism. It involves taking a pill or liquid dose of radioactive iodine. Once absorbed by the thyroid gland, the iodine destroys the thyroid cells that are making too much hormone. Surgery is an effective treatment for hyperthyroidism. It involves removing most or all of the thyroid gland. Note: Radioiodine ablation and surgery may result in the need for daily thyroid hormone pills. Talk with your doctor to learn more. 10
Treating Nodules If you have a nodule, you may need a procedure called fine needle aspiration (FNA) biopsy. It is done to remove a sample of cells from the nodule. This helps check whether the nodule is benign or cancerous. During the procedure, a needle is used to take cells from the nodule. The cells are then viewed and analyzed under a microscope. If the nodule is benign, you may not need treatment right away. Instead, your doctor may suggest regular exams and ultrasound tests to monitor the nodule and watch whether it grows. If the nodule is cancerous or suspected to be cancerous, surgery may be needed to remove part or all of the thyroid gland. Surgery may also be done to treat a nodule that grows or causes troublesome symptoms. In some cases, surgery is followed by radioiodine ablation (see left). Note: Surgery and radioiodine ablation may result in the need for daily thyroid hormone pills. Talk with your doctor to learn more. Nodule Thyroid Ultrasound probe Ultrasound is often used during an FNA biopsy to help the doctor guide the needle into the nodule. 11
If You Need Surgery Some thyroid problems are best treated with surgery. In certain cases, surgery is done to help diagnose a thyroid problem. During surgery, part or all of the thyroid gland is removed. Your surgeon will discuss the goals of surgery with you and outline the benefits and risks. Risks and Complications Thyroid surgery is typically a safe procedure, but it does have some risks. These include: Before Surgery Prepare for surgery as instructed. Be sure to follow directions for not eating or drinking before surgery. When you arrive at the hospital, an IV line will be put into a vein in your arm or hand. This line supplies fluids and medications. You may be asked more than once to provide your name and the procedure you re having. This is for your safety. You ll be told about the medication (anesthesia) that keeps you free from pain during the surgery. You ll likely receive general anesthesia. This type of anesthesia puts you into a state like deep sleep during the surgery and for a short time after. Bleeding Infection Injury to nearby structures, such as the recurrent laryngeal nerve. Nerve injury may lead to temporary or permanent hoarseness. Damage to the parathyroid glands, which are located behind the thyroid gland. They help control the amount of calcium in the bloodstream. If these glands are damaged, temporary or lifelong calcium and vitamin D supplements may be needed.! 12
During Surgery The surgery takes about 1 to 3 hours. Part or all of the thyroid gland will be removed. How much varies depending on the type of thyroid problem you have. Your surgeon may not know exactly how much of the gland needs to be removed until after surgery begins. Removing Part of the Thyroid To treat benign nodules, a lobectomy or a hemithyroidectomy may be done. These remove one section of the thyroid gland. The remaining thyroid tissue is left to continue its function. Removing Most or All of the Thyroid A subtotal or near-total thyroidectomy removes most of the thyroid gland. A total thyroidectomy removes the entire thyroid gland. With these procedures, little or no thyroid tissue is left behind. One of these procedures may be done to treat hyperthyroidism, a multinodular goiter, or cancer. After Surgery Most of thyroid removed Part of thyroid removed You ll likely spend a few hours in the recovery room. Then, you may be allowed to go home or moved into another room to stay overnight. Your calcium levels may be checked. This is to find out if the parathyroid glands were affected during surgery (see Risks and Complications on the left). You may have a drain that was placed at the wound site during surgery to help collect fluid. If you have a sore throat or hoarseness after your procedure, don t worry. This is common and should go away in 1 to 2 weeks. Possible incision site All of thyroid removed 13
Recovering After Surgery You should be able to return to your normal routine in 1 to 2 weeks. See your surgeon for follow-up visits as directed. Afterward, your primary care doctor or thyroid specialist will likely monitor your recovery. Caring for Yourself Follow the home care instructions given by your surgeon. Be sure to: Take all medications as directed. These may include pain relievers, thyroid hormone pills, calcium and vitamin D supplements, or antibiotics. Avoid heavy lifting, strenuous exercises, and driving until your surgeon says it s okay. Care for your incision as directed. If you have a drain, you may need to take antibiotics until it is taken out. Within 6 months, your incision scar will likely flatten out and fade. When to Call the Surgeon Once at home, call your surgeon right away if you have any of these: Increasing pain, redness, warmth, swelling, bleeding, or drainage at the incision site Fever of 100.4 F (38 C) or higher Trouble breathing or swallowing Muscle cramps; numbness or tingling in the lips or mouth, fingers, or feet; or twitching in the face (signs of a low blood calcium level) Follow-Up Appointments You ll see your surgeon for a follow-up visit within 2 weeks after the surgery. Your wound will be checked. If needed, your stitches or drain will be removed. Several weeks after the surgery, a TSH test will be ordered. The results will help determine if you need to take thyroid hormone pills. 14
In the Years to Come No matter what thyroid problem you have or how it was treated, it is vital for you and your doctor to monitor your condition. See your doctor for follow-up visits as directed. And watch for returning symptoms. With proper care, you can feel good and stay healthy. Staying Healthy To help keep your thyroid problem under control, follow any instructions your doctor gives you. These may include the following: For hypothyroidism, take your thyroid hormone pills daily. Get blood tests as directed to make sure the dosage is correct. If you have any symptoms, tell your doctor. For hyperthyroidism, if treatment caused you to need thyroid hormone pills, take them as instructed. If you still have part of your thyroid, watch for returning hyperthyroid symptoms and report any to your doctor. The Importance of Taking Thyroid Hormone Pills For nodules or goiter, have regular exams and ultrasounds as instructed. Report if the size of a nodule or goiter changes or if new nodules appear. If you ve had surgery, watch for these same changes. Take any prescribed thyroid hormone pills as instructed. After treatment for cancer, have regular checkups and tests as instructed by your doctor. If your body no longer makes thyroid hormone, you need to take thyroid hormone pills for the rest of your life. The simple act of taking these pills daily will help you control your condition. Follow these tips: Take your pills at the same time each Certain medications and foods can day. This might be first thing in the affect how well your pills work. Check morning when you get up. with your doctor before taking any Always take your pills on an empty supplements, herbal remedies, or stomach. After taking your pills, wait over-the-counter medications with at least 30 minutes to 1 hour before your pills. Also check if you should eating. Food can keep thyroid avoid eating certain foods after hormone from being absorbed fully taking your pills. by your body. Stick to one brand of thyroid hormone pills. If your brand is switched, ask your doctor if you need a TSH test. 15
Also available in Spanish Work with Your Doctor Treatment for thyroid problems varies depending on the type of problem you have. Many people only need to take daily medication to manage their thyroid condition. Others may need additional treatments. Talk with your doctor to learn more about your options and what they may mean for you. By being informed, you can help your doctor ensure that your needs are met. TAKE OUR PATIENT SURVEY. Help us help other patients. Please visit www.kramesurvey.com to provide your feedback on this booklet. This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. 2014, 2015, 2016 The StayWell Company, LLC. www.kramesstore.com 800.333.3032 All rights reserved. Made in the USA. 11986 1603