Q
: What is thyroid disease and how common is it ?
A
: The thyroid is a butterfly-shaped gland in the neck that produces thyroid hormones , which are critical for the body ’ s metabolism . If you don ’ t have enough of these hormones , metabolism drops , while if you have excess production , it can cause your metabolism to be too high . In order to regulate the body ’ s metabolism , you need the thyroid to work adequately and appropriately .
Autoimmune thyroid disease , when the body attacks its own thyroid gland , is not uncommon . It affects 3-5 percent of the population , though maybe just 10-20 percent of these have thyroid illness . Women are more likely to get it than men , with a ratio of 6:1 to 7:1 , depending on the population .
Thyroid disease can be due to thyroid dysfunction , which means that hormone production is out of sync and the gland either produces too much thyroid hormone or not enough .
People with hyperthyroidism produce too much thyroid hormone . The most common cause of this is Graves ’ disease , an autoimmune condition in which the body produces an antibody that stimulates the body to over-produce the hormone .
But if you have hypothyroidism , which is a lifelong condition , it means your thyroid gland is not working and is unable to produce thyroid hormone adequately .
In children , thyroid hormones are very important for growth . Without a properly working metabolism , a child will not be able to grow adequately . Hypothyroidism can lead to stunting and mental , intellectual , and psychological developmental issues .
Q
: How are hyper- and hypothyroidism treated ?
A
: For hyperthyroidism , a number of medicines can return hormone levels back to normal . While we still aren ’ t able to regulate the antibody level that stimulates its production , we can use drugs to help regulate the thyroid hormone levels being produced from the excessive antibody stimulation so that metabolism returns to normal .
In some people , the moment you stop this treatment , the hyperthyroidism bounces back . In such cases , you might consider radioactive iodine as a definitive treatment . Seen as very safe , it uses iodine containing small amounts of radioactivity to reduce the activity of the thyroid by getting rid of excess thyroid cells that over-produce the thyroid hormone .
For hypothyroidism , you would need to replace thyroxin , the main hormone normally produced by the thyroid gland , with a synthetic form .
Q
: What is swollen thyroid and how is it treated ?
A
: The other end of the spectrum is growth or swelling of the thyroid . The concern is that a swollen thyroid is due to a benign or cancerous tumour . Since thyroid cancer is not uncommon , a lump in the neck should be investigated with an ultrasound to ascertain its cause . The risk of thyroid swelling being cancerous , however , is less than five percent , as it is often due to a cyst within the thyroid .
To diagnose thyroid cancer , fine needle aspiration cytology is used to remove some of the fluid in the swelling for examination . If found to be cancerous , the thyroid gland should be removed and in some cases followed up with radioactive iodine . If it is treated appropriately , thyroid cancer has a 90-95 percent cure rate .
If the swelling is not cancerous , most of the time it is not very big and doesn ’ t interfere with swallowing and breathing . In rare cases where it does , for example when the gland is 3-4 times its normal size , the thyroid should be removed .
Dr Hew Fen Lee
Dr Hew Fen Lee is a consultant endocrinologist at Subang Jaya Medical Centre in Kuala Lumpur who specialises in endocrinology and internal medicine .
GlobalHealthAsiaPacific . com APRIL 2021
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