Thyroid Disorders, Diagnosis, and Thyroid Function

The thyroid gland is one of the so-called endocrine organs, meaning it produces hormones. It produces thyroid hormones, stores them, and releases them into the body. Its activity is controlled by the hypothalamus and the pituitary gland.

There are two thyroid hormones: triiodothyronine (T3) and tetraiodothyronine (T4). Of these, T3 is the metabolically active hormone. It affects the basal activity of every cell. For this reason, thyroid hormones are essential for survival. A prolonged deficiency leads to death.

Thyroid disorders can be classified based on the metabolic state. A distinction is made between:

• Hypothyroid disorders (underactive thyroid), such as Hashimoto’s thyroiditis
• Hyperthyroid disorders (overactive thyroid), such as autonomous adenoma (hot nodule) and Graves’ disease with generalized hyperthyroidism and eye problems (endocrine orbitopathy)
• Euthyroid thyroid disorders (normal thyroid function), such as nodular goiter of various sizes (“goiter”)

These benign thyroid disorders must be distinguished from the very rare malignant thyroid tumors.

The thyroid gland is a vital organ. It can be affected by various disorders © eddows | AdobeStock

The symptoms of thyroid disorders depend primarily on the thyroid’s metabolic state.

In cases of hyperthyroidism, all the body’s cells become overactive. Clinically, this manifests as

• nervousness,
• restlessness,
• sensitivity to heat,
• weight loss,
• diarrhea,
• hair loss, or
• rapid heartbeat.

In contrast, an underactive thyroid causes

• causes fatigue,
• lack of energy,
• weight gain, and
• constipation.

Furthermore, in cases of thyroid disease, a severely enlarged thyroid gland can lead to local symptoms such as

• difficulty swallowing,
• a sensation of a lump in the throat,
• shortness of breath, and
• hoarseness

.

Not every thyroid disorder requires surgical treatment. In some cases, medication is sufficient. In select cases, alternative treatment methods (radioactive iodine therapy) are available.

Thyroid surgery is indicated in the following cases:

• Scintigraphically cold nodules,
• hyperthyroidism that cannot be treated with medication,
• significantly enlarged thyroids causing shortness of breath or difficulty swallowing,
• autoimmune diseases with ocular changes, and
• thyroid carcinomas.

Many clinics offer outpatient consultations to patients. This means they are examined and advised by a specialist.

The thyroid examination also includes an ultrasound scan. Once all test results are available, the patient is informed about the possible treatment options. These include

• medication,
• radioiodine therapy,
• surgery.

If surgery is necessary, the patient can choose between inpatient or pre-hospitalization care, depending on their personal risk profile.

Before treatment, an ENT examination should be performed to check the vocal cord nerves.

The patient must not take any anticoagulant medications, such as

• aspirin,
• ASS 100, or
• Plavix

.

They should stop taking diabetes medications from the biguanide class (e.g., Glucophage, Metformin, Mescorit) 48 hours before the procedure.

If pre-hospitalization care is required, the patient should arrive at the hospital on an empty stomach on the day of surgery.

Thyroid surgery is always performed under general anesthesia.

The diseased tissue is removed through an incision in the neck measuring approximately 3 to 5 cm. The goal is to leave small, cosmetically pleasing scars.

If changes are present on only one side, only the affected lobe is removed (hemithyroidectomy). In cases of

• extensive nodular changes,
• significant enlargement, or
• autoimmune diseases

, the entire organ is removed (thyroidectomy). In cases of malignant thyroid tumors, depending on the type, it may also be necessary to remove the surrounding lymph nodes.

The vocal cord nerves are also located near the thyroid gland. To avoid impairing the patient’s voice, special care must be taken with these nerves during all thyroid surgeries. Surgeons monitor their function using a technique called “neuro-monitoring” during the operation.

This allows the thyroid surgery to be performed more safely without damaging the important vocal cord nerves.

On the 2nd or 3rd day after surgery, an ENT specialist will examine the vocal cord nerves.

The hospital stay usually lasts 3 to 4 days. Depending on the results of the histological examinations and the type of surgery performed, lifelong thyroid hormone replacement may be necessary.

If thyroid tissue was left behind during surgery, taking iodine tablets or a combination iodine/hormone preparation is recommended to prevent recurrence (the formation of new nodules).

What are the typical symptoms of thyroid disease?

Typical symptoms of thyroid disease depend on whether the thyroid is overactive or underactive. Hypothyroidism is often characterized by weight gain, fatigue, and a depressed mood, while hyperthyroidism is typically marked by symptoms such as sweating, nervousness, and heart palpitations. The symptoms are varied and can range in severity depending on the type of disorder.

What is the difference between hypothyroidism and hyperthyroidism?

In hypothyroidism, the thyroid gland produces too few thyroid hormones. In hyperthyroidism, the thyroid gland produces too many hormones. Graves’ disease is an autoimmune disorder in which hyperthyroidism is triggered by antibodies.

How are thyroid disorders diagnosed?

Diagnosis involves a blood test to measure TSH, T3, and T4 levels, as well as antibody levels. In addition, an ultrasound is performed to assess the size of the thyroid gland and the structure of the thyroid tissue. If a thyroid disorder is suspected, further tests may be necessary to rule out thyroid nodules or tumors.

What causes thyroid disorders?

The causes of thyroid disorders are varied. Iodine deficiency can lead to an enlarged thyroid and goiter. Autoimmune disorders such as Hashimoto’s thyroiditis or Graves’ disease are also common causes. In addition, inflammation, congenital disorders, or malignant tissue changes may play a role.

How are thyroid disorders treated?

Treatment for thyroid disorders depends on the type of disorder. Hypothyroidism is usually treated with thyroxine medication. For hyperthyroidism, thyreostatic agents, radioiodine therapy, or, in certain cases, thyroidectomy may be considered. It is crucial to have a personalized treatment plan and to monitor thyroid function regularly.