Thyroid disease and the symptoms you need to know about

One in 10 Canadians suffer from thyroid disease — but only about 50% know they have one. When your thyroid’s working properly, you don’t have to pay very much — if any — attention to it. But when it malfunctions, it can throw you off completely.

From subclinical issues to thyroid cancer, there’s a lot that can go wrong with your thyroid. Here’s what to look out for, and who to speak to about it.

What does the thyroid do?

The thyroid is a butterfly-shaped gland found in the front of your neck. It only weighs between 20 to 60 grams, but it’s one of your body’s workhorses. It produces two hormones — triiodothyronine (T3) and thyroxine (T4) — that influence the production of proteins throughout your body and regulate your metabolic rate.

This means that your thyroid is responsible for how fast the cells in your body work. Your heart rate, digestion, and brain function all speed up or slow down depending on the hormones your thyroid secretes.

The thyroid depends on your pituitary gland — found at the base of your brain — to determine what to do. Your pituitary gland produces thyroid-stimulating hormone (TSH), which prompts your thyroid to make T3 and T4. When there’s too much T4 in your blood, your pituitary sends out less TSH, causing your thyroid to decrease its production of the hormone. If there’s too little, your pituitary gland signals your thyroid that it’s time to ramp up production.

The thyroid also works in collaboration with your adrenal glands — small, triangular-shaped glands that are just above your kidneys — to produce and release necessary hormones. If the adrenal glands aren’t functioning properly, it has a ripple effect on the thyroid, causing it to malfunction as well.

What is thyroid disease?

Thyroid disease is any kind of medical condition that affects how your thyroid works. It can range in severity from a temporary inflammation of the gland to cancer. While there’s a certain amount of variation in the conditions, it tends to fall into one of two categories. Either they cause your thyroid to increase its hormonal output (hyperthyroidism), or they cause it to decrease its hormonal production (hypothyroidism).

What are the signs of thyroid problems?

Your thyroid is a small gland, but its effect on your bodily functions is outsized. However, symptoms can be hard to pick up on as they tend to be nonspecific. This means that symptoms alone aren’t enough to diagnose thyroid disease. Despite that, clusters of certain ones may indicate hyperthyroidism, while others can signal hypothyroidism.

Hyperthyroidism

Also known as overactive thyroid, hyperthyroidism is an endocrine disorder that occurs when your thyroid produces too much T3, T4, or both, causing your metabolism to speed up. Signs of hyperthyroidism include weight loss, increased sweating, rapid heartbeat, irritability, and anxiety. It may also cause high blood pressure, difficulty sleeping, frequent bowel movements, abnormal periods, heat intolerance, and dry skin.

Hypothyroidism

Hypothyroidism — also called underactive thyroid — is an endocrine disorder that often occurs when the immune system attacks the thyroid gland. This damages the thyroid so that it’s not able to produce enough hormones, causing a hormone imbalance.

For the most part, its symptoms are the opposite of those associated with hyperthyroidism. You may experience things like lack of energy, weight gain, cold intolerance, difficulty with memory, depression, constipation, abnormal periods, and brittle hair and nails. If left untreated, long-term effects can include joint pain, infertility, and heart disease.

Thyroid problems in women

Thyroid research and awareness have mainly centred on women, as they’re five to eight times more likely to have thyroid problems than men. Despite this, many symptoms are the same for both genders. Women, however, face the added complication of reproductive health issues.

Women suffering from an underactive thyroid, for example, may have irregular or heavy periods, while those with an overactive thyroid may experience light or missed periods. And in pregnant women, hyperthyroidism can be associated with preeclampsia, preterm delivery, miscarriage, and developmental issues in their children.

Thyroid problems in men

While thyroid issues affect women more often, men are also at risk. Symptoms, including low libido, manifest in similar ways for both genders. This symptom may be more noticeable in men, however, as it can result in erectile dysfunction.

For men with hypothyroidism, this shows up as a higher likelihood of experiencing delayed ejaculation. Those with hyperthyroidism, conversely, may have a greater risk of premature ejaculation.

Risk factors for thyroid disease

Risk factors for thyroid problems are genetic and to a certain degree, environmental. While you can’t do anything about your genes, age, or gender, certain lifestyle factors are more controllable. Risk factors include:

• Gender — women are more likely to develop thyroid problems than men
• Age — women over 60 are especially vulnerable to thyroid dysfunction
• Being pregnant within the past six months
• Having an immediate family member with thyroid dysfunction
• Smoking
• Quitting smoking within the past two years
• Receiving radiation in the chest or neck area
• Iodine deficiency — not usually a problem in most countries where iodine is added to table salt

How is thyroid disease diagnosed?

Because symptoms are so general, a diagnosis must include a blood test. If you think you have thyroid disease, your healthcare provider can refer you for a blood test that measures your TSH levels. High levels of TSH in your blood can mean that your pituitary gland is trying to get your thyroid to work more, indicating hypothyroidism. Too little TSH likely means it’s overproducing T3 or T4, or both — an indication of hyperthyroidism.

Depending on your results, your healthcare provider may refer you for additional blood tests to help determine specific types of thyroid dysfunction like Graves disease or subclinical hypothyroidism. These can include looking at your levels of T3 and T4, or the amount of thyroid-stimulating immunoglobulin (TSI) in your blood.

In certain cases, you might also go for an imaging test, which involves swallowing (very slightly) radioactive iodine. This test can help determine if you have Graves disease, an iodine deficiency, or thyroiditis (inflamed thyroid), among other things.

If bloodwork shows that your symptoms aren’t thyroid-related, a general health assessment might be a good option. Symptoms are vague and can mimic many other illnesses, or even aging. As part of your check-up, the healthcare provider might order additional lab tests to help provide a comprehensive evaluation of your health.

Treatment

Treatment for thyroid disease typically involves taking thyroid replacement hormones or other medications. Depending on which version you have, these either suppress or supplement your thyroid’s production of hormones. In the case of hyperthyroidism, your doctor may recommend surgery to remove the thyroid, or treatment with radioactive iodine to destroy it.

Is there a link between diabetes and thyroid disorder?

Yes, there can be. Thyroid disorders and diabetes both involve a dysfunctional endocrine system and often occur together. While the evidence is unclear for type 2 diabetes, it’s clear that type 1 diabetes, sometimes known as autoimmune diabetes, is associated with an increased risk for thyroid disorders. If you have type 1 diabetes, your healthcare provider will likely recommend regular screening for thyroid dysfunction.

Since your thyroid dictates how your body treats insulin, having a thyroid disorder increases your risk for diabetes. At one end of the spectrum, hyperthyroidism speeds up your metabolism, causing insulin to cycle through your system more quickly. This can precipitate a build-up of blood sugar, putting you at higher risk for type 2 diabetes, or, if you already have diabetes, making it more difficult to control.

Conversely, hypothyroidism slows down your metabolism, which means insulin isn’t eliminated from your body as quickly. This can cause your levels of blood sugar to drop. If you’re already taking insulin for diabetes, this increases your chances of becoming hypoglycemic — a serious low blood sugar condition that causes dizziness, confusion, and loss of consciousness.

The best way to protect yourself from developing the other condition is to appropriately manage and treat the condition you already have.

What happens if you ignore thyroid problems?

Thyroid problems don’t go away on their own. Without treatment, your symptoms will progress and worsen.

Left untreated, hypothyroidism can wreak havoc on your body, causing depression, heart issues, infertility, and a decline in mental functioning. In extreme cases, untreated hypothyroidism can become myxedema. This is a severe condition causing cognitive decline, coma, and potentially death.

Hyperthyroidism also results in serious problems if you don’t treat it. Untreated, it can lead to heart issues, blindness, or thyrotoxic crisis. This is an acute condition, also called a thyroid storm, that causes fever, and may result in heart failure, coma, or death.

What are the signs of thyroid cancer?

Thyroid cancer develops in the neck. As such, many symptoms affect that area of the body and can include:

• A lump or swelling in the neck (thyroid nodules)
• Hoarse voice
• Difficulty breathing
• Swallowing problems

How treatable is thyroid cancer?

Most types of thyroid cancer are very treatable. Treatment may involve surgery, hormone or radiation therapy, chemotherapy, or radioiodine therapy — taking radioactive iodine. The most common type of thyroid cancer is papillary carcinoma which generally responds well to treatment.

In Canada, the five-year survival rate for thyroid cancer is 98%. In other words, most people with it are still alive five years later. Prompt diagnosis and treatment, however, are key. If you’ve received a diagnosis and are looking for more guidance regarding your treatment, you might want to consider seeing an oncologist navigator for a second opinion.

Why see an endocrinologist?

Endocrinologists are doctors who study hormones and treat hormone-based diseases and disorders. If you have symptoms of thyroid issues, you’ll most likely be referred to an endocrinologist to figure out the right treatment plan. This is especially true if your treatment isn’t progressing as planned. An endocrinologist will ensure all treatment avenues are pursued to help manage your condition.

Hypothyroidism and hyperthyroidism can be debilitating, but with proper treatment, you can live a symptom-free life. Book an appointment with an endocrinologist on Maple today and get the care you need without a referral or having to leave home — help is just around the corner.