"I think we should check his thyroid."

I said while looking at his neck, where I could clearly see a swollen thyroid gland, and his thyroid hormone levels were found to be very high in the blood test. It was Hyperthyroidism. After starting treatment, when I saw him a month later, the transformation was miraculous. The discomfort, lack of sleep, and scanning behavior had completely disappeared. His hand tremor was completely gone. He had even started gaining back the weight he had lost.

For those who are unaware, thyroid problems are of various types. The most common one people are familiar with is Hypothyroidism, a condition where the thyroid function is decreased. Many assume that thyroid disease only refers to Hypothyroidism. This is why when people visit a doctor, they often just mention that they are taking thyroid medication, without realizing there might be more to it.

The thyroid is a gland shaped like a butterfly located at the front of the neck. The thyroid gland controls many functions in the body, and an imbalance in thyroid hormones—either too high or too low—can cause various health issues. But is the thyroid alone responsible for its function? Absolutely not. The thyroid's work is regulated by another gland located in the brain, the pituitary gland. This gland controls the thyroid function by releasing a hormone called TSH. Additionally, the hypothalamus, another gland, also regulates the pituitary function.

This means that thyroid problems might not only arise from issues within the thyroid itself but also from problems in the regulation of hormones from the brain. If the levels of stimulation from the brain's glands (hypothalamus and pituitary) increase or decrease, you will see an impact on thyroid function.

Now, let's look at some diseases affecting the thyroid:

The most common thyroid disorder is Hypothyroidism, where thyroid hormone levels are low.

Autoimmune thyroiditis or Hashimoto's thyroiditis is the primary cause of Hypothyroidism. In this condition, the body's immune system mistakenly attacks and destroys the thyroid gland. If the iodine levels in the food are either too low or too high, it can lead to thyroid dysfunction. Even radiation therapy on the neck during cancer treatment, or surgery on the thyroid gland for other conditions, can cause thyroid function to decline. Certain medications used for heart disease, mental health issues, and other conditions can also disrupt thyroid function.

In rare cases, Hypothyroidism can occur due to inherited enzyme defects. Some forms of thyroiditis that are not autoimmune also impair thyroid function. Additionally, dysfunctions in the hypothalamus and pituitary glands, which regulate the thyroid, can also lead to Hypothyroidism.

What are the symptoms of Hypothyroidism?

A doctor with experience in long-term, severe Hypothyroidism can diagnose a patient just by observing them from a distance. If they speak a sentence or two, there's no need to look further.
The face soaked in sweat, dull eyes, unhealthy, easily falling out, lifeless hair, dry, flaky skin, and a face devoid of energy... Is the person speaking to you in a slow, gentle voice? You can be sure that their thyroid should be examined.

Below are some of the key symptoms:

• Excessive sleep and weight gain
• Swelling in the legs
• Water retention in the heart and lungs
• Constipation
• Menstrual irregularities
• Infertility
• Some muscles becoming abnormally enlarged
• Increased blood pressure, cholesterol, etc.

These symptoms may not appear in every patient. In some cases, only mild symptoms may be observed. For this reason, doctors often request thyroid tests to rule out thyroid-related issues if any of these symptoms are present.

Now, let's look at the condition called Hyperthyroidism, where there is an excess of thyroid hormones.

There are several causes for excessive production of thyroid hormones. The primary causes include:

• Graves' disease: The thyroid gland swells and produces more hormones.
• Toxic multi-nodular goiter: Multiple small nodules form inside the thyroid, producing excess hormones.
• Toxic nodule: A single nodule in the thyroid producing more hormones.
• Nodules in the pituitary and hypothalamus glands.
• Certain stages of thyroiditis disease.
• Rarely, nodules or cancers in other organs can lead to hyperthyroidism by producing thyroid hormones.

Symptoms: Recall the patient's case mentioned earlier. Hyperthyroidism is a condition where the body loses weight rapidly. The main symptoms are:

• Weight loss
• Muscle weakness
• Hand tremors
• Increased heart rate
• Eyes protruding
• Increased appetite
• Heart palpitations
• Frequent bowel movements
• Increased sweating
• Unexplained, prolonged fever

Not all patients will exhibit all these symptoms.

Thyroiditis: Thyroiditis is a condition where the thyroid cells temporarily or permanently get damaged, releasing stored hormones into the bloodstream. This condition may be caused by the body creating antibodies that destroy its own thyroid cells, certain viral infections, or some medications. Since the stored hormones are released all at once, the blood test during the initial stage of this disease may resemble that of Graves' disease. Sometimes, this leads to incorrect treatment being given. However, the treatment for Graves' disease is not needed for thyroiditis.

In the second stage, due to the damage caused to the cells, thyroid function slows down, and hormone levels drop, leading to hypothyroidism. After a few weeks, the thyroid cells may recover, and hormone levels return to normal. However, in a small percentage of cases, the cells may not recover, and the person will need to take thyroid hormone replacement tablets (Thyroxin) for the rest of their life.

Thyroid Nodules: Thyroid nodules are one of the most commonly found issues. They can cause significant concern for many individuals. Most thyroid nodules do not cause serious problems. Once confirmed that they are not problematic, they do not pose any special issue, and periodic checkups (once or twice a year) are enough. However, if a nodule grows excessively and presses on the trachea or surrounding areas, surgery to remove the nodule becomes necessary. For those who are concerned about the cosmetic appearance of a nodule in the front of the neck, it can also be removed through surgery.

What to do if a thyroid nodule is found?

Since most thyroid nodules are non-problematic, the main concern is the presence of thyroid cancers. A doctor's primary role is to ensure this is properly diagnosed. Although thyroid cancer is not very common, some types of thyroid cancer can be completely cured if treated early. It is distressing if it goes unnoticed.

By examining the thyroid gland manually, the nature of the nodule can often be understood. The next step is to check the thyroid hormone levels, followed by an ultrasound scan of the thyroid gland. The ultrasound can help clarify the type of nodule and whether there are any signs of cancer. If there are suspicious signs, a Fine Needle Aspiration Cytology (FNAC) test is required to take a sample. If cancerous cells are found, treatment according to the type of cancer is necessary.

Next, let's understand some key facts about thyroid function tests. These are very commonly conducted tests, and many misconceptions exist about them.

T3 and T4 are the primary hormones produced by the thyroid gland. When their levels decrease, it leads to hypothyroidism. When these hormone levels increase, it leads to hyperthyroidism. If thyroid issues cause the thyroid to produce excess T3 or T4 hormones, the body will attempt to counteract this by reducing the stimulation from the pituitary gland. In cases of hyperthyroidism, the report will show elevated T3 and T4 levels along with a low TSH level.

In hypothyroidism, the thyroid hormone levels (T3 and T4) drop, and the pituitary gland compensates by producing more TSH to stimulate thyroid hormone production.

Many people mistakenly think that TSH directly reflects thyroid function, assuming that high TSH means thyroid function is increased, and low TSH means thyroid function is decreased. This confusion is common when asking about the disease.

It is not always so simple to analyze thyroid tests. In cases where thyroid problems are caused by disorders in the pituitary or hypothalamus, the hormone report may not follow the usual patterns mentioned above. These thyroid problems are rare, and explaining them in detail here would be too complex.

Thyroid tests during pregnancy are another area with specific issues. Pregnancy can affect many hormones in the body, which can influence thyroid test results. It's important to keep this in mind when analyzing reports.

Steroid medications, some medications for mental health disorders, certain heart conditions, kidney and liver issues, and other severe conditions can also cause changes in thyroid test results. Doctors consider all these factors before starting treatment based on thyroid reports.

In cases of thyroiditis, test results can be misleading. Sometimes patients may receive incorrect treatment based on test reports, as thyroiditis can mimic other thyroid disorders.

Pregnancy and Thyroid:

Thyroid problems during pregnancy often cause concern for many. Whether the thyroid hormone is high or low, it can cause problems for both the mother and the baby. Hyperthyroidism in the mother can lead to high blood pressure, abortion, preterm delivery, and growth restriction in the baby. Hypothyroidism can cause severe developmental issues in the baby's brain.

For those who have had thyroid problems earlier, it is best to get the condition completely under control before becoming pregnant. The target TSH levels for pregnant women and those planning to become pregnant are lower than normal. Even with a report that seems normal at a glance, it is important not to question why thyroid hormone medication (Thyroxin) is being prescribed by the doctor.

Congenital Hypothyroidism (Congenital lack of thyroid hormone)

The main cause of congenital hypothyroidism is when the thyroid gland does not develop properly or when the enzymes needed to produce thyroid hormone are absent at birth. In some cases, mothers with hyperthyroidism who take medications to reduce thyroid hormone levels may inadvertently cause hypothyroidism in the baby, as these medications can cross the placenta. If not identified in time, this can lead to serious problems in the baby’s brain development. That is why thyroid hormone testing is done on all newborns immediately after birth.

Signs of thyroid hormone deficiency in babies can include a swollen face, a large or sometimes outwardly protruding tongue, a weak appearance, a hoarse cry, constipation, difficulty breastfeeding, a bloated stomach, a hernia in the groin area, and a yellowish color in the skin.

Thyroid-related issues can occur in people of all ages and genders. The symptoms may sometimes be mild. Even if there is a slight doubt, it is best to conduct the necessary tests and clarify the condition.

"I think we should check his thyroid."

I said while looking at his neck, where I could clearly see a swollen thyroid gland, and his thyroid hormone levels were found to be very high in the blood test. It was Hyperthyroidism. After starting treatment, when I saw him a month later, the transformation was miraculous. The discomfort, lack of sleep, and scanning behavior had completely disappeared. His hand tremor was completely gone. He had even started gaining back the weight he had lost.

For those who are unaware, thyroid problems are of various types. The most common one people are familiar with is Hypothyroidism, a condition where the thyroid function is decreased. Many assume that thyroid disease only refers to Hypothyroidism. This is why when people visit a doctor, they often just mention that they are taking thyroid medication, without realizing there might be more to it.

The thyroid is a gland shaped like a butterfly located at the front of the neck. The thyroid gland controls many functions in the body, and an imbalance in thyroid hormones—either too high or too low—can cause various health issues. But is the thyroid alone responsible for its function? Absolutely not. The thyroid's work is regulated by another gland located in the brain, the pituitary gland. This gland controls the thyroid function by releasing a hormone called TSH. Additionally, the hypothalamus, another gland, also regulates the pituitary function.

This means that thyroid problems might not only arise from issues within the thyroid itself but also from problems in the regulation of hormones from the brain. If the levels of stimulation from the brain's glands (hypothalamus and pituitary) increase or decrease, you will see an impact on thyroid function.

Now, let's look at some diseases affecting the thyroid:

The most common thyroid disorder is Hypothyroidism, where thyroid hormone levels are low.

Autoimmune thyroiditis or Hashimoto's thyroiditis is the primary cause of Hypothyroidism. In this condition, the body's immune system mistakenly attacks and destroys the thyroid gland. If the iodine levels in the food are either too low or too high, it can lead to thyroid dysfunction. Even radiation therapy on the neck during cancer treatment, or surgery on the thyroid gland for other conditions, can cause thyroid function to decline. Certain medications used for heart disease, mental health issues, and other conditions can also disrupt thyroid function.

In rare cases, Hypothyroidism can occur due to inherited enzyme defects. Some forms of thyroiditis that are not autoimmune also impair thyroid function. Additionally, dysfunctions in the hypothalamus and pituitary glands, which regulate the thyroid, can also lead to Hypothyroidism.

What are the symptoms of Hypothyroidism?

A doctor with experience in long-term, severe Hypothyroidism can diagnose a patient just by observing them from a distance. If they speak a sentence or two, there's no need to look further.
The face soaked in sweat, dull eyes, unhealthy, easily falling out, lifeless hair, dry, flaky skin, and a face devoid of energy... Is the person speaking to you in a slow, gentle voice? You can be sure that their thyroid should be examined.

Below are some of the key symptoms:

• Excessive sleep and weight gain
• Swelling in the legs
• Water retention in the heart and lungs
• Constipation
• Menstrual irregularities
• Infertility
• Some muscles becoming abnormally enlarged
• Increased blood pressure, cholesterol, etc.

These symptoms may not appear in every patient. In some cases, only mild symptoms may be observed. For this reason, doctors often request thyroid tests to rule out thyroid-related issues if any of these symptoms are present.

Now, let's look at the condition called Hyperthyroidism, where there is an excess of thyroid hormones.

There are several causes for excessive production of thyroid hormones. The primary causes include:

• Graves' disease: The thyroid gland swells and produces more hormones.
• Toxic multi-nodular goiter: Multiple small nodules form inside the thyroid, producing excess hormones.
• Toxic nodule: A single nodule in the thyroid producing more hormones.
• Nodules in the pituitary and hypothalamus glands.
• Certain stages of thyroiditis disease.
• Rarely, nodules or cancers in other organs can lead to hyperthyroidism by producing thyroid hormones.

Symptoms: Recall the patient's case mentioned earlier. Hyperthyroidism is a condition where the body loses weight rapidly. The main symptoms are:

• Weight loss
• Muscle weakness
• Hand tremors
• Increased heart rate
• Eyes protruding
• Increased appetite
• Heart palpitations
• Frequent bowel movements
• Increased sweating
• Unexplained, prolonged fever

Not all patients will exhibit all these symptoms.

Thyroiditis: Thyroiditis is a condition where the thyroid cells temporarily or permanently get damaged, releasing stored hormones into the bloodstream. This condition may be caused by the body creating antibodies that destroy its own thyroid cells, certain viral infections, or some medications. Since the stored hormones are released all at once, the blood test during the initial stage of this disease may resemble that of Graves' disease. Sometimes, this leads to incorrect treatment being given. However, the treatment for Graves' disease is not needed for thyroiditis.

In the second stage, due to the damage caused to the cells, thyroid function slows down, and hormone levels drop, leading to hypothyroidism. After a few weeks, the thyroid cells may recover, and hormone levels return to normal. However, in a small percentage of cases, the cells may not recover, and the person will need to take thyroid hormone replacement tablets (Thyroxin) for the rest of their life.

Thyroid Nodules: Thyroid nodules are one of the most commonly found issues. They can cause significant concern for many individuals. Most thyroid nodules do not cause serious problems. Once confirmed that they are not problematic, they do not pose any special issue, and periodic checkups (once or twice a year) are enough. However, if a nodule grows excessively and presses on the trachea or surrounding areas, surgery to remove the nodule becomes necessary. For those who are concerned about the cosmetic appearance of a nodule in the front of the neck, it can also be removed through surgery.

What to do if a thyroid nodule is found?

Since most thyroid nodules are non-problematic, the main concern is the presence of thyroid cancers. A doctor's primary role is to ensure this is properly diagnosed. Although thyroid cancer is not very common, some types of thyroid cancer can be completely cured if treated early. It is distressing if it goes unnoticed.

By examining the thyroid gland manually, the nature of the nodule can often be understood. The next step is to check the thyroid hormone levels, followed by an ultrasound scan of the thyroid gland. The ultrasound can help clarify the type of nodule and whether there are any signs of cancer. If there are suspicious signs, a Fine Needle Aspiration Cytology (FNAC) test is required to take a sample. If cancerous cells are found, treatment according to the type of cancer is necessary.

Next, let's understand some key facts about thyroid function tests. These are very commonly conducted tests, and many misconceptions exist about them.

T3 and T4 are the primary hormones produced by the thyroid gland. When their levels decrease, it leads to hypothyroidism. When these hormone levels increase, it leads to hyperthyroidism. If thyroid issues cause the thyroid to produce excess T3 or T4 hormones, the body will attempt to counteract this by reducing the stimulation from the pituitary gland. In cases of hyperthyroidism, the report will show elevated T3 and T4 levels along with a low TSH level.

In hypothyroidism, the thyroid hormone levels (T3 and T4) drop, and the pituitary gland compensates by producing more TSH to stimulate thyroid hormone production.

Many people mistakenly think that TSH directly reflects thyroid function, assuming that high TSH means thyroid function is increased, and low TSH means thyroid function is decreased. This confusion is common when asking about the disease.

It is not always so simple to analyze thyroid tests. In cases where thyroid problems are caused by disorders in the pituitary or hypothalamus, the hormone report may not follow the usual patterns mentioned above. These thyroid problems are rare, and explaining them in detail here would be too complex.

Thyroid tests during pregnancy are another area with specific issues. Pregnancy can affect many hormones in the body, which can influence thyroid test results. It's important to keep this in mind when analyzing reports.

Steroid medications, some medications for mental health disorders, certain heart conditions, kidney and liver issues, and other severe conditions can also cause changes in thyroid test results. Doctors consider all these factors before starting treatment based on thyroid reports.

In cases of thyroiditis, test results can be misleading. Sometimes patients may receive incorrect treatment based on test reports, as thyroiditis can mimic other thyroid disorders.

Pregnancy and Thyroid:

Thyroid problems during pregnancy often cause concern for many. Whether the thyroid hormone is high or low, it can cause problems for both the mother and the baby. Hyperthyroidism in the mother can lead to high blood pressure, abortion, preterm delivery, and growth restriction in the baby. Hypothyroidism can cause severe developmental issues in the baby's brain.

For those who have had thyroid problems earlier, it is best to get the condition completely under control before becoming pregnant. The target TSH levels for pregnant women and those planning to become pregnant are lower than normal. Even with a report that seems normal at a glance, it is important not to question why thyroid hormone medication (Thyroxin) is being prescribed by the doctor.

Congenital Hypothyroidism (Congenital lack of thyroid hormone)

The main cause of congenital hypothyroidism is when the thyroid gland does not develop properly or when the enzymes needed to produce thyroid hormone are absent at birth. In some cases, mothers with hyperthyroidism who take medications to reduce thyroid hormone levels may inadvertently cause hypothyroidism in the baby, as these medications can cross the placenta. If not identified in time, this can lead to serious problems in the baby’s brain development. That is why thyroid hormone testing is done on all newborns immediately after birth.

Signs of thyroid hormone deficiency in babies can include a swollen face, a large or sometimes outwardly protruding tongue, a weak appearance, a hoarse cry, constipation, difficulty breastfeeding, a bloated stomach, a hernia in the groin area, and a yellowish color in the skin.

Thyroid-related issues can occur in people of all ages and genders. The symptoms may sometimes be mild. Even if there is a slight doubt, it is best to conduct the necessary tests and clarify the condition.