Diagnosis and Treatment of Thyroid Problems

You should work with your doctor to treat any thyroid problem.

For thyroid disorders stemming from the over- or under-production of thyroid hormones, you want to try to restore the hormone levels to their proper balance. Hyperthyroidism needs treatment that will slow down the making of thyroid hormone, while hypothyroidism needs hormone replacement.

Drugs and surgery are usually effective ways to adjust hormone levels. Other treatments, including diet supplements, herbal remedies, and special exercises, may relieve some of the discomfort and help the thyroid gland work better.

Before they decide which treatment is best for you, your doctor will consider your particular thyroid condition as well as your age, general health, and past medical issues.

Blood Tests

Your doctor can diagnose hyperthyroidism and hypothyroidism by testing the levels of thyroid hormones in your blood. The tests measure hormones from the thyroid itself, as well as thyroid-stimulating hormone (TSH), a chemical released by the pituitary gland that triggers your thyroid.

When you are hypothyroid, you have higher TSH levels because your body is trying to tell your thyroid to make more hormones. The reverse is true with hyperthyroidism: TSH levels are below normal and thyroid hormone levels are high.

One uncommon type of thyroid cancer can be diagnosed through a blood test that measures levels of a hormone called calcitonin that's needed to build bones.

Iodine Uptake Tests

Doctors often use this to identify the cause of hyperthyroidism. It tracks the amount of iodine absorbed by the thyroid gland. We get this mineral from the foods we eat. It's a key ingredient of thyroid hormone, so the amount of iodine your thyroid absorbs is a good way to tell how much hormone the gland is making.

First, the doctor places a device over your neck to measure how much background radioactivity there is. Then, you swallow a small amount of radioactive iodine in a liquid or as a capsule. After a time, usually 4-6 hours and at most 24 hours, the doctor takes another measurement to see how much of the radioactive iodine has gathered in your thyroid.

When the gland has a lot of iodine, the doctor may do a radioactive iodine uptake scan. They'll use a special film to make a picture that shows the exact location of the radioactive iodine in your thyroid.

Iodine collecting in nodules suggests that they're responsible for the extra hormone. If the scan shows that the iodine is spread throughout the gland, the whole thyroid is involved.

Nodules

Nodules that appear suddenly are typically fluid-filled sacs. Your doctor can check them with an ultrasound exam. Depending on a nodule's size, how it looks on ultrasound, and your chances for getting thyroid cancer, your doctor may do an aspiration or biopsy. They'll take a tissue sample of the nodule and examine it. Further tests will show if the nodule has the potential to become cancerous.

You should get regular checkups when you have a nodule on your thyroid gland.

Subacute Thyroiditis Treatment

Although subacute thyroiditis can bring on temporary hyperthyroidism, this condition doesn't require medical treatment.

You can take acetaminophen or aspirin for any pain from the inflamed thyroid. (Children under age 19 shouldn't take aspirin because it's been linked to Reye's syndrome.) If over-the-counter drugs don't help, your doctor may prescribe anti- inflammatory drugs like prednisone or dexamethasone for a short time.

Hyperthyroidism Treatment

Thyroid hormone production can be slowed or stopped completely with:

• Radioactive iodine treatment
• Anti-thyroid medication
• Surgery

If your doctor decides that radioactive treatment is best, you'll swallow a tablet or liquid with enough radioactive iodine to damage the cells of your thyroid gland so they can't make hormones. Sometimes you'll need more than one treatment to cut back hormone production to a normal level. Many people develop hypothyroidism as a result of this procedure.

After you start using anti-thyroid medications, your symptoms should begin to disappear in about 6-8 weeks. But you'll typically need to keep taking the medication for about a year. At that time, your doctor will check to see if you can stop. You'll need regular checkups once you're off the medicine to make sure your hormone levels stay balanced.

Doctors don't usually do surgery unless you're pregnant (and can’t take anti- thyroid medicine) or have a large goiter or cancerous nodule.

Hypothyroidism Treatment

Someone with hypothyroidism will have to take thyroid hormone replacement for the rest of their life. No surgery, drugs, or complementary medicine can boost your thyroid once it slows down.

Doctors generally prescribe man-made forms of thyroid hormone, such as levothyroxine. Side effects are rare, but some people have nervousness or chest pain while taking these drugs. Adjusting the dose of medication usually gets rid of any unpleasant effects.

Let your doctor know about everything you're taking, because some things could affect how well the medication works:

• Diabetes
• Antidepressants
• Estrogen in hormone replacement therapy or birth control
• The blood-thinning drug warfarin
• The heart drug digitalis
• Supplements and products with magnesium, aluminum, iron, or soy

Thyroid Cancer Treatment

The first way to treat thyroid cancer is usually by removing either the cancerous tissue or the whole thyroid gland, a surgical procedure known as a thyroidectomy.

If the cancer has spread, any other affected tissue, such as the lymph glands in the neck, will be removed, too.

Complementary and Alternative Medicine

Some people try other therapies to cleanse the body, restore immune function, and balance the production and release of hormones. You should talk to your doctor if you're interested in these other methods to make sure they won't harm you or interfere with your treatment.

A naturopath may use homeopathic mixtures, herbs, preparations based on traditional Chinese medicine (which links thyroid problems to emotional distress), and acupuncture to remove blocks to your ''life force energy.'' Naturopaths are authorized to treat thyroid disease in some states, but in others, it's illegal. While they may help with the stress associated with thyroid disease, there are no good studies showing that these therapies are effective for treating thyroid disorders.

Chiropractors use spinal manipulation to treat symptoms of thyroid disorders by easing muscle tension and improving blood circulation.

Diet and Nutrition

Protein, calcium, magnesium, and iodine help your thyroid work. Make sure you're getting plenty of all the B vitamins, vitamin A, and vitamin C.

If you don't have enough iodine in your system, taking selenium can cause hypothyroidism.

Avoid these products:

• Pseudoephedrine (found in over-the-counter cold remedies) can cause nervousness, insomnia, headache, and high blood pressure.
• Alkaloids, including caffeine, morphine, and quinine, can raise your blood pressure and heart rate.

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