Patient Information - thyroid cancer, thyroid problems, hyperthyroid, hypothyroid, thyroid doctor, thyroidologist, Hypothyroid/Hashimoto's, Goiter

The influence of the thyroid gland is both far-reaching and critical to normal body function. It affects heart rate, cholesterol level, body weight, energy level, muscle strength, skin condition, vision, menstrual regularity, mental state and a host of other conditions. Despite its pervasive influence, however, the thyroid gland and its disorders are still not widely understood among the general public.

The thyroid is a butterfly shaped gland which wraps around the front part of the windpipe just below the Adam's apple. It produces hormones that regulate the body's metabolism and organ function. Thyroid hormone influences essentially every organ, every tissue and every cell in the body.

The most common thyroid disorder is an underactive thyroid, or hypothyroidism. This results when the thyroid fails to produce enough hormone. Less frequently, an overactive thyroid condition, or hyperthyroidism, occurs when the thyroid produces more thyroid hormone than is needed. If properly treated, patients with thyroid disorders lead normal, active lives. When left untreated, however, thyroid disorders can affect the patient's cardiovascular system, reproductive system and other major organs.

The thyroid gland operates as part of a feedback mechanism involving the hypothalamus and the pituitary gland. First, the hypothalamus sends a signal to the pituitary gland through a hormone called TRH (thyrotropin releasing hormone). When the pituitary gland receives this signal, it releases TSH (thyroid stimulating hormone) to the thyroid gland. Upon receiving TSH, the thyroid responds by releasing two of its own hormones, T4 and T3, which then enter the bloodstream and affect the metabolism of the heart, liver, muscle and other organs. T4 is the main hormone released by the thyroid. T3 is made in the tissue after T4 to T3 conversion. Finally, the pituitary "monitors" the level of thyroid hormone in the blood and increases or decreases the amount of TSH released, which then changes the amount of thyroid hormone in the blood.

The most common type of thyroid disorder, hypothyroidism (underactive thyroid) occurs when the thyroid gland fails to produce enough thyroid hormone -- hormones which influence essentially every organ, every tissue and every cell in the body. Hypothyroidism affects an estimated 11 million Americans, particularly women and the elderly.
In the U.S., the most common type of hypothyroidism is Hashimoto's disease, a condition caused when the immune system produces killer lymphocytes that destroy the thyroid. As the damaged thyroid gland produces less thyroid hormones, the pituitary gland secretes more thyroid-stimulating hormone (TSH) to encourage the thyroid to work harder. This increased demand on the thyroid may cause it to enlarge, resulting in what is commonly known as a goiter. Antibodies are produced that serve as a diagnostic test for Autoimmune Disease.

Careful monitoring of thyroid Hormone Therapy is needed to prevent thyroid cancer. TSH is a risk factor for thyroid cancer in Hashimoto's. High TSH can stimulate latent cancer to grow.

In the case of mild thyroid failure, patients often do not show obvious symptoms and thus may not even be aware of their condition. Left untreated, however, mild thyroid failure can progress to where symptoms begin to surface. Some of the signs and symptoms of hypothyroidism include:

Fatigue • Hoarse voice • Mood swings
Difficulty swallowing • Forgetfulness • Intolerance to cold
Dry, coarse skin and hair

Hypothyroidism may be difficult to detect because its often vague signs and symptoms are easily confused with other conditions, such as the natural aging process, menopause or stress. Many patients remain undiagnosed and untreated for years due to their lack of awareness of hypothyroidism and its signs and symptoms.

Fortunately, even mild hypothyroidism can be detected by a sensitive TSH (thyroid stimulating hormone) test, which enables physicians to identify thyroid disorders much earlier than with previous tests. By detecting hypothyroidism in its early stages, physicians may administer treatment and prevent the onset of symptoms.

New data has caused a change in the normal TSH range. Hypothyroidism is likely if TSH is >2.5, not 4 - 5 as was the prior upper limit.

The goal for treating hypothyroidism is to restore normal blood levels of thyroid hormone by replacing missing hormone. The treatment of choice for hypothyroidism involves supplementing the body's naturally produced hormone with a synthetic hormone tablet, levothyroxine sodium, which is generally taken for life.

After levothyroxine sodium therapy has been prescribed, periodic TSH tests are needed to monitor thyroid hormone levels. Because patient dosage requirements may change over time according to age, body weight, cardiovascular status and other diseases or medications, it is essential to monitor patients' medication needs on a regular basis. Monitoring precise dosages effectively prevents recurrence of symptoms of hypothyroidism and prevents over-replacement, which can in turn lead to hyperthyroidism.

Hypothyroid patients should not switch to different brands of levothyroxine sodium without consulting a physician. Both the American Association of Clinical Endocrinologists (AACE) and the American Thyroid Association (ATA) have released clinical guidelines recommending that patients be retested and their dosages adjusted accordingly if they switch levothyroxine sodium products. AACE further advocates that physicians treat patients with the same brand of levothyroxine throughout their lifetime. There is no place for Armour Thyroid in therapy. Beware of pseudoscientific non-diseases such as Wilson's.

Hyperthyroidism, a less common thyroid disorder, occurs when the thyroid gland becomes overactive and produces too much thyroid hormone. It affects approximately one to two million Americans, and is more prevalent among women, particularly those in their 30s and 40s. The most common form of this disorder is Graves' disease, the illness that affected Olympic athlete Gail Devers and former First Lady Barbara Bush. The cause of Graves' disease is unknown.

The spectrum of possible signs and symptoms resulting from an overactive thyroid includes:

Irritability/nervousness • Sleep disturbances
Muscle weakness/tremors • Enlarged thyroid (goiter)
Irregular menstrual periods • Heat intolerance
Weight loss • Vision problems or eye irritation

Treatment of an overactive thyroid may be complex and requires a long-term care plan. Once diagnosis is confirmed, treatment involves reducing the amount of thyroid hormone produced by the gland. Treatment methods for hyperthyroidism include antithyroid drug therapy, which blocks thyroid hormone production; radioactive iodine treatment, in which the overactive thyroid is disabled and reduced in size; and thyroid surgery to remove part or all of the gland, which is usually used to treat very young patients with Graves' disease and older patients with diseased thyroid glands.

Radioactive iodine therapy is currently the treatment of choice in most cases in the United States. Patients are given a dose of radioactive iodine that essentially "shuts down" thyroid hormone production. Normal hormone levels must often be restored through levothyroxine sodium tablets. These patients require careful lifetime management to ensure they are receiving the proper dosage of thyroid medication.

Surgery is a good option for some, especially if a nodule is present that is suspicious of FNA.

A Johns Hopkins University study published in the Journal of the American Medical Association proposes routine testing for mild thyroid failure among the general adult population. It concluded that periodic screening men and women 35 and older at regular intervals is as cost-effective a health strategy as screening for more common medical conditions such as high cholesterol or high blood pressure. In making this determination, the study involved the use of the test widely considered to provide the most accurate measure of thyroid gland activity the sensitive thyroid-stimulating hormone (TSH) test.

In the past, doctors were unable to detect thyroid disorder until a patient's symptoms were fairly advanced. With the sensitive TSH test, however, physicians are able to diagnose thyroid disorders at an earlier stage in many cases, even before patients begin to experience symptoms. TSH tests, due to their high degree of sensitivity, enable physicians to detect even slight abnormalities in thyroid function. Early detection and treatment of thyroid disorder allows physicians to prevent the onset of disease symptoms and curb potential organ effects for their patients.

Prior to the introduction of the TSH test, the standard blood tests for thyroid disorders measured the levels of thyroid hormones (T4 and T3) in the blood. Research showed, however, that these hormone levels could be within the normal range even when the thyroid was not functioning normally. The TSH test offers a marked advance by identifying the amount of thyroid-stimulating hormone produced by the pituitary gland, the organ that signals the thyroid gland to produce more or less T4 and T3 based on the body's need. In effect, the TSH test takes advantage of the "wisdom" of the pituitary gland, the organ that first recognizes thyroid dysfunction, and therefore provide a more exact measure of thyroid failure.

A TSH test is administered by drawing a small blood sample and sending it to a laboratory for analysis. The laboratory will read the level of TSH, and based on a reported normal value range, it will determine whether the level is below normal (hyperthyroid), above normal (hypothyroid) or within the normal range (euthyroid).

People who believe they may have a thyroid disorder should ask their primary care physician or an endocrinologist to have their TSH level assessed. In support of this precise tool for measuring thyroid activity, the American Association of Clinical Endocrinologists released clinical practice guidelines strongly advocating the use of TSH tests for diagnosing thyroid conditions.

Beyond disease diagnosis, TSH tests play a critical role in helping physicians manage thyroid disorders. In this capacity, TSH tests are used to determine precise medication treatment dosages for patients with hypothyroidism and hyperthyroidism, as well as to monitor changes in dosage requirements over time.

What is a thyroid nodule?
A nodule is a small lump, or localized growth in part of the thyroid gland. It differs from a goiter, which is an enlarged thyroid gland. However, an enlarged thyroid gland (goiter) may contain one or more nodules. A nodule is an area of the gland that appears to be different than the rest by being raised or a different texture. Nodules are very, very common. In most cases they are not cancerous, but a physician should evaluate them all. These growths may be fluid filled (cysts) or solid and formed of thyroid tissue. They may be mixtures of solid and cysts and can bleed into themselves and appear to enlarge in a matter of hours. Nodules can be very small, less than a millimeter, or as large as a few inches. They can occur alone or with others of different sizes in the same gland. Nodules are not a disease, but are a sign of an underlying problem in the thyroid gland. The cause of the nodules needs to be determined.

What causes a nodule?
Between 90-95% of all nodules are benign, noncancerous overgrowths of thyroid tissue. Only about 5% are cancerous. Because of the chance of a nodule being cancerous, all nodules should be fully evaluated. The causes of the benign nodules include a cyst (collection of fluid), thyroid tissue that is overactive (hyperactive nodule), or many growths in an enlarged thyroid gland (multinodular goiter).

What are the symptoms of a thyroid nodule?
Most often they have no symptoms, but can press against the neck and cause a sensation of a lump in the throat, difficulty swallowing, hoarseness or a cough. A nodule can produce excess thyroid hormone (hyperactive nodule) and symptoms of hyperthyroidism - fast heart rate, weight loss, feeling jittery or nervous, diarrhea, tremor. Nodules are sometimes found in a thyroid gland that is underactive, a condition known as hypothyroidism. Symptoms of hypothyroidism include slow heart rate, weight gain, constipation's, depression and fatigue.

How common are nodules in the thyroid?
In a word - VERY. It is estimated that about 50% of the population will develop a small, unnoticeable thyroid nodule at some time in their life. Most nodules are never detected and do not cause problems. In fact they are only found by doing an ultrasound, many nodules are found while doing a CT scan or MR for other reasons. This is called a thyroid nodule incidentaloma. Only 4-7% of the population will have a nodule that is large enough to be found by a physician feeling, or palpating, for it. They are more common in women and the incidence of nodules increases with age. About 4% of women aged 20 years have a palpable nodule whereas 9% of women over age 70 have a palpable nodule. Nodules are only found in about 1% of men.

How do I tell if I have a nodule?
You can check your own thyroid by standing in front of a mirror. Look at the area of your neck just above the notch where the collarbone comes together and just below the Adam's apple. This is where the thyroid gland is located. If possible, have a light shine from the side to throw a shadow over the area. Then tilt your head back slightly and watch this area for any shadows while you swallow. If you see any prominence or enlargement in this area, you may have a thyroid nodule or an enlarged thyroid gland (goiter). See your physician for a more complete check up. You should also have your thyroid gland area examined during a general physical examination by a medical care provider.

What should I do if I have a nodule?
If you have a nodule, you should have it evaluated by a physician trained in the diagnosis and management of thyroid nodules. Endocrinologists, Clinical Thyroidologists, internal medicine specialists, ear, nose and throat specialists, and endocrine surgeons are experienced in assessing nodules. The doctor will take a careful history for risk factors for thyroid disease (including radiation exposure), do a physical examination and order blood tests to check the activity of the gland. In most cases, the best approach is to have a small aspiration of the nodule done, a procedure called a fine needle aspirate (FNA). An ultrasound test may be performed to accurately measure the nodule and check for others in the gland. A thyroid scan may also be recommended to see if the nodule is overactive (a "hot" nodule) or inactive (a "cold" nodule). These tests are not dangerous nor particularly painful. The most accurate test is the fine needle aspirate, which should be done with at least six samples from each nodule. The use of ultrasound to guide the needle into the nodule is the test of choice for accurate results.

Does radiation cause nodules?
Certain forms of radiation have been associated with increased risk of cancerous nodules in the thyroid. The risk is small and you have to be exposed to very high amounts of radiation, not the amounts that occur with regular x-rays or sun exposure. Radiation at Hiroshima, Chernobyl, and nuclear weapons testing in the US in the 1940-1970s have all been associated with increased risk of thyroid nodules and cancer. Regular x-rays or dental x-rays are not a known risk factor. However, if you had radiation treatments to your head, neck, tonsils, or thymus, you may be at a slightly increased risk of thyroid cancer. If you are concerned that you had exposure, see your doctor for a check up for thyroid nodules.

How is a nodule treated?
The treatment of a nodule depends upon its cause. If the fine needle aspirate from your thyroid nodule shows benign, non cancerous cells, then the nodule may just be watched to make sure that it does not grow larger. You may also be advised to take thyroid hormone to suppress the activity of the gland so that it does not grow other nodules. If it grows larger, you may need another biopsy. If the biopsy is inconclusive or indeterminate, it will be repeated. If the second biopsy comes back indeterminate, then you may be advised to have it removed surgically. This was the case with the Vice-President's wife, Tipper Gore. She had two thyroid biopsies that were indeterminate and then she had part of her thyroid removed. Like most people, her nodule was not cancerous. If the fine needle biopsy is suspicious for cancer, then surgical removal is recommended. If you are advised to have surgery, then make sure that your surgeon is very experienced with thyroid gland surgery and has done at least 50 surgeries a year.

What if my nodule is cancer?
In the rare case that your nodule is cancerous, most often it is curable. Surgery is the main way to remove the cancerous nodule. Before surgery an ultrasound of the neck lymphoid may reveal cancer spread to the nodes. An ultrasound guided FNA of the node and Thyroglobulin washing can change the extent of surgery 40% of the time. Afterwards, you will take thyroid hormone tablets to replace the hormones made by your removed thyroid and to suppress the cancer cells' growth in any remaining cancer thyroid tissue. You will be followed closely afterward, preferably with marker Thyroglobin (TG), and ultrasensitive TSH testing, and may be treated with radioactive iodine to destroy any remaining thyroid tissue so that it does not develop cancer. Some forms of thyroid cancer run in families, so if this type is identified, then you may be advised to have other family members checked. Neck ultrasound and TG are the best follow up methods for long-term cancer control.

American Association of Clinical Endocrinologists - Clinical Guidelines: Cancer, Hypothyroidism, Hyperthyroidism, Nodules

Asia and Oceanic Thyroid Association
Department of Nuclear Medicine
Kyoto University of School of Medicine
Kyoto 606-01, Japan
Phone: 81-958-49-7260 Fax: 81-958-49-7270

Cross Town Endo Club
A Los Angeles association of physicians and scientists with an interest in endocrinology.

European Thyroid Association
Thyroid Unit - HCUG
Rue Micheli-Du-Crest, 24
1211 Geneva 14, Switzerland
Phone: 41-22-372-9195 Fax: 41-22-347-6468

Latin American Thyroid Society
Endocrinology/Medicine
Escola Paulista de Medicina
Universidade Federal de Sao Paulo
Caixa Postal 20266
04034-970 Sao Paulo, SP, Brazil
Phone: 55-11-571-9826 Fax: 55-11-575-0311

Light of Life Foundation for Thyroid Cancer Patients
32 Marc Drive
Englishtown, NJ 07726
Phone and Fax: (732) 536-4824

The Thyroid Society - A non-profit organization whose mission is to pursue the prevention, treatmeant, and cure of thyroid disease.
7515 South main Street, Suite 545
Houston, TX 77030
Phone: 1-800-THYROID (1-800-849-7643) or 713-799-9909

Thyroid Foundation of Canada
1040 Gardiners Rd., Suite C
Kingston, Ontario K7P lR7
Phone: (613) 634 3426
In Canada: (800) 267 8822
Fax: (613) 634 3483

Gland Central - a comprehensive web resource dedicated to your thyroid health.

AOL Cancer Forum
Thyroid Cancer Support Group
Meets on Monday nights and has over 50 Members.

Synthroid - Knoll Pharmaceutical's information site about Synthroid, a synthetic thyroid hormone that is identical to one of the hormones produced by the thyroid gland.

Thyca.org - Thyroid Cancer Survivors' Association, Inc.

Univ. Doz. Dr. Georg Zettinig, Austrian thyroidologist at the Department of Nuclear Medicine, University of Vienna,
Practice Home Page: schilddruesenpraxis.at
Private Homepage: nuklearmedizin.org

The Bridge
Thyroid Foundation of America Newsletter
Ruth Sleeper Hall, RSL 350
40 Parkman St.
Boston, MA 02114-2698
Phone: (800) 832 8321
Become a member of the TFA for $25. Student and senior citizen membership is $15. This includes a subscription to their newsletter, mailings with updated information on various conditions, names of endocrinologists in your area, and information on relevant books and publications. They also distribute a series of brochures on thyroid topics.

Thyroid Connection
Available directly from: Thyroid Society for Education and Research
7515 South Main Street, Suite 545
Houston, TX 77030 Phone: (800) 849 7643

Dr. Guttler, thyroid cancer expert, states there is a link now between thyroid and his other main passion, wine.

The skins of red wine grapes contain Resveratrol, in high concentration. It is therefore found in high concentration in red wine, but not white wine. 3 mgs/liter is found in red wine. This can stop cancers cells from growing. Thyroid cancer cell growth was inhibited by the substance Resveratrol, found In red wine. Both papillary and Follicular carcinoma cell lines were inhibited.

The Journal of clinical endocrinology 87:1223-1232 2002, by Ai Shih F.B.Davis H.Lin, and Paul Davis.

Tipper Gore, became the third resident of the Blair House (the vice-president's residence) to suffer from thyroid problems. Both President George Bush and First Lady Barbara Bush suffered from hyperthyroidism. Even their dog Millie had thyroid disease. Tipper's recent surgery to have her thyroid gland removed because of a nodule has raised awareness of the thyroid in general and thyroid nodules in particular.

Hillary Clinton’s Thyroid, according to the February 20, 2001 article in the “Star” by Pat Gregor, Hillary Clinton’s recent decline in appearance is due to a thyroid problem. Hillary’s reps said her decline in appearance is due to hard work and not spending time in front of mirrors.

Experts said her symptoms, which include fatigue, sluggishness, weight gain, cold intolerance, headaches, dull glaze, slightly bulging eyes, puffy face, and brittle hair, point to a thyroid disorder. The New York Thyroid Centers adds sensitivity to bright light to these symptoms.

Their sources said that during her New York Senate campaign she had a prescription for 175 micrograms of Synthroid filled. According to a leading endocrinologist, Synthroid is the drug of choice when the thyroid, a gland in the neck, becomes underactive.

Insiders close to Hillary said that she has been suffering from headaches and prior to the inauguration she had the window drapes drawn because the sunlight coming through was so painful that she was getting nauseous. It was also reported that her Senate colleagues were so concerned that she was suffering a chill, they asked if she wanted the thermostat turned up.

A friend is quoted as saying “Hillary tends to ignore her health. She just pushes it back into the recesses of her mind and says she'll do something about it later. We just hope she doesn't wait too long.”

Rod Stewart, underwent surgery to remove a cancerous growth from his thyroid gland early last year at Los Angeles’ Cedar-Sinai Medical Center. The tumor was picked up after a routine scan.

Stewart expected to regain his voice in about six months. Although he could talk, it took about nine months to regain his singing voice. He said he had to retrain his voice and learn how to sing all over again because his throat muscles had withered. When his voice eventually returned it was warmer than before the surgery.

Stewart, father of five, has agreed to become a spokesman for the City of Hope children's cancer charity. He has auctioned off several personal items online and will play several concerts to raise funds for research and treatment. Stewart is also committed to raising public awareness and making tests for thyroid cancer a routine part of their lives.

Thyroid cancer is rare and affects women more often than men. It is treated through surgery, radiotherapy or drinking radioactive iodine. “Most thyroid cancers are highly treatable and with excellent outcomes, particularly if they're detected early,” says Dr. Paul S. Jellinger, president of the American Association of Clinical Endocrinologists (AACE).

Julia Child, had a Goiter when this cover photograph was taken in the mid 1940's. She had surgery to remove the enlarged thyroid after world War II.

Isaac Asimou, author, had Thyroid Cancer.

We have provided this information to help answer some of the questions a thyroid nodule can raise, along with a bump in your neck.

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