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  • Writer's pictureDr Jesse Hu

Thyroid Disorder, Thyroid Nodules & Goitres - Are They The same?

Updated: Aug 29, 2023


Thyroid conditions and thyroid treatment

Yes and no.


They are all used to describe conditions associated with the thyroid gland.


So, what is the thyroid gland?


The thyroid is a small butterfly-shaped gland in the neck, just in front of the windpipe (trachea). We have many different glands in the body which produces different types of hormones.


Hormones are your body's chemical messengers. They travel in your bloodstream to tissues or organs. They work slowly, over time, and affect many different processes, including:

  • Growth and development

  • Metabolism - how your body gets energy from the foods you eat

  • Sexual function

  • Reproduction

  • Mood

Endocrine glands, which are special groups of cells, make hormones. The major endocrine glands are the pituitary, pineal, thymus, thyroid, adrenal glands, and pancreas. In addition, men produce hormones in their testes and women produce them in their ovaries.


The thyroid gland is one of the most superficial endocrine organ as it lies in the front of the neck and also one of the commonest that causes problems.


When we talk about thyroid disorders, they are be broadly classified into hormonal imbalances (thyroid disease) and structural abnormalities (thyroid nodules and goitres). Both conditions can occur simultaneously or independent of each other. It is important to distinguish the two as the treatment is vastly different.


We shall first look into thyroid disorders caused by hormonal imbalances.


The thyroid gland produces hormones called thyroxine that affect things such as your heart rate and body temperature.


Hyperthyroidism

Having too much of thyroxine results in a condition called hyperthyroidism. Hyperthyroidism speeds up the body's metabolism and that can cause many symptoms, such as weight loss, hand tremors, and rapid or irregular heartbeat.


Other symptoms of hyperthyroidism include:

  • Pounding of the heart, sometimes called heart palpitations.

  • Increased hunger.

  • Nervousness, anxiety and irritability.

  • Tremor, usually a small trembling in the hands and fingers.

  • Sweating.

  • Changes in menstrual cycles.

  • Heat intolerance

  • Changes in bowel patterns, especially more-frequent bowel movements

  • Tiredness.

  • Muscle weakness.

  • Sleep problems.

  • Warm, moist skin.

  • Thinning skin.

  • Fine, brittle hair.

Thyroid Nodules
Source: Cleveland Clinic

There are many causes of hyperthyroidism and some are associated with structural abnormalities in the thyroid gland. When a part of the thyroid gland is enlarged and forms a lump, it's called a thyroid nodule. A goiter is an enlargement of the thyroid gland itself and may be due to general enlargement of the gland or enlargement due to the presence of multiple nodules (called multinodular goitre).


Diagnosis is made by a blood test which will show a high thyroxine (T4) level and low thyroxine-stimulating hormone (TSH) level. Additional blood tests such as TSH-receptor antibodies (TRAB) and anti-TPO levels may be needed to aid in diagnosis the cause of hyperthyroidism. Ultrasound thyroid is also used to look for any nodules and radioiodine scan is used to look for any "hot nodules". Hot nodules are thyroid nodules which are hyperactive, secreting a large amount of thyroxine resulting in hyperthyroidism.

Goiter and the thyroid gland

The initial treatment is invariably medication to control the hyperthyroidism. The common medication used includes anti-thyroid medication (such as carbimazole and propylthiouracil) to stop the thyroid gland from making too many hormones. Sometimes, beta-blockers are added in the initial phase to help control the symptoms while waiting for the anti-thyroid medication to work.


The treatment course usually lasts 12-18 months and for some people, the anti-thyroid medicine puts hyperthyroidism into long-term remission. But other people may find that hyperthyroidism comes back after this treatment.


For those patients with recurrence, options include continuation of anti-thyroid medication, radioiodine ablation and surgery to remove the thyroid gland (thyroidectomy). People who have a thyroidectomy or radioiodine therapy need lifelong treatment with the medicine levothyroxine which supplies the body with thyroid hormones.


Hypothyroidism

The other end of the hormonal imbalance is underactive thyroid gland (hypothyroidism). This tends to manifest slowly due to slowing of metabolism and results in:

  • Tiredness.

  • Cold intolerance

  • Constipation.

  • Dry skin, coarse hair and skin, thinning hair.

  • Weight gain.

  • Puffy face.

  • Hoarse voice.

  • Muscle weakness, muscle aches, tenderness and stiffness.

  • Menstrual cycles that are heavier than usual or irregular.

  • Slowed heart rate, also called bradycardia.

  • Depression.

  • Memory problems.

Diagnosis is also by blood test to evaluate the thyroid function which will show a low thyroxine (T4) and high thyroxine-stimulating hormone (TSH) level. Treatment is by taking oral levothyroxine daily.


Structural Disorders of the Thyroid Gland

Lastly, we will touch on the structural disorders of the thyroid gland. The term thyroid nodule refers to an abnormal growth of thyroid cells that forms a lump within the thyroid gland. When there are many nodules in the thyroid gland causing the whole gland to be enlarged, it's called multi-nodular goitre. Although the vast majority (>95%) of thyroid gland are benign (non-cancerous), additional tests are sometimes needed to aid in evaluation.


The first step in evaluation of the thyroid gland involves a thyroid ultrasound.


The thyroid ultrasound helps to determine the number of nodules, the size and the characteristics of the nodules. Some thyroid nodules are cysts, which are fluid-filled cavities in the thyroid. These are usually benign and most commonly result from degenerating thyroid adenomas. Some thyroid nodules are solid and have certain features on ultrasound that suggest a more sinister cause. In such cases, we will need to a fine needle aspiration cytology (FNAC) to obtain some cells from the nodule itself to determine whether it is cancerous. Depending on the results of the thyroid FNAC, the surgeon may recommend observation, repeating FNAC or surgery (diagnostic lobectomy) to remove part of the thyroid gland.


If you are looking for help for thyroid-related issues, drop us a message and make an appointment with our specialist today!




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