Symptoms of problems with thyroid: what to pay attention to

With respect to the symptoms of thyroid disorders, Dr. Masu specifies: “This is a complex question, as precisely because the thyroid gland regulates a variety of aspects of the body, from sleep to respiration, from metabolism to cardiovascular activity, alterations (excess or deficiency) in thyroid hormone production have very broad and diverse clinical manifestations (symptoms).” 

The symptoms also vary depending on the issue encountered, which may be functional (i.e., due to altered thyroid function) or structural (changes in the structure of the gland). 

Functional problems include: 

• hypothyroidism: characterized by insufficient production of thyroid hormones, resulting in a slowdown in the body's metabolic processes and even serious health effects, especially in fetuses/newborns; 
• hyperthyroidism: derived from excess circulating thyroid hormones, resulting in general hyperfunctionality and improper acceleration of the body's metabolic processes.

In contrast, structural problems include:

• nodules: solid formations that develop within the thyroid gland;
• goiter (or struma): enlargement of the thyroid gland, or an increase in its volume, which may also be due to the presence of one or more thyroid nodules.

Symptoms of hypothyroidism

In most cases, hypothyroidism is acquired, that is, it manifests in adulthood due to various causes (iodine deficiency; taking drugs such as lithium and amiodarone; a treatment with radioactive iodine; thyroid removal), but there is also a congenital form, that is, present from birth.

At an early stage, acquired hypothyroidism may run asymptomatic. Later, clinical manifestations, which vary according to age of onset, severity and duration of disease, may occur, such as:

• fatigue and drowsiness;
• weight gain;
• cold intolerance;
• constipation;
• hoarse voice;
• memory loss and difficulty concentrating;
• muscle weakness and cramps;
• hypercholesterolemia;
• irregular menstrual cycle;
• brittle and thin hair;
• depression;
• osteoporosis;
• anemia (long-term complications).

Symptoms of hyperthyroidism

Hyperthyroidism occurs particularly in young people, between the ages of 20 and 40 (it can result from causes such as Basedow-Graves disease: a form of autoimmune thyroiditis, thyroid nodules, drugs such as interferon and amiodarone, thyroiditis, etc.), characterized by the release of hormones stored in the thyroid gland into the bloodstream in excessive amounts. Symptoms associated with this condition include:

• sudden weight loss;
• increased appetite;
• tachycardia;
• palpitations;
• anxiety, nervousness;
• fever;
• restlessness and irritability;
• tremors;
• intense sweating;
• irregular menstrual cycle;
• heat intolerance;
• fatigue and muscle weakness;
• sleep disturbances;
• Graves' ophthalmopathy (abnormal protrusion of the eyes, manifested by Basedow-Graves' disease).

Symptoms of thyroid nodules

Thyroid nodules very often turn out to be asymptomatic and are detected purely by chance, then turning into incidentalomas, i.e., nodules accidentally identified during other examinations, such as a supra-aortic vessel echocolordoppler or an MRI of the spine, and in most cases are benign.

If, however, symptoms related to the presence of one or more nodules occur, they may be:

• difficulty swallowing and/or breathing;
• sense of constriction in the neck.

Nodules can also result in excess production of thyroid hormones, thus leading to hyperthyroidism.

Symptoms of thyroid goiter

Thyroid goiter can very often depend on iodine deficiency. Its most common manifestation is a swelling at the base of the neck, externally visible, but asymptomatic or accompanied by general symptoms of a compression on the trachea and esophagus such as:

• difficulty breathing and/or swallowing;
• feeling of constriction in the throat;
• coughing or hoarseness.

Symptoms of Hashimoto's thyroiditis

Autoimmune thyroiditis represents the most common diseases affecting this gland and is the leading cause of hypothyroidism. These are diseases due to an abnormal production by the body of antibodies directed against the thyroid gland itself, causing inflammation of the gland, which can result in hypo- or hyperthyroidism. 

The most common of these thyroid diseases is Hashimoto's thyroiditis, which is linked to a family predisposition and can occur at any age. This condition can remain silent even for years, with progressive destruction of the gland, while sometimes the process is so abrupt that it causes the release of an excessive amount of thyroid hormone (thyrotoxicosis) into the bloodstream, which can manifest with symptoms similar to hyperthyroidism. 

Thyroid evaluation is performed as a screening at the time of birth. It should, then, be performed:

• in anticipation of pregnancy and during all 9 months;
• in individuals with a family history of thyroid disease;
• in persons suffering from vitiligo, type 1 diabetes, and autoimmune diseases in general.

Functional evaluation can be performed in the presence of characteristic symptoms after clinical evaluation by the endocrinology specialist. 

The majority of thyroid cancers have a controllable course and are not a cause of death or disability. Some rare malignancies, such as bone marrow cancer, are hereditary in nature and have high malignancy, so performing preventive checks, during treatment and as follow-up, including post-healing, is essential. 

Diagnosis of thyroid disease generally comes through a blood test done to assess FT3 and FT4 hormone levels and TSH levels. An ultrasound and blood assay of anti-thyroid antibodies (anti-thyroglobulin and anti-thyreoperoxidase antibodies) may also be performed on the specialist's instructions.

Ultrasound allows us to assess the morphological appearance of the thyroid gland, thus confirming or not the presence of potential nodules identified by the physician through palpation in the neck. In any case, it should not be used as a screening tool.

In case the endocrinology specialist suspects a risk of malignancy, he/she may possibly request an in-depth study with needle aspiration: cell sampling with cytological analysis.

Compared with hypothyroidism, early diagnosis is even more important for hyperthyroidism, so a specialist endocrinological examination is essential in these cases to assess the general clinical picture and the symptoms experienced. 

Most thyroid diseases are chronic, and this applies to both rare congenital diseases and more common acquired diseases such as autoimmune diseases. For this reason, long-term or lifelong therapies are required, which in most cases allow full wellness. Below are the specifics of the most common individual issues encountered.

Treatments for hypothyroidism

The standard approach for the treatment of hypothyroidism is based on hormone replacement therapy, which is the oral administration of the deficient thyroid hormone, levothyroxine. 

It is also important in these cases to report to your doctor whether you are taking drug therapy, supplements and your eating habits, as some drugs, supplements and foods can inhibit the absorption of this hormone (e.g., soy, papaya, oats, iron supplements, cholestyramine, calcium, aluminum hydroxide etc.).

Treatments for hyperthyroidism

Hyperthyroidism therapy should be individualized according to:

• triggering cause;
• patient characteristics (age, medical history, severity of symptoms).

In the presence of this condition, it is first appropriate to limit the intake of iodine, which is present in certain supplements and foods (iodized salt, seaweed, shellfish, or other foods indicated by the doctor).

Depending on the clinical picture, standard therapy is medication with antithyroid drugs, but in case these are not indicated or are ineffective, it could also include:

• radiometabolic therapy (with radioactive iodine);
• surgical intervention (thyroidectomy).

Treatments for nodules

Based on the evaluation method, the following specific therapies will be performed:

• benign, nonfunctioning, and small: periodic observation and monitoring;
• benign, enlarged or hyperfunctioning: possible surgical therapy or radiometabolic therapy with iodine;
• with features suspicious of malignancy: a multidisciplinary evaluation is performed with the surgeon. In 90% of cases, surgery leads to definitive healing, sometimes in the case of invasive forms it may be combined with radiometabolic therapy.