THYROID GLAND DISEASES (GOITR):
The thyroid gland is a butterfly-shaped gland located just in front of the trachea, weighing 20-30 g on average, consisting of right and left lobes. It acts by swallowing and may be slightly larger in females than in males.
The thyroid gland produces hormones called T3 and T4 that regulate our metabolism. The production of these hormones is controlled by another hormone called TSH, which is secreted from our pituitary gland in our brain.
A decrease in the amount of thyroid hormone due to various reasons is called HYPOTHYROID, and an increase is called HYPERTHROID.
DIAGNOSIS AND TREATMENT OF HYPOTHYROID:
Definition: While TSH is high, fT4 and,or fT3 is low.
Symptoms: Depending on the degree of the disease, weakness, fatigue, weight gain, forgetfulness, low concentration, dry skin, constipation, hair loss, chills, thickening of the voice, irregular and heavy menstrual bleeding, infertility, depression, edema and can cause many different symptoms, such as muscle pain.
Causes:
Chronic autoimmune thyroiditis (Hashimoto’s Disease) (Most Common Cause)
Iodine Deficiency
Thyroiditis
Surgical or radioactive iodine therapy
Medicines used for other diseases
Hereditary
Due to aging.
Secondary Hypothyroidism (Pituitary Gland Diseases)
Diagnosis: After the patient’s history and medications are questioned, a manual thyroid examination is performed. Then, thyroid hormones (fT3,sT4,TSH), thyroid autoantibodies (Anti TPO and Anti TG), urine iodine level in necessary cases and Thyroid Ultrasonography test are requested from the blood.
Treatment: Thyroid hormone replacement is started at the dose needed for those with low hormone levels. Levothyron, Euthyrox and Tefor are pills that are used for this purpose and contain the thyroid hormone we call levothyroxine (T4). Patients should take their medications regularly at least half an hour before breakfast on an empty stomach. Selenium supplementation and non-iodized salt (Himalayan salt) are also recommended for eligible patients.
Follow-up: It is recommended that patients who are started on hormone replacement therapy have their hormone levels measured at intervals deemed appropriate by their doctor and, if necessary, the drug level should be adjusted.
DIAGNOSIS AND TREATMENT OF HYPERTHROID:
Definition: It is high fT4 and/or fT3 hormone while TSH is low.
Symptoms: Weakness, irritability, palpitations, shortness of breath, Weight loss, intolerance to heat, intolerance to crowds, anxiety, increased appetite, decreased menstrual bleeding, sweating, tremors in the hands, diarrhea, eye findings (specific to Graves’ Disease ) can cause many different symptoms, such as
Causes:
Graves’ Disease
Toxic nodular goiter
Pregnancy hyperthyroidism
Due to high-dose iodine intake
Thyroiditis
TSHOMA (Pituitary Adenoma)
Drugs used in the treatment of other diseases.
Refetoff Syndrome (Thyroid Hormone resistance)
Diagnosis: Thyroid hormones are first checked in a person with clinical symptoms. High levels of fT4 and fT3 hormones together with low TSH make the diagnosis of hyperthyroidism. In the second stage, tests are performed for the cause of hyperthyroidism. For this purpose, TSH receptor antibody, Thyroid Ultrasonography, Thyroid autoantibodies (Anti TPO and TG) and, if necessary, Thyroid scintigraphy and Uptake tests are requested.
Treatment: Anti-thyroid drugs (Propycil, Thyromazol) and symptomatic drugs (beta blockers), radioactive iodine therapy and surgical treatment are used in the treatment of hyperthyroidism. Which of these treatments will be applied is decided according to the cause of hyperthyroidism. For example, while drug treatment is preferred primarily in Graves’ Disease, radioactive iodine or surgical treatment is preferred in those with toxic nodules. In some cases, these treatments can be given together.
Follow-up: Treatment is continued for an average of 12-24 months in cases where anti-thyroid drugs are started for treatment. During this process, patients are kept under control by looking at various tests for the evaluation of side effects and efficacy of drugs within an average of 1-2 months. In cases where radioactive iodine is given for therapeutic purposes, since hypothyroidism may develop after treatment, hormone controls should be performed at regular intervals. Again, in patients undergoing surgical treatment, various levels of hypothyroidism may develop after the operation, depending on the type of surgery performed, and in this case, life-long thyroid hormone replacement is required.
THYROIDITS:
Definition: It is the name given to a group of diseases that progress with inflammation of the thyroid gland (inflammatory condition) or an inflammation-like picture.
Types:
Acute (suppurative) thyroiditis (Infective)
Subacute Thyroiditis: 1- Subacute granulomatous Thyroiditis (Painful)
2- Postpartum (pregnancy) after) Thyroiditis (Painless)
3- Subacute Lymphocytic thyroiditis (painless)
Chronic Thyroiditis (Hashimoto’s disease)
Fibrous Thyroiditis (Reidel Thyroiditis)
Radiation Thyroiditis
Drug-Induced Thyroiditis
Symptoms: Hashimoto’s disease, which is the most common cause, usually does not cause symptoms unless it is very advanced. When hypothyroidism develops due to hahimoto, patients present with symptoms related to low thyroid hormone. more rarely, it occurs in patients who present with enlargement of the thyroid gland (goiter).
Subacute Granulomatous Thyroiditis usually occurs days after a viral infection. It causes severe pain in the neck area where the thyroid gland is located, swelling in the thyroid gland, palpitations, sweating and shivering.
Acute Thyroiditis, which usually occurs with the infection of the thyroid gland by bacteria or fungi, results in symptoms such as pain in the neck, swelling on the thyroid gland, redness, fever, weakness and lymph nodes in the neck.
Postpartum Thyroiditis, on the other hand, is a non-painful condition that is seen in women in the first year after pregnancy and causes various levels of thyroid hormone disorder and associated clinical symptoms. There are both hyperthyroid and hypothyroid phases in the course of this disease, and clinical symptoms vary accordingly.
Fibrous Thyroiditis is extremely rare. Fibrosis develops in the thyroid gland. Due to this, the gland becomes very hard and can cause symptoms such as shortness of breath and difficulty in swallowing by pressing on the surrounding tissues in the neck.
After drugs such as Interferon alpha, Interleukin-6 and amiodoran, which are used in the treatment of various diseases, and after radiotherapy or radioactive iodine treatment applied to the neck area, destruction of the thyroid gland and related pain and symptoms of thyroid hormone disorder may occur.
Diagnosis: Thyroid Hormones, Thyroid autoantibodies (Antitpo and TG), Thyroglobulin, sedimentation, CRP, Hemogram, Thyroid Ultrasound and in necessary cases thyroid gland scintigraphy and Uptake tests are requested for the suspected cause and the results are obtained. treatment is planned accordingly.
Treatment: In general, thyroiditis is not treated with antithyroid drugs during the transient hyperthyroidism phase. During this period, methods such as beta-blocker therapy and an iodine-free diet are used to suppress the symptoms of hyperthyroidism. In the phase of hypothyroidism due to thyroiditis, thyroid hormone replacement is given for the required time and dose.
In painful thyroiditis (subacute granulomatous), firstly NSAID group drugs are given for pain control, if no response to this treatment, oral steroid treatment is started.
Antibiotic and antifungal treatments are used in acute infective thyroiditis.
Follow-up: Thyroiditis other than chronic thyroiditis usually resolves completely within a few months with appropriate treatment. During the active period of the disease, controls are made at appropriate intervals in terms of treatment effect and side effects.
