The Health series is presented by AdventHealth
A Conversation with Joel Kavan, DO, family medicine physician, AdventHealth Medical Group Primary Care at State Line
The butterfly-shaped thyroid—located in the front of the neck, just behind the Adam’s apple—is a little gland that does a lot. The thyroid is part of the body’s endocrine system that helps regulate important functions, such as metabolism, heart rate, body temperature, blood pressure, and how the body reacts to other hormones.
When the thyroid doesn’t produce the right amount of hormones—too little or too much—that’s when we notice symptoms of thyroid disease.
Joel Kavan, DO, a family physician with AdventHealth’s newest primary care office—opening this month at 103rd and State Line in Kansas City, Missouri—explains more.
What is thyroid disease?
The most common thyroid diseases are hypothyroidism, which is an underactive thyroid, and hyperthyroidism, or an overactive thyroid. Other diseases include thyroid nodules, thyroid cancer, thyroiditis, and goiter. A goiter as an enlarged thyroid gland usually due to one of the other above conditions. Thyroiditis is inflammation of the thyroid that can occur with certain conditions including viral infections, medications, trauma, radiation or autoimmune diseases such as Graves’ disease and Hashimoto’s thyroiditis.
What are the symptoms and how is it diagnosed?
Some symptoms of hypo- and hyperthyroidism overlap: fatigue, swelling, and weakness. But there are also distinct symptoms of each. Hypothyroidism results in decreased production of the thyroid hormones, creating symptoms of reduced metabolism, such as weight gain, constipation, hair loss, cold intolerance, depression, dry skin, irregular menstrual cycles, and memory or focus problems. Hyperthyroidism, on the other hand, is the result of an overactive thyroid gland and may cause weight loss, heart palpitations, anxiety, tremor, heat intolerance, diarrhea, and difficulty sleeping. As these symptoms can be common, blood testing is needed to confirm the diagnosis. The most sensitive test measures thyroid stimulating hormone, which tells the thyroid what to do.
Thyroid nodules, cancer, or a goiter may be found on clinical exam and further evaluated by laboratory testing or imaging. These may also be found incidentally on imaging when testing for other reasons, such as a CT scan of the chest.
What leads to underactive thyroid function (hypothyroidism)?
When hypothyroidism is caused by Hashimoto’s, the body produces antibodies that destroy the person’s own thyroid gland. Other causes of hypothyroidism include certain medications, pituitary gland tumor or dysfunction, radiation to the neck, thyroid surgeries, removal of thyroid gland for other reasons, postpartum thyroiditis, severe iodine deficiency, overtreatment of hyperthyroidism with medication, or post-radioactive thyroid treatment.
What leads to overactive thyroid function (hyperthyroidism)?
Hyperthyroidism can be caused by Graves’ disease when antibodies stimulate the thyroid stimulating hormone receptor leading to overproduction of thyroid hormones. Other less common causes include primary problems with the pituitary gland making increased thyroid stimulating hormone, toxic multinodular goiter, medications, viral infections, and certain cancers or tumors.
Is thyroid disease curable or a condition that needs to be managed?
Hypothyroidism can be managed by medications. Treatment with levothyroxine, the most common medication, is usually lifelong.
Hyperthyroidism can be more difficult to treat, and it requires additional testing with a radioactive iodine uptake scan, but is usually also managed with medication, at least initially. In some cases, the thyroid can become extremely elevated, called thyrotoxicosis, and additional medication may be needed to reduce heart rate and blood pressure. Hyperthyroidism is usually managed by an endocrinologist and can go into remission with oral medications but unfortunately may return. The condition can also be treated definitively with surgery or radioactive iodine after which the patient will likely need long-term thyroid medication for treatment of the now secondary hypothyroidism.
Other diseases, such as thyroid cancers, are usually treated with surgery. Benign nodules may be monitored and sometimes removed depending on their growth. People with removal of a majority of the thyroid gland may also need to be treated with medication long-term for secondary hypothyroidism.