Thyroid

I’m writing to tell you about another ‘metabolically relevant’ part of the body, that people talk a lot about. A majority of the women I’ve known have told me that they suffer from thyroid problems. The overweight ones try to justify their bulginess, and the skinny ones, why they won’t put on any weight. Both of these statements could be true, but in many cases are not. However, two things need to be acknowledged, it’s mostly the women who get struck by thyroid problems, in the ratio of something like 4 : 1 as compared to men. And that thyroid issues are pretty much common, rarely checked & not very well understood.

The thyroid is a small 2 inch gland which sits in the front part of the neck, just above the larynx or the voice box. It’s shaped like a butterfly, with two equally sized distinctive lobes on either side of the food pipe. As a part of the endocrine system it releases some hormones (T3 & T4) into the body, which then regulate metabolic activity in target organs or cells. This thyroid action is controlled by the pea sized pituitary gland, a tiny part of the brain, by the secretion of another hormone (TSH). Having received this signal the thyroid makes it’s hormones from iodine in the body.

Analogically, if the body was to be compared to a car, the liver for sure would be the car engine, and the thyroid could be thought of as the accelerator. It controls how fast or slow the car will go. It is the body’s Metabolism Regulator - now that’s a very important role. Virtually every cell in the body has receptors for the thyroid hormones, which then regulate how efficiently the cell converts/utilizes energy. Therefore, many everyday symptoms require a look into the thyroid functioning first, before proceeding with other tests and analysis.

So this is how the system works. The pituitary gland secretes TSH (thyroid stimulating hormone or thyrotropin) to stimulate the Thyroid to increase/decrease its production/secretion of T3/T4. This is based on the levels of circulating thyroid hormones T3 (triiodothyronine) & T4 (thyroxine) & cellular requirement. The thyroid gland mostly produces T4 & a very marginal amount of T3. T4 contains 4 atoms of iodine, and most of the T3 in circulation is converted from T4 by removing 1 iodine atom. T3 is the active form of the hormone which is usable by the cells.

The T4 & T3 in circulation are known as Total T4 & T3. These are mostly bound to a protein TBG (thyroid binding globulin). Until they are bound to the TBG the thyroid hormones are not usable by the cells. To become usable they are freed from the TBG & are then known as Free T4 & T3 (FT4 & FT3). Each of these hormones has a different role in the body & when tests are done; their levels also mean differing conditions to your medicare team. When a full thyroid panel is ordered, T4, T3, FT4, FT3, TSH are reported along with the presence of antibodies to the proteins. This would indicate if there are any auto immune issues within the body.

When the thyroid hormones are in excess supply the thyroid is overworking and the condition is known as Hyperthyroid, and when the hormonal supply is lower, the thyroid is supposed to be sluggish & the condition is called Hypothyroid. Naturally both the conditions can have differing causes, symptoms, diagnoses & treatment. If the thyroid is under attack by the body’s own immune system, then the hypo condition is termed as Hashimoto’s Thyroiditis & the hyper condition is known as Grave’s Disease. The thyroid is also susceptible to overgrowth which can either be cancerous or benign which condition is known as Goiter.

Thyroid problems need a keen eye to be determined and that is why they generally go unnoticed. The usual symptoms can run into hundreds with each individual exhibiting maybe a group of ten out of these. Normally a hypothyroid will give indications of fatigue, weakness, insomnia, difficulty in weight loss, hair loss, feelings of cold sensations, muscle cramps, joint pains, constipation, depression among others. Most of these are also shared by the hyperthyroid people. They can also exhibit fatigue, weakness, sleep problems, hand tremors, mood swings, nervousness, palpitations or irregular heartbeat, skin dryness and weight loss.

This makes proper diagnosis a team effort between the doctor & the patient. Treatments are trickier as the proper analysis of a full thyroid panel requires a fair bit of adrenal & endocrine knowledge. A good treatment plan would involve a lot of trial and error & a lot of patience is required. If the treatment is on the right track & proper protocols are followed, thyroid remission is also possible. That is the reason we find that in many cases the treatment for hyperthyroid can cause hypothyroid & vice versa. But by and large, though not always, treatments are easy but lifelong.