About thyroid disorders
Hypothyroidism is common, particularly in women and with age, and is most often caused by Hashimoto's thyroiditis, an autoimmune condition in which the immune system gradually damages the gland. Hyperthyroidism is most often caused by Graves' disease, another autoimmune condition, or by overactive nodules in the gland.
Thyroid nodules are lumps within the gland. They are very common, most are harmless and many are found by chance on scans done for other reasons. A small proportion need further assessment to rule out cancer, which is why nodules are checked with ultrasound and sometimes a needle biopsy.
Symptoms we assess
Thyroid symptoms are easy to put down to stress, age or a busy life, which is why a blood test is worth doing. Reasons to be assessed include:
- Tiredness, feeling cold, weight gain, dry skin and constipation (underactive)
- Anxiety, palpitations, heat intolerance, weight loss, tremor and loose bowels (overactive)
- A lump or swelling in the neck, or difficulty swallowing
- Changes in periods or difficulty conceiving
- Hair thinning or brittle nails
- Abnormal thyroid blood tests on a routine check
- Eye changes such as grittiness, staring or prominence
How we diagnose it
Thyroid function is measured with a blood test for TSH, the pituitary signal that drives the gland, and the thyroid hormones T4 and T3. Antibody tests identify the autoimmune causes. Where the picture is unclear, or where there is a nodule or goitre, the consultant arranges a thyroid ultrasound through Beacon Hospital and, if a nodule has features that warrant it, a fine needle biopsy.
The consultation itself covers your symptoms, medication, family history and pregnancy plans, and includes an examination of the neck. Many patients arrive with an abnormal result their GP has already found; the consultant explains what it means and whether it needs treatment at all, since mild abnormalities sometimes need only monitoring.
Treatment and follow-up
An underactive thyroid is treated with levothyroxine, a daily tablet that replaces the missing hormone. The dose is adjusted against blood tests over the first months, and once stable most patients are checked once a year. Getting the dose right matters, and the consultant will explain timing, interactions with other medicines and what to do in pregnancy.
An overactive thyroid has three treatment options: antithyroid tablets, radioactive iodine or surgery. Which is right depends on the cause, your age, whether you are planning a pregnancy and your preference. Most patients start with tablets while the choice is made. Eye involvement in Graves disease is managed with an ophthalmologist.
Nodules that are benign on ultrasound and biopsy are monitored rather than removed. Those that are suspicious are referred to a thyroid surgeon. A consultant follows you through that pathway and coordinates with your GP.
When to see a GP, and when to see a consultant
Your GP can start levothyroxine for straightforward hypothyroidism. A consultant is the right next step for an overactive thyroid, a nodule or goitre, abnormal results that do not fit the usual pattern, thyroid problems in pregnancy or when trying to conceive, or symptoms that persist despite treatment.
