Thyroid Disease May Have Few or No Symptoms, So Awareness is Vital

The thyroid gland, located in the front of the neck below the Adam’s apple, is about two inches long — but it plays a big role in overall health. The thyroid hormone it produces affects a person’s physical energy, temperature, weight and mood.

Moreover, thyroid diseases — which generally fall into two broad groups of disorders: abnormal function and abnormal growth (nodules in the gland) — can exist with few or no symptoms.  Functional disorders are usually related to the gland producing too little thyroid hormone (hypothyroidism) or too much thyroid hormone (hyperthyroidism). Women are five to eight times more likely than men to have thyroid problems, according to the American Thyroid Association. (January is Thyroid Awareness Month.)

“About 20 million Americans have some form of thyroid disease or issue, which goes to show how common they are,” explains  Jonathan Fialkow, M.D., deputy medical director and chief of cardiology at Miami Cardiac & Vascular Institute. “What’s also interesting is that up to 60 percent of those with thyroid disease have no idea about it. Learning about the warning signs went to seek health and treatment options can make all the difference.”

The good news: Most thyroid problems can be detected and treated. A primary care physician can diagnose hypothyroidism or hyperthyroidism, starting with a blood test. Depending on the results, your primary can refer you to an endocrinologist, who treat those people who suffer from hormonal imbalances, typically from glands in the endocrine system or certain types of cancers. An endocrine surgeon focuses predominantly on diseases of the thyroid, parathyroid, and adrenal glands.

Neeta Erinjeri, M.D., endocrine surgeon at Miami Cancer Institute.

Dr. Fialkow hosted a Resource LIVE — Can I Blame It on My Thyroid? — with two Baptist Health experts: Pascual De Santis, M.D., an endocrinologist with Baptist Health Medical Group; and Neeta Erinjeri, M.D., endocrine surgeon at Miami Cancer Institute. (It’s also featured as a Baptist HealthTalk podcast.)

“The thyroid essentially controls many functions of the body,” said Dr. De Santis.

“Pretty much every cell in the body is a target for thyroid hormones and it will affect energy expenditure and oxygen consumption. It is evolved in development and growth in children. It affects the cardiovascular system … and it can affect the reproductive system. It is involved very importantly in development of the central nervous system and nerve conduction as well. So, it pretty much affects every function in the body.”

What are the symptoms or what are things that someone may feel that might trigger getting checked the thyroid checked, asks Dr. Fialkow?

“Because the thyroid affects so many different things with regards to hormones, it produces a lot of symptoms that can be associated to the thyroid — but also could be caused by other things,” explains Dr. Erinjeri. “When the thyroid hormone levels are too high, they can cause a lot of symptoms, such as palpitations, elevated heart rate, excessive sweating, weight loss, and diarrhea. And some people really don’t notice them at all.

Pascual De Santis, M.D., an endocrinologist with Baptist Health Medical Group.

“When the thyroid function is too low, this is what people worry about a lot. You can notice things like weight, gain, feeling cold all the time, feeling very tired and lethargic, having dry skin. You know, these are all symptoms that can also be caused by other things, but it is often what triggers a work-up and evaluation of the thyroid gland.”

The most concerning of the two conditions — too little thyroid hormone (hypothyroidism) or too much thyroid hormone (hyperthyroidism) — is hyperthyroidism. Some of the most serious complications of hyperthyroidism involve the heart, including a rapid heart rate and the heart rhythm disorder, atrial fibrillation, that increases your risk of stroke, and congestive heart failure

“Hyperthyroidism because of the effects that it has on the whole body, even in a subclinical state, is something that requires more in-depth evaluation, compared to hypothyroidism, because of the downstream effects it can have,” said Dr. Erinjeri.

And then there are nodules that need further assessments, she adds. “We also see problems that have nothing to do with hormone production — but are actual nodules within the thyroid. And depending on where those grow and how big they are, those can also trigger other effects such as local symptoms or pushing on surrounding structures, being visible externally — or causing no symptoms at all — but showing up on imaging that we do for other reasons altogether.”

Here’s a bit more from the Resource LIVE: Can I Blame It on My Thyroid? — which can be seen in its entirety here.

Dr. Fialkow: “We don’t want people jumping to conclusions with minimal symptoms. So, explain to us the role of the primary care doctor when someone may suspect a thyroid disorder, and when should they go to an endocrinologist?

Dr. De Santis:
“People who are very mild form of abnormality, either in the hypo or the hyper range, and depending on their age, may be perfectly asymptomatic. When a patient has a concern that they may have a thyroid problem, the first person they need to go to is the primary care doctor. When symptoms are very vague and unspecific, they could be caused by anything, as Dr. Erinjeri explains. But they certainly could be related to a thyroid hormone abnormality. Your primary care doctor can easily order just a blood test. And that will immediately alert the primary if there is a thyroid function abnormality or not.”

Dr. Fialkow: “With hypothyroidism, is there a tendency for them to become more symptomatic over time? Or could people go long periods of time as asymptomatic?

Dr. Erinjeri:
“The most common cause of hypothyroidism is a condition called Hashimoto’s thyroiditis (an autoimmune disorder involving chronic inflammation of the thyroid). Because it could be an autoimmune-related disease, the thing about Hashimoto’s is that it does tend to progress over time. So, even if there are no symptoms at the moment and it may not cause anything, most conditions with the thyroid are slowly progressive. It’s not something that goes from one week to the next, or even necessarily from one year to the next that you would notice. But it’s something that, if noted, it needs to be followed.  Over time, it would get worse and eventually reach the point where it would require treatment, which is easily treated with thyroid hormone.”