Thyroid Diseases

Programs and Disease Treatment

Thyroid Diseases

The thyroid is a butterfly-shaped gland that is located in the lower neck and rests in front of the trachea (windpipe). One of the largest endocrine organs in the body, the thyroid produces hormones that help regulate growth and metabolism (how the body processes energy). Diseases of the thyroid gland typically include abnormalities in the production of thyroid hormone (either too much or too little hormone), or abnormalities in the anatomy or structure of the thyroid (such as a thyroid nodule).

The most common functional abnormality of the thyroid gland is hypothyroidism. This occurs when the thyroid gland makes too little thyroid hormone. Common symptoms of hypothyroidism may include fatigue, unexplained weight gain, intolerance of cold, constipation, dry skin, brittle hair, joint and muscle pains, or difficulty with concentration.

A less common abnormality of the thyroid gland is hyperthyroidism. This occurs when the thyroid gland makes too much thyroid hormone. Common symptoms of hyperthyroidism may include racing heart, hand tremor, intolerance of heat, unexplained weight loss, anxiety, or insomnia. There are many different reasons why the thyroid gland might make too much or too little thyroid hormone. Some of these include:

Hypothyroidism

Autoimmune thyroiditis
Infectious thyroiditis
Thyroid hormone resistance
Congenital hypothyroidism
Central hypothyroidism (pituitary insufficiency)
Medications
Surgery
Radioactive iodine
Radiation treatment

Hyperthyroidism (thyrotoxicosis)

Grave’s disease
Solitary toxic adenoma
Toxic multinodar goiter
Autoimmune thyroiditis
Infectious thyroiditis
Medications
Struma ovarii

Often, the thyroid gland functions normally, but there might be a structural or anatomical abnormality such as a “thyroid nodule.” These nodules are lumps that arise in an otherwise normal thyroid gland. Thyroid nodules are typically discovered by a physician during a routine office visit, or by imaging scans (ultrasound, CT scan, MRI) performed for other health reasons.

Thyroid nodules are very common, and are seen in up to 60 percent of women over the age of 50 years. The vast majority of thyroid nodules are benign (noncancerous) growths. In a small percentage of patients, the nodule may be cancerous. Thyroid cancer is uncommon, and about 37,200 new cases will be diagnosed in the United States in 2009. It is typically a very treatable form of cancer, particularly when diagnosed early. Thyroid cancer very rarely produces thyroid hormone.

Some benign thyroid nodules make excessive amounts of thyroid hormone, and are referred to as “toxic nodules.” These nodules are almost never cancerous, but they can cause symptoms of hyperthyroidism and need to be treated.

Diagnosis of Thyroid Diseases

Medical College of Wisconsin endocrinologists are experts at diagnosing and treating a wide range of thyroid gland disorders. The endocrinologist will take a complete patient history, conduct a physical exam, order tests, coordinate treatment and make additional referrals. At all stages of care, the endocrinologist maintains communication with the patient’s referring physician or nurse practitioner.

There are a number of tests used to detect thyroid disease.

Thyroid function testing

Thyroid function testing is a blood test to determine the level of thyroid hormones TSH (thyroid stimulating hormone), T4 (thyroxine) and T3 (triiodothyronine). The levels of thyroglobulin and calcitonin (markers for thyroid cancer) and antibodies associated with autoimmune diseases may also be determined. Medical College of Wisconsin endocrinologists are experts in interpreting blood tests to accurately diagnose thyroid disorders.

Thyroid ultrasound

Thyroid ultrasound imaging involves exposing part of the body to high-frequency sound waves to produce pictures of the inside of the body. The sound waves are emitted from a small hand-held transducer that is passed over the thyroid. Ultrasound images show the structure and movement of the internal organs in real time.

An ultrasound exam of the thyroid is typically done to help diagnose a lump in the thyroid or a thyroid that is not functioning properly. Ultrasound can also be used to assess lymph nodes in the neck in cases of suspected thyroid cancer. The use of thyroid ultrasound facilitates an immediate answer regarding the size and characteristics of a thyroid nodule, and allows the endocrinologist to determine the need for a biopsy.

Ultrasound-guided fine needle aspiration biopsy

Ultrasound-guided fine needle aspiration biopsy is a method of removing a small tissue sample from a nodule using a thin, hollow needle. The placement of the needle is guided with ultrasound imaging. The tissue sample is examined in a laboratory to determine if the cells are benign or malignant (cancerous). For patients with a positive biopsy or suspicious cells, an appointment with a surgeon is arranged.

Thyroid uptake/scan

Thyroid uptake/scan is a nuclear medicine test that uses a radioactive iodine tracer to see how well the thyroid is working. A patient is given a pill that contains radioactive iodine. After the radioactive iodine has been absorbed by the thyroid (in a few hours), the scanner detects the location and intensity of the rays given off by the radioactive material. A computer displays images of the thyroid gland. This test is done to check for hyperthyroidism, thyroid cancer and thyroid nodules or other growths.

CT and MRI

Computed tomography (CT) and magnetic resonance imaging (MRI) may be used to diagnose thyroid disease.

Thyrogen stimulation

Thyrogen stimulation is a synthetic form of thyroid stimulating hormone (TSH) given to patients to assist in the diagnosis and treatment of thyroid cancer.

Treatment for Thyroid Disorders

The treatment of thyroid disease depends on many factors, including the type and severity of the disorder, and patient’s age and overall health. Medical College of Wisconsin endocrinologists tailor treatment to the unique needs of each patient, using a colaborative multidisciplinary team approach. Physicians who specialize in endocrinology, endocrine surgery, pathology, radiology, nuclear medicine and other areas may be involved in treatment.

Treatments for functional thyroid disease may include:

Thyroid hormone replacement to replace thyroid hormone levels when the thyroid is underactive (hypothyroidism)
Medication to treat hyperthyroidism (overactive thyroid), blocking the production of thyroid hormone
Radioactive iodine to treat overactive thyroid (hyperthyroidism)

Treatments for anatomic thyroid disease (benign or malignant nodules) may include:

Surgery to remove a nodule (cancer, possible cancer or benign)
Surgery for hyperthyroidism and goiters
Radiation therapy using external beam radiation to destroy cancer cells
Radioactive iodine to treat patients with thyroid cancer after the cancer has been removed
Thyroid hormone replacement to suppress further growth of thyroid tissue in the treatment of thyroid cancer
Chemotherapy to treat thyroid cancer

Thyroid Disease Research

At Froedtert & The Medical College of Wisconsin, Medical College physicians and scientists continually search for new ways to diagnose and treat a wide range of diseases and disorders. In thyroid disease, current research involves: