Thyroid and Parathyroid Glands

Thyroid diseases can be classified into functional & structural diseases. Functional diseases of the thyroid include:

Hypothyroidism (an underactive thyroid): In this condition, the gland does not release enough thyroid hormones, and when this happens then the thyroid-stimulating hormone goes up. One of the common causes of hypothyroidism is Hashimoto's disease (an autoimmune disease) where the antibodies target the thyroid and destroy the ability to produce thyroid hormone. Hypothyroidism is a treatable condition, and in most patients, it can not be cured, i.e. they would need treatment life long.

Hyperthyroidism (an overactive thyroid): In this condition, too many thyroid hormones are released, or too much medication is taken which results in the thyroid-stimulating hormone going down. It happens when the thyroid gland becomes overactive and produces too much thyroid hormone. One of the most common causes of hyperthyroidism is called Graves' disease. It is an autoimmune condition where antibodies target the gland and cause it to speed up hormone production.

Structural diseases of the thyroid include:

Goitre: It is a condition in which the thyroid becomes enlarged due to Hashimoto's disease, Graves' disease, nutritional deficiencies, or other thyroid imbalances.
Thyroid Nodules (lumps in thyroid gland): Some people develop solid or liquid-filled cysts, lumps, bumps and tumours (both benign and cancerous) in the thyroid gland. These are known as thyroid nodules. These patients may require ultrasound, thyroid nuclear scan and biopsy of the gland.
Thyroid Cancer (malignant thyroid nodules or tissue): A small percentage of thyroid nodules are cancerous. While thyroid cancer is a rare form of cancer, it is on the rise.
Thyroiditis (inflammation of the thyroid): This is a condition where the thyroid becomes inflamed, due to bacterial or viral illness. Most patients eventually get an overactive thyroid (thyrotoxicosis) but may end up with short term to long term hypothyroidism. In such cases, the gland just pours the restored hormone, but the production of the hormone does not increase. This condition usually settles down in a week to a month's time.

Most thyroid dysfunctions such as hypothyroidism or hyperthyroidism occur due to autoimmune thyroid diseases where the body's natural ability to differentiate between its organs, tissues, glands and the outside bacteria, viruses and pathogens becomes disrupted. This causes the immune system to wrongly attack on the affected area by producing antibodies.

Losing or gaining weight: Extreme change in weight signal an abnormal function of thyroid gland. Low levels of thyroid hormones (hypothyroidism) can cause weight gain, while unexpected weight loss can signal that too many thyroid hormones are being produced (hyperthyroidism). Hypothyroidism is much more common than hyperthyroidism. 

Swelling in the neck: A goitre is an enlargement of the thyroid gland. A goitre can occur both as a result of hypothyroidism and hyperthyroidism. It can sometimes also result from tumors or nodules that develop within the thyroid gland. 

Changes in heart rate: The hormones made in the thyroid gland affect almost every organ in the body, including the heart. Hypothyroidism can cause the heart to beat slowly while hyperthyroidism causes a fast heartbeat. Elevated levels of thyroid hormones also can lead to increase in blood pressure and a feeling that your heart is pounding (palpitations). 

Changes in mood or energy:Thyroid disorders can affect emotions, energy, and mood. Hypothyroidism can cause symptoms like depression, tiredness, and feeling sluggish. Hyperthyroidism is associated with sleep disturbances, irritability, anxiety, and restlessness.

Hair loss: Hair loss is a common sign of a thyroid problem. Both too high and too low levels of thyroid hormones can lead to hair loss. The hair typically grows back once the condition is treated.

Body temperature too cold or hot: The thyroid affects regulation of body temperature, So, those with hypothyroidism often report feeling cold. In contrast, people with hyperthyroidism tend to have excessive sweating and an aversion to heat.

• Sleepiness
• Fatigue
• Lethargy
• Loss of memory and trouble concentrating
• Unusually dry, coarse skin
• Goitre
• Gradual personality change
• Depression Increase in weight
• Bloating or puffiness (Edema)
• Sensitivity to cold
• Hair Loss or sparseness of hair

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• Anxiety and irritability
• Weakness (particularly in upper arms and thighs, making it difficult to lift heavy items or climb stairs) 
• Tremors (of the hands)
• Perspiring more than normal
• Rapid or irregular heartbeats

• Hardness of the gland
• A rapid increase in size and hoarseness of voice
• Difficulties in swallowing or breathing

Max Institute of Endocrinology and Diabetes, at Max Hospitals, India is one of the largest chains of tertiary care centres in North India, with presence in Delhi NCR (Saket, Patparganj, Shalimar Bagh, Pitampura, Vaishali, Gurgaon, Noida & Panchsheel Park), Dehradun, Mohali and Bathinda. Each institute is led by a capable team of highly-trained endocrinologists, oncologists, surgeons, thyroid specialists and other staff who work together to provide patients with best-in-class treatment options. The team has experience treating various conditions related to the thyroid, pituitary and the metabolic system, including obesity, PCOS, osteoporosis, and hormonal disorders. Patient safety, satisfaction and faster recovery is ensured with extensive support services ranging from lifestyle management to preventive measures.
Max Institute of Endocrinology and Diabetes is equipped with state-of-the-art infrastructure for quality diagnostic and treatment. The support of such leading technologies helps the team manage complicated patient cases and smoothens the treatment process.

When it comes to problems associated with the thyroid gland, medical history, specialized tests, and a thorough physical examination play a significant role in both diagnosis and treatment. Accordingly, the doctors at Max Institute of Endocrinology and Diabetes begin by noting down the patient’s history which is followed by physical examination and various diagnostic tests. The latter includes:

• Blood tests (TSH, T3, T4, Reverse T3): Blood tests are typically used to measure the level of thyroid hormones and Thyroid Stimulating Hormone (TSH). There are tests that identify antibodies against the thyroid tissue.
• Imaging tests: When there is an enlargement of the thyroid gland present, imaging tests may be advised. An ultrasound is used to provide visuals of the tissue and may help to reveal any cysts.

• Anti-Thyroid Antibodies test (TPO antibodies and Thyroglobulin antibodies) - To access the evidence of damage to the thyroid gland.
• Serum Lipid Profile (As cholesterol may be elevated in hypothyroidism)
• CBC-Screening for Anaemia
• Ultrasound of thyroid
• Fine needle biopsies in case of nodule
• Thyroid uptake scan in cases of nodule

Once all diagnostic tests are done, treatment can begin. Factors such as age and the severity and type of the condition are important in determining the best course for treatment.

• Surgical intervention is required to remove a large goitre or hyperfine tumour. It is important, especially when there is a chance of thyroid cancer. If the gland is removed during the surgery, medications for hypothyroidism may be needed further. Though a permanent cure for hyperthyroidism, surgery to remove the thyroid gland is used far less than antithyroid drugs or radioactive iodine because of the risks associated.
• Medications: In cases of hypothyroidism, medications help compensate for the missing thyroid hormone. The thyroid hormone is given in the shape of a pill. While in cases of hyperthyroidism, medicines can reduce the production of excess thyroid hormone. The two main types of medicines used to treat hyperthyroidism are antithyroid drugs and beta-blockers.
• Radioactive iodine: Destroying the thyroid with radiation is called radioiodine ablation. It is a permanent way to resolve hyperthyroidism. In this treatment option, the amount of radiation used is small, which does not cause cancer. Thyroid diet & lifestyle:
• Thyroid disorders are not a lifestyle-related disease. There is no evidence of any particular yoga or exercise or health supplements that can help prevent thyroid diseases. Nevertheless, the doctors at Max Institute of Endocrinology and Diabetes prescribe patients with an intake of a normal healthy diet and iodized salt, which is available in most states of India.