Thyroid diseases and their treatments
Located at the base of the neck, the thyroid produces hormones essential to the proper functioning of many vital organs, at all ages. But sometimes this conductor derails, giving the body too fast or too slow. She can also see her size grow or nodules appear, some of which can hide cancers. Find out the basics about these thyroid diseases and their treatments.
Weight gain or loss, constipation, fatigue … The symptoms of thyroid disease are numerous but sometimes discreet, and yet they affect millions of people around the world. Overview of thyroid diseases.
What is the thyroid?
The thyroid is a butterfly-shaped gland located in the middle of the neck in front of the trachea. « Made up of two lobes located on either side of the trachea below the larynx, it produces hormones released in the blood which regulate the functioning of many organs (body temperature, sweating, heart rate, sleep, nervousness, weight…) « , specifies Dr Nathalie Beressi, endocrinologist at the American hospital (Paris) 1.
The synthesis of these hormones (the main ones being T3 and T4) is regulated by two structures located in the brain (the pituitary gland and the hypothalamus) via another hormone, TSH. But this conductor is sometimes the victim of disorders, some of which require medical and / or surgical management. Before, it is necessary to recognize the symptoms and to make the diagnosis thanks to several examinations.
The different symptoms of thyroid disease
• Hyperthyroidism (hypersecretion of thyroid hormones) causes hyperfunction of all metabolisms. Everything works too much, and too quickly: rapid weight loss, rapid pulse, trembling of the hands, hot flashes, diarrhea, nausea or vomiting, brittle hair, irritability, emotivity;
• Hypothyroidism (lower production of thyroid hormones) causes a wide variety of symptoms: fatigue, chilliness, unexplained weight gain with decreased appetite, slower heart rate, increased cholesterol, joint and muscle pain, menstrual cycle disorders, constipation, goiter, puffy face, mood swings, memory problems, pale skin, brittle fragile nails and hair, hoarse voice …
• The thyroid nodule is a lump that forms in the thyroid. In most cases, the nodule does not give rise to any symptoms and this condition is mild. Sometimes the known nodule becomes painful and its volume increases;
• Goiter is an increase in the volume of the thyroid. There are several kinds of goiter: tumor (the tumor can be benign or malignant), inflammatory (Hashimoto’s thyroiditis), vascular (hyperthyroidism, Graves’ disease), goiter with hypothyroidism which are due to a disorder of the synthesis of thyroid hormones, simple goiters which correspond to an isolated increase in the size of the gland, without tumor, without inflammation, without disorder of the thyroid secretion;
• Thyroid cancers: a distinction must be made between differentiated cancers sensitive to TSH and undifferentiated cancers independent of TSH. For the former, clinical signs are often limited to an isolated thyroid nodule or associated with lymph nodes, which can cause signs of local compression (difficulty breathing, swallowing, abnormal voice). Bone metastases (bone pain, spontaneous fractures) or lung (cough, difficulty breathing) may be noted. For differentiated cancers, the thyroid is hard and signs of local compression are also present. The general condition is altered.
What exams for the diagnosis of the thyroid?
According to Dr. Beressi, « thyroid diseases affect more than 15% of the French population ». To detect them, several exams are available:
• Palpation of the neck: this is the first examination, the simplest and most direct, to assess the characteristics of the thyroid gland and possibly detect a goiter or nodules;
• Biological examinations: the determination of T3, T4 and TSH by a blood test make it possible to detect possible anomalies in their production;
• Ultrasound of the neck: it allows to know more about any nodules present: number, dimensions, solid or liquid content … It also allows to examine the ganglionic chains of the neck;
• Cytological puncture: this painless and harmless gesture (often carried out under ultrasound control) consists of removing cells from a nodule with a fine needle;
• Scintigraphy: this consists of the intravenous injection of a radioactive product (technetium isotope or iodine). The patient is then laid on his back and a camera is placed above him. This will make it possible to detect the radiation emitted by the radioactive product and thus to distinguish « hot » or « cold » nodules, depending on whether or not they fix the radioactive isotope injected.
Thyroid diseases and their treatments
There are several thyroid pathologies and their treatments can be summarized in the table below 2,3,4,5,6.
Type of pathology Disease Description Treatment
The thyroid works in overspeed (T3 / T4 high and TSH low). This may be due to the presence of hyper-secreting nodules. – Synthetic antithyroid drugs
– Radioactive iodine (mainly for hypersecreting nodule)
– Surgery is only considered in the event of recurrence or the desire for pregnancy.
The thyroid works at idle (low T3 / T4 and increased TSH). Synthetic hormones
Nodules are very common: 50% of the population has a thyroid nodule greater than 1 cm. There are, however, several types of nodules depending on their size, their activity and whether or not they are clever. – Surveillance or surgery in case of suspected cancer (nodule larger than 3-4 cm, too many nodules…)
– High intensity focused ultrasound (HIFU) echotherapy
A distinction is made between simple goiters (often of family origin) and nodular goiters (with a large number of nodules) – Monitoring or surgery if the number of nodules is too large or the risk of cancer is high
– Radioactive iodine for very secreting goiter
5% of thyroid tumors are cancers. On the increase, these cancers affect three times more women (4000 to 6000 cases per year). Detected early, their chances of recovery are close to 100%.
About 4,000 thyroid cancers are discovered each year in France. This number is constantly increasing, by around 6% per year. – Surgery with total thyroidectomy (total removal of the gland) followed by taking thyroxine (T4) to compensate for the absence of thyroid and use of iodine 131 to eliminate possible thyroid residues;
– Certain localized cancers can be treated by radiosurgery (CyberKnife)
Other thyroid diseases
Thyroiditis is a set of conditions caused by an infectious, inflammatory, or immune process in the thyroid.
There are several types of thyroiditis:
• Acute suppurative thyroiditis: infection with a thyroid starting point or a distant starting point (dissemination of an infection);
• Subacute thyroiditis (from De Quervain): « flu » of the thyroid. It is an inflammation probably of viral origin;
• Painless or silent thyroiditis;
• Fibrous thyroiditis (from Riedel): exceptional but serious. It is a very rapid fibrous inflammation
• Chronic lymphocytic thyroiditis (from Hashimoto): the most frequent, it is of autoimmune origin. It is a chronic inflammation causing an infiltration of the thyroid with in the long term destruction of the cells of the thyroid and the appearance of hypothyroidism.
• Postpartum thyroiditis: thyrotoxicosis can occur a few months after childbirth;
• Thyroiditis after treatment with cytokines: in general during cancer treatments with interleukin or interferon.