How are thyroid diseases diagnosed?
Thyroid disease can be difficult to diagnose because the symptoms are similar to a variety of other health problems. The doctor will typically start by asking the patient about their health history, such as if they have a family history of thyroid disease. The doctor may also give the patient a physical exam and check their neck for thyroid nodules.
Depending on the symptoms, the doctor may recommend other tests, such as:
● Blood tests. Testing the level of thyroid-stimulating hormone (TSH) in the patient’s blood can help the doctor determine if the thyroid is functioning normally. TSH instructs the thyroid to make additional thyroid hormones. Depending on the results, the doctor might order a second round of blood tests to check the levels of one or both of the thyroid hormones.
● Thyroid ultrasound. The thyroid ultrasound uses sound waves to create a picture of the thyroid on a computer screen. This test can help the doctor determine the size of the nodule and the type of nodule the patient has. The patient may need additional thyroid ultrasounds over time to determine if their nodule is growing or shrinking. An ultrasound may also be helpful for detecting thyroid cancer, although it can’t be used by itself to diagnose thyroid cancer.
● Thyroid fine needle biopsy. This test determines whether or not the thyroid nodules have normal cells in them. The doctor may numb an area on the patient’s neck before sticking a very thin needle into the thyroid to remove some cells and fluid. A doctor will then look at the cells under a microscope to see if they are normal because abnormal cells could indicate thyroid cancer.
● Radioactive iodine uptake test. For this test, the patient swallows a liquid or capsule that holds a small dose of radioactive iodine (radioiodine). The radioiodine collects in the thyroid because the thyroid uses iodine to make the thyroid hormones. High levels of radioiodine mean that the thyroid is making excessive thyroid hormones and low levels mean that the thyroid is not making enough thyroid hormones.
● Thyroid scan. A thyroid scan uses the same radioiodine dose that was given by mouth for the uptake test. The patient will lay on a table while a special camera makes an image of their thyroid on a computer screen. This scan shows the pattern of iodine uptake in the thyroid.
According to the National Cancer Institute, three types of nodules show up on a thyroid scan:
● “Hot” nodules. These thyroid nodules show up as bright areas on the scan compared to a normal thyroid nodule. They take up more radioiodine than the surrounding thyroid and make excessive hormones. Fortunately, over 99% of these nodules are noncancerous.
● “Warm” nodules. These nodules make a normal amount of hormones and take up the same amount of radioiodine as a normal thyroid. Additionally, 92-95% of these nodules are noncancerous.
● “Cold” nodules. A lot of nodules are considered “cold”. These nodules show up as dark areas on the scan. They do not take up much radioiodine and do not make thyroid hormones. About 75% of these nodules are noncancerous.
Can thyroid disease cause problems getting pregnant?
Both hyperthyroidism and hypothyroidism can make it harder for a patient to get pregnant. This is because thyroid hormone problems can upset the balance of the hormones that cause ovulation. Hypothyroidism can also cause the body to make more prolactin, the hormone that tells the body to make breastmilk and too much prolactin can prevent ovulation.
Thyroid problems can also affect the menstrual cycle. A patient may experience heavy or irregular periods. A patient could also develop amenorrhea where they don’t have any periods at all for several months or longer.
How does thyroid disease impact pregnancy?
Pregnancy hormones raise the level of thyroid hormones in the blood, which is essential for fetal brain development.
It can be harder to diagnose thyroid problems during pregnancy because of the normal hormonal changes that occur. However, it is essential for patients to check for problems prior to getting pregnant and during pregnancy. Uncontrolled hyperthyroidism and hypothyroidism can cause complications for the pregnant patient and her fetus.
According to the NIDDK, hyperthyroidism that is not treated with medicine during pregnancy can cause:
● Premature birth
● Low birth weight (under 5 pounds)
● Thyroid storm (a sudden, severe worsening of symptoms)
● Fast heart rate in the newborn, which can lead to heart failure, poor weight gain, or enlarged thyroid that can make it hard to breathe
● Preeclampsia, a severe condition that starts after 20 weeks of pregnancy. This condition causes the patient to experience high blood pressure and issues with their organs such as their kidneys along. The only way to remedy preeclampsia is with childbirth.
According to the NIDDK, hypothyroidism that is not treated with medicine during pregnancy can cause:
● Low birth weight (smaller than 5 pounds)
● Problems with fetal growth and brain development
● Anemia (lower than normal amount of healthy red blood cells)
What is postpartum thyroiditis?
According to the Thyroid Research Journal, postpartum thyroiditis is defined as inflammation of the thyroid after giving birth and it affects 10% of women. Unfortunately, it often goes undiagnosed because symptoms are similar to postpartum depression. For example, women with postpartum thyroiditis may feel lethargic and emotional.
According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), postpartum thyroiditis typically (but not always) happens in two phases:
● The first phase begins 1-4 months postpartum and typically lasts 1-2 months. In this phase, a patient may experience symptoms of hyperthyroidism because the damaged thyroid leaks the hormones into the bloodstream.
● The second phase starts about 4-8 months postpartum and lasts 6-12 months. In this phase, a patient may experience symptoms of hypothyroidism. This is either because the thyroid has lost most of its hormones or because the immune attack is over which means the thyroid may be recovering.
Who is at a higher risk for postpartum thyroiditis?
A patient’s immune system may cause postpartum thyroiditis. If a patient has an autoimmune disease their risk is higher.
According to The Journal of Clinical Endocrinology & Metabolism, a patient’s risk is also higher if they:
● Have a personal history or family history of thyroid disorders
● Had postpartum thyroiditis after a previous pregnancy
● Have chronic viral hepatitis
How is postpartum thyroiditis treated?
The treatment method chosen for postpartum thyroiditis depends on the phase of the disease and which symptoms the patient is experiencing. For example, if a patient has symptoms of hyperthyroidism in the first phase, their treatment may include medicines to slow down the heart rate.
According to The Journal of Clinical Endocrinology & Metabolism, most women who have postpartum thyroiditis have their thyroid return to normal within a year and a half after symptoms begin. However, if the patient has a history of postpartum thyroiditis, they have an increased risk of developing permanent hypothyroidism within the next 5 to 10 years.
Want more information about thyroid diseases?
For more information about thyroid diseases, call our office at (530) 345-0064 ext. 281 or contact one of the following organizations:
● National Cancer Institute (NCI), NIH Phone Number: 800-422-6237
● National Endocrine and Metabolic Diseases Information Service, NIDDK, NIH Phone Number: 800-860-8747
● Hormone Health Network Phone Number: 800-467-6663
● Thyroid Cancer Survivors’ Association, Inc. Phone Number: 877-588-7904
● Office on Women’s Health Phone Number: 800-994-9662