A Simple Guide to Thyroid Disorders: From Diagnosis to Treatment
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About this ebook
If your doctor has told you that you have a thyroid disorder, perhaps you feel some relief in having pinpointed the source of your troublesome symptoms. As you may know, thyroid ailments often elude a diagnosis since they may mimic other illnesses.
Now that you have a diagnosis, becoming informed will help you receive better health care. The authors, specialists in thyroid treatment, can help you understand both the complex function of your thyroid and how your disorder can best be treated. In A Simple Guide to Thyroid Disorders, they take special care to lay out the basics in a reader-friendly way. Among the topics they discuss:
medical tests you need to diagnose thyroid problems
hypothyroidism...symptoms and treatment
hyperthyroidism...symptoms and treatment
coping with emotional highs and lows
dealing with thyroid-related weight problems
medications and surgeries for thyroid disorders
thyroid nodules and cancers
A Simple Guide to a Complex Disorder
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A Simple Guide to Thyroid Disorders - Paul Ruggieri
Table of Contents
Cover
Acknowledgments
Introduction
Chapter 1
Understanding Your Thyroid Gland
The Thyroid Gland
How the Thyroid Gland Works
How Thyroid Hormone Is Produced
Lock and Key
Analogy
How the Body Regulates Thyroid Hormone
Risk Factors for Thyroid Disorders
Gender
Age
Heredity
Diet
Environment
Chapter 2
Getting a Diagnosis
Medical History
Medication Review
Physical Examination
Common Diagnostic Tests
Thyroid Stimulating Hormone (TSH) Test
Free
versus Total
Thyroid Hormone Levels
Total Thyroxine (TT4) and Free Thyroxine (FT4)
Total Triiodothyronine (TT3) and Free Triiodothyronine (FT3)
Thyroid Ultrasound
Referral to a Specialist
Your Relationship with the Specialist
Importance of the Specialist’s Experience
Tests Commonly Ordered by Specialists
Antithyroid Antibodies (ATA)
Thyroglobulin Level
Calcitonin Level
Radioactive Iodine Uptake and Scan
Fine Needle Aspiration (FNA)
Direct Laryngoscopy
Barium Swallow
Computed Tomography (CT) Scan of the Neck
Chapter 3 Hypothyroidism: The Underactive Thyroid Gland
Types of Hypothyroidism
Who Is at Risk for Hypothyroidism?
Symptoms of an Underactive Thyroid
Loss of Appetite and Weight Gain
Fatigue or Depression
Swelling of Limbs and Puffiness of the Face
Forgetfulness, Difficulty Concentrating
Dry Skin
Brittle Nails and Hair Loss
Goiter and Hoarseness
Increased Cholesterol, High Blood Pressure, and Heart Disease
Anemia
Sensitivity to Cold
Constipation
Slowing Heart Rate and Congestive Heart Failure
Stiff or Sore Muscles
Allergies
Increased Sensitivity to Medications
Menstrual Cycle Changes
Increased Frequency of Miscarriages
Causes of Hypothyroidism
Hashimoto’s Thyroiditis
Subacute Thyroiditis
Postpartum Thyroiditis
Reidel’s Thyroiditis
Congenital Hypothyroidism
Idiopathic Hypothyroidism
Damage to Brain or Pituitary Gland
Result of Treatment for Hyperthyroidism
Medications
Radiation Exposure
Dietary Causes
Chapter 4 Treatment for Hypothyroidism
Thyroid Hormone Replacement
Levothyroxine (T4)
Possible Side Effects
Liothyronine (Cytomel) T3
Combination Thyroid Hormone Products (T4 and T3)
Possible Side Effects
Response to Medication
Symptoms That May Require Additional Treatment
Goiter
Depression
Hypothyroidism and Weight
Chapter 5
Hyperthyroidism: The Overactive Thyroid Gland
Who Is at Risk for Hyperthyroidism?
Symptoms of an Overactive Thyroid
Rapid Heart Rate
Nervousness
Weight Loss
Hot Flashes or Feeling Warm
Diarrhea or Frequent Bowel Movements
Goiter
Bulging Eyeballs
Depression and Mood Swings
Muscle and Bone Weakness
Changes in Skin, Hair, and Nails
Menstrual Cycle Changes
Causes of Hyperthyroidism
Graves’ Disease
Thyroid Nodules (Single or Multiple)
Toxic Adenoma (Hot
Nodule)
Toxic Multinodular Goiter
Thyroiditis
Subacute Thyroiditis
Silent Thyroiditis (Hashitoxicosis)
Postpartum Thyroiditis
Excessive Iodine Ingestion
Overmedication with Thyroid Hormone
Chapter 6
Treatment for Hyperthyroidism
Choosing the Best Treatment
Antithyroid Drugs (ATD)
Possible Side Effects
Assessing the Effectiveness of ATDs
Radioactive Iodine (RAI)
Possible Side Effects of RAI
Assessing the Effectiveness of RAI
Precautions after RAI Treatment
Surgery
Hair Loss during Treatment
Symptoms That May Require Additional Treatment
Rapid Heart Rate
Possible Side Effects of Beta-Blockers
Bulging Eyes
Weight Changes with Hyperthyroidism
Insomnia
Pretibial Myxedema
Depression
Chapter 7
Thyroid Nodules and Thyroid Cancer
Who Is at Risk for Thyroid Nodules?
Causes of Thyroid Nodules
Characteristics of Thyroid Nodules
Types of Thyroid Nodules
Single Nodules
Hot
Nodules
Cold
Nodules
Complex Nodules
Multiple Nodules
Cystic Nodules (Thyroid Cysts)
Solid Nodules
Treatment for Hot
Nodules
Radioactive Iodine
Antithyroid Drugs (ATD)
Surgery
Ethanol Injections
Treatment for Cold
Nodules
FNA and Surgery
Thyroid Hormone Suppression Therapy
Thyroid Cancer
Chapter 8
Thyroid Surgery
Who Performs Thyroid Surgery?
Types of Thyroid Operations
Thyroid Lobectomy
Subtotal Thyroidectomy
Total Thyroidectomy
Preparing for Surgery
The Operation
Possible Complications
Damage to the Parathyroid Glands
Nerve Damage
Other Possible Complications
Recovering from Thyroid Surgery
Recovering at Home
Resuming Daily Activities
Chapter 9
Thyroid Disease and Pregnancy
Detecting Thyroid Disorders
Effects of Pregnancy on the Thyroid
Hypothyroidism during Pregnancy
Testing for Hypothyroidism during Pregnancy
Treatment for Hypothyroidism during Pregnancy
Hyperthyroidism during Pregnancy
Testing for Hyperthyroidism during Pregnancy
Treatment for Hyperthyroidism during Pregnancy
Thyroid Nodules during Pregnancy
Postpartum Thyroid Disease
What Causes Postpartum Thyroid Disorders?
Treatment for Postpartum Thyroid Disease
Resources
Glossary
About the Authors
Copyright 2004 by Paul Ruggieri, M.D. and Scott Isaacs, M.D. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopied, recorded, or otherwise, without the prior written permission of the publisher. For information, write Addicus Books, Inc., P.O. Box 45327, Omaha, Nebraska 68145.
ISBN# 978-1-886039-63-6
Cover design by George Foster and Darcy Lijoodi
Illustrations by Jack Kusler
Typography by Linda Dageforde
This book is not intended to serve as a substitute for a physician, nor is it the authors’ intent to give medical advice contrary to that of an attending physician.
Ruggieri, Paul, 1959-
A simple guide to thyroid disorders / Paul Ruggieri, Scott Isaacs.
p. cm.
An Addicus Nonfiction Book.
Includes bibliographical references and index.
ISBN 1-886039-63-1 (alk. paper)
1. Thyroid gland--Diseases--Popular works. I. Isaacs, Scott, 1967-
II. Title.
RC655.R84 2003
616.4'4--dc22
2003016226
Addicus Books, Inc.
P.O. Box 45327
Omaha, Nebraska 68145
www.AddicusBooks.com
Printed in the United States of America
Acknowledgments
I would llike to thank all my patients—past and present —for the privilege of being involved in their care. I would also like to acknowledge my patients’ family members. Their love, understanding, and support is vital for ensuring a healthy recovery for patients.
I wish to thank all the nurses at Charlton Hospital on Atwood 3 and at St. Anne’s Hospital on 1N for taking care of my thyroid patients. I am also grateful for the editorial efforts of Dr. Charles Eils and Dr. Tamer Yacoub toward the completion of this manuscript.
This book would not have been possible without the efforts of all those involved at Addicus Books. I especially thank Rod Colvin for his uncompromising focus and drive for perfection. I acknowledge Kate Maloy, Mary Campbell, Jane Kenyon, and Susan Adams for their editorial support; and I thank Jack Kusler for his work on the illustrations.
Finally, I would like to thank my office staff at the Truesdale Clinic for their work and daily efforts in taking care of my patients.
—Paul Ruggieri, M.D.
I would like to dedicate this book to my grandmother, Minna Rothberg, who has been on thyroid replacement for over fifty years, and who has been an incredible example of how to live in harmony with thyroid disease. I would also like to thank all of my patients with thyroid disease, who have taught me about its many faces and how illness can be overcome. I would also like to thank my family, Sheryle and Howard Isaacs, and Lori and Chase Johns for their love and support. Finally, I would like to thank my staff at Intelligent Health Center and my office manager, Holyn Ivy for their daily efforts and hard work in taking care of my patients with thyroid disease.
—Scott Isaacs, M.D.
Introduction
If you have been told you have a thyroid disorder, know that you are not alone. Every year, some 20 million Americans receive treament for thyroid problems. If you’re like may of those diagnosed, you probably have a lot of questions. You may wonder what caused the problem . How can your disorder be brought under control? What are the treatment options? What can you do to help yourself?
In this book, you will find the information you need to better understand your thyroid gland. The thyroid exerts more power over the human body than any other glandular structure; simply stated, it influences every cell in your body. Every organ and every bodily system—cardiac, respiratory, reproductive, circulatory, nervous, skeletal—is affected by this small powerhouse.
If you have a thyroid disorder, the good news is that most thyroid problems can be treated with conventional medicine so you can live normally. It is our hope that within these pages you will find understandable explanations of thyroid diseases and treatments to help you feel better.
Chapter 1
Understanding Your Thyroid Gland
If you’re like most people, you may not have given much thought to your thyroid gland. Over the years, you’ve probably heard about other people having thyroid problems; but the truth is that most of know very little about this gland. In fact, we usually don’t feel we need to know much about it…until it causes us a problem. Then, many of us want to gain a better understanding of how this small but powerful gland can have such a dramatic impact on our health.
One in ten Americans is affected by thyroid problems. And unfortunately, as many as half of those people have not been diagnosed. The reasons for the large number of undiagnosed cases include lack of public awareness about thyroid disorders as well as lack of knowledge about the thyroid gland itself. To lay a foundation for a better understanding of thyroid disorders, let’s first examine the thyroid gland and its function.
The Thyroid Gland
The thyroid gland is located at the front of your throat, just below your voice box (larynx). It is a light purplish-red, about the size of a hen’s egg, weighs less than three-quarters of an ounce, and is encased in a thin layer of tissue.
Shaped like a butterfly, the thyroid has wings,
or rubbery lobes