Is there something wrong with my thyroid?
The thyroid is a small gland in the front part of your lower neck that plays a role in regulating your metabolism. Problems can arise when the gland does not produce the appropriate amount of hormone, when it is enlarged, or rarely by developing cancer. There are many misconceptions about the thyroid and often it is the “boogieman” that is blamed for weight gain, swallowing issues, or hoarseness. Here are some of the more common issues that can be encountered and what to do if you suspect you have a thyroid disorder.
Hypothyroidism: When your thyroid gland is underactive it can cause symptoms such as weight gain, fatigue, hair loss, dry skin, and constipation. This can be diagnosed by a simple blood test and treated with medication. It can be managed by your primary care doctor or an endocrinologist (hormone specialist).
Hyperthyroidism: When your thyroid is overactive, it can result in symptoms such as weight loss, a racing heart beat, and diarrhea. Hyperthyroidism can also be diagnosed by a blood test but often several other radiologic tests will be needed to determine the cause. Depending on the cause, treatment may consist of medication, radioactive iodine, or surgery. Medications and radioactive iodine treatments are administered by an endocrinologist, while surgery would be performed by an ear, nose and throat (ENT) surgeon.
Goiter: Goiter is the medical term for an enlarged thyroid. It is a relatively rare condition in the United States. Even in cases when goiter is diagnosed, surgery is only considered when the goiter is causing symptoms such as trouble swallowing, shortness of breath, or tightness in the neck. Goiters are almost always benign. When surgery is required this would be performed by an ENT surgeon. If you suspect you have a goiter, your primary care physician would order an ultrasound to better examine your thyroid gland.
Thyroid nodules and cysts: Often patients will be diagnosed with a thyroid nodule or cyst after a routine physical examination by their primary care doctor. Also, nodules and cysts are commonly found during an imaging study performed for another reason (exams of the spine or chest). These nodules and cysts are very common and the vast majority are benign. After the nodule is discovered it is common to refer to an ENT doctor to evaluate the thyroid nodule or cyst. If it meets certain criteria an ultrasound guided needle biopsy may be performed to determine the nature of the nodule. This is a relatively simple procedure that can be done in the ENT clinic. Even when a biopsy is performed the vast majority are benign. In the rare instances where a cancerous nodule is diagnosed, the majority of thyroid cancers are very low grade and can be treated with an outpatient surgery to remove the thyroid. The treatment of these cancers does not require radiation or chemotherapy.
In summary, there are a number of diseases that can occur within the thyroid. If you suspect a thyroid disorder, discuss this with your primary care doctor. Simple lab tests and an ultrasound can often determine whether you have thyroid disease. Based on the results, you may be referred to an endocrinologist for a medical issue with the thyroid or an ENT surgeon if a surgical disease is suspected.
Jason Acevedo, MD, MBA
Dr. Acevedo is a board-certified Otolaryngologist-Head and Neck Surgeon and a partner at ENT Specialists of Abilene. Along with Drs. Tidmore and Thompson, he is a specialist in the surgical treatment of thyroid and parathyroid diseases.