IDENTIFYING SYMPTOMS OF THYROID DISORDERS

Common thyroid symptoms for different thyroid disorders include:

Hypothyroidism (Underactive Thyroid)
• Fatigue and Weakness: Reduced levels of thyroid hormones can decrease overall energy production in the body, leading to fatigue and general weakness.
• Weight Gain or Difficulty Losing Weight: Lowered thyroid hormone levels can slow down the metabolic rate, making it difficult to lose weight and easy to gain it.
• Dry Skin and Hair: Hypothyroidism can reduce sweat and oil production in the skin, leading to dry, flaky skin and dry, brittle hair.
• Cold Intolerance: With decreased metabolism, the body generates less heat, which can make a person with hypothyroidism more sensitive to cold.
• Constipation: Reduced hormone production can slow down the digestive process, leading to constipation.
• Depression or Mood Changes: Thyroid hormones have a significant impact on brain chemistry. Low levels can lead to mood disturbances, including depression.
• Cardiovascular changes: Decrease in heart rate(bradycardia) and an increase in diastolic blood pressure greater than the increase in systolic blood pressure.
• Neurological changes: Hypothyroidism may present as a slowing down of thought processes such as a decrease in memory(especially verbal), concentration and the ability to make decisions. Other changes include a delayed response in the reflex relaxation phase(Woltman’s sign).
• Irregular Periods: Hypothyroidism can disrupt reproductive hormones, causing irregular menstrual cycles. Women may experience heavier, longer, or more frequent periods, or lighter and less frequent menstruation.
• Infertility: Low thyroid hormone levels can interfere with ovulation, making conception more difficult. This hormone imbalance can contribute to challenges in achieving and maintaining pregnancy.

• Hyperthyroidism (Overactive Thyroid)
• Fatigue and Muscle Weakness: Despite increased energy levels, the breakdown of muscle proteins and increased energy demands can result in fatigue and muscle weakness.
• Weight Loss: Increased metabolism caused by excess thyroid hormones can lead to significant weight loss despite normal or increased appetite.
• Skin and hair changes: hyperthyroidism may cause hives, skin sensitivity, itchiness, thinning hair
• Heat Intolerance and Over Sweating: Hyperthyroidism can cause the body to generate more heat and increase sweat production to cool down.
• Bowel changes: Hyperthyroidism may cause hypermotility of the GI tract resulting in frequent bowel movements
• Nervousness, Anxiety, or Irritability: Excess thyroid hormones can stimulate the nervous system, leading to feelings of anxiety or irritability.
• Cardiovascular changes: Excess thyroid hormones causes an increased heart rate and heart contraction resulting in palpitations and increased blood pressure
• Neurological changes: Hyperthyrodism may cause memory loss, brain fog, decrease in executive functions and attention deficit. Other symptoms may include fine shaking, especially in the hands, due to heightened stimulation of the nervous system.
• Irregular Periods: Hyperthyroidism can disrupt reproductive hormones, causing irregular menstrual cycles. Women may experience heavier, longer, or more frequent periods, or lighter and less frequent menstruation.
• Infertility: Low thyroid hormone levels can interfere with ovulation, making conception more difficult. This hormone imbalance can contribute to challenges in achieving and maintaining pregnancy.
• Thyroid Nodules or Goiter
• Visible Swelling at the Base of the Neck: A most common sign, the swelling can vary in size from barely noticeable to very large and obvious.
• Feeling of Tightness in the Throat: As the thyroid gland enlarges, it can press against other structures in the throat, causing a sensation of tightness or discomfort.
• Hoarseness or Voice Changes: If the growth impinges on the recurrent laryngeal nerve (which controls the vocal cords), it can cause changes in the voice, including hoarseness.
• Difficulty Swallowing or Breathing: Large nodules may compress the esophagus or trachea respectively, leading to difficulty swallowing or breathing. These are more severe symptoms and usually occur when the nodules are significantly enlarged.

ESSENTIAL THYROID FUNCTION TESTS

In the regulation of thyroid hormones, the hypothalamus in the brain plays a foundational role by producing Thyrotropin-Releasing Hormone (TRH). TRH signals the pituitary gland to release Thyroid Stimulating Hormone (TSH), which in turn stimulates the thyroid gland to produce thyroxine (T4) and triiodothyronine (T3). This process is essential for maintaining the body's metabolic rate, heart function, and more.

Thyroid function tests are essential tools used to diagnose and manage thyroid disorders effectively. These tests measure levels of various hormones in your blood that are crucial for proper thyroid function. Here is a detailed explanation for each test and an example to elucidate it:

• TSH Test (Thyroid-Stimulating Hormone)
• Detailed Explanation: The TSH test is often the first step in thyroid evaluation. Thyroid-stimulating hormone, produced by the pituitary gland, regulates the production of thyroid hormones. If your TSH levels are high, it usually indicates that your thyroid gland is not making enough hormones (hypothyroidism), prompting your pituitary to produce more TSH to stimulate the thyroid gland to produce more thyroid hormone. Conversely, low TSH levels can suggest hyperthyroidism, where the thyroid gland produces too much hormone, reducing the need for pituitary stimulation.
• Example: Imagine your body as a factory where the thyroid gland consists of the workers. Thyroid hormones are the product, and the manager is the pituitary gland.
• Hypothyroidism: When production is at a standstill, the manager increases calls( increase TSH) to the workers to increase production, but there are no materials to make the product(low T4 and sometimes low T3). This is primary hypothyroidism; the thyroid gland has run out of material to make thyroid hormones. The pituitary gland senses this low production and sends a signal to the thyroid (high TSH level) to increase production of thyroid hormones. The thyroid gland is unable to respond due to lack of materials( low T4 and sometimes low T3). TSH (signal) levels will be high. T4 and sometimes T3levels (product) levels will be low.
• Hyperthyroidism: When product is flooding the market (high T4 levels and sometimes high T3 levels), the manager stops calls (decrease TSH) to the workers to decrease production. This is primary hyperthyroidism; the thyroid gland operates on its own, making thyroid hormones and releasing them into the system. The pituitary gland senses the high levels of thyroid hormones and decreases its signal (TSH) to the thyroid gland. The thyroid gland, operating on its own, does not respond to the decrease in the signal. TSH (signal) levels will be low. T4 and sometimes T3levels (product) levels will be high.
• T4 Tests (Thyroxine Levels)
• Detailed Explanation: These tests measure thyroxine levels in the blood. Total T4 includes both bound and free thyroxine, while Free T4 measures thyroxine that is not bound to proteins and is available for your body to use. The balance of free and total T4 provides insight into how the thyroid is functioning and how it's interacting with other body systems.
• Example: Consider thyroxine as money. The money in your bank account plus the money in your wallet is like the Total T4. Money that you have in your wallet is Free T4.
• T3 Tests (Triiodothyronine)
• Detailed Explanation: Triiodothyronine tests are additional tests that might be ordered to further assess thyroid function, particularly in cases where more information is needed beyond TSH and T4 levels. Total T3 includes both bound and free triiodothyronine, while Free T3 measures triiodothyronine that is not bound to proteins and is available for your body to use.
• Example: Consider triiodothyronine as money. The money in your bank account plus the money in your wallet is like the Total T3. Money that you have in your wallet is Free T3.
• Thyroid Antibody Tests
• Detailed Explanation: These tests check for the presence of antibodies against thyroid-specific proteins, indicating autoimmune thyroid diseases like Hashimoto's thyroiditis or Graves' disease. These antibodies are inherited and can alter thyroid function, leading to chronic thyroid health issues.
• Example: Imagine your immune system as a home security system. In autoimmune disorders, the security system mistakenly identifies some of the home’s components (thyroid cells) as intruders, leading to an attack on those components.

Understanding these key tests for assessing thyroid health can help you understand your thyroid health management journey. Here is a summary of their purpose and when they are ordered:

• TSH Test (Thyroid-Stimulating Hormone)
• Purpose: Measures TSH levels in the blood to evaluate thyroid function. TSH is produced by the pituitary gland and is responsible for regulating the production of hormones by the thyroid gland.
• When Ordered: Typically, the first test to assess for potential thyroid dysfunction. Elevated levels may indicate hypothyroidism, while lower levels could suggest hyperthyroidism.
• T4 Tests (Thyroxine)
• Purpose: Determines the levels of total or unbound thyroxine in the blood. Thyroxine is a major hormone produced by the thyroid gland.
• When Ordered: Conducted following a TSH test to further evaluate thyroid function.
• T3 Tests (Triiodothyronine)
• Purpose: Measures the levels of triiodothyronine in the blood, helpful in diagnosing hyperthyroidism.
• When Ordered: Typically ordered when T4 and TSH tests do not fully explain the suspected thyroid dysfunction.
• Thyroid Antibody Tests
• Purpose: Identifies the presence of antibodies against thyroid peroxidase (TPO) and thyroglobulin, suggesting autoimmune thyroid conditions.
• When Ordered: Recommended if autoimmune disorders like Hashimoto's thyroiditis or Graves' disease are suspected.

AT-HOME TESTING: DRY BLOOD TESTS

Dry blood spot (DBS) testing offers a less invasive method for obtaining blood samples through a finger prick, facilitating thyroid-related tests at home.

Thyroid Antibody Tests: Some labs have developed methods to evaluate thyroid antibodies using DBS samples. However, the feasibility depends on test sensitivity, available technology, and antibody stability.

EMPOWERING YOUR THYROID HEALTH JOURNEY

Here are some tools and information to recognize symptoms and understand when to seek medical advice or further evaluation:

• Symptom Awareness and Self-Checks: Educate yourself on how to identify signs of thyroid issues and perform initial self-assessments.
• Navigating Through Telehealth and In-Person Care: Learn to use convenient telehealth services effectively, while understanding the importance of in-person assessments when necessary.

Physical examination of the thyroid includes palpating the gland in the neck to check for enlargement, nodules, or tenderness. These tests cannot be adequately performed remotely and is essential for diagnosing conditions like thyroiditis or thyroid nodules.

Here are instances where in-person visits are necessary:

• Suspected thyroid nodules or goiter: Requires ultrasound and possible biopsy.
• Complex cases: Where symptoms and blood tests do not align, or if there is a history of thyroid cancer or radiation exposure.
• Procedure-based diagnostics: Such as fine needle aspiration or radioactive iodine studies.