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Information: Thyroid Problems

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The thyroid gland is located on the front part of the neck below the thyroid cartilage (Adam's apple). The gland produces thyroid hormones, which regulate metabolic rate (how fast calories are consumed to produce energy). Thyroid hormones are important in regulating body energy, body temperature, the body's use of other hormones and vitamins, and the growth and maturation of body tissues.

Diseases of the thyroid gland can result in either production of too much (overactive thyroid disease or hyperthyroidism), too little (underactive thyroid disease orhypothyroidism) thyroid hormone, thyroid nodules, and/or goiter. Thyroid problems are much more common in women than in men.

  • Production of thyroid hormones:The process of hormone synthesis begins in a part of the brain called the hypothalamus. The hypothalamus releases thyrotropin-releasing hormone (TRH). The TRH travels through the venous plexus located in the pituitary stalk to the pituitary gland, also in the brain. In response, the pituitary gland then releases thyroid-stimulating hormone (TSH, also called thyrotropin) into the blood. The TSH travels to the thyroid gland and stimulates the thyroid to produce the two thyroid hormones, L-thyroxine (T4) and triiodothyronine (T3). The thyroid gland also needs adequate amounts of dietary iodine to be able to produce T4 and T3, the molecules of which contain four and three atoms of iodine, respectively.
  • Regulation of thyroid hormone production: To prevent the overproduction or underproduction of thyroid hormones, the pituitary gland senses how much hormone is in the blood and adjust the production of hormones accordingly. For example, when there is too much thyroid hormone in the blood, TRH and TSH production are both decreased. The sum effect of this is to decrease the amount of TSH released from the pituitary gland and to reduce production of thyroid hormones from the thyroid gland to restore the amount of thyroid hormone in the blood to normal. Defects in these regulatory pathways rarely may result in hypothyroidism (underactive thyroid problem) or hyperthyroidism (overactive thyroid problem). The most common cause of hypothyroidism and hyperthyroidism occurs due to problems within the thyroid and not the regulatory system.
  • Thyroid goiter: Thyroid goiter is any enlargement of the thyroid that can occur with hyperthyroidism or hypothyroidism but also with benign and malignant (cancerous) nodules. Worldwide, the most common cause of goiter is iodine deficiency. Although it used to be very common in the U.S., it is now less common with the use of iodized salt. Multiple nodules in the thyroid are very common, but only about 5% of the nodules are a thyroid cancer. Thyroid cancer rates have been increasing steadily by about 6% every year for more than 20 years. It is one of the few cancers whose rate is increasing and whose very low rate of mortality is also rising with time. Although radiation exposure as a child can increase the risk of thyroid cancer, we do not know why the overall rate has been increasing. Thyroid cancer is diagnosed after a thyroidultrasound exam and a needle aspiration biopsy of the nodule.

Thyroid Problems Symptoms

Symptoms of thyroid problems depends on the age of the person and the exact problem with the thyroid. For example, some symptoms of hypothyroidism in children include:

Symptoms similar to adult symptoms
Excessive fatigue
Poor growth
Poor school performance
Symptoms of hypothyroidism in adults include:

Easy fatigue, exhaustion
Poor tolerance to cold temperatures
Carpal tunnel syndrome (pain at the wrists and numbness of the hands)
Some of the symptoms of hyperthyroidism in adults include:

Hand tremors

How common is thyroid disease?
Thyroid disease is more common than diabetes or heart disease. Thyroid disease is a fact of life for as many as 30 million Americans – and more than half of those people remain undiagnosed. Women are 5 times more likely than men to suffer from hypothyroidism (when the gland is not producing enough thyroid hormone). Aging is just one risk factor for hypothyroidism.
How important is my thyroid in my overall well-being?
The thyroid gland produces thyroid hormone, which controls virtually every cell, tissue, and organ in the body. If your thyroid is not functioning properly, it can produce too much thyroid hormone, which causes the body’s systems to speed up – this is called hyperthyroidism; or it can create too little thyroid hormone, which causes the body’s systems to slow down – this is called hypothyroidism. If your thyroid gland isn’t working properly, neither will you.
Untreated thyroid disease may lead to elevated cholesterol levels and subsequent heart disease, as well as infertility and osteoporosis. Research also shows that there is a strong genetic link between thyroid disease and other autoimmune diseases, including types of diabetes, arthritis, and anemia.
How do you know if you have a thyroid problem?
First, understand how to recognize the symptoms and risk factors of thyroid disease. Since many symptoms may be hidden, the best way to know for sure is to ask your doctor for a TSH (thyroid-stimulating hormone test), a simple blood test to verify your thyroid gland’s condition. Also, take a minute and perform a self “Neck Check. Because thyroid disease often runs in families, examinations of your family members may reveal other individuals with thyroid problems.
Who should have a TSH test?
Individuals over the age of 60 and those who have symptoms or the risk factors associated with thyroid disease should talk to their doctor about undergoing a TSH test.
What causes hypothyroidism?
Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormone. The most common cause of hypothyroidism is an autoimmune disease called Hashimoto’s thyroiditis, in which the body’s immune system attacks the thyroid. Hypothyroidism can also be caused by some treatments of hyperthyroidism because the remaining active thyroid cells cannot produce enough thyroid hormone. In addition, hypothyroidism can be caused by certain medicines such as lithium, iodine, and amiodarone. Hypothyroidism can temporarily arise after pregnancy or if the thyroid is inflamed due to a viral infection. This disease can also be present at birth and runs in families.
What can affect my thyroid disease treatment results?
To reach optimal treatment results, it is important to take your medicine as instructed by your doctor. Do not stop taking your thyroid medicine, even if you feel better, without talking to your doctor first. It is important to stay on the exact dose and brand of medicine your doctor prescribes to help avoid any variations in your thyroid hormone levels. Thyroid hormone imbalance can result from untreated thyroid disease, or from over- or under-treatment. In addition, various medicines and supplements may affect the absorption of thyroid hormone; therefore, you should talk to your doctor about any medicines and supplements you are taking and about the best time of day to take your thyroid medicine if you are taking other medicines or supplements.
What is radioiodine therapy?
If you have an overactive thyroid gland or have been diagnosed with thyroid cancer, your endocrinologist may prescribe radioactive iodine (radioiodine) as part of your overall treatment. You, your family, and your coworkers may have some questions about this therapy.
How is radioiodine therapy used to treat hyperthyroidism?
Before the development of current treatment options, the death rate from severehyperthyroidism was as high as 50%. Now several effective treatments (antithyroid drugs, surgery, and radioiodine) are available, and death from hyperthyroidism is rare. Deciding which treatment is best depends on what caused the hyperthyroidism, its severity, and other conditions present. Endocrinologists are experienced in the management of thyroid diseases and can confidently diagnose the cause of hyperthyroidism and prescribe and manage the best treatment program for each patient.
Thousands of patients have received radioiodine treatment, including former President of the United States George H. W. Bush and his wife, Barbara. The treatment appears to be a very safe, simple, and reliably effective one. Because of this, it is considered by most thyroid specialists in the United States to be the treatment of choice for hyperthyroidism cases caused by overproduction of thyroid hormones.
Radioactive iodine is given by mouth, usually in capsule form, and is quickly absorbed from the bowel. It then enters the thyroid cells from the bloodstream and gradually destroys them. Although the radioactivity from this treatment remains in the thyroid for some time, it is largely eliminated from the rest of the body within a few days. Its effect on the thyroid gland usually takes between 1 and 3 months to develop, and maximal benefit is usually noted within 3 to 6 months.
It is not possible to eliminate “just the right amount” of the diseased thyroid gland, since radioiodine eventually damages all thyroid cells. Therefore, most endocrinologists strive to completely destroy the diseased thyroid gland with a single dose of radioiodine. This results in the intentional development of an underactive thyroid state (hypothyroidism), which is easily, predictably and inexpensively corrected by lifelong daily use of oral thyroid hormone replacement therapy. Although every effort is made to calculate the correct dose of radioiodine for each patient, not every treatment will successfully correct the hyperthyroidism, particularly if the goiter is quite large and a second dose of radioactive iodine is occasionally needed.
How is radioiodine therapy used for the treatment of thyroid cancer?
The two most common types of thyroid cancer (papillary and follicular) can usually be treated with radioiodine because the cells are able to take up some iodine. Radioiodine is used in treating thyroid cancer in the following two general situations:
AFTER REMOVAL OF THE THYROID- An experienced thyroid surgeon can remove most of the thyroid with a very low risk of surgical complications. Radioiodine can be used to destroy the remainder of the thyroid gland, which might harbor additional microscopic clusters of cancer cells. This is called radioiodine remnant ablation. It is also used to treat thyroid cancer that has spread beyond the thyroid gland. In this case, when thyroid cancer is definitely being treated it is called radioactive iodine therapy. Elevated TSH levels are required in order to adequately stimulate normal or cancerous cells to pick up enough radioiodine for the treatment to be effective. This can be accomplished by either not taking replacement thyroid hormone for several weeks after surgery or by getting synthetic TSH (recombinant human thyrotropin) injections. Synthetic TSH is FDA- approved for radioiodine remnant ablation, but not for treating thyroid cancer that has already spread. This treatment significantly reduces the possibility of recurrent cancer in whatever thyroid tissue is left and also improves the ability to detect and treat any future cancer recurrences that might develop.
DURING FOLLOW-UP- Patients with residual thyroid cancer or cancer that has spread to regions outside of the neck can undergo a scan with a test amount of radioiodine. Scanning with radioiodine helps to determine the extent of “persistent” or “recurrent” thyroid cancer, whether it may respond to additional doses of radioactive iodine, and how much radioactive iodine to use for treatment. If any iodine is concentrated in the areas of the thyroid cancer, another dose of radioiodine can be given to try to destroy the tumor. This treatment is safe, well tolerated, and has successfully treated many cases of thyroid cancer even after the tumor has spread.
All patients with thyroid cancer should have regular follow-up examinations by an endocrinologist. Additional doses of radioactive iodine may be recommended if thyroid cancer remains (which is called “persistent”) or reappears later (which is called “recurrent”). Your thyroid hormone replacement therapy will need to be stopped long enough to allow you to become hypothyroid, so that maximum response to the treatment will occur.
What happens to the radioiodine after a treatment?
Since surgery removes the vast majority of thyroid tissue, much of the radioiodine will not be absorbed and will leave the body primarily through the urine. Small amounts will also be excreted in saliva, sweat, tears, vaginal secretions, and feces. Nearly all the radioactive iodine will leave the body during the first 2 days after the dose has been given.
What about breast-feeding during treatment?
Radioactive iodine treatment should never be given to a pregnant woman! Small amounts of radioactive iodine will also be excreted in breast milk. Since radioiodine could permanently damage the infant’s thyroid, breast-feeding is not allowed. If radioiodine is inadvertently administered to a woman who is subsequently discovered to be pregnant, the advisability of terminating the pregnancy should be discussed with the patient’s obstetrician and endocrinologist. Therefore, prior to administering diagnostic or therapeutic radioiodine treatment, pregnancy testing is mandatory whenever pregnancy is possible.
Are future pregnancies possible?
For safety’s sake, males are advised to avoid fathering a child for several months. Females are advised to postpone pregnancy for six or so months after radioiodine treatment. Women are advised to wait longer to help stabilize their thyroid status before conception. Even though the amount of radioactivity retained may be small and there is no medical proof of an actual risk from radioiodine treatment, there is a theoretical risk to a developing fetus. Such precautions essentially eliminate direct fetal exposure to radioactivity, and markedly reduce the possibility of conception with sperm that might theoretically have been damaged by exposure to radioiodine. You may need to contact your physician for guidance about methods of contraception.
Regulations regarding the use of radioiodine therapy are made by the US Nuclear Regulatory Commission (NRC). Physicians and hospitals that administer this therapy must have a license to administer radioiodine, and must adhere to stringent regulations regarding its use. If you have any questions before or after receiving your treatment, please do not hesitate to contact your physician or your hospital radiation safety officer for clarification.
Click here to learn more about pregnancy and thyroid.
Is hospitalization necessary for treatment with radioiodine?
Treatment for hyperthyroidism is almost always done on an outpatient basis, because the dose required is relatively small in comparison with the doses typically used for treatment of thyroid cancer. If you have to take a larger dose of radioiodine for treatment of thyroid cancer, you may need to be admitted to the hospital for several days depending on the amount of radioiodine administered, your living environment, state of residence, or local practice patterns.
If you require hospitalization, your hospital room will have frequently handled items (such as the television control, table, phone, faucet handles, etc), covered with protective material, and the floor will be partially covered. These precautions are designed to prevent the radioactive iodine from contaminating those items that will be reused by other patients after your dismissal from the hospital. To limit the contamination of your personal items, you should bring a minimal amount of belongings for your stay. All items will be monitored at your dismissal. Clothing should be limited to what you wear when you are admitted. You should use hospital gowns during your stay. You may want to bring disposable items like magazines and newspapers, but important or durable items like hardback books, work papers, and craft items should be left at home. Check with your endocrinologist about any other issues.
What are some recommendations for the reduction of exposure to others after treatment?
Use private toilet facilities, if possible; flush twice after each use.
Bathe daily and wash hands frequently.
Drink normal amount of fluids.
Use disposable eating utensils or wash your utensils separately from others.
Sleep alone and avoid prolonged intimate contact.
Launder your linens, towels, and clothes daily at home, separately from others. No special cleaning of the washing machine is required between loads. This is because the radioiodine administered is water soluble.
Do not prepare food for others that requires prolonged handling with bare hands (such as mixing a meat loaf or kneading bread)
Brief periods of close contact, such as handshaking and hugging, are permitted.
Your endocrinologist or radiation safety officer may recommend continued precautions for up to several weeks after treatment, depending on the amount of radioactivity administered and retained by your body. Patients receiving radioactive iodine should also carry information about their treatment with them in order to fully inform authorities who are in charge of screening for radioactive materials in public areas such as airports and subways.
( Courtesy:, )


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