Symptoms Of Too Much Thyroid Medication

In this article:

• How thyroid medication treats hypothyroidism

• What medicine treats hypothyroidism?

• What causes overmedication?

• Symptoms of too much thyroid medication

• What to do if you are taking too much thyroid medication

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Thyroid replacement medication is necessary for people who have hypothyroidism. However, taking too much thyroid medication can cause more harm than good. Indeed, too much thyroid medication can cause hyperthyroidism, a state of an overactive thyroid. Like hypothyroidism, hyperthyroidism can have damaging effects on your body and mind. 

How thyroid medication treats hypothyroidism

The thyroid gland is responsible for regulating cellular metabolism, growth, and development. When the thyroid does not produce enough hormone, it can slow down all body systems.  

Common symptoms of hypothyroidism include: 

• Fatigue and malaise

• Weight gain

• Cold intolerance

• Slowed heart rate

• Slowed digestion (constipation)

• Hair thinning (including eyebrows)

• Dry skin

• Depression

Thyroid hormone replacement medication can relieve the above symptoms and improve your overall health and quality of life. 

Hashimoto’s thyroiditis, an autoimmune condition, is often the cause of hypothyroidism. Chronic inflammation from Hashimoto’s can lead to the thyroid gland’s eventual failure, making it unable to produce enough thyroid hormone. Surgical removal, radiation, thyroiditis, and damage to the pituitary gland can also cause hypothyroidism. No matter the cause, people with hypothyroidism often need thyroid replacement medication.   

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What medication treats hypothyroidism?

The thyroid gland produces two hormones: thyroxine (T4) and triiodothyronine (T3). Similarly, thyroid hormone replacement medication also comes in T4 and T3 formulations. In a healthy thyroid gland, the inactive T4 hormone is released into circulation and then converted by the body into the active T3 hormone. Often, treatment for thyroid replacement starts with T4-only formulations, assuming that the body can successfully do the conversion independently. 

Suppose your body has a hard time converting T4 to T3, or you take an interfering medication. In that case, standard T4 medicines may not be sufficient for you. For the few patients who do not feel completely normal taking a synthetic preparation of T4 alone, the addition of T3 may be of benefit. 

Those who are interested in a more natural approach may prefer combination therapies. There are two main types of combination thyroid medications – desiccated and compounded.  

• Natural desiccated thyroid (NDT) comes from the dried (desiccated) thyroid glands of pigs.

• Compounded thyroid medication is a personalized medication in which drug ingredients are combined, mixed, or altered to solve specific patient needs.

Each person is unique with individual sensitivities. Our bodies will not all react the same way to a specific medication or dosage. It usually takes a few weeks to see a remarkable improvement in your symptoms when you start thyroid hormone replacement therapy. Your doctor may need to adjust your dosing to reach a therapeutic level. 

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What causes overmedication? 

Several factors may cause overmedication, including:

Titration

The titration process can sometimes make you have hyperthyroidism symptoms when T4 levels are too high. Sometimes, your doctor may also start you on too high of a dose. 

Issues of drug quality

There are variations in formulations between different thyroid medications. For example, liquid suspensions of T4 tend to be absorbed better compared to tablets. Liquid medications may also contain additives, such as dyes and fillers that may aggravate your system. Furthermore, doctors and pharmacists are human and sometimes make mistakes, so always look over your prescription, even when you refill it.

Dietary changes

Certain foods can interfere with thyroid hormone absorption. For example, if you stop eating a high fibrous diet, you may start absorbing more medication.

Medications and supplements

Certain supplements boost your thyroid function with “thyroid glandular” from animals, or increase your iodine. These supplements may increase thyroid hormone in your body. Similarly, certain medications may block thyroid hormone absorption while taking them and then increase your absorption after stopping. These medications include estrogen replacement therapy, birth control pills with estrogen, and antacids containing calcium. Please talk to your doctor before taking any over-the-counter glandular supplements.

Pregnancy

Your doctor will likely increase your dose of thyroid hormone medication while pregnant. Once you have your baby, your doctor must decrease your dosage so that you do not overmedicate during the postpartum period.

Symptoms of too much thyroid medication

When thyroxine levels are too high, it can lead to symptoms of hyperthyroidism. In hyperthyroidism, your metabolic processes speed up. Thus, you may imagine what the symptoms may be like as they are the opposite of hypothyroidism.

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Common symptoms of hyperthyroidism include:

• A racing heart

• Perspiration

• Nervousness

• Irritability

• Tremors

• Insomnia

• Anxiety

• Brittle hair

• Thinning skin

• Muscle weakness

• Frequent bowel movements (usually not diarrhea)

Sometimes, overmedication symptoms can paradoxically be the same as those you experience when you have low thyroid hormones. These symptoms may include exhaustion, achiness, and weight gain despite feeling jittery and nervous. Some people even describe their symptoms as flu-like.

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Share what it feels like to take too much thyroid medication:

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What to do if you are taking too much thyroid medication

It is crucial that you not abruptly stop your thyroid medication. If you think your thyroid medication dose is too high, request to have a thyroid blood test so that your doctor can assess your levels. 

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If you are on too much thyroid medication, your thyroid-stimulating hormone (TSH) test will likely be on the lower end of the reference range. Your doctor may also check your T4 and T3 levels. If these are on the upper end of the reference range, that may also indicate overmedication.

It is also helpful to track your symptoms to have a log of what you are experiencing and what time of day. This information helps your doctor assess factors that cause dosage or absorption issues that may not show up in your blood work.

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Thyroid preparation overdose: MedlinePlus Medical Encyclopedia

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Thyroid preparations are medicines used to treat thyroid gland disorders. Overdose occurs when someone takes more than the normal or recommended amount of this medicine. This can be by accident or on purpose. Symptoms of thyroid preparation overdose can be the same as symptoms of stimulant drugs.

This article is for information only. DO NOT use it to treat or manage an actual overdose. If you or someone you are with overdoses, call the local emergency number (such as 911), or the local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

These ingredients in thyroid medicines can be poisonous if a person takes too much of the medicine:

• Levothyroxine
• Liothyronine
• Liotrix (in international medicines)
• Other thyroid medicine

Other thyroid preparations may also contain harmful ingredients.

The poisonous ingredients may be found in these medicines with these brand names:

• Levothyroxine (Euthyrox, Levo-T, Levoxyl, Synthroid, Thyro-Tabs, Tirosint, Unithroid)
• Liothyronine (Cytomel)
• Other thyroid medicine

Symptoms of poisoning with this type of medicine include:

• Anxiety, nervousness
• Tremor, shaking
• Insomnia
• Seizures
• Confusion
• Muscle aches or cramps
• Irregular heartbeat
• Palpitations
• Chest pain or discomfort
• Changes in menstrual pattern
• Dilated pupils
• Excessive sweating, skin flushing
• Nausea, vomiting
• Diarrhea
• Weight loss
• Shock (extremely low blood pressure and collapse)

Seek medical help right away. Do not make a person throw up unless poison control or a health care provider tells you to do so.

Have this information ready:

• Person’s age, weight, and condition
• The name of the product (ingredients and strength, if known)
• The time it was swallowed
• The amount swallowed
• If the medicine was prescribed for the person

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline number will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

Take the container with you to the hospital, if possible.

The provider will measure and monitor the person’s vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated. The person may receive:

• Activated charcoal
• Blood and urine tests
• Breathing support, including oxygen, tube through the mouth into the lungs, and breathing machine (ventilator)
• Chest x-ray
• ECG (electrocardiogram, or heart tracing)
• Intravenous (IV) fluids through a vein
• Laxative
• Medicines to treat (counteract) the effects of the thyroid preparation overdose

People who receive quick treatment make a good recovery. But heart-related complications can lead to death.

Symptoms may not appear until a week after the overdose or may build up over time. They may be treated successfully with several medicines.

Aronson JK. Thyroid hormones. In: Aronson JK, ed. Meyler’s Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:931-944.

Thiessen MEW. Thyroid and adrenal disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 120.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

When to have thyroid surgery: signs and recommendations

Contents

• 1 When to decide on thyroid surgery: signs, risks and consequences
  • 1.1 When to have thyroid surgery: what are the signs?
  • 1.2 The role of the thyroid gland in the body
  • 1.3 Thyroid diseases
  • 1.4 Symptoms of thyroid diseases
  • 1.5 When is thyroid surgery indicated
  • 1.6 Benefits of thyroid surgery
    • 1.6.1 Get rid of dangerous tumors
    • 1.6.2 Eliminate thyroid problems
    • 1.6.3 Improve neck aesthetics

  900 05 1. 7 Preparing for thyroid surgery

  • 1.7 .1 Specialist consultation
  • 1.7.2 Avoiding certain medications
  • 1.7.3 Food restriction
  • 1.7.4 Daily routine
  • 1.7.5 Training efficiency
  • 1.8 Progress of thyroid surgery
    • 1.8.1 Stages of surgery
    • 1.8.2 Postoperative period
  • 1.9 Postoperative period for thyroid surgery
    9 0005 1.9.1 Feelings expected
    • 1.9.2 Care
    • 1.9.3 Nutrition
    • 1.9.4 Physical activity
    • 1.9.5 Condition monitoring
  • 1.10 Complications after thyroid surgery
  • 1.11 Rehabilitation after thyroid surgery0004
  • 1.11.1 The first days after the operation
  • 1.11.2 Later in the rehabilitation period
  • 1.11.3 Control examination
• 1.12 Alternative to surgery: manual therapy
• 1.13 Related video:
• 1.14 Q&A:
  • • 1.14.0.1 What signs indicate the need for thyroid surgery?
    • 1. 14.0.2 How often do I need to be tested to determine the need for thyroid surgery?
    • 1.14.0.3 What types of operations can be performed on the thyroid gland?
    • 1.14.0.4 How is thyroid surgery performed and how long is the recovery after surgery?
    • 1.14.0.5 Can thyroid surgery be avoided if diseases are detected?
    • 1.14.0.6 What are the possible complications after thyroid surgery?

Find out when a thyroid tumor requires surgery and what symptoms to consider when making a decision. Read the article on our website and get useful information for the health of your thyroid gland.

The thyroid gland plays an important role in the human body, producing hormones necessary for the normal functioning of the endocrine system. However, with age, as a result of disturbances in its work or other factors, problems may arise that require medical attention.

Thyroid surgery is an effective treatment for many diseases, such as tumors, nodes, inflammation, etc. However, sometimes it is necessary due to a possible malignant tumor.

If you encounter such problems, be sure to consult a specialist and go through all the necessary examinations to identify the disease and determine the method of its treatment.

In this article, you can learn about the causes of thyroid problems, what symptoms may indicate the disease and when to seek surgery. Also, you will receive advice from experts on the prevention and treatment of thyroid problems.

When is thyroid surgery required: what are the signs?

The thyroid gland is responsible for providing the body with the necessary hormones that regulate metabolism. If the gland does not work properly, it can lead to serious disorders such as hypo- or hyperthyroidism. In some cases, thyroid surgery is necessary to restore the patient’s health.

Thyroid problems arise from a variety of causes, including autoimmune disease, tumors, heredity, trauma, or inflammation. Here are a few signs that may indicate the need for surgery:

• Enlargement of the thyroid gland (goiter). If the thyroid gland is greatly enlarged, it can lead to cosmetic defects, as well as pressure on nearby organs and tissues, which can lead to difficulty breathing and swallowing.
• Knot formation. If the ultrasound shows that there are cancerous or suspicious nodules on the thyroid gland, then surgery is usually prescribed to remove them.
• Change in the level of thyroid hormones. If the level of hormones is very different from the norm, the body may experience unpleasant symptoms. In such cases, various methods of treatment, including surgery, may be recommended.

Thyroid surgery is a serious step that should be considered with great responsibility. If the doctor recommended the procedure, be sure to follow his recommendations and ask all your questions in order to be aware of all stages of the operation and the recovery period.

The role of the thyroid gland in the body

The thyroid gland is an organ located in the throat, in front of the trachea. It plays an important role in the metabolism and development of the body as a whole. Hormones produced by the thyroid gland control many processes, including growth and development, thermoregulation, digestion, and cardiovascular function.

The thyroid gland also controls calcium levels in the bones. If the level of hormones produced by the thyroid gland drops or rises significantly, it can lead to osteoporosis or other bone health problems.

In general, the thyroid gland plays an important role in the functioning of the body. Therefore, with any signs of possible problems with the thyroid gland, you should consult a doctor for diagnosis and treatment.

Diseases of the thyroid gland

The thyroid gland is an organ located in the prepericurdial region. Despite its small size, the thyroid gland plays an important role in the functioning of the body. Its activity is directly related to the synthesis of hormones that control the work of many organs and systems.

Another common thyroid disorder is hyperthyroidism, in which the thyroid gland produces too much hormone. Symptoms of hyperthyroidism include weight loss, aggressive tendencies, abnormal heart rhythms, blurred vision, rapid breathing, sweating, and drowsiness.

In addition, the thyroid gland can suffer from various tumors, cysts and nodes.

All of the above diseases require referral to an endocrinologist and may require thyroid surgery.

Thyroid symptoms

Hyperthyroidism is a condition in which the thyroid gland produces too much hormone. One of the most common symptoms is increased activity, which manifests itself in the form of nervousness, restlessness and anxiety.

• Rapid pulse
• Increased sweating
• Drowsiness
• Indigestion
• Periodic pain in the head
• Fever

Hypothyroidism is a condition in which the thyroid gland does not produce enough hormones. One of the most common symptoms is a reduced level of activity, which manifests itself in the form of fatigue, drowsiness and weakness.

1. Fatigue
2. Drowsiness
3. Shortness of breath
4. Weight gain
5. Decreased body temperature
6. Dry skin

W about is an enlargement of the thyroid gland caused by a lack of iodine in the body. One of the first symptoms is an increase in the size of the neck.

Symptoms of goiter Conditions for their occurrence

When thyroid surgery is indicated

The thyroid gland is an important organ that is responsible for many processes in the body, such as metabolism, growth, development, body temperature management and much more. In some cases, when the thyroid gland is not functioning properly, a doctor may recommend surgery to remove part or all of the gland.

Thyroid surgery may be indicated in the following cases:

• Nodules or tumors in the thyroid gland, which may be malignant or benign.
• Hyperthyroidism, when the thyroid gland produces too many hormones and causes excessive activity in the body.
• Hypothyroidism, when the thyroid gland works too slowly and does not produce enough hormones.
• Restriction of breathing or difficulty in swallowing due to an enlarged thyroid gland.

Prior to thyroid surgery, a series of examinations and consultations with physicians is required to determine the most appropriate treatment. In addition, surgery may have some risks and complications that need to be discussed with your doctor.

Advantages of thyroid surgery

Getting rid of dangerous tumors

One of the main advantages of thyroid surgery is the ability to get rid of dangerous tumors. A thyroid tumor can be either malignant or benign. If you have a tumor that is potentially dangerous or makes breathing or swallowing difficult, surgery can help get rid of the tumor completely and reduce the risk of further growth and spread.

Correction of thyroid problems

Thyroid surgery can also help correct problems associated with an overactive or underactive thyroid gland. Hyperthyroidism can cause feelings of nervousness, a feeling of sweating, increased appetite, and mood instability. Hypothyroidism can lead to chronic fatigue, the possibility of depression, and even problems with memory and concentration. Surgery can help correct thyroid hormone levels and improve quality of life.

Improving the aesthetic appearance of the neck

One of the consequences of an increase in the size of the thyroid gland can be a change in the shape of the neck. People with an enlarged gland may experience discomfort and discomfort when wearing clothes with a high collar or tie. Thyroid surgery can help shrink the gland and improve the aesthetic appearance of the neck.

Preparing for Thyroid Surgery

Specialist Consultation

Consultation with an endocrinologist is required prior to thyroid surgery. The doctor will assess the condition of the thyroid gland, conduct the necessary diagnostic studies and determine the appropriateness of the operation. Also, the doctor will tell the patient in detail about how the preparation for the operation will take place.

Avoiding certain medications

The patient needs to stop taking certain medications that may affect bleeding during surgery. In addition, before the operation, mandatory tests for infections and other diseases should be carried out.

Food restriction

In preparation for thyroid surgery, it is necessary to limit the intake of fatty, sweet and fried foods. Also, before the operation, you need to consistently reduce food intake until complete failure for 12 hours before surgery.

Daily routine

Before the operation, it is necessary to observe the daily routine and rest in order to normalize the functioning of the body and reduce stress.

Efficiency of preparation

Compliance with all recommendations of a specialist significantly increases the efficiency of preparation for thyroid surgery. This reduces the risk of possible complications and speeds up the recovery process after surgery.

Thyroid surgery progress

Operation steps

Thyroid surgery involves several stages. First, the patient is given a general blood and urine test, as well as an ECG and X-ray. After that, a preparatory stage is carried out, including taking an anamnesis, determining the location of the tumor and its size. If an operation is indicated, then the patient is explained how all the stages will go through.

The operation is performed under general anesthesia. The doctor makes an incision in the neck to get to the thyroid gland. Then, part of the gland or the entire gland is removed. In the process, the vessels and nerves are separated from the thyroid gland so as not to damage them during the operation.

After removal of the tumor, follow-up examinations are carried out to make sure that everything went without complications and the gland stopped producing hormones. The neck is then closed with stitches, which heal in about 10 days.

Postoperative period

After thyroid surgery, the patient must follow a number of recommendations in order to recover faster. In the early days, you may experience pain in the neck, swelling and bruising. Analgesics are taken to reduce pain. It is also recommended to rest and not lift heavy weights for a few weeks.

The second important point after the operation is hormonal support. If the patient has had a complete thyroid gland removed, then he must take thyroid hormones (inacated) to compensate for its absence. With partial removal of the gland, this is not required, however, the patient must still monitor his health and do regular tests in order to timely identify possible complications.

Postoperative period for thyroid surgery

Expected sensations

After thyroid surgery, the patient may experience various sensations, including pain in the neck, dry mouth, and the throat may be sore.

Also, the patient may feel weak and tired, so it is important to give the body time to recover.

Wound care

To speed up the healing of a wound left after thyroid surgery, it is recommended to occasionally rinse the mouth with saline or gargle with ratania.

Ward mates can help keep the personal area in good condition and good hygiene.

Nutrition

After thyroid surgery, the patient may have difficulty swallowing, but meals should not be skipped.

It is important to eat easily digestible foods and drink plenty of water so that the body gets enough nutrients and stays hydrated.

• Avoid spicy, greasy, smoked foods, alcohol, strong tea and coffee.
• Follow the diet prescribed by your doctor.
• Avoid eating before bed to prevent heartburn.

Physical activity

In the first days after thyroid surgery, the patient is not recommended to do physical exercises or heavy physical activity.

However, the patient should gradually increase physical activity with light exercise as soon as the condition allows.

• Start with short walks in the open air, and as the condition improves, increase the time and distance of the walk.
• Avoid elevators and use stairs to increase activity in daily life.

Monitoring

In the first weeks after thyroid surgery, it is important to follow your doctor’s instructions and attend all appointments.

If you experience severe pain or any other symptoms that cause concern, be sure to contact your doctor.

Symptoms of possible complicationsWhat to do

Complications after thyroid surgery

Thyroid surgery may be necessary in case of diseases such as thyroid cancer, nodules or hyperthyroidism. However, complications may occur after the operation, such as:

• Bleeding. After surgery, the wound may continue to bleed, which can lead to anemia or even hematoma formation, requiring additional surgical intervention.
• Voice problems. During the operation, the nerves that control the vocal cords can be damaged, which can lead to a change in the tone of the voice or loss of voice. In some cases, this condition may be temporary, while in others it may be permanent.
• Hypoparathyroidism. This is a condition in which the function of the parathyroid glands deteriorates or they are removed during surgery. This can lead to low levels of calcium in the blood, which can lead to muscle cramps, numbness, and bone pain.
• Infection. After surgery, the wound may become infected, especially if other diseases are present.

All complications after thyroid surgery must be reported to the doctor in order to take timely measures and prevent further deterioration of the condition.

Rehabilitation after thyroid surgery

First days after surgery

As a rule, the patient stays in the hospital for several days to control the condition and prevent complications. Immediately after the operation, a scar is left on the neck, which will heal within a few weeks.

In the first days after thyroid surgery, there may be some discomfort, neck pain, difficulty swallowing and vocal apparatus. However, this goes away after a few days, and patients usually feel better the very next day after surgery.

Later in the rehabilitation period

After discharge from the hospital, the patient should follow the doctor’s recommendations and take prescribed medications. During the rehabilitation period, attention should be paid to nutrition, which should be rich in proteins and micronutrients to accelerate healing.

In the absence of complications, the patient can return to normal life a few weeks after the operation. However, some restrictions remain for a while – for example, it is necessary to avoid strenuous exercise, heavy lifting and intense training for several weeks after the operation.

Check-up

After thyroid surgery, patients should have regular check-ups with a doctor. This will make sure that the treatment is effective and warn of possible complications if they occur.

Your doctor may also recommend regular blood tests to monitor hormone balance and evaluate thyroid function.

An alternative to surgery: manual therapy

In cases where thyroid surgery causes fear and anxiety in the patient, doctors may recommend an alternative treatment method – manual therapy.

Manual therapy is a method based on the use of massage, manual therapy, exercises and other elements to influence the thyroid gland and surrounding tissues. The goal of this method is to improve blood flow, reduce inflammation, and expand the range of motion in the neck area.

Manual therapy can be an effective way to treat diseases such as hyperthyroidism, hypothyroidism, subacute thyroiditis, and others. This method can help reduce symptoms and even prevent the need for surgery.

However, it must be remembered that manual therapy will not help in cases where immediate surgery is needed. In addition, before starting manual therapy, you should consult with a specialist and find out which technique is right for your disease.

In any case, manual therapy can be an effective and more gentle treatment option instead of an immediate decision to have surgery.

Related videos:

Q&A:

What signs indicate the need for thyroid surgery?

If the patient has an enlarged thyroid gland, nodules, pain, difficulty swallowing, voice disturbances, elevated levels of thyroid hormones in the blood, these are signs that thyroid surgery may be required.

How often do I need to be tested to determine the need for thyroid surgery?

Doctors usually recommend a thyroid examination once a year, and if there is a predisposition to diseases of this gland, then more often – every 6 months.

What types of operations can be performed on the thyroid gland?

There are several types of thyroid surgery. For example, a thyroidectomy is the complete or partial removal of the thyroid gland. A lobectomy can also be performed, when only one lobe of the gland is removed.

How does thyroid surgery work and how long does it take to recover?

Thyroid surgery is performed under general anesthesia, the duration may vary depending on the complexity of the case, but usually takes 1-2 hours. Rehabilitation after surgery lasts about a week, during this time the patient needs to monitor their health, take medications and avoid physical exertion.

Can thyroid surgery be avoided if diseases are detected?

In some cases, thyroid disorders can be treated with medication without surgery. But if the disease is not treatable, or the enlargement of the gland poses a threat to the patient’s life, an operation may be prescribed as a necessary measure.

What are the possible complications after thyroid surgery?

After thyroid surgery, the following complications may occur: hypoparathyroidism, which occurs when the thyroid gland is damaged, temporary voice disturbance, low calcium levels in the blood, infections.

How many masks does the thyroid gland have?

Why was screening of thyroid function introduced in the Healthy Moscow pavilions?

How the thyroid gland affects the intellect, how many masks its diseases have and why iodized salt should be in the diet for prevention, and also why early diagnosis of hormonal levels is important and whether amber beads will help prevent thyroid diseases – at These questions were answered by Mikhail Antsiferov, chief freelance endocrinologist, and Olga Dukhareva, chief physician of the Endocrinological Dispensary of the Moscow City Health Department.

The most hidden disease

– Mikhail Borisovich, can you really understand from your feelings that there are some problems with the thyroid gland? And how many masks do thyroid diseases have?

In most cases, especially at the beginning of the development of diseases, the symptoms of thyroid pathology do not have characteristic features. And only in advanced severe cases do people pay attention to a significant increase in the neck or “bulging eyes” and turn to an endocrinologist. But it is much more important to identify the pathology of the thyroid gland in the early stages.

The thyroid gland (TG) is located in the lower part of the front surface of the neck and throughout our life has a huge impact on the functioning of the whole organism. Thyroid hormones ensure the supply of oxygen and nutrients to the cell, the removal of toxins, the growth and renewal of cells. With an insufficient level of thyroid hormones, all metabolic processes are inhibited, the body falls into hibernation – this condition is called hypothyroidism. With an excess of thyroid hormones, all processes in the body are activated and this is called hyperthyroidism (thyrotoxicosis). The thyroid gland has a large margin of safety to fight for our health. But when we see clinical manifestations, this means that the problem in the human body has existed for a long time. The initial signs of thyroid dysfunction are nonspecific, similar to many other chronic diseases, which greatly complicates their recognition.

With a lack of thyroid hormones (hypothyroidism), a person develops fatigue, apathy, depressed mood, heaviness in the legs, puffiness of the face, chilliness, dry skin, hair loss, brittle nails, constipation, hoarseness of voice. All of these symptoms may come on gradually, or they may appear as symptoms related to one system of our body. Then we are talking about the “masks” of hypothyroidism: “cardiological”, when an increase in diastolic (lower) pressure, pain in the heart (due to edema in the heart bag), an increase in cholesterol and its fractions come to the fore. The “gastroenterological” mask is characterized by chronic constipation and cholelithiasis (because intestinal motility and bile ducts slow down), the “dermatological” mask – hair loss, brittle nails, thickening of the skin in the joints, “psychiatric / neurological” – depression and memory loss. People have been treated for years by various narrow specialists or do not turn to anyone at all, explaining the deterioration of their condition by stress, fatigue, lack of sleep and not linking these symptoms with a lack of thyroid hormones.

– Olga Viktorovna, how common is hypothyroidism and what are its causes?

Primary hypothyroidism (a disease associated with the pathology of the thyroid gland itself) is a fairly common disease and, according to the large population-based study NHANES-III, occurs in 4.6% of the population. Most often, primary hypothyroidism develops as a result of chronic autoimmune damage to the thyroid gland. This condition for a long time (10 years or more) can be characterized only by elevated titers of antibodies to thyroid tissue (anti-TPO and anti-TG antibodies). These antibodies can be very high, but they don’t hurt. We cannot stop this process, because it is connected with the defeat of our own immune system. Once, accidentally revealing an increase in antibodies to the thyroid gland by 5 or more times, you need to understand for yourself that the autoimmune process in the thyroid gland has started. The level of these antibodies does not affect the further development of events, so it is not necessary to control them. In this situation, it is important to control only TSH 1 time in 6-12 months.

In women, thyroid diseases are more common, especially hypothyroidism and nodular goiter. In men, these diseases also occur, but 5-6 times less frequently than in women. There is a genetic predisposition to the pathology of the thyroid gland in the female line.

Therefore, it is recommended to check the function of the thyroid gland for all women who have in the family (in a straight line: mothers, grandmothers, aunts) any diseases of the thyroid gland. The presence of thyroid pathology in childhood or adolescence is also important. A burdened history of thyroid diseases is the reason for conducting a TTT study and ultrasound of the thyroid gland.

For men, it is also important to check the function of the thyroid gland, especially if there is an abnormal heart rhythm.

How to check the thyroid gland? Is it possible to judge the work of the thyroid gland by one hormone?

М.А .: If you are thinking about the work of your thyroid gland for the first time, then I recommend that you study thyroid-stimulating hormone (TSH) and do ultrasound of the thyroid gland . This will be quite enough to determine whether you need to contact an endocrinologist for a more in-depth examination, or everything is fine with you and you just need to carry out the prevention of mild iodine deficiency, which is observed in Moscow.

The thyroid gland produces two main hormones: T3 (triiodothyronine) and T4 (tetraiodothyronine or thyroxine). TSH is a hormone that controls the functioning of the thyroid gland. It is produced in the pituitary gland, in the brain. If T3 and T4 are not produced enough, then the cells begin to “complain to a higher authority” – to the pituitary gland. It is a small endocrine gland about the size of a pinky nail. It produces controlling hormones for all endocrine glands and, as a “puppeteer”, organizes the work of our body. If there is not enough thyroid hormone, then the amount of TSH increases. He, like a whip, spurs the work of the thyroid gland.

If thyroid hormones are produced in excess (with thyrotoxicosis), then TSH is suppressed and its level in the blood drops sharply. And since TSH reflects the work of the thyroid gland in 99% of cases, it is enough to determine only its level for screening.

– In the Healthy Moscow pavilions, what are the possibilities for examining the thyroid gland and other endocrine diseases?

O.D.: As Mikhail Borisovich has already said, thyroid dysfunction can be monitored by the level of TSH. But in the thyroid gland, changes in its structure and structure are also often found. These include nodules. They are single, multiple, with and without thyroid dysfunction. There are many reasons for the formation of nodular goiter (defect in the synthesis of thyroid hormones, goitrogenic substances), but the most common cause of its development is iodine deficiency. We often forget about this and media talk about iodine deficiency problems is perceived as propaganda and advertising. But in fact, lack of iodine has a huge negative impact on our health and the health of our children. An increase in the volume of the thyroid gland or nodules in it is the visible part of the iceberg among many iodine deficiency diseases. Therefore, in order to identify the pathology of the thyroid gland, especially if you have noticed an increase in the thyroid gland (the roller in the lower part of the neck has become visible “by eye”), if there are relatives in the family with nodular goiter, we definitely recommend that you contact the Healthy Moscow pavilion or a polyclinic for an examination. thyroid ultrasound .

I would like to say a few words about the early detection of another slowly progressing, but very formidable endocrine disease – type 2 diabetes mellitus (T2DM). Unfortunately, this disease is detected late in most cases, when its complications already appear, such as damage to the lower extremities, decreased kidney function or blindness. In the early stages of the development of the disease, an increase in fasting blood sugar is not always recorded. More often problems begin with blood sugar control after eating. Therefore, for the earliest detection of type 2 diabetes in the Healthy Moscow pavilions, a referral for research is issued glycated hemoglobin ( HbA 1 c ). This is an indicator that reflects the average level of sugar in the blood over the past 3 months. And you can explore it at any time, regardless of the meal.

Iodine is the head of everything!

– There is a lot of talk about iodized salt these days. Is it so useful?

MA: Moscow is a region with confirmed mild iodine deficiency. Iodine is not enough throughout the mainland of our continent. It is an integral part of the thyroid hormones, which is reflected even in their name: triiodine and tetraiodothyronines (T3 and T4). In conditions of insufficient intake of iodine with food, the synthesis of thyroid hormones decreases. This leads either to a compensatory increase in the volume of the thyroid gland or to the formation of nodes. In this way, our body tries to increase the synthesis of T3 and T4. Hidden mild iodine deficiency leads to the development of a large number of pathological conditions, such as: miscarriage, fetal abnormalities, decreased intelligence in children, impaired cognitive function in adults, hypothyroidism, iodine-induced thyrotoxicosis and functional autonomy of the thyroid gland. In all countries, full-scale studies were carried out to develop the most effective ways to prevent iodine deficiency. Based on these studies, WHO approved iodized salt as the most affordable and safest product for mass prevention of iodine deficiency in the world. Now only potassium iodate is used in production, which allows to extend the shelf life of iodized salt.

Why is salt chosen to prevent iodine deficiency? Because you can’t eat too much salt. So there will be no overdose of iodine. 5 grams – a teaspoon without a top – covers the daily human need for iodine. Such a daily amount of salt is not contraindicated even for hypertensive patients. Therefore, every home must have iodized salt. It is recommended to store it in closed salt shakers and use it to add salt to cooked food. Even if you use it in the process of hot cooking, some of the iodine will still be absorbed. This is the most effective and safest prevention.

– Is it true that iodine deficiency affects IQ ?

O.D.: Anti-goiter dispensaries have been successfully operating in our country for many decades. Good results have been achieved. Then their work was completed. At the beginning of 2000 an increase in nodular goiter and hypothyroidism has been reported in the country. In accordance with WHO recommendations, monitoring of iodine deficiency diseases among schoolchildren (8-10 years old) was resumed in Russia. The amount of iodine excreted in the urine was determined, the number of children with goiter according to ultrasound data, the level of intelligence was studied. According to the results of these population studies in Moscow, mild iodine deficiency was confirmed and iodine deficiency prevention was resumed, especially in high-risk groups. This group includes children of puberty (from 11 to 15 years), women planning pregnancy, pregnant and lactating women. Why are these periods classified as critical? Because iodine deficiency affects children’s mental development and the formation of all organs and systems. First of all, this affects the formation of the cerebral cortex during the period of intrauterine development of the fetus.

The thyroid gland is formed at 7-8 weeks of fetal development, and at 14-16 weeks it begins to actively produce hormones in the same amount as in an adult. During this period, thyroid hormones are actively involved in the laying of all organs and systems. In the second half of pregnancy, they are involved in the formation of the cerebral cortex in the fetus. Numerous studies have shown that if the mother had subclinical hypothyroidism (no symptoms of hypothyroidism were noted, but the synthesis of hormones was reduced against the background of mild iodine deficiency), then during pregnancy the deficiency of thyroid hormones will be compensated by the work of the fetal thyroid gland. In this situation, a child can be born with congenital hypothyroidism and reduced intelligence (IQ is reduced by 10-15 points). What does this mean? If IQ is 70, then the child cannot study in a comprehensive school. According to the results of studies in Moscow, IQ in children on average corresponded to 90-100, there were few children with IQ 115-120. Would you like your child’s intelligence to decline due to iodine deficiency, which is so easily preventable? I think no.

Therefore, every home should always have iodized salt. Just 1 teaspoon of iodized salt per day (5 grams) is guaranteed to protect you and your children. In truth – a golden little spoon.

Hypothyroidism or hyperthyroidism?

– At what age does hypothyroidism most often occur?

MA: Transitional age is dangerous for hypofunction, when the intensive growth of the child’s body begins. In adulthood, hypothyroidism occurs with the same frequency at any age. But, there are periods or conditions when it is definitely recommended to check the function of the thyroid gland. First of all, this applies to the period of pregnancy planning. The next age period when hypofunction of the thyroid gland can significantly worsen the state of health is after 50 years, against the background of those “masks” that we talked about above. Hidden edema in the pericardial area can affect the function of the heart, lead to heart failure, the development of arrhythmias.

– What happens in hyperthyroidism?

O.D.: Hyperthyroidism (thyrotoxicosis) is an excessive synthesis of thyroid hormones. The most common cause of thyrotoxicosis is Graves’ disease (GD). Against the background of iodine deficiency, the autonomy of the thyroid nodes can become the cause of thyrotoxicosis. The prevalence of thyrotoxicosis is much lower and is about 1.5%. HD is more common in women (3% in women and 0.5% in men), the peak incidence occurs at the age of 30-60 years.

In this situation, the clinical picture of well-being is opposite to hypothyroidism. A person complains of increased excitability, emotional lability, tearfulness, palpitations, trembling in the body, weight loss against the background of increased appetite. There is a rapid stool, menstrual irregularities, decreased potency, muscle weakness, an increase in the thyroid gland. In 40-50% of patients with thyrotoxicosis, endocrine ophthalmopathy develops (exophthalmos, “bulging eyes”). Because GD is an autoimmune disease, it requires the appointment of thyreostatics. These patients should be constantly under the supervision of an endocrinologist.

– Which manifestations of hyperthyroidism are of increased risk?

М.А.: The greatest danger is the heart rhythm disturbance against the background of overt or latent thyrotoxicosis, especially in the elderly. It must be remembered that such people have an increased risk of developing thromboembolism. With severe symptoms of thyrotoxicosis, patients should definitely contact an endocrinologist. Long-term latent thyrotoxicosis can lead to a decrease in the reserve of the heart and the development of heart failure. Therefore, all patients with cardiac arrhythmias should be examined in the Healthy Moscow pavilion and undergo a TSH study.

– Who is more likely to develop hyperthyroidism?

O. D.: Thyrotoxicosis develops more often in women. Mostly between the ages of 40 and 60. A great danger is the excessive function of the thyroid gland for the older age group and in persons with cardiac arrhythmias. For these patients, therapy is prescribed very carefully in conjunction with a cardiologist. There are no alternative methods of traditional medicine that would treat thyroid diseases. No need to self-medicate. At one time there was a passion to wear amber beads for the prevention of thyroid diseases – it’s beautiful, but absolutely ineffective. There are no food additives other than iodized salt. Hypothyroidism and hyperthyroidism are treated with officially registered drugs.

How is the thyroid gland treated?

– Do we have drugs for the treatment of hypothyroidism and hyperthyroidism?

M.A.: Yes. Hormone replacement therapy is used to treat hypothyroidism. The drug of choice is levothyroxine sodium. It is obtained artificially. It is completely identical to the human hormone (T4). When prescribing it, we simply replace the missing amount of the natural hormone. The dose of the drug is selected according to the level of TSH. Thyrotoxicosis is treated with thyreostatics. This requires constant monitoring of their effectiveness and the development of side effects.

– How important is it to detect thyroid diseases in the early stages ?

O.D.: Early detection of any endocrine diseases is the key to a full active life and prevention of their complications. The use of levothyroxine sodium in the treatment of hypothyroidism is absolutely safe. I am often asked the question, what if hypothyroidism is detected during pregnancy planning? Should I take hormones or not? And how will it affect the child? I always explain to a woman the meaning of thyroid hormones, their impact on the health of the mother and the unborn child. In this situation, it is important to fully compensate for hypothyroidism before conception, so that the fetal thyroid gland works only for its development.