Thyroid Disorders

Over 20 million people are under treatment for thyroid disorders in India. Approximately two million people have an undiagnosed thyroid disease. Thyroid disorders are overall more common in women than in men and increase with age, especially if they also have a history of insulin-dependent diabetes, pernicious anemia, rheumatoid arthritis or another autoimmune disease.

When the thyroid is underactive, and does not produce enough thyroid hormones, the result is hypothyroidism.

When the thyroid is overactive, and produces too much thyroid hormone, the result is hyperthyroidism.

Pain in the thyroid gland can occur as a result of inflammation, known as subacute thyroiditis.

The entire thyroid can enlarge in size, known as a goiter. Goiters may be removed with surgery if they grow to cause problems breathing or swallowing, or for cosmetic reasons.

A smaller area of the thyroid can enlarge to form a thyroid nodule. Solitary thyroid nodules are very common, and as people grow older, over 50% of the population may have these nodules. They are usually benign. However, they must be evaluated for cancer with an ultrasound and biopsy if they grow in size.

Thyroid cancer accounts for less than 2% of all cancers. Although thyroid cancer has increased in incidence in recent years, it is usually treatable. Death from thyroid cancer accounts for less than 1% of all cancer-related deaths.

There are many thyroid medications that can be used to treat some of the above-mentioned conditions.

Thyroid hormone can be used to treat an underactive thyroid or to prevent growth of thyroid tissue after surgery for thyroid cancer.

Anti-thyroid medications can be used to decrease the production of thyroid hormones in the case of an overactive thyroid.

Radioactive iodine can be used to remove, or "ablate", over-functioning or cancerous thyroid tissue.

The thyroid can be removed surgically to treat some of the above-mentioned conditions. Thyroid surgery is used in the case of an overactive or enlarged thyroid and thyroid cancer.

Thyroid disorders can significantly impact pregnancy and fertility. Both over - and underactive thyroid disease can occur during pregnancy, or may be the cause of infertility.

Investigations :
Diagnosing thyroid disease is a process that can incorporate numerous factors, including clinical evaluation, blood tests, imaging tests, biopsies and other tests. In this article, you’ll learn more about the blood tests that are used as part of thyroid disease diagnosis and management.
Usually these tests are done in the morning on fasting or non fasting sample. If you under any specific medication for any thyroid related condition, then consult with your physician before the blood test. Also inform the laboratory staff about the same before giving your blood sample.

The most common thyroid test is the blood test that measures the amount of thyroid-stimulating hormone (TSH) in your bloodstream. The test is sometimes called the thyrotropin-stimulating hormone test.
TSH that is elevated, or above normal, is considered indicative of hypothyroidism. TSH that is “suppressed” or below normal, is considered evidence of hyperthyroidism.
As of 2003, the American Association of Clinical Endocrinologists is recommending that the normal range run from 0.3 to 3.0, versus the older range of 0.5 to 5.5. So, according to the new standards, levels above 3.0 are evidence of possible hypothyroidism, and levels below 0.3 are evidence of possible hyperthyroidism. Keep in mind that there is disagreement among practitioners, and some follow the older range, others use the newer range.

Free T4 / Free Thyroxine
Free T4 measures the free, unbound thyroxine levels in your bloodstream. Free T4 is typically elevated in hyperthyroidism, and lowered in hypothyroidism.
Free or unbound T4 levels represent the level of hormone available for uptake and use by cells. Bound levels represent a circulating hormone that may not all be immediately available, because it is affected by other drugs, illness, and physical changes such as pregnancy. Because the free levels of T4 represent immediately available hormone, free T4 is thought to better reflect the patient's hormonal status than total T4 (below).

Total T4/Total Thyroxine/Serum Thyroxine
This test measures the total amount of circulating thyroxine in your blood. Thyroxine, a hormone produced by the thyroid, is also known as T4. A high value can indicate hyperthyroidism, a low value can indicate hypothyroidism. Total T4 levels can be elevated due to pregnancy, and other high estrogen states, including use of estrogen replacement or birth control pills.

Total T3/Total Triiodothyronine
Triiodothyronine is the active thyroid hormone, and is also known as T3. Total T3 is typically elevated in hyperthyroidism, and lowered in hypothyroidism.

Free T3 / Free Triiodothyronine
Free T3 measures the free, unbound levels of triiodothyronine in your bloodstream. Free T3 is considered more accurate than Total T3. Free T3 is typically elevated in hyperthyroidism, and lowered in hypothyroidism.

Thyroid Peroxidase (TPO) Antibodies (TPOAb) / Antithyroid Peroxidase Antibodies
Thyroid Peroxidase (TPO) antibodies, are also known as Antithyroid Peroxidase Antibodies. (In the past, these antibodies were referred to as Antithyroid Microsomal Antibodies or Antimicrosomal Antibodies). These antibodies work against thyroid peroxidase, an enzyme that plays a part in the T4-to-T3 conversion and synthesis process. TPO antibodies can be evidence of tissue destruction, such as Hashimoto's disease, less commonly, in other forms of thyroiditis such as post-partum thyroiditis.
It’s estimated that TPO antibodies are detectable in approximately 95 percent of patients with Hashimoto's thyroiditis, and 50 to 85 percent of Graves’ disease patients. The concentrations of antibodies found in patients with Graves' disease are usually lower than in patients with Hashimoto's disease.

Thyroglobulin Antibodies / Antithyroglobulin Antibodies
Testing for thyroglobulin antibodies (also called antithyroglobulin antibodies) is common. If you have already been diagnosed with Graves' disease, having high levels of thyroglobulin antibodies means that you are more likely to eventually become hypothyroid. Thyroglobulin antibodies are positive in about 60 percent of Hashimoto's patients and 30 percent of Graves' patients.
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