The phrase thyroid disease refers to medical conditions which affect the way the thyroid gland works. The thyroid gland typically produces an amount of hormones which help the body to function well. Too much thyroid hormone production is referred to as hyperthyroidism, whilst too little thyroid hormone production is referred to as hypothyroidism.
Hyperthyroidism usually causes tachycardia, weight loss, and nervousness. On the other hand, hypothyroidism may cause lethargy, weight gain, and cold intolerance.
Thyroid Disease Risk Factors
- family history of thyroid disease
- medical conditions eg. type 1 diabetes and rheumatoid arthritis)
- high iodine-containing medication eg. amiodarone
- increased age
- past thyroidectomy
- past radiation
Hyperthyroidism Causes
- Graves’ Disease
- Nodules
- Thyroiditis
- Excessive iodine intake
Symptoms
- anxiety
- irritability
- nervousness
- heat sensitivity
- insomnia
- vision problems
- eye irritation
- goitre
- tremors.
- irregular periods
- period cessation
- shortness of breath – patient has high metabolism, muscle wasting, leading to exhaustion and fatigue, all of which can cause shortness of breath
- weight loss – imbalanced nutrition due to high metabolic rate (adequate food intake needs to be ensured)
- muscle weakness – in case of inadequate food intake, if no carbs or glucose are available to be broken down, the body turns to protein breakdown, leading to muscle wasting
Hypothyroidism Causes
- Thyroiditis
- Hashimoto’s Thyroiditis
- Post-Partum Thyroiditis (usually temporary)
- Iodine Deficiency
- Non-Functioning Thyroid Gland
Symptoms
- cold sensitivity
- memory problems
- voice hoarseness
- hair dryness and coarseness
- fatigue
- weight gain
- frequent and heavy periods
Thyroid Disease Diagnostic Tests
- TFTs (TSH, T4 and T3 levels) – to check the amount of thyroid stimulating hormone (TSH) and circulating thyroid hormones in serum, so thyroid gland’s thyroid hormone production and regulation ability is assessed
- CBC – to check amount of red blood cells in the blood (to rule out anaemia)
- Renal Profile – to determine the kidneys’ health by evaluating parameters such as proteins, electrolytes, and minerals
Subclinical Thyroid Dysfunction
Subclinical Thyroid Dysfunction is a biochemical diagnosis in which TSH levels are outside the reference range, and circulating T4 and T3 are within the reference range.
Subclinical Thyroid Dysfunction is most commonly detected incidentally. However, in certain cases, individuals may exhibit symptoms of hypothyroidism or hyperthyroidism. Studies related to long-term consequences of subclinical thyroid dysfunction indicate increased cardiovascular morbidity and mortality, increased risk of osteoporosis, and possible links to dementia.
Thyroid Disease Patient Education – Based On NICE Guidelines (2019)
Ensure that information is presented to facilitate shared decision making…
Explain to people with thyroid disease who need treatment, and their family or carers…that:
– Thyroid disease usually responds well to treatment.
– The goal of treatment is to alleviate symptoms and align thyroid function tests within or close to the reference range.
– People may feel well even when their thyroid function tests are outside the reference range.
– Even when there are no symptoms, treatment may be advised to reduce the risk of long-term complications.
– Even when thyroid function tests are within the reference range, changes to treatment may improve symptoms for some people.
– Symptoms may lag behind treatment changes for several weeks to months.
– Day-to-day changes in unexplained symptoms are unlikely to be due to underlying thyroid disease because the body has a large reservoir of thyroxine.
Provide people with thyroid disease, and their family or carers…with written and verbal information on:
– their underlying condition, including the role and function of the thyroid gland and what the thyroid function tests mean
– risks of over-and under-treatment
-their medicines
-need for and frequency of monitoring
– when to seek advice from a healthcare professional
– how thyroid disease and medicines may affect pregnancy and fertility
Provide people with hypothyroidism, and their family…with written and verbal information on:
– possible drug interactions of thyroid hormone replacements, including interactions with over-the-counter medicines
– how and when to take levothyroxine
NICE Guidelines, 2019
Patients with thyroid disease need to have a clear understanding on the disease, treatment goals, and connection between thyroid function tests and symptoms. Medication (Levothyroxine) is frequently taken incorrectly, possibly leading to suboptimal treatment.
Patient information and support on thyroid disease help patients make informed decisions on the management of their condition.
A complete drug history of the patient helps determine if Levothyroxine may interfere with other medications currently being taken, in which case, the patient may be recommended to take Levothyroxine earlier or half hour before food and other medications.
Review of other drug intake should be made so if needed, changes may be made to drug prescription. Example: Iodine may cause toxicity problems with the thyroid gland and may lead to hypothyroidism. Example: Lithium use blocks thyroid hormone production.
The patient needs to be made aware that any side effects experienced may be due to thyroid disease, and that, if kept under control, such side effects may be reduced. Constipation, which is one of the side effects of hypothyroidism, may subside following regular use of Levothyroxine. However, if it persists, increasing high fibre intake and more fluids should help further. Movicol may also be prescribed to help with constipation (if other methods fail to help).
Regular exercise needs to be encouraged, starting slowly, and increasing gradually. This is because patients with thyroid disease such as hypothyroidism tend to gain weight. If necessary, patient may be referred to a dietitian.
Medication compliance is very important with regards to Levothyroxine. The patient needs to be educated about the condition – that it is a lifelong condition which needs to be controlled by medication. It is a chronic disease. Thus, Levothyroxine should not be stopped, even if patient feels well.
Patient should be encouraged to attend all follow-ups so as to ensure that the right dose has been prescribed. It may take a couple of follow-ups until the right dose is achieved. The patient should be instructed that in case of palpitations, chest pain, and tachycardia, contact should be made with clinician so as to ensure she is not going into hyperthyroidism instead.
References
Cleveland Clinic (2020). Thyroid Disease: Causes, Symptoms, Risk Factors, Testing & Treatment. Retrieved from https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease on 5th May 2022
NICE Guidelines (2019). Thyroid Disease: assessment and management. Retrieved from https://www.nice.org.uk/guidance/ng145 on 5th May 2022
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