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Thyroid Problems: Tests, Diagnosis, Medications, and Treatment

Thyroid Problems: Tests, Diagnosis, Medications, and Treatment

Posted By Rupa Jaiswal Posted on July 13, 2021

Evaluate Your Thyroid Suspected thyroid dysfunction should first be shown to a doctor. If the doctor concurs that it could be a thyroid problem, he recommends the pathological laboratory to test the patient's thyroid functional status. Normalcy in thyroid function tests suggest that the thyroid has no functional abnormality, i.e. It produces just the required quantities of hormones. The next step is, in case of enlargement in the gland due to nodules (single or multiple) is to rule out a tumor. For this, some tests like thyroid scan, ultrasound or Fine Needle Aspiration Cytology (FNAC) may be done to establish diagnosis.

Thyroid Problems: Tests, Diagnosis, Medications, and Treatment

Why do I need to check my thyroid?

People from the following categories are more prone to thyroid disorders.
Women above 25 years of age
Women who have recently given birth
Those having high cholesterol
Those who lose or gain weight rapidly
Those who feel exhausted and fatigued
Those with abnormalities in menstrual pattern
Those suffering from infertility
Those with a family history of thyroid disease

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Physical examination of Thyroid Physical examination is a preliminary step which aids in diagnosis for presence of any nodules or inflammation in the gland. The patient is asked to sit upright with the head raised in a hyperextension and asked to swallow water. The examination of the neck portion is carried out to detect any abnormalities of the thyroid gland like enlargement, asymmetry or presence of any abnormal masses. The neck of the patient is also inspected for any prominent pulsation.

Biochemical test for thyroid evaluation Thyroid biochemistry, physiology and pathophysiology is quite complicated. Biochemical tests are used in combination to study the function of the gland and the causes behind any dysfunction. However, testing for FT3, FT4 and TSH is the most used combination by doctors. These are the basic thyroid tests, which reveal concentration of the hormones in the bloodstream and the diagnosis thereof. The tests asked can be one or two or many, out of the 7 tests mentioned below:
Triiodothyronine (T3)
Thyroxine (T4)
Thyroid Stimulating Hormone (TSH)
Free Thyroxine (Ft4)
Free Triiodothyronine (Ft3)
Anti-thyroglobulin antibodies (ATG)
Anti-microsomal antibodies (AMA)

Thyroid scan This is a technique of taking images of the thyroid gland by using small amounts of a radioisotope such as Tc99m pertechnatate or radioiodine. This isotope moves to the thyroid gland and its distribution can be imaged by special machines called gamma cameras. The structural & functional information helps in diagnosing thyroid abnormalities.

Fine Needle Aspiration Cytology (FNAC) FNAC is type of biopsy technique for obtaining a small part of the gland for examination under the microscope. The presence of cancer cells can only be seen under magnification by a microscope. Using a small needle, which one uses for blood collection, an experienced pathologist will needle out a small amount of tissue from the nodule or part of the thyroid gland. As the needle is fine, only a pricking sensation will be felt. There is no need for anesthesia, a special operation theater or specific preparations. There are no side effects . it is an outpatient procedure and takes a minute or two .

Thyroid ultrasound Ultrasound examination of the thyroid is a method of imaging the gland. High frequency ultrasound waves are passed through the thyroid gland and the echoes or reflected rays are detected by special electronics which take up the form of an image. It helps in determining whether the thyroid has any nodules and whether the nodules are fluid-filled or solid. If they are solid then the chances of a cancer are high.

Weight speaks about thyroid health What we eat should be converted into energy for a normal and healthy life. In hypothyroidism, due to paucity of hormones, the energy conversion is reduced. Hence, fat accumulation and increase in weight is very common in hypothyroid patients. Whereas, in hyperthyroidism, the hormones are in excess and hence they burn out the energy more than required, resulting in heavy loss of weight. Some patients even lose 10 kgs in just a month or two. Thus, weight and stamina are the two main criteria in thyroid evaluation.

Cold and Hot nodules Normal thyroid gland is seen on the scan as a uniform distribution of the Radioisotope. In patients who have a nodule in the gland, it is necessary to show whether it is over functioning or under functioning. An over functioning nodule will appear darker than the rest of the gland and is called a "hot nodule". The opposite is true for a "cold nodule". The need for this test is because the chance of a cancer is high (about 30-35%) in cold nodules.

Is thyroid cancer deadly?

Fortunately, thyroid cancer is one of the least frightening among all cancers. The tumor can be removed by surgery along with the entire gland. This may be followed by giving oral radioiodine to clear any tissue remaining behind after surgery, and the required hormones for the rest of the life. Many thyroid cancer patients lead a normal life and die of causes other than cancer.

What causes thyroid problems in females?

It is known and proven that, women have a five fold higher risk than men in suffering from a thyroid dysfunction. Menstrual cycle, pregnancy delivery, hormonal changes, immunological factors and stress makes women more prone to thyroid dysfunction.

Does thyroid affect baby during pregnancy?

During pregnancy, the requirement for thyroid hormones is increased (for child also) and hence, a thyroid patient should be monitored closely in the first and second trimester. Both the mother and fetus require optimum hormone levels.

In a hypothyroid pregnant patient, the dose monitoring should be done more frequently and with extra care. It is known that, deficiency of thyroid hormones can cause irreversible damage to both - physical and mental growth of the fetus. Hence, it is recommended that, a good endocrinologist be approached for better management.

How much does it cost to get your thyroid checked? More than 100 good laboratories in the country are doing Thyroid tests with the promise of best quality, but majority of them charge rates ranging from 400 to 1200 for the three investigations namely FT3, FT4 and TSH. However, under the new concept of specialisation, networking and blending the break through in laboratory technologies, and with the advent of information technology, the most reliable thyroid diagnosis service is available for 300 to 400 in any part of the country. The major contribution in such a breakthrough is from Thyrocare, world's largest thyroid test laboratory.

Can values of T3, T4, and TSH mismatch?

The values can mismatch and the causes could be one or more of the following:
The test could have been done during the long transition period from normal to abnormal or vice versa.
T3, T4 and TSH levels influence each other; so an abnormality in one may be an early indication of the others to follow suit within few days.
Ingestion of any thyroid related drug or recent radioiodine treatment or thyroid surgery.
Drugs like Propanolol, Amiodarone, Phenytoin, Carbamazepine, Gluco-corticoids, Androgens, Anabolic Steroids and Salicylates, which influence thyroid hormone levels.
Thyroiditis.
Non-thyroidal illness.
80% of T3 is derived from T4 and hence, under certain circumstances, the T3 can be low, borderline or high without a thyroid dysfunction.
Low T3 syndrome, T3 toxicosis, TBG deficiency or excess, Familial Dysalbuminemic Hyperthyroxinemia (FDAH), Prealbumin- associated Hyperthyroxinemia (PAH), and the presence of antibodies to thyroid hormones.

Appropriate timings for specimen collection
A minimum of 8 hrs fasting blood serum sample should be obtained to enable optimal comparison with reference values. (If this is not possible, specimens can be collected at any time of day).
Post-operative samples should be collected at least ten days after thyroidectomy. Again a fasting blood sample would be preferred.
Thyroid medications (thyroid hormones and anti-thyroid drugs) should be omitted prior to blood sample collection.
To reduce the variability of test results, specimens should be obtained at the same time of the day for follow-up with similar fasting conditions.

Frequency of abnormal reports A laboratory performing high quality thyroid testing can expect mismatched results in 10% to 15% of the samples received. Most of these show normal T3 and T4 values and abnormal TSH. These results can be due to various reasons. They can indicate near past or near future thyroid illness or a sensitive or lethargic thyroid feedback mechanism

besides the influence of drugs, and such cases should be closely watched or symptomatically treated or even further investigated wherever desired.

Fortnight variations in patient reports This is possible in many situations. For example, in thyroiditis, which involves damage of thyroid cells, the stored hormones in each thyroid cell may leak during cell destruction. The thyroid hormone levels thus increase, although there is no over functioning of the gland. Hence, when the disease is very active, the picture observed is hyperthyroidism and once the immune attack is over, the patient will become hypothyroid for life.

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Variation in values from one laboratory to another Normally they should not. If reputed laboratories are compared then, there should not be much variations. However, some times due to difference in techniques, automations and quality systems, conscientiousness and methodology, there can be minor to major variations. It should also be noted that neither two brands of kits nor two kits made in the same manufacturing unit have identical normal range. Hence, no two laboratories are likely to give identical test values.

Thyroid Cancers
Thyroid cancers arise from tumors in the thyroid gland. Most nodules are, however, noncancerous. Thyroid cancers can show no symptoms and silently spread to different parts of the body. The different types of cancer are papillary thyroid cancer, follicular thyroid cancer, medullary thyroid cancer, and anaplastic thyroid cancer.

Symptoms
- Enlargement of lymph nodes
- Swelling
- Thyroid nodules
- Pain in the neck
- Breathing difficulty
- Persistent cough not associated with a cold

Detection and Diagnosis of Thyroid Cancers As the symptoms of thyroid disorders are hard to identify, it is generally recommended, especially for older women to get tested for thyroid disorders. This can be done by blood tests that measure the levels of thyroid hormones, as most thyroid disorders manifest with thyroid hormone imbalances.
1. Testing of T3, T4 and TSH Abnormally high levels of TSH with low levels of thyroid hormones indicate hypothyroidism, while high levels of T4 and T3 and low levels of TSH can be indicative of hyperthyroidism.
2. lodine uptake test Done to detect nodules in the thyroid gland;nodules take up the radioactive iodine that is injected into the blood. The location where iodine is accumulated is then detected through scanning,
3. Antithyroid antibodies These are immune proteins produced by the body which are directed against healthy thyroid tissues. Their presence in blood can indicate an autoimmune reaction against the thyroid gland and can be used to diagnose autoimmune thyroid conditions.

The thyroid gland is like a knob that is turned one way or the other to suit the body's needs. This tiny gland of around 30 g is a regulator of key processes that ensure our well-being. A disorder of this organ can severely affect the quality of life. Routine check-up on the functioning of the thyroid gland can assist the early diagnosis of thyroid disorders.

Think Good Health. Think Thyroid. Think Thyroid. Think Thyrocare.

Thyroid Testing at Thyrocare Complete automation for Precision & Accuracy! Thyroid Tests carried out at Thyrocare are witnesses of the transformation from manual to complete automation. Testing of thyroid parameters are performed using Chemiluminescence Immunoassay i.e. CLIA which is a completely automated assay and it has enhanced the operational efficiency with high throughput screening. The entire procedure from sample loading, addition of antigens, washing, detection and measurement of luminescence is performed with the help of automated movements of paths and probes. Then comes the result which is generated by the analyser itself in ng/dL units.

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