Category Archives: Endocrinology & Diabetes

Feeling tired. Gaining or losing weight unexpectedly. Feeling unusually cold or hot. Noticing changes in your mood, heart rate, or sleep.

On their own, symptoms like these can have many explanations. But when several start happening together, your thyroid may be one of the things worth considering.

The thyroid is a small, butterfly-shaped gland located at the front of your neck. Despite its size, the hormones it produces help regulate many important processes throughout the body. When thyroid hormone levels become too low or too high, the effects can show up in ways that are easy to mistake for stress, aging, lifestyle changes, or other health concerns.

What Does Your Thyroid Actually Do?

Your thyroid produces hormones that help regulate your metabolism, which affects how your body uses energy.

Thyroid hormones also influence functions involving your heart, digestive system, muscles, body temperature, brain, and other parts of the body.

This is one reason thyroid disorders can produce such a wide range of symptoms. There isn’t necessarily one specific change that immediately points to the thyroid.

Two of the most common thyroid problems involve producing either too little or too much thyroid hormone.

When Your Thyroid Is Underactive

An underactive thyroid is known as hypothyroidism. It occurs when the thyroid does not produce enough thyroid hormone to meet the body’s needs.

Symptoms can develop gradually, which sometimes makes them difficult to recognize.

Possible signs of hypothyroidism can include:

• Fatigue or feeling unusually sluggish
• Unexplained weight gain
• Increased sensitivity to cold
• Dry skin
• Thinning or dry hair
• Constipation
• Muscle weakness or aches
• Changes in mood or difficulty concentrating
• A slower heart rate
• Changes in menstrual periods

Not everyone experiences the same symptoms, and their severity can vary.

Many of these changes can also occur for reasons completely unrelated to the thyroid. Fatigue, for example, is extremely common and does not automatically indicate a thyroid disorder.

What Happens When the Thyroid Is Overactive?

An overactive thyroid, known as hyperthyroidism, occurs when the thyroid produces more thyroid hormone than the body needs.

Because thyroid hormones influence how quickly many processes occur within the body, symptoms can sometimes feel like things have sped up.

Possible signs can include:

• Unexplained weight loss
• Rapid or irregular heartbeat
• Feeling nervous, anxious, or unusually irritable
• Increased sweating
• Greater sensitivity to heat
• Difficulty sleeping
• Muscle weakness
• More frequent bowel movements
• Trembling or shakiness
• Changes in menstrual periods

Again, symptoms vary from person to person. Some people may experience several noticeable changes, while others have much subtler symptoms.

Why Thyroid Symptoms Are Easy to Overlook

One of the challenges with thyroid disease is that many of its symptoms overlap with everyday experiences and other medical conditions.

Feeling tired could be related to poor sleep. Weight changes could result from changes in nutrition or activity. Feeling anxious or having difficulty concentrating could have numerous causes.

Age can make the picture even less obvious. Some symptoms may simply be attributed to “getting older” when another explanation deserves consideration.

That’s why symptoms alone aren’t enough to determine whether you have a thyroid disorder.

How Are Thyroid Problems Identified?

Blood testing plays an important role in evaluating thyroid function.

A common starting point is a thyroid-stimulating hormone (TSH) test. Depending on the results, symptoms, and medical history, additional thyroid hormone tests or other evaluations may be appropriate.

A physician may also examine your thyroid and ask about symptoms, medications, personal medical history, and family history.

If a thyroid nodule or enlargement is discovered, additional evaluation such as imaging or, in some cases, a biopsy may be recommended. Having a thyroid nodule does not automatically mean that it is cancerous, but appropriate evaluation can help determine whether further care is needed.

When Should You Have Your Thyroid Checked?

Having one vague symptom doesn’t necessarily mean you need thyroid testing. But a combination of persistent or unexplained changes may be worth discussing with a physician.

Pay particular attention if symptoms are new, continue over time, or begin interfering with your normal routine.

A personal or family history of thyroid disease, certain autoimmune conditions, pregnancy or recent pregnancy, medications, and other health factors can also influence thyroid function or the likelihood of developing thyroid disease.

Don’t Try to Diagnose Your Thyroid From Symptoms Alone

It’s tempting to search a list of symptoms and conclude that your thyroid must be the explanation. The problem is that symptoms associated with thyroid disorders overlap with many other conditions.

Testing helps separate suspicion from diagnosis.

At SMC Physicians, our Endocrinology specialists evaluate and manage thyroid disorders as part of comprehensive endocrine care. If you’ve noticed persistent changes in your energy, weight, temperature tolerance, heart rate, or other symptoms that could be related to thyroid function, contact SMC Physicians to schedule an evaluation.

Your thyroid may be small, but when it isn’t functioning as it should, the effects can be felt throughout your body.

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A fine needly biopsy of a thyroid nodule may sound frightening, but the needle used is very small and a local anesthetic may not even be necessary. This simple procedure is often done in the doctor’s office. Sometimes, medications like blood thinners may need to be stopped for a few days before the procedure. Otherwise, the biopsy does not usually require any other special preparation (no fasting). Patients typically return home or to work after the biopsy without even needing a bandaid! For a fine needle biopsy, your doctor will use a very thin needle to withdraw cells from the thyroid nodule. Ordinarily, several samples will be taken from different parts of the nodule to give your doctor the best chance of finding cancerous cells if they are present. The cells are then examined under a microscope by a pathologist. 

The report of a thyroid fine needle biopsy will usually indicate one of the following findings:

• The nodule is benign (noncancerous)
• This result is obtained in up to 80% of biopsies. The risk of overlooking a cancer when the biopsy is benign is generally less than 3 in 100 tests or 3%. This is even lower when the biopsy is reviewed by an experienced pathologist at a major medical center. Generally, benign thyroid nodules do not need to be removed unless they are causing symptoms like choking or difficulty swallowing. Follow up ultrasound exams are important. Occasionally, another biopsy may be required in the future, especially if the nodule grows over time. 
• The nodule is malignant (cancerous) or suspicious of malignancy. 
• A malignant result is obtained in about 5% of biopsies and is most often due to papillary cancer, which is the most common type of thyroid cancer. A suspicious biopsy has a 50-75% risk of cancer in the nodule. These diagnoses require surgical removal of the thyroid after consultation with your endocrinologist and surgeon.
• The nodule is indeterminate. This is actually a group of several diagnoses that may occur in up to 20% of cases. An indeterminate finding means that even though an adequate number of cells was removed during the fine needle biopsy, examination with a microscope cannot reliably classify the result as benign or cancer. 
• The biopsy may be indeterminate because the nodule is described as a Follicular Lesion. These nodules are cancerous 20-30% of the time. However, the diagnosis can only be made by surgery. Since the odds that the nodule is not a cancer are much better here (70-80%), only the side of the thyroid with the nodule is usually removed. If a cancer is found, the remaining thyroid gland usually must be removed as well. If the surgery confirms hat no cancer is present, no additional surgery to “complete” the thyroidectomy is necessary. 
• The biopsy may also be indeterminate because the cells from the nodule have features that cannot be placed in one of the other diagnostic categories. The diagnosis is called atypic, or a follicular lesion of undetermined significance. Diagnoses in this category will contain cancer rarely, so repeat evaluation with FNA or surgical biopsy to remove half of the thyroid containing the nodule is usually recommended. 
• The biopsy may also be non-diagnostic or inadequate. This result is obtained in less than 5% of cases when an ultrasound is used to guide the FNA. This result indicates that not enough cells were obtained to make a diagnosis but is a common result if the nodule is a cyst. These nodules may require revelation with second fine needle biopsy, or may need to be removed surgically depending on the clinical judgment of your doctor. 

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