Focusing on non-surgical methods and preventing complications

Do you often feel fatigue for no reason, even if you get your daily dose of sleep? Do you find it difficult to tolerate cold weather when everybody else is complaining of the weather being warm? Or do you experience increased unusual perspiration or frequent bouts of hunger with relatively less weight gain? If the answers to any of the above are yes, you are most likely to have a hormonal imbalance related to the thyroid gland.

“Hypothyroidism and Hyperthyroidism refer to two medical conditions which are caused by the defective secretion of Thyroxin hormone. This hormone is secreted by the Thyroid gland, a small, butterfly-shaped gland in the neck, responsible in producing Thyroid hormones. The hormonal secretion is regulated by the pituitary which is the centre of body hormone regulation, situated in the brain” explains Dr. Vindya Wellala, Senior Registrar in Endocrinology, Colombo South Teaching Hospital, Kalubowila.

When this gland starts working or producing hormones more or less than the normal concentrations required it can result in hyperthyroidism or hypothyroidism respectively. This condition leads to a range of symptoms which needs timely medical interventions in order to avoid discomfort.

Hypothyroidism 
This is a common condition, which occurs as a result of thyroid hormone deficiency and can be categorized into primary, secondary or tertiary (central) depending on the basic pathophysiology. Primary hypothyroidism which accounts for the majority of cases (95%) is due to an intrinsic defect in the thyroid gland itself. 

Secondary and tertiary hypothyroidism occurs due to insufficient stimulation of the thyroid gland by Thyroid Stimulating Hormone and can be the result of an underlying hypothalamic or pituitary disease.

Symptoms often go unnoticed due to their vagueness. 

Congenital Hypothyroidism 
Congenital hypothyroidism, is another sub-type of this condition which affects 1 in every 4000 new-born babies.
In addition, patients with Hashimotos’s thyroiditis will characteristically present with fever, sensation of fullness in the throat, painless or painful enlargement of the thyroid gland, indescribable exhaustion and transient neck pain, sore throat, or both.

Treatment
“In fact, if the condition is due to thyroiditis which is a transient process we can watch and wait or depending on the cause we will offer thyroxin replacement. Some patients might need pain killers and immune-suppressants and this should be carried out under the supervision of a consultant physician or an endocrinologist.

Levothyroxine (LT4) is the treatment of choice for hypothyroidism.

Improperly managed hypothyroidism can lead to the progression of disease and worsening of symptoms.

Hyperthyroidism
Hyperthyroidism occurs due to increased production of thyroid hormones (T4, T3, or both) from the thyroid gland. The two major causes of hyperthyroidism include, glandular hyper function (primary) and increased stimulation of the hormone.

Graves’ disease which is an autoimmune disorder accounts for most of the cases of hyperthyroidism. 
High amounts of thyroid hormones can result in an excessively high metabolic rate where patients will present with increased heart rate, increased perspiration, elevated blood pressure, tremors, diarrhea, weight loss despite of increased appetite, difficulty in sleeping etc  “Undiagnosed Hyperthyroidism can result in cardiac arrhythmias known as atrial fibrillation which can lead a patient towards a stroke or congestive heart failure” highlights Dr. Wellala.

It’s very rarely that cancer related to thyroid can occur as solitary or in association with other endocrine disorders such as pituitary and pancreatic tumours. 

Surgery
Surgery which involves the complete or partial removal of the gland is indicated in cases which do not respond to medical treatment. Also, some patients would want to get the gland out for cosmetic reasons as well. We try to see if the patient responds to non-invasive modalities of therapy and try to stick to non-surgical methods in order to prevent complications.