Tag Archives: Thyroid Gland

CANCERS: DIAGNOSING CARCINOID TUMORS

Cancer is a huge problem, since it is actually a collection of a lot of different diseases in different places, resulting from mutation of the genes and invasiveness as the common characteristic. All cancers are different.

Carcinoid tumor is a good illustration. These are so called neutoendocrine tumors. They are slow growing, and are usually not detected until they are quite advanced. They can be located in different organs such as the gastrointestinal tract and the lung.

In their vicinity they produce symptoms characteristic of the area; trouble swallowing, nausea, vomiting, constipation and abdominal pain for gastrointestinal carcinoid, and cough, wheezing, shortness of breath and chest pain for those located in the lung.

Many advanced cancers can produce weight loss, muscle pain and fatigue In addition to symptoms characteristic of their location. The special characteristic of carcinoid tumors is that they may secrete substances that produce diverse symptoms such as  flushing of the skin, sudden diarrhea and vomiting and, strangest of all, heart valve leakages.

Diagnosis of carcinoid tumors is often made by checking for serotonin or chromogranin-A in the blood, and 5-Hydroxy indolacetic acid ( 5-HIAA) in the urine, and locating the tumor with Imaging such as CT and MRI.

It is usually treated best for surgery, but cell surface somatostatin can be targeted for hormone therapy, and targeted radiotherapy with PRRT. It is very much to the advantage of the patient if she has a tumor with specific hormone or other marker that can be targeted for treatment, such as a breast cancer with estrogen receptors that can be targeted by tamoxifen.

Please check the accompanying mayo clinic article for more information.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #53: GRAVES’ DISEASE

Graves’ disease is the most common cause of hyperthyroidism. Hyperthyroidism is an over activity of the thyroid gland, and can also be produced by an overgrowth in the gland called an adenoma.

The thyroid gland is an H-shaped structure sitting astride the wind pipe. If a physician palpates the front of your neck, she is most likely trying to see if she can feel the thyroid gland. Enlargement of the grand can interestingly be produced by either overactivity or under activity.

Graves’ disease is an auto immune disease, where the antibodies produced attach to the TSH receptor on the thyroid gland, stimulating overactivity.

Many  metabolic processes are regulated by the thyroid gland, and increased activity produces difficulties like insomnia, fast irregular heartbeat, shaking of the hands, heat intolerance, and irritability. Other symptoms are protrusion of the eyes, fatigue, muscle weakness, and unexplained weight loss.

The doctor suspects the disease because of the symptoms, and must do blood tests and perhaps imaging tests to make the diagnosis. Treatment consists of decreasing thyroid activity, either by radiation techniques, anti-thyroid chemicals, or surgery.

It is very difficult to reduce thyroid activity in exactly the right amount, so that thyroid administration will be necessary. This can be tricky, and requires several visits for adjustment.

The ultimate cause of Graves’ disease is unknown. The immediate cause is thyroid stimulating immunoglobulin. Graves is an auto immune disease, and is more common in people who suffer from other autoimmune diseases, such as type one diabetes, rheumatoid arthritis, or inflammatory bowel disease. The doctor will question you about some of these diseases.

Both causes of hyperthyroidism have occurred in friends of mine. The friend with the adenoma had an easier time with medication adjustment, and had no other problems. The one with the Graves’ disease has had a difficult time getting a proper dose of thyroid medication, and she has other problems with auto immunity. Women typically have more  autoimmune problems.

Interestingly, the commonest cause of low thyroid activity is also an autoimmune disease. Some of the symptoms of low thyroid are the opposite of excessive thyroid activity; sleeping is excessive, there is sensitivity to cold, unexplained weight gain, and sluggishness.

Check with the doctor if you have any of the symptoms mentioned.
There is a Cleveland clinic discussion of Graves’ disease following this article.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #50: HASHIMOTO’S DISEASE

Hashimoto’s thyroiditis is the most common cause of thyroid deficiency. As a practicing allergist, I would routinely palpate the front of the neck area around the windpipe where the thyroid is located. Every few months or so, I would feel an enlarged thyroid, order a high sensitivity TSH test, and, if positive, check for thyroid antibodies.

This saved my patients from having to go through the symptoms of underactive thyroid(hypothyroidism), since I detected the problem at an early stage, before symptoms developed.

Major symptoms of an underactive thyroid include fatigue, increased sensitivity to the cold, constipation, unexplained weight gain, and depression. Be sure to seek medical care if you are suffering from these symptoms.

An elevated LDL cholesterol is one of the biochemical results of hypothyroidism, and can lead to heart problems. I have been hearing that the routine physical examination it is becoming less common, and may even be replaced by telemedicine. The early detection of Hashimoto’s thyroiditis will be one of the casualties, since the doctor can’t find an enlarged thyroid unless she palpates for it.

You might wonder why an enlarged thyroid gland is associated with decreased thyroid production. The way it works is that the pituitary gland at the base of the brain detects a decrease in thyroid production. It responds by secreting a thyroid stimulant, TSH. The TSH causes enlargement of the thyroid gland, leading to the association of an elevated TSH with decreased thyroid activity.

Hashimoto’s  is one of the large number of autoimmune diseases. A person who has an autoimmune disease, such as rheumatoid arthritis, type one diabetes, or celiac disease, is more likely to develop others, and should be alert to that possibility.

Finding that you have  low thyroid activity is only part of the problem. It takes several visits plus input from both patient and doctor in order to arrive at the proper medication schedule. There are several different thyroid medications, and people respond differently to them.

Be on the alert for hypothyroidism. It can sneak up on you.

—Dr. C.

Endocrinology: Thyroid Nodule Treatment (Video)

The Endocrine Surgery Program at Massachusetts General Hospital provides multidisciplinary, specialized treatment for thyroid nodules, a lump that commonly occurs in the thyroid. If you think that you may have a thyroid nodule, you should be evaluated by a physician. In this video, Sareh Parangi, MD, endocrine surgeon at Mass General, shares more about what to expect for diagnosis and treatment of thyroid nodules.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #40: HYPOTHYROIDISM

Hypothyroidism is a very common hormonal deficiency where there is an insufficient amount of thyroid hormone, T4. The thyroid gland regulates your metabolic activity. If you have insufficient thyroid hormone, everything seems to slow down; Your energy level, your muscle strength, your heart rate, your brain activity, and even your intestinal activity are all slower.

The causes of thyroid hypothyroidism. Infographics. Vector illustration on isolated background

One of my habits in practice was to check the size of the thyroid, which is an H shaped gland astride the windpipe beneath the voice box. It becomes enlarged in a condition known as Hashimoto’s thyroiditis, the most common cause of adult hypothyroidism.

As you recall from the last posting, when the thyroid function is low, the brain causes a release of TSH, which stimulates the thyroid gland. In order to produce more thyroid hormone, the gland enlarges and the examining physician can feel it.

Babies can be born without a thyroid. I had one such patient when I was in training. The baby was inexplicably limp, and did not cry vigorously like other babies. When given thyroid hormone, she developed normally. Such babies often go undetected, don’t grow and become mentally deficient.

The thyroid gland produces thyroxine, which is T4.  In the tissues, the T4 is converted into the much more active T3. This is often the medication of choice in hypothyroidism. In giving thyroid Hormonal, the physician must adjust the dose, depending on the patients  response. Only after a number of visits is the proper dose found.

Please refer to the Mayo clinic article on hypothyroidism. The use of the TSH as a blood test is also discussed.

—Dr. C.

Mayo Clinic Article

DR. C’S JOURNAL: THYROID STIMULATING HORMONE

Thyroid stimulating hormone (TSH) is one of a series of regulatory hormones to come from the pituitary gland, often called the “master gland“ of the body. Most of the pituitary hormones are released upon signals from the hypothalamus, part of the real master coordinator of the body, the brain.

TSH Instructs the Thyroid gland to produce more Thyroid hormone. When more Thyroid hormone is produced, The increase of Thyroxin in the  bloodstream causes the TSH level to drop.

Our metabolism is full of these servomechanisms which control the level of critical substances. When the thyroid does not function properly, and the thyroid level drops, the TSH is increased. An elevated TSH it is presently the best test we have for hypothyroidism.

Conversely, when there is excessive thyroid activity (hyperthyroidism), the TSH level drops to vanishingly low amounts. Tomorrow the subject will be thyroxin.

—Dr. C.