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The thyroid is a butterfly-shaped gland that lies beneath the skin and muscles but on top of the trachea (windpipe) in the neck. It sits just under the Adam’s apple (voice box) but above the clavicles (the collarbones). The thyroid is a major regulatory gland and regulates many of the body’s functions by secreting the thyroid hormones, Thyroxine (T4) and Triiodothyronine (T3). When our thyroids are functioning properly, our bodies are able to regulate temperature, process our foods to produce energy, produce and regulate hormones (controlling menstrual cycles, fertility, sugar metabolism and calcium absorption), help maintain our weight and food intake, and maintain regular heart rhythms. When thyroids are healthy and functioning properly, we seldom notice them and they are often not palpable. It’s only when the thyroid is not functioning properly that its presence is noted.
Such was the case for Patti Smith, an austinwoman former cover subject and general manager for the KVUE news station. In 2005, Smith began having various symptoms. She developed high cholesterol, high blood pressure and heart palpitations. After consulting with her primary physician, Smith consulted with a cardiologist who started her on cardiac medications. “It was really surprising,” says Smith who has been generally healthy all of her life. “All of a sudden I started having all these problems. I just figured it had to do with my age.” Smith took her medications and continued on with her life. In late 2005, Smith got what she describes as “the worst flu of my life.” She was so ill that she went to see her primary care physician and was referred for a CT scan of her neck and chest to rule out a pulmonary embolism (blood clot in her lungs). The CT showed no blood clot, but did show that Smith had golf ball sized gallstones and an enlarged thyroid with multiple nodules. “Over the course of a few months, I went from having no medical problems to having heart problems for which I was taking medication, immediate surgery to remove my gallbladder and a work up for an enlarged thyroid. It was all pretty overwhelming,” says Smith. The initial tests on the thyroid nodules showed that there was one “master” nodule in the right lobe that did not radiate well on tests. The nodule showed no cancer so Smith was advised to follow-up in one year.
It turned out to be an eventful year for Smith. In December of 2006, Smith had some moles removed and while applying ointment to the removal areas she noted a lump in her throat. She went back to her primary physician on a Monday and was immediately referred for a sonogram on Tuesday, the next day, of her throat. “I knew something was wrong because the technician’s expression was very serious and she was very quiet. I knew that she could not tell me anything, but I asked to see the images. I didn’t know exactly what I was looking at but I did see a mass in my throat that probably shouldn’t have been there.” That afternoon, Smith’s primary physician called her with an appointment to see Dr. Simona Scumpia, an expert in thyroid disease and lead physician at Austin Thyroid and Endocrinology the following day. Scumpia recommended that Smith have her thyroid removed and referred to her to Patti Huang, MD, otolaryngologist (ears, nose and throat) and surgeon at the Austin Diagnostic Clinic. Smith saw Huang the following day.
Huang explained to Smith that they could remove the right lobe of her thyroid and hence the master nodule which had grown in the past year. That would leave Smith with the left lobe of her thyroid and potentially enough thyroid gland to produce the thyroid hormone needed to carry out her bodily functions. However, Smith would run the risk of more nodules developing and growing in the left lobe requiring surgery in the future. Smith opted to have her entire thyroid removed and had a complete thyroidectomy on January 9, 2007. The surgery went well and there was no indication that the nodules were not benign. So it was a bit surprising that Smith’s biopsy of the master nodule returned positive for the early stages of thyroid cancer – to everyone but Dr. Huang.
“It wasn’t at all odd that the nodules grew, in fact we see that all the time,” say Huang. “Even the pathology report was not alarming.” Smith had micro papillary carcinoma, “A very non-life threatening form of cancer,” say Huang. “This was at such an early stage that it was only detected because of the other problems she (Smith) was having. Otherwise it may have been detected years later or perhaps not detected at all. Sometimes we don’t see these cancers until autopsy. Thyroid nodules are increasingly common with age, but the vast majority are benign. You just have to evaluate each patient individually and determine treatment on an individual basis.”
According to the National Cancer Institute, each year about 30,000 people will be diagnosed with thyroid cancer in the United States and about three times as many women will develop thyroid cancer than men. It is more common in white women than women of other races. People with a history of radiation to the head or neck or radiation exposure are at a greater risk of developing thyroid cancer, as are people who may have a family history of thyroid cancer. In developing countries where there is not enough iodine in the diet, thyroid cancer is more common, but this is not a common cause in the United States. Here, the vast majority of people with thyroid cancer have few or no identifiable risk factors.
Smith was lucky. Her cancer was in the very early stages and once the nodules were removed there were no other threats. She did not need chemotherapy nor did she need treatment with radioactive iodine. The only side effect that she has post operatively is a nonfunctioning parathyroid gland, which is responsible for calcium metabolism. Smith takes 1500 milligrams of calcium five times a day to maintain adequate calcium levels along with her thyroid hormone replacement and her cardiac meds. Smith also has her thyroid hormone levels checked monthly and her cancer markers checked at regular intervals. “It’s so strange,” says Smith. “I was completely ‘healthy’ until all of this happened and now I take multiple pills multiple times a day. It’s kind of a pain but I suppose it could be worse.”
Dr. Scumpia reiterates that thyroid disease is common and thyroid cancer comparatively is uncommon but is on the rise in men. “The most common thyroid disease is hypothyroidism,” says Scumpia and this is usually the result of Hashimoto’s Thyroiditis, a condition where the immune system attacks the thyroid and destroys the cells.” With fewer cells, the thyroid makes less thyroid hormone. In an attempt to compensate, the pituitary sends more thyroid stimulating hormone to the thyroid to try to make it produce more thyroid hormone. The remaining cells are overworked and become enlarged resulting in a goiter. Meanwhile, a person may experience fatigue, hoarseness, weight gain, cold intolerance, irritability and mood swings, memory loss and irregular periods. However, many people who have clinical hypothyroidism have no noticeable symptoms and only learn of their condition after routine examination and screening. Hypothyroidism is easily treated with synthetic thyroid hormones, usually taken for the rest of a person’s life.
Hyperthyroidism results when the thyroid produces too much thyroid hormone. The most common cause is Grave’s disease, an autoimmune reaction leading to increased thyroid hormone production. Hyperthyroidism is less common than hypothyroidism, but perhaps more well known. Famous for his bulging eyes (exophthalmos), Hollywood actor Marty Feldman had Grave’s disease. Other notable celebrities with Grave’s disease are former First Lady Barbara Bush and Olympic track and field star Gail Devers. Hyperthyroidism is treated by surgically removing the thyroid or obliterating it with radioactive iodine so that it no longer produces thyroid hormones. Then a person goes on lifelong thyroid hormone replacement with regular follow up.
According to Scumpia, thyroid disorders can be transient. “Many women experience post partum hyperthyroidism, but their thyroid hormone levels normalize over time. Viral infections are another common cause of transient hyperthyroidism. While most viral infections cause little or no long term damage to the thyroid, 20% will destroy the thyroid.”
Other medications can cause thyroid disorders. For example, Amiodarone, an antiarrhythmic medication can cause hyperthyroidism. Patients on Amiodarone must be closely monitored and must have their thyroid hormone levels checked at regular intervals.
Thyroid disorders are typically slow to develop and are easy to diagnose and treat by a skilled clinician. If you notice any suspicious or abnormal lumps in your neck, have them evaluated. They are likely benign, but then again, things aren’t always what they seem.
Common Signs and Symptoms of Hypothyroidism
• Fatigue
• Weight Gain
• Hoarse or Deepening Voice
• Depression
• Memory Loss/Decreased Attention Span
• Anxiety
• Difficulty Swallowing
• Brittle Nails and Dry Skin and Hair
• Cold Intolerance
• Muscle and Joint Aches
• Abnormal Menstrual Cycles (Heavy Bleeding)/Infertility
• Decreased Libido
• Elevated Cholesterol
Common Signs and Symptoms of Hyperthyroidism
• Goiter (Thyroid Enlargement)
• Exophthalmos (Bulging Eyes), Vision Problems and Eye Irritation
• Edema (Swelling in the Extremities)
• Weight Loss
• Increased Appetite
• Palpitations or Arrhythmia
• High Blood Pressure
• Heat Intolerance and Sweating
• Insomnia
• Irritability
• Altered Mental Status (Memory Lapses, Diminished
Concentration/Attention Span)
• Menstrual Changes/Infertility
Resources
The Endocrine Society
www.endo-society.org
The American Thyroid Association
www.thyroid.org
Austin Thyroid and Endocrinology
Simona Scumpia, MD
www.austinthyroid.com
The Austin Diagnostic Clinic
Patti Huang, MD
Otolaryngologist
www.adcclinic.com