Thyroid Disorders

The thyroid is a small butterfly-shaped gland located in the lower neck. It produces hormones (T3 and T4) which help with regulating the function of other organs. The thyroid helps regulate how your body metabolizes (processes) the food you eat and controls your body's overall temperature. Thyroid hormones are also important in maintaining the body's production and use of other hormones and chemicals.

Production of thyroid hormone by the thyroid gland is also regulated by another hormone (thyroid stimulating hormone - TSH) that is made by the pituitary gland (a small gland that is part of the brain). The pituitary and thyroid glands work together to produce the right amount of thyroid hormone for the body. If the body needs more thyroid hormone, the pituitary will increase production of TSH to stimulate production of thyroid hormone from the thyroid gland. If the body has enough thyroid hormone, or makes too much, the pituitary will make less TSH.

An Introduction to Common Thyroid Disorders

Thyroid nodules are very common. About 95% of nodules are benign (not cancer), and most do not require any treatment or surgery. While thyroid nodules can be found in up to 60% of patients, especially in older patients, only 5-8% are able to be felt by the patient or their physician. Most thyroid nodules are identified on imaging studies performed for reasons unrelated to the thyroid gland (carotid duplex, CT scans of the neck or chest). Once a thyroid nodule is found, it should be evaluated to ensure that it is benign. Even if there are nodules found within the thyroid gland, the gland usually continues to function normally. On occasion, some thyroid nodules will produce excess thyroid hormone leading to hyperthyroidism.

Hyperthyroidism is the result of production of excess thyroid hormone. Hyperthyroidism can lead to weight loss, a fast heartbeat, sweating, feelings of nervousness, change in the skin, hair, or weight. If left untreated it can lead to serious heart, bone and other problems. Graves’ disease is one of the main causes of hyperthyroidism. It is an autoimmune disease, more common in women than men, and can be associated with eye problems (Graves’ eye disease).

Hypothyroidism is the result of inadequate production of thyroid hormone that may lead to changes in the hair, skin or weight, as well as cause fatigue, weakness, and/or other issues. Hashimoto’s thyroiditis is an autoimmune disorder that may ultimately lead to hypothyroidism.

Thyroid cancer is found in about 5% of thyroid nodules. The most common types of thyroid cancer are papillary and follicular. Long term outcomes from thyroid cancer are usually quite good. Hurthle cell cancers, medullary thyroid cancers (MTC), thyroid lymphoma, and anaplastic thyroid cancers are much less common.

Diagnosis of Thyroid Disorders

The appropriate evaluation of thyroid disease starts with a complete history and physical exam. Blood work is obtained, and depending on the specific problem, an ultrasound of the thyroid may be performed to look for nodules or other abnormalities. Other imaging tests that may be ordered include CT scans, MRIs, or nuclear medicine studies such as radioiodine and PET scans. If a thyroid nodule or other abnormality is detected, your doctor may recommend a biopsy done with a small needle [fine needle aspiration (FNA)].

Treatment for Thyroid Disorders

To decide on the best course of treatment, each patient is carefully evaluated. In most cases, evaluation shows the nodule to be benign (non-cancerous) and the function of the thyroid is normal. In this circumstance, usually no specific treatment is needed, and the thyroid nodule can be followed to ensure there are no concerning changes over time.

Benign nodules causing symptoms (for example, difficulty swallowing, a sensation of pressure or discomfort, visible swelling) due to their size and location are potential candidates for thyroid radiofrequency ablation (RFA) treatment, a minimally invasive treatment used to shrink thyroid nodules.

If your physician is suspecting that your nodule may be cancerous or is large enough to cause problems with breathing or swallowing, thyroid surgery may be recommended. Your surgeon will discuss the appropriate surgical options with you. Surgical options range from removing only the side of the thyroid gland that contains the nodule (thyroid lobectomy or hemithyroidectomy) to removing the entire thyroid gland (total thyroidectomy).

What's Special About University of Michigan's Treatment for Thyroid Disorders?

University of Michigan endocrine surgeons perform their own thyroid ultrasounds. Their overall experience and insight into thyroid disease allows them to gather necessary information at the time of the first office visit so they can formulate a specific course of treatment for each patient. This approach supports streamlined patient care, avoidance of unnecessary visits and minimizing the time from diagnosis to treatment.

For patients needing thyroid surgery, minimally invasive approaches are offered by some of our surgeons.