More than 12% of Americans will develop a thyroid condition at some point, with women at greater risk than men.
The thyroid gland, a butterfly-shaped organ in the front of the neck, produces hormones that regulate metabolism, support growth, and promote brain development, among other vital functions.
Dr. Kepal Patel, co-director of the Thyroid Program at NYU Langone Health and chief of the Division of Endocrine Surgery, gave us the lowdown on thyroid, symptoms that may indicate thyroid dysfunction, and common treatments.
What is the thyroid gland and how does it work?
The thyroid gland is part of your endocrine system, producing hormones that regulate your metabolism, affecting how your body uses energy. These hormones affect almost every organ, affecting heart rate, body temperature and digestion. When your thyroid isn’t working properly, it can affect your entire body.
What are the early warning signs and symptoms of thyroid disease?
There are several types of thyroid disease, each with specific symptoms. Early warning signs include a slow or fast heart rate, unexplained weight changes (gain or loss), sensitivity to cold or heat, depression or anxiety, persistent fatigue, and irregular menstrual periods.
In hypothyroidism (an underactive thyroid), common symptoms include fatigue, weight gain, and feeling cold. This can result from conditions such as Hashimoto’s disease, a chronic autoimmune disorder and the most common cause in regions where iodized salt and other iodine-rich foods are widely available. Iodine deficiency can also lead to hypothyroidism, while congenital hypothyroidism refers to cases where babies are born with an absent or underactive thyroid.
Hyperthyroidism (an overactive thyroid), on the other hand, can cause anxiety, weight loss, a racing heart, and feeling unusually hot. It is often associated with Graves’ disease, another autoimmune condition that overstimulates the thyroid. Thyroid nodules, which are abnormal lumps in the thyroid, and excess iodine can cause the thyroid to produce more hormones than it should.
Early recognition of these symptoms is key to effective management and treatment.
When should someone see a specialist for thyroid-related symptoms?
You should see a specialist, usually an endocrinologist, if you have persistent, unexplained symptoms that don’t improve with primary care treatment, or if you notice changes in the appearance of your neck.
If a family member has thyroid disease, inform your doctor, as thyroid disease often runs in families. Since thyroid symptoms can be subtle, diagnosis can sometimes be delayed. Consult your doctor if you feel significantly different from usual. A simple blood test can check your thyroid hormone levels and help determine if your thyroid is the cause.
What do you tell patients who come in with a lump in their neck?
Lumps in the neck are quite common and are usually not life-threatening. The most common cause is swollen lymph nodes due to infections such as a cold or sore throat. Irritants such as allergies or post-nasal drip can also cause swollen lymph nodes. Other possible causes include thyroid nodules, cysts, or noncancerous tumors. Most benign lumps tend to go away on their own, but if a lump persists, it should be evaluated further. This may include an ultrasound of the neck and, if necessary, a biopsy to determine the cause.
When should I worry about lumps or knots in my neck?
Be concerned about lumps that last more than two weeks, especially if they are not related to an infection. Warning signs include lumps that seem to grow, are hard, or feel firm. These should be evaluated by a specialist, and a physical exam or thyroid ultrasound can help assess whether the lump requires further evaluation.
How is a diagnosis made?
To diagnose thyroid disease, nodules or cancer, we usually start with a complete medical history and physical examination. This may include feeling the thyroid area for any abnormalities. A blood test that measures thyroid-stimulating hormone levels is often the first step. If the results come back abnormal or there are obvious lumps or pain, imaging tests such as neck ultrasound, a useful tool for evaluating and diagnosing thyroid nodules and most thyroid cancers, may be ordered. Our team may also use radioactive iodine scans, which can help distinguish between different types of nodules and abnormalities of thyroid function.
If a lump or nodule looks suspicious, a biopsy may be needed to check for cancerous or abnormal cells. This is done using a thin needle where a small sample of tissue is removed and examined. If thyroid cancer is suspected, a more detailed biopsy with molecular testing or advanced imaging techniques may be used. By combining these tests, we can accurately diagnose and recommend a course of treatment.
How is thyroid disease treated?
Treatment depends on the specific condition and its underlying cause. Our goal is to return your thyroid hormone levels to a healthy range. For hyperthyroidism, options include medications that block the thyroid’s production of hormones, radioiodine therapy to destroy thyroid cells and reduce hormone production, or surgery to remove the thyroid gland. Those who undergo surgery or radioiodine therapy may need to take lifelong thyroid hormone replacement. Hypothyroidism is mainly treated with thyroid hormone replacement.
At NYU Langone’s Thyroid Program, we provide innovative, multidisciplinary care tailored to each patient’s needs to deliver the best treatment at the optimal time. Thyroid disease is often lifelong, requiring ongoing treatment. Although it may take some time to find the right treatment plan to regulate your hormone levels, most people with thyroid disease lead normal lives.
How can I keep my thyroid healthy?
Eat a balanced diet rich in fruits, vegetables, whole grains and adequate iodine. Regular exercise, stress management techniques such as yoga and routine check-ups can help. Avoid smoking, limit alcohol and reduce exposure to harmful chemicals to support thyroid health.
Kepal N. Patel, MDis chief of the Division of Endocrine Surgery and co-director of NYU Langone Thyroid Program. He is an internationally recognized endocrine surgeon and thyroid specialist, providing a full spectrum of care for the diagnosis and treatment of thyroid conditions. Dr. Patel is the lead author of the first comprehensive guidelines for the surgical management of thyroid disease in adults.
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