When Shakespeare wrote, “Though she be but little, she is fierce!” in A Midsummer Night’s Dream, he wasn’t talking about the thyroid gland. But he might as well have been.

A small, butterfly-shaped organ located in the front of the neck, the thyroid gland plays a big role in regulating many critical bodily functions, including metabolism, heart rate, growth and development, muscle and digestive function, body temperature, and bone maintenance.

It’s not hyperbolic to say that the thyroid gland influences nearly every organ system in the human body, which makes proper thyroid function essential for overall health.

This is especially true for women.

Why? Because women experience thyroid problems – like thyroid nodules, hypothyroidism, and hyperthyroidism – at much greater rates than men, and when thyroid health is compromised, it can lead to chronic disorders that can have a significant impact on a person’s quality of life.

Keep reading to learn much more about treating, managing, and understanding thyroid disorders.

What is the Thyroid and How Does it Work?

The thyroid gland produces hormones - primarily thyroxine (T4) and triiodothyronine (T3) - that regulate the body’s metabolic rate. These hormones influence everything from your calorie burn-rate to how well your heart and digestive systems function.

The pituitary gland, a pea-sized body attached to the base of the brain, controls the activity of the thyroid gland. It releases thyroid stimulating hormone (TSH) in response to the body’s need for more thyroid hormones.

When thyroid levels are low, the pituitary gland releases TSH to stimulate the thyroid gland to release more hormones. When thyroid levels are high, the pituitary gland stops releasing TSH.

Fun fact: Healthcare providers measure TSH levels in your blood to indirectly check thyroid hormone levels. If you’re TSH level is too low, it means your thyroid is over-producing thyroid hormone. If it’s too high, it means your thyroid isn’t producing enough thyroid hormones.

Thyroid disorders occur when this delicate balance is disrupted. This can happen due to overproduction or underproduction of thyroid hormones.

What are the Most Common Thyroid Disorders?

HYPOTHYROIDISM

Hypothyroidism occurs when the thyroid gland doesn’t produce enough thyroid hormones, which leads to a generalized slowdown of many bodily functions.

The most common cause of hypothyroidism is Hashimoto's thyroiditis, an autoimmune disorder where the immune system mistakenly attacks thyroid tissue. Other causes of hypothyroidism include iodine deficiency, certain medications, and previous treatments for hyperthyroidism.

These are the most common symptoms of hypothyroidism:

· Fatigue

· Weight gain

· Cold intolerance

· Depression

· Constipation

· Dry skin and hair

· Irregular periods

HYPERTHYROIDISM

Hyperthyroidism is essentially the opposite of hypothyroidism. This condition is characterized by an overproduction of thyroid hormones and leads to an acceleration of bodily functions.

The most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder that stimulates the thyroid to produce excessive amounts of hormones. Other causes of hyperthyroidism include thyroid nodules (see below) and inflammation of the thyroid (thyroiditis).

The most common symptoms of hyperthyroidism include:

· Unexplained weight loss

· Rapid heart rate or heart palpitations

· Increased appetite

· Nervousness or irritability

· Sweating

· Tremors

· Difficulty sleeping

THYROID NODULES AND GOITER

A thyroid nodule is caused by an abnormal growth of thyroid cells that forms a lump (or multiple lumps) in the thyroid gland. Usually, they are harmless and not something to worry about. But sometimes thyroid nodules do contain cancer.

According to the American Thyroid Association more than 90% of thyroid nodules are benign (noncancerous) lesions, but 4-7% of thyroid nodules do contain cancer.

Thyroid nodules are four times more common in women than men and are detected in approximately 5-7% of the adult female population by physical exam alone. (National Institutes of Health)

A goiter is an enlarged thyroid gland, which can occur due to thyroid dysfunction, autoimmune disease, iodine deficiency, and other causes.

Thyroid nodules and goiters don’t always cause symptoms, but large goiters can lead to difficulty swallowing or breathing.

THYROID CANCER

Thyroid cancer, which is caused by an abnormal growth of cells in the thyroid gland, is relatively rare but is another thyroid disorder you need to have on your radar.

Thankfully, the most common types of thyroid cancer are slow-growing and highly treatable. Left undetected and untreated, thyroid cancer can spread to lymph nodes and spread to other parts of the body.

Papillary thyroid cancer is most common type of thyroid cancer followed by follicular thyroid cancer. Other forms of thyroid cancer, like Hurthle cell thyroid cancer, anaplastic thyroid cancer, and medullary thyroid cancer, are rarer but also can be more difficult to treat.

Most thyroid cancers don’t cause any signs or symptoms early in the disease course, but it can present as a painless lump or nodule. This is why it’s important to get any new lumps in your lower neck checked out by your provider.

As thyroid cancer grows, it may eventually cause symptoms, such as these:

· A lump or nodule that can be felt in your neck

· Voice changes, like hoarseness

· Difficulty swallowing

· Swollen lymph nodes in your neck

· Pain or pressure in your neck or throat

Risk Factors for Thyroid Disorders

Scientists have found a few risk factors that make a person more likely to develop thyroid cancer, including gender, age, genetics, family history, radiation, obesity, autoimmune diseases, and iodine.

Gender

· For unknown reasons, thyroid cancer occurs three times more often in women.

Age

· Thyroid cancer is most common in people 30-60 years old.

Genetics

· Some inherited conditions, like multiple endocrine neoplasia type 2 (MEN2) and Gardner syndrome, increase your risk of developing thyroid cancer. Keep in mind, these are rare conditions and only account for a small portion of overall thyroid cancers.

Family History of Thyroid Cancer

· If you have a first-degree relative (parent, brother, sister, or child) with thyroid cancer, you have an increased risk of developing it as well.

Radiation

· Radiation exposure, usually from certain medical tests and treatments (a possible side effect of radiation therapy), is another risk factor for thyroid cancer.

Obesity

· People with excess body weight have a higher risk for thyroid cancer, and this risk seems to rise as BMI (body mass index) increases.

Autoimmune Diseases

· Certain conditions, like type 1 diabetes and celiac disease, are associated with developing thyroid cancer.

Iodine

· People who ingest too little iodine (follicular thyroid cancer) or ingest too much iodine (papillary thyroid cancer) have a higher risk of thyroid cancer. In the United States, most people get enough iodine because it’s added to table salt and many other foods.

Diagnosing Thyroid Disorders

The initial evaluation for people with thyroid nodules or symptoms of thyroid conditions starts with a medical history, a physical exam, and blood tests to measure TSH (thyroid stimulating hormone), T3, and T4. As mentioned above, a high TSH level indicates hypothyroidism while a low level of TSH suggests hyperthyroidism.

Your provider can also order tests to look for antibodies to determine if an autoimmune disorder, like Hashimoto’s thyroiditis or Graves’ disease, might be causing your thyroid dysfunction.

If your provider suspects a thyroid disorder, she will most likely order imaging tests and/or a biopsy of your thyroid gland.

Imagine studies may include an ultrasound or CT scan to get a closer look at any suspicious nodules or a radioactive iodine uptake scan (aka a thyroid scan) to determine how well your thyroid is functioning. The thyroid absorbs iodine to produce hormones that regulate metabolism and energy, and this scan can allow your doctor to see how effectively your thyroid uptakes iodine.

Your provider can also perform a fine-needle biopsy to collect tissue samples, assess thyroid health, and look for thyroid cancer cells.

Managing and Treating Thyroid Disorders

After being diagnosed with a thyroid disorder, your provider has several options for managing and treating it, including medication, surgery, and lifestyle changes.

Medication

· Synthetic thyroid hormone (levothyroxine) is the standard treatment for hypothyroidism. This oral medication restores normal hormone levels and can alleviate symptoms. You will need regular blood tests to monitor hormone levels and adjust dosage.

· Treatment for hyperthyroid include antithyroid medications that reduce the production of thyroid hormones. It may also include therapy with beta-blockers, a class of medicine that can reduce symptoms, like rapid heartbeat. In some cases, surgery to remove part or all of the thyroid gland or radioactive iodine therapy may be necessary to alleviate symptoms of hyperthyroidism.

Surgery

· For certain thyroid disorders - like large goiters, multiple nodules, severe hyperthyroidism, and cancer – surgical removal of the thyroid gland (thyroidectomy) may be recommended.

Radioactive Iodine Treatment

· This is another treatment option for people with hyperthyroidism and certain thyroid cancers. It involves ingesting a small amount of radioactive iodine, which is taken up by the thyroid gland and destroys overactive thyroid tissue.

Diet and Lifestyle

· Iodine is essential for thyroid function, so it’s important to get enough of this mineral by eating an array of iodine-rich foods like fish, dairy products, and iodized salt.

· Chronic stress can worsen thyroid imbalances, especially in people with autoimmune disorders, like Hashimoto’s or Graves’. Practices like yoga, meditation, and breath work can help manage stress and can make a big difference to your thyroid health.

· Regular exercise can helps regulate metabolism and body weight, which is especially helpful for people diagnosed with hypothyroidism.

Conclusion

Even though thyroid disorders are common, they are also often misunderstood and misdiagnosed. The wide-range of signs and symptoms associated with thyroid conditions can often lead providers down the wrong diagnostic path, which can delay treatment of these highly manageable disorders. 

It’s worth repeating that women need to be particularly vigilant about their thyroid health. They are more likely to experience thyroid disorders, including hyperthyroidism, hypothyroidism, and thyroid nodules, and periods of hormonal fluctuations (pregnancy, menopause) can exacerbate thyroid issues.

By better understanding how the thyroid works and recognizing the symptoms of thyroid dysfunction, people can take back their thyroid health and regain their quality of life.