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Typically, doctors recommend maintaining a healthy diet, engaging in physical activity, and undergoing routine health examinations to prevent various illnesses. In the case of thyroid disease prevention, a straightforward measure would be to incorporate iodized salt into your cooking.
What is the thyroid gland?
The thyroid gland is located in the front of the neck and resembles a butterfly in shape, with two lobes that wrap around the trachea and connect in the middle by an isthmus. In a healthy individual, the thyroid gland is typically not visible or palpable.
Functions of the thyroid gland.
The thyroid gland is an organ that absorbs iodine from the blood and converts it into hormones, which are iodine-containing compounds. Like other hormones, these regulate metabolism in the body, primarily affecting the heart rhythm and nervous system function.
What happens when the thyroid gland malfunctions
When the thyroid gland malfunctions, it can either produce insufficient hormones or, conversely, produce an excess.
Hypothyroidism.
This is a deficiency of thyroid hormones. When hypothyroidism occurs, a person feels weakness, sleepiness, develops edema, experiences cognitive impairment, and slow speech. They gain weight, have difficulty tolerating cold, experience low blood pressure, dry skin, and constipation. The disease is particularly dangerous for pregnant women. Untreated hypothyroidism can lead to a coma.
Hyperthyroidism, or thyrotoxicosis.
This is a condition that arises from an excess of thyroid hormones. When hyperthyroidism occurs, a person becomes nervous, sweats heavily, loses weight rapidly, experiences accelerated heartbeat, and even shortness of breath with slight exertion. If left untreated, hyperthyroidism increases the risk of atrial fibrillation and cardiac arrest.”
The Link Between Thyroid Gland Diseases and Iodine Deficiency
As long as the person’s blood contains a normal amount of iodine, the thyroid gland functions normally. However, if there is a shortage of iodine, the gland compensates for the deficit by increasing in size. This way, it processes more blood, takes up more iodine, and produces more hormones.
Diffuse non-toxic goiter
Diffuse non-toxic goiter is sometimes visible from the outside as a swelling on the neck that resembles a bird’s goiter, which is why the disease has such a name. It is called diffuse because the gland is enlarged uniformly. And it is non-toxic because the person’s condition does not change – the gland functions normally and the hormone levels are normal.
Nodular and multinodular nontoxic goiter.
The less iodine there is in the blood, the more intensively the thyroid gland enlarges to provide the body with the necessary amount of its hormones, but there is a limit to any compensation. If the process is allowed to run, after some time, additional formations – nodules – may appear in the thyroid gland. Then, the goiter becomes nodular or multinodular, instead of diffuse.
In goiter, the thyroid gland can function normally, but sometimes the cells in the nodules lose the ability to capture iodine from the blood and produce hormones. In this case, the amount of hormones becomes insufficient, and hypothyroidism develops.
Nodular and multinodular toxic goiter.
This is a different scenario for the development of the situation. Nodules consist of thyroid cells, so they also absorb iodine and produce hormones. The thyroid gland does not regulate their activity, so in some cases, such cells begin to produce too many hormones. This leads to hyperthyroidism. And the goiter becomes toxic nodular or multinodular goiter because the excess hormones almost poison the body.
Diffuse toxic goiter, or Graves’ disease.
Thyrotoxicosis can occur not only due to iodine deficiency. It also occurs against the background of an autoimmune disease called diffuse toxic goiter. Such a goiter usually has no nodules, that is, the thyroid gland enlarges uniformly, but the symptoms will be the same as with the formation of nodules, with an excess of hormone production.
Autoimmune thyroiditis.
The cause of hypothyroidism is not always a deficiency of iodine – it can also develop with autoimmune thyroiditis, or Hashimoto’s thyroiditis. This is an autoimmune disease that causes destruction of the thyroid gland and disruption of its function. This disease is considered the main cause of hypothyroidism. A deficiency of thyroid hormones can also occur after the gland is removed for various reasons.
In addition, an excess of iodine can also be harmful – like a deficiency of this micronutrient, it can lead to hypothyroidism and other thyroid diseases. However, in Russia, this problem is practically non-existent, while a deficiency of iodine is observed in all regions of the country, which is why it is necessary to replenish it with iodized salt.
Prevention of thyroid diseases
Thyroid problems are frequently attributed to a deficiency in iodine. Therefore, the simplest way to prevent them is by consuming an adequate amount of micronutrients. An adult requires 150 mcg, children aged 2 to 6 require 90 mcg, and pregnant or lactating women require at least 200 mcg.
Iodine poses two issues. Firstly, it is generally scarce in some regions. As you move further away from the sea, there is less iodine in the air, water, and, most significantly, food.
Moreover, it does not accumulate in the body and instead gets excreted during visits to the toilet. To prevent thyroid ailments, one must ensure that they consume iodine every day. Some companies iodize salt, which is available in the same locations as regular salt and does not cost much more.
Consuming just a few grams of iodized salt every day is sufficient for adults to prevent goiters. We barely even notice this amount of product in our diets.
Some individuals may argue that salt iodization is not needed because you can consume sea salt, which also includes iodine. While it is present in sea salt, after being evaporated in the sun, rinsed and dried, only a small amount remains – 40 times less than in iodized salt. This translates to around 1 mg per kg, compared to 40 mg per kg in iodized salt. You would need 200 grams of sea salt per day to obtain the recommended daily amount of iodine.
It is worth noting that iodized salt is not the only source of iodine, which is beneficial since some people may not consume enough salt, for instance, due to health issues. However, there are other foods that contain iodine that can be added to your diet, such as seafood like squid, shrimp, mussels, various types of redfish, mackerel, herring, and seaweed. Feijoa, southern region walnuts, and cranberries are also high in iodine. Drinking a tablespoon of cranberry juice per day or consuming one persimmon fruit daily is adequate to reach the recommended daily amount.
| Product | Iodine Content per 100g |
|---|---|
| Squid | 300 mcg |
| Seaweed | 200 mcg |
| Shrimp | 190 mcg |
| Feijoa | 80 mcg |
| Herring | 70 mcg |
| Apples | 65 mcg |
| Tuna | 50 mcg |
It is important to note that most of the micronutrients can be lost during the cooking process. For instance, 100 grams of fried shrimp, which has 190 milligrams of iodine, only contains 11 milligrams after cooking. Since the concentration of iodine decreases over time, nuts, berries, and fruits should be eaten fresh whenever possible.
It is unnecessary to measure the body’s trace element levels down to the microgram, as a minor decrease in the concentration of iodine does not have a significant impact on the body.
Diagnosis
In the initial stages of goiter, there are generally no noticeable symptoms. Frequently, individuals consult me about a lump in their throat and suspect they have thyroid problems. However, such sensations are usually caused by other factors, as thyroid issues do not produce discomfort in the throat at an early stage. In fact, it is only in the later stages that neck enlargement is visible to the naked eye, indicating that the goiter has progressed to the second or third degree.
Thyroid problems typically manifest with non-specific symptoms of thyrotoxicosis or hypothyroidism, which can also be caused by other conditions such as alopecia, neurasthenia, hypertension, hypotension, or coronary heart disease.
It is essential to consult a physician for a diagnosis as these symptoms do not necessarily indicate thyroid problems. A doctor may conduct an ultrasound of the thyroid gland, a blood test to measure hormone levels, and sometimes perform palpation to check for enlarged glands, which may not be visible from the outside.
Regular check-ups with an endocrinologist every two years are recommended for individuals living in iodine-deficient regions, even if they do not exhibit any symptoms.
Ultrasound
If the examination detects changes in the gland, it will be repeated again in a year to monitor the dynamics.
Blood test to measure hormone levels
If the ultrasound reveals an abnormality, your doctor will request a blood test to evaluate hormone levels. The test usually begins with thyroid-stimulating hormone, or TSH, which regulates the thyroid gland’s function. If iodine hormone production is too low, TSH will increase it, and if there is too much hormone, TSH will slow it down. Thus, the relationship between the two is inverse: elevated TSH levels in the blood indicate insufficient iodine hormone production, while low TSH levels indicate hormone levels are higher than necessary.
Sometimes, an endocrinologist will also order a free T4 test, which measures one of the iodine-containing hormones directly. This test can help determine whether the thyroid gland is working efficiently or overactive, depending on whether there is enough or too much free T4 in the blood.
| Indicator | Normal value |
|---|---|
| TSH | 0.4-4 mU/L |
| T4 | 62-141 nmol/L |
| Free T4 | 9.0-19.05 pmol/L |
Some people think that these tests are interchangeable, and that doctors order unnecessary procedures, but this is not true. The reason is that the TSH levels change every three months, on average. Even if the disease has already started, the TSH level may still be normal. In contrast, free T4 levels change immediately when the disease appears.
On the other hand, TSH is a very stable hormone that is unaffected by medication or physical activity before testing. Free T4, on the other hand, can vary significantly depending on factors such as medication or other conditions. Conducting tests on two hormones simultaneously minimizes their weaknesses and allows for a more comprehensive evaluation.
Additional lab tests
If a diagnosis is confirmed, additional medical tests may be required such as an electrocardiogram (ECG), a complete blood count, a biochemical blood test, and in some cases, a gland scintigraphy or gland puncture may also be recommended by the doctor.
The ECG, complete blood count, and biochemical blood test are performed only once to establish the patient’s baseline condition at the onset of treatment.
ECG
In the case of thyrotoxicosis, the heart rate increases, while in hypothyroidism, it slows down. Therefore, the ECG is used to assess the severity of the disease and to identify any contraindications for treatment.
Complete blood count
A complete blood count test can help evaluate the number of leukocytes, which are responsible for protecting the body against infections. Since medication used to treat thyrotoxicosis can reduce leukocyte activity, it’s essential for doctors to understand the impact on the immune system to adjust dosage and avoid excessive suppression.
Biochemical blood test
The analysis of the blood biochemistry provides information about the kidney and liver function. If these organs are not functioning properly, medications may not be properly metabolized by the body. Thus, determining the state of these organs is important for the doctor to calculate the correct dosage.
Scintigraphy
When thyroid nodules are detected on an ultrasound, it may be necessary to undergo scintigraphy and a biopsy. Scintigraphy, also known as a gamma scan, can determine if the cells within the nodule are producing hormones. If the answer is yes, a doctor may recommend removing the nodule to prevent further deterioration of the condition. During the scintigraphy procedure, a medication similar to iodine is injected into a vein. The blood carries it to the thyroid gland, where the nodules absorb it. If the nodules are producing hormones, they will absorb iodine from the medication, which the doctor can then detect using imaging. This procedure can help the doctor determine the best course of treatment.
Fine needle aspiration biopsy
To determine the type of cells present in the node, a needle puncture (fine needle aspiration biopsy) can also be performed, although this is usually done to check for tumors. The thyroid gland is punctured with a needle, and the washout is examined under a microscope. If malignant cells are found, it means that the thyroid gland is cancerous and needs to be removed.
The use of scintigraphy and puncture can provide insight into the progression of the disease and help determine the appropriate treatment.
Goiter treatment
Treatment for goiter depends on the age of the patient. In children and adolescents, goiter can be fully treated by giving them iodine supplements which reduce the size of the goiter.
However, for adults, the chances of complete recovery are low, and monitoring the goiter is the recommended approach. Regular visits to an endocrinologist and yearly blood tests are necessary to keep an eye on hormone levels. If hormone levels are normal, then monitoring is enough. However, if hormone levels are abnormal, treatment is required.
Treatment of hypothyroidism
Hypothyroidism is treated only with one drug – L-thyroxine. It replaces the thyroid hormone. To determine the dosage of the drug, at the beginning of treatment, blood tests for hormones are necessary, and you will need to visit an endocrinologist every two to four weeks. Later, the visits can be reduced to once a year.
L-thyroxine should be taken for the rest of your life, at least one tablet per day
Thyrotoxicosis treatment
Treating thyrotoxicosis is a complex process. At first, doctors try to use medications, but if they prove ineffective, the thyroid gland may be removed or irradiated. Individuals who have had their thyroid gland removed are treated as if they are hypothyroid.
Treatment with medications
Thyrotoxicosis is treated with medication, typically thiamazole or propylthiouracil, which inhibit the production of thyroid hormones. The dosage and frequency of administration are determined by the patient’s condition, and treatment usually lasts at least 18 months with a minimum of one tablet per day.
After 18 months, regardless of the treatment’s outcome, the medication is stopped. However, their side effect is that the longer they are taken, the larger the thyroid gland becomes. When drugs that reduce hormone production are taken, the gland receives a signal that less hormone is being produced than usual, leading to a similar process as with a lack of iodine, causing the gland to grow. This creates a vicious cycle in which the gland initially decreases its activity during treatment, but then it grows, leading to the production of excess hormones again. As a result, thyrotoxicosis cannot be treated with medication for more than 18 months.
Radioiodine therapy and gland removal.
Radioactive iodine therapy and removal of the gland are both treatment options for thyrotoxicosis. In cases where thyrotoxicosis returns, gland removal is necessary. Radioactive iodine therapy involves feeding the thyroid gland with radioactive iodine, which ultimately destroys it.
Compared to surgery, radioactive iodine therapy does not require anesthesia or preparation before treatment, and there is no risk of nerve damage that could leave the patient voiceless.
However, there are some situations where radioactive iodine therapy is not recommended, such as during pregnancy and for those with very large goiters. It can also worsen certain chronic diseases, such as gastritis, cystitis, and pyelonephritis.
Additionally, a disadvantage of radioiodine therapy is that the patient’s body emits radioactive radiation for a few days after treatment, which requires isolation from others. Upon leaving the hospital, the patient must change into their own clothes after returning the hospital gowns, change shoes, and take a shower. Planning for pregnancy must also be delayed for six months after treatment.
Treatment for autoimmune thyroiditis (AIT):
With autoimmune thyroiditis, hypothyroidism develops, but not always immediately. Usually, the function of the thyroid gland is initially disrupted slightly, with elevated TSH levels and thyroid hormone levels still within the normal range. This condition is called subclinical hypothyroidism, and usually only requires observation rather than treatment. The doctor’s approach will depend on the patient’s age, pregnancy status, and other factors.
When hormone levels decrease, hormone replacement therapy is necessary, just as it is for any other type of hypothyroidism. There is no other treatment for the disease, and it is not possible to stop the autoimmune process.
In autoimmune thyroiditis, antibodies to the thyroid gland are also elevated. A doctor may order this test to confirm the diagnosis, but the level of antibodies does not affect the treatment or prognosis, so regular monitoring of these levels is unnecessary.
Here is a summary of how to manage the thyroid gland:
- Regularly consult with an endocrinologist and have your hormone levels checked.
- If there is a suspected disease, tests such as an ECG, gamma scan, fine needle aspiration biopsy, complete blood count, and biochemical profile may be necessary.
- If you have hypothyroidism, you will need to take L-thyroxine for the rest of your life.
- In the case of thyrotoxicosis, medication is taken for a year and a half, and if it does not improve, the thyroid gland may need to be removed, after which L-thyroxine will be required for life.
- It is recommended to use iodized salt.
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