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1 in 9 patients may suffer from a thyroid disorder and over half of them might not be aware of this. The thyroid is a gland that resides below the voice box (where the Adam’s apple is in the males) in the neck.

The major thyroid problems are:

  • Too much thyroid hormone – known as hyperthyroidism
  • Too little thyroid hormones – known as hypothyrioidism
  • Too big a thyroid gland – known as a goitre
  • Cancer
Too much thyroid hormones- hyperthyroidism


  • feels too hot
  • losing weight even with increased appetite
  • shaking of hands
  • fast heart rate or feeling a sense of heart beating very fast in the chest
  • bulging eyes
  • menstrual irregularities
  • hair loss
  • diarrhoea
  • anxious, restless, fidgety


  • most likely secondary to antibodies against the thyroid gland causing it to produce more hormones
  • less likely – thyroid nodule that is active, gland with many nodules that are active, a central pituitary cause that is producing command hormones that tell the thyroid gland to produce more thyroid hormones


  • medication – in most countries this is the initial treatment eg methimazole, carbimazole or propylthiouracil
  • radioactive iodine
  • surgery – usually this is a method of last resort unless the thyroid gland is too big and is obstructing the airway or for cosmetic reasons
Too little thyroid hormones –hypothyrioidism


  • slowing down
  • weight gain
  • cold intolerance
  • constipation
  • feeling tired
  • menstrual irregularities
  • hair loss
  • Causes

    • Vast majority due to thyroid antibodies that destroy the thyroid gland hence leading to a decrease in production of thyroid hormones


    • Appropriate replacement of the thyroid hormone
    Big thyroid – goitre


    • Both hyper- and hypo-thyroidism can be associated with a big thyroid
    • A nodule (lump) or multiple nodules in the thyroid
    • Rarely cancer


    • First to be able to visualise the thyroid gland using an ultrasound. And to see if there are any nodules. If there are, to ascertain whether they are cancerous or not – one way is by the ultrasound characteristics and the other by doing a biopsy of the thyroid nodule – this is known as fine needle aspiration cytology. A small needle (smaller than that of a needle used to take blood from patients) is inserted into the thyroid nodule and cells obtained for visualisation under the microscope.
    • If the nodules are not cancerous – options of management are discussed and will include the following:
      • Continue with monitor regularly with ultrasound
      • Removal of the lobe which the nodule is in
    • If the nodule is cancerous – see below.
    Thyroid cancer

    This is usually slow growing and might present as a nodule. For treatment of nodules see above. If cancer is proven, management is as such:

    • Removal of the whole of the thyroid gland
    • Decision made as to whether radioactive iodine is needed – this is usually done for thyroid cancers with higher risk of recurrence
    • Suppressive therapy – ie to suppress the command hormones for the thyroid gland that can also stimulate cancer cells. This is usually done by giving thyroid hormone replacements at a higher dose than normal.