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It affects your muscles and skin, menstrual cycles and cholesterol levels. It even affects your metabolism—the number you see on your bathroom scale and the number you prefer to dial up on your home thermostat.
Your thyroid—a small, butterfly-shaped gland nestled beneath your voice box—is one of your body’s great communicators. It produces two hormones that send feedback to and help to regulate all of the other systems in your body. Unfortunately, it is prone to a variety of diseases, including cancer, and when any of these disorders strike, your body’s delicate balance of hormones is thrown into turmoil. The result can manifest as anything from dry skin and weight gain to headaches, hyperactivity, exhaustion, and depression. “We’ve seen increased diagnosis in all categories of thyroid disease,” says James Chen, MD, director of the new Center for Thyroid Diseases at Overlook Hospital. Chen, who is triple board-certified in internal medicine, endocrinology, and nuclear medicine, attributes much of this to greater awareness overall and the proliferation of better diagnostic tools—both of which most certainly contribute to improved manageability in the case of hyper- and hypothyroidism, and high cure rates in the case of thyroid cancer.
Thyroid cancer and nuclear medicine
Chen reports that thyroid cancer has a 90 percent cure rate, and credits the impressive statistic to radioactive iodine. The thyroid needs iodine—absorbed from everyday sources like water and salt and fortified foods—to produce its hormones, he explains. In cases where thyroid cancer is detected, a surgeon will remove the entire thyroid (natural hormones are easily replaced by synthetic hormones with a daily pill) and then a nuclear-medicine specialist will administer a swallowable capsule of radioactive iodine to destroy any remaining thyroid cancer cells. “It’s like a magic wand,” Chen says of the highly regulated material.
Radioactive iodine is also used as a preparation for imaging to diagnose the recurrence of thyroid cancer or to track whether there is any thyroid tissue remaining. In these cases, the patient swallows the small capsule, waits for it to be absorbed by the body, and comes back 24 or 48 hours later for imaging with a Gamma Camera. The camera, similar to a CT machine but in a wide-open space, detects radioactive activity in the iodine soaked up by thyroid cancer cells or any remaining thyroid tissue.
Overactive or underactive?
Hyperthyroidism, or overactive thyroid, occurs when the gland produces too much of the thyroid hormones. Patients may experience heart palpitations, nervousness, irritability, hair loss, or breathlessness, among other signs. Hyperthyroidism is often detected with a simple blood test, but an endocrinologist often will prescribe a nuclear imaging test to determine what has caused the hyperthyroidism and thereby arrive at the best course of treatment. In some cases, hyperthyroidism can be treated with medications that interfere with the gland’s ability to produce its hormones. This is the most conservative course of treatment, Chen explains, and doctors will usually try this if the patient is on the younger side. The most widely recommended treatment, however, is again radioactive iodine. Most patients are cured with a single dose.
An underactive thyroid (hypothyroidism) often is marked by fatigue, constipation, weight gain, abnormal menstrual cycles, or depression. Here, the thyroid does not make enough thyroid hormones. This is the most common form of thyroid disease, and also the easiest to treat. It is diagnosed strictly by a blood test, and patients are prescribed any one of a number of medications that are taken daily to replace the hormones that the gland normally secretes. Thyroid medications come in a variety of strengths, which means that an appropriate dosage can be tailored to each patient’s needs.
Is it a nodule, or something more?
Although there does not seem to be a relationship between hyper- or hypothyroidism and thyroid cancer, Chen says that patients with either disorder do exhibit a greater number of thyroid nodules than are seen in the general population. Thyroid nodules are common (many people will develop one or more as they age) and most cause no symptoms at all. Many nodules—and by extension, thyroid cancers—are found incidentally. Chen refers to these as “technology driven” diagnoses.
“The thyroid is located at the same level as the top portion of the lungs, which aligns with the lower part of the neck,” he says. “A lot of CT scans done for unrelated reasons pick up thyroid nodules incidentally. Three decades ago, the most common way would be that a patient would feel something in the neck or a physician would pick up a nodule during a physical exam. Then, two decades ago, when the MRI was introduced, nodules were picked up very often by doctors ordering MRIs of the cervical spine after car accidents; the thyroid is in front of cervical spine. Today, one of the most common ways of picking up a thyroid nodule is with a CT scan of the chest.”
Regardless of how a nodule is detected, the most important thing is to make certain that a nodule is just that and not a malignancy. A biopsy can be performed to test for cancerous cells. The majority of nodules turn out to be benign, Chen says—but even if you test positive for a cancerous nodule, remember that it is highly curable. “The most important thing,” he reminds, “is detection.”
Overlook Hospital’s new Center for Thyroid Diseases provides patients with access to thyroid-related testing, imaging, treatment, and ongoing care. A network of endocrinologists, surgeons, and nuclear-medicine specialists are available to ensure that your disease is diagnosed and managed. For more information on the Center for Thyroid Diseases or for a referral to a physician, call (888) 871-9293.