The thyroid gland is a butterfly-shaped organ located in the front of the neck. It produces the vital thyroid hormones. Too high or too low a level of thyroid hormones causes dysfunction in a wide variety of organs.
In diseases of the thyroid gland, a basic distinction is made between hormonal dysfunctions (including hyperthyroidism & hypothyroidism) and changes in the size and condition (enlargements, nodules, tumors) of the thyroid gland. Often overlapping and mixed forms exist, whereby a structural change does not yet say anything about the function of the organ and vice versa.
We have compiled the most common diseases of the thyroid gland for you here and give you an overview of the appropriate examinations for diagnosis and the treatment options in each case.
The most common diseases include enlargement of the thyroid gland (goiter) often together with nodules or cysts. The causes are iodine deficiency and a genetic predisposition.
Cysts are usually harmless, but can cause difficulty swallowing depending on their size. This is where a relief puncture helps.
Nodes are benign in the vast majority of cases and only need to be surgically removed if their size causes discomfort.
Some of the benign nodules may produce increased thyroid hormones, leading to hyperthyroidism. To detect such nodules, thyroid scintigraphy is performed. Such “hot” nodes must be destroyed by radioiodine therapy or surgically removed, depending on the extent of hyperfunction. Malignant lumps are very rare, and the chances of cure are excellent in most cases. Modern ultrasound techniques, including elastography and tissue sampling with a fine needle aspiration, allow malignant nodules to be detected more reliably nowadays than in the past, so that the number of diagnostic operations has decreased significantly.
In hypothyroidism, there is an insufficient supply of thyroid hormones to the body. This can have various causes.
The most common cause of hypothyroidism is the loss of originally functional thyroid tissue as a result of Hashimoto’s thyroiditis, a chronic inflammation of the thyroid gland caused by autoimmune processes.
Hypothyroidism can also occur as a result of thyroid surgery or radioiodine therapy of the thyroid gland, if hormone replacement with medication has not yet been optimally adjusted. Less common are congenital hormone synthesis defects.
Treatment of hypofunction is done by replacing the missing hormones with hormone tablets. The dosage is determined individually and regularly checked by blood controls.
The most common inflammation of the thyroid gland is a (chronic) autoimmune disease in which the body’s immune system develops antibodies against components of the thyroid gland. This leads to a chronic inflammation of the thyroid gland in the course of which thyroid cells are destroyed.
As a result, organ enlargement (Hashimoto’s thyroiditis proper) may initially occur. In most cases, tissue destruction during the course of the disease causes the thyroid gland to shrink to small remnants without function. In the initial phase of the disease, hormone levels may be elevated due to increased hormone release; in the long term, ongoing tissue destruction leads to permanent and irreversible hypothyroidism, which must be treated with medication.
At the beginning of the disease, Hashimoto’s thyroiditis can be mild for a long time and go unnoticed by those affected.
A much rarer form of thyroiditis is rapid-onset subacute thyroiditis de Quervain. This is often very painful with a considerable feeling of illness, but can be treated effectively.
Graves’ disease is one of the autoimmune diseases. The body produces defensive substances (antibodies) against parts of the thyroid gland (TSH receptors), which stimulates the thyroid gland to produce more hormones and also to grow. As a result, hyperthyroidism and often goiter (enlargement of the thyroid gland) occur.
Due to the disease, an often severe hyperthyroidism develops with typical symptoms. The so-called “Merseburg Triassic”, named after Carl von Basedow’s place of residence, is considered “classic”. It includes protruding eyeballs (exophthalmos, endocrine orbitopathy), palpitations (tachycardia), and thyroid enlargement (goiter, goiter). However, the absence of these symptoms does not rule out the disease.
Treatment may initially be with tablets that inhibit thyroid hormone production (thyrostatic agents). However, the drugs are administered for a maximum period of 1-2 years. If there is no lasting improvement, the thyroid gland must be removed in the long term either by surgery or destroyed by treatment with radioactive iodine (radioiodine therapy).
Thyroid cancer is very rare. It should be emphasized again at this point that thyroid nodules are usually benign.
Treatment consists of surgical removal of the affected side of the thyroid gland for small tumors confined to the thyroid gland. For larger tumors, the entire thyroid gland is usually removed and additional radioiodine therapy is given. The chances of curing the disease are excellent even with larger tumors and even when lymph nodes are affected. Tumor spread to other organs, such as the lungs, can also be effectively treated by radioiodine treatment.
