Thyroid

Diagnostics and therapy
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A large part of the world's population suffers from a thyroid disease. One well-known - possibly the best known - symptom is the gloiter - in medical terms called Struma.
The gloiter, or Struma, can either be associated with a normal thyroid function (medical term euthyreoidism) or it could be a symptom of an hyper- or hypofunction of the thyroid (medical term hpyer-/hypothyreoidism).
In order to learn about the triggering disease blood work alone is not enough.

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To be able to provide a reliable diagnosis, an ultrasound (sonography) and scintigraphy are required in addition to the blood work.

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The Struma is generally in need of treatment because an enlargement of the thyroid could result in a compression of the trachea (narrowing of the wind-pipe) and surrounding vessels. Mostly the Struma is easily treated with iodine and/or thyroid hormones.
In some cases - usually in larger gloiters with nodules - a suppression scintigraphy is neccessary to ensure or eliminate certain forms of thyroid hyperfunction - the so-called thyroid autonomia. If this is caused by so-called hot nodules the therapy with iodine or thyroid hormones would be wrong, instead a therapy with radioactive iodine (RAI), operation or Echotherapy - also called HIFU / high intensity focused ultrasound - (this therapy can be performed in our practice) would be considered.
Before the treatment with Echotherapy can be considered, a series of additional tests need to be conducted, such as a MIBI scintigraphy to exclude malignancy.

Other forms of thyroid diseases are for example autoimmune diseases such as Graves' disease. In this clinical picture, the thyroid almost gets completely out of control, it is overactive and it comes to uncontrolled increased release of thyroid hormones into the blood stream. Patients often suffer from a severe hyperfunction and particularly need to be treated when developing heart problems (cardiac symptoms). Primarly, this is done with medication that "slows down" the thyroid (antithyroid) or - if this treatment fails - by removing the whole thyroid using radioactive iodine or operation.
Patient with this disease absolutely need to avoid products or medication (contrast medium) that contain iodine. Selenium has proven itself as a supportive agent to ease the course of disease.

Hashimoto's thyreoiditis is also a common cause for an hypofunction. This autoimmune disease is something like the "sister" of Graves' disease and also an autoimmune disease. In this case, the body forms antibodies against the thyroid which slowly destroys itself. In this case, iodine also influences the course of disease unfavorably and needs to be avoided. Selenium has proven itself as supportive in this case as well and is recommended all over the world.
If you suffer from a thyroid disease, the probability of your children to be affected too is most likly, as the disease is usually inherited. This is also particulary true of malignant diseases of the thyroid.
By the way, smokers are considerably more at risk to suffer from a thyroid dysfunction than non-smokers. The most likly form would be the nicotine induced transmigrating thyroiditis that reactively occurs due to the chronic irritation of the larynx caused by smoking, that usually results in a hypofunction of the thyroid due to loss of thyroid cells caused by inflammatory decomposition.

Once lost, thyroid cells cannot be replaced or recover from the disease. A once occuring hypofunction usually needs to be treated lifelong with thyroid hormone pills.



Thyroid ultrasound
Ultrasound is painless and allows an evaluation of the thyroid without radiation exposure.
Size, shape and position are evaluated. Nodular changes are compared with the thyroid scintigraphy and thus evaluated. The ultrasound however does not give any information about the function and performance of the thyroid, which is why a scintigraphy - expecially if there are nodular changes - is recommended.

Thyroid scintigraphy
The thyroid scintigraphy is a diagnostic method of nuclear medicine that is used both for functional and morphological examination of the thyroid. The performance and activity of thyroid nodules of the thyroid are evaluated with this method.
Procedure:
Prior to the examination, you need to stop your thyroid medication. When making an appointment, you will be told the exact duration of the medication to be stopped, because it's dependent on the kind and dose of medication that was prescribed to you.
You will be injected with a very small amount of a radioactive substance (Technetium Pertechnetat). Within about 15 minutes, this substance is absorbed by the thyroid cells.
After this time, an image of your thyroid is made with a so-called gamma camera.





Definitions

Hot nodules
Hot nodules are changes in the thyroid tissue that form hormomes uncontrollably and distribute them into the blood stream. The intake of iodine is also amplified. In the long term, this will cause a thyroid hyperfunction. Because of this nodules becoming "autonomous" and are no longer controlled by the pituitary gland they are called "autonomous adenomas".
As the name already states, this nodules are active independently and responsible for at least half of all thyroid hyperfunctions. Hot nodules are mostly benign.
Autonomous adenomas accumulate in their scintigraphic visualisation and are hown yellow or red in the image of thyroid activity - this is why they are called hot or warm nodules.

Cold nodules
Cold nodules are inactive, meaning they don't produce thyroid hormones and don't take iodine in. On the scintigraphy they are shown as blue areas - that is why they are described as "cold".
Most cold nodules are benign changes, only in rare cases a malignant tumor can hide behind a cold nodule, that is why regular checkups are important.

Gamma camera
The gamma camera is a diagnsotic device of nuclear medicine.
With this cam, gamma rays inside a patient can be made visible that can give information about pathologic changes.