Search for tag: "thyroid"

Dr. Jones: "It brought a lump to my throat." This is a phrase that usually implies an emotional response to something. But what if there's really a lump in your throat? Or really a lump in your neck? This is Dr. Kirtley Jones from Obstetrics and Gynecology at the University of Utah Health, and we're talking about thyroid cancer and women today on The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Most of the time one of our most important hormone glands in our body just does its thing without us feeling it. For women, men are another story, the thyroid is the only gland that we can touch with our fingers. It's sort of a flat butterfly-shaped gland about two inches across in the front of our neck in front of our throat. It regulates the metabolism at every cell in the body.

Millions of women have thyroid problems, the most common being under or overactive thyroid. The majority of people in the United States with thyroid problems are women. We're not sure why that's the case except that most thyroid problems are due to autoimmune disease, antibodies that we make against part of the thyroid gland. All autoimmune diseases are more common in women.

Over and underactive thyroid symptoms are vague. The symptoms are feeling cold or slightly depressed. For underactive thyroid, feeling hot, your heart pounding and anxious, maybe weight loss are common for overactive thyroid. Sometimes the thyroid is slightly enlarged with over or underactive thyroid problems, but thyroid cancer presents as a lump. Sometimes the lump is noticed by the patient, but sometimes it presents with hoarseness of voice or difficulty swallowing, and sometimes the lump is detected by a clinician during a physical exam.

It's important to know that lumps in the thyroid are very common, and only 5% to 10 % of lumps in the thyroid in women are cancer. Now, thyroid cancer is the most cancer in women 15 to 30 years of age and is the second most common cancer after breast cancer in women under 50. Seventy-five percent of all thyroid cancers occur in women. And thyroid cancers generally happen younger in women than men.

There are a number of risk factors for thyroid cancer, the majority of which you can't change. I already mentioned that being a woman is one of them and you mostly can't change that. There are families that have genetic mutations that make cancers more common, and thyroid cancers are part of that family risk.

Another risk for thyroid cancer is exposure to radiation, especially as a child. The most common reason for a young person to have radiation exposure these days is because of radiation treatment for another cancer when the person was a child. Also, for those of us who grew up in the Intermountain West, the increased exposure to radiation from nuclear testing in the 50s is associated with a slightly increased risk of thyroid cancer. And of course exposure to an accident at a nuclear power plant that releases radiation can increase the risk, but this is uncommon.

Finally, children with a low diet in iodine are at an increased risk, but that's uncommon in the U.S. because table salt and sea salt have iodine and iodine is found in fish and is added when salt is added to some foods. Now, if you have a lump in your thyroid or an enlargement in the front of your neck where your thyroid is, you should see your doctor. The doctor will feel your thyroid, do a blood test to check out the thyroid hormones, and sometimes check a blood test to see if you have antibodies to your thyroid.

If there's any question of a lump in the thyroid, an ultrasound of your thyroid is the next step. If the ultrasound shows a lump, the next step could be to collect cells from the lump with a small needle. Now there's some controversy about when to do this test. So many thyroid lumps or nodules are totally benign. If the lump is less than a half inch or about one centimeter, most experts would just recommend watching it over time, unless of course you have a family history of thyroid cancer. In that case, you really need to watch things more carefully and the biopsy would be right.

If it's over an inch, most experts will recommend a biopsy. Now, if the biopsy shows cancerous cells, the next step is surgery usually to remove the thyroid and make sure the cancer hasn't spread to the lymph nodes. If it's spread, the next step can be radiation. It's most important to know that thyroid hormone can be easily and inexpensively replaced with a pill if you've had your thyroid removed. The other important fact, and listen up, is that thyroid cancer in young women is very curable with over 90%, survival for 20 years. So thyroid cancer is one of the most curable kinds of cancers.

So if you have a lump in your throat, first check out and make sure it isn't really your adorable child or the movie you're watching, but if it really is a lump in your neck, and bring it to your attention to your doctor. The chances are highly likely that it isn't cancer, but it should be evaluated. And if it's found to be thyroid cancer, it's often easily cured in women, and that's the best news. And thanks for joining us on The Scope.

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Interviewer: Could it be a thyroid problem that's sabotaging your diet and weight loss plan? We'll find out next on The Scope.

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Interviewer: You've been trying to lose weight but you're just not seeing the results that you would like to see and you've been at it for a little while. Now, you're starting to wonder if there's something else in play like maybe it's a thyroid problem that's sabotaging your weight loss. Dr. Dev Abraham is the Medical Director of the Utah Diabetes and Endocrinology Center. So could a thyroid problem sabotage my diet and weight loss plan?

Dr. Abraham: There's a little misconception with regards to thyroid and weight connection. If you look at the older textbooks, it is very categorically stated that it is the cause of weight gain. So in another words, if someone gains weight, they must have thyroid problem. It's not necessarily true in modern times for several reasons.

The number one reason is in olden days they didn't have an accurate way of testing thyroid dysfunction with blood tests, let alone reliable, reproducible blood tests. In the last 15, 20 years duration, we have super accurate thyroid blood tests so it's very easy to determine whether weight change a person may experience is due to thyroid or not.

If you look at how much weight patients gain when you don't take thyroid hormones for months, it's really a small amount on an average of few pounds. If someone gains 50 pounds, 100 pounds over a span of a year or two years, it's uncharacteristic for a thyroid hormone imbalance to do that.

Interviewer: It's something else at that point.

Dr. Abraham: It is usually something else. But thyroid is often the first test that's often done because it's a very simple and easily available test. And it's also very, very treatable. So even if that much weight gain cannot be attributed to thyroid, if these patients have mild abnormality of the thyroid we still try to treat it first because it's a simple remedy.

Interviewer: So in the instance of somebody trying to lose weight and we're taking them at their word that their diet is on, their exercise is on, but they're not losing weight, could it be a thyroid problem that's causing that?

Dr. Abraham: It should definitely be tested, but if the test comes negative for thyroid dysfunction, that virtually rules out thyroid as a cause for the weight fluctuations.

Interviewer: And as a physician, how often have you seen thyroid being responsible for somebody not being able to lose weight or putting on weight unexpectedly?

Dr. Abraham: A very, very small percent.

Interviewer: Oh, really?

Dr. Abraham: Yes.

Interviewer: So it's a whole different kind of thinking than it was?

Dr. Abraham: It is, absolutely. If you look at the amount of weight gain that the society is experiencing, which is stated to get worse, it's quite astronomical. If only thyroid is the problem for this weight gain, we literally would be able to cure obesity.

Interviewer: With a pill.

Dr. Abraham: With a pill.

Interviewer: And that's what we want.

Dr. Abraham: And that hasn't occurred because the thyroid is usually not the single main cause.

Interviewer: So it sounds like, unfortunately, if I've been trying to lose weight and I'm not losing weight and I think everything else is right, it's probably not going to be my thyroid.

Dr. Abraham: That is a fair statement to make with a few exceptions. If there is a strong family history of thyroid dysfunction, in particularly female members of the family, or if there has been unexpected thyroid abnormality after childbirth, in those subjects, at least a test should be done before making that determination whether it is the thyroid or not. But it is accurate, in most patients if there is weight fluctuations, that's independent of thyroid. At least in the current day situation.

Interviewer: So look someplace else? Maybe I just need to exercise a little harder.

Dr. Abraham: Well, exercise is extremely important to lose weight but if you, for example, walk on a flat surface, you expend the equivalent of a slice of breads worth of calories. So one extra pound weight gain during Christmas, for example, can have the equivalent calories of about 3,500 calories. Which is about walking on a steady pace for about 35 miles.

So to expect weight loss purely by exercise is a very difficult process. But a combination of caloric restriction and adding some exercise has a multiplying effect with regards to weight loss. So most of the programs that are offered through the Utah Diabetes and Endocrinology Center focus on a whole health improvement with regards to dietary modification, exercise and caloric restriction without becoming deficient in micronutrients.

Interviewer: And sometimes it just takes time?

Dr. Abraham: It does take a longer time than most patients anticipate with weight loss and they give up sometimes. And that's what we try to encourage, any small loss is still a step in the right direction.

Interviewer: What about those individuals that they have been really religious but they're not losing anything? They're not gaining but they're not losing.

Dr. Abraham: It's a very complicated mechanism of why an individual gains weight. What we're beginning to understand is that there is a reset mechanism of how much calories does one need to feel full. In other words, these are probably mechanisms and centers in the brain that reset and we always feel hungry when there are enough calories that are retained in our system that we haven't burned yet. So researchers are still working on it. So it appears to be multiple factors that are involved.

Interviewer: And your piece of advice to that person still trying to lose that weight?

Dr. Abraham: A multi-pronged or multi-disciplinary approach works the best. You cannot change your genetics, it's too late to choose your parents, but at the same time, you can work with what you have if you have a plan about it. Sometimes, it does involve including professionals who are skilled in those fields to guide patients to decide the right thing. Not one cap fits all in this situation. So we try to modify what works best for each patient.

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