From insomnia and anxiety to cancer, thyroid disorders affect millions of people, and the symptoms can easily be confused with the effects of everyday stress. The author of this text knows this from personal experience, and with the help of experts she brings everything you need to know about one of the most widespread endocrine diseases today.
It was already long ago in 2016. I was 25 years old and for months before that my heart was racing, with an average above 120 beats per minute. My hands were shaking, my eyelids were swollen, and out of seven nights during the week, I could hardly sleep longer than three hours.
It was a stressful period for me, so I didn't pay attention to the symptoms, until I went to my parents around New Year's holidays, where my mother noticed that when I was lying covered with a blanket, it "bounced" in the area of my chest. I'm not exaggerating. It was like that.
On her initiative, I left to the doctor and it soon turned out that I had hyperthyroidism and Grace's disease.
Hyperthyroidism, along with hypothyroidism, is one of the disorders in the functioning of the thyroid gland. The first means that the work is accelerated and that the thyroid gland produces more hormones than the normal level necessary for the healthy functioning of the metabolism. In hypothyroidism, things are the opposite.
While the hormones T3 and T4 - the two main ones produced by the thyroid gland in my case - were increased, the TSH level was almost unmeasurable. In people with hypothyroidism, the levels of these three hormones are opposite - T3 and T4 are lowered and TSH is elevated.
Symptoms that may indicate the disease
The symptoms are also different, so with an accelerated work of the thyroid gland, unplanned weight loss occurs even with a normal appetite, fatigue and muscle weakness are felt. Sweating is increased, as is sensitivity to heat, heart rate is accelerated, arrhythmias are inevitable, skin and hair are dry, insomnia, anxiety, irritability are increased, and often the neck is enlarged. Menstrual cycle disorders occur in women.
With sluggish work, people gain weight, are tired and sleepy, feel cold all the time, the heart beats slowly, mood swings are common, the face and body swell, and in women, the menstrual cycle is also disturbed.
And it doesn't mean that if you have all these symptoms or some of them you definitely have a thyroid disorder, but the selected doctor could suspect it and send you to an endocrinologist.
Regular check-ups are important in the prevention and monitoring of the course of the disease, so that complications do not occur.
"It is very important to check TSH once a year in patients who have diabetes, cardiology patients who are on therapy, autoimmune diseases, with a positive family history of thyroid diseases, are exposed to ionizing radiation, and in women who are planning pregnancy or are pregnant, TSH should be checked in accordance with the recommendations of the doctor", said recently on the occasion of the celebration of the International Thyroid Week prof. Dr. Miloš Žarković, from the Clinic for endocrinology, diabetes and metabolic diseases Clinical Center of Serbia.
A disease of the modern age
It is estimated that 350 million people worldwide live with a thyroid disorder, while as many as 60 percent of them remain undiagnosed. Women are more exposed to dysfunction of this organ.
These disorders can have serious health consequences, but their symptoms can often be confusing and can easily be confused with those of other illnesses.
"Symptoms such as fatigue, forgetfulness, constipation, dry skin, where it is difficult for a person to understand that he actually has a disease, are masked and non-specific," said Prof. Dr. Biljana Nedeljković Beleslin, from the Clinic for Endocrinology, Diabetes and Metabolic Diseases of the Clinical Center of Serbia, at a conference on the occasion of International Thyroid Week.
The most common endocrine disorder
The thyroid gland produces hormones that are necessary for normal growth and energy metabolism. Dysfunction of the thyroid gland is common, easily recognized and easily treated, but if it is not diagnosed or treated, it can have serious side effects, according to world associations that deal with this issue.
Thyroid gland diseases are among the most common endocrine disorders worldwide, right after diabetes, according to data from the European Society of Endocrinologists.
The two most common types of thyroid disorders are hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid).
Apart from work disorders, epidemiological studies show that one percent of men and five percent of women have clinically detectable nodules on this organ and that the prevalence increases with age and in iodine-deficient communities, according to experts.
"More than 60 percent of the population has some kind of nodule (nodule), which is usually insignificant. Some nodules can cause the thyroid gland to malfunction, then large nodules can press on the neck structures, and the third thing is the malignant potential of nodule changes," she said at the conference on the occasion of International Thyroid Week. Dr. Mirjana Stojković, Clinic for Endocrinology, Diabetes and Metabolic Diseases of the Clinical Center of Serbia.
Iodine and the thyroid gland
Zinc, selenium and iodine are important minerals for the optimal function of this butterfly or shield-shaped organ located in the neck.
Iodine is a mineral that is needed for the production of all thyroid hormones. It is necessary and irreplaceable for the work of this organ, and we find it in table salt, seafood and algae.
It is estimated that 40 percent of the world's population - about 2,8 billion people - are at risk of iodine deficiency, a nutrient that is necessary for the production of thyroid hormones, writes the scientific journal "Lancet".
Iodine deficiency remains a major cause of morbidity worldwide, it said. Although significant improvements have been made in developing countries, mainly through the provision of iodized salt, iodine deficiency is still increasing in some developed countries - including Australia and the UK.
In iodine-deficient populations, thyroid dysfunction is most commonly due to autoimmunity of this organ—which includes Graves' disease, Hashimoto's thyroiditis, and postpartum thyroiditis with characteristic autoreactive thyroid-specific antibodies.
In the case of Graves' disease and Hashimoto's thyroiditis, the body attacks its own tissue, in this case the thyroid gland.
Graves' disease causes it to be overactive, while Hashimoto's disease causes it to be underactive.
Both deficiency and excess of iodine can lead to hypothyroidism as well as hyperthyroidism.
Stress and the thyroid gland
Apart from iodine, the normal work of this organ is also affected by stress. Stress, the experts explain, will not cause the disorder of this gland itself, but it can worsen the condition, writes the scientific health magazine "Heltline".
The thyroid gland works in tandem with the adrenal glands. The adrenal glands, located above the kidneys, can handle small amounts of stress well. When faced with stress, they release cortisol, which improves various bodily functions.
Stress alone will not cause a thyroid disorder, but it can make the condition worse.
The impact of stress on this endocrine organ occurs by slowing down the body's metabolism. This is another way stress and weight gain are linked. When thyroid function slows down during stress, levels of the hormones triiodothyronine (T3) and thyroxine (T4) drop. Also, conversion of the hormone T4 to T3 may not occur, leading to higher levels of reverse T3, experts explain.
For the thyroid gland to function properly, there must be a delicate balance between stress hormones and cortisol, according to experts. If this delicate balance is altered, symptoms can worsen.
Thyroid cancer – the most common endocrine malignancy
After many years of treatment, the therapy I was taking did not help in treating my hyperthyroidism. My neck was getting wider, so surgery was the only solution.
I was happy for her - because I just wanted to literally take the problem off my neck.
In the meantime, I went to different endocrinologists for advice, took regular therapy, but the hyperthyroidism was persistent.
In the midst of the corona virus pandemic in 2020, my symptoms worsened, so I ended up at the Institute of Oncology and Radiology of Serbia by strange means. I was operated on there, and a month and a half later I found out that going to this clinic was a complete hit, since it turned out that my gland was carrying malignancy.
The incidence of thyroid cancer has been increasing in recent years.
Thyroid cancer is the most common endocrinological malignancy in the world, with an alarmingly increasing incidence rate in recent years, according to experts at MDPI, a Swiss publisher of scientific publications known for a wide range of journals and books.
The reason for the increased number of recorded cases is not only a greater awareness of this malignancy and a detailed diagnosis that leads to the early detection of less typical clinical symptoms, but also its increasingly frequent occurrence due to a constantly changing world and the environmental threats associated with it, according to experts for this Swiss scientific paper.
According to their data, thyroid cancer ranks as the seventh most common cancer in the world, with a death rate that is the 24th highest among all cancers.
During the year 2022, which is the latest data from the International Agency for Cancer, more than 820.000 cases of this malignancy were diagnosed. In the same year, around 20 million new cases of all cancers were recorded in the world.
In Serbia, in 2022, according to the data of the "Dr. Milan Jovanović Batutu" Institute for Public Health, about 41.500 new cases of cancer were recorded, and 420 people learned that they had thyroid cancer that year.
This malignancy is three times more common in women than in men, and is often diagnosed at a younger age than any other adult cancer.
The average age of patients globally with this problem is 51 years.
There are several types of thyroid cancer, and they are most often divided according to the degree of aggressiveness.
The treatment of thyroid cancer depends on the extension - the stage of the disease and the risk factors that are evaluated during diagnostic examinations.
Treatment methods include surgery, thyroid hormone therapy, radioactive iodine therapy, external radiation, chemotherapy, and in some cases special drugs are used.
The best approach is to apply two or more of these methods, according to the manual of the Institute of Oncology and Radiology of Serbia.
Artificial intelligence and the thyroid gland
In order to draw attention to thyroid diseases worldwide, the last week of May is dedicated to this organ.
World Thyroid Day was established for the first time in 2010 and is celebrated on May 25, and the whole week is dedicated together with that day to the week of this organ.
This year's theme is the application of artificial intelligence in disease diagnosis.
Artificial intelligence is also applied in Serbia.
"What we have and what we use is artificial intelligence for the stratification of thyroid nodules - software that recognizes and classifies thyroid nodules. We have that on the ultrasound machine and it has been used for the last two years," explains Prof. Dr. Miloš Žarković.
In addition, a multigenome classifier for thyroid cancers is also applied.
"We insert a tissue sample into the machine and in two and a half hours we get the result whether it is malignant or benign. Cytology is done first, and in cases where it is unclear, then genetics is done," Žarković concludes.
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