Dr. Rashmi Roy

   Thyroid disease — a condition in which your body uses energy more slowly or more quickly than it should — is a common disorder that often affects women, especially those over the age of 50.

   In fact, one in eight women will develop thyroid problems during their lifetime, according to the U.S. Department of Health and Human Services.

   While thyroid problems require medical attention, they can often be easily treated and managed with medication and in some cases, surgery.

   Located just below the Adam’s apple, the thyroid gland produces hormones that regulate your metabolism. These hormones control how fast you burn calories and how fast your heart beats. They help you stay warm and keep your organs working.

   One of the most common conditions affecting thyroid function is hypothyroidism — often referred to as underactive thyroid — when the thyroid fails to produce enough hormones.

   Symptoms of hypothyroidism may include:

   • Unexplained weight gain.

   • Fatigue.

   • Over-sensitivity to cold temperatures.

   • Pain and stiffness in the muscles or joints.

   • Brittle nails and hair.

   Conversely, hyperthyroidism — or overactive thyroid gland — leads to the overproduction of thyroid hormones. Symptoms of hyperthyroidism may include:

   • Unexplained weight loss.

   • Increased heart rate.

   • Increased appetite.

   • Over-sensitivity to hot temperatures.

   • Nervousness, irritability, tremors, sweating.

   These conditions are caused by a variety of factors, the most common of which are autoimmune disorders such as Hashimoto’s thyroiditis (hypothyroidism) or Graves’ disease (hyperthyroidism). Lack of iodine in the diet, pituitary gland problems, certain medications, radiation treatment and overactive nodules also can contribute to thyroid disease.

   A thyroid nodule is a collection of thyroid cells that form a lump on the gland. Nodules are common and often do not cause any symptoms. In some cases, however, the nodule may grow so big that it causes problems with swallowing or breathing and may also cause voice changes, such as hoarseness.

   Thyroid nodules are often first detected incidentally through imaging for other conditions, but you can sometimes see or feel a thyroid nodule yourself. Stand in front of a mirror and raise your chin slightly. Look for a bump on either side of your windpipe below your Adam’s apple. If the bump moves up and down when you swallow, it may be a thyroid nodule. Ask your doctor to look at it.

   While thyroid nodules are often benign, they can be a sign of thyroid cancer. In the United States, an estimated 62,450 people (the majority women) were diagnosed with thyroid cancer in 2015, according to the American Cancer Society.

   Thyroid cancer is rare compared to other cancers, though it is the most rapidly increasing cancer in the United States. This is in part due to more sophisticated diagnostic tools that can detect small thyroid nodules that may have gone undetected in the past.

   Family history of thyroid cancer or previous radiation to the head and neck are the only two known risk factors for thyroid cancer. However, it is common to have thyroid cancer without these two risk factors.

   In general, hypothyroidism and hyperthyroidism — which can typically be diagnosed through blood tests — can be managed with hormone medication that resets and restores thyroid function.

   For nodules, doctors will perform a fine needle biopsy to test for cancer cells. Between 70 and 80 percent of biopsy results are benign, according to the American Thyroid Association, and do not require surgery unless they are causing symptoms.

   A definite cancer is found in about 5 percent of biopsies, requiring surgery to remove the thyroid completely.

   However, in up to 20 percent of biopsies a definite diagnosis cannot be made. In these cases, a second biopsy may be needed, or the nodule may look suspicious enough to require surgery.

   While thyroid surgery is generally safe, there are risks for complications. Potential complications of thyroid surgery include:

   • Temporary or permanent hoarseness or loss of voice. This can happen if the nerves to the larynx (or vocal cords) are damaged during surgery.

   • Damage to the parathyroid glands (small glands near the thyroid that help regulate blood calcium levels). This can lead to low blood calcium levels, causing muscle spasms, numbness and tingling sensations.

   As the American Cancer Society notes, complications are less likely to occur if the operation is performed by an experienced surgeon. Patients at University Medical Center of Princeton benefit from the use of nerve-monitoring technology to confirm the location of the nerves to the larynx to help the surgeon avoid them during the operation.

   Additionally, patients will have a small (four centimeters) scar across their neck after the surgery though surgeons will often try to make the incision in a natural crease in the neck so the scar is not visible.

   Patients who have the entire thyroid removed will need to take man-made (synthetic) thyroid hormone for the rest of their lives. Some patients who only have partial thyroid surgery may also need to take thyroid hormone replacement. After surgery to remove the whole thyroid, some patients are at risk for low calcium levels and may need to take calcium supplements.

   Princeton HealthCare System through its Community Education & Outreach Program will host a discussion titled, “Are My Thyroid Issues Cause for Concern?” from 7 p.m. to 8 p.m. on Tuesday, Jan. 12 at the Princeton Fitness & Wellness Center, 225 State Road, Princeton.

   To register for the free session or for more information, visit www.princetonhcs.org/calendar.

   To find a physician affiliated with Princeton HealthCare System, call (888) 742-7496 or visit www.princetonhcs.org.

Rashmi Roy, M.D., F.A.C.S. specializes in endocrine surgery, thyroid disease, adrenal disorders and parathyroid disease. She is a fellow of the American College of Surgeons and a member of the medical staff at University Medical Center of Princeton.


(1) comment


There is a lot of controversy in the endocrinology world regarding hypothyroidism treatment. There are those that believe that patients who test within the normal range but have very low basal metabolic rates and very low basal temperatures need thyroid supplementation. There are others that argue that only patients with significant abnormalities should be supported with thyroid hormones. Calvert

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