May 22: Thyroid gland is a butterfly shaped gland which is present in the neck in front of the trachea (windpipe). The main function of this gland is to produce thyroid hormones which are T4 and T3. T4 is produced in more abundance compared to T3, however excess T4 is converted to T3 at tissue levels. T3 is more active than T4 at tissue level. The main function of the thyroid gland is metabolism. It helps in body utilising and distributing the energy in form of ATP (adenosine triphosphate). Over functioning of thyroid or under functioning of the gland can lead to hyperthyroidism and hypothyroidism respectively.   

Although thyroid disorders can affect both men and women - women tend to get thyroid disorders more and are more symptomatic. Women are generally more prone to autoimmune thyroid disorders due to their variations in estrogen levels and pregnancies. Women have more symptoms than men and seek medical help because thyroid dysfunction can lead to menstrual problems and problems with pregnancy. The problems women face in different phases of their live due to thyroid disorders are discussed below:

At Puberty 

Girls with hypothyroidism tend to have short stature and delayed puberty. Very rarely, sometimes severe hypothyroidism can overstimulate the ovaries and cause early puberty. Undiagnosed hypothyroid girls entering puberty and adolescence may also face secondary PCOS (polycystic ovary).  

Early Adulthood

Hypothyroidism in women during early adulthood may lead to irregular & heavy periods. Sometimes it may give rise to features of PCOS which is reversible with thyroid medications.  

Both untreated hypothyroidism and hyperthyroidism may lead to delay in conceiving - which are sometimes detected only during evaluation for infertility.  

During Pregnancy 

Severe hypothyroidism and hyperthyroidism is associated with pregnancy loss

Mild hypothyroid is associated with more pregnancy related complications compared to normal pregnancy, hence they must be treated aggressively. Mild hyperthyroidism is usually well tolerated in pregnancy. Problem with pregnancy and hyperthyroidism is that if a patient has severe hyperthyroidism - treatment options are limited to medical management; surgery or radioactive iodine are difficult in these patients.  

Middle and Menopause

Subjects with uncontrolled hypothyroidism tend to have more problems with dyslipidaemia, heart problems, hypertension and diabetes than the general population. Women with hyperthyroidism have weaker bones leading to osteoporosis.  

Besides the problems discussed above women tend to have goitre (thyroid enlargement) more frequently compared to men. Goitre could due to hyperthyroidism, hypothyroidism, cancer or multinodular goitre, etc. - which needs further evaluation. 

Management 

The most important part in prevention of thyroid disorders is the use of iodised salt. Iodine is required for normal thyroid function; iodine deficient salt can result in more thyroid disorders and goitre. Also good healthy diet and sleep reduces the risk of acquiring these disorders.  

The next part is diagnosing these diseases early. If diagnosed and treated at the right time, it can avoid further complications. Not all the abnormal thyroid function test results need medicines, hence patients should consult the endocrinologist before embarking on treatment.

(Dr Shrinath P Shetty, Consultant Endocrinology, KMC Hospital, Dr B R Ambedkar Circle, Mangaluru).