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World Thyroid Day is celebrated every year on May 25th and is dedicated to recognizing the burden caused by thyroid diseases, as well as to those who are committed to the international study and treatment of thyroid diseases. This initiative has been adopted by all international medical organizations dealing with the thyroid. It is an occasion to inform ourselves both about the value of the gland for the smooth functioning of the human body and about the wide range of its diseases.

What is (and what does) the thyroid gland do?

The thyroid gland is located at the base of the neck and is one of the most important endocrine glands in our body. Its name is due to its shape that resembles a shield and comes from the Greek word “thyreos”. It mainly produces the hormones thyroxine (T4) and triiodothyronine (T3) that affect every cell, tissue and organ of the body, regulating both the body’s metabolism – that is, the rate at which the body produces energy from nutrients and oxygen – and bodily functions, such as heart rate, body temperature and level of physical activity.

In addition, in infancy and childhood, the secretion of thyroid hormones is essential for the smooth physical and mental maturation of the child.

How common are thyroid diseases?

Almost all of us know someone who has thyroid disease. According to research in recent years in Greece, there is an increase in thyroid diseases. In fact, over the past 40 years, the annual incidence of thyroid cancer has tripled, with a significant increase in the diagnosis of microcarcinomas. According to the American Thyroid Association, 20 million Americans have some form of thyroid disease and over 12% of the US population will develop some form of thyroid disease during their lifetime. Surprisingly, up to 60% of these patients will not learn about their disease, while women are 5-8 times more likely to develop thyroid pathology than men.

What are thyroid diseases?

They are divided into functional and morphological, depending on whether the problem is located in the function of the gland or in its structure.

The most common diseases of the gland are:

1. Autoimmune thyroid disease: its frequency is twice as high in Greece as the average in the Western world (about 10% of the population and 3-5x more common in women). It can cause:
2. Hypothyroidism: insufficient production of thyroid hormones by the gland, resulting in weight gain, lethargy, constipation, feeling of fatigue, intolerance to cold, depression, memory impairment, menstrual cycle disorders, dry skin, hair loss. Treatment is the administration of a synthetic form of thyroid hormone (levothyroxine). The most common cause of hypothyroidism is autoimmune thyroiditis (Hashimoto’s), which occurs mainly in women. The diagnosis is made by the presence of positive autoantibodies (antiTg, antiTPO), imaging findings of goiter and low levels of thyroid hormones.
3. Hyperthyroidism: hyperfunction of the gland resulting in excessive production of thyroid hormones and the appearance of symptoms such as nervousness, weight loss, insomnia, tachycardia, diarrheal syndrome, tremor of the limbs, heat intolerance, visual disturbances. It may be due to a single nodule that is hyperfunctioning (toxic adenoma) or the presence of autoantibodies (Graves’ disease). Treatment may be pharmaceutical, surgical or administration of radioactive iodine. It is important to note that autoimmunity against the thyroid gland is not synonymous with the presence of disease – function may remain adequate for varying periods of time.
4. Thyroid nodule: These are growths (nodules) of the thyroid gland caused by overgrowth of cells in the thyroid gland. These growths can be: benign, fluid-filled (cysts), thyroid cancer or very rarely infections. With the widespread use of ultrasound that reveals even small nodules, it is estimated that 50% of those examined will have a nodule. Nodular goiter, i.e. the increased size of the gland and the presence of nodular formations, which can be treated conservatively with simple monitoring or surgically if the patient shows symptoms such as signs of obstruction (difficulty swallowing or breathing), voice alteration, pain when swallowing. Thyroid cancer constitutes a small percentage (~ 1%) of all human cancers. It can occur at any age, but most cases of the disease occur in people over 40 years of age, with women being affected 2-3 times more often than men. In most cases it is curable as early and accurate diagnosis, proper treatment (with total thyroidectomy and possible administration of radioactive iodine) and regular monitoring can in most cases ensure a healthy future for patients with thyroid cancer.

The main tests for the Thyroid:

1. Thyroid hormones (FT4, T3, CT) along with thyroid-stimulating hormone (TSH) which is secreted by the pituitary gland and controls the function of the thyroid gland.
2. Antibodies related to the thyroid (antiTg, antiTPO, TSI).
3. Ultrasound to check the anatomy of the thyroid gland (size, location, presence of nodules, existence of any suspicious lymph nodes).
4. Scintigraphy.
5. Cytological examination through nodule aspiration.
6. Computed tomography (CT) or magnetic resonance imaging (MRI) in cases of large, submersible nodular goiter, suspected medullary thyroid cancer.

The likelihood of thyroid function problems during pregnancy increases, because the thyroid gland produces up to 75% more hormone during pregnancy. This increases the likelihood of hypothyroidism during pregnancy. It is recommended that women at high risk for thyroid disease be tested early in their pregnancy and the need for adequate iodine intake during pregnancy is emphasized.

The Treatment

Today, medicine has more tools than ever before, offering targeted medical interventions to patients with thyroid gland diseases. The Medical Center’s staff includes experienced Endocrinologists who, with the support of the other specialties involved (laboratories, diagnostic ultrasound cytologists, surgeons), provide the care required for the early prevention and treatment of thyroid diseases.