The thyroid — the butterfly-shaped gland that keeps all systems humming along in harmony. But let it flap its wings a few times, and all sorts of discord can erupt. Governing the body’s metabolic activity from head to toe, the hormones produced by the thyroid influence every major system. When all processes are in synch, we feel great, but imbalances can leave us feeling out of sorts.

No one is immune to thyroid disease. More than 20 million Americans have some form of the disease, and in many cases it is misdiagnosed or undiagnosed. Women are affected with hypothyroidism 10 times more frequently than men. In women over age 75, an estimated one out of five will develop Hashimoto’s thyroiditis during her lifetime. Malignancies are another concern; about 18,000 to 20,000 new cases of thyroid cancer are diagnosed every year.¹

Thyroid dysfunction complicates 5% to 9% of all pregnancies. One out of every 4,000 infants is born without a functioning thyroid gland.¹ Moreover, children born to mothers with untreated hypothyroidism during pregnancy score lower on IQ tests than children born to healthy mothers.²

The thyroid secretes hormones directly into the bloodstream. As a ductless endocrine gland, thyroid tissue is mainly composed of follicular cells, which secrete iodine containing hormones T4 and T3. A smaller component of thyroid tissue, the para-follicular cells, emit the hormone calcitonin. Thyroxin — T4 — the main thyroid hormone, is a molecule that contains four iodine atoms. Thiodothyronine — T3 — a smaller molecule, contains three iodine atoms and is more potent than T4. To function effectively, the thyroid needs a small continuous extrinsic source of iodine from foods, such as shellfish, milk products, and iodized salt. Additionally, because T3 stimulates the body to burn fat, individuals have different rates at which they change T4 and T3 and this may lead to differences in body adipose tissue among different people. Clinical trials are currently in progress to learn more about these phenomena.³

Known as the watchdog of the thyroid, the pituitary gland monitors T4 and T3 blood levels. When levels drop to a certain point, the pituitary signals the thyroid to produce more by secreting thyroid-stimulating hormone (TSH).

Conversely, when hormone levels are high, TSH production decreases. Another member of the team, the hypothalamus, also plays a vital role by secreting a thyroid-releasing hormone (TRH) that prompts the pituitary to release TSH when necessary.³

A case example can help explain the thyroid’s biochemical synchrony — when it works and when it’s off kilter. Many of these problems can be traced to autoimmunity.

Kate is a 33-year-old mother of a 3-year-old and a 4-month-old. In her 20s, she was diagnosed with rheumatoid arthritis, but is currently in remission. Kate’s hair has been prematurely gray for several years. During the past month, she lost a few pounds, despite a ravenous appetite and a hectic schedule. Kate complains of feeling “constantly stressed, hot, and tired.” Her primary care provider tells her she is in good health and her problems are related to caring for two small children and a chaotic lifestyle.

Recently, she noted tremors in her hands when she changed her infant’s diaper. Kate shared her experiences with her friend Joan, a nurse, telling her that she had frequent palpitations. Joan found that Kate’s blood pressure was within her normal range, but her pulse was rapid. Her skin was warm, moist, and flushed. She had an enlarged thyroid, but no tenderness when Joan palpated her neck. Her friend suggested she return to her healthcare provider for further evaluation.

Kate follows her friend’s advice and revisits her provider, who carefully evaluates her signs and symptoms and examines her. The clinician notes symmetric enlargement of the lower neck. Kate’s neck tissue rises with swallowing and is nontender on palpation. No bruits are present.

The initial diagnosis is postpartum thyroiditis, a painless, temporary inflammation of the thyroid gland. This disease can also occur in the nonpostpartum period, as well as in men. It is usually classified as an autoimmune thyroid disease, and it is related to Hashimoto’s thyroiditis. Postpartum thyroiditis is usually a temporary period of hyperthyroidism lasting six weeks to three months postpartum. It affects approximately 8% to 10% of women after they give birth.

The provider explains that certain antithyroid peroxidase antibodies (TPOAb) are present in women who develop postpartum thyroiditis. This suggests the possibility of an autoimmune disease. During pregnancy some immunosuppression occurs, but after birth, the immune system rebounds, and may produce antibodies that attack the thyroid gland. On the other hand, postpartum thyroiditis may also occur in women who do not have antithyroid antibodies.⁴ The syndrome can follow one of three courses:

• A hyperthyroid stage; usually no treatment
• A hypothyroid stage; usually short course of thyroxin treatment
• Some women never recover from the hypothyroid phase and require long-term thyroid replacement therapy.⁴

Kate’s laboratory blood tests reveal a low TSH and a high T4 level, establishing the diagnosis of a hyperthyroid stage of postpartum thyroiditis.⁴ Treatment is not recommended during the hyperthyroid phase, which lasts approximately two to four months. However, the provider prescribes a low-dose beta-blocker to slow Kate’s heart rate and ease her on-edge feelings. She will monitor the progress of Kate’s condition. Also, the provider advises her to plan on long-term follow-up. Women who experience postpartum thyroiditis may develop recurrent hypothyroidism two to four years after the initial illness.⁵ The provider also teaches Kate how to check her own neck for possible thyroid problems.⁶

Many women who have emotional disorders after pregnancy may not have a thyroid dysfunction as the cause of their difficulty. One recent study addressed this issue.⁵ However, it is deemed reasonable to perform thyroid tests including a TSH blood level in women who experience emotional upset.⁵

The High-Gear/Low-Gear Story

Both hyperthyroidism and hypothyroidism may present as a mild or subclinical state. Many people with a thyroid disorder attribute their symptoms to other conditions, such as aging, menopause, and depression.

Women are especially vulnerable to thyroid disorders, particularly those with autoimmune conditions, such as pernicious anemia, rheumatoid arthritis, insulin-dependent diabetes, and vitiligo (nonpigmented, white patches of skin). The presence of an autoimmune condition in the patient or family members considerably heightens the risk for developing an autoimmune thyroid disorder, such as Graves’ disease or Hashimoto’s thyroiditis. In the case example above, Kate had rheumatoid arthritis and premature graying of her hair before age 30; both might indicate that she had the genes predisposing her to a thyroid disorder.⁷ Thyroid disease often strikes during key life stages, such as postpartum, menopause, or after age 60.⁸

The Fast Lane: The leading cause of hyperthyroidism — Graves’ disease — is also known as diffuse toxic goiter. Antibodies called thyroid-stimulating immunoglobulin (TSI) cause sustained stimulation of the thyroid cells and overproduction of thyroid hormones.⁹ In turn, the pituitary suppresses TSH to a point where it is low or undetectable. The same TSIs also stimulate cell growth, hence, the goiter.

Overt signs and symptoms of Graves’ disease may include nervousness, irritability, tremors of the hands, insomnia, tachycardia, cardiac dysrhythmia, weight loss (despite increased appetite), muscle weakness, increased sweating, heat intolerance, increased peristalsis, and lighter menstrual periods. Patients may have a goiter, as well as exophthalmos (protruding eyeballs), which can lead to mild to severe visual problems. On the other hand, signs and symptoms may be subtle or nonexistent, putting those not appropriately diagnosed at risk of complications ranging from osteoporosis to heart disease.¹⁰ According to the literature, women who receive treatment for subclinical hyperthyroidism experience improvement in skeletal muscle strength and bone mineral mass.¹¹

John walked his Labrador retriever, Jake, each morning in the local park. One cold windy morning as they were jogging around the park, John felt out of breath with a strange tightness in his chest. He felt so fatigued, he wanted to lie down. He sat on the grass, while his dog sat beside him and licked his face and barked. Another jogger stopped and talked briefly to John and then called an ambulance on his cell phone. John was taken to a local hospital and diagnosed with atrial fibrillation.

Soon after, a further work-up revealed Graves’ disease, his response illustrating the heart’s sensitivity to changes in the level of thyroid hormone.¹² A resting heart rate change is especially significant, preferably assessed in the morning, to help identify the tachycardia or bradycardia associated with hyper- or hypothyroidism.⁷

Hyperthyroidism caused by Grave’s disease is common in women, yet little information is available about risk factors for the disease. One recent study looked at lifestyle factors, such as smoking, alcohol consumption, physical activity, and body mass index, to determine if they were risk factors for Graves’ hyperthyroidism. The analysis was conducted using data from the Nurses’ Health Study,¹¹ including women 25 to 42 years at entry. The results of the study revealed cigarette smoking was a predictor of Graves’ hyperthyroidism. Alcohol intake and physical activity level were not linked with the disease. Body mass was an indicator, even though obesity may be associated with a reduced risk. However, weight loss as the first symptom of hyperthyroidism cannot be excluded.¹³

To diagnose Graves’ disease, the physician or nurse practitioner orders a TSH assay, a sensitive screening test to detect even minimal thyroid hormone excess. The results may be low even if the T4 and T3 are normal. Clinicians must also be aware that several commonly used drugs, such as amiodarone (Cordarone), haloperidol (Haldol), metoclopramide (Reglan), lithium, morphine, and aminoglutethimide (Cytadren) tend to increase TSH levels.⁷ If the TSH is less than low normal, a freeT4 is performed.

Treatment with antithyroid drugs, such as methimazole (Tapazole) or propythiouracil (PTU), help resolve the problem. By concentrating in thyroid tissue, the drugs block the synthesis of thyroid hormone; they also lessen the autoimmune attack on the thyroid. Monthly follow-ups continue as long as necessary, and the healthcare provider reduces the medication as lab values return to normal.¹³ Another modality of treatment, ablation of a portion of the thyroid gland with radioactive iodine (radioiodine), is not used during pregnancy. Women of childbearing age must undergo a pregnancy test before this treatment is considered. The majority of patients who have had treatment eventually develop hypothyroidism and will need hormone replacement therapy for life. Surgery is rarely performed for Graves’ disease, except in special circumstances, such as children and adolescents, people with large goiters, and those with severe thyroid eye disorders;⁹ it is considered technically difficult.⁷

A major adverse reaction to antithyroid drugs is agranulocytosis, a dramatic reduction in infection-fighting leukocytes in the blood and bone marrow. It occurs in a very small percentage of patients and is reversible.

All patients on antithyroid drugs must be instructed to discontinue the medication and call their healthcare provider if they develop a fever, sore throat, and/or sore mouth, all symptoms of agranulocytosis.¹⁴ Other adverse effects of these drugs during the early months of therapy include liver disease and a lupus-like syndrome. Baseline laboratory data must include a leukocyte count and liver function tests.¹³

The Slow Lane: Hashimoto’s disease, a chronic lymphocytic thyroiditis, is a major cause of hypothyroidism.¹⁵ Problems occur when the thyroid gland is unable to respond to the pituitary’s TSH stimulus, so thyroid hormone levels are low. In an effort to stimulate the thyroid, the pituitary increases TSH, resulting in high TSH levels. Although thyroid hormone production remains low, TSH does stimulate growth of the thyroid gland, hence the goiter.

Symptoms are initially mild, and patients may not realize they have thyroid disease. Initially, they may notice an enlarged thyroid, which is caused by inflammatory cells. This inflammation destroys thyroid cells, which leads to long-term scarring. Because the damaged cells stop producing thyroid hormone, all body systems slow down. Early symptoms may be mild, such as fatigue, weight gain, and difficulty concentrating;¹⁵ however, if left untreated, the patient may begin to experience bradycardia, hypothermia, ataxia, myxedema (generalized interstitial edema), depression, mental impairment, and hoarseness. In addition, severe hypothyroidism may lead to elevated cholesterol levels and coronary artery disease.¹⁵ A recent study in ophthalmology discovered a significant association between hypothyroidism and open-angle glaucoma in men.¹⁶

Generally, clinicians confirm the diagnosis of Hashimoto’s thyroiditis as the etiology of hypothyroidism by measuring TSH and free T4, along with antibodies. The most sensitive test is TPOAb.

To treat hypothyroidism, healthcare providers prescribe thyroid hormone replacement with levothyroxine (Synthroid), a synthetic thyroid hormone; they adjust the dose on an individual basis.⁹

Patient Education: Some key points to include in patient teaching for patients with hypothyroidism appear below. Patients should —

• Take thyroid medication at the same time each day, preferably before breakfast with at least one glass of water.
• Wait at least four hours before taking antacids, ferrous sulfate, or multivitamins with iron. (Iron binds with thyroid hormone and blocks its absorption.)
• Notify their healthcare provider if they take calcium carbonate, cholesterol-lowering drugs, or products with kelp, which contains iodine that can cause a thyroid imbalance.⁸
• Confer with their healthcare provider before adjusting dose
  or brand.
• Notify their healthcare provider of any symptoms of intolerance, such as dyspnea, palpitations, chest pain, anxiety, a sudden increase in the size of their thyroid gland, or worsening of any hypothyroid symptoms.
• Expect symptoms to subside within two weeks of replacement.¹⁵
• Notify their healthcare provider if they become pregnant.
• Maintain regular visits to their healthcare provider.
• Inform other members of their healthcare team that they are taking thyroid hormone replacement.
• Keep appointments for blood tests, such as TSH, and follow-up.

Thyroid cancer

Thyroid cancer affects women more often than men. However, women’s mortality rate is lower. Overall, mortality rates are lower than incidence rates by a factor of five to 10 in men and eight to 20 in women. The majority of cases occur in individuals between ages 25 and 65. Age seems to be the single most important predictor of the disease. The incidence has increased over the last decade.¹⁷

Increases in thyroid cancer are linked to ionizing radiation exposure, radioactive fallout produced from nuclear weapons tests, exposure to sources of radioactive iodine from nuclear accidents, and testing in the 1930s and 1940s. X-rays were often used therapeutically in the treatment of benign diseases as well as enlarged thymus and tonsils. Diets high and low in iodine are suspected risk factors.¹⁸

Typically, thyroid cancer presents as a lump or nodule in the thyroid gland, or sometimes as a swollen lymph node in the neck. The patient may be hoarse because of the tumor’s pressure on the laryngeal nerve or find it difficult to swallow or breathe if the tumor is obstructing the esophagus or trachea.

The following history may point to the presence of a benign thyroid nodule —

• Family history of benign thyroid nodular disease, Hashimoto’s thyroiditis, or another autoimmune disease
• Soft, smooth, mobile nodule (some benign nodules may be hard because of calcification)
• Multinodular goiter without a predominating nodule
• Gradual or sudden onset of pain or tenderness.¹⁹

The following characteristics increase the suspicion of a malignant nodule —

• Patient younger than age 20 or older than age 65
• Nodule plus hoarseness and difficulty swallowing or shortness of breath
• History of external neck irradiation during childhood
• Firm, irregular, fixed nodule (some are smooth and not especially hard)
• Presence of cervical lymphadenopathy, especially one-sided
• Previous history of thyroid cancer¹⁹

Initial screening starts with a sensitive TSH assay to detect the presence of hyper- or hypothyroidism, along with T3 and T4 levels. Although it is rare for people with solitary malignant nodules to have hyper- or hypothyroidism, an abnormal TSH test decreases the suspicion of malignancy. Ultrasound can ascertain the size and number of thyroid nodules; however, it cannot determine if a nodule is malignant or benign. Magnetic resonance imaging and computerized tomography (CT) offer meager assistance with the diagnosis of a thyroid nodule. Currently the most effective diagnostic tool, fine-needle aspiration (FNA) biopsy is the recommended first step in the evaluation process of a patient with a palpable thyroid nodule. The biopsy’s diagnostic accuracy is approximately 95%.¹⁸ The four major types of thyroid cancer — papillary, follicular, medullary, and anaplastic — tend to grow at different rates.

Papillary Carcinoma: This is the most common thyroid cancer and includes 70% to 80% of all thyroid cancers. The female to male ratio is 3:1 Papillary carcinoma affects people from ages 30 to 60 more frequently, but is more virulent in the elderly. This cancer commonly appears in people with a history of radiation exposure. Most papillary carcinomas contain components of follicular cancer (described below), but this does not alter the basic characteristics of the tumor.¹⁹ This type of cancer grows in cells that produce iodine. Papillary cancer is classified as well-differentiated, slow-growing, and containing cells that are similar to healthy thyroid cells.

Papillary carcinoma characteristically has a favorable prognosis. The tumor spreads via lymphatics to regional lymph nodes in about one third of patients and can metastasize to the lungs. Patients  younger than age 45 with small tumors confined to the thyroid have a good prognosis. Factors that enhance prognosis include an age younger than 40 years, female gender, small tumor size, and absence of extracapsular extension or vascular invasion. Patients with primary tumors less than 4 cm in size have an excellent prognosis when treated surgically.¹⁹

The National Cancer Institute recommends that anyone who received radiation to the head and/or neck in childhood be checked every one to two years and undergo a careful examination of the neck, including palpation for lumps in the thyroid and enlargement of proximal lymph nodes. Cancer of the thyroid may develop as early as five years following radiation treatment or as late as 20 years or longer.¹⁷

Surgery is the treatment of choice for all primary lesions. Surgical options include lobectomy or total thyroidectomy. The size of the nodule and the age of the patient, along with the preference and practice of the treating physician, influence the choice of procedure. In either procedure, survival results depend on surgical complications and local recurrences. Lobectomy is associated with a lower incidence of complications; approximately 5% to 10% of patients will have recurrences. Because patients younger than age 45 have greatest possibility of recurrence, they require the longest follow-up period.

Postoperatively, patients receive exogenous thyroid hormone in doses adequate to suppress TSH, as well as therapeutic (ablative) doses of I-131 radiation. Studies show that these modalities result in a decreased recurrence rate in papillary and follicular carcinoma.²⁰

Patients with tumors larger then 1.5 cm or diffusely spreading tumors usually require total or near-total thyroidectomy. In addition, radioiodine whole-body scanning makes up part of the postoperative care.²⁰ After total thyroidectomy patients generally undergo radioactive iodine scanning at six weeks and at three- to six-month intervals, making monitoring for recurrences relatively easy. I-131 scanning cannot be used after lobectomy, however.³

When the scan is negative and serum thyroglobulin level is less than 1.5 mg/mL, whole-body scanning is usually repeated in three to five years, depending on the patient’s risk assessment. If indicated, appropriate doses of I-131 are given for ablation of residual thyroid tissue. Serum thyroglobulin levels help detect recurrent or persistent cancer since thyroglobulin should cease after a thyroidectomy and ablation of residual thyroid tissue.²⁰ Scanning is most sensitive when TSH is elevated before the imaging. Clinicians withdraw the patient from thyroid hormone or use recombinant TSH (Thyrogen).⁷ Recombinant TSH prevents the abrupt and unpleasant development of a hypothyroid state for the patient.³

Follicular Carcinoma: This type of thyroid cancer accounts for about 10% of thyroid cancers. It is common among elderly patients and in regions of iodine deficiency. It is more virulent than papillary carcinoma and spreads through the circulatory system with distant metastases; it does not spread to the lymph nodes. Treatment is similar to papillary cancer. TSH- suppressive doses of L-Thyroxine are given after treatment. Serum thyroglobulin should be monitored to detect recurrent or persistent disease. Follicular cancer is well differentiated and develops in thyroid cells that produce iodine-containing hormones.¹⁹

Medullary Carcinoma: Medullary thyroid cancer (MTC) constitutes 3% of all thyroid cancers. It usually presents as a mass in the neck/thyroid and may be associated with lymphadenopathy. It is composed of parafollicular cells that produce calcitonin. The cancer occurs in two forms, sporadic and familial. Because the cells implicated in MTC produce calcitonin, determining the level of this hormone is useful for diagnosis and monitoring treatment results. All patients with MTC, whether familial or sporadic, should be tested for the RET (rearranged during transfection) gene mutations. If they are positive, family members should be tested. Gene carriers should undergo a prophylactic thyroidectomy early in life. Medullary tumors are aggressive, metastasize early, and have a poor prognosis.¹⁹

Patients diagnosed with medullary carcinoma require total thyroidectomy unless distant metastasis is evident. Occasionally, palliative chemotherapy has produced a response with metastatic disease. Because the cancer cells do not pick up radioactive iodine, I-131 is not a useful treatment modality. Overall survival rate with MTC is 65% at 10 years. The outcome can be compromised by age, advanced stage, and previous neck surgery.²¹

Anaplastic Carcinoma: This type of carcinoma accounts for approximately 10% of thyroid cancers and usually occurs in elderly women slightly more frequently than elderly men. The tumor grows rapidly and spreads locally to the neck and airway. The goal of surgery is to remove as much of the cancer as possible before metatases. About 80% of patients die within a year of diagnosis.¹⁹

The thyroid gland may be a site of metastasis from other cancers, including the lung, breast, and kidney.

The following patient example helps illustrate the care of patients undergoing thyroidectomy for thyroid cancer.

Jerry, a 21-year-old college student, is beginning his junior year in college and plans to try out for the hockey team. He works out three times a week, jogs regularly, and generally enjoys good health. Currently, he has a nagging hoarseness that lingers after a recent upper respiratory infection. When he visits his physician for an exam, she finds a moderately firm, nontender fixed nodule during palpation of the thyroid. She finds no regional neck lymphadenopathy. After a thorough consultation with an endocrinologist, Jerry undergoes an FNA of the nodule. Results indicate thyroid cancer.

Jerry’s treatment included a total thyroidectomy at a local medical center. Later, his pathology report revealed papillary thyroid cancer, stage one, and a 4-cm tumor; he had no regional lymph node or distant metastasis.

Postoperatively, Jerry experienced some swelling of the neck around the incision site, a sore throat, and some difficulty in swallowing. The back of his neck ached from positioning during surgery. His nurse, Mark, positioned Jerry in semi-Fowlers with his head supported on pillows. Mark taught him how to support his head and neck when changing position to avoid tension on the incision site. He also kept Jerry comfortable with prescribed analgesic medication. He assessed his respiratory status for stridor and airway compromise that could occur as a result of injury to the laryngeal nerve or glottal edema.

Mark assessed Jerry for any indications of overt or internal bleeding, aware that the thyroid is a highly vascular gland; he checked behind Jerry’s neck where blood can pool and remain undetected. To evaluate voice changes, Mark asked Jerry to speak to him at intervals. Although initial hoarseness is common after intubation, voice weakness, unusual hoarseness, or limited voice range may indicate laryngeal nerve damage and could result in permanent hoarseness.

Mark also assessed Jerry for early signs of hypocalcemia that could result if the parathyroid glands, which sit on the posterior surface of the thyroid, are damaged during surgery. The most common symptoms include tingling and numbness around the mouth, spasms of the hands or feet, and muscular twitching. As a precaution, Mark kept IV calcium on hand.

To prevent hypothyroidism postoperatively Jerry received exogenous thyroid hormone. Jerry did well postoperatively and went home on day two.

Before discharge, Mark taught Jerry how to move his neck as the wound healed and once his surgeon had given him the go-ahead, usually three to four days postoperatively. Mark demonstrated the following range-of-motion steps —

1. Touch chest.
2. Lift chin up as high as possible.
3. Turn head and touch chin to left shoulder.
4. Turn head and touch chin to right shoulder.
5. Rotate head in a circular motion.²⁰

Mark reviewed Jerry’s thyroid medication regimen and reinforced the need for lifelong replacement therapy. He cautioned him on the importance of keeping appointments for TSH levels to monitor his treatment. Mark also went over the signs and symptoms of infection and potential complications, including calcium imbalance, that he should report to his surgeon right away.²⁰

Mark helped Jerry discuss his diagnosis and concerns. He offered him information about ThyCa, Inc, The Thyroid Cancer Survivors Association, and contact information for the local group.

Jerry was scheduled for radioiodine scanning six weeks after surgery.

Thyroid surgery with a scope

Since 1998 surgeons have begun using a new minimally invasive endoscopic surgical technique for thyroid surgery using CO₂ insufflation. The surgeon makes several small incisions in the neck, instead of the single large incision used in conventional thyroidectomy. Pathology is among the many factors that currently play a role in patient selection for this procedure. The most common indicators are a single, nonfunctioning thyroid nodule, recurring thyroid cysts, small multinodular goiters, and a long, narrow neck.

Patients with carcinoma are not candidates for the endoscopic approach, which may lead to inadequate staging. Additionally, the effects of CO₂ insufflation on malignant disease have not been investigated in this type of surgery. Other exclusions include thyroid nodules larger than 3 cm, a history of previous neck surgery, obesity, or a short or wide neck.

Positive aspects of endoscopic surgery over conventional thyroidectomy include better cosmetic results, better visualization of thyroid anatomy during surgery, less tissue trauma and pain, and a quicker return to normal activity. The primary disadvantage is the length of surgery.^21,22

Currently the approach with this surgical technique is minimally invasive video assisted thyroidectomy (MIVAT). Some studies were implemented that asked the question, “MIVAT: Is there an advantage over conventional thyroidectomy?”

According to the literature, MIVAT is as safe and effective as conventional thyroidectomy, with similar requirements for analgesics, and smaller incisions, although operative time was considerably longer in some cases. Selected cases had superb results regarding patient cure rate, comfort, cosmetic results, and shorter hospital stay.^21,22,23

How to take the thyroid “Neck Check”

The symptoms of thyroid illness are sometimes vague and mistaken for other conditions, such as depression, aging, and menopause. However, one in 10 Americans has some form of thyroid disease, while many are misdiagnosed or undiagnosed. Although the incidence of thyroid cancer has risen during the past decade, a simple check can help detect problems earlier, so treatment can begin earlier. The American Association of Clinical Endocrinologists recommends the “neck check” to assess for an enlarged thyroid gland. Nurses can teach patients this simple procedure.

1. Pour a glass of water, and obtain a hand-held mirror.
2. Hold the mirror in your hand, focusing on the area of your neck just below the Adam’s apple and right above the collarbone. Your thyroid gland is located in this area of your neck.
3. While focusing on this area in the mirror, tip your head back.
4. Now take a sip of water and swallow.
5. As you swallow, look at your neck.
6. Check for any bulges or protrusions in this area when you swallow. Reminder: Don’t confuse the Adam’s apple with the thyroid gland. The thyroid gland is located farther down on your neck, closer to the collarbone.
7. You may want to repeat this process several times. If you do see any bulges or protrusions in this area, call your physician. You may have an enlarged thyroid gland or a thyroid nodule and should be checked to determine whether cancer is present or if treatment for thyroid disease is needed.⁶