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Thyroid is a small butterfly shaped gland found at the base of your neck, just below your Adam’s apple. The thyroid produces two main hormones called T3 and T4 which is essential to all growth and metabolism. The gland is a regulator of all body functions. These hormones travel in your blood to all parts of your body. The thyroid hormones control the rate of many activities in your body. These include how fast you burn calories and how fast your heart beats. All of these activities together are known as your body’s metabolism. A thyroid that is working right will produce the right amounts of hormones needed to keep your body’s metabolism working at a rate that is not too fast or too slow.

About 200 million people in the world have some form of thyroid disease. In Nepal more than 1 million people have thyroid disorders. Thyroid disorders are found in 0.8-5% of the population and are 4 to 7 times more common in women.

Thyroid disorders	Over All Prevalence %
Hypothyroidism	4.0
Subclinical hypothyroidism	10.0
Hyperthyroidism	1.2
Subclinical hyperthyroidism	0.6
Goiter	13.0
Thyroid cancer	0.2

Hypothyroidism is when your thyroid does not make enough thyroid hormones. It is also called underactive thyroid. The most common cause of hypothyroidism is Hashimoto’s disease. Hashimoto’s disease is an autoimmune disease, in which the immune system mistakenly attacks the thyroid. This attack damages the thyroid so that it does not make enough hormones. Hypothyroidism also can be caused in:

Patient on treatment for hyperthyroidism
Patient having surgery for thyroid gland
Radiation treatment of certain thyroid cancers
Patient on Lithium medication

In rare cases, problems with the pituitary gland can cause the thyroid to be less active.

Symptoms of hypothyroidism tend to develop slowly, often over several years. At first, you may just feel tired and sluggish. Later, you may develop other symptoms of a slowed down metabolism, including: •

* Weight gain, even though you are not eating more food

Increased sensitivity to cold
Constipation
Muscle weakness
Joint or muscle pain
Depression
Fatigue (feeling very tired)
Pale dry skin, coarse hair
A puffy face
A hoarse voice, hearing loss,
Excessive menstrual bleeding
Slow heart rate

In addition to these symptoms, people with hypothyroidism may have high blood levels of Total Cholesterol, Triglycerides & LDL cholesterol. LDL the so-called “bad” cholesterol, which can increase your risk for heart disease.

How can you prevent? Yes it can occur in new born and also in childhood. Early diagnosis and treatment can prevent the onset of brain damage and delayed mile stone of child development. Pregnant women with goitre, high anti-thyroid antibody titre, family history of thyroid disease or symptoms suggestive of hypothyroidism, should be screened early in pregnancy, or preferably prior to conception, and treated.

Some disorders cause the thyroid to make more thyroid hormones than the body needs. This is called hyperthyroidism, or overactive thyroid. The most common cause of hyperthyroidism is Graves’ disease. Graves’ disease is an autoimmune disorder, in which the body’s own defense system, called the immune system, stimulates the thyroid. This causes it to make too much of the thyroid hormones. Hyperthyroidism can also be caused by thyroid nodules that prompt excess thyroid hormones to be made.

At first, you might not notice symptoms of hyperthyroidism. They usually begin slowly. But over time, a speeded up metabolism can cause symptoms such as:

Weight loss, even if you eat the same or more food
Eating more than usual
Rapid or irregular heartbeat or pounding of your heart
Anxiety
Irritability
Trouble sleeping
Trembling in your hands and fingers
Increased sweating
Increased sensitivity to heat
Muscle weakness
Bulging of one or both eyeballs
More frequent bowel movements
Less frequent menstrual periods with lighter than normal menstrual flow
Osteoporosis or brittle bones, more common in postmenopausal women

Thyroid function test fT3, fT4, TSH and Anti TPO
Thyroid ultrasound
Thyroid fine needle biopsy
Thyroid scan
Radioactive iodine uptake test

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