Barts and The London Endocrinology Centre
The thyroid gland is one of the body’s most important glands and is situated in the neck in the front of the windpipe. The thyroid gland produces a hormone called thyroxine which, when produced in the right amounts, keeps all bodily functions occurring at the correct rate – as a result, it has actions on the heart rate, bowel activity, skin, muscle and other major organs. For children, thyroxine also has a very important role in brain development in the first few years of life, as well as growth and puberty.
The two most common thyroid disorders we diagnose and treat include:
Hypothyroidism (underactive thyroid)
Hypothyroidism occurs when too little thyroxine is produced. The exact reasons for this are still relatively unknown although there is a tendency for this condition to run in families. Symptoms of the condition include tiredness, lack of concentration, poor memory, muscle aches, constipation, dry skin, weight gain and, in women - heavy menstrual periods. Poor growth and delayed puberty are also often seen in children with an underactive thyroid gland.
Treatment of hypothyroidism includes replacing thyroxine in a tablet form. As the condition starts gradually, treatment may need to be started slowly to avoid any over rapid correction of the slow-down in bodily activity which might put a strain on the circulation. Increases in the amount of thyroxine are at 2-3 weekly intervals but this may also depend on the patient’s symptoms and the results of blood tests. It may take up to six months for a patient to become stable and treatment is life-long. Once adult patients have left our centre they will be looked after by their GP who will ensure they receive the right drug treatment. Children affected by hypothyroidism will be monitored more closely by our specialists and will visit us for clinic appointments two to three times a year. Once they reach early adulthood, they are referred to their GP who will maintain treatment and care.
Hyperthyroidism (overactive thyroid)
Hyperthyroidism refers to a situation in which the thyroid becomes overactive and too much thyroxine is produced. This may happen for various reasons but the most common cause is stimulation of the thyroid gland by proteins in the blood stream called antibodies, which are normally produced by our white blood cells in order to fight off infection. It is not known why the body should start to produce antibodies to the thyroid gland but this condition is known as Graves’ disease. Symptoms include weight loss, palpitations, loose stools, trembling of the hands, muscular weakness, difficulty in sleeping, feeling hot and irritable. In women, menstruation may become less frequent. In children, where graves' disease usually occurs in the second decade, there is also an associated rapid height increase. Eye problems may be also be symptoms associated with this condition. Some patients may experience a sensation of grittiness or discomfort in the eye and, very rarely, difficulty with vision. Our department has great experience of treating patients with eye problems associated with the thyroid but we also have very close links with expert eye specialists for the most complex cases.
Treatment includes prescribing a drug called carbimazole which decreases the quantity of thyroxine produced in the thyroid gland. This treatment takes approximately 2-3 weeks to start working and additional treatments may also be given to patients to help control the palpitations and tremor. Treatment with carbimazole may be continued for up to 2 years, after which some patients may find they have no more symptoms.
For many patients with an overactive thyroid gland, radioactive iodine is an excellent choice of treatment. Patients take a capsule by mouth which contains a small amount of radioactivity, which is concentrated within the thyroid gland and this in turn reduces thyroid activity. Following radioiodine treatment, careful monitoring of thyroid function is required and this is usually initially performed at the hospital, and for many patients this is subsequently performed by their GP.
Surgical treatment may be recommended for some patients who have enlargement of the thyroid or for those individuals who have relapsed following drug therapy. If surgery is recommended, this will be discussed in great detail with patients and they will have a clear understanding of what the surgery involves.
Other causes of hyperthyroidism may be thyroid nodules - single or multiple (called multi-nodular goitre). Both types are often treated with radioactive iodine.
For more information on thyroid disorders, or to contact the national support group, please click here