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The thyroid is a very small gland which under normal conditions weighs only about ten grams. Although small in size, its functioning must be optimal to ensure optimal production and release of the hormones necessary for the growth and development of the organism. About six million Italians of all ages, from children to the elderly, suffer from problems related to this part of the body. In terms of incidence, it is women who are most affected, since 10% of them develop a disorder in their lifetime. Furthermore, according to a survey carried out by Doxa, 70% of those interviewed never checked the functionality of their thyroid or failed to grasp the first symptoms of hypothyroidism and confused them with some other disease. The lack of information among people related to the correct functioning of this gland often causes a significant delay in diagnosis and a deterioration in quality of life.
Anatomically, the thyroid is located at the border between the larynx and trachea and is made up of two symmetrical lobes. It has a shape that resembles that of a butterfly: its rather superficial location means that it is easily accessible for inspection and palpation.
Behind the lobes of the thyroid are what are called parathyroid glands, also known as the parathyroid glands.
The gland houses inside the C cells (or parafollicular), whose task consists in the secretion of calcitonin, the hormone that regulates blood calcium levels, and the thyroid follicles, engaged in collecting the iodine circulating in the blood and transforming it in thyroid prehormone, stored inside specific vesicles.
There are two pathologies that most frequently affect the thyroid: hypothyroidism, which occurs when the gland works too little, and hyperthyroidism, when it “works too much”. About 5% of the Italian population suffers from the first problem, while about 2% are affected by the second.
Among the widespread disorders there is also nodular thyroid disease, the diagnosis of which has recently increased thanks to more precise and accurate methods of analysis. Following the traditional procedures, which included epidemiological studies based on palpation of the neck, it was possible to identify thyroid nodules in 3-5% of the adult population. Instead, using a more modern method, such as thyroid ultrasound, now used on a large scale, we realized how these formations are very widespread, so much so that they are present in at least 30-50% of the adult population. A very high percentage which, however, should not cause alarm: in most cases, in fact, they are benign nodules.
In daily clinical practice, malignant formations are found in only 3-4% of cases. In case of malignant nodules, the most common carcinomas are papillary or papillary-follicular adenocarcinomas. The prognosis for this condition is exceptionally good, with over 90 percent chance of cure.
There are also other rarer diseases, such as Hashimoto’s thyroiditis and postpartum thyroiditis.
The problems connected to the functioning of the thyroid also include goiter, a term which defines the increase in volume of the thyroid gland which can occur both in the case of hyperthyroidism and in the case of hypothyroidism. Going into more detail, we speak of a nodule or uninodular goiter when it consists of a single area of the thyroid, and of a multinodular goiter when it involves several areas.
If the gland still manages to work correctly we speak of euthyroid goiter, in the case in which, however, the functions are altered we refer to a hyperfunctioning or hypofunctioning goiter.
Hyper and hypothyroidism, guide to the differences
Thyroid disorders affect approximately 20% of the population. Among these the most common are hormonal dysfunctions, distinguishable in hyperthyroidism and hypothyroidism.
At the root of the problem
As the name itself suggests, these are two conditions in which the thyroid does not work well, i.e. when triiodothyronine (T3) and thyroxine (T4), the two thyroid hormones which have the function of regulating metabolism, work excessively or too much little. However, the symptoms and causes are completely different.
Basedow-Graves disease, thyroiditis, and thyroid nodules usually cause hyperthyroidism. On the other hand, hypothyroidism is mostly caused by autoimmune pathologies, such as Hashimoto’s disease, or the low intake of iodine in the diet, or even the total or partial removal of the thyroid in the presence, for example, of tumors or situations at risk.
As is easily imaginable, the symptoms between the two conditions are opposite. When there is an excess of hormones, or in the presence of hyperthyroidism, there is a general increase in oxygen consumption and metabolic heat production. This leads to weight loss, insomnia, nervousness and increased heart rate. The scalp is also affected: the hair appears fragile, thin and dull. The eyes also tend to become more sensitive and more prone to conjunctivitis. Those suffering from hypothyroidism, on the other hand, can run into chronic muscle weakness (asthenia), cold intolerance, tiredness, memory impairment, facial swelling and, in the most serious cases, depression.
The severity of the effects of hypothyroidism depends on the period of life in which it manifests itself. Indeed, during fetal life and in the years of early youth, the disorder is often responsible for serious and irreversible alterations in body development (pituitary dwarfism), brain development (cretinism) and sexual development.
The treatments are also generally different, the treatment of hyperthyroidism must be established according to the triggering cause and can be purely pharmacological (makes use of the use of thyrostatic drugs), surgical (removal of part or all of the thyroid) or radioactive with iodine 131 (radiometabolic therapy).
The treatment for hypothyroidism, on the other hand, is strictly pharmacological and consists in the lifetime administration of synthetic thyroxine orally, better known as levothyroxine.
Hyperthyroidism can occur at any age but predominantly affects people between the ages of 20 and 40. The incidence of the disease is around 1-2 percent in women, with a ratio between women and men of seven to one.
Hypothyroidism, on the other hand, affects an average of 0.5-1% of the population, with a clear prevalence in women and in elderly subjects.
Hashimoto’s disease, how to recognize it
Among the most common pathologies related to the functioning of the thyroid gland is Hashimoto’s disease, which affects up to 15 percent of the female population, increasing in frequency as age progresses. Recognizing it is not so easy: often, in fact, the symptoms are mild and can also be traced back to other problems, such as the most common states of anxiety.
Causes and symptoms
It is an autoimmune disease, in which the immune system mistakenly attacks cells and organs of its own body. In this case it affects the thyroid, affecting its ability to produce hormones. Inflammation, carried out by white blood cells, reduces their functionality, leading to a general situation of hypothyroidism.
Among the causes there is undoubtedly a familiarity with the disease that makes some people more predisposed than others. Among the risk factors is also iodine deficiency, an essential element for the proper functioning of the thyroid.
But what are the symptoms? Tiredness, difficulty in concentrating, little desire to carry out daily activities are among the most common and immediate effects. In fact, thyroid hormones regulate the metabolism and therefore the way in which our body uses energy. It is therefore natural to feel slowed down and tired. However, when hypothyroidism has persisted for some time and the pathology is neglected, more serious symptoms can develop, even up to heart failure problems.
Being chronic, Hashimoto’s disease hardly disappears over time, but it is possible to reduce its side effects. There is no real treatment, it is sufficient to act on the hypothyroidism condition underlying the disorder. It will therefore be enough to take the deficient thyroid hormone, levothyroxine, once a day.
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