YOUR DOCTOR FOR THE THYROID GLAND

Examination and treatment | Questions | PDF Thyroid gland

The doctors at the praevenio Berlin group practice are highly trained in the diagnosis and treatment of thyroid diseases. Recent studies have shown that around 15 percent of the population have a functional disorder of the thyroid gland - for example as a result of an inflammation of the thyroid gland such as Hashimoto's thyroiditis. A change in the thyroid tissue - nodules, goitre - occurs increasingly with age in up to 50 percent of people. Overall, significantly more women are affected than men.

The thyroid gland fulfils many functions in our body and influences metabolism, circulation and also our psyche. It is a small, butterfly-shaped organ that nestles below the larynx around the thyroid cartilage and the trachea. A healthy thyroid gland is no larger than a person's thumb limb. The normal thyroid volume is less than 18 ml in women and less than 20 ml in men.

With the help of thyroid sonography, the thyroid doctor determines the size and structure of the thyroid gland. By comparing this with the previous examinations, the course of the disease can be monitored.

The thyroid gland releases the hormones tetraiodothyronine (T4) and triiodothyronine (T3) into the blood. This influences metabolism, heat balance, the cardiovascular system, digestion, sexual organs, muscles, nerves and the mental state.

If the thyroid gland secretes too many hormones (hyperthyroidism), the basal metabolic rate and organ functions are increased. If it produces too little thyroid hormone (hypothyroidism), the entire metabolism is slowed down. The control of hormone production by the thyroid gland is subject to a physiological regulatory circuit involving structures in the brain (including the hypothalamus and pituitary gland). The pituitary gland stimulates the thyroid gland to produce hormones by releasing thyroid-stimulating hormone (TSH).

Our thyroid doctors will be happy to explain the causes, triggers, symptoms and treatment options of thyroid diseases to you in a personal consultation. Below you will also find information on the symptoms, examination and treatment of thyroid diseases.

Examination and treatment by a thyroid specialist in Berlin Schöneberg-Charlottenburg

The thyroid doctors at the praevenio group practice in Berlin Schöneberg-Charlottenburg offer you these services:

• Counselling/differential diagnosis whether symptoms indicate thyroid dysfunction
• Clarification of the thyroid gland in the case of (unfulfilled) desire to have children and pregnancy
• Blood tests (TSH, fT3, fT4, autoantibodies): Daily until 5 pm possible, not fasting
• Ultrasound examination (with appointment)
• Follow-up laboratory and ultrasound examinations for existing thyroid diseases
• Prescription of thyroid hormone/thyroid-specific medication (prescription also by post for known patients).
• Initiation of a scintigraphy, radioiodine therapy or surgery with cooperating medical institutions

Questions we are often asked in our thyroid practice

1. How do disorders of the thyroid gland become noticeable?
2. What examination methods are available for the thyroid gland?
3. Which hormone values can be determined in the blood?
4. What are the symptoms of hypofunction and hyperfunction?
5. What causes hypothyroidism?
6. What causes hyperthyroidism?
7. What is a goitre or goiter?
8. Who is allowed to take iodine supplements and who is not?
9. When does thyroid cancer develop?
10. How are thyroid diseases treated?

1. how can thyroid diseases become noticeable?

The following symptoms (individually/in combination) may indicate thyroid dysfunction:

• Unwanted increase/decrease in body weight
• Unusual tiredness, lack of drive and performance
• Dry skin, dull hair or brittle nails
• Mood swings, depressive episodes/nervousness, irritability
• Lumpy feeling in the throat area/narrowing of the throat with possible shortness of breath
• Palpitations, rapid pulse
• Freezing, feeling cold/sweaty, feeling hot
• Indigestion, constipation/diarrhoea
• Irregular menstruation, unfulfilled desire to have children

2. what examination methods are available for the thyroid gland?

In addition to the physical examination with palpation of the thyroid gland, ultrasound examination (sonography) offers a painless and risk-free method of determining the size of the thyroid gland and detecting nodules or other structural changes in the tissue.
The blood test reveals how the thyroid gland is working (normal, over- or underfunction), whether thyroid hormone tablets are correctly dosed or whether the body's own antibodies are interfering with the thyroid's ability to function.

If further examinations are required, our thyroid doctors will refer you to nuclear medicine for a scintigraphy. With the help of thyroid scintigraphy, statements can be made in particular about the hormone activity of nodes. The result can have a significant influence on the therapy.
If abnormal findings need further clarification or treatment, we organise referral to endocrinology specialists (for example, for puncture of suspicious nodules) or to specialised surgeons for an operation.

3. what thyroid hormone levels can be determined in the blood?

The most important measured value for clarifying thyroid dysfunctions is TSH (thyroid-stimulating hormone). This control hormone of the pituitary gland in the brain regulates the formation and secretion of thyroid hormones according to the body's needs. The normal range is about 0.3-4 µIU/ml, depending on the laboratory.

An increased TSH value is a warning signal of an underactive thyroid gland (hypothyroidism). A lower value is found in the case of a pathological overfunction of the thyroid gland (hyperthyroidism) or in the case of an overdose of hormone tablets. In the case of thyroid hormones, the free hormones (fT3 + fT4) not bound to carrier proteins are predominantly determined in the blood.

In certain situations, the immune system reacts erroneously against organs of the own body. For example, after severe infectious diseases, during pregnancy or in the case of hereditary disposition, the body forms so-called autoantibodies against structures of the thyroid gland.

Put simply, TPO antibodies (formerly MAK) can be detected mainly in people with so-called Hashimoto's thyroiditis and TRAK antibodies (TSH receptor autoantibodies) mainly in patients with Graves' disease.

4) What are the symptoms of hypofunction or hyperfunction?

Common symptoms of hypothyroidism are:

• Impaired performance, lack of concentration
• Frequent and/or persistent fatigue
• A feeling of dejection
• Freeze
• Weight gain
• Constipation
• In women: Menstrual disorders

Common symptoms of hyperthyroidism are:

• Feelings of restlessness, irritability, mood swings, etc.
• Increased blood pressure, palpitations and heart palpitations
• Weight loss, although one eats well or even a lot
• Diarrhoea
• In women: Disruption of the menstrual cycle
• Muscle cramps
• Increased body temperature

See also the symptoms under point 1.

5. what causes hypothyroidism?

The most common cause is inflammation of the thyroid gland (thyroiditis). In chronic Hashimoto's thyroiditis, the thyroid tissue is destroyed by the body's own autoantibody-mediated inflammation, which leads to a hormone deficiency in the long term.

At the beginning of the disease and when the thyroid hormones in the blood are still normal, a therapy with the trace element selenium can be considered. With progressive loss of thyroid function, the only treatment is to compensate for the hormone deficiency with L-thyroxine (synthetic thyroid hormone).

Other causes lie in a congenital hormone formation disorder or in an iodine deficiency. Temporary hypofunction can occur in particular with an increased iodine requirement during growth, puberty, pregnancy and breastfeeding.

6. what causes hyperthyroidism?

Often the hyperfunction can be traced back to thyroid autonomy. In this case, tissue has changed in such a way (often in the form of scintigraphically detectable "hot" nodes) that it produces hormones independently of the higher-level control of the regulatory circuit.

In Graves' disease, the body's own autoantibodies lead to increased hormone production. Typical features are an enlarged thyroid gland with a large blood supply and possibly protruding eyeballs (endocrine orbitopathy).

What is a goitre or goiter?

A goitre/truma is an enlarged thyroid gland, which may also have nodular remodelled tissue. The most common cause is insufficient iodine intake or a hereditary disorder of iodine utilisation. In both cases, attention should be paid to an iodine-rich diet. In some cases, the iodine deficiency can only be covered in the form of tablets.

The nodes of a thyroid enlargement (struma nodosa) should be checked regularly every 1-2 years by ultrasound, because in the long term (scintigraphically hot) autonomous nodes with hormone overproduction or malignant nodes with thyroid cancer can develop from the changed tissue. The latter, however, only forms in about three to four percent of the otherwise mostly harmless (scintigraphically cold) low-function nodes.

8. who is allowed to take iodine supplements and who is not?

Due to the increased need, iodine prophylaxis with 100-200 µg iodide is recommended for adolescents at the beginning of puberty in Germany as an iodine deficiency area. For pregnant women and breastfeeding mothers, an additional iodine intake to the normal diet is also recommended.

In women with an unfulfilled desire to have children, the thyroid function should be examined before taking iodine-containing food supplements.

In the case of hyperfunction (e.g. due to thyroid autonomy), Graves' disease and Hashimoto's thyroiditis, iodine-containing medicines, food supplements or X-ray contrast media should be avoided. In most cases, however, iodised salt may be used or sea fish eaten.

9. when does thyroid cancer develop?

The causes of thyroid carcinoma are diverse and have not yet been conclusively clarified. In the case of nodular changes, for example in the case of a long-standing nodular goiter, in individual cases there may be doubts about the benign nature of the nodules. In these cases, a fine needle aspiration and/or a MIBI scintigraphy can confirm the diagnosis before a possible operation. With early surgery and subsequent radiation therapy (radioiodine therapy), thyroid cancer is usually curable.

10. how are thyroid diseases treated?

Treatment focuses on correcting the body's altered hormone secretion. In the more common hypothyroidism, the body is not supplied with enough thyroid hormones. To compensate for the deficiency, the hormone is taken in the form of a small tablet once a day. The duration of hormone replacement depends on the type of disorder, but it often has to be maintained for life. The hormone level in the blood should be checked regularly, every six to twelve months if it is stable.

Excessive hormone secretion (hyperfunction) can be suppressed with thyroid blockers. These drugs are mainly used in Graves' disease or thyroid autonomy. In the long term, radioiodine therapy (irradiation of the thyroid gland with radioactive iodine in special centres) or surgery may become necessary.

You can obtain further information from our thyroid doctors in a personal consultation in our practice rooms in the Ärztehaus am Europacenter. We recommend these pages if you would like to find out more about the thyroid gland yourself:

http://www.forum-schilddruese.de/Startseite.htm
http://www.best-med-link.de/d/erkrankungen/e03stoff_horm_schild.htm
http://www.sd-krebs.de/