YOUR THYROID DOCTOR

Examination and treatment | Questions | PDF Thyroid

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

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

The thyroid doctor uses thyroid sonography to determine the size and structure of the thyroid. The course of an illness can be monitored by comparing it with the previous examinations.

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

The thyroid secretes too many hormones (Overactive thyroid/hyperthyroidism) The basal metabolic rate and organ functions are increased. It produces too little thyroid hormone (underactive thyroid/hypothyroidism), the entire metabolism is slowed down. The control of hormone production by the thyroid is subject to a physiological control 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).

In a personal conversation, our thyroid doctors will be happy to explain to you the causes, triggers, symptoms and treatment options for thyroid diseases. Below you will also find information about the symptoms, examination and treatment of thyroid diseases.

Examination and treatment at the thyroid specialist in Berlin Schöneberg-Charlottenburg

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

• Advice/differential diagnosis as to whether symptoms indicate thyroid dysfunction
• Investigation of the thyroid gland in cases of (unfulfilled) desire to have children and pregnancy
• Blood tests (TSH, fT3, fT4, autoantibodies): possible daily until 17 p.m., not fasting
• Ultrasound examination (with appointment)
• Follow-up laboratory and ultrasound checks for existing thyroid diseases
• Prescription of thyroid hormone/thyroid-specific medication (for known patients, prescription also by post)
• Initiation of scintigraphy, radioiodine therapy or surgery with cooperating medical institutions

Questions that we are frequently asked in our thyroid practice

1. How do thyroid disorders become noticeable?
2. What examination methods are there for the thyroid?
3. Which hormone levels can be determined in the blood?
4. How does hypofunction or hyperfunction manifest itself?
5. What causes an underactive thyroid (hypothyroidism)?
6. What causes an overactive thyroid (hyperthyroidism)?
7. What is a goiter or a goiter?
8. Who can take iodine supplements and who can't?
9. When does thyroid cancer develop?
10. How are thyroid diseases treated?

1. How can thyroid diseases manifest themselves?

The following symptoms (individually/in combination) can 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
• Feeling of a lump in the neck area/tightness in the throat with possible shortness of breath
• Heart racing, pulse rapid
• Freezing, feeling cold/tending to sweat, feeling hot
• Indigestion, constipation/diarrhea
• Irregular period bleeding, unfulfilled desire to have children

2. What examination methods are there for the thyroid?

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

If further examinations are necessary, 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 hormonal activity of nodules. The result can significantly influence the therapy.
If abnormal findings need to be further clarified or treated, we will organize referral to endocrinological specialists (for example, for puncture of suspicious lumps) or to specialized surgeons for an operation.

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

The most important measurement for clarifying thyroid dysfunction is TSH (thyroid stimulating hormone). This control hormone of the pituitary gland in the brain regulates the formation and release of thyroid hormones according to the body's needs. Depending on the laboratory, the normal range is approx. 0,3–4 µIU/ml.

An increased TSH value is a warning signal that the thyroid gland is underactive (hypothyroidism). A reduced value occurs when the thyroid gland is overactive (hyperthyroidism) or when an overdose of hormone tablets is taken. When it comes to thyroid hormones, the free hormones (fT3 + fT4) that are not bound to carrier proteins are predominantly determined in the blood.

In certain situations, the immune system mistakenly reacts against organs in the body. For example, after serious infectious diseases, during pregnancy or in cases of hereditary predisposition, the body forms so-called autoantibodies against structures of the thyroid gland.

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

4. How does hypofunction or hyperfunction manifest itself?

Common symptoms of hypothyroidism include:

• Limited performance, difficulty concentrating
• Frequent and/or persistent tiredness
• A feeling of dejection
• Freeze
• Weight gain
• constipation
• In women: menstrual disorders

Common symptoms of hyperthyroidism include:

• Feeling of restlessness, irritability, mood swings, etc.
• Increased blood pressure, heart palpitations and palpitations
• Weight loss despite eating well or even a lot
• diarrhea
• In women: disruption of the cycle
• Muscle spasms
• Elevated body temperature

Also see the symptoms under point 1.

5. What causes hypothyroidism?

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

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

Other causes include a congenital hormone production disorder or an iodine deficiency. Temporary hypothyroidism can occur, particularly if there is an increased need for iodine during growth, puberty, pregnancy and breastfeeding.

6. What causes overactivity (hyperthyroidism)?

The hyperfunction is often due to one Thyroid autonomy to lead back. The tissue has changed in such a way (often in the form of “hot” nodules that can be detected using scintigraphy) that it produces hormones independently of the higher-level control of the control circuit.

Within the Graves' disease (Graves' disease) The body's own autoantibodies lead to increased hormone production. Typical features are an enlarged, heavily supplied thyroid gland and possibly protruding eyeballs (endocrine orbitopathy).

7. What is a goiter or a goiter?

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

The nodules in the case of an enlarged thyroid (Struma nodosa) should be checked regularly by ultrasound every 1-2 years, as in the long term (scintigraphically hot) autonomous nodules with hormone overproduction or malignant nodules with thyroid cancer can develop from the changed tissue. However, the latter only forms in around three to four percent of the otherwise mostly harmless (scintigraphically cold) low-function nodules.

8. Who can take iodine supplements and who can't?

Due to the increased need, iodine prophylaxis with 100–200 µg iodide is recommended for young people at the beginning of puberty in Germany, where there is an iodine deficiency. It also makes sense for pregnant and breastfeeding women to supplement their normal diet with additional iodine.

Women with an unfulfilled desire to have children should have their thyroid function examined before taking dietary supplements containing iodine.

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

9. When does thyroid cancer develop?

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

10. How are thyroid diseases treated?

The focus of the treatment is on correcting the body's altered hormone secretion. In the more common case of hypothyroidism, the body is not sufficiently supplied with 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 often has to be maintained throughout life. The hormone level in the blood should be checked regularly, every six to twelve months if the level is stable.

Excessive hormone secretion (overactivity) can be suppressed with thyroid blockers. These medications are primarily used for Graves' disease or thyroid autonomy. In the long term, radioiodine therapy (radiation of the thyroid with radioactive iodine in special centers) or surgery may be necessary.

You can obtain further information from our thyroid doctors in person in our practice rooms in the medical center at the Europacenter. We recommend these pages if you would like to find out more about the topic of the thyroid:

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