THYROID Disorders in Clinical Practice

Thyroid disorders are commonly encountered in clinical practice. Thyroid gland produces two hormones, Thyroxine (T4) and Triiodothyronine (T3). in general, thyroid disorders are manifested as a state of less hormone porduction (hyothyroidism), more hormone production (hyperthyroidism) or swelling of the gland itseld. Hypothyroidism is easily diagnosed once suspected by hormone disease is the commonest, followed by toxic multinodular goitre and toxic adenoma. It is important to rule out thyroiditis by doing an isotope study of thyroid, isotope uptake of the gland will be low in thyroiditis and high in hyperthyroidism. The treatment mobalities in hyperthyroidism are antithyroid drugs, radio-active iodine or surgery. Choice of treatment depends upon the underlying cause, the preference of physician, the preference of patient, cost, availability of infrastructure, and availability of skilled surgeon.

There are clinical situatuions where thyroid hormones in the circulation are within normal range, but gland is enlarged ex: diffuse goitre, multinodular goitre, single thyroid nodule. single thyroid nodule. Single thyroid nodule deserves attention for its association with malignancy. FNAC by and experienced cytologist is of great help to rule out malignany. Once suspected, a differentiated carcinoma of thyroid calls for total thyroidectomy, followed by radio-iodine ablation, so that no thyroid tissue remains in the thyroid bed. This will facilitate to diagnose recurence of tumour by estimation thyroglobulin in circulation during the follow-up period. Fortunately most of the thyroid disorders including differentiated carcinoma of thyroid, are curable if managed properly.

Auto-immunity plays a major role in the aetiopathogenesis of thyroid disorders whether it is hypothyroidism or hyperthyroidism. However, iodine deficiency is still recognised as the commonest environmental factor keeping a large population at risk across the globe in spite of global effort to overcome the iodine deficiency. No continent is totally free of iodine deficiency. Iodine deficiency disorders include still birth, congenital malformation, deaf-mutism, cretinism, goitre and hypothyroidism in scholl going children and in adults. Physicians of India have a great task to overcome the illiteracy and misconception of the people towards iodised salt intake, and facilitate the governments effort for compulsory use of iodised salt by all.