Thyroid gland: symptoms, tests and when to have an ultrasound
The thyroid gland sits at the front of the neck, under the Adam's apple, and makes hormones that control metabolism, heart rate and body temperature. When it is underactive, people feel cold, tire quickly and gain weight; when it is overactive, they have a racing heart, sweating, weight loss and shaking hands. Testing usually starts with a TSH blood test, and the doctor adds free T4, antibodies or an ultrasound if needed.
Where the thyroid gland is and what it controls
The thyroid gland, often just called the thyroid, lies between the Adam’s apple and the notch above the breastbone. It is shaped like a butterfly: two lobes sit on either side of the windpipe, joined by a narrow bridge of tissue called the isthmus. A healthy thyroid usually can’t be seen. It moves up and down with the larynx when you swallow, so an enlarged gland or a nodule is sometimes noticed exactly when a person swallows.
The gland makes the hormones thyroxine (T4) and triiodothyronine (T3), which need iodine. They affect your heart rate, body temperature, weight, bowel function, menstrual cycle, mood and concentration. The thyroid is controlled by the pituitary gland through thyroid-stimulating hormone, or TSH. When thyroid hormones are low, TSH rises, and when there are too many, it falls. That’s why TSH is checked first.
Symptoms of an underactive or overactive thyroid
An underactive thyroid, or hypothyroidism, develops slowly, and the first signs are easy to put down to tiredness or age:
- constant weakness and sleepiness;
- feeling cold;
- weight gain without changes in diet;
- dry skin, brittle hair and hair loss;
- constipation;
- a puffy face and a hoarse voice;
- low mood and poorer memory;
- heavy or irregular periods.
In adults, hypothyroidism is often caused by autoimmune thyroiditis, when the immune system gradually damages the thyroid tissue.
An overactive thyroid, or hyperthyroidism, speeds up metabolism. Signs include:
- a racing or irregular heartbeat, even at rest;
- sweating and poor tolerance of heat;
- weight loss despite a normal or even bigger appetite;
- shaking hands, irritability, anxiety and insomnia;
- frequent bowel movements and muscle weakness;
- sometimes eyes that seem to bulge, with grittiness and swollen eyelids.
Thyroid nodules and when to have an ultrasound
A nodule is a lump in the thyroid tissue. Nodules are often found by chance, during an exam or an ultrasound done for another reason. Most of them are benign and don’t change hormone levels. Still, every nodule should be assessed by a doctor, who decides from its size and structure on ultrasound whether monitoring is enough or other tests are needed.
A thyroid ultrasound is usually ordered if:
- there is visible swelling in the neck or a lump can be felt;
- the gland is enlarged;
- you feel a lump in the throat or pressure in the neck;
- hormone tests are abnormal and the doctor wants to look at the structure of the gland;
- nodules were found before and need monitoring.
This ultrasound usually needs no special preparation. At Viva Clinic it is done at the polyclinic at 27a Sobornosti St by appointment, and it is paid.
Which thyroid tests to take and how to prepare
If TSH is abnormal, the doctor adds free T4 and sometimes free T3. Antibodies to thyroid peroxidase (anti-TPO) show whether you have autoimmune thyroiditis, and antibodies to TSH receptors help find the cause of an overactive thyroid. Your doctor decides which tests you need.
Before the test:
- come in the morning on an empty stomach, as for most blood tests;
- if you take thyroid hormone medicine, ask your doctor whether to take your pill before or after the blood draw on the day of the test;
- tell your doctor or the lab about any vitamins for hair, skin and nails, because the biotin in them can distort the result, and you may be advised to stop taking it for a while before the test.
TSH, free T4 and anti-TPO antibody tests can be done for a fee, without a referral, at Viva Clinic’s Diagnost-Lab laboratory at 32 Sobornosti St, 4th floor; ask about TSH receptor antibodies when you book. You can book by calling the lab or on Viber, and you’ll get a Viber message when your results are ready.
Which doctor to see
With symptoms or abnormal test results, you can see a family doctor or go straight to an endocrinologist. An endocrinologist at Viva Clinic sees patients in Slavuta at 27a Sobornosti St or 3 Danyla Halytskoho St, and the exact address is confirmed when you book. The clinic’s family doctors also include internists who specialize in endocrinology. Bring your previous test and ultrasound results and a list of your medicines and vitamins. You can book by phone or on Viber.
See a doctor soon if a lump in your neck is clearly growing or your voice has been hoarse for several weeks. If swallowing has become difficult, get help the same day. Call an ambulance on 103 if you find it hard to breathe, if a strong heartbeat comes with chest pain or fainting, or if a person with an overactive thyroid has a high fever and confusion.
Questions and answers
Can a thyroid problem be identified without tests?
No. Symptoms of an underactive or overactive thyroid look like those of tiredness, stress, anemia or menopause, so you can't tell from how you feel whether the thyroid is to blame. Hormone tests give the answer, and an ultrasound shows the structure of the gland.
Does the thyroid hurt?
Usually not: most thyroid conditions are painless. Pain at the front of the neck together with a fever and weakness happens with inflammation of the gland, called subacute thyroiditis. With these symptoms, see a doctor within the next few days.
Should you take iodine to prevent thyroid problems?
Don't take iodine supplements on your own. For most people, iodized salt and foods with iodine, such as sea fish, are enough. Too much iodine can also disrupt the thyroid, so iodine supplements are prescribed by a doctor, for example during pregnancy or breastfeeding.
How often should the thyroid be checked?
If nothing bothers you, not everyone needs regular checks. A TSH test is recommended when symptoms appear, when planning a pregnancy, if thyroid disease runs in the family or after thyroid treatment. For people with a diagnosed condition, the doctor decides how often to check.
