Thyroid in India linked to immunity : The Tribune India

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Thyroid in India linked to immunity

The thyroid gland is in the middle of the lower neck; it produces a hormone that influences every cell, tissue and organ in the body.



Sameer Aggarwal

Rohtak-based endocrinologist

The thyroid gland is in the middle of the lower neck; it produces a hormone that influences every cell, tissue and organ in the body.  Hypothyroidism is the most common form of thyroid malfunctions. The diagnoses have been climbing because technology has enabled lab tests to recognise milder conditions that weren't recognised previously. 

Though hypothyroidism worldwide is due to iodine deficiency in people's diets, that's not the case in India.

Here, it's because a person's immune system fails to recognise the thyroid and attacks — a situation in which antibodies directed against the thyroid gland lead to chronic inflammation — also known as Hashimoto's thyroiditis.

The problem frequently runs in families.

The opposite situation — an overactive thyroid condition known as hyperthyroidism — is far less common. 

Both hypothyroidism and hyperthyroidism are five to 10 times more common in women than in men for unknown reasons. And though thyroid problems may crop up at any time, most start when women are 40 or older — again, for unknown reasons. One woman in eight will develop a thyroid disorder in her lifetime

Most nodules, or lumps within the thyroid, are found by accident when a person is having imaging done for some other condition. Over half of women over 50 have at least one nodule, but 95 per cent turn out to be benign. Any nodules that look suspicious need to be biopsied to make sure they're not thyroid cancer.

Though thyroid cancer diagnoses have been climbing over the past 30 years, the treatments are usually effective and thyroid cancer deaths have remained stable over the years.

Therapies

There are new and evolving therapies. In most cases, it is a very treatable cancer. The therapy story is a happy one.

A concern remains, however, that pregnant women are ingesting inadequate amounts of iodine. That's important because dietary iodine is needed to produce adequate thyroid hormone, which is important for the foetus' brain development. Pregnant women with undiagnosed or inadequately treated hypothyroidism also have an increased risk of miscarriage and pre-term delivery. Pregnant women need to check their pre-natal multi-vitamins to make sure they include 150 mcg of iodine daily and to get more iodine by including seafood, milk, other dairy products and iodised salt in one's diet. Many people don't realise that commercially manufactured foods contain no iodised salt.

In the old days, most patients would have their thyroids removed after a lump was found that was thyroid cancer in their neck, and after surgery, they'd get treatments with radioactive iodine. Now, doctors recognise that many patients with so-called micropapillary thyroid cancers, which are a centimetre in diameter or smaller, may not require surgery. Doctors advise that patients get tested for thyroid problems, especially if they run in the family. The blood test measures the level of the thyroid stimulating hormone, known as TSH, that is produced in the pituitary gland. The hormone is usually the first test to become abnormal when a patient has thyroid dysfunction.

In patients with family history of thyroid disease, history of autoimmune disorders or abnormal thyroid labs, checking thyroid antibodies (anti-TPO ab, anti-thyroglobulin antibody) is helpful to check for autoimmune thyroid disease.

Consult an endocrinologist if you have thyroid problems.

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