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If your thyroid is not functioning properly, neither do you! – such a slogan accompanies the American Awareness Week, which promotes knowledge about the functioning and diseases of the thyroid gland. In Poland, the Week for Combating Thyroid Diseases has been organized since 2009. Where does such interest in this organ come from?
The thyroid gland can be compared to the engine that drives the body – the hormones released by it ensure an appropriate metabolic rate, regulate the growth and development of the system. At the same time, diseases of this organ are quite common – in Poland they affect about 22% of the population, and many patients are not aware of the disease. Some of the symptoms accompanying disorders of the thyroid gland (including chronic fatigue, problems with remembering, maintaining weight and body temperature) are often confused with aging or menopause, the more so as the peak incidence is 50-60 years of age, and women they are sick 8,5 times more often than men. A more specific symptom of thyroid dysfunction is the appearance of a goiter.
Blood laboratory tests assessing the function of the thyroid gland are readily available, and their results allow to detect disorders of this organ at an early stage. The level of pituitary hormone, TSH and the so-called free (biologically active) fractions of thyroid hormones – FT3 and FT4. Behind these enigmatic symbols are triiodothyronine and thyroxine, respectively.
TSH regulates the level of FT3 and FT4 on the basis of feedback, and its quantitative measurement allows the fastest detection of thyroid disorders, even when the concentration of FT3 and FT4 remains normal. However, in the case of severe clinical symptoms or previously diagnosed and treated thyroid diseases, it is also recommended to measure FT3 and FT4 hormones.
What should be done if any of these determinations deviated from the range of reference values (commonly speaking – standards) provided by the laboratory? Of course, you need to see a doctor, but before the visit, you can do some tests that may shed light on the causes of the disease. Thyroid diseases often have an autoimmune background. This means that the patient’s own defense cells, lymphocytes, start to get confused and attack their own tissues, mainly with the help of the so-called autoantibodies – antibodies against self proteins. This phenomenon leads to the development of diseases such as diabetes or celiac disease, and in the case of the thyroid gland – Hashimoto’s thyroiditis, leading to hypothyroidism and Graves’ disease, manifested by hyperthyroidism. The autoimmune basis of these diseases can be confirmed by determining the level of autoantibodies against thyroid proteins – thyroid peroxidase (anti-TPO) and thyroglobulin (anti-TG). The differentiating test between them (Hashimoto’s disease progresses from the overactive stage) is the determination of autoantibodies against the TSH receptor (TRAb), which is also useful in monitoring the treatment of this disease.
The thyroid gland deserves special attention in pregnant and planning women. Disorders of its functions can cause both problems with fertility and the maintenance of pregnancy, as well as birth defects of the newborn. Therefore, it is worth checking the level of TSH before pregnancy, and in justified cases (clinical symptoms, family history of thyroid diseases), also FT3, FT4 and anti-thyroid autoantibodies.
The presence of a goiter or a nodule within the thyroid gland may also suggest thyroid neoplasms. It should be remembered that most thyroid hyperplastic diseases are completely healed, so prompt diagnosis is essential. Laboratory diagnosis is especially useful in medullary thyroid cancer, the diagnosis of which may be based on the presence of an elevated level of calcitonin. This test is also used to assess the effectiveness of the treatment or disease recurrence. In the case of elevated calcitonin, it is also recommended to determine another, non-specific tumor marker – CEA. Medullary cancer in 20% of cases is hereditary – it is associated with the presence of certain mutations in the RET proto-oncogene. Molecular diagnostic tests make it possible to detect them by analyzing the DNA of the patient’s and his family’s blood. This is a prerequisite for early prophylaxis. The diagnosis of other thyroid cancers is based on the analysis of the biopsy material, but also laboratory tests are necessary in monitoring the effectiveness of treatment and the potential recurrence of the disease. The most common method is to measure the increase in thyroglobulin concentration (a marker of thyroid neoplastic cells) in the period after treatment. This test is reliable when no anti-TG antibodies that interfere with the test are also found.
Therefore, it is worth spending some time on preventive examinations from the earliest years of life in the face of the threat of the population with diseases related to thyroid dysfunction.
text: dr n. med. Emilia Martin