At the University of Michigan, patients with thyroid disorders are cared for by experts from endocrinology, endocrine surgery, nuclear medicine, otolaryngology’s head and neck surgery, radiation and medical oncology, radiology, genetics, and pathology. Our team is focused on reaching accurate diagnosis through comprehensive testing and providing the best treatment options for each patient. We are often referred patients with very complex issues and are constantly evaluating new techniques and therapies to offer our patients the best care possible.
About the Thyroid Gland
The thyroid is a small, butterfly-shaped gland located in the lower portion of the neck. It produces hormones that control many of our organs and our metabolism. The thyroid helps regulate how your body metabolizes (processes) proteins, fats, carbohydrates and vitamins, and helps determine your body's overall temperature. Thyroid hormones are also important in helping the body produce and use other hormones and chemicals.
Production of thyroid hormone by the thyroid gland is regulated by another hormone that is made by the pituitary gland (a small gland in the base of your brain). The pituitary and thyroid glands work together to produce the right amount of thyroid hormone for the body. If the body needs more thyroid hormone, the pituitary will increase production of thyroid stimulating hormone (TSH) to stimulate production of thyroid hormone from the thyroid gland. If the body has enough thyroid hormone, or makes too much, the pituitary will make less TSH.
About Thyroid Disorders
Sometimes production of thyroid hormone can become unbalanced. People are considered hypothyroid when they produce too little thyroid hormone and hyperthyroid when they produce an excess. In hypothyroid patients, the TSH level is elevated, and in those with hyperthyroidism the TSH level is low. There are many causes for hypo- and hyperthyroidism.
We see patients with thyroid disorders, including:
- Thyroid nodules are a growths or lumps in the thyroid gland. They are fairly common and can be found in a normal sized or an enlarged thyroid gland. Around 95% of nodules are benign, or non-cancerous, but nodules are often tested for cancer. Occasionally they lead to problems in hormone production or breathing and swallowing.
- Thyroid cancer is found in about 5% of thyroid nodules. The most common types are papillary and follicular thyroid cancers. Rarer are Hurthle, medullary thyroid carcinoma (MTC) and anaplastic thyroid carcinoma.
- Hyperthyroidism is a disorder caused by an overactive thyroid that causes the body to speed up. It can cause weight loss, a fast heartbeat, sweating, or feelings of nervousness. If untreated it can lead to serious heart, bone and other problems.
- Hypothyroidism is a disorder caused by an underactive thyroid that may lead to changes in the hair or skin, fatigue and weakness, memory problems, or other issues.
- Graves’ Disease is one of the main causes of hyperthyroidism. It is an autoimmune disease, more common in women than men, and can be associated with a special type of eye abnormality (Graves’ eye disease).
- Hashimoto’s Thyroiditis, also known as Hashimoto’s disease, is an autoimmune disease. It causes the body’s immune system to produce antibodies that attack thyroid tissue and damage the gland, leading to an underproductive thyroid—or hypothyroidism.
Diagnosis of Thyroid Disorders
We diagnose thyroid disorders through comprehensive testing that starts with a complete history and physical exam, and is followed by blood work, which is important for identifying the disorder. Depending on the specific problem, we may conduct an ultrasound of the thyroid to identify nodules or other abnormalities. Ultrasounds also allow us to guide a needle biopsy, if necessary, to evaluate a nodule or lymph nodes in the neck. Other imaging tests that may be ordered include CAT scan, MRI, and nuclear medicine tests such as radioiodine scans and PET scans.
Treatment for Thyroid Disorders
Each case will be carefully evaluated by the care team to decide the best course of treatment. In most cases, evaluation shows the nodule to be benign (non-cancerous) and that the function of the thyroid gland is normal. In that circumstance, usually no specific treatment is needed, and the thyroid can simply be followed to make sure the nodules don't become a problem over time.
If your physician is concerned that your nodule may be cancerous or is large enough to cause problems with breathing or swallowing, surgery may be recommended. Your surgeon will discuss the appropriate surgical options with you. Surgical options range from removing only the side of the thyroid gland that contains the nodule in question, to removing the entire thyroid gland, known as a thyroidectomy. For patients with nodules that need to be removed, some of these surgeries can be performed as a minimally invasive outpatient procedure.
Other treatments may include fine needle aspiration or radioactive iodine treatment. Fine needle aspiration involves using a small needle to drain a fluid-filled (cystic) nodule. Some cysts do not return after they are drained, but many do. If the cyst continues to return, surgery or an ethanol injection may be necessary. Radioactive iodine treatment for thyroid nodules is more often used to treat hyperthyroidism caused by noncancerous thyroid nodules. The thyroid is one of the few glands in the body that avidly takes up iodine. This allows the radioactive iodine to selectively damage the thyroid gland without affecting other parts of the body. The damage to the thyroid gland lowers production of thyroid hormone, curing hyperthyroidism.
The University of Michigan’s Multidisciplinary Thyroid Cancer Clinic, part of the U-M Comprehensive Cancer Center Endocrine Oncology Program, offers comprehensive interdisciplinary care for patients with all types of thyroid cancers. Our team includes endocrine surgeons, endocrinologists, oncologists, nuclear medicine specialists, pathologists, radiation oncologists, genetic counselors and others who are leaders in their fields. Cases are reviewed weekly by our Multidisciplinary Thyroid Tumor Board. Learn more about care for thyroid cancer at the University of Michigan.
Currently, there are several effective treatments available for hyperthyroidism. Deciding which treatment is best depends on the cause, the severity, and other factors. The most common treatments are antithyroid medicine and radioactive iodine.
Antithyroid medication (most often methimazole) helps to slow down hormone production. Antithyroid medicine does not cure the disease but works while the patient takes the drug. That means that this medication is not usually a long term solution, although in some patients the hyperthyroidism does go into long term remission. Some forms of hyperthyroidism do not respond well to this treatment, and antithyroid drugs have occasional side effects. Often patients are given beta blockers to help relieve the symptoms of hyperthyroidism, although these drugs do not normalize the amount of thyroid hormone in your system like antithyroid medications.
Radioactive iodine (RAI) is a common treatment for hyperthyroidism. The thyroid is one of the few organs in the body that avidly takes up iodine. This allows radioactive iodine to selectively damage the thyroid gland without affecting other parts of the body. The damage to the thyroid gland lowers production of thyroid hormone, curing hyperthyroidism. In general, this treatment can be used in patients with Graves' disease or in those patients with nodules in the thyroid gland causing hyperthyroidism. Not all cases of hyperthyroidism respond well to radioactive iodine. In most patients, radioactive iodine leads to the opposite conditions of hypothyroidism, which is easily treated with levothyroxine (lifelong therapy is needed).
Less commonly, patients will have all or part of their thyroid surgically removed.
After treatment, you will need regular checkups and blood tests to make sure your thyroid hormone levels remain steady. As noted above, sometimes treatment cures hyperthyroidism but causes hypothyroidism, the opposite issue of too little thyroid hormone, and you will need to take hormone pills.
Usually, hypothyroidism can be easily treated with thyroid hormone medicine. The medicine typically used is levothyroxine, which is identical to the main thyroid hormone made by the thyroid gland. In many cases, symptoms will start to improve in the first week or two after treatment begins and will completely disappear within a few months. You will need to have regular visits and blood work to monitor your progress and maintain a healthy medicine dose.
Make an Appointment
To see an endocrinologist about your thyroid disorder, call our clinic at 734-647-5871. Your physician may also refer you to an endocrine surgeon or other specialist at the University of Michigan Health System.