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Thyroid disorders are among the most common diseases – one in three adults will develop a thyroid disorder in their lifetime. One in four has an enlarged thyroid gland or a lump in the tissue. One in ten people suffer from Hashimoto’s thyroiditis, which is a persistent inflammation of the thyroid gland. Dr. Franz Christoph Robiller, Chief Physician, and Dr. Josephine Meister, senior physician at the Clinic for Nuclear Medicine at Bad Berka Central Clinic, on modern diagnostic options.

So small organ and so many effects on vital metabolic processes – what are the most common thyroid disorders?

Robiller: Fortunately, benign diseases are the most common. A goiter with or without a lump is commonly known. Without lumps, this change is called struma diffusa, with lumps it is called goiter nodosa. Germany is an iodine deficient region, unlike Switzerland or the countries of Northern Europe. Goiter, that is, an enlarged thyroid gland, is the most common thyroid disease in people over the age of 60. Goiter but normal-sized thyroid glands can also have cold nodules. There is a risk that a thyroid carcinoma will develop or is already present. Hot nodes are usually associated with an overproduction of thyroid hormones, accompanied by a corresponding acceleration of metabolic processes. There is also diffuse autonomy of the thyroid gland – the autoimmune disease Graves’ disease is thought to cause diffuse autonomy. There are various inflammations of the thyroid gland (thyroiditis), often autoimmune mediated.

Thyroid carcinoma has become somewhat more common in recent years: 6 new cases per 100,000 residents in men and 11 new cases per 100,000 residents in women. Most thyroid carcinomas are well differentiated and have a good prognosis.

More women than men are affected by hypofunction, but children can also suffer from it – how can you tell?

Master: Children have different aspects of underfunction. It is important to note the family history and consider a certain genetic predisposition to thyroid disorders. The second topic is the condition during pregnancy and immediately after childbirth. Thanks to today’s health care, it is possible to detect abnormalities early in U-tests, eg. B. If development is delayed. Furthermore, determination of the TSH value is part of newborn screening, so that congenital thyroid disease can be detected at an early stage and appropriate action can be taken. For example, even with young people affected by obesity, you need to look for clues and, if necessary, keep an eye on the thyroid gland and possible hypofunction. In general, children and adults differ in many respects, for example with respect to symptoms, but also, for example, with respect to chemical laboratory reference values. For example, the TSH reference value in children differs from that of adults. Like all patients, it is important to have a good medical history. Parents who are concerned about the presence of thyroid disease in their children should definitely raise it with their pediatric colleagues.

Medication can help hyperthyroidism – when is surgery necessary, when is radioiodine therapy an option?

Robular: In case of hyperfunction, eg in the case of diffuse autonomic, the symptoms are very stressful for the patient: nervousness, weight loss, sweating, and in older patients there is a risk of osteoporosis. You have to weigh in when an operation and when a radioiodine therapy makes sense. Of course there are advantages and disadvantages. During thyroid surgery, the vocal cord nerve can be injured, resulting in hoarseness with unilateral paralysis. In well-equipped specialized centres, such as the Central Clinic in Bad Berka, such interventions are always carried out using interactive neuromonitoring to prevent this from happening. Radioiodine therapy is indicated for older patients or generally in patients with surgical risk and small thyroid glands. It is always important to us that options are discussed in detail with patients.

Singers, moderators and teachers, that is, everyone who works with their voice, has an objection about this kind of operation…

Master: This is a decision that has to be made in a collaborative and interdisciplinary manner with the patient. And it assumes that those affected also know what the advantages and disadvantages are. Of course, a quick result cannot be expected after radioiodine therapy, which develops its main effect only after about six to eight weeks. You will need to request surgery in individual cases, for example in life-threatening situations. If, for example, a serious heart arrhythmia is triggered by hyperfunction, then of course, immediate action is needed. Like many other decisions in medicine, it is important that patients are well informed about possible medical procedures and are able to make decisions on an equal footing with doctors.

It was said that you should eat a lot of fish?

Robiller: Absolutely! Marine fish are good, but resources are limited. You can improve your supply of iodine tablets, especially in the case of iodine deficiency and a tendency to goiter. But it is important that you consult your family doctor and get your TSH level checked. Perhaps an ultrasound of the thyroid gland should be done.

What symptoms should you see a doctor for?

Robular: If you have unexplained weight gain, lethargy, fatigue, hair loss, edema, these symptoms indicate an underactive thyroid. Hyperfunction leads to unexplained weight loss, nervousness, excessive sweating, restlessness and hair loss. Then you should go to the doctor and get the TSH value determined.

MR: Thyroid screening is particularly worthwhile for patients who suffer from cardiac arrhythmias, particularly atrial fibrillation. An overactive thyroid can trigger such arrhythmias. You should also keep an eye on thyroid values ​​if you do not want to have children. Fortunately, many gynecologists are already very well versed in this regard.

Interview: Anke Geyer