Hyperthyroidism also occurs in other situations. In the elderly it may be caused by an enlarged, lumpy thyroid gland called a toxic nodular goiter. Usually such individuals have had a goiter for several years and the increased thyroid activity has developed very slowly. Women who have just had a baby are also prone to hyperthyroidism. This form is called postpartum thyroiditis. In other individuals, a viral infection in the thyroid gland can cause a disease called subacute thyroiditis, which is one of the very few conditions that causes pain in the thyroid gland. Unlike Graves’ disease, the hyperthyroidism that occurs with postpartum and subacute thyroiditis resolves itself in a few weeks. Sometimes a temporary period of hypothyroidism occurs after a bout of postpartum or subacute thyroiditis.
Goiter – In younger people, a goiter, or enlarged thyroid gland, is most commonly caused by some form of thyroiditis. In the elderly, goiters usually result from the growth of one or more lumps (called nodules) in the gland. Goiters usually develop over many months or years. In most cases the thyroid continues to function normally, meaning that hypothyroidism or hyperthyroidism are not present. Nodules in the thyroid gland are common in both younger and older individuals. Fortunately, most are just benign growths that are not a cause of great concern.
How Are Thyroid Problems Diagnosed?
If you and your doctor suspect that you have an underactive or overactive thyroid gland, blood tests are the best way find out for sure. In hypothyroidism, the level of T4 in the blood is usually below normal, whereas in hyperthyroidism both T4 and T3 levels are usually elevated. In mild cases of hypothyroidism and hyperthyroidism, however, the levels of T4 and T3 may actually be within the normal range. In that case, the measurement of thyroid stimulating hormone, or TSH, level in the blood is the best test.
TSH is a hormone from the pituitary gland. It keeps close watch on the thyroid gland and acts like a thermostat to control thyroid activity. When the thyroid is even mildly underactive, the pituitary tries to stimulate the thyroid by making more TSH. This shows up as an elevated TSH level in the blood. In the case of an overactive thyroid, the pituitary tries to shut-off the thyroid by making less TSH, causing the blood TSH level to drop. The fact that the pituitary gland is such a sensitive thermostat makes the TSH test the best blood test to diagnose hypo- and hyperthyroidism. Although problems can arise in the pituitary gland that will affect the way the thyroid functions, these are quite rare.
A doctor usually diagnoses a goiter by simply examining the patient’s neck and feeling for an enlarged thyroid gland. Several types of scans and sound wave, or ultrasound, tests are available to take a better look at the thyroid and detect nodules.
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