More than six million. There are many people who, at all ages, have to deal with a thyroid that works too much or too little. And bad anyway. With all the consequences of the case, also in terms of healthcare spending. Because gland pathologies are among the most frequent causes of consultation for the doctor, as well as diagnostic tests and any surgical therapies, with the need to avoid possible excesses of treatment. Not for nothing, a slogan for World Thyroid Week (SMT) which is celebrated starting from May 20th and ending on May 25th, on the occasion of the World Thyroid Dayreads: “Chronic thyroid diseases: more information, fewer unnecessary tests”.
In short, there must be appropriateness in the study and management of gland pathologies. In fact, classifying thyroid diseases among chronic pathologies has great significance, given that biomedical research in this sector requires substantial funding. Therefore, this recognition would allow access to greater funding for new studies whose results would benefit the population affected by these pathologies.
How the thyroid is made and what happens if it works badly
The thyroid is a butterfly-shaped endocrine gland located in the neck, immediately below the Adam's apple. The two wings of the organ form the so-called lobes, while the central area, where the two lateral parts join, is called the isthmus. Although normally small, increases in glandular volume they can be linked to particular pathologies or to the classic goiter.
The thyroid is of great importance for the well-being of the organism. In fact, it produces a series of hormones which operate directly on different organs and above all affects factors of great importance for health. For example, in those who have a thyroid that works little, or suffers from hypothyroidism, the heart tends to beat more slowly, fatigue is felt much more, one suffers particularly from the cold and even the cholesterol values in the blood tend to rise. The exact opposite happens if the gland, or a part of it, works too hard, i.e. in the case of hyperthyroidism. The heart tends to beat faster, so much so that sometimes even certain palpitations can be referred to an excess function of the gland, and the metabolism tends to accelerate, with a possible weight loss.
How important is iodine for the thyroid
Hormone production and thyroid regulation depend onactivity of the pituitary gland, a gland located inside the brain: the glandular action is governed by the thyroid-stimulating hormone (TSH). Driven by this, the thyroid produces its own hormones, in which some iodine molecules are incorporated: it is for this reason that an insufficient intake of iodine to the organism over time it can lead to a deficit in the production of thyroid hormones and therefore to manifestations of compensation on the part of the glandular tissue, which therefore tends to hypertrophy in an attempt to respond to the organism's requests.
When there is one chronic iodine deficiency, the thyroid reacts by trying to develop its own structures in order to produce the quantities of hormones necessary for the proper functioning of the organism. The gland then increases in volume, to the point of creating a real swelling in the neck (goiter), which can sometimes be invisible because it develops inwards, thus compressing the trachea and esophagus. Sometimes the anomalous development of the gland can be linked to a single nodule that forms inside it; other times it may be due to a series of small nodules. Therefore it is necessary to monitor the evolution of the picture together with the doctor, who can choose the most effective therapeutic options.
What are the main tests to study the thyroid
There TSH measurement (thyroid stimulating hormone produced by the pituitary gland) is the main (and inexpensive) method for precisely defining thyroid function. The dosages should also be done when young in all subjects with first-degree relatives who suffer from autoimmune diseases of the gland. To understand whether the thyroid is working too much or too little, the thyroid hormones T3 (triiodothyronine) and T4 (thyroxine), whose production is regulated by TSH, can also be measured. Thyroid function is best assessed with the dosage of FT3 and FT4 which correspond to the truly “active” fraction of the hormone. Normal values of TSH and FT3-FT4 indicate that the thyroid is functioning normally. An increase in TSH and low FT3 and FT4 values indicate the presence of hypothyroidism, i.e. reduced thyroid function; vice versa, we are in the presence of hyperthyroidism.
Because thyroid diseases should be considered chronic
“Most thyroid diseases can rightfully enter the group of non-communicable diseases, in fact, both hyperthyroidism and hypothyroidism are chronic pathologies, in the majority of cases of an “autoimmune” nature, that is, caused by an abnormal immune reaction that turns against the thyroid cells, causing destruction in the case of hypothyroidism or excessive stimulation in the case of hyperthyroidism – explains Gianluca Aimaretti, President of SIE (Italian Society of Endocrinology). In both cases these are pathologies that need to exist check periodically, without exceeding the number of checks and the type of tests to be performed cyclically. For example, the dosage of autoantibodies, whose numerical value can vary independently of the clinical variation of the disease, should not be repeated at every check-up, but only at particular moments of the treatment process identified by the specialist”.
“It is important, however, to underline that, if it is true that on the one hand the frequent repetition of clinical and instrumental tests that are not strictly necessary, represents one of the most expensive itemsas far as the budget of our NHS is concerned, on the other hand, the need for the monitoring of thyroid function in elderly patients with a known pathology, especially if under therapy with thyroid hormone or antithyroid drugs – underlines Fabio Monzani, Delegate of the Italian Society of Gerontology and Geriatrics – SIGG”.
“Precisely due to the chronic nature of most thyroid pathologies – highlights Renato Cozzi, President of AME (Association of Endocrinologists) – it is essential that the endocrinologist approach these patients with empathy, who often meet the specialist after long periods of waiting, listening carefully to the symptoms they complain about, visiting them by also placing your hand on their neck and reassuring them, once they have seen the tests, that their symptoms can be treated effectively when dependent on a real thyroid pathology”.
The impact of benign and non-benign thyroid nodules
“Nodular thyroid disease is also a chronic disease – recalls Laura Fugazzola, President of ETA – European Thyroid Association. The presence of small nodules, sometimes smaller than 1 centimeter, is very common in the general adult population (50 percent of those over 50) but their clinical relevance is very poor. For this reason theperforming thyroid ultrasound scans on large segments of the population, performed without a clinical reason, is currently not recommended because it will highlight nodules which will have very little clinical importance, but which will causeuseless concern in the subject in which they were accidentally detected. Otherwise, nodules larger than those described above must be evaluated for the possibility of altering thyroid function and to verify their nature. Benign nodules that do not alter glandular function will still need to be checked periodically and the inclusion of this clinical condition among chronic diseases could help reduce healthcare spending through better planning of clinical checks, thus avoiding the repetition of useless tests. At the same time, it could be envisaged to include this pathology, as it is chronic, among the exempt from paying the ticket”.
“Speaking of the thyroid tumors – adds Rossella Elisei, President of the AIT – Italian Thyroid Association – in particular the papillary form, are certainly to be considered among the chronic non-communicable diseases as very often, and fortunately, they heal or become chronic with a low probability of recurring but, since the patients have been thyroidectomized and subjected to thyroid hormone therapy, they must be followed for a long time. Also for this pathology there are risk factors that can be positively modified, for example by avoiding or minimizing exposure of the neck region to ionizing radiation. Identification of the malignancy of the nodule occurs with needle aspiration and thecytological examination which however today are reserved only for nodules larger than one centimeter and with suspicious ultrasound characteristics. It is important to remember that only 5% of thyroid nodules are malignant in nature and rarely present in an advanced form with distant lesions. Surgical therapy and, when appropriate, metabolic radiotherapy can completely resolve the disease. Given the characteristics of these very widespread diseases, but often not serious and treatable successfullyit is particularly important to promote comprehensive but not alarmist information, avoiding unmotivated diagnostic investigations”.
