- MEDICINE ATHENS MED4WOMAN ATHENS
- MEDICINE VOLOS MED4WOMAN VOLOS
- 2103390838
- 2421022988
Obstetrician Gynaecologist
Doctor of Medicine, University of Athens Medical School
Panagiotis Polyzos, Gynaecologist Obstetrician, is active at the Institute of Life - IVF Unit of Iaso Maternity Hospital.
The thyroid is a butterfly-shaped gland located at the front of the neck, and it plays an extremely important role in many of the body’s functions. When a problem occurs, the thyroid may develop nodules and may either underfunction or overfunction, leading to the production of an incorrect amount of hormones. When thyroid dysfunction is present, symptoms typically appear because as the level of thyroid hormones in the body increases, the TSH (thyroid-stimulating hormone) level decreases to progressively lower values.
The thyroid gland produces the hormones thyroxine or tetraiodothyronine (T4), triiodothyronine (T3), and calcitonin. The hormones T3 and T4 contain iodine and regulate how the body uses energy. They increase what is called the basal metabolic rate, meaning they enhance the body’s overall energy consumption. T3 and T4 are secreted by the thyroid gland when it is stimulated by the hormone TSH, which is produced by a region of the brain called the pituitary gland. The secretion of TSH is promoted by the hormone TRH, which is released by another area of the brain called the hypothalamus. TRH is secreted when T3 and T4 levels are low. Calcitonin is essential for regulating calcium levels in the blood.
- Hyperthyroidism
- Hypothyroidism
- Thyroiditis (especially postpartum thyroiditis)
- Goiter
- Thyroid nodules
- Thyroid cancer
Hyperthyroidism is an overactivity or excessive production of thyroid hormones (FT3 and FT4) in the body. The symptoms are exactly the opposite: tachycardia, diarrhea, nervousness, weight loss, hypertension, loss of bone mass, sweating, feeling hot, eye disorders (redness, dryness, tearing or irritation of the eyes, photophobia, or even upper eyelid retraction that creates a “bulging” or aggressive look, etc.). There is also the possibility, in the case of subclinical hyperthyroidism and subclinical hypothyroidism, that there are no clear but rather atypical symptoms.
In the case of hyperthyroidism, the patient must be nutritionally protected from weight loss by consuming larger amounts of food daily in order to take in the necessary energy to maintain a stable body weight. It is important to meet the increased calcium needs by consuming increased amounts of dairy products during the day (2–3 servings daily), as well as taking calcium supplements if the doctor deems it necessary. In the case of diarrhea, the consumption of insoluble fiber (fruits and vegetables), the consumption of soluble fiber (whole-grain products), and the consumption of probiotics, either through foods (e.g., yogurt, yogurt drinks) or supplements, should be limited. Attention must also be given to the replenishment of fluids and electrolytes (Sodium, Potassium, Chloride) because, due to diarrhea, the losses are significant.
When the gland underfunctions, it is called hypothyroidism. Hypothyroidism occurs when the thyroid gland fails to produce a sufficient amount of thyroid hormone for the body’s needs. Symptoms include fatigue, tiredness, sleepiness, constipation, excess weight (because the body’s energy expenditure decreases), increased feeling of cold, hoarseness, dry skin, thin and brittle hair, hair loss, menstrual disorders, anemia, sadness or even depression, dental problems, etc.
In the case of hypothyroidism, the symptoms related to diet and those that should be monitored are: the B-complex vitamins, vitamins A, C, and E, as well as zinc, which play a role in hypothyroid conditions. If constipation occurs, the intake of soluble dietary fiber (whole-grain products) should be increased, water intake should be sufficient, and the consumption of probiotics should be included in the daily diet. Foods such as Brussels sprouts, potatoes, peanuts, and soy cause malabsorption of iodine, and it would be better if they do not accompany iodine-rich foods.
Blood tests used to check the levels of your thyroid hormones (T3, T4, TSH, etc.), as well as thyroid antibodies, can confirm whether your thyroid is overactive, underactive, or functioning normally.
If there are relevant indications from the blood tests or from the clinical examination (if the endocrinologist has palpated a nodule), you may need to undergo an ultrasound, which will show the morphology of the thyroid (size, texture, presence or absence of nodules, etc.).
If nodules are present (especially if they are large), the doctor may recommend a scintigraphy scan, which provides information about their functionality — whether a nodule is “hot” or “cold” (cold nodules are more suspicious for malignancy than hot ones), whether it is toxic, etc.
If the nodules are suspicious, the next step will be a fine-needle aspiration (preferably under ultrasound guidance), where a special needle is used to collect cells from the nodules to investigate the possibility of malignancy.
A thyroid ultrasound also helps in diagnosing Hashimoto’s disease, because it can very early show initial changes in the size and structure of the thyroid gland — such as enlargement, heterogeneity, hypoechogenicity, nodules, and increased vascularity of the gland.
People suffering from Hashimoto’s thyroiditis may not show any symptoms for many years, but eventually most will develop some degree of hypothyroidism, which will progressively worsen over time.
Postpartum thyroiditis is an inflammation of the gland that occurs in about 10% of women after childbirth. In many cases, it is not diagnosed on time. Women with postpartum thyroiditis may feel extremely tired and experience low mood. The condition often appears in two phases: In the first phase (1–4 months after giving birth), symptoms of hyperthyroidism occur. This phase lasts about 1–2 months. In the second phase (4–8 months after giving birth), symptoms of hypothyroidism appear. This phase can last 6–12 months.
Just like the thyroid gland, the ovaries are stimulated by the brain and controlled by the hypothalamus and the pituitary gland. When long-term imbalances occur in the hypothalamus–pituitary–thyroid axis, problems in metabolism (due to the thyroid) and reduced ovarian function may develop. In extremely rare cases, since the body is already affected by one autoimmune disorder, it may also develop an autoimmune condition of the ovaries, where the body mistakenly produces antibodies against the ovarian tissue.
In cases where the ovaries become dysregulated, hormonal therapy with estrogens and progesterone restores balance.
A lack of thyroid hormones can affect the ability to conceive in several ways. Hypothyroidism causes an increase in prolactin, disrupts the secretion of gonadotropins from the pituitary gland, affects adequate progesterone production, and influences estrogen metabolism, among other mechanisms. Therefore, it reduces fertility by causing irregular menstrual cycles, reduced frequency of ovulation, and impaired embryo implantation. Treatment with levothyroxine restores normal hormonal balance, regulates the menstrual cycle, and increases the chances of natural conception.
Mild hyperthyroidism does not seem to affect fertility to the same extent as hypothyroidism. Most women with mild thyroid overactivity may notice changes in the duration and amount of menstrual bleeding, but ovulation is usually not impaired. Women with low TSH but normal thyroid hormone levels do not require treatment, only close monitoring. This is not the case in severe hyperthyroidism (when thyroid hormones are significantly above normal levels). In these cases, menstruation may cease.
Overall, autoimmune thyroid disorders are particularly common in young women. The presence of elevated thyroid autoantibodies (even when thyroid function is normal) is associated with a two-fold increase in the risk of infertility.
Pregnancy, even in women without any thyroid condition, causes significant changes in thyroid hormone levels. This can affect the course of pregnancy and the developing fetus, as well as the mother’s health during pregnancy and after childbirth. The diagnosis and management of thyroid diseases during pregnancy require specialized care.
Hypothyroidism must be corrected before or in the early stages of pregnancy. The first trimester is very important for the fetus, as this is when organogenesis takes place — the formation of the various organs, especially the brain. After 14 weeks, the fetal thyroid gland begins to function on its own. If hypothyroidism is not treated in time, it can be dangerous because there is an increased risk of neurological defects in the fetus and reduced mental development after birth.
Hyperthyroidism during pregnancy may cause several complications for both the mother and the fetus. Miscarriage, excessive increase in blood pressure, preterm labor, fetal growth restriction, fetal tachycardia, and low birth weight are only some of these problems.
The good news, however, is that most thyroid problems are manageable when diagnosed early, and with proper monitoring, everything can be effectively treated.
