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Diagnosing Thyroid Disorders

  • Blood tests are used to measure thyroid hormones and antibodies
  • For investigating symptoms such as lumps in the throat, hoarseness, and difficulty swallowing
  • Imaging tests and a biopsy may be the next steps
  • Involves Endocrinology and Surgery

Overview

You may not spend much time thinking about whether your thyroid gland is functioning well, but it's more important than you would probably guess. This butterfly-shaped organ wraps around your windpipe and sits just beneath the Adam’s apple. Despite its small size, the thyroid gland contributes in large ways to the overall quality of your life. It plays a key role in the body’s endocrine system, which regulates metabolism, growth and development, reproduction, sleep and mood.

If your thyroid gland malfunctions in some way that affects the the production levels of hormones, you may notice something is amiss. However, because thyroid problems can be difficult to diagnose, doctors rely heavily on lab test results to provide insight.

This is why Yale Medicine researchers, such as Joe M. El-Khoury, PhD, who specializes in reading diagnostic tests, and others conduct ongoing research aimed at improving the tests used to detect thyroid disorders. The goal is to improve diagnostic techniques for thyroid problems, as well as other endocrine disorders.

What role does the thyroid play in the body’s endocrine system?

The thyroid gland produce thyroid hormones. Problems can result if it produces too much or too little. Low thyroid levels can leave you feeling extremely tired. Too much of this hormone in your bloodstream might cause your heart to beat fast and make you feel anxious.  

Hormone fluctuations occur naturally during different life stages—for instance, during puberty or menopause for women—but they can also occur unnaturally due to exposure to toxins, chronic stress and/or infections. A healthy thyroid produces just enough hormones to regulate the body’s metabolism, which in turn dictates how much energy you create and use. 

How are thyroid disorders diagnosed?

Your doctor will perform a physical examination and take your medical history. If thyroid disease is suspected, your physician will order a blood test to measure thyroid-stimulating hormone (TSH) to determine if you have low levels of TSH, which can be the first indication of a thyroid disorder. Another blood test measures a hormone called T4, also produced by the thyroid. A third blood test is called the anti-thyroid microsomal antibody test. This measures the amount of anti-thyroid peroxidase (anti-TPO) antibodies in the blood stream. Large amounts of antibodies, which are produced by the immune system, could indicate that some thyroid damage has already occurred.

If you have an abnormally high level of the hormone TSH, then you might have an under-active thyroid gland, a condition called hypothyroidism. Low levels of TSH is an indicator of hyperthyroidism.

How are thyroid disorders treated?

In many cases, a thyroid disorder can be alleviated by taking medicine. If necessary, a doctor may recommend surgery in order to retrieve a small piece of tissue from the thyroid and examine it for the possibility of thyroid cancer or other thyroid-related diseases.

A doctor can send a blood sample off for analysis and have an answer back within minutes. During surgical operations for thyroid cancer, these quick testing methods become more important. “We have a testing instrument located right next to the operating room, so a surgeon can have a tissue sample analyzed immediately to gauge how much of the thyroid gland needs to be removed,” Dr. El-Khoury says. This helps reduce surgery time, which also helps a patient recover faster. 

How is Yale Medicine’s approach to diagnosing thyroid disorders unique?

Yale Medicine doctors and staff ensure that patients receive necessary tests to diagnose a condition—but none more than necessary. Researchers at Yale have led national efforts to encourage health care providers to choose lab tests wisely and this is the case with thyroid disorders, too.