T3 and T4

What is T3 and T4

The thyroid gland produce two major hormones called Triiodothyronine (T3) and Thyroxine (T4). The thyroid gland takes iodine, found in our diet, combines it with an amino acid, tyrosine and converts it into T3 and T4.

  • T3 – Triiodothyronine: Containing three iodine atoms.
  • T4 – Thyroxine: Containing four iodine atoms
T3 Triiodothyronine Image
T4 Thyroxine Image

The Follicular cells are the major cell type in the thyroid gland and are responsible for the production and secretion of the thyroid hormones T3 and T4.

T3 (triiodothyronine): Approximately 20% of T3 is secreted into the bloodstream directly by the thyroid gland. The remaining 80% is produced by the removal of one iodine atom from T4 by a process called deiodination. This process occurs primarily in organs such as the liver and kidneys. T3 is the active form of the thyroid hormone T4 (thyroxine).

T4 (thyroxine): functions as a “storage” hormone. On its own, it is unable to produce energy. Therefore, it must undergo a process known as deiodination in which it loses an atom of iodine to become triiodothyronine (T3).

Both triiodothyronine (T3) and thyroxine (T4) are essential hormones for brain and physical development in infants and for metabolic activity in adults. Thyroid hormones help the brain, heart, liver, muscles, and other organs function properly.

How is T3 and T4 controlled?

The production and release of T3 and T4 is controlled by thyroid stimulating hormone (TSH) secreted by the pituitary gland, which is in turn regulated by thyrotropin-releasing hormone (TRH) secreted by the hypothalamus (a small region of the brain).

Negative Feedback Loop Image
Negative Feedback Loop

This process works as a negative feedback loop. When levels of T3 and T4 decrease below normal, the pituitary gland produces TSH, stimulating the thyroid gland to produce more hormones (T3 and T4). Once the levels rise, the pituitary gland then decreases TSH production.

Hence, this system allows the body to maintain a constant level of T3 and T4 in the body. 

Forms of T3 and T4 hormones.

Most of the T3 and T4 in your body are bound to serum protein such as ( thyroxine-binding globulin (TBG), transthyretin (TTR), albumin, and lipoproteins) and transported throughout the body.

However, a smaller portion of T3 and T4 doesn’t bind to protein is called Free T3 (FT3) & Free T4 (FT4), which circulates through the bloodstream as free or unbound hormones.

T3 exists in two forms in the blood:

  • Bound T3: More than 99.5% of T3 are bound to serum proteins that help transport the hormone through the body.
  • Free or Unbound T3: About 0.5% of T3 doesn’t bind to serum protein is called free T3 and circulates unbound in your blood.

T4 exists in two forms in the blood:

  • Bound T4: More than 99.95% of T4 are bound to serum proteins.
  • Free or Unbound T4: A minimal amount, about 0.02%, of T4 doesn’t bind to serum protein is called free T4 and circulates unbound in your blood.

Why doctors perform T3 and T4 tests

Blood tests for thyroid function such as T3, T4, TSH and others are an important part of diagnosing and treating thyroid disorders. Some conclusions can be drawn from a single test, however a combination of two or more tests are usually needed to check the health of your thyroid.

By comparing the values of different thyroid tests, a doctor can determine whether a person has hypothyroidism  (low thyroid function), hyperthyroidism (overactive thyroid), or an autoimmune thyroid disease such as Graves’ disease or Hashimoto’s thyroiditis.

T3 (triiodothyronine) Test

T3 (triiodothyronine) is a thyroid hormone and the test measures how much is in your blood.

  • Total T3 test: This test simply measures how much of T3 hormone both (bounded and free) is present in your blood. If the level is either abnormally high or abnormally low, it can be an indicator of thyroid disease.
  • Free T3 test: This test just measures free or unbounded T3 present in your blood. This test is often not reliable and therefore not typically helpful.
  • Reverse T3 test: Reverse T3 (RT3) is a biologically inactive protein that is structurally very similar to T3, but the iodine atoms are placed in different locations, which makes it inactive. RT3 is a blood test that not commonly ordered by the doctors.
Reverse T3 Image

What does T3 test results mean?

This single test may not give your doctor any definitive answers about what is wrong. However, abnormal results can help point them in the right direction. If your results show high T3 levels, it may mean you have hyperthyroidism (overactive thyroid). Low T3 levels may mean you have hypothyroidism, a condition in which your body doesn’t make enough thyroid hormone.

However, T3 tests are generally more useful for diagnosing hyperthyroidism than hypothyroidism.

Further, T3 tests are frequently ordered with T4 and TSH (thyroid stimulating hormone) tests, because it can give your doctor a more complete picture of what’s going on.

If you have questions about your results, talk to your health care provider.

T4 (thyroxine) Test

T4 (thyroxine) is a thyroid hormone and the test measures how much is in your blood.

The T4 test measures two key values:

  • Total T4 test: This test measures how much of T4 hormone (both bounded and free) is present in your blood. 
  • Free T4 test: This test just measures free or unbounded T4 present in your blood. A free T4 test is often preferred over a total T4 test.

What does T4 test results mean?

Your results may come in the form of total T4, free T4. High levels of any of these tests (total T4, free T4) may indicate an overactive thyroid, also known as hyperthyroidism. Low levels of any of these tests (total T4, free T4) may indicate an underactive thyroid, also known as hypothyroidism.

Therefore, if your T4 test results are not normal, your health care provider will likely order more thyroid tests to help make a diagnosis. These may include:

  • T3 thyroid hormone tests.
  • A TSH (thyroid stimulating hormone) test.
  • Tests to diagnose Graves’ disease, an autoimmune disease that causes hyperthyroidism.
  • Tests to diagnose Hashimoto’s thyroiditis, an autoimmune disease that causes hypothyroidism.

How do I get ready for T3 and T4 test?

It’s important to tell your doctor about all of the medications you’re currently taking, as some may affect your T3, T4 test results. If your doctor knows about your medications in advance, they can advise you to temporarily stop using them or consider their effect when interpreting your results.
Some medications that can affect your T3, T4 levels include:

  • Thyroid related drugs
  • Steroids
  • Birth control pills or other medications containing hormones, such as androgens and estrogens etc.

In addition, you may also need to fast (not eat or drink) for several hours before the test. Your health care provider will let you know if there are any special instructions to follow.

Procedure for T3, T4 test

A health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial (a small glass or plastic bottle).

Blood sample from a vein Image
Blood sample from a vein

You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Note: A normal T3 test result doesn’t necessarily mean that your thyroid is functioning perfectly. Measuring your T4 and TSH can help your doctor figure out if you have a thyroid problem despite a normal T3 result.

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Hair Loss and Thyroid

Hair loss can occur when your thyroid gland is not working correctly.

Hair Loss and Thyroid

Thyroid is a small gland which has the shape like a butterfly that sits low on the front of the neck. It helps to regulate many body functions by constantly releasing a steady amount of thyroid hormones into the bloodstream.

The important hormones produced by thyroid gland are thyroxine (T4) and triiodothyronine (T3)

Furthermore, thyroid conditions occur when your thyroid gland is not producing enough hormones Or producing too much of hormones. The most common type of thyroid conditions are as following:

Both conditions (Hypothyroidism & Hyperthyroidism) can cause dry, brittle hair or thinning hair on your scalp and body.

The Link Between Thyroid Conditions and Hair Loss

Thyroid conditions can cause hair loss if they are severe and left untreated. But, before understanding how these conditions cause hair loss, let us first understand the hair growth process.

  1. Hair starts growing from the roots (bottom of your hair follicles) on your scalp.
  2. Your scalp’s blood vessels provide nutrients to the root and help in hair growth.
  3. Hair pushes up and out through your skin. The hair passes through the oil glands that help maintain the required moisture in the hair.
  4. Hair grows for sometime and then falls off as a new hair growth cycle starts.

Kindly note, the thyroid hormones (T3 and T4) directly affect hair growth and its development. When the hormone production is disturbed, it can lead to hair thinning across your scalp and other areas such as your eyebrows.

Hair loss due to Autoimmune thyroid disease

Most people with Hypothyroidism or Hyperthyroidism have autoimmune thyroid disease. If someone has one type of autoimmune disease, he/she is more likely to develop another autoimmune condition for example: 

Alopecia areata: Alopecia areata is an autoimmune condition that causes hair loss in people having autoimmune thyroid disease.

It causes circular patches of hair loss in more discrete areas. In most cases this is temporary and does not progress, but unfortunately it can cause significant baldness. 

There are other rare autoimmune conditions that can also cause hair loss :

Hair loss and Antithyroid Drugs

Some antithyroid drugs such as (carbimazole and propylthiouracil) can, in rare cases, cause hair loss. But, it may be very difficult to tell whether the drug or your thyroid condition is causing hair loss.

Furthermore, it is very rare for anti-thyroid drugs or treatment to cause hair loss. Kindly note, Antithyroid drugs are used to treat an overactive thyroid (Hyperthyroidism).

Symptoms of Thyroid Related Hair Loss

Slow and gradual thinning of hair is the most common symptom of thyroid related hair loss. You may notice more than usual hair lose while combing.

Furthermore, hair loss may develop slowly with hypothyroidism and hyperthyroidism. You won’t necessarily see patches or bald spots on your scalp, but, your hair may seem thinner all over.

In most cases, hair loss caused by thyroid conditions is temporary, but regrowth of hairs may take several months.

It is important to note here that, you can still experience hair loss even after starting medicines for your thyroid condition. This is because the hair growth cycle is a months long process. But some people start wrongly blaming the thyroid medicines for hair loss. Unfortunately, if they stop their thyroid medicines, the hair loss problem will become worse.

Kindly note, it is perfectly normal to lose 50–100 hairs from your head each day. However, hair loss beyond this needs medical attention and may be related to thyroid problem.

Treatment options for thyroid related hair loss

Dear Reader, always remember that, “Treating thyroid related hair loss requires treating the Thyroid Problem“.

Working with your doctor to keep your thyroid disorder under control with medication may keep your hair thicker and can regenerate hair growth. But try to be patient because, regrowth of hairs can be unpredictable and may take several months.

Treatment for an underactive thyroid – (hypothyroidism):

  • levothyroxine: Your doctor will usually prescribe a synthetic hormone called levothyroxine to treat an underactive thyroid (hypothyroidism).

    This medicine is given when your thyroid gland does not produce enough of this hormone on its own.

Treatment for an overactive thyroid – (hyperthyroidism):

  • Antithyroid medications: Antithyroid medications, such as (propylthiouracil and methimazole) decrease the thyroid gland’s ability to make the thyroid hormone. It is used to treat overactive thyroid (hyperthyroidism).
  • Radioactive iodine: This treatment kills some cells in the thyroid gland and reduce the amount of hormones that the gland produces. This treatment induces hypothyroidism, which is then managed by using thyroid hormone replacement therapy for the rest the life.
  • Surgery: Your doctor will monitor your thyroid levels while you are on medication. In some cases, surgery may be necessary. It involves the removal of some or all of the thyroid gland, which may lead to hypothyroidism.

Kindly note, with the treatment, hair growth may be noticeable within several months. But be aware that the new hair may differ in color or texture from your original hair.

Home Remedies for thyroid related hair loss

Along with medication suggested by your doctor, you may try different home remedies to slowdown hair loss or regenerate hair growth. While the home remedies given below do not hold any scientific evidence, but you can give them a try to boost your hair growth.

1. Eating a balanced diet can help in growth and improve the condition of your hair. Foods that can increase the chances of having healthy hair include:

  • Fish: Oily fish contains omega-3 fatty acids that can help prevent a dry scalp.
  • Green vegetables: Vegetables such as spinach have high levels of vitamins A and C. These vitamins can improve the condition of hair.
  • Protein rich foods: Eating foods rich in protein can help prevent weak hair. Dairy products, nuts and lean meats all contain high levels of protein.
  • Calcium rich foods: Calcium is key to hair growth. Dairy products, such as milk and cheese are Good sources of calcium.
  • Iron Rich Foods: Iron deficiency and thyroid related hair loss are related. You can get tested for iron levels in your body and consider supplements for iron rich foods like liver, eggs, lamb, green leafy vegetables and so on.

2. Apply Essential Oils: Essential oils like eucalyptus oil and other plant extracts are known to improve hair growth. But, it’s important to talk with your doctor before using essential oils and use caution while choosing a quality brand.

Furthermore, you should also always do a patch test before using any essential oil for hair growth.

3. Control Iodine Intake: People with autoimmune thyroid disorders should check their iodine consumption. The body uses iodine to make thyroid hormone, so too much of iodine consumption may lead to imbalances.

Therefore, It is very important to understand how much iodine you would require in a day.

4. Yoga Asanas: A healthy lifestyle, which includes balanced diet and regular exercise, can help you live well with thyroid disease. Furthermore, adding yoga to your daily routine may help improve your thyroid function and hair growth.

Yoga for healthy thyroid and hair growth

Dear Reader, please discuss the above mentioned home remedies with your doctor before you start.

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Pituitary Gland

Your Pituitary gland is the main endocrine (hormone producing) gland that sits just beneath the base of the brain. It is very small in size (only about the size of a pea). It produces hormones that controls the function of many other hormone glands in your body (especially the thyroid, adrenals, ovaries and testicles).

Therefore, the pituitary gland is often called the master gland of the endocrine system. 

Location of the Pituitary Gland Image
Location of the Pituitary Gland

How does the Pituitary gland Work ?

The pituitary gland controls the function of several other hormone glands by producing and releasing number of hormones into the bloodstream. In turn, the pituitary gland is controlled by the hypothalamus, a small region of the brain that lies just above the pituitary.

The Pituitary gland takes messages from the hypothalamus (in the form of hormones) and uses these messages for stimulating all the other hormone glands to produce their own hormones.

Parts of Pituitary gland

The pituitary gland can be divided into two different parts:

  • Front (anterior) lobe, which accounts for 80% of the pituitary gland’s weight.
  • Back (posterior) lobe.

These lobes are connected to the hypothalamus by a stalk that contains blood vessels and nerve cell projections (nerve fibers). The hypothalamus controls the anterior lobe by releasing hormones through the connecting blood vessels. It controls the posterior lobe through nerve impulses.

The Pituitary gland and its target organs:

pituitary gland and its targeted organs image

Hormones produced by the pituitary gland

The pituitary gland secretes hormones from both the front part (anterior) and the back part (posterior) of the gland.

Anterior lobe hormones:

The anterior lobe of the pituitary gland produces and releases eight main hormones:

  • Growth hormone (GH): Growth hormone regulates growth and physical development. It has important effects on body shape by stimulating muscle formation.
  • Adrenocorticotropic hormone (ACTH): This hormone is also called corticotropin, which stimulates the adrenal glands to produce cortisol and other hormones.
  • Follicle-stimulating hormone (FSH): Follicle-stimulating hormone is involved with estrogen secretion and the growth of egg cells in women. It’s also important for sperm cell production in men.
  • Luteinizing hormone (LH): Luteinizing hormone is involved in the production of estrogen in women and testosterone in men.
  • Prolactin (PRL): Prolactin stimulates the mammary glands of the breasts to produce milk.
  • Endorphins: Endorphins have pain-relieving properties and are thought to be connected to the “pleasure centers” of the brain.
  • Beta-melanocyte-stimulating hormone: This hormone helps to stimulate increased pigmentation of your skin in response to exposure to ultraviolet radiation.

Posterior lobe hormones:

The posterior lobe of the pituitary gland also secretes hormones. These hormones are usually produced in your hypothalamus but are stored in the posterior lobe until they’re released.

Hormones stored in the posterior lobe include:

  • Vasopressin (ADH): Vasopressin (also called antidiuretic hormone) regulates the amount of water excreted by the kidneys and is therefore important in maintaining water balance in your body.
  • Oxytocin: This hormone stimulates the release of breast milk. It also stimulates contractions of the uterus during labor.

Pituitary gland conditions

Several conditions can affect your pituitary gland. Most are caused, when a tumour develops in or around the pituitary gland.

Pituitary tumors are abnormal growths that develop in or around your pituitary gland. Some pituitary tumors may begin to produce too much of one or more pituitary hormones. However, some tumors may start pressing your normal pituitary gland. Due to this pressure, your pituitary gland produce lower levels of hormones, a condition called hypopituitarism.

In addition to the above, pituitary tumors that make hormones are called “functioning” tumors and pituitary tumors that don’t make hormones are called “non-functioning” tumors.

Furthermore, most pituitary tumors are noncancerous (benign), also called an adenoma. It can remain in your pituitary gland or surrounding tissues and don’t spread to other parts of your body. The Pituitary tumours are not “brain tumours” according to The Pituitary Fundation. The term benign is used by doctors to describe a swelling which is not cancerous.

Most common pituitary gland conditions:

  • Acromegaly: In most cases, it is caused by a tumor of the pituitary gland, that produces too much growth hormone (GH).

    This can lead to excessive growth of bones, especially of your hands and feet, because an excessive amount of growth hormone is released by the pituitary tumor.

    Kindly note, In children, the condition is called gigantism. In adults, it is called acromegaly.
  • Cushing’s disease: In this condition, the pituitary gland produces large amounts of Adrenocorticotropic hormone (ACTH). This can lead to easy bruising, high blood pressure, weakness, and weight gain. It’s often caused by a tumor near or in the pituitary gland.
  • Hyperprolactinemia: In this condition, the prolactin hormone levels are elevated in your blood. This can lead to infertility and a decreased sex drive. The tumor causes the pituitary gland to produce too much prolactin leading to hyperprolactinemia.
  • Non-functioning tumours: is an abnormal growths that develop in your pituitary gland. Non-functioning tumours are usually noncancerous (benign). However, it can cause headaches and visual problems by pressing other areas of your brain. It can also press your normal pituitary gland, causing your pituitary gland to produce lower levels of hormones, resulting a condition called hypopituitarism.
  • Diabetes insipidus: This condition is caused due to problem in release of hormone vasopressin. It usually happens due to a head injury, surgery, or a tumor. In this condition, your body can’t properly balance fluid levels.

    As a result, people with Diabetes insipidus pass large amounts of heavily diluted urine.
  • Hypopituitarism: This condition causes your pituitary gland to produce very little or none of one or more of pituitary hormones. Hence, hypopituitarism can affect many of your body’s routine functions, such as growth, blood pressure or reproduction.

Rare pituitary gland conditions:

  • Empty Sella Syndrome (ESS): It is a rare condition, in which your pituitary gland shrinks or gets flattened. The pituitary gland sits in sella turcica (a bony structure that holds and protects your pituitary gland).

    People with ESS have a defect/weakness in the membrane that normally keeps the spinal fluid around the brain separate from the sella turcica. As a result of the weakened membrane, spinal fluid can leak into the sella turcica and apply pressure on the pituitary gland. This pressure causes the gland to shrink or flatten.

    In addition to the above, when your pituitary gland shrinks or becomes flattened, it cannot be seen on an MRI scan. Hence, your sella turcica looks like empty. This is called as empty sella syndrome.
  • Kallmann Syndrome (KS): In this condition, your hypothalamus fails to make enough of a hormone called gonadotrophin-releasing hormone (GnRH). The role of GnRH is to stimulate the testicles in males and the ovaries in females, to make sex hormones. If not enough of these hormones are made, the child will not enter puberty and will not be able to have children of their own without special treatment. 

    Furthermore, children with Kallmann syndrome also have either very poor or no sense of smell. KS occurs in both sexes but males are more commonly diagnosed with this condition.
  • Rathke’s Cleft Cysts: It is an abnormal fluid-filled sac (cyst) that usually is found between the two lobes of the pituitary gland (anterior lobe and posterior lobe).

    During fetal development, the anterior lobe of the pituitary gland develops from a sac like structure known as Rathke’s pouch. This pouch normally closes early in fetal development. If this pouch does not close completely, this leaves a space that can fill with fluid and grow over time. As a result, Rathke cleft cyst can form. 
  • Multiple Endocrine Neoplasia Type 1: MEN1 is a rare disorder that causes tumors in the endocrine glands and parts of the small intestine and stomach. MEN1 is sometimes called Wermer’s syndrome, after one of the first doctors to recognize it.

    In people with MEN1, multiple endocrine glands (usually the parathyroids, pancreas and pituitary) grow tumors and release excessive amounts of hormones that can lead to disease. 
  • Wolfram Syndrome: It is an inherited condition, that leads to many different abnormalities including diabetes insipidus (inability to concentrate the urine), diabetes mellitus (the usual type of diabetes), blindness and deafness.

    Patients usually also suffer from severe abnormalities of the nervous system that can be accompanied by behavior problems, psychiatric hospitalizations.

    Furthermore, Wolfram syndrome is sometimes referred to as “DIDMOAD” (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness).
  • Septo-Optic Dysplasia (SOD): It is a disorder of early brain and eye development. The most common features of SOD are underdevelopment of the eye (optic) nerve, abnormal formation of structures along the midline of the brain, and a small pituitary (pituitary hypoplasia).
  • Sheehan’s Syndrome (SS): Sheehan’s Syndrome is a condition that affects women who lose excess amount of blood in childbirth or who have severe low blood pressure during or after childbirth, which can deprive the body of oxygen. This lack of oxygen that causes damage to the pituitary gland is known as Sheehan’s syndrome.

    Hence, this condition causes the pituitary gland to not produce enough pituitary hormones (hypopituitarism).
  • Lymphocytic Hypophysitis (LH): is a condition in which your pituitary gland is harmed by lymphocytes (a types of white blood cells), resulting in pituitary enlargement and weakened function. It most often occurs in women in late pregnancy or the postpartum period, but can also occur in prepubertal or post-menopausal women, and in men.

    Symptoms of LH may include headache, visual field impairment and more rarely, double vision (diplopia). The exact cause of this condition is unknown but is thought to be autoimmune-related.
  • Nelson’s Syndrome: It is a rare disorder that occurs in some patients with Cushing’s disease. In Nelson’s syndrome, the pituitary tumor continues to grow and release excess amount of the hormone ACTH. As a result, both the adrenal glands (located on top of each kidney) have to remove surgically from a patient.

    Moreover, this enlargement of tumor, often cause visual loss, pituitary failure and headaches.

Symptoms of a pituitary gland condition

The following list shows many of the symptoms associated with pituitary gland conditions in adults.

  • Headaches 
  • Vision problems 
  • Unexplained weight gain 
  • Reduced sex drive
  • Feeling dizzy and nauseous 
  • Pale complexion 
  • Weakening, loss of Muscle
  • Enlarged hands and feet 
  • Excessive sweating and oily skin 
  • Mood changes 
  • Inappropriate breast growth or production of breast mil
  • Erectile dysfunction

Please make sure you tell your doctors about all symptoms that you regularly notice. This will help them to treat you.

The following list shows some of the symptoms of pituitary gland conditions in children.

  • Poor growth
  • Loss of vision
  • Excessive drinking
  • Excessive frequency of passing urine
  • Tiredness
  • Overweight
  • Late puberty
  • Early puberty
  • Milk secretion

Please make sure you tell your doctors about all symptoms that you regularly notice in your child. This will help them to treat your child.

Tests for Pituitary Tumors

To diagnose a pituitary tumor, your doctor will take your complete health history and perform a physical exam. He or she might order:

  • Blood tests: These tests can determine whether you have an overproduction or deficiency of pituitary hormones. Your doctor will look for abnormal hormone levels in your body for example. cortisol and thyroid hormone.
  • Urinalysis: This involves collecting a sample of urine for chemical analysis. Because hormone levels naturally go up and down during the day and night, it may be necessary to do a 24-hour urine collection.
  • Vision testing: These tests can help determine if a pituitary tumor is impacting your vision, especially your peripheral vision.
  • Pituitary MRIs: The best way to look at tumors or other abnormalities of the pituitary gland is magnetic resonance imaging (MRI). 

    In addition to the above, a pituitary gland MRI is different than a regular MRI of the brain. It creates high resolution images that allow doctors to see the pituitary region better. It can show the location, size, and shape of your pituitary tumor.
  • Computed tomography (CT) scan: A CT scan uses x-rays to create detailed cross-sectional images of part of your body. CT scans can find a pituitary tumour, if it’s large enough. However, MRI scans are used much more often to look at the brain and pituitary gland.
  • Pituitary tissue samples: A biopsy (removing a sample of the tumor to examine under a microscope) is usually the only way to be certain about the diagnosis. In many cases, doctors won’t treat a tumor until a biopsy has been done.

    But a biopsy isn’t usually needed before treating a pituitary tumor. One reason is that the hormone tests for some types of adenomas are very accurate, so a biopsy isn’t likely to provide much more information on pituitary tumor. 

Note: Your doctor can usually diagnose a pituitary tumor with one or all of these tests, but that’s not always the case. If you need additional testing, your doctor may refer you to an endocrinologist.

Treatment for Pituitary Disorders

Most pituitary tumors are noncancerous (benign). However, many tumors still require treatment. The treatment involves a team of medical experts, possibly including a brain surgeon (neurosurgeon), endocrine system specialist (endocrinologist) and a radiation oncologist.

Doctors generally use Surgery, Radiation therapy and Hormone replacement therapy, either alone or in combination, to treat a pituitary tumor and return hormone production back to normal levels.

Surgery: Surgical removal of a pituitary tumor is necessary if the tumor is pressing the optic nerves (to the eyes) or if the tumor is overproducing certain pituitary hormones. The two main surgical techniques for treating pituitary tumors are:

  • Endoscopic transnasal transsphenoidal approach: This usually enables your doctor to remove the tumor through your nose. No other part of your brain is affected, and there’s no visible scar by using this procedure. 

Endoscopic Transnasal Approach
  • Transcranial approach (craniotomy): The tumor is removed through the upper part of your skull via an incision in your scalp. It’s easier to reach large tumors by using this procedure.
Craniotomy Image

Radiation therapy uses high-energy sources of radiation to destroy pituitary tumors. It can be used after surgery or alone if surgery is not an option. Radiation therapy can be beneficial if a tumor persists or returns after surgery. Methods of radiation therapy include:

  • Stereotactic radiosurgery
  • External beam radiation
  • Intensity modulated radiation therapy (IMRT)
  • Proton beam therapy

Furthermore, the benefits and complications of these forms of radiation therapy often are not immediate and may take months or years to be fully effective. Your radiation oncologist will evaluate your condition and discuss the pros and cons of each option with you.

Hormone replacement therapy: If your pituitary gland is not functioning properly, you may not produce hormones that are essential for your well being and for vital bodily functions. You may need to take hormone replacement therapy, which will be prescribed to you by your doctor.

Moreover, in this therapy, a patient takes hormones to replace the hormones, not being produced by his/her pituitary gland. Such hormones include (cortisol, thyroid hormone, vasopressin, sex hormones and growth hormone). 

Follow-up treatment for pituitary condition: Most people with a pituitary tumour or with pituitary condition will have regular check-ups at doctor’s clinic for the rest of their life. These check-ups enable your doctor to monitor your condition and pick up any changes as soon as possible.

In most patients their condition remains stable after initial treatment(s). However, regrowth of a pituitary tumour can occasionally occur. The chance of this happening is lower, if you had radiation therapy after your surgery. If regrowth does occur, your doctor may suggest you another surgery, or radiation therapy.

Tips for pituitary gland health

Eat a balanced, healthy diet: A balanced diet is good for your health. General tips for healthy eating include:

  • Eating a diet rich in fruits and vegetables, which are great sources of fiber, vitamins, and minerals
  • Choosing good sources of fats, such as those that contain omega-3 fatty acids and monounsaturated fats.
  • Opting for whole grains over refined grains.
  • Reducing sodium intake.
  • Avoiding refined sugars.
  • Drinking at least four to six cups of water a day.

Reduce your stress: The stress causes your body to release several stress hormones, such as cortisol and adrenaline, into your bloodstream. These hormones increase your concentration, ability to react, and strength. After you have dealt with your short term stress, your body returns to normal.

However, a long term stress can cause health problems, because your body is constantly producing higher levels of stress hormones and does not have time to recover. In other words, the constant production of stress hormones can cause serious health problems. For example:

Too much cortisol (a stress hormone) can sometimes lead to:

  • insomnia
  • weight gain
  • anxiety
  • depression

Therefore, try to spare some time to get at least 45 minutes per day of exercise or work on a relaxing hobby.

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Thyroid Nodule

The term thyroid nodule refers to an abnormal growth of thyroid cells that forms a lump within the thyroid gland. It can be solid or filled with fluid. You can have a single nodule or a cluster of nodules in thyroid gland. Most thyroid nodules aren’t serious and don’t cause symptoms. Only a small percentage of thyroid nodules are cancerous.

A thyroid nodule can occur in any part of the gland. Some nodules can be felt quite easily. Others can be hidden deep in the thyroid tissue or located very low in the gland, where they are difficult to feel. You often won’t know you have a thyroid nodule until your doctor discovers it during a routine medical exam.

Thyroid Nodule Image
Thyroid Nodule Image

Types of Thyroid Nodules

There are several different types of thyroid nodules.

Toxic Nodules: This occurs when thyroid nodules, makes the thyroid gland overactive. In other words, thyroid gland starts producing excess thyroid hormones. It is known as toxic nodules. It may also lead to hyperthyroidism. In which the body’s metabolism speeds up. Toxic nodules may slowly become very large and press on surrounding structures in the neck or upper chest.

Toxic nodules are almost always benign (noncancerous), but they may require treatment to address hyperthyroidism.

Multinodular Goiter: When more than one nodules grow on thyroid gland the condition is called a multinodular goiter, or enlarged thyroid. Furthermore, Multinodular goiters can be either a toxic multinodular goiter (i.e. makes too much thyroid hormone and causes hyperthyroidism or non-toxic (i.e. does not make too much thyroid hormone and causes hypothyroidism).

It is associated with a higher risk of thyroid cancer. Up to 20 percent of people with multinodular goiters will also develop thyroid cancer. If you do have a multinodular goiter, your doctor will most likely screen you for thyroid cancer as well.

Thyroid Cyst: When thyroid nodules contain fluid, they are called cystic nodules. These can be completely filled with fluid known as simple cysts, or filled with partly solid and partly fluid known as complex cysts. Cysts are usually noncancerous, but they occasionally contain cancerous solid components.

Hot and Cold Nodules: Nodules detected by thyroid scans are classified as cold, hot, or warm. If a nodule is composed of cells that do not make thyroid hormone, then it is “cold”. If a nodule that is producing too much hormone is called “hot.”

85% of thyroid nodules are cold, 10% are warm, and 5% are hot. Remember that 85% of cold nodules are benign (noncancerous), 90% of warm nodules are benign, and 95% of hot nodules are benign.

Although thyroid scanning cannot truly differentiate benign or malignant nodules. Therefore, the evaluation of a thyroid nodule should always include history and examination by a physician. Remember, a biopsy is the only way to tell for sure that a nodule is benign or malignant.

Symptoms of a thyroid nodule?

Most thyroid nodules do not cause symptoms. Often, thyroid nodules are discovered incidentally during other routine physical examination. Occasionally, patients themselves find thyroid nodules by noticing a lump in their neck while looking in a mirror, buttoning their collar, or fastening a necklace. 

However, if the thyroid nodule gets large enough, you may develop following symptoms:

  • An enlarged thyroid gland, known as a goiter.
  • A few people with thyroid nodules complain of pain at the site of the nodule that can travel to the ear or jaw.
  • Breathing difficulties
  • Swallowing difficulties
  • Rarely, a person with a thyroid nodule may complain of hoarseness or difficulty speaking because of compression of the voice box.

Furthermore, if your thyroid nodule is producing excess thyroid hormones, you may also develop symptoms of hyperthyroidism, such as:

  • Unexplained weight loss
  • Increased sweating
  • muscle weakness
  • difficulty sleeping
  • Tremor
  • Rapid or irregular heartbeat

If production of your thyroid hormones is too low due to thyroid nodule, you may also develop symptoms of hypothyroidism, such as:

  • Weight Gain
  • Dry Skin
  • Puffy Face
  • Cold Sensitivity
  • Tiredness
  • Depression

Very rarely, nodules may cause pain or discomfort. But the most common of these symptoms is a lump in the neck followed by a sense of mass while swallowing.

What may cause thyroid nodules?

It’s not always clear why a person gets thyroid nodules. Several medical conditions can cause them to form. They include:

  • Genetics
  • Iodine deficiency
  • Hashimoto’s disease, an autoimmune disease that leads to hypothyroidism.
  • Thyroiditis or chronic inflammation of the thyroid.

Furthermore, cancer is the biggest concern when nodules form. Fortunately, cancer is very rare. Over 90% of such nodules are benign (noncancerous), but still, it is important to see a doctor if you think you have a nodule.

In addition, the risk for thyroid nodules is higher in women than men. Incidence increases with age, and is greater in people exposed to radiation from medical treatments

How are thyroid nodules diagnosed?

Thyroid nodules usually are discovered by the health care professional during routine physical examination of the neck. Once a nodule is discovered, a physician will use one or more of the following tests to diagnose and assess your nodule:

Ultrasonography: A physician may order an ultrasound examination of the thyroid to:

  • Detect nodules that are not easily felt.
  • Determine the number of nodules and their sizes.
  • Determine if a nodule is solid or cystic.

Despite its value, the ultrasound cannot determine whether a nodule is benign or cancerous.

Thyroid Fine Needle Aspiration Biopsy (FNA or FNAB): For a fine needle biopsy, your doctor will use a very thin needle to withdraw cells from the thyroid nodule. Ordinarily, several samples will be taken from different parts of the nodule to give your doctor the best chance of finding cancerous cells if they are present.

The cells are then examined under a microscope by a pathologist to check if nodule is benign (noncancerous), malignant (cancerous) or suspicious for malignancy.

Blood tests: Your doctor may take a blood sample to measure levels of T3 and T4—the thyroid hormones, and thyroid-stimulating hormone (TSH).

  • Elevated levels of the thyroid hormones (T4 & T3) and low level of TSH (thyroid stimulating hormone) suggests hyperthyroidism.
  • Abnormally low level of the thyroid hormones (T4 & T3) and elevated level TSH (thyroid stimulating hormone) suggests hypothyroidism.
  • A antibodies test detects the antibodies against TPO (Thyroid Peroxidase) in the blood. The presence of TPO antibodies in your blood suggests that the cause of thyroid disease is an autoimmune disorder, such as Hashimoto’s disease or Graves’ disease.

Molecular Diagnostics: It examines the genes in the DNA of thyroid nodules. Therefore, these tests can provide helpful information about whether cancer may be present or absent.

These tests are particularly helpful when the specimen evaluated by the pathologist is indeterminate. These specialized tests are done on samples, which is obtained during the normal biopsy process. These are currently available only at highly specialized medical centers, however, their availability is increasing rapidly.

Thyroid Scans: Your doctor may recommend a thyroid scan to help evaluate thyroid nodules. During this test, an isotope of radioactive iodine is injected into a vein in your arm. You then lie on a table while a special camera produces an image of your thyroid on a computer screen.

Nodules that produce excess thyroid hormone — called hot nodules — show up on the scan because they take up more of the isotope than normal thyroid tissue does. Hot nodules are almost always noncancerous.

In some cases, nodules that take up less of the isotope — called cold nodules — are cancerous. However, a thyroid scan can’t distinguish between cold nodules that are cancerous and those that aren’t cancerous.

How are thyroid nodules treated?

Your treatment options will depend on the size and type of thyroid nodule you have.

Observation: If a thyroid nodule is benign (noncancerous) and small, the usual treatment is “watchful waiting.” This is not a form of active treatment but rather an observation period. Patients treated this way should be checked by their doctor every 3 months to monitor the growth of the nodule. As long as the nodule does not grow, there’s usually no need to worry. 

Radioactive iodine treatment: Nodules that make too much thyroid hormone may be treated with radioiodine. It’s radioactive iodine that can be taken in a pill or liquid form. It helps reduce the size of the thyroid nodule without harming other tissue.

Thyroid hormone therapy: If your thyroid function test finds your gland isn’t producing enough thyroid hormone, your doctor may recommend thyroid hormone therapy (Synthetic levothyroxine).

Surgery: If a nodule is cancerous or grows despite hormone pill treatment, surgery to remove the nodule may be needed. Almost all thyroid nodules that are malignant (cancerous) are treated by surgery. A noncancerous nodule may sometimes require surgery if it’s so large that it makes it hard to breathe or swallow.

Can thyroid nodules be prevented?

There’s no way to prevent the development of a thyroid nodule. However, most people who have thyroid nodules lead a normal life. You might need to check in with your doctor more often, but there usually are no complications.

Furthermore, if your thyroid nodules have symptom of thyroid cancer, you may need surgery. During the surgery, the doctor will remove most (if not all) of your thyroid. After the surgery, you’ll take daily thyroid replacement hormones for the rest of your life.

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Hyperthyroidism

Hyperthyroidism is a condition in which thyroid gland produces too much thyroid hormones. It refers to a state in which a person’s thyroid hormones production is above normal level. It is also called overactive thyroid. Hyperthyroidism can accelerate the metabolism rate of your body. As a result, it can cause weight loss and irregular heart activity. It is more common in women than men. Blood tests are the only way to reliably confirm a diagnosis.

Furthermore, having too much of thyroid hormones can cause unpleasant and potentially serious problems that may need treatment. Signs and symptoms of it varies from person to person. But some symptoms of it can be easily confused with other disease.

Symptoms of Hyperthyroidism

  • Bulging Eyes
  • Abnormal Heart Rate
  • Diarrhea
  • Weight Loss
  • Irritability
  • Itching
  • Heat Intolerance
  • Stress
  • Sleeplessness
  • Vision Problem
  • Frequent Sweating
  • Irregular Mensuration
  • Nervousness
Hyperthyroidism Symptoms Image

If you suspect your symptoms are the result of a thyroid problem, it’s most important you talk with your doctor. They can order a blood test to measure the amount of thyroid hormones in your blood. Because high levels of Thyroxine (T4) and low amounts of TSH (Thyroid Stimulating Hormone) in blood indicates an overactive thyroid.

Treatment of Hyperthyroidism

Antithyroid medications (sometimes written as anti-thyroid medications) suggested by your doctor is a common treatment for hyperthyroidism. Hence, the goal of antithyroid medications is to prevent the thyroid from producing excess amounts of T3 and T4 hormones.

Diet In Hyperthyroidism

If we talk about diet plan, then there are certainly many do’s and dont’s. Although a healthy diet can’t cure or prevent hyperthyroidism. However, eating healthy foods may help ease hyperthyroidism symptoms.

What to Eat
  • Lentils
  • Mushrooms
  • Spinach
  • Potato
  • Honey
  • Red Meat
  • Cauliflower, Broccoli
  • Strawberry, Blueberry, Raspberry
  • Unsalted Nuts
What to avoid
  • Dairy Products
  • Soy Products
  • Salted Nuts and Seeds
  • Caffeine

Also, healthy eating, exercising and stress management plan can help ease hyperthyroid symptoms. Medication plays an important role in treating hyperthyroidism, but it is also important to do exercise on daily basis. So you can start with some simple exercises like walking, aerobics, pushups and yoga.

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