Thyroid diseases are amongst the most common of all diseases of the endocrine system. Thyroid gland located in the neck produces thyroxine which regulates the metabolism of the body. Low production of thyroxine (hypothyroidism) can cause weight gain, dry skin, irregular periods, low pulse, infertility, fatigue and high cholesterol levels. Increased production of thyroid hormones due to an overactive thyroid gland can produce weight loss, sweating, palpitations, anxiety and prominent eyes.
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In general, there is no definite age when “ routine “ thyroid testing needs to be started. Screening tests are done when there is a high risk of detecting disease and when such detection and treatment can improve health status. All newborn children are to be screened for congenital hypothyroidism. Thyroid disease can have adverse outcomes in pregnant women. So it is preferable to screen all pregnant women for thyroid disease. Beyond this thyroid, disease screening is done only if a person has symptoms of thyroid disease or goiter is present. It is suggested that people with inherited thyroid diseases including a strong family history of thyroid disease consider screening. Elders may not show typical symptoms of thyroid disease and hence considered for screening.
In general, it is not required. However, if you are taking thyroxine tablets ( Eltroxin, Thyronorm, etc), it can interfere with the T4 or free T4 levels. Remember to mention this to your treating doctor when you consult them. Although there are likely to be minor variations in the TSH test done after a meal, these are minor and not considered significant to alter treatment decisions. But it is important that you continue to consume the thyroid medicine till the day prior to testing samples. Skipping the medicine even for a few days can lead to abnormal reports and this may lead to wrong treatment decisions.
Studies have linked hypothyroidism to the progression of pre-diabetes to diabetes. In people with hypothyroidism, there can be an increase in weight ( increased BMI) which is linked to increased risk of pre-diabetes and diabetes. Thyroid hormones can also influence insulin secretion and insulin resistance, the main risk factors of diabetes. People with hypothyroidism and prediabetes should be more aggressive in their lifestyle changes like exercise to prevent developing diabetes.
People with type 1 diabetes have a 30 % chance of developing autoimmune thyroid disease. Hence they have to be tested for thyroid disease every year. In people with type 2 diabetes, it is not clear if they have an increased predilection for thyroid disease. They can be tested if they have any symptoms or signs of thyroid disease. However, people with hyperthyroidism may have higher than normal risk of developing diabetes especially if they are remaining uncontrolled.
Thyroxine is used to treat hypothyroidism. The dose of thyroxine is adjusted to keep the thyroid functions normal. When people with hypothyroidism are optimally replaced, there is no increased risk of diabetes. When thyroxine is over replaced, there is an increased risk of glucose intolerance. To avoid this, it is important that we keep the thyroid function normal with an appropriate dose of thyroxine.
For the development of the baby, thyroid hormones are extremely important. Especially for the development of the brain and skeleton. The thyroid gland in the fetus starts producing thyroid hormones starting from the 12 th week of gestation. So, during early gestation and throughout the pregnancy till the gland is fully functional, the fetus depends on the thyroxine from the mother for development. So any deficiency in the mother, the fetus will also be exposed to reduced hormones and hence developmental issues affecting the brain. So it is important that the mother maintains normal thyroid functions during and prior to conception.
