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class="vector-toc-numb">2</span> <span>Diseases</span> </div> </a> <button aria-controls="toc-Diseases-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diseases subsection</span> </button> <ul id="toc-Diseases-sublist" class="vector-toc-list"> <li id="toc-Low_function" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Low_function"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.1</span> <span>Low function</span> </div> </a> <ul id="toc-Low_function-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-High_function" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#High_function"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.2</span> <span>High function</span> </div> </a> <ul id="toc-High_function-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Structural_abnormalities" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Structural_abnormalities"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.3</span> <span>Structural abnormalities</span> </div> </a> <ul id="toc-Structural_abnormalities-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Tumors" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Tumors"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.4</span> <span>Tumors</span> </div> </a> <ul id="toc-Tumors-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Medication_side_effects" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medication_side_effects"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.5</span> <span>Medication side effects</span> </div> </a> <ul id="toc-Medication_side_effects-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Pathophysiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Pathophysiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Pathophysiology</span> </div> </a> <button aria-controls="toc-Pathophysiology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Pathophysiology subsection</span> </button> <ul id="toc-Pathophysiology-sublist" class="vector-toc-list"> <li id="toc-Autoimmune_Thyroid_Disease" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Autoimmune_Thyroid_Disease"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Autoimmune Thyroid Disease</span> </div> </a> <ul id="toc-Autoimmune_Thyroid_Disease-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Goiter" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Goiter"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Goiter</span> </div> </a> <ul id="toc-Goiter-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Pregnancy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Pregnancy"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Pregnancy</span> </div> </a> <ul id="toc-Pregnancy-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Blood_tests" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Blood_tests"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Blood tests</span> </div> </a> <ul id="toc-Blood_tests-sublist" class="vector-toc-list"> <li id="toc-Thyroid_function_tests" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Thyroid_function_tests"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.1</span> <span>Thyroid function tests</span> </div> </a> <ul id="toc-Thyroid_function_tests-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Antithyroid_antibodies" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Antithyroid_antibodies"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.2</span> <span>Antithyroid antibodies</span> </div> </a> <ul id="toc-Antithyroid_antibodies-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_markers" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Other_markers"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1.3</span> <span>Other markers</span> </div> </a> <ul id="toc-Other_markers-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Ultrasound" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Ultrasound"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Ultrasound</span> </div> </a> <ul id="toc-Ultrasound-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Radioiodine_scanning_and_uptake" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Radioiodine_scanning_and_uptake"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Radioiodine scanning and uptake</span> </div> </a> <ul id="toc-Radioiodine_scanning_and_uptake-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Biopsy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Biopsy"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.4</span> <span>Biopsy</span> </div> </a> <ul id="toc-Biopsy-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Medication" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medication"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Medication</span> </div> </a> <ul id="toc-Medication-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Surgery"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Surgery</span> </div> </a> <ul id="toc-Surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Radioiodine" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Radioiodine"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Radioiodine</span> </div> </a> <ul id="toc-Radioiodine-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Epidemiology</span> </div> </a> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1 vector-toc-list-item-expanded"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon 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href="https://as.wikipedia.org/wiki/%E0%A6%A5%E0%A6%BE%E0%A6%87%E0%A7%B0%E0%A6%AF%E0%A6%BC%E0%A6%A1_%E0%A7%B0%E0%A7%8B%E0%A6%97" title="থাইৰয়ড ৰোগ – Assamese" lang="as" hreflang="as" data-title="থাইৰয়ড ৰোগ" data-language-autonym="অসমীয়া" data-language-local-name="Assamese" class="interlanguage-link-target"><span>অসমীয়া</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Malaltia_tiroidal" title="Malaltia tiroidal – Catalan" lang="ca" hreflang="ca" data-title="Malaltia tiroidal" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Enfermedad_de_tiroides" title="Enfermedad de tiroides – Spanish" lang="es" hreflang="es" data-title="Enfermedad de tiroides" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Tireopatia" title="Tireopatia – Italian" lang="it" hreflang="it" data-title="Tireopatia" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E7%94%B2%E7%8A%B6%E8%85%BA%E7%96%BE%E6%82%A3" title="甲状腺疾患 – Japanese" lang="ja" hreflang="ja" data-title="甲状腺疾患" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-pa mw-list-item"><a href="https://pa.wikipedia.org/wiki/%E0%A8%A5%E0%A8%BE%E0%A8%87%E0%A8%B0%E0%A8%BE%E0%A8%87%E0%A8%A1_%E0%A8%B0%E0%A9%8B%E0%A8%97" title="ਥਾਇਰਾਇਡ ਰੋਗ – Punjabi" lang="pa" hreflang="pa" data-title="ਥਾਇਰਾਇਡ ਰੋਗ" data-language-autonym="ਪੰਜਾਬੀ" data-language-local-name="Punjabi" class="interlanguage-link-target"><span>ਪੰਜਾਬੀ</span></a></li><li class="interlanguage-link interwiki-ckb mw-list-item"><a href="https://ckb.wikipedia.org/wiki/%D9%86%DB%95%D8%AE%DB%86%D8%B4%DB%8C%DB%8C_%D8%AA%D8%A7%DB%8C%D8%B1%DB%86%DB%8C%D8%AF" title="نەخۆشیی تایرۆید – Central Kurdish" lang="ckb" hreflang="ckb" data-title="نەخۆشیی تایرۆید" data-language-autonym="کوردی" data-language-local-name="Central Kurdish" class="interlanguage-link-target"><span>کوردی</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B9%82%E0%B8%A3%E0%B8%84%E0%B9%84%E0%B8%97%E0%B8%A3%E0%B8%AD%E0%B8%A2%E0%B8%94%E0%B9%8C" title="โรคไทรอยด์ – Thai" lang="th" hreflang="th" data-title="โรคไทรอยด์" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a 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href="/wiki/Thyroid_disease_in_women" title="Thyroid disease in women">Thyroid disease in women</a></div> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Thyroid disease</th></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Blausen_0534_Goiter.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/2/29/Blausen_0534_Goiter.png/220px-Blausen_0534_Goiter.png" decoding="async" width="220" height="293" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/2/29/Blausen_0534_Goiter.png/330px-Blausen_0534_Goiter.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/2/29/Blausen_0534_Goiter.png/440px-Blausen_0534_Goiter.png 2x" data-file-width="768" data-file-height="1024" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">An illustration of goiter, a type of thyroid disease</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Endocrinology" title="Endocrinology">Endocrinology</a>, <a href="/wiki/Medical_genetics" title="Medical genetics">medical genetics</a> <span class="penicon autoconfirmed-show"><span class="mw-valign-text-top" typeof="mw:File/Frameless"><a href="https://www.wikidata.org/wiki/Q6673122?uselang=en#P1995" title="Edit this on Wikidata"><img alt="Edit this on Wikidata" src="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/10px-OOjs_UI_icon_edit-ltr-progressive.svg.png" decoding="async" width="10" height="10" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/15px-OOjs_UI_icon_edit-ltr-progressive.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/8/8a/OOjs_UI_icon_edit-ltr-progressive.svg/20px-OOjs_UI_icon_edit-ltr-progressive.svg.png 2x" data-file-width="20" data-file-height="20" /></a></span></span></td></tr></tbody></table> <p><b>Thyroid disease</b> is a medical condition that affects the function of the <a href="/wiki/Thyroid" title="Thyroid">thyroid gland</a>. The thyroid gland is located at the front of the neck and produces <a href="/wiki/Thyroid_hormones" title="Thyroid hormones">thyroid hormones</a><sup id="cite_ref-1" class="reference"><a href="#cite_note-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> that travel through the blood to help regulate many other organs, meaning that it is an <a href="/wiki/Endocrine_organ" class="mw-redirect" title="Endocrine organ">endocrine organ</a>. These hormones normally act in the body to regulate energy use, infant development, and childhood development.<sup id="cite_ref-:123_2-0" class="reference"><a href="#cite_note-:123-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>There are five general types of thyroid disease, each with their own symptoms. A person may have one or several different types at the same time. The five groups are: </p> <ol><li><a href="/wiki/Hypothyroidism" title="Hypothyroidism">Hypothyroidism</a> (low function) caused by not having enough free thyroid hormones<sup id="cite_ref-:123_2-1" class="reference"><a href="#cite_note-:123-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">Hyperthyroidism</a> (high function) caused by having too many free thyroid hormones<sup id="cite_ref-:123_2-2" class="reference"><a href="#cite_note-:123-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li> <li>Structural abnormalities, most commonly a <a href="/wiki/Goitre" title="Goitre">goiter</a> (enlargement of the thyroid gland)<sup id="cite_ref-:123_2-3" class="reference"><a href="#cite_note-:123-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Tumors" class="mw-redirect" title="Tumors">Tumors</a> which can be benign (not cancerous) or cancerous<sup id="cite_ref-:123_2-4" class="reference"><a href="#cite_note-:123-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li> <li>Abnormal thyroid function tests without any clinical symptoms (subclinical hypothyroidism or subclinical hyperthyroidism).<sup id="cite_ref-:123_2-5" class="reference"><a href="#cite_note-:123-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup></li></ol> <p>In the US, hypothyroidism and hyperthyroidism were respectively found in 4.6 and 1.3% of the >12y old population (2002).<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> </p><p>In some types, such as subacute thyroiditis or postpartum thyroiditis, symptoms may go away after a few months and laboratory tests may return to normal.<sup id="cite_ref-:42_4-0" class="reference"><a href="#cite_note-:42-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> However most types of thyroid disease do not resolve on their own. Common hypothyroid symptoms include fatigue, low energy, weight gain, inability to tolerate the cold, slow heart rate, dry skin and constipation.<sup id="cite_ref-5" class="reference"><a href="#cite_note-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Common hyperthyroid symptoms include irritability, anxiety, weight loss, fast heartbeat, inability to tolerate the heat, diarrhea, and enlargement of the thyroid.<sup id="cite_ref-6" class="reference"><a href="#cite_note-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> Structural abnormalities may not produce symptoms, however some people may have hyperthyroid or hypothyroid symptoms related to the structural abnormality or notice swelling of the neck.<sup id="cite_ref-:52_7-0" class="reference"><a href="#cite_note-:52-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Rarely goiters can cause compression of the airway, compression of the vessels in the neck, or difficulty swallowing.<sup id="cite_ref-:52_7-1" class="reference"><a href="#cite_note-:52-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> Tumors, often called thyroid nodules, can also have many different symptoms ranging from hyperthyroidism to hypothyroidism to swelling in the neck and compression of the structures in the neck.<sup id="cite_ref-:52_7-2" class="reference"><a href="#cite_note-:52-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup> </p><p>Diagnosis starts with a history and physical examination. Screening for thyroid disease in patients without symptoms is a debated topic although commonly practiced in the United States.<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> If dysfunction of the thyroid is suspected, laboratory tests can help support or rule out thyroid disease. Initial blood tests often include <a href="/wiki/Thyroid-stimulating_hormone" title="Thyroid-stimulating hormone">thyroid-stimulating hormone</a> (TSH) and free <a href="/wiki/Thyroxine" class="mw-redirect" title="Thyroxine">thyroxine</a> (T4).<sup id="cite_ref-Hammer_2018_9-0" class="reference"><a href="#cite_note-Hammer_2018-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Total and free <a href="/wiki/Triiodothyronine" title="Triiodothyronine">triiodothyronine</a> (T3) levels are less commonly used.<sup id="cite_ref-Hammer_2018_9-1" class="reference"><a href="#cite_note-Hammer_2018-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> If autoimmune disease of the thyroid is suspected, blood tests looking for <a href="/wiki/Anti-thyroid_autoantibodies" class="mw-redirect" title="Anti-thyroid autoantibodies">Anti-thyroid autoantibodies</a> can also be obtained. Procedures such as ultrasound, biopsy and a radioiodine scanning and uptake study may also be used to help with the diagnosis, particularly if a nodule is suspected.<sup id="cite_ref-:123_2-6" class="reference"><a href="#cite_note-:123-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p><br /> Thyroid diseases are highly prevalent worldwide,<sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Atasayar_2019_11-0" class="reference"><a href="#cite_note-Atasayar_2019-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Müller_2001_12-0" class="reference"><a href="#cite_note-Müller_2001-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> and treatment varies based on the disorder. <a href="/wiki/Levothyroxine" title="Levothyroxine">Levothyroxine</a> is the mainstay of treatment for people with hypothyroidism,<sup id="cite_ref-:0_13-0" class="reference"><a href="#cite_note-:0-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> while people with hyperthyroidism caused by Graves' disease can be managed with iodine therapy, antithyroid medication, or surgical removal of the thyroid gland.<sup id="cite_ref-:4_14-0" class="reference"><a href="#cite_note-:4-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> Thyroid surgery may also be performed to remove a thyroid nodule or to reduce the size of a goiter if it obstructs nearby structures or for cosmetic reasons.<sup id="cite_ref-:4_14-1" class="reference"><a href="#cite_note-:4-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Symptoms of the condition vary with type: hypo- vs. hyperthyroidism, which are further described below. </p><p>Possible symptoms of <a href="/wiki/Hypothyroidism" title="Hypothyroidism">hypothyroidism</a> are:<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col" style="column-width: 30em;"> <ul><li><a href="/wiki/Tiredness" class="mw-redirect" title="Tiredness">Tiredness</a></li> <li>Unexplained weight gain</li> <li>Slow movement</li> <li><a href="/wiki/Muscle" title="Muscle">Muscle</a> <a href="/wiki/Cramps" class="mw-redirect" title="Cramps">cramps</a></li> <li>Slow heart rate (<a href="/wiki/Bradycardia" title="Bradycardia">bradycardia</a>)</li> <li>Sensitivity to cold temperatures</li> <li><a href="/wiki/Constipation" title="Constipation">Constipation</a></li> <li><a href="/wiki/Depression_(mood)" title="Depression (mood)">Depressed</a> mood</li> <li><a href="/wiki/Memory" title="Memory">Memory</a> difficulty</li></ul></div><p>Possible symptoms of <a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">hyperthyroidism</a> are:<sup id="cite_ref-17" class="reference"><a href="#cite_note-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1184024115"></p><div class="div-col" style="column-width: 30em;"> <li>Difficulty sleeping (<a href="/wiki/Insomnia" title="Insomnia">insomnia</a>)</li> <li>Unexplained <a href="/wiki/Weight_loss" title="Weight loss">weight loss</a></li> <li><a href="/wiki/Tremor" title="Tremor">Tremors</a></li> <li>Fast heart rate (<a href="/wiki/Tachycardia" title="Tachycardia">tachycardia</a>) or <a href="/wiki/Palpitations" title="Palpitations">palpitations</a></li> <li>Sensitivity to hot temperatures, excess sweating</li> <li><a href="/wiki/Diarrhea" title="Diarrhea">Diarrhea</a></li> <li><a href="/wiki/Anxiety" title="Anxiety">Anxiety</a>, irritability</li></div><p>Note: certain symptoms and physical changes can be seen in both hypothyroidism and hyperthyroidism —fatigue, fine / thinning hair, menstrual cycle irregularities, muscle weakness / aches (<a href="/wiki/Myalgia" title="Myalgia">myalgia</a>), and different forms of <a href="/wiki/Myxedema" title="Myxedema">myxedema</a>.<sup id="cite_ref-:1_18-0" class="reference"><a href="#cite_note-:1-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:2_19-0" class="reference"><a href="#cite_note-:2-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup> </p><div class="mw-heading mw-heading2"><h2 id="Diseases">Diseases</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=2" title="Edit section: Diseases"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Low_function">Low function</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=3" title="Edit section: Low function"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Hypothyroidism" title="Hypothyroidism">Hypothyroidism</a></div> <p><a href="/wiki/Hypothyroidism" title="Hypothyroidism">Hypothyroidism</a> is a state in which the body is not producing enough thyroid hormones, or is not able to respond to / utilize existing thyroid hormones properly. The main categories are: </p> <ul><li><a href="/wiki/Thyroiditis" title="Thyroiditis">Thyroiditis</a>: an inflammation of the thyroid gland <ul><li><a href="/wiki/Hashimoto%27s_thyroiditis" title="Hashimoto's thyroiditis">Hashimoto's thyroiditis</a> / Hashimoto's disease</li> <li><a href="/wiki/Ord%27s_thyroiditis" title="Ord's thyroiditis">Ord's thyroiditis</a></li> <li><a href="/wiki/Postpartum_thyroiditis" title="Postpartum thyroiditis">Postpartum thyroiditis</a></li> <li><a href="/wiki/Silent_thyroiditis" class="mw-redirect" title="Silent thyroiditis">Silent thyroiditis</a></li> <li><a href="/wiki/Acute_infectious_thyroiditis" title="Acute infectious thyroiditis">Acute thyroiditis</a></li> <li><a href="/wiki/Riedel%27s_thyroiditis" title="Riedel's thyroiditis">Riedel's thyroiditis</a> (the majority of cases do not affect thyroid function, but approximately 30% of cases lead to hypothyroidism)</li></ul></li> <li>Iatrogenic hypothyroidism<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> <ul><li>Postoperative hypothyroidism</li> <li>Medication- or radiation-induced hypothyroidism</li></ul></li> <li><a href="/wiki/Thyroid_hormone_resistance" title="Thyroid hormone resistance">Thyroid hormone resistance</a></li> <li><a href="/wiki/Euthyroid_sick_syndrome" title="Euthyroid sick syndrome">Euthyroid sick syndrome</a></li> <li><a href="/wiki/Congenital_hypothyroidism" title="Congenital hypothyroidism">Congenital hypothyroidism</a>: a deficiency of thyroid hormone from birth, which untreated can lead to <a href="/wiki/Cretinism" class="mw-redirect" title="Cretinism">cretinism</a></li></ul> <div class="mw-heading mw-heading3"><h3 id="High_function">High function</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=4" title="Edit section: High function"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:OSC_Microbio_19_02_exophth.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/46/OSC_Microbio_19_02_exophth.jpg/220px-OSC_Microbio_19_02_exophth.jpg" decoding="async" width="220" height="144" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/46/OSC_Microbio_19_02_exophth.jpg/330px-OSC_Microbio_19_02_exophth.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/46/OSC_Microbio_19_02_exophth.jpg/440px-OSC_Microbio_19_02_exophth.jpg 2x" data-file-width="700" data-file-height="457" /></a><figcaption>Exophthalmos is the eye bulging that may be seen with Graves Disease, one of the major causes of hyperthyroidism</figcaption></figure> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">Hyperthyroidism</a></div> <p><a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">Hyperthyroidism</a> is a state in which the body is producing too much thyroid hormone. The main hyperthyroid conditions are: </p> <ul><li><a href="/wiki/Graves%27_disease" title="Graves' disease">Graves' disease</a></li> <li><a href="/wiki/Toxic_thyroid_nodule" class="mw-redirect" title="Toxic thyroid nodule">Toxic thyroid nodule</a></li> <li><a href="/wiki/Hyperthyroidism#Thyroid_storm" title="Hyperthyroidism">Thyroid storm</a></li> <li><a href="/wiki/Toxic_nodular_struma" class="mw-redirect" title="Toxic nodular struma">Toxic nodular struma</a> (Plummer's disease)</li> <li><a href="/wiki/Hashitoxicosis" title="Hashitoxicosis">Hashitoxicosis</a>: <i>transient</i> hyperthyroidism that can occur in Hashimoto's thyroiditis</li></ul> <div class="mw-heading mw-heading3"><h3 id="Structural_abnormalities">Structural abnormalities</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=5" title="Edit section: Structural abnormalities"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Kone_med_stor_struma.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/43/Kone_med_stor_struma.jpg/220px-Kone_med_stor_struma.jpg" decoding="async" width="220" height="305" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/43/Kone_med_stor_struma.jpg/330px-Kone_med_stor_struma.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/43/Kone_med_stor_struma.jpg/440px-Kone_med_stor_struma.jpg 2x" data-file-width="1939" data-file-height="2691" /></a><figcaption>Endemic goiter</figcaption></figure> <ul><li><a href="/wiki/Goitre" title="Goitre">Goiter</a>: an abnormal enlargement of the thyroid gland <ul><li><a href="/wiki/Endemic_goitre" title="Endemic goitre">Endemic goiter</a></li> <li><a href="/wiki/Diffuse_goitre" class="mw-redirect" title="Diffuse goitre">Diffuse goiter</a></li> <li><a href="/wiki/Multinodular_goitre" class="mw-redirect" title="Multinodular goitre">Multinodular goiter</a></li></ul></li> <li>Lingual thyroid</li> <li><a href="/wiki/Thyroglossal_cyst" title="Thyroglossal cyst">Thyroglossal duct cyst</a></li></ul> <div class="mw-heading mw-heading3"><h3 id="Tumors">Tumors</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=6" title="Edit section: Tumors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Thyroid_cancer" title="Thyroid cancer">Thyroid cancer</a> <ul><li><a href="/wiki/Papillary_thyroid_cancer" title="Papillary thyroid cancer">Papillary</a></li> <li><a href="/wiki/Follicular_thyroid_cancer" title="Follicular thyroid cancer">Follicular</a></li> <li><a href="/wiki/Medullary_thyroid_cancer" title="Medullary thyroid cancer">Medullary</a></li> <li><a href="/wiki/Anaplastic_thyroid_cancer" title="Anaplastic thyroid cancer">Anaplastic</a></li></ul></li> <li><a href="/wiki/Lymphoma" title="Lymphoma">Lymphomas</a> are usually <a href="/wiki/Cancer" title="Cancer">malignant</a></li> <li><a href="/wiki/Thyroid_adenoma" title="Thyroid adenoma">Thyroid adenomas</a> are <a href="/wiki/Benign_tumor" title="Benign tumor">benign tumors</a></li></ul> <div class="mw-heading mw-heading3"><h3 id="Medication_side_effects">Medication side effects</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=7" title="Edit section: Medication side effects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Certain medications can have the unintended side effect of affecting thyroid function. While some medications can lead to significant hypothyroidism or hyperthyroidism and those at risk will need to be carefully monitored, some medications may affect thyroid hormone lab tests without causing any symptoms or clinical changes, and may not require treatment.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (December 2016)">citation needed</span></a></i>]</sup> The following medications have been linked to various forms of thyroid disease: </p> <ul><li><a href="/wiki/Amiodarone" title="Amiodarone">Amiodarone</a> (more commonly can lead to hypothyroidism, but can be associated with some types of hyperthyroidism)<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Lithium_salt" class="mw-redirect" title="Lithium salt">Lithium salts</a> (hypothyroidism)</li> <li>Some types of <a href="/wiki/Interferon" title="Interferon">interferon</a> and <a href="/wiki/Aldesleukin" class="mw-redirect" title="Aldesleukin">IL-2</a> (thyroiditis)<sup id="cite_ref-Haugen_793–800_22-0" class="reference"><a href="#cite_note-Haugen_793–800-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li> <li><a href="/wiki/Glucocorticoid" title="Glucocorticoid">Glucocorticoids</a>, <a href="/wiki/Dopamine_agonist" title="Dopamine agonist">dopamine agonists</a>, and <a href="/wiki/Somatostatin_analogue" class="mw-redirect" title="Somatostatin analogue">somatostatin analogs</a> (block TSH, which can lead to hypothyroidism)<sup id="cite_ref-Haugen_793–800_22-1" class="reference"><a href="#cite_note-Haugen_793–800-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="Pathophysiology">Pathophysiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=8" title="Edit section: Pathophysiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Most thyroid disease in the United States stems from a condition where the body's immune system attacks itself. In other instances, thyroid disease comes from the body trying to adapt to environmental conditions like iodine deficiency or to new physiologic conditions like pregnancy. </p> <div class="mw-heading mw-heading3"><h3 id="Autoimmune_Thyroid_Disease">Autoimmune Thyroid Disease</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=9" title="Edit section: Autoimmune Thyroid Disease"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Autoimmune thyroid disease is a general category of disease that occurs due to the immune system targeting its own body. It is not fully understood why this occurs, but it is thought to be partially genetic as these diseases tend to run in families.<sup id="cite_ref-Hammer_2018_9-2" class="reference"><a href="#cite_note-Hammer_2018-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> In one of the most common types, Graves' Disease, the body produces antibodies against the TSH receptor on thyroid cells.<sup id="cite_ref-:42_4-1" class="reference"><a href="#cite_note-:42-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> This causes the receptor to activate even without TSH being present and causes the thyroid to produce and release excess thyroid hormone (hyperthyroidism).<sup id="cite_ref-:42_4-2" class="reference"><a href="#cite_note-:42-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Another common form of autoimmune thyroid disease is Hashimoto's thyroiditis where the body produces antibodies against different normal components of the thyroid gland, most commonly thyroglobulin, thyroid peroxidase, and the TSH receptor.<sup id="cite_ref-Hammer_2018_9-3" class="reference"><a href="#cite_note-Hammer_2018-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> These antibodies cause the immune system to attack the thyroid cells and cause inflammation (lymphocytic infiltration) and destruction (fibrosis) of the gland.<sup id="cite_ref-Hammer_2018_9-4" class="reference"><a href="#cite_note-Hammer_2018-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Goiter">Goiter</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=10" title="Edit section: Goiter"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Goiter is the general enlargement of the thyroid that can be associated with many thyroid diseases. The main reason this happens is because of increased signaling to the thyroid by way of TSH receptors to try to make it produce more thyroid hormone.<sup id="cite_ref-Hammer_2018_9-5" class="reference"><a href="#cite_note-Hammer_2018-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> This causes increased vascularity and increase in size (<a href="/wiki/Hypertrophy" title="Hypertrophy">hypertrophy</a>) of the gland.<sup id="cite_ref-Hammer_2018_9-6" class="reference"><a href="#cite_note-Hammer_2018-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> In hypothyroid states or iodine deficiency, the body recognizes that it is not producing enough thyroid hormone and starts to produce more TSH to help stimulate the thyroid to produce more thyroid hormone.<sup id="cite_ref-Hammer_2018_9-7" class="reference"><a href="#cite_note-Hammer_2018-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> This stimulation causes the gland to increase in size to increase production of thyroid hormone. In hyperthyroidism caused by Graves' Disease or toxic multinodular goiter, there is excess stimulation of the TSH receptor even when thyroid hormone levels are normal.<sup id="cite_ref-:42_4-3" class="reference"><a href="#cite_note-:42-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> In Graves' Disease this is because of an autoantibodies (Thyroid Stimulating Immunoglobulins) which bind to and activate the TSH receptors in place of TSH while in toxic multinodular goiter this is often because of a mutation in the TSH receptor that causes it to activate without receiving a signal from TSH.<sup id="cite_ref-:42_4-4" class="reference"><a href="#cite_note-:42-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> In more rare cases, the thyroid may become enlarged because it becomes filled with thyroid hormone or thyroid hormone precursors that it is unable to release or because of congential abnormalities or because of increased intake of iodine from supplementation or medication.<sup id="cite_ref-Hammer_2018_9-8" class="reference"><a href="#cite_note-Hammer_2018-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Pregnancy">Pregnancy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=11" title="Edit section: Pregnancy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>There are many changes to the body during pregnancy. One of the major changes to help with the development of the fetus is the production of human chorionic gonadotropin (hCG). This hormone, produced by the placenta, has similar structure to TSH and can bind to the maternal TSH receptor to produce thyroid hormone.<sup id="cite_ref-:22_23-0" class="reference"><a href="#cite_note-:22-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> During pregnancy, there is also an increase in estrogen which causes the mother to produce more thyroxine binding globulin, which is what carries most of the thyroid hormone in the blood.<sup id="cite_ref-:32_24-0" class="reference"><a href="#cite_note-:32-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> These normal hormonal changes often make pregnancy look like a hyperthyroid state but may be within the normal range for pregnancy, so it necessary to use trimester specific ranges for TSH and free T4.<sup id="cite_ref-:22_23-1" class="reference"><a href="#cite_note-:22-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:32_24-1" class="reference"><a href="#cite_note-:32-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> True hyperthyroidism in pregnancy is most often caused by an autoimmune mechanism from Graves' Disease.<sup id="cite_ref-:22_23-2" class="reference"><a href="#cite_note-:22-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> New diagnosis of hypothyroidism in pregnancy is rare because hypothyroidism often makes it difficult to become pregnant in the first place.<sup id="cite_ref-:22_23-3" class="reference"><a href="#cite_note-:22-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> When hypothyroidism is seen in pregnancy, it is often because an individual already has hypothyroidism and needs to increase their levothyroxine dose to account for the increased thyroxine binding globulin present in pregnancy.<sup id="cite_ref-:22_23-4" class="reference"><a href="#cite_note-:22-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=12" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Diagnosis of thyroid disease depends on symptoms and whether or not a thyroid nodule is present. Most patients will receive a blood test. Others might need an ultrasound, biopsy or a radioiodine scanning and uptake study. </p> <div class="mw-heading mw-heading3"><h3 id="Blood_tests">Blood tests</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=13" title="Edit section: Blood tests"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Thyroid_system.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d1/Thyroid_system.svg/220px-Thyroid_system.svg.png" decoding="async" width="220" height="255" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d1/Thyroid_system.svg/330px-Thyroid_system.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d1/Thyroid_system.svg/440px-Thyroid_system.svg.png 2x" data-file-width="871" data-file-height="1010" /></a><figcaption>Overview of the thyroid system and the various hormones involved.</figcaption></figure> <div class="mw-heading mw-heading4"><h4 id="Thyroid_function_tests">Thyroid function tests</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=14" title="Edit section: Thyroid function tests"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Thyroid_function_tests" title="Thyroid function tests">Thyroid function tests</a></div> <p>There are several hormones that can be measured in the blood to determine how the thyroid gland is functioning. These include the <a href="/wiki/Thyroid_hormones" title="Thyroid hormones">thyroid hormones</a> <a href="/wiki/Triiodothyronine" title="Triiodothyronine">triiodothyronine</a> (T3) and its precursor <a href="/wiki/Thyroxine" class="mw-redirect" title="Thyroxine">thyroxine</a> (T4), which are produced by the thyroid gland. <a href="/wiki/Thyroid-stimulating_hormone" title="Thyroid-stimulating hormone">Thyroid-stimulating hormone</a> (TSH) is another important hormone that is secreted by the anterior pituitary cells in the brain. Its primary function is to increase the production of T3 and T4 by the thyroid gland. </p><p>The most useful marker of thyroid gland function is serum thyroid-stimulating hormone (TSH) levels. TSH levels are determined by a classic <a href="/wiki/Negative_feedback" title="Negative feedback">negative feedback</a> system in which high levels of T3 and T4 suppress the production of TSH, and low levels of T3 and T4 increase the production of TSH. TSH levels are thus often used by doctors as a screening test, where the first approach is to determine whether TSH is elevated, suppressed, or normal.<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Elevated TSH levels can signify inadequate thyroid hormone production (hypothyroidism)</li> <li>Suppressed TSH levels can point to excessive thyroid hormone production (hyperthyroidism)</li></ul> <p>Because a single abnormal TSH level can be misleading, T3 and T4 levels must be measured in the blood to further confirm the diagnosis. When circulating in the body, T3 and T4 are bound to transport proteins. Only a small fraction of the circulating thyroid hormones are unbound or free, and thus biologically active. T3 and T4 levels can thus be measured as free T3 and T4, or total T3 and T4, which takes into consideration the free hormones in addition to the protein-bound hormones. Free T3 and T4 measurements are important because certain drugs and illnesses can affect the concentrations of transport proteins, resulting in differing total and free thyroid hormone levels. There are differing guidelines for T3 and T4 measurements. </p> <ul><li>Free T4 levels should be measured in the evaluation of hypothyroidism, and low free T4 establishes the diagnosis. T3 levels are generally not measured in the evaluation of hypothyroidism.<sup id="cite_ref-:0_13-1" class="reference"><a href="#cite_note-:0-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup></li> <li>Free T4 and total T3 can be measured when hyperthyroidism is of high suspicion as it will improve the accuracy of the diagnosis. Free T4, total T3 or both are elevated and serum TSH is below normal in hyperthyroidism. If the hyperthyroidism is mild, only serum T3 may be elevated and serum TSH can be low or may not be detected in the blood.<sup id="cite_ref-:4_14-2" class="reference"><a href="#cite_note-:4-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup></li> <li>Free T4 levels may also be tested in patients who have convincing symptoms of hyper- and hypothyroidism, despite a normal TSH.</li></ul> <div class="mw-heading mw-heading4"><h4 id="Antithyroid_antibodies">Antithyroid antibodies</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=15" title="Edit section: Antithyroid antibodies"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Autoantibody" title="Autoantibody">Autoantibodies</a> to the thyroid gland may be detected in various disease states. There are several anti-thyroid antibodies, including <a href="/wiki/Anti-thyroglobulin_antibodies" class="mw-redirect" title="Anti-thyroglobulin antibodies">anti-thyroglobulin antibodies</a> (TgAb), <a href="/wiki/Anti-microsomal" class="mw-redirect" title="Anti-microsomal">anti-microsomal</a>/<a href="/wiki/Anti-thyroid_peroxidase_antibodies" class="mw-redirect" title="Anti-thyroid peroxidase antibodies">anti-thyroid peroxidase antibodies</a> (TPOAb), and TSH receptor antibodies (TSHRAb).<sup id="cite_ref-:0_13-2" class="reference"><a href="#cite_note-:0-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p> <ul><li>Elevated anti-thryoglobulin (TgAb) and anti-thyroid peroxidase antibodies (TPOAb) can be found in patients with Hashimoto's thyroiditis, the most common autoimmune type of hypothyroidism. TPOAb levels have also been found to be elevated in patients who present with subclinical hypothyroidism (where TSH is elevated, but free T4 is normal), and can help predict progression to overt hypothyroidism. The American Association Thyroid Association thus recommends measuring TPOAb levels when evaluating subclinical hypothyroidism or when trying to identify whether nodular thyroid disease is due to autoimmune thyroid disease.<sup id="cite_ref-:2_19-1" class="reference"><a href="#cite_note-:2-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup></li> <li>When the etiology of hyperthyroidism is not clear after initial clinical and biochemical evaluation, measurement of TSH receptor antibodies (TSHRAb) can help make the diagnosis. In Graves' disease, TSHRAb levels are elevated as they are responsible for activating the TSH receptor and causing increased thyroid hormone production.<sup id="cite_ref-:1_18-1" class="reference"><a href="#cite_note-:1-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading4"><h4 id="Other_markers">Other markers</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=16" title="Edit section: Other markers"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li>There are two markers for thyroid-derived cancers. <ul><li><a href="/wiki/Thyroglobulin" title="Thyroglobulin">Thyroglobulin</a> (TG) levels can be elevated in well-differentiated papillary or follicular adenocarcinoma. It is often used to provide information on residual, recurrent or metastatic disease in patients with differentiated thyroid cancer. However, serum TG levels can be elevated in most thyroid diseases. Routine measurement of serum TG for evaluation of thyroid nodules is therefore currently not recommended by the American Thyroid Association.<sup id="cite_ref-:3_26-0" class="reference"><a href="#cite_note-:3-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup></li> <li>Elevated <a href="/wiki/Calcitonin" title="Calcitonin">calcitonin</a> levels in the blood have been shown to be associated with the rare <a href="/wiki/Medullary_thyroid_cancer" title="Medullary thyroid cancer">medullary thyroid cancer</a>. However, the measurement of calcitonin levels as a diagnostic tool is currently controversial due to falsely high or low calcitonin levels in a variety of diseases other than medullary thyroid cancer.<sup id="cite_ref-:3_26-1" class="reference"><a href="#cite_note-:3-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup></li></ul></li> <li>Very infrequently, <a href="/wiki/Thyroxine-binding_globulin" title="Thyroxine-binding globulin">TBG</a> and <a href="/wiki/Transthyretin" title="Transthyretin">transthyretin</a> levels may be abnormal; these are not routinely tested.</li> <li>To differentiate between different types of hypothyroidism, a specific test may be used. <a href="/wiki/Thyrotropin-releasing_hormone" title="Thyrotropin-releasing hormone">Thyrotropin-releasing hormone</a> (TRH) is injected into the body through a vein. This hormone is naturally secreted by the hypothalamus and stimulates the pituitary gland. The pituitary responds by releasing thyroid-stimulating hormone (TSH). Large amounts of externally administered TRH can suppress the subsequent release of TSH. This amount of release-suppression is exaggerated in primary hypothyroidism, major depression, cocaine dependence, amphetamine dependence and chronic phencyclidine abuse. There is a failure to suppress in the manic phase of bipolar disorder.<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading3"><h3 id="Ultrasound">Ultrasound</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=17" title="Edit section: Ultrasound"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Many people may develop a thyroid nodule at some point in their lives. Although many who experience this worry that it is thyroid cancer, there are many causes of nodules that are benign and not cancerous. If a possible nodule is present, a doctor may order thyroid function tests to determine if the thyroid gland's activity is being affected. If more information is needed after a clinical exam and lab tests, <a href="/wiki/Medical_ultrasonography" class="mw-redirect" title="Medical ultrasonography">medical ultrasonography</a> can help determine the nature of thyroid nodule(s). There are some notable differences in <i>typical</i> benign vs. cancerous thyroid nodules that can particularly be detected by the high-frequency sound waves in an ultrasound scan. The ultrasound may also locate nodules that are too small for a doctor to feel on a physical exam, and can demonstrate whether a nodule is primarily solid, liquid (<a href="/wiki/Cyst" title="Cyst">cystic</a>), or a mixture of both. It is an imaging process that can often be done in a doctor's office, is painless, and does not expose the individual to any radiation.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> </p><p>The main characteristics that can help distinguish a benign vs. malignant (cancerous) thyroid nodule on ultrasound are as follows:<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p> <table class="wikitable"> <tbody><tr> <th>Possible thyroid cancer</th> <th>More likely benign </th></tr> <tr> <td>irregular borders</td> <td>smooth borders </td></tr> <tr> <td>hypoechoic (less echogenic than the surrounding tissue)</td> <td>hyperechoic </td></tr> <tr> <td>incomplete "halo"</td> <td>spongiform appearance </td></tr> <tr> <td>significant intranodular / central blood flow by power Doppler</td> <td>marked peripheral blood flow </td></tr> <tr> <td>microcalcifications</td> <td>larger, broad calcifications (note: these can be seen in medullary thyroid cancer) </td></tr> <tr> <td>nodule appears more tall than wide on transverse study </td> <td>"comet tail" artifact as sound waves bounce off intranodular colloid </td></tr> <tr> <td>documented progressive increase in size of nodule on ultrasound </td> <td> </td></tr></tbody></table> <p>Although ultrasonography is a very important diagnostic tool, this method is not always able to separate benign from malignant nodules with certainty. In suspicious cases, a tissue sample is often obtained by biopsy for microscopic examination. </p> <div class="mw-heading mw-heading3"><h3 id="Radioiodine_scanning_and_uptake">Radioiodine scanning and uptake</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=18" title="Edit section: Radioiodine scanning and uptake"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Thyroid_scintigraphy.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/0/0a/Thyroid_scintigraphy.jpg/220px-Thyroid_scintigraphy.jpg" decoding="async" width="220" height="162" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/0a/Thyroid_scintigraphy.jpg/330px-Thyroid_scintigraphy.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/0a/Thyroid_scintigraphy.jpg/440px-Thyroid_scintigraphy.jpg 2x" data-file-width="2012" data-file-height="1478" /></a><figcaption>Five scintigrams taken from thyroids with different syndromes: A) normal thyroid, B) Graves' disease, diffuse increased uptake in both thyroid lobes, C) Plummer's disease, D) Toxic adenoma, E) Thyroiditis.</figcaption></figure> <p>Thyroid <a href="/wiki/Scintigraphy" title="Scintigraphy">scintigraphy</a>, in which the thyroid is imaged with the aid of <a href="/wiki/Isotopes_of_iodine" title="Isotopes of iodine">radioactive iodine</a> (usually <a href="/wiki/Iodine-123" title="Iodine-123">iodine-123</a>, which does not harm thyroid cells, or rarely, <a href="/wiki/Iodine-131" title="Iodine-131">iodine-131</a>),<sup id="cite_ref-thyroid.org_31-0" class="reference"><a href="#cite_note-thyroid.org-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> is performed in the <a href="/wiki/Nuclear_medicine" title="Nuclear medicine">nuclear medicine</a> department of a hospital or clinic. Radioiodine collects in the thyroid gland before being excreted in the urine. While in the thyroid, the radioactive emissions can be detected by a camera, producing a rough image of the shape (a <i>radioiodine scan</i>) and tissue activity (a <i>radioiodine uptake</i>) of the thyroid gland. </p><p>A normal radioiodine scan shows even uptake and activity throughout the gland. Irregular uptake can reflect an abnormally shaped or abnormally located gland, or it can indicate that a portion of the gland is overactive or underactive. For example, a nodule that is overactive ("hot") -- to the point of suppressing the activity of the rest of the gland—is usually a thyrotoxic adenoma, a surgically curable form of hyperthyroidism that is rarely malignant. In contrast, finding that a substantial section of the thyroid is inactive ("cold") may indicate an area of non-functioning tissue, such as thyroid cancer. </p><p>The amount of radioactivity can be quantified and serves as an indicator of the metabolic activity of the gland. A normal quantitation of radioiodine uptake demonstrates that about 8-35% of the administered dose can be detected in the thyroid 24 hours later. Overactivity or underactivity of the gland, as may occur with hyperthyroidism or hypothyroidism, is usually reflected in increased or decreased radioiodine uptake. Different patterns may occur with different causes of hypo- or hyperthyroidism. </p> <div class="mw-heading mw-heading3"><h3 id="Biopsy">Biopsy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=19" title="Edit section: Biopsy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A medical <a href="/wiki/Biopsy" title="Biopsy">biopsy</a> refers to the obtaining of a tissue sample for examination under the microscope or other testing, usually to distinguish cancer from noncancerous conditions. Thyroid tissue may be obtained for biopsy by <a href="/wiki/Fine_needle_aspiration" class="mw-redirect" title="Fine needle aspiration">fine needle aspiration</a> (FNA) or by <a href="/wiki/Surgery" title="Surgery">surgery</a>.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (December 2016)">citation needed</span></a></i>]</sup> </p><p>Fine needle aspiration has the advantage of being a brief, safe, outpatient procedure that is safer and less expensive than surgery and does not leave a visible scar. Needle biopsies became widely used in the 1980s, though it was recognized that the accuracy of identification of cancer was good, but not perfect. The accuracy of the diagnosis depends on obtaining tissue from all of the suspicious areas of an abnormal thyroid gland. The reliability of fine needle aspiration is increased when sampling can be guided by ultrasound, and over the last 15 years, this has become the preferred method for thyroid biopsy in North America.<sup id="cite_ref-32" class="reference"><a href="#cite_note-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup><sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (December 2016)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=20" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Medication">Medication</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=21" title="Edit section: Medication"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Levothyroxine" title="Levothyroxine">Levothyroxine</a> is a <a href="/wiki/Stereoisomer" class="mw-redirect" title="Stereoisomer">stereoisomer</a> of <a href="/wiki/Thyroxine" class="mw-redirect" title="Thyroxine">thyroxine</a> (T4) which is degraded much more slowly and can be administered once daily in patients with hypothyroidism.<sup id="cite_ref-:0_13-3" class="reference"><a href="#cite_note-:0-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> Natural thyroid hormone from pigs is sometimes also used, especially for people who cannot tolerate the synthetic version. Hyperthyroidism caused by Graves' disease may be treated with the <a href="/wiki/Thioamide" title="Thioamide">thioamide</a> drugs <a href="/wiki/Propylthiouracil" title="Propylthiouracil">propylthiouracil</a>, <a href="/wiki/Carbimazole" title="Carbimazole">carbimazole</a> or <a href="/wiki/Methimazole" class="mw-redirect" title="Methimazole">methimazole</a>, or rarely with <a href="/wiki/Lugol%27s_solution" class="mw-redirect" title="Lugol's solution">Lugol's solution</a>. Additionally, hyperthyroidism and thyroid tumors may be treated with <a href="/wiki/Radioactive_iodine" class="mw-redirect" title="Radioactive iodine">radioactive iodine</a>. <a href="/wiki/Ethanol" title="Ethanol">Ethanol</a> <a href="/wiki/Injection_(medicine)" title="Injection (medicine)">injections</a> for the treatment of recurrent thyroid cysts and metastatic thyroid cancer in lymph nodes can also be an alternative to surgery.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (December 2016)">citation needed</span></a></i>]</sup> </p> <div class="mw-heading mw-heading3"><h3 id="Surgery">Surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=22" title="Edit section: Surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Thyroid surgery is performed for a variety of reasons. A <a href="/wiki/Thyroid_nodule" title="Thyroid nodule">nodule</a> or lobe of the thyroid is sometimes removed for <a href="/wiki/Biopsy" title="Biopsy">biopsy</a> or because of the presence of an autonomously functioning <a href="/wiki/Thyroid_adenoma" title="Thyroid adenoma">adenoma</a> causing <a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">hyperthyroidism</a>. A large majority of the thyroid may be removed (<i>subtotal thyroidectomy)</i> to treat the hyperthyroidism of <a href="/wiki/Graves%27_disease" title="Graves' disease">Graves' disease</a>, or to remove a <a href="/wiki/Goitre" title="Goitre">goiter</a> that is unsightly or impinges on vital structures.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (April 2022)">citation needed</span></a></i>]</sup> </p><p>A complete <a href="/wiki/Thyroidectomy" title="Thyroidectomy">thyroidectomy</a> of the entire thyroid, including associated <a href="/wiki/Lymph_nodes" class="mw-redirect" title="Lymph nodes">lymph nodes</a>, is the preferred treatment for <a href="/wiki/Thyroid_cancer" title="Thyroid cancer">thyroid cancer</a>. Removal of the bulk of the thyroid gland usually produces <a href="/wiki/Hypothyroidism" title="Hypothyroidism">hypothyroidism</a> unless the person takes <a href="/wiki/Thyroid_hormone" class="mw-redirect" title="Thyroid hormone">thyroid hormone</a> replacement. Consequently, individuals who have undergone a total thyroidectomy are typically placed on thyroid hormone replacement (e.g. levothyroxine) for the remainder of their lives. Higher than normal doses are often administered to prevent recurrence.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (April 2022)">citation needed</span></a></i>]</sup> </p><p>If the thyroid gland must be removed surgically, care must be taken to avoid damage to adjacent structures, the <a href="/wiki/Parathyroid_gland" title="Parathyroid gland">parathyroid glands</a> and the <a href="/wiki/Recurrent_laryngeal_nerve" title="Recurrent laryngeal nerve">recurrent laryngeal nerve</a>. Both are susceptible to accidental removal and/or injury during thyroid surgery.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">[<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (April 2022)">citation needed</span></a></i>]</sup> </p><p>The parathyroid glands produce <a href="/wiki/Parathyroid_hormone" title="Parathyroid hormone">parathyroid hormone</a> (PTH), a hormone needed to maintain adequate amounts of calcium in the blood. Removal results in <a href="/wiki/Hypoparathyroidism" title="Hypoparathyroidism">hypoparathyroidism</a> and a need for supplemental calcium and <a href="/wiki/Vitamin_D" title="Vitamin D">vitamin D</a> each day. In the event that the blood supply to any one of the parathyroid glands is endangered through surgery, the parathyroid gland(s) involved may be re-implanted in surrounding muscle tissue. </p><p>The recurrent laryngeal nerves provide motor control for all external muscles of the <a href="/wiki/Larynx" title="Larynx">larynx</a> except for the <a href="/wiki/Cricothyroid_muscle" title="Cricothyroid muscle">cricothyroid muscle</a>, which also runs along the posterior thyroid. Accidental laceration of either of the two or both recurrent laryngeal nerves may cause paralysis of the <a href="/wiki/Vocal_cords" title="Vocal cords">vocal cords</a> and their associated muscles, changing the voice quality. A 2019 <a href="/wiki/Systematic_review" title="Systematic review">systematic review</a> concluded that the available evidence shows no difference between visually identifying the nerve or utilizing intraoperative <a href="/wiki/Neuroimaging" title="Neuroimaging">neuroimaging</a> during surgery, when trying to prevent injury to recurrent laryngeal nerve during thyroid surgery.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Radioiodine">Radioiodine</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=23" title="Edit section: Radioiodine"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Radioiodine_therapy" class="mw-redirect" title="Radioiodine therapy">Radioiodine therapy</a> with iodine-131 can be used to shrink the thyroid gland (for instance, in the case of large goiters that cause symptoms but do not harbor cancer—after evaluation and biopsy of suspicious nodules has been done), or to destroy hyperactive thyroid cells (for example, in cases of thyroid cancer). The iodine uptake can be high in countries with iodine deficiency, but low in iodine sufficient countries. To enhance iodine-131 uptake by the thyroid and allow for more successful treatment, TSH is raised prior to therapy in order to stimulate the existing thyroid cells. This is done either by withdrawal of thyroid hormone medication or injections of recombinant human TSH (Thyrogen),<sup id="cite_ref-thyroid.org_31-1" class="reference"><a href="#cite_note-thyroid.org-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> released in the United States in 1999. Thyrogen injections can reportedly boost uptake up to 50-60%. Radioiodine treatment can also cause hypothyroidism (which is sometimes the end goal of treatment) and, although rare, a pain syndrome (due to <a href="/wiki/Radiation-induced_thyroiditis" title="Radiation-induced thyroiditis">radiation thyroiditis)</a>.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=24" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In the United States, autoimmune inflammation is the most common form of thyroid disease while worldwide hypothyroidism and goiter due to dietary iodine deficiency is the most common.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-:42_4-5" class="reference"><a href="#cite_note-:42-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> According to the American Thyroid Association in 2015, approximately 20 million people in the United States alone are affected by thyroid disease.<sup id="cite_ref-Atasayar_2019_11-1" class="reference"><a href="#cite_note-Atasayar_2019-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> Hypothyroidism affects 3-10% percent of adults, with a higher incidence in women and the elderly.<sup id="cite_ref-pmid16033723_37-0" class="reference"><a href="#cite_note-pmid16033723-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid19121255_38-0" class="reference"><a href="#cite_note-pmid19121255-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid17636722_39-0" class="reference"><a href="#cite_note-pmid17636722-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> An estimated one-third of the world's population currently lives in areas of low dietary iodine levels. In regions of severe iodine deficiency, the prevalence of goiter is as high as 80%.<sup id="cite_ref-:02_40-0" class="reference"><a href="#cite_note-:02-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> In areas where iodine-deficiency is not found, the most common type of hypothyroidism is an autoimmune subtype called <a href="/wiki/Hashimoto%27s_thyroiditis" title="Hashimoto's thyroiditis">Hashimoto's thyroiditis</a>, with a prevalence of 1-2%.<sup id="cite_ref-:02_40-1" class="reference"><a href="#cite_note-:02-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> As for hyperthyroidism, <a href="/wiki/Graves%27_disease" title="Graves' disease">Graves' disease</a>, another autoimmune condition, is the most common type with a prevalence of 0.5% in males and 3% in females.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> Although thyroid nodules are common, thyroid cancer is rare. Thyroid cancer accounts for less than 1% of all cancer in the UK, though it is the most common endocrine tumor and makes up greater than 90% of all cancers of the <a href="/wiki/Endocrine_gland" title="Endocrine gland">endocrine glands</a>.<sup id="cite_ref-:02_40-2" class="reference"><a href="#cite_note-:02-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=25" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">Hyperthyroidism</a> <ul><li><a href="/wiki/Graves%27_disease" title="Graves' disease">Graves' disease</a></li></ul></li> <li><a href="/wiki/Hypothyroidism" title="Hypothyroidism">Hypothyroidism</a> <ul><li><a href="/wiki/Hashimoto%27s_thyroiditis" title="Hashimoto's thyroiditis">Hashimoto's thyroiditis</a></li></ul></li> <li><a href="/wiki/Thyroid_nodule" title="Thyroid nodule">Thyroid nodule</a></li> <li><a href="/wiki/Thyroid_disease_in_pregnancy" title="Thyroid disease in pregnancy">Thyroid disease in pregnancy</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Thyroid_disease&action=edit&section=26" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist"> <div class="mw-references-wrap mw-references-columns"><ol class="references"> <li id="cite_note-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-1">^</a></b></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output 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title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Endocrine+Practice&rft.atitle=Subclinical+thyroid+dysfunction%3A+a+joint+statement+on+management+from+the+American+Association+of+Clinical+Endocrinologists%2C+the+American+Thyroid+Association%2C+and+the+Endocrine+Society&rft.volume=10&rft.issue=6&rft.pages=497-501&rft.date=2004&rft_id=info%3Adoi%2F10.4158%2Fep.10.6.497&rft_id=info%3Apmid%2F16033723&rft.aulast=Gharib&rft.aufirst=H&rft.au=Tuttle%2C+RM&rft.au=Baskin%2C+HJ&rft.au=Fish%2C+LH&rft.au=Singer%2C+PA&rft.au=McDermott%2C+MT&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThyroid+disease" class="Z3988"></span></span> </li> <li id="cite_note-pmid19121255-38"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid19121255_38-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFFatourechi2009" class="citation journal cs1">Fatourechi V (2009). 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title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Mayo+Clinic+Proceedings&rft.atitle=Subclinical+hypothyroidism%3A+an+update+for+primary+care+physicians&rft.volume=84&rft.issue=1&rft.pages=65-71&rft.date=2009&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2664572%23id-name%3DPMC&rft_id=info%3Apmid%2F19121255&rft_id=info%3Adoi%2F10.4065%2F84.1.65&rft.aulast=Fatourechi&rft.aufirst=V&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC2664572&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThyroid+disease" class="Z3988"></span><sup class="noprint Inline-Template"><span style="white-space: nowrap;">[<i><a href="/wiki/Wikipedia:Link_rot" title="Wikipedia:Link rot"><span title=" Dead YouTube link tagged February 2022">dead YouTube link</span></a></i>]</span></sup></span> </li> <li id="cite_note-pmid17636722-39"><span class="mw-cite-backlink"><b><a href="#cite_ref-pmid17636722_39-0">^</a></b></span> <span 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class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/17636722">17636722</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+Cochrane+Database+of+Systematic+Reviews&rft.atitle=Thyroid+hormone+replacement+for+subclinical+hypothyroidism&rft.volume=2007&rft.issue=3&rft.pages=CD003419&rft.date=2007-07&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6610974%23id-name%3DPMC&rft_id=info%3Apmid%2F17636722&rft_id=info%3Adoi%2F10.1002%2F14651858.CD003419.pub2&rft.aulast=Villar&rft.aufirst=HC&rft.au=Saconato%2C+H&rft.au=Valente%2C+O&rft.au=Atallah%2C+AN&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC6610974&rfr_id=info%3Asid%2Fen.wikipedia.org%3AThyroid+disease" class="Z3988"></span></span> </li> <li id="cite_note-:02-40"><span class="mw-cite-backlink">^ <a href="#cite_ref-:02_40-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-:02_40-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-:02_40-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFVanderpump2011" class="citation journal cs1">Vanderpump MP (2011-09-01). 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margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q6673122" class="extiw" title="d:Q6673122">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: E00-E07, Q89.1-Q89.2</li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=240">240</a>-<a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=246">246</a>, <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=759.1">759.1</a>-<a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=759.2">759.2</a></li><li><b><a href="/wiki/Medical_Subject_Headings" title="Medical Subject Headings">MeSH</a></b>: <a rel="nofollow" class="external text" href="https://meshb.nlm.nih.gov/record/ui?ui=D013959">D013959</a></li><li><b><a href="/wiki/SNOMED_CT" title="SNOMED CT">SNOMED CT</a></b>: <a rel="nofollow" class="external text" href="http://snomed.info/id/14304000">14304000</a></li></ul></div></div></td></tr></tbody></table></div> <ul><li><a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/thyroiddiseases.html">Medline Plus Medical Encyclopedia entry for Thyroid Disease</a></li> <li><a rel="nofollow" class="external text" href="http://www.endocrine.niddk.nih.gov/">National Institutes of Health</a> <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150225175414/http://www.endocrine.niddk.nih.gov/">Archived</a> 2015-02-25 at the <a href="/wiki/Wayback_Machine" title="Wayback Machine">Wayback Machine</a></li></ul> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Thyroid_disease" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse 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.navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Thyroid_disease" title="Template:Thyroid disease"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Thyroid_disease" title="Template talk:Thyroid disease"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Thyroid_disease" title="Special:EditPage/Template:Thyroid disease"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Thyroid_disease" style="font-size:114%;margin:0 4em"><a class="mw-selflink selflink">Thyroid disease</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hypothyroidism" title="Hypothyroidism">Hypothyroidism</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Iodine_deficiency" title="Iodine deficiency">Iodine deficiency</a></li> <li><a href="/wiki/Cretinism" class="mw-redirect" title="Cretinism">Cretinism</a> <ul><li><a href="/wiki/Congenital_hypothyroidism" title="Congenital hypothyroidism">Congenital hypothyroidism</a></li></ul></li> <li><a href="/wiki/Myxedema" title="Myxedema">Myxedema</a></li> <li><a href="/wiki/Myxedema_coma" title="Myxedema coma">Myxedema coma</a></li> <li><a href="/wiki/Euthyroid_sick_syndrome" title="Euthyroid sick syndrome">Euthyroid sick syndrome</a></li> <li><a href="/wiki/Van_Wyk_and_Grumbach_syndrome" title="Van Wyk and Grumbach syndrome">Van Wyk-Grumbach syndrome</a></li> <li>Signs and symptoms <ul><li><a href="/wiki/Sign_of_Hertoghe" title="Sign of Hertoghe">Queen Anne's sign</a></li> <li><a href="/wiki/Woltman_sign" title="Woltman sign">Woltman sign</a></li> <li><a href="/wiki/Edema" title="Edema">Myoedema</a></li></ul></li> <li><a href="/wiki/Thyroid_dyshormonogenesis" title="Thyroid dyshormonogenesis">Thyroid dyshormonogenesis</a></li> <li><a href="/wiki/Pickardt_syndrome" title="Pickardt syndrome">Pickardt syndrome</a></li> <li>Hypothyroid myopathy <ul><li><a href="/wiki/Kocher%E2%80%93Debre%E2%80%93Semelaigne_syndrome" title="Kocher–Debre–Semelaigne syndrome">KDSS</a></li> <li><a href="/wiki/Hoffmann_syndrome" title="Hoffmann syndrome">Hoffmann syndrome</a></li> <li><a href="/wiki/Lambert%E2%80%93Eaton_myasthenic_syndrome" title="Lambert–Eaton myasthenic syndrome">LEMS</a></li> <li>Atrophic type</li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hyperthyroidism" title="Hyperthyroidism">Hyperthyroidism</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hyperthyroxinemia" title="Hyperthyroxinemia">Hyperthyroxinemia</a> <ul><li><a href="/wiki/Thyroid_hormone_resistance" title="Thyroid hormone resistance">Thyroid hormone resistance</a></li> <li><a href="/wiki/Familial_dysalbuminemic_hyperthyroxinemia" title="Familial dysalbuminemic hyperthyroxinemia">Familial dysalbuminemic hyperthyroxinemia</a></li></ul></li> <li><a href="/wiki/Hashitoxicosis" title="Hashitoxicosis">Hashitoxicosis</a></li> <li><a href="/wiki/Thyrotoxicosis_factitia" title="Thyrotoxicosis factitia">Thyrotoxicosis factitia</a></li> <li><a href="/wiki/Thyroid_storm" title="Thyroid storm">Thyroid storm</a></li> <li><a href="/wiki/Amiodarone_induced_thyrotoxicosis" title="Amiodarone induced thyrotoxicosis">Amiodarone induced thyrotoxicosis</a></li> <li>Hyperthyroid myopathy</li></ul> </div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Graves%27_disease" title="Graves' disease">Graves' disease</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>Signs and symptoms <ul><li><a href="/wiki/Abadie%27s_sign_of_exophthalmic_goiter" title="Abadie's sign of exophthalmic goiter">Abadie's sign of exophthalmic goiter</a></li> <li><a href="/wiki/Boston%27s_sign" title="Boston's sign">Boston's sign</a></li> <li><a href="/wiki/Dalrymple%27s_sign" title="Dalrymple's sign">Dalrymple's sign</a></li> <li><a href="/wiki/Stellwag%27s_sign" title="Stellwag's sign">Stellwag's sign</a></li> <li><a href="/wiki/Von_Graefe%27s_sign" title="Von Graefe's sign">lid lag</a></li> <li><a href="/wiki/Griffith%27s_sign" title="Griffith's sign">Griffith's sign</a></li> <li><a href="/wiki/M%C3%B6bius_sign" title="Möbius sign">Möbius sign</a></li> <li><a href="/wiki/Pretibial_myxedema" title="Pretibial myxedema">Pretibial myxedema</a></li></ul></li> <li><a href="/wiki/Graves%27_ophthalmopathy" title="Graves' ophthalmopathy">Graves' ophthalmopathy</a></li></ul> </div></td></tr></tbody></table><div> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Thyroiditis" title="Thyroiditis">Thyroiditis</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Acute_infectious_thyroiditis" title="Acute infectious thyroiditis">Acute infectious</a></li> <li><a href="/wiki/Subacute_thyroiditis" title="Subacute thyroiditis">Subacute</a> <ul><li><a href="/wiki/De_Quervain%27s_thyroiditis" title="De Quervain's thyroiditis">De Quervain's</a></li> <li><a href="/wiki/Subacute_lymphocytic_thyroiditis" title="Subacute lymphocytic thyroiditis">Subacute lymphocytic</a></li> <li><a href="/wiki/Palpation_thyroiditis" title="Palpation thyroiditis">Palpation</a></li></ul></li> <li><a href="/wiki/Autoimmune_thyroiditis" class="mw-redirect" title="Autoimmune thyroiditis">Autoimmune</a>/chronic <ul><li><a href="/wiki/Hashimoto%27s_thyroiditis" title="Hashimoto's thyroiditis">Hashimoto's</a></li> <li><a href="/wiki/Postpartum_thyroiditis" title="Postpartum thyroiditis">Postpartum</a></li> <li><a href="/wiki/Riedel%27s_thyroiditis" title="Riedel's thyroiditis">Riedel's</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Enlargement</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Goitre" title="Goitre">Goitre</a> <ul><li><a href="/wiki/Endemic_goitre" title="Endemic goitre">Endemic goitre</a></li> <li><a href="/wiki/Toxic_nodular_goiter" class="mw-redirect" title="Toxic nodular goiter">Toxic nodular goiter</a></li> <li><a href="/wiki/Toxic_multinodular_goiter" class="mw-redirect" title="Toxic multinodular goiter">Toxic multinodular goiter</a></li></ul></li> <li><a href="/wiki/Thyroid_nodule" title="Thyroid nodule">Thyroid nodule</a> <ul><li><a href="/wiki/Colloid_nodule" title="Colloid nodule">Colloid nodule</a></li></ul></li></ul> </div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Congenital_endocrine_disorders" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Congenital_endocrine_disorders" title="Template:Congenital endocrine disorders"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Congenital_endocrine_disorders" title="Template talk:Congenital endocrine disorders"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Congenital_endocrine_disorders" title="Special:EditPage/Template:Congenital endocrine disorders"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Congenital_endocrine_disorders" style="font-size:114%;margin:0 4em">Congenital <a href="/wiki/Endocrine_disease" title="Endocrine disease">endocrine disorders</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pituitary_gland" title="Pituitary gland">Pituitary</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Congenital_hypopituitarism" class="mw-redirect" title="Congenital hypopituitarism">Congenital hypopituitarism</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Thyroid" title="Thyroid">Thyroid</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a class="mw-selflink selflink">Thyroid disease</a></li> <li><a href="/wiki/Persistent_thyroglossal_duct" title="Persistent thyroglossal duct">Persistent thyroglossal duct</a></li> <li><a href="/wiki/Thyroglossal_cyst" title="Thyroglossal cyst">Thyroglossal cyst</a></li> <li><a href="/wiki/Congenital_hypothyroidism" title="Congenital hypothyroidism">Congenital hypothyroidism</a> <ul><li><a href="/wiki/Thyroid_dysgenesis" title="Thyroid dysgenesis">Thyroid dysgenesis</a></li> <li><a href="/wiki/Thyroid_dyshormonogenesis" title="Thyroid dyshormonogenesis">Thyroid dyshormonogenesis</a></li> <li><a href="/wiki/Pendred_syndrome" title="Pendred syndrome">Pendred syndrome</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Parathyroid_gland" title="Parathyroid gland">Parathyroid</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hypoparathyroidism" title="Hypoparathyroidism">Congenital absence of parathyroid</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Adrenal_gland" title="Adrenal gland">Adrenal</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Absent_adrenal_gland" title="Absent 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