A middle age lady with a large thyroid lump

1. Is it true that thyroid symptoms are often misdiagnosed?
There are 2 main groups of thyroid management problems that doctors encounter clinically. The first is the problem of abnormal nodular growth in the thyroid gland while the second involves thyroid gland dysfunctions. Misdiagnosis most frequently occurs in problems related to the latter group. A thyroid gland may become overactive and produce excessive amount of thyroid hormone (thyroxine) or under-secrete them. Former results in a condition called hyperthyroidism and the latter is termed hypothyroidism. Patients with hyperthyroidism frequently present with non-specific symptoms such as anxiety, insomnia, irritability and weight loss. Assessment of one’s blood thyroid hormone level will nail the diagnosis.

2. Why do thyroid disorders tend to be misdiagnosed?
The problem with thyroid disorders (hyper or hypo states) is that the symptoms tend to be non-specific. Unless the GP taking care of the patient has a high index of suspicion, patients usually go untreated until the disease become more established and obvious. With widespread annual full body checkups offered by medical clinics, however, patients with deranged thyroid functions are now detected much earlier.

3. What may happen if thyroid disorders are misdiagnosed?
As the diseases progresses, symptoms usually become more severe. Patients with hyperthyroidism for example may begin to lose unaccounted and dramatic amount of weight. Or they may suffer increasingly troublesome restlessness and insomnia. Patients who go untreated may suffer from heart complications which results from hyperthyroidism.

4. Has there been any data showing how common thyroid disorders (or each thyroid disorder) is among Singaporeans?
There is currently no data on this but extrapolation from predictive models based on studies in the US has the following estimates.

Prevalance Rate for Thyroid disorders: approx 1 in 13 or 7.35%

Undiagnosed Prevalence Rate for Thyroid disorders: approx 1 in 20 or 4.78%

5. Which group of people is at greatest risk for thyroid disorders? Why?
Women are 8 times more likely then men to face the disorder. People with a family history of thyroid problem and those with a high exposure to radiation also have higher chances of a thyroid disorder as the gland is sensitive to any form of radiation. Elderly people amongst us also have a higher risk of developing thyroid problems.

6. Who should check for thyroid disorders? How often should these tests be repeated?
Patients with symptoms of increased thyroid hormone levels (unexplained weight loss in spite of an increase in appetite, anxiety, insomnia, inability to withstand heat, palpitation and bowel irritability etc) or decreased thyroid levels (weight gain, lethargy, constipation and mental slowness. Patients with unusual thyroid lumps (at the front of your neck) should also seek medical attention. For patients with abnormal thyroid functions, assessment of the blood thyroid hormone levels will usually review the severity of the problem. Patients with thyroid lumps will require fine needle biopsy, ultrasound of the thyroid and blood thyroid levels assessment.

7. Should people with thyroid nodules be concerned that the lumps are cancerous?
The incidence of thyroid nodules increases with age. It has been estimated that about ten percent of the adult population have some form of thyroid nodules. Autopsy studies have reveal the presence of thyroid nodules in 50 percent of the population. Fortunately 95% of solitary thyroid nodules are benign. The chance of a solitary nodule being malignant is therefore only five percent.

8. Is thyroid cancer common in Singapore?
Thyroid cancer is fortunately not common in Singapore. According to the Singapore Cancer Registry, between 1998 - 2002, only 184 cases were reported in Singapore. It is the 9th commonest cancer in Singapore women.

9. How likely is a person suffering from thyroid cancer to recover from it?
Thyroid cancers are amongst the cancers with the best cure rates. These cancers consist of a diverse group of cancers with varying survival rates. Those commonly encountered are the papillary (65%) and the follicular (30%) types. Cure rates of more than 95% can frequently be attained when treated early and effectively. Unusual thyroid cancers include the medullary type (4%) and the anaplastic type (1%). The latter is extremely aggressive and gives poor prognosis.

10. How are common thyroid disorders are treated, including common side effects of drugs or complications?
Patients with hypothyroidism require daily thyroid hormone replacement.

Patients with hyperthyroidism may be treated by anti-thyroid hormones (such as carbamazepine or PTU), cellular destruction of the thyroid gland by radio-iodine or by subtotal removal of the thyroid gland.

Patients with thyroid tumours will require surgical excisions.

11. Are there any misconceptions and myths regarding thyroid disorders?
That only women gets thyroid problems. That it is mostly frequently caused by eating too much seafood. Or that it is caused by iodine deficiency