Ah, the joys of heredity!  My mom is the youngest of 11 siblings. Her 5 older sisters give her a chronological idea of what she will look like in the years to come.  Genetics and ancestral similarities run strong in our family. I am basically a Xerox copy of my mom at 35.  Her sisters are stair-step cookie cutters of one another with only subtle differences such as a touch more grey hair here or a tad more smile lines there.  They have a lighthearted spirit when they joke about the Aldridge family genes and what we have in store for us.  Human genomics is currently the forefront of medicine.  We are not yet born with an expiration date, but is the day coming that a single drop of blood from a baby’s foot will stamp the date they will leave this world?

My genetics tell me I’m in line to develop a few things: a bunion, glaucoma, and thyroid issues.  Not the worst gauntlet to walk through in the world of blood lines.  I am diligent to get my eye pressures checked, and thankfully my feet don’t hurt, but I have a palpable suspicion that something sinister is lurking in my DNA, specifically in my throat.  My mother underwent a thyroidectomy for a what she thought was a benign thyroid nodule in 2009.  Surgical pathology came back as a surprise confirming papillary thyroid carcinoma.  Thankfully, surgical margins were clear and she required no further treatments. 

Being the ever-hypochondriac that I am, I diligently went in for a thyroid ultrasound.  After a few squirts of squishy jelly and a few passes from an ultrasound probe, it was apparent my thyroid was in perfect structural order.  No nodules. No large lobes. No cancer.  Pleased with the results, I assumed I could check off thyroid cancer from my “To-Do” list for the time being.  But my provider suggested thyroid labs.  My thyroid function tests came back normal, ruling out chemical thyroid issues such as hyperthyroidism or hypothyroidism.  But my Thyroid Peroxidase Antibody (TPO-Antibody) was elevated.  I did what any logical thirty-five-year old would do… I opened my laptop and googled all the horrible things elevated TPO could entail.  Basically, an elevated TPO suggests high antibodies.  Antibodies are the gunships your immune system sends when it is anticipating a fight. Well that didn’t sound good. Why was my thyroid preparing for battle?  So, with a very confused look on my face, I asked my doctor, “So you’re telling me that I don’t have thyroid problems now, but I will?”  The test is suggestive she told me.   The idea of a dormant-thyroid-attacking-monster lurking in my throat doesn’t exactly sit well, especially when coupled with my Mom’s history. But it isn’t the end of the world; and it has certainly made me more diligent about my thyroid health.

Thyroid structure and function can get down right complicating.  Perhaps because that’s just it…. It’s two processes to treat: Structure and Function. Further complicated by each is treated by its own specialty.  Endocrinologists focus on the hormonal function of the thyroid whereas ENT physicians focus more on the structure (i.e. nodules, enlarged lobes, and cancer).  But there a few things you should know to help optimize the health of your thyroid.  As an Ear Nose and Throat Nurse Practitioner, I wish I had a dollar for every patient that thought their thyroid was the root of their fatigue.  I am definitely no hypocrite and I’ve had mine drawn a time or two, (or 20), hoping I had found an explanation for why the snooze button keeps hitting itself each morning.  But fatigue is a huge indicator of thyroid dysfunction.  Abnormal hormone secretion in the thyroid will affect regulation of our metabolism. 

Signs of thyroid dysfunction can include:

Hypothyroidism

• Fatigue or tiredness
• Weight gain
• Elevated cholesterol level
• Cold intolerance
• Constipation
• Dry skin
• Hoarseness
• Muscle weakness
• Aching joints and muscles
• Dry hair or hair loss
• Itchy and dry skin
• Concentration and memory issues
• Depression
• Irregular or heavy menstruation

Hyperthyroidism

• Swelling of the thyroid gland
• Prominent or bulging eyes
• Irregular or rapid heartbeat
• Heat Intolerance
• Tremors or shaking hands
• Increased sweating
• Irritability and restlessness
• Anxiety
• Increased bowel movements or diarrhea
• Weight loss
• Weakness
• Sleep dysfunction
• Brittle hair and or hair loss
• Irregular menstrual cycles in women

Thyroid dysfunction to detect hypothyroidism and hyperthyroidism can be evaluated with simple blood tests to measure how well the thyroid gland is performing.  But function is only part of what can go awry in the thyroid gland. Structural abnormalities should also be on our radar.  Thyroid nodules are smalls solid or fluid-filled masses that can develop inside the thyroid.  The majority of nodules aren’t serious, however, they should always be evaluated and monitored for enlargement with thyroid ultrasound and occasionally CT imaging of the neck.  A small portion of thyroid nodules do contain thyroid cancer (right Mom?). Many times, ENT physicians, Endocrinologists, and some family practice providers will recommend a biopsy of a nodule(s) called a fine needle aspirate to detect cancer cells. Risk factors for thyroid cancer include a known family history of thyroid cancer, prior radiation exposure, being female, diets low in iodine, and having a history of breast cancer.

            Thyroid goiter is an abnormal enlargement of the thyroid gland that can be associated with many thyroid diseases.  Abnormal signaling of hormones can cause increased vascularity and increased size of the gland itself.  As the thyroid gland gets larger, compression to remaining vital structures in the neck occur.  Symptoms include hoarseness, difficulty swallowing, lump sensation, or pressure in the neck.

            Screening evaluation of the thyroid with thyroid palpation by a trained professional is important.  Thyroid ultrasound is critical in evaluating nodules, and thyroid size. Biopsy is crucial if suspicious nodules are noted. Screening thyroid labs will help detect thyroid dysfunction.  Other lab investigations and scans may be warranted once initial screening tests are performed.  Treatment depends on the underlying cause.

I am grateful to know my family history and what I’ll (possibly) have in store for me in the years to come. It is somewhat disconcerting to think about all the cute shoes my future bunion will prevent me from wearing, but I am glad to know to keep a close eye on my thyroid and what may be lying dormant inside.