Endocrinologist Valentin Fadeev told how to monitor the health of the thyroid gland

– Let’s start with the basics. How is the thyroid gland arranged and what is its role in the body?

– It is arranged, like all endocrine glands, it is difficult. This is a fairly small organ, consisting of balls – follicles, the wall of which is lined with cells that synthesize thyroxine, which enters directly into the blood. This synthesis is the main function of the thyroid gland (TG). Thyroid hormones are very small molecules that must contain iodine.

Why are these hormones needed? Their function is comparable to the function of a battery in some device. Just as when burning firewood, heat energy is generated, each cell in our body receives energy due to the oxidation (combustion) of fats, carbohydrates and proteins. Thyroxine controls the intensity of this “burning” and the formation of energy in the cells, which is necessary for all processes without exception. With a deficiency of thyroid hormones – hypothyroidism, what happens to your mobile phone when the battery runs out in it: all life processes are disrupted without exception.

– There are many known pathologies of the thyroid gland: hypo- and hyperfunction, nodes, malignant tumors … Which of them are the most common and why?

– All the problems you listed can be associated with it, and all of them are quite common, with the exception of malignant tumors, which develop relatively rarely in the general mass. Without exception, all thyroid diseases are much more common among women: they make up at least 2/3, or even 3/4 of our patients.

The greatest danger to human health and life is posed by dysfunction of the thyroid gland, when there is an excess (thyrotoxicosis) or deficiency (hypothyroidism) of thyroid hormones in the body, which can develop in diseases of the thyroid gland that are completely different in nature.

These diseases can occur at any age, but a certain pattern still exists. Hypothyroidism and thyroid nodules are more common in patients over 50 years of age, and their prevalence continues to increase further with aging. There are diseases characteristic of a young, reproductive age, there are those that occur exclusively in the postpartum period.

– Are there any statistics that certain problems with the thyroid gland have become more common or less common?

– Statistics, as you know, is a delicate matter, and sometimes it serves the tasks that are set before it. But it can be said with all obviousness that over the past decades, the detection of various diseases has increased many times over, as well as completely harmless phenomena from the thyroid gland.

It is important not to confuse detection and incidence, they are different things. If we subject a large part of the population to ultrasound examination (ultrasound) of the thyroid gland, which in itself is absurd and will lead to the collapse of the endocrinological service, then we will detect thyroid nodules in 30% of the population. In the vast majority of cases, this is a completely harmless phenomenon that poses almost no problems. However, its identification dictates the need to launch a diagnostic process that is not simple in essence.

Over the past decades, hormonal studies have become routine, and their mass nature has led to a decrease in their cost, as a result of which they are done by almost everyone in a row “just in case”. This does not lead to such dramatic consequences as the general “ultrasound” of the population, but the detection of minimal deviations in hormonal studies, which have not yet received an exhaustive assessment in medicine, has increased many times over.

– Can problems with the thyroid gland be associated with lifestyle, with heredity?

— We always say to our students and residents: “In clinical medicine, when we are dealing with real people, and not with graphs, anything can happen!” Monogenic hereditary diseases of the thyroid gland, which are directly transmitted from parents to children, are rare. But in the development of most chronic diseases, including thyroid diseases, hereditary predisposition can be of considerable importance.

Our body is very individual, it inherits from its ancestors certain “weak points” that, under the influence of environmental factors, can lead to diseases. Some thyroid diseases are slightly more common in smokers, but this does not mean that tobacco smoke directly causes them. Lifestyle, within reason, of course, does not particularly affect the development of thyroid diseases.

How are thyroid problems usually diagnosed? What specific signs should definitely alert?

– Only some thyroid diseases have specific signs, for example, Graves’ disease (Basedow’s disease). Sometimes this diagnosis is “seen” from afar, as we say, from the door. Severe thyrotoxicosis can have very characteristic signs. For example, palpitations, weight loss, protrusion of the eyeballs, a number of emotional disorders. Severe, severe hypothyroidism is manifested by symptoms of “slowdown”: memory loss, anemia, drowsiness, depression, constipation, menstrual irregularities, increased cholesterol levels. Hypothyroidism, which is, in fact, a generalized decrease in energy production, is very insidious and often resembles numerous diseases of the liver, heart, kidneys, reproductive and nervous system.

In a significant part of cases in the modern world, thyroid diseases are detected during examination “just in case”, and this is far from always a joyful find or luck. Very often, borderline shifts in hormonal studies are not caused by some kind of disease, but simply by random factors. Diagnosis of a non-existent disease in this situation does not bring anything good. I would not focus our modern neurotic population on any symptoms, because we don’t want millions of healthy people to burst into our offices, or, let’s say more accurately, people without real thyroid pathology.

If a person is worried about something, it is best for him to consult a doctor who will decide whether he needs an examination for thyroid diseases. I understand that there may not be a doctor in the immediate vicinity or the doctor does not have the opportunity to delve deeply into the essence of the patient’s problems, but here I am speaking as it should be, and not as it actually happens.

– But are there any tests or examinations that should be done regularly?

– Do not unnecessarily disturb the thyroid gland! If you feel like a healthy person, I would not recommend undergoing any periodic examinations on the part of the thyroid gland. There are not many exceptions to this rule. For example, I would recommend an assessment of thyroid function for women planning a pregnancy if they have a family history of thyroid disease or have any problems getting pregnant.

If a person feels unhealthy, and sooner or later we all get sick with something, then in this situation the assessment of thyroid function is quite justified. To do this, it is enough to determine the level of thyroid-stimulating hormone (TSH) in the blood. It is quite obvious that if a person has thyroid diseases, his treatment may require quite close control, but this is a completely different area, and this should not be extended to everyone.

– What treatment do patients need if their thyroid gland is not in order? Hormone therapy, surgery, just a lifestyle change?

– Contrary to the ideas of many, the words “the thyroid gland is not in order” mean little! To date, several dozens of thyroid diseases that are completely different in terms of causes and in their essence have been described. Their diagnosis and treatment are very different, sometimes even directly opposite actions: it can be the appointment of thyroid hormones and blockers of their production, removal of the thyroid gland, both surgically and with radioactive iodine. For some diseases of the thyroid gland, we do not prescribe anything to patients. Finally, much of what is detected by ultrasound or hormonal research is not a disease at all as such and does not require any action.

Solving all these issues is not so easy – this requires a qualified endocrinologist, whose training takes many years. This is what represents the biggest problem for our country – personnel decide everything. No hormonal studies, even weekly, no ultrasound, and even more so the Internet, will not make you healthy and will not cure you of anything. To do this, you need a doctor, and a doctor who is able to make decisions and take responsibility for you. It would be great to buy some hardware or software that will diagnose and treat, but this will only work in completely “clumsy” situations. Only another person is capable of understanding the problems of a person, especially in everything that surrounds him, and making some integral decision. Therefore, alas, it is impossible to buy and import doctors from somewhere, like Cheburashek in a box of oranges, they need to be raised for years and decades, but we, alas, are bad with this, and this is a sad topic that I would not like to delve into now .

Is it possible to change something in your diet, habits, attitude towards health in general, in order to reduce the likelihood of developing thyroid problems?

– I could say “no, nothing needs to be done”, since the development of most thyroid diseases really practically does not depend on us. It could, if in our country, as in its time in the USSR, programs of universal salt iodization would work. Since these programs do not exist, no matter how simple they are to implement, I have to recommend that all our fellow citizens buy iodized salt instead of ordinary table salt.

You can talk a lot about the problem of iodine deficiency, but, frankly, over the past 25 years, it has even gotten tired of it. Instead of spending a lot of time writing, reading and delving into all this, just accept this moment: buy iodized salt. Believe me, I am not pursuing any personal interests in this recommendation, this is a public health measure accepted in most countries of the world, something like disinfecting the water that flows in our homes from a tap. I wouldn’t dare to distract you from your normal and fulfilling life, which I sincerely wish you to enjoy with nothing else!