March 2025: The Ever-Present Thyroid

We are two doctors who are curious about aging. Our monthly newsletter embraces conversations about aging from many different perspectives—medical, psychological, societal and even personal.

You can read our February edition here.

This month we share some interesting facts about thyroid nodules, including how to diagnose thyroid cancer. We also cover the basics of underactive and overactive thyroid conditions and their impact on aging. Bonus: Explore several links to medical websites that are chock-full of helpful data.

Susan B:

Thyroid Nodules

What do dark chocolate-covered almonds have to do with thyroid nodules? In case you missed it, you can learn the answer by reading my LinkedIn post from last month here (spoiler alert, it’s a story about thyroid cancer): https://www.dhirubhai.net/feed/update/urn:li:activity:7281331052571193344/.

Thyroid nodules are quite common. So common that many people have them and remain completely unaware as they are too small to feel and don’t cause any symptoms. In fact, they can be present for years or even decades. Caveat: Most thyroid nodules do not require treatment.

Nodules often come to attention when they enlarge and cause some or all of the following signs or symptoms.

??? Visible lump in the neck region

??? Sensation of neck tightness or constriction

??? Lump in throat sensation

??? Neck pain or tenderness

??? Difficulty swallowing

??? Change in voice or hoarseness

??? Symptoms of hyperthyroidism or hypothyroidism

Careful neck palpation by your physician can confirm the presence of a large nodule and blood tests can clarify thyroid function. But, the best way to evaluate what is going on is typically a neck ultrasound.

The ultrasound is the easy part—it’s the classification of thyroid nodules that gets a bit tricky!

At the risk of oversimplification, points are given based on the nodule’s composition (cystic versus solid), echogenicity (appearance on ultrasound), shape (wide or tall), margin (smoothness), and presence of calcifications. The sum total of points gives a TR score with low scores reassuring and higher scores more concerning. Biopsy (FNA, or fine needle aspirate) is then recommended based on consideration of points and nodule size.

To further add to this complexity, pathology results from a biopsy provide yet another set of probabilities based on the microscopic findings. Also, when carcinoma is actually detected, yet another set of criteria are used to determine treatment options based on surgical pathology: tumor size, tumor cell type, proliferative activity (mitotic rate), presence of necrosis, vascular invasion, lymph node invasion, and margin status.

The WHO developed classification criteria for thyroid tumors over the years and most recently refined these in 2022. These criteria added more nuances to considerations between benign, low-risk and high-risk neoplasms.

Clear as mud?

The good news: Thyroid nodules are usually benign and not reflective of a malignant process. For those that harbor actual cancer, the most frequent “cure” is surgical removal of part or all of the thyroid gland. Current research is also aimed at consideration of ablation treatments that don’t require surgery. There are additional protocols for concurrent and adjuvant treatment based on many factors, of course, as not all thyroid cancer is “the good kind.”

For more information, I recommend searching the American Thyroid Association and the American Association of Clinical Endocrinology websites.

Susan V:

Thyroid diseases come with a variety of unpleasant symptoms. People are either gaining or losing weight, having mood changes such as feeling depressed, experiencing menstrual cycle changes, or feeling constantly tired. Other people may have dry skin or sensitivity to hot and cold temperatures. Many of these symptoms are like the transition into menopause.

That pesky thyroid gland lies in the front of the neck and is a butterfly-shaped gland just underneath the skin. The thyroid gland produces potent hormones that regulate metabolism while influencing nearly every organ in the body. Thyroid disease is more prevalent in women, affecting one in eight. An imbalance in thyroid function can lead to either low or high thyroid activity, resulting in various symptoms.

Abnormal thyroid function can affect the menstrual cycle. Some women have irregular menstrual bleeding, others have heavy menstrual bleeding, and some may experience an unpredictable pattern. These changes in menstrual bleeding can be a sign of perimenopause, but they also could be related to changes in thyroid hormone production.

Low thyroid activity, or hypothyroidism, and high thyroid activity, or hyperthyroidism, become more prevalent as we age. The symptoms of low thyroid function, such as sleep disturbances, fatigue, temperature instability, weight gain, and depression, can closely resemble symptoms during menopause. Diagnosing thyroid-related issues can be challenging due to these overlapping symptoms. ?

Prompt evaluation by a physician is essential. A comprehensive assessment of symptoms, blood testing, imaging, and often biopsy determine the appropriate treatment. A thyroid stimulating hormone test (TSH) is a screening test for thyroid abnormality, and it's generally the first test performed to evaluate for thyroid abnormality. Depending on the TSH result, additional blood tests measuring T4 (thyroxine) and T3 (triiodothyronine) can help further identify a thyroid problem. Accurate diagnosis is crucial for differentiating between thyroid disease and menopausal symptoms, as this will determine the appropriate treatment.

Thyroid disease treatments depend on the disorder. The thyroid depends on iodine to make thyroid hormones, so in the case of a lack of iodine in the diet, the replacement of iodine will correct the abnormality. Fun fact: did you know that less than a teaspoon of iodized salt contains the US Food and Drug Administration's recommended daily intake?

In many cases, a thyroid corrective medication taken daily is all that is needed, but in others, a permanent treatment such as surgical removal of the gland is medically necessary.

The good news is that thyroid diseases are relatively common, and many treatments are available to manage them effectively.

To learn more about thyroid disorders, please visit https://www.thyroid.org.

??? Our April edition will draw attention to Stress Awareness Month.

???? The 2 Susans would love to hear from you!

Let us know the aging topics YOU are curious about. Please also share this newsletter in your network and tag us—we are so grateful.

Susan B: [email protected]

LinkedIn, myMDadvocate, MenopauseMenu, The Menopause Menu book

Susan V: [email protected]

LinkedIn, Vogler Medical

#the2susans #aging #newsletter #thyroid #thyroidnodule #menopause #womenshealth

The 2 Susans newsletter is for informational purposes only. It does not represent medical advice and is not intended as a substitute for professional advice, diagnosis, or treatment. Always consult with your private physician.