The thyroid is a gland that sits at the base of the neck below the voice box, or larynx. It is part of the endocrine system, and is responsible for producing key hormones that regulate the body’s metabolism. When the thyroid gland malfunctions, it can trigger effects that cause significant disruptions in a number of organ systems. Abnormal thyroid readings are a main way of determining which particular malfunctions are affecting a given individual.
According to the nonprofit Hormone Foundation, your thyroid may malfunction in a number of different ways. If tests performed by an endocrinologist (hormone and endocrine specialist) reveal abnormally high levels of thyroid hormone, you may be suffering from a condition called hyperthyroidism. Symptoms of hyperthyroidism include fatigue, rapid heartbeat, weight loss, muscle weakness, diarrhea and menstrual cycle disruptions. The most likely cause of your hyperthyroidism is called Graves’ disease, which occurs when antibodies from your immune system mistakenly attack your thyroid gland, forcing it to produce excess hormones. If you have Graves’ disease, your symptoms may also include swelling behind your eyes that causes them to bulge or press forward.
If you have abnormally low levels of thyroid hormones, you may suffer from an underactive thyroid gland. This condition is called hypothyroidism. Symptoms of hypothyroidism include weight gain, fatigue, depression, constipation, sluggishness, dry hair and skin and menstrual cycle irregularities. If your hypothyroidism is severe, you may be additionally diagnosed with a condition called myxedema. In some individuals with myxedema, the presence of infections, injury or the common cold may bring about life-threatening complications including coma and dangerously lowered body temperature (hypothermia).
Thyroid testing may also reveal the presence of abnormal nodules within your thyroid gland. These nodules typically manifest as either growths of your thyroid tissue or as fluid-filled cysts. Thyroid nodules are quite common, and as a rule they do not pose any real health risks. However, if your nodules are larger than half an inch in diameter, your doctor may want to investigate them further and see if they indicate the presence of a more dangerous condition such as cancer.
To determine the seriousness of your thyroid nodules, your doctor may order a tissue sampling procedure called a biopsy. If the results of a biopsy indicate that your nodules are benign (non-cancerous), you will likely need to see your doctor at regular intervals to make sure that no dangerous changes occur at a later date. If your thyroid nodules are malignant (cancerous), you will likely undergo surgical removal of all or part of your thyroid gland. Doctors may also perform surgery if they cannot determine through other testing whether a nodule is malignant.
Consult your endocrinologist for additional information on the results of thyroid testing. Consult your surgeon if testing reveals the presence of malignant nodules.
American Thyroid Association-ATA Patient Education Web Brochures
U.S. National Library of Medicine-National Institutes of Health: Thyroid Diseases
A headache involves pain in the head which can arise from many disorders or may be a disorder in and of itself.
There are three types of primary headaches: tension-type (muscular contraction headache), migraine (vascular headaches), and cluster. Virtually everyone experiences a tension-type headache at some point. An estimated 18% of American women suffer migraines, compared to 6% of men. Cluster headaches affect fewer than 0.5% of the population, and men account for approximately 80% of all cases. Headaches caused by illness are secondary headaches and are not included in these numbers.
Approximately 40–45 million people in the United States suffer chronic headaches. Headaches have an enormous impact on society due to missed workdays and productivity losses.
Traditional theories about headaches link tension-type headaches to muscle contraction, and migraine and cluster headaches to blood vessel dilation (swelling). Pain-sensitive structures in the head include blood vessel walls, membranous coverings of the brain, and scalp and neck muscles. Brain tissue itself has no sensitivity to pain. Therefore, headaches may result from contraction of the muscles of the scalp, face or neck; dilation of the blood vessels in the head; or brain swelling that stretches the brain’s coverings. Involvement of specific nerves of the face and head may also cause characteristic headaches. Sinus inflammation is a common cause of headache. Keeping a headache diary may help link headaches to stressful occurrences, menstrual phases, food triggers, or medication.
Tension-type headaches are often brought on by stress, overexertion, loud noise, and other external factors. The typical tension-type headache is described as a tightening around the head and neck, and an accompanying dull ache.
Migraines are intense throbbing headaches occurring on one or both sides of the head, usually on one side. The pain is accompanied by other symptoms such as nausea, vomiting, blurred vision, and aversion to light, sound, and movement. Migraines often are triggered by food items, such as red wine, chocolate, and aged cheeses. For women, a hormonal connection is likely, since headaches occur at specific points in the menstrual cycle, with use of oral contraceptives, or the use of hormone replacement therapy after menopause. Research shows that a complex interaction of nerves and neurotransmitters in the brain act to cause migraine headaches.
Cluster headaches cause excruciating pain. The severe, stabbing pain centers around one eye, and eye tearing and nasal congestion occur on the same side. The headache lasts from 15 minutes to four hours and may recur several times in a day. Heavy smokers are more likely to suffer cluster headaches, which also are associated with alcohol consumption.
Since headaches arise from many causes, a physical exam assesses general health and a neurologic exam evaluates the possibility of neurologic disease as a cause for the headache. If the headache is the primary illness, the doctor asks for a thorough history of the headache. Questions revolve around its frequency and duration, when it occurs, pain intensity and location, possible triggers, and any prior symptoms. This information aids in classifying the headache.
Warning signs that should point out the need for prompt medical intervention include:
- “Worst headache of my life.” This may indicate subarachnoid hemorrhage from a ruptured aneurysm (swollen blood vessel) in the head or other neurological emergency. Headache accompanied by one-sided weakness, numbness, visual loss, speech difficulty, or other signs. This may indicate a stroke. Migraines may include neurological symptoms. Headache that becomes worse over a period of 6 months, especially if most prominent in the morning or if accompanied by neurological symptoms. This may indicate a brain tumor. Sudden onset of headache. If accompanied by fever and stiff neck, this can indicate meningitis.
Headache diagnosis may include neurological imaging tests such as computed tomography scan (CT scan) or magnetic resonance imaging (MRI).
Headache treatment is divided into two forms: abortive and prophylactic. Abortive treatment addresses a headache in progress, and prophylactic treatment prevents headache occurrence.
Tension-type headaches can be treated with aspirin, acetaminophen, ibuprofen, or naproxen. In early 1998, the FDA approved extra-strength Excedrin, which includes caffeine, for mild migraines. Physicians continue to investigate and monitor the best treatment for migraines and generally prefer a stepped approach, depending on headache severity, frequency and impact on the patient’s quality of life. A group of drugs called triptans are usually preferred for abortive treatment. About seven triptans are available in the United States and the pill forms are considered most effective. They should be taken as early as possible during the typical migraine attack. The most common prophylactic therapies include antidepressants, beta blockers, calcium channel blockers and antiseizure medications. Antiseizure medications have proven particularly effective at blocking the actions of neurotransmitters that start migraine attacks. Topiramate (Topamax) was shown effective in several combined clinical trials in 2004 at 50 to 200 mg per day.
In 2004, a new, large study added evidence to show the effectiveness of botulinum toxin type A (Botox) treatment to prevent headache pain for those with frequent, untreatable tension and migraine headaches. Patients were treated every three months, with two to five injections each time. They typically received relief within two to three weeks.
Cluster headaches may also be treated with ergotamine and sumatriptan, as well as by inhaling pure oxygen. Prophylactic treatments include prednisone, calcium channel blockers, and methysergide.
Alternative headache treatments include:
- acupuncture or acupressure biofeedback chiropractic herbal remedies using feverfew (Chrysanthemum parthenium), valerian (Valeriana officinalis), white willow (Salix alba), or skullcap (Scutellaria lateriflora), among others homeopathic remedies chosen specifically for the individual and his/her type of headache hydrotherapy massage magnesium supplements regular physical exercise relaxation techniques, such as meditation and yoga transcutaneous electrical nerve stimulation (TENS) (A procedure that electrically stimulates nerves and blocks the signals of pain transmission.)
Headaches are typically resolved through the use of analgesics and other treatments. Research in 2004 showed that people who have migraine headaches more often than once a month may be at increased risk for stroke.
Some headaches may be prevented by avoiding triggering substances and situations, or by employing alternative therapies, such as yoga and regular exercise. Since food allergies often are linked with headaches, especially cluster headaches, identification and elimination of the allergy-causing food(s) from the diet can be an important preventive measure.
Source: The Gale Group. Gale Encyclopedia of Medicine, 3rd ed.
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