Women and Thyroid Disease

Hyperthyroidism results from overproduction of the thyroid hormones T4 or T3. The endogenous condition occurs relatively infrequently, while exogenous hyperthyroidism states may be triggered by excess medication.⁷ Excess thyroid hormones affect cardiac performance, the renal and skeletal systems, liver function, and the female reproductive system.

Graves’ disease is estimated to affect 2–3% of the general population. One of the most common forms of hyperthyroidism, Graves’ disease is an autoimmune disorder characterized by the presence of stimulating TSH receptor autoantibodies. TSH receptor autoantibodies mimic the activity of TSH, leading to elevated production of thyroid hormone.⁸ Left untreated, Graves’ disease can lead to miscarriage, birth defects, and thyroid eye disease and can be life-threatening.

Although anyone can develop Graves’ disease, a number of factors can increase the risk of disease, including:⁹

• Family history
• Gender: Women are much more likely to develop Graves’ disease than are men, at a ratio of 7:1.
• Age: Graves’ disease usually develops in people younger than 40
• Other autoimmune disorders
• Emotional or physical stress
• Pregnancy or recent childbirth
• Smoking

Common signs and symptoms of Graves’ disease include:

• Irritability
• Difficulty sleeping
• Fatigue
• A rapid or irregular heartbeat
• A fine tremor of the hands or fingers
• An increase in perspiration or warm, moist skin
• Sensitivity to heat
• Weight loss, despite normal eating habits
• Enlargement of the thyroid gland (goiter)
• Change in menstrual cycles
• Bulging eyes (Graves’ ophthalmopathy)
• Thick, red skin, usually on the shins or tops of the feet (Graves’ dermopathy)

Hypothyroidism is when the thyroid gland is underactive due to improper formation at birth, surgical removal (all or in part), or inability to produce enough thyroid hormone. One of the most common causes of hypothyroidism in women is the autoimmune disease called Hashimoto's disease, in which antibodies gradually target the thyroid and destroy its ability to produce thyroid hormone. Globally the prevalence of Hashimoto’s disease is 1%, but subclinical hypothyroidism affects 4% of the population. Females make up the vast majority of the patients at a ratio of 8:1, female to male.^10,11

Risk factors include:

• Gender: Hypothyroidism is more common in women than men
• Presence of other autoimmune disorders
• Surgical removal of part or all of the thyroid gland
• Radiation treatment for Hodgkin’s disease, lymphoma, or cancers of the head or neck
• Congenital hypothyroidism or hypothyroidism that a baby is born with
• Thyroiditis or inflammation of the thyroid gland, usually caused by an autoimmune attack or viral infection
• Certain medicines such as amiodarone, lithium, interferon alpha, and interleukin-2 can prevent the thyroid gland from being able to make hormone normally
• Too much or too little iodine
• Damage to the pituitary gland
• Rare disorders that infiltrate the thyroid

The rate of hypothyroidism goes up:

• During pregnancy
• After delivery
• Around menopause

Hypothyroidism symptoms in women tend to develop slowly, often over several years. They may include the following:

• Dry, itchy skin
• Dry, coarse hair
• Hair loss
• Mild weight gain, and difficulty losing weight
• Slower thinking, memory loss
• Fatigue
• More frequent and severe muscle cramps and joint aches
• Puffiness around the face
• Heavier and/or more frequent menstrual periods
• Goiter (swelling in the front of the neck, caused by enlargement of the thyroid)
• Slowing of heart rate
• Slightly higher blood pressure
• Higher cholesterol levels

Thyroid cancer forms in the thyroid gland. It is the most common endocrine cancer, with an increasing incidence rate globally. There are four main types of thyroid cancer, which are classified by how the cancer cells appear under a microscope: papillary, follicular, medullary, and anaplastic.¹⁵ Most thyroid cancers grow very slowly and can either be cured or treated successfully. Only anaplastic thyroid cancer, which represents 2% of thyroid cancers, grows quickly and is difficult to control.¹⁶

The worldwide incidence of thyroid cancer has increased dramatically during the past three decades and it is now the fastest growing cancer in women. Almost all of this increase is in papillary thyroid cancer.¹⁶ This may be due to increased detection of small tumors using new, more sensitive diagnostic procedures, as well as increased exposure to radiation or other undiscovered environmental carcinogens.¹⁷

 The survival rate for thyroid cancer depends on many factors, but the most important is how early the nodule is identified. Early detection increases the chance that the thyroid tumor remains localized and allows for earlier initiation of appropriate treatment.¹⁶

• Gender and age: Women are three times more likely than men to develop thyroid cancer. Women are most often diagnosed at ages 40–50, men in their 60s or 70s.
• Low iodine diet: Increases risk for follicular thyroid cancer.
• Radiation: Exposure may come from certain medical treatments (e.g., neck radiation treatments in childhood) and radioactive fallout from power plant accidents and nuclear weapons.
• Hereditary conditions and family history: Especially medullary thyroid cancer.

Thyroid cancer in women is typically discovered during a routine physical exam. Thyroid nodules are difficult to feel through the skin. If nodules are suspected, ultrasound imaging is required to confirm their presence and for diagnosis. Swelling or a lump in the neck is the most common symptom of thyroid cancer. Left untreated, the size of the tumor may increase and other symptoms may begin to occur, such as difficulty in swallowing and hoarseness.

Siemens Healthineers offers a complete solution for evaluating, diagnosing, and monitoring the effectiveness of therapy for thyroid disorders:

• Atellica® Solution, ADVIA Centaur®, and IMMULITE® systems’ comprehensive thyroid assay portfolio includes assays for the assessment of thyroid function and secondary biomarkers for the differentiation of thyroid disease. Major thyroid function hormone assays are also available on the Dimension Vista® and Dimension® EXL™ Integrated Chemistry systems.
• From initial screening and diagnosis through ultrasound-guided biopsy procedures, Siemens Healthineers ACUSON® Systems are affordable, high-resolution ultrasound products for the evaluation and management of thyroid disease.