“The main hormones your thyroid make and release in the body are triiodothyronine (T3) thyroxine (T4).

Hyperthyroidism is a condition in which your thyroid creates and releases more of these hormones than you need.

Hyperthyroidism, also called overactive thyroid, is when the thyroid gland makes more thyroid hormones than your body needs. The thyroid is a small, butterfly-shaped gland in the front of your neck. Thyroid hormones control the way the body uses energy, so they affect nearly every organ in your body, even the way your heart beats. With too much thyroid hormone, creating many of your body’s functions to speed up.

About 1 out of 100 Americans ages 12 years and older have hyperthyroidism  Hyperthyroidism is more common in women and people older than 60.”

National Institute of  Diabetes and Digestive and Kidney Disease –  NIDDH

“Women are much more likely than men to develop hypothyroidism. The disease is also more common among people older than age 60.¹

You are more likely to have hypothyroidism if you

• had a thyroid problem before, such as a goiter
• had surgery or radioactive iodine to correct a thyroid problem
• received radiation treatment to the thyroid, neck, or chest
• have a family history of thyroid disease
• were pregnant in the past 6 months
• have Turner syndrome NIH external link, a genetic disorder that affects women.”

National Institute of Diabetes, Digestive and Kidney Diseases – NIH

(https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism#who)

“Your thyroid gland, as an endocrine gland, makes and secretes hormones. Your thyroid produces and releases the following hormones:

• Thyroxine (T4): This is the primary hormone your thyroid makes and releases. Although your thyroid makes the most of this hormone, it doesn’t have much of an effect on your metabolism. Once your thyroid releases T4 into your bloodstream, it can convert to T3 through a process called deiodination in the liver.
• Triiodothyronine (T3): Your thyroid produces lesser amounts of T3 than T4, but it has a much greater effect on your metabolism than T4.
• Reverse triiodothyronine (RT3): Your thyroid makes very small amounts of RT3, which reverses the effects of T3.
• Calcitonin: This hormone helps regulate the amount of calcium in your blood. It plays a role in regulating the level of calcium in your blood by decreasing it. The C-cells in your thyroid gland produce calcitonin.

Your thyroid’s main job is to control your metabolism — how your body uses energy. Sometimes, your thyroid doesn’t work properly. These conditions are common and treatable.

More than 12 percent of the U.S. population will experience a thyroid condition at some point in their lives.  Yet, thyroid disease often goes undetected: as many as 60% of people don’t know they have it, which is why regular screening is important.”

Cleveland Clinic (https://my.clevelandclinic.org/health/body/23188-thyroid)

“The term “goiter” simply refers to the abnormal enlargement of the thyroid gland. It is important to know that the presence of a goiter does not necessarily mean that the thyroid gland is malfunctioning. A goiter can occur in a gland that is producing too much hormone (hyperthyroidism), too little hormone (hypothyroidism), or the correct amount of hormone (euthyroidism). A goiter indicates there is a condition present which is causing the thyroid to grow abnormally.  One of the most common causes of goiter formation worldwide is iodine deficiency. While this was a very frequent cause of goiter in the United States many years ago, it is no longer commonly observed. The primary activity of the thyroid gland is to concentrate iodine from the blood to make thyroid hormone. The gland cannot make enough thyroid hormone if it does not have enough iodine. Therefore, with iodine deficiency the individual will become hypothyroid. Consequently, the pituitary gland in the brain senses the thyroid hormone level is too low and sends a signal to the thyroid. This signal is called thyroid stimulating hormone (TSH). As the name implies, this hormone stimulates the thyroid to produce thyroid hormone and to grow in size. This abnormal growth in size produces what is termed a “goiter.” Thus, iodine deficiency is one cause of goiter development. Wherever iodine deficiency is common, goiter will be common. It remains a common cause of goiters in other parts of the world.”

American Thyroid Association (https://www.thyroid.org/goiter/)

Goiter in the thyroid

A goiter is simply an enlarged thyroid gland. Multiple conditions can lead to goiter, including hypothyroidism, hyperthyroidism, excessive iodine intake, or thyroid tumors. Goiter is a non-specific finding that warrants medical evaluation.

History: The doctor will take a detailed history, evaluating both past and present medical problems. If the patient is younger than 20 or older than 70 years, there is increased likelihood that a nodule is cancerous. Similarly, the nodule is more likely to be cancerous if there is any history of radiation exposure, difficulty swallowing, or a change in the voice. It was actually customary to apply radiation to the head and neck in the 1950s to treat acne! Significant radiation exposures include the Chernobyl and Fukushima disasters. Although women tend to have more thyroid nodules than men, the nodules found in men are more likely to be cancerous. Despite its value, the history cannot differentiate benign from malignant nodules. Thus, many patients with risk factors uncovered in the history will have benign lesions. Others without risk factors for malignant nodules may still have thyroid cancer.

Physical examination: The physician should determine if there is one nodule or many nodules, and what the remainder of the gland feels like. The probability of cancer is higher if the nodule is fixed to the surrounding tissue (unmovable). In addition, the physical exam should search for any abnormal lymph nodes nearby that may suggest the spread of cancer. In addition to evaluating the thyroid, the physician should identify any signs of gland malfunction, such as thyroid hormone overproduction (hyperthyroidism) or underproduction (hypothyroidism).

Blood tests: Initially, blood tests should be done to assess thyroid function. These tests include:

• The free T4 and thyroid stimulating hormone (TSH) levels. Elevated levels of the thyroid hormones T4 or T3 in the context of suppressed TSH suggests hyperthyroidism
• Reduced T4 or T3 in the context of high TSH suggests hypothyroidism
• Antibody titers to thyroperoxidase or thyroglobulin may be useful to diagnose autoimmune thyroiditis
• (for example, Hashimoto’s thyroiditis).
• If surgery is likely to be considered for treatment, it is strongly recommended that the physician als determine the level of thyroglobin. Produced only in the thyroid hormone in the blood. Thyroglobulin carries thyroid hormone in the blood. Thyroglobulin levels should fall quickly within 48 hours in the thyroid gland is completely remobed. If thyroglobulin levels start to climb.
• Ultrasonography: A physician may order an ultrasound examination of the thyroid to:
• Detect nodules that are not easily felt
• Determine the number of nodules and their sizes
• Determine if a nodule is solid or cystic
• Assist obtaining tissue for diagnosis from the thyroid with a fine needle aspirate (FNA)Radionuclide scanning: Radionuclide scanning with radioactive chemicals is another imaging technique a physician may use to evaluate a thyroid nodule. The normal thyroid gland accumulates iodine from the blood and uses it to make thyroid hormones. Thus, when radioactive iodine (123-iodine) is administered orally or intravenously to an individual, it accumulates in the thyroid and causes the gland to “light up” when imaged by a nuclear camera (a type of Geiger counter). The rate of accumulation gives an indication of how the thyroid gland and any nodules are functioning. A “hot spot” appears if a part of the gland or a nodule is producing too much hormone. Non-functioning or hypo-functioning nodules appear as “cold spots” on scanning. A cold or non-functioning nodule carries a higher risk of cancer than a normal or hyper-functioning nodule. Cancerous nodules are more likely to be cold, because cancer cells are immature and don’t accumulate the iodine as well as normal thyroid tissue. However, cold spots can also be caused by cysts. This makes the ultrasound a much better tool for determining the need to do an FNA.
• Fine needle aspiration: Fine needle aspiration (FNA) of a nodule is a type of biopsy and the most common, direct way to determine what types of cells are present. The needle used is very thin. The procedure is simple and can be done in an outpatient office, and anesthetic is injected into tissues traversed by the needle. FNA is possible if the nodule is easily felt. If the nodule is more difficult to feel, fine needle aspiration can be performed with ultrasound guidance. The needle is inserted into the thyroid or nodule to withdraw cells. Usually, several samples are taken to maximize the chance of detecting abnormal cells. These cells are examined microscopically by a pathologist to determine if cancer cells are present. The value of FNA depends upon the experience of the physician performing the FNA and the pathologist reading the specimen. Diagnoses that can be made from FNA include:
• Despite its value, the ultrasound cannot determine whether a nodule is benign or cancerous.
• Benign thyroid tissue (non-cancerous) can be consistent with Hashimoto’s thyroiditis, a colloid nodule, or a thyroid cyst. This result is reported from approximately 60% of biopsies.
• Cancerous tissue (malignant) can be consistent with diagnosis of papillary, follicular, or medullary cancer. This result is reported from approximately 5% of biopsies. The majority of these are papillary cancers.
• Suspicious biopsy can show a follicular adenoma. Though usually benign, up to 20% of these nodules are found ultimately to be cancerous.
• Non-diagnostic results usually arise because insufficient cells were obtained. Upon repeat biopsy, up to 50% of these cases can be distinguished as benign, cancerous, or suspicious.

One of the most difficult problems for the pathologist is to be confident that a follicular adenoma – usually a benign nodule – is not a follicular cell carcinoma or cancer. In these cases, it is up to the physician and the patient to weigh the option of surgery on a case-by-case basis, with less reliance on the pathologist’s interpretation of the biopsy. It is also important to remember that there is a small risk (3%) that a benign nodule diagnosed by FNA may still be cancerous. Thus, even benign nodules should be followed closely by the patient and physician. Another biopsy may be necessary, especially if the nodule is growing. Most thyroid cancers are not very aggressive; that is, they do not spread rapidly. The exception is poorly differentiated (anaplastic) carcinoma, which spreads rapidly and is difficult to treat.

“Participants testify to how great a month off from alcohol can be; they sleep better, have more energy, some lose weight and save money, and others notice improvements in their skin and hair.

More recently, research from the Royal Free Hospital in London² has shown that there are positive physiological effects to be gained from taking part in Dry January. The study, performed on moderate drinkers (those drinking around the levels of recommended limits), has shown people experiencing improvements in concentration and sleep patterns, as well as having reduced cholesterol and lower glucose levels, lower blood pressure, weight loss overall, and losing 40% of their liver fat.”

National Library of Medicine NIH

“Glaucoma medication, in the form of eye drops or pills, is the most common early treatment for glaucoma. Medications work by lowering eye pressure, either by slowing the production of aqueous humor fluid or by improving the drainage of fluid from the eye.

Prior vision loss from glaucoma is not reversible with treatment or surgery.”

UCLA Health (https://www.uclahealth.org/medical-services/ophthalmology/non-surgical-treatments)

“Glaucoma is the silent thief of sight. Glaucoma has no symptoms in its early stages. In fact, half the people with glaucoma do not know they have it! Having regular eye exams can help your ophthalmologist find this disease before you lose vision. Your ophthalmologist can tell you how often you should be examined.”

American Academy of Ophthalmology (https://www.aao.org/eye-health/diseases/what-is-glaucoma)

“There are different types of glaucoma.

“January marks the 53rd anniversary of National Blood Donor Month – a time to recognize the importance of giving blood and platelets while celebrating the lifesaving impact of those who roll up a sleeve to help patients in need. It is also a time to encourage new and lapsed donors to resolve to give blood during one of the most difficult times to maintain a sufficient blood supply – the winter months.

This year’s National Blood Donor Month comes as the nation’s blood supply has dipped to concerning levels and could force hospitals to delay essential blood and platelet transfusions. Blood donors of all blood types – particularly type O blood, the blood group hospitals need most – are needed now to give blood or platelets to help meet daily hospital demands.  Donors are urged to schedule an appointment now

The American Red Cross shelters, feeds and provides comfort to victims of disasters; supplies about 40% of the nation’s blood; teaches skills that save lives; distributes international humanitarian aid; and supports veterans, military members and their families. The Red Cross is a nonprofit organization that depends on volunteers and the generosity of the American public to deliver its mission.”

American Red Cross (https://www.redcross.org/about-us/news-and-events/news/2021/help-save-lives-during-national-blood-donor-month.html)