How to diagnose a thyroid problem

Diagnose a thyroid problem. The thyroid is a gland that is found in the upper area of the clavicle – specifically in the neck –  and it is shaped like a butterfly. This gland has a high hormonal production; these hormones are responsible for controlling many bodily activities, having a direct effect on the body’s metabolism.

Sometimes the thyroid gland does not work properly for some reason, and here we are going to give you the list of some tests to rule out a thyroid problem.

Blood test

These blood draws can be done at any time because the pituitary and thyroid hormones have very little variation in the day, and they also do not change when you eat.

To determine if thyroid function is normal, levels of the hormone thyrotropin and active thyroid hormones, which go hand in hand with proteins such as globulin or albumin, must be measured.

In some physiological situations such as the use of contraceptives or when there is a pregnancy, the level of proteins in the blood can be altered, but the function will be the same.

Cervical and thoracic computed tomography

This test is carried out to determine the limits of the thyroid in goiters or when a poor position of the gland is suspected, which is sometimes located behind the sternum. This test will also help us to know if there is thyroid growth. The procedure is simple, takes very little time, uses radiation, and does not cause claustrophobia.

Fine needle aspiration (FNA)

This test is carried out to obtain a sample of thyroid cells by means of a puncture in the gland, this is done in order to study them under a microscope to know their nature: benign or malignant. It is not necessary to fast or withdraw any type of medication to perform this test. However, there is an exception such as anticoagulants, since there would be a possible risk of bleeding, so it is replaced by heparin.

There are no complications that prevent normal activities after this test, although it is advisable to rest afterwards or perform any activity that involves contraction of the cervical muscles.

This test is normally performed after a thorough cleaning in the neck area (no anesthesia is needed for this cleaning). A needle is then inserted through the skin to remove cells from the thyroid nodule while an aspiration is performed during one minute. Sometimes it may be necessary to insert the needle into different parts of the nodule. It is very likely that there is pain after the puncture, but this can be treated without problem with any anti-inflammatory or paracetamol.

Once the samples are analyzed, certain categories are established:

• Benign: The percentage of malignancy in these tests is usually low, less than 3%. If the nodules do not produce any symptoms and the thyroid function is working without problem, it can be monitored with laboratory tests from time to time and ultrasound scans.
• Malignant: If it is found, it has a very high risk of being cancerous. The papillary thyroid is the most common cancer of this gland. If this is discovered, surgery is necessary.
• Suspicion of malignancy: It is when the pathologist cannot make a definitive diagnosis with the test shown, although the risk of cancer is also high when this happens. Surgery is also the best option for this type of result.
• Atypia of uncertain significance: Here there is a small risk of malignancy, only 5-15%. Atypical cells are discovered that do not allow us to know their exact nature. When this happens, the puncture must be repeated and some genetic or molecular tests may even be performed as well.
• Follicular neoplasia: The risk of malignancy in these cases is 15 to 30%. The cells show a different appearance and make it difficult to recognize the condition of the same. It can be follicular adenoma (benign) or follicular carcinoma (malignant). Surgery may be necessary.
• Non-diagnosis: this happens when there are samples with little cellular quantity to be able to create a diagnosis. The puncture is done correctly, only there are not many thyroid cells or there is a lot of blood or fluid. The test must be repeated.

Cervical ultrasound

This technique is used to diagnose thyroid diseases through images, especially to carry out a study of the nodules found in the thyroid. In summary, ultrasound is used to apply this technique.

It is painless and has no contraindications, it is very safe. It is not necessary either to stop taking any medication, there is no radiation and it gives us information about the thyroid and cervical ganglia.

It is used mainly to characterize and study the thyroid nodules. Most are 90% non-dangerous (benign). This ultrasound will allow us to detect the presence of malignant nodules, or if this is suspected. A cytological examination will be done to rule out.

This ultrasound also serves to treat thyroid nodules, empty cysts and nodules as well, introduce substances to this nodule or to be able to shrink some nodules through the skin.

It also allows us to control the goiter, although it does not provide us with such clear information when the thyroid is inflamed.

Magnetic resonance

It is not very commonly used to study thyroid nodules. Nevertheless, it is used to know if there is infiltration in the surrounding structures due to thyroid cancer.

Thyroid scan

This test is done to get a clear picture of thyroid function. It is useful to know if there is hyperthyroidism. 

Seven days before the test, some things should be avoided such as excessive consumption of iodine or supplements containing this nutrient. Also, if you have had a CT scan with iodinated contrast, you will need to postpone the test for at least a month. You should also stop taking medications that can slow your thyroid function a little. Remember not to stop taking amiodarone. You should still inform the medical team if you have any questions.

This test is also used to see if the thyroid is working properly or if it is swollen and to know if it is working excessively or having little activity. It should be noted that it tells us when there is hyperthyroidism, but not when there is hypothyroidism or normal thyroid function.

The thyroid has a function which is to absorb iodine or substances similar to iodine from the same blood in order to produce thyroid hormones. To do this, technetium pertechnetate and an isotope of iodine are administered, after this, an X-ray is performed, with which the areas of the thyroid that the isotope has captured can be located. The test is quite simple, it does not cause claustrophobia, but there is radiation.

The thyroid is a very important gland, its endocrine function is necessary for the correct metabolic development of our body. Sometimes this gland can have problems and not work properly, it can be a minor problem or even cancer. If you have any suspicions, go to your doctor and if not, a preventive checkup would be the best alternative. Remember that your health is very important.