Thyroid disorders are quite common now a days and once someone get thyroid disorder worst fear come that we have to take medicine lifelong but today I am going to negate this fear by explaining scientifically which disorders are lifelong and which one is not.
What are the type of Thyroid gland malfunction
In simple language you have three kinds of common thyroid disorders
- Hypothyroidism suggestive of increase in TSH
- Hyperthyroidism suggestive of decrease in TSH
- Normal thyroid function with goiter where you need to rule out if there is any possibility of thyroid cancer in that goiter.
Hypothyroidism are of two type; one we call subclinical where your TSH is < 10 and T3 and T4 hormone are within normal range. Usually such kind of the patient are one, we start treatment selectively as there is almost more than 50% chance that with time this will revert back to normal. We only start on treatment if there are symptom and clinical findings suggestive of hypothyroidism. Second if someone has Anti TPO antibody positive, and third if a women in fertile age group has not yet completed their family. Else we usually wait for 6 month to 1 year before we start them on treatment and even if once they have been put on treatment if antibody were negative we may consider withdrawal of therapy at later date depending on clinical scenario.
In overt hypothyroidism where either T4 is less or TSH beyond 10 we consider starting on therapy irrespective of other parameters and usually this therapy will be lifelong in form of T4 replacement.
Hyperthyroidism usually does not require lifelong therapy and we may consider stopping it after 2 years and if there is recurrence usually it is treated with Radio Iodine to cure same. If it is just thyroid, it is usually no treatment require other than symptomatic and it improves on its own with 2 to 3 month.
Most of time goiter is asymptomatic and does not require any treatment however if there is symptom in form of choking or breathing difficulty this may require surgery. Only thing which we need to rule out is cancer and if there is no cancer we may just follow up on yearly basis.