The thyroid measures out very precise amounts of one or both of two hormones as the body’s needs dictates, in order to support a healthy metabolism, good heart health, efficient digestion and so on. But every now and then, something goes wrong and the thyroid malfunctions, pouring out too many hormones or not quite enough. These two conditions are called hyperthyroidism (too much) and hypothyroidism (too little) and, depending on their cause, they can be treated with tried and trusted methods. There are also other issues that can plague the thyroid – such as iodine deficiency – but even these will often result in one of the two conditions.

Idiopathic hyper- or hypothyroidism is usually treated symptomatically, not only because it can be tricky to pinpoint the cause of the issue, but because the conditions can be treated effectively to restore hormone levels to normal, without needing to know if it was an accident of the immune system or a problem that began when the patient was forming in their mother’s womb – and quite often knowing makes little difference to the treatment anyway.

Very occasionally hormone levels will restore themselves naturally, and treatments can be discontinued, but in most patients’ treatment needs to be ongoing for life.

For hypothyroidism patients, synthetic versions of the hormones produced by the thyroid are taken, usually in the form of thyroxine or T4, and occasionally in the form of triiodothyronine, the active version of thyroxine, or T3. In a functional thyroid, the body naturally produces both hormones, and converts much of the T4 into T3 as needed. Most patients can be treated with just T4 as the body’s ability to convert it into T3 is usually not compromised.

In hyperthyroidism patients, treatment is through medication, a single treatment of radioactive iodine, or – if these measures fail – surgery to remove the thyroid. Essentially, the medication reduces the overproduction of the thyroid, and these treatments are usually taken while the radioactive iodine is given a chance to work. The thyroid absorbs all iodine ingested by the patient, and when it takes in the radioactive iodine, this damages the thyroid, reducing its function. Often, curing hyperthyroidism the patient is given hypothyroidism instead, which is then treated, as above, with synthetic hormones.

Two conditions commonly associated with the thyroid are Graves Disease and Hashimoto’s Thyroiditis.

In Grave’s Disease – named for the doctor who discovered the condition almost two hundred years ago – the immune system mistakenly attacks the thyroid, which causes it to over-produce T3 and T4, essentially causing hyperthyroidism. Left untreated, Grave’s Disease can cause heart problems and brittle bones. Treatments ease symptoms, and reduce the over-production of hormones, often following the treatment pathways detailed above, with the same result of leaving the patient with treatable hypothyroidism. TSH (Thyroid Stimulating Hormone – released by the pituitary gland when signalled to do so by the hypothalamus in a complicated system of checks and balances that still, occasionally, fails!) levels tend to be high in a Grave’s patient.

Hashimoto’s Thyroiditis starts the same way as Grave’s – with the immune system mistakenly attacking the thyroid – but the results are the polar opposite. The attack by the immune system is slower than with Grave’s, and the patient develops an underactive thyroid as a result of the immune system attack, and their TSH levels tend to be low. Treatment, as above, eases symptoms and follows protocols for hypothyroidism.

There is no real way to avoid thyroid issues aside from ensuring that your diet contains enough iodine (found in iodised salt, fish and dairy), but in most cases, hormone levels can be balanced and a full and active lifestyle can be enjoyed.