While thyroid disorders are relatively low risk, lack of control over the condition could cause problems for potential policyholders, reveals Daniel Patrick
Thyroid disorders are common in adults and, in some cases, can affect children and adolescents. The conditions can be varied and cover a wide spectrum of symptoms and clinical features.
The thyroid gland is the largest of the endocrine glands and is situated at the front and across the lower portion of the neck, between the pharynx and the oesophagus. The gland consists of two lateral lobes connected by a smaller piece of tissue, which acts as a bridge between the two opposing lobes. It is closely attached to the thyroid cartilage at the upper end of the windpipe (trachea) and so can move upon swallowing. The thyroid gland impacts on the body's metabolic rate, which regulates the breaking down and regeneration of cells in the body.
The thyroid releases two main hormones, triiodothyronine and thyroxine, into the blood stream. The production of these two hormones is regulated by the thyroid stimulating hormone (TSH) released from the pituitary gland, situated underneath the centre of the frontal part of the brain. Both of these hormones are synthesised in the thyroid gland and utilise iodine, which is required to produce these two hormones. Lack of iodine or an increase of it can result in various thyroid disorders.
One of the most common thyroid disorders is an underactive thyroid (hypothyroidism). This is sometimes referred to as cretinism or myxoedema. The term 'underactive thyroid' is used to describe the general effects of under-activity of the secreting thyroid gland. It can cause a variety of symptoms and can affect all bodily functions.
Generally, symptoms are associated with a slow metabolism causing mental and physical sluggishness. As with the majority of conditions, it can vary greatly in severity. When the thyroid is underactive, symptoms may include weight gain, bad moods and constipation. There can also be a cold intolerance, with the voice being hoarse and the skin cool to the touch. There may also be more severe complications, such as slowing of the heart (bradycardia), a 'puffy' complexion and, often, an enlarged thyroid gland.
Rarely, hypothyroidism can lead to other complications, such as raised blood pressure, heart enlargement and raised cholesterol, with the resulting risks of vascular disease. These complications may be reversed if treatment is not delayed excessively. Usually, this only affects the elderly and, in some circumstances, can be life threatening - with the patient being unresponsive to treatment with decreased breathing, low blood pressure and blood sugar levels. In some cases, dementia may occur and, although treatment can be given for the thyroid function disorder, cognitive impairment is difficult to resolve and is rarely restored back to the original cognitive function.
Cretinism hypothyroidism occurring in children and infants is generally described as the 'mild' form of the condition. Children with hypothyroidism may not always show the classic signs of the condition. Children with this condition often have a slow growth velocity, poor school performance, and sometimes arrest of pubertal development.
Hyperthyroidism is described as the over-secretion of hormones and has the opposite effect on the body as an underactive thyroid (hypothyroidism) producing too much thyroxine. The condition can also be referred to as Graves' disease, thyroidtoxicosis or exophthalmic goitre. The most common of these conditions is Graves' disease. The condition is an auto-immune process - essentially is described as being over-production of the thyroid hormone secretion caused by a binding agent that attaches itself to the TSH and promotes over-secretion. Symptoms associated with a fast metabolism may include jumpiness, over-activity, and the patient can sometimes appear anxious. There can be a fast and irregular pulse, sweating, shakiness, loss of weight despite a good appetite and palpitations.
Goitre is the clinical name used to describe the enlargement of the thyroid gland. It can be either physiological or pathological. It is also referred to as a toxic goitre. The condition mainly affects women, but can be a clinical feature of hyperthyroidism and, generally, where a goitre is present, special care should be taken as the enlargement of the gland can promote hyperthyroidism. It can be seen as increased in those diagnosed with Graves' disease and decreased in puberty and pregnancy. Where a goitre is present and is in isolation, in other words with no underlying thyroid disorder, it is referred to as a simple goitre. Where a client has a visible goitre, malignancy should be excluded and a blood sample should be taken to measure the TSH levels. The World Health Organisation has a staging system to represent how far the goitre protrudes from the neck. This varies from grade zero - not visible or palpable goitre, through to grade three - large goitre visible from a distance.
Thyroiditis is a condition describing the inflammation of the thyroid gland. This is differentiated from an enlarged thyroid gland as seen in a goitre. It can either be described as acute, where a full recovery will be made from the initial inflammation with little effect on function of thyroid, or can be described as chronic, prolonged inflammation or recurrent episodes. The latter being referred to as Hasimoto's thyroiditis. This condition is mainly seen in middle-aged females and can lead to hyperthyroidism.
Diagnosis
As with all medical conditions, a firm diagnosis is key. Where a client shows symptoms of any of the thyroid disorders, a blood test should be sought on clients who present features suggestive of an underactive or overactive thyroid.
Moreover, where a goitre or thyroiditis is present, special care should be taken to exclude malignancy and distinguish between acute illness, which may affect the thyroid gland, including blood tests, and underlying thyroid disorders.
Notice should also be taken of a client's blood pressure on a medical exam, particularly in the first six months after firm diagnosis of a thyroid disorder, and caution should be applied to any other clinical features of thyroid disorders either on the application, a GP report or attendance to a medical exam.
Particular care should be taken with clients who have been diagnosed with coronary artery disease and are being treated for hypothyroidism. The client's physician would normally start on a lower dose of thyroxine. An ECG may be required to check that there have not been any changes to the cardiac function and that there is no evidence of angina.
As the majority of the symptoms can be associated with old age, it can be difficult to differentiate based on the symptoms alone, so a blood sample should be taken to check the level of the TSH for a firm diagnosis. A high level indicates hypothyroidism. In certain circumstances, this may not always be conclusive as other separate issues can cloud the results of the blood tests. Hyperthyroidism should be excluded in patients with oligomenorrhoea/amenorrhoea (absent, irregular menstruation), menorrhagia (excessive uterine bleeding) and infertilility.
Daniel Patrick is underwriting support at Aegon Scottish Equitable
