UNC Health Care
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Could It Be Your Thyroid?

Count your thyroid as one of those small things that can create big trouble.

This butterfly-shaped gland in the center of your neck regulates many bodily functions including metabolism, temperature, hunger and energy. If your thyroid is not functioning optimally, then neither are you.

And thyroid problems are common.

According to the American Thyroid Association, an estimated 20 million Americans have problems with their thyroids, yet half may not know it. Women are much more likely than men to have a thyroid disorder.

“The thyroid gland is like the gas pedal for your car,” says UNC endocrine surgeon Lawrence Kim, MD. “If you press too much, you’re going too fast, and if you don’t press enough, you’re going too slow. If you have too much thyroid hormone, your heart rate can go up, your metabolism goes up, you feel hot all the time and jittery and have difficulty sleeping. If it is too slow, you feel lethargic, cold all the time and can gain weight.”

Here’s what to know about your thyroid and what happens when it’s not working properly.

Hypothyroidism

If your thyroid does not make enough thyroid hormone, you have hypothyroidism, the most common thyroid condition. Hypothyroidism is most common in middle-aged women. Because hypothyroidism develops slowly, many people don’t notice symptoms of the disease. Signs you may have hypothyroidism are:

  • Lethargy
  • Inability to lose weight even with a healthy diet and regular exercise
  • Always feeling cold
  • Dry, flaky skin
  • Muscle cramps not related to any sports injury or strain
  • Constipation
  • Forgetfulness
  • Irregular menstrual periods

But Dr. Kim points out that many middle-aged Americans experience some of these symptoms and don’t have a thyroid disorder.

“In our society, almost everyone of a certain age starts to gain weight, and anybody who has children is tired all the time, so nearly everyone is tired and gaining weight,” Dr. Kim says. “The first place we turn to for answers is the thyroid. That occasionally is the problem, but it’s usually not.”

The most common cause of hypothyroidism in the United States is Hashimoto’s thyroiditis, an autoimmune disorder that results in chronic inflammation and impaired ability of the thyroid to create hormones.

Hyperthyroidism

If your thyroid makes too much thyroid hormone, you have hyperthyroidism. Signs can include:

  • Unexplained weight loss
  • Insomnia
  • Racing pulse
  • Sweating when you’re not hot or exercising
  • Loose bowels

Older adults may not experience symptoms or their symptoms may be subtle, such as increased heart rate, heat intolerance and a tendency to become tired during ordinary activities. Beta blockers, which are medicines used to treat high blood pressure and other conditions, can mask many of the signs of hyperthyroidism.

Hyperthyroidism is most often caused by an autoimmune condition called Grave’s disease.

“This occurs when your immune system activates your thyroid gland, which causes it to produce too much thyroid hormone,” Dr. Kim says. “It can be severe and lead to thyroid eye disease, which is when your eyes bug out. But that’s pretty rare.”

Other causes include the growth of lumps on the thyroid, consuming too much iodine and taking too much synthetic thyroid hormone. 

Goiters and Nodules

Lumps on the thyroid—called nodules—are very common. In fact, “more than half the population has some type of thyroid nodule or abnormality that can be detected on an ultrasound, but most of the time these are small and insignificant,” Dr. Kim says.

“It is now recommended that small nodules are not even biopsied because they are so common.”

Goiter means enlarged thyroid, and it is commonly used to mean a multinodular goiter, which is an overgrowth of thyroid tissue, but not a tumor. Dr. Kim says they may require surgery because they grow too large and impair swallowing.

Thyroid Cancer

Thyroid cancer is very common, affecting 10 percent of Americans at some point in their lives, Dr. Kim says. The five-year survival rate for thyroid cancer is 98 percent, and that “includes some rare types that are very aggressive,” Dr. Kim says. “The most common type of thyroid cancer will have an even higher survival rate.”

Most thyroid growths are benign, but when doctors do find cancer, it’s often “because a patient comes to us when they or their doctor suspects a thyroid condition such as hypothyroidism,” Dr. Kim says.

At UNC Health Care, endocrine surgeons perform the ultrasounds that detect thyroid cancer.

“That makes a big difference because you have experienced clinicians seeing the same thing year after year,” Dr. Kim says, “which means we know what to look for.”

At UNC Health Care’s multidisciplinary endocrine tumor clinic, an endocrine surgeon and endocrinologist often see patients with complicated conditions together and collaborate on the best treatment options.

Dr. Kim recommends talking to your doctor if you experience any of these symptoms. A simple blood test can help determine if you may have a thyroid condition.


 If you suspect your thyroid is not functioning properly, talk to your doctor. If you do not have one, find one near you.