THYROID DISORDERS
Thyroid disorders are common medical problems, affecting about 200 million people worldwide. It affects 10 percent of population in United States of America. However, it affects 30 percent of population in Middle East and Far East countries. In certain endemic areas with iodine deficiency in food, it can affect nearly 80 percent of their population. Thyroid cancer is 10th most common cancer, resulting in 47,000 deaths per year worldwide.
Thyroid is an endocrine organ, situated in front of the neck, striding on the two sides of upper part of trachea. It is an important organ controlling metabolism of the whole body through the hormones it secrets. It makes three hormones namely thyroxin (T-4), Triiodothyronine (T-3) and Calcitonin. It manages energy production and metabolic consumption, along with controlling chemical balance, particularly calcium levels.
The enlargement of thyroid gland is called goiter. They can present as diffuse enlargement of the whole gland filling both sides of front of neck, or enlarge one side disproportionately, or there can be one or more palpable nodules in it. Careful palpation of the gland is done by standing behind the neck as well as from the front of the neck to evaluate the nodules. One key feature of nodule of thyroid origin is that it moves with deglutition. The doctor may ask you to swallow your saliva when feeling the thyroid.
Causative factors for thyroid problems include iodine deficiency in food, genetic factors, autoimmune problems, environmental and lifestyle problems. Certain medications, previous radiation exposure, female gender and older age group are risk factors. Smoking, obesity and metabolic syndrome increase risk. Certain hereditary hormonal conditions can happen to include thyroid gland disorder. In addition to iodine, other trace metals such as selenium, iron, calcium, vitamin D and zinc also influence thyroid function.
Disorders of the thyroid gland include overactive (hyperthyroidism) or underactive (hypothyroidism) functioning of the gland. Both are not good and need to be corrected. Other disorders can be due to infections or autoimmune conditions. It is possible to have cysts and nodules of varying sizes which may not be cancers. However, cancer of the thyroid gland must be ruled out in such instances. Fortunately, vast majority of thyroid problems are benign or non-cancerous. Even most of the cancers of thyroid gland can be effectively treated and controlled.
Excessively overactive thyroid gland is termed hyperthyroidism, thyrotoxicosis or Grave’s disease. These patients may have fine tremors of hands, bulging eyes (exophthalmos), rapid heart beats (tachycardia), restlessness, heat intolerance, irregular heart beats (atrial fibrillation), weight loss, muscle weakness, fatigue, menstrual irregularities, sweating and anxiety. First line of treatment is with antithyroid medications such as methimazole, propylthiouracil, iodine supplements and beta blockers. One may consider radio-iodine ablation therapy or subtotal thyroidectomy based on recommendations of the endocrinologist for more definitive treatment.
Excessively underactive thyroid gland is called hypothyroidism or myxedema. These patients may have weight gain, pretibial edema, loss of appetite, fatigue, cold intolerance, sluggishness, dry skin, facial puffiness, hoarseness, constipation, bradycardia, depression, memory loss and menstrual irregularities. Treatment is by administering thyroid supplements.
Thyroid cancers are of four varieties – papillary, follicular, medullary and anaplastic. Fortunately, majority of them are papillary or follicular that carry good prognosis as they can be treated effectively if diagnosed and treated early. Medullary has less favorable outcome, while anaplastic is the worst one with high mortality rate. First line of treatment is by surgical removal of the thyroid gland and the related lymph nodes. Radio-iodine treatment, chemotherapy or immunotherapy are other modalities.
Many patients present for evaluation of a goiter which is appearance of an enlarged thyroid. They may have palpable nodules of different sizes, called nodular goiter. At times the patients come for cosmetic correction. Important items to consider are 1. any pressure symptoms caused by the goiter that may cause hoarseness of voice, or deviation of trachea, 2. functional status of the thyroid gland being hyper or hypo active and finally 3. whether any of the nodules can be cancer or not.
Evaluation of thyroid gland involves careful history taking and physical examination followed by blood tests called thyroid function tests. Measurements of hormones such as TSH (Thyroid stimulating hormone), T-3 and T-4 levels give an idea as to how the gland is functioning. Next set of tests are to ensure that there are no cancers in the gland. An ultrasound is done followed by fine needle aspiration cytology (FNA) of any suspicious nodule. At times additional tests such as radio-iodine scan and uptake or CT scan of neck are done.
Treatment is individualized in consultation with an endocrinologist, head and neck surgeon, radiation oncologist and medical oncologist. Most of the goiters are benign and require only dietary advice and close observation. They may need thyroid supplements in addition. If there is suspicion of cancer based on fine needle aspiration cytology, they are recommended to have surgery as the first line of treatment. Surgery has small chance of complications such as hoarseness of voice or parathyroid deficiency but still provides the best outcome. Patients will need lifelong follow up and intake of thyroid supplements.
What can one do to reduce chances of getting thyroid related problems? A well-balanced diet with enough amounts of iodine, selenium, zinc, iron and vitamins, such as a plant-based Mediterranean diet is good. Lifestyle measures reducing smoking, obesity and alcohol are helpful. Avoiding environmental pollution or radiation exposure, living in a non-endemic area are other considerations. Routine medical checkups will help early detection of correctable problems.
EYE CARE
New Year, New Eyes: Why 2026 Might Be the Year You Finally See Clearly
By Dr. ARUN GULANI
January is a magical month. Gyms are full. Salads are eaten with enthusiasm. And people everywhere promise themselves things like: “This is the year I’ll finally take care of myself.”
But somewhere between January 12th and the first slice of chocolate cake, many resolutions quietly develop … cataracts. So, let me suggest something different this year. Instead of “New Year, New Me,” how about “New Year, New Vision?”
Because whether you’re 18 or 80, your eyes are working overtime – and most of us don’t realize how much we’re asking of them until they protest. Loudly. With blur.
If your eyes could talk, they would probably say: “Please stop staring at your phone at 11:47 p.m. in a dark room.” “Blink. Just … blink.” “And no, holding the menu at arm’s length doesn’t mean the lighting is bad.”
Our eyes are remarkably polite organs. They tolerate dry air, screens, aging, stress, bad glasses, worse contacts and even decades-old surgeries from the 1980s that nobody wants to talk about anymore. Until one day they say, “Enough.”
Vision myths we all secretly believe: Let’s clear up a few things – pun fully intended.
Myth #1: Glasses mean your eyes are getting worse.
Not true. Glasses don’t weaken eyes. They just reveal the truth – meaning your vision needs help and can be helped with next-generation laser techniques like LaZrPlastique which is a no-blade, no-cuts version of Lasik surgery.
Myth #2: Lasik is only for young people.
Vision today isn’t about age – it’s about individual design. Eyes age differently and there is surgery and technology for every age.
Myth #3: If you’ve had Lasik or cataract surgery and have side effects or bad outcomes, and been told “nothing can be done,” that’s the end of the story.
In my experience, that phrase usually means the question wasn’t finished – not that the answer didn’t exist (Previous Khaasbaat columns of mine explains these concepts and cures ).
So January is actually the best time to think about your vision; here’s a secret most people don’t know: January isn’t just the start of the year – it’s the reset button.
• People are mentally open to change and improvement;
• And eyes that have been “managed” for years finally get examined more thoughtfully.
But more importantly, this month brings clarity – literally and figuratively. When the holiday lights come down and the decorations are packed away, many people suddenly notice: “Why does everything still look sparkly?” Spoiler alert: It’s not the tree.
Vision isn’t just about seeing: It’s about living
I’ve watched patients cry – not because they couldn’t see before, but because they forgot what good vision felt like. Seeing your grandchild’s face clearly. Reading a menu without theatrical lighting. Driving at night without fear. Waking up and seeing the world – without reaching for something on the nightstand.
Vision isn’t vanity. It’s independence. And when vision is approached with patience, customization and respect for each eye’s history, people don’t just see better – they live differently.
A gentle New Year challenge
So here’s my New Year challenge for you: Not a diet. Not a gym membership. Not a complicated resolution you’ll abandon by Valentine’s Day. Just this: Listen to your eyes. If they’re dry, strained, blurry, tired or “just not what they used to be,” don’t ignore them.
Eyes don’t age silently. They whisper first.
And when someone finally listens carefully enough, those whispers often turn into solutions people never thought were possible.
Final Thought (with a wink)
Arun C. Gulani, M.D., M.S., is director and chief surgeon of Gulani Vision Institute in Jacksonville. He can be reached at [email protected] or visit www.gulanivision.com