The thyroid gland - the most important things to know - Prof. Dr. Anton Luger

1. Is screening for endocrine diseases possible?

There are an extremely large number of hormones involved in controlling various functions in the human body, making their screening impossible. Only diabetes and thyroid diseases are common; all other endocrine diseases are rare. For diabetes and thyroid diseases, screening procedures are standard. When we talk about problems with other hormones, we conduct tests only when there are existing symptoms, clinical signs, or unusual laboratory values.

2. When should men and women consult an endocrinologist?

A consultation with an endocrinologist is recommended only when signs, symptoms, or abnormal routine laboratory values point to a possible underlying endocrine disorder. For example, in the following cases:

• If the parathyroid glands are overactive, they cause an increase in serum calcium levels. High concentrations of parathyroid hormone can lead to kidney calcification, stomach ulcers, lethargy, osteoporosis, and even coma.
• Unexplained weight loss or gain can indicate thyroid, adrenal, or pituitary gland disorders.
• Hypertension that is not responsive to usual medications is likely associated with adrenal gland problems.
• Early osteoporosis in women and men can also be due to problems with the adrenal glands, gonads, thyroid gland, pituitary gland, or gonads.
• Changes in fat distribution, loss of muscle mass and strength, changes in appearance, loss of energy, increased hair growth in women (hirsutism), irregular menstruation, and secondary amenorrhea can be the result of pituitary gland diseases.
• Reduced serum sodium levels and increased potassium concentrations can also be associated with adrenal or pituitary problems.

3. What signs can point us towards thyroid problems?

Symptoms requiring consultation with an endocrinologist include changes in gland size, the presence of nodules or pain, as well as signs of dysfunction. These can range from underactivity (hypothyroidism) to overactivity (hyperthyroidism). Signs of hypothyroidism include loss of energy, weight gain, and constipation. Also, sensitivity to cold, dry skin, thinning hair, loss of the outer part of the eyebrows, and depression. Hyperthyroidism manifests with tachycardia (rapid heart rate), nervousness, anxiety, tremors, unintentional weight loss, diarrhea, sensitivity to heat, sweating, and sleep disturbances.

4. Why is it important for men to have hormonal tests?

In addition to routine thyroid, fasting glucose, and testosterone checks, testosterone level testing is recommended for symptoms such as decreased libido, erectile dysfunction, or hair loss. Low testosterone levels are often observed in patients with obesity. They can also result from disorders of the pituitary gland, which controls testosterone and sperm production. Besides decreased libido and erectile dysfunction, low testosterone levels can lead to osteoporosis. A decrease in muscle mass and an increase in fat depots can also occur, hindering glucose metabolism.

5. Statistics show that one in two people with diabetes do not know they have it. What should Bulgarian patients learn about this disease?

Diabetes mellitus is not a homogeneous disease, as symptoms and signs depend on its type. Type 1 diabetes is an autoimmune disease that primarily affects children and young people. It develops due to the destruction of insulin-producing cells in the pancreas. Symptoms include intense thirst, frequent urination, unexpected weight and energy loss, and sometimes severe metabolic disturbances leading to coma. Diagnosis is made quickly due to the intense symptoms.

Type 2 diabetes, which accounts for about 90% of all diabetes cases, is more common in older adults. Most of these patients are overweight or obese. Its symptoms often go unnoticed, and it can take years before a diagnosis is made. This leads to the development of complications such as vision problems.

There are other forms of diabetes, such as gestational diabetes, diabetes caused by medications or pancreatic diseases, and genetic forms.

6. Is it important to get tested for diabetes?

Type 1 diabetes can lead to dangerous metabolic crises, while undiagnosed type 2 diabetes increases the risk of late complications affecting the eyes, heart, blood vessels, kidneys, and nervous system.

7. What are the options for diabetes prevention?

Prevention of type 2 diabetes and gestational diabetes involves a healthy lifestyle with a balanced diet, regular physical activity, and maintaining a normal body weight. Type 1 diabetes and some rare forms cannot be prevented, but a healthy lifestyle is also important for their management.

8. Prediabetes - myth or reality? And how is it controlled?

Prediabetes is a real condition characterized by elevated blood glucose levels, either when fasting or after eating. The thresholds for prediabetes are defined as fasting glucose levels between 100 and 126 mg/dl and HbA1c levels between 5.7% and 6.4%. Concentrations above these values are considered diabetes.

Several studies show that prediabetes significantly increases the risk of developing diabetes. A key factor in preventing progression to type 2 diabetes is a healthy lifestyle with regular physical activity and maintaining a normal weight.

9. What tests are useful for people with prediabetes?

Monitoring fasting glucose levels, HbA1c, serum lipids, blood pressure, and maintaining a healthy weight are key for individuals with prediabetes.