Could It Be Your Thyroid?
Familiarity with this body part can serve you well in more ways than one.
January being Thyroid Awareness Month, let’s take a few minutes to consider what can go wrong with this body part, and how to know when it’s time to see your physician. Naturally, we’ll throw in a little coding, too.
Get to Know Your Thyroid
The thyroid is a part of our bodies we don’t think about much, until it acts up. Then we want to know where it is, what it does, and how we can make it better.
The thyroid is located along the trachea, just below the larynx. It consists of two lobes, joined by a narrow band of tissue called the isthmus (see Figure A).
The thyroid is a gland, making it part of the endocrine system. Thyroid cells absorb and combine iodine with amino acid (tyrosine) to create the metabolism-regulating hormones thyroxine (T4) and triiodothyronine (T3). The pituitary gland signals the thyroid gland to secrete these hormones into the blood stream by releasing another hormone: thyroid-stimulating hormone (TSH). The pituitary gland is controlled by yet another gland, the hypothalamus, which sends out TSH-releasing hormones (TRH) when it senses the need. Unfortunately, it isn’t always right, for a variety of reasons.
Common Thyroid Diseases
There are several diseases that result from a thyroid hormone imbalance, and just as many diseases that cause it to get out of sync. More common than diabetes or heart disease, thyroid disease affects as many as 30 million Americans — half of which are undiagnosed, according to www.thyroidawareness.com.
Common diseases specific to the thyroid include:
Graves’ disease — also known as toxic diffuse goiter. This is an autoimmune disorder and a common cause of hyperthyroidism. With
this disease, the immune system
makes an antibody called thyroid-stimulating immunoglobulin (TSI). TSI mimics TSH and stimulates
the thyroid to make too much T3
Hashimoto’s thyroiditis — also known as autoimmune or lymphocytic thyroiditis — is another autoimmune disorder that causes the body to produce immune cells and auto-antibodies that can damage thyroid cells and compromise its ability to create T3 andT4.
Hyperthyroidism develops when the thyroid gland secretes too much T3 and T4. There are many symptoms, most of which make your body feel as if it’s in overdrive. Causes include Graves’ disease.
Hypothyroidism develops when the thyroid gland secretes too little T3 and T4. Symptoms are the opposite of hyperthyroidism: You feel like you can’t get yourself in drive. Causes include Hashimoto’s thyroiditis.
Thyroid cancer usually appears as a painless lump in the thyroid gland. There are four types of this cancer: papillary, follicular, medullary, and anaplastic. Papillary and follicular cancers are most common. These are slow-growing cancers that do not spread to other parts of the body, so the survival rate is high.
Thyroid nodules are lumps, usually benign, but should be checked.
Knowing these facts might help you to identify your own possible thyroid disease, and will help to improve your ICD-10-CM coding. For example, if the physician documents Graves’ disease, naturally that is what you will look up. The ICD-10-CM Index directs you to “see Hyperthyroidism, with goiter.” Graves’ disease isn’t listed under Hyperthyroidism, but “with goiter (diffuse)” is. Knowing that toxic diffuse goiter is another term for Graves’ disease is the clue you need to find E05.0 Thyrotoxicosis with diffuse goiter in the Tabular List. Graves’ disease is listed as another definition for this code.
Also note that not every thyroid disease is classified under Disorders of thyroid gland (E00-E07) in ICD-10-CM. For example, postsurgical hypothyroidism is classified under category E89 Postprocedural endocrine and metabolic complications and disorders, not elsewhere classified.
Causes Are Plentiful
Genetics, age, radiation, and medications can all contribute to thyroid disease. Women are five times more likely to experience hypothyroidism.
Diagnosis Is Simple Enough
At home, you can perform a thyroid neck check (www.thyroidawareness.com/neck-check) to detect an enlarged thyroid. If you have cause for concern, an exam and review of symptoms by your physician may be in order. A blood test or needle biopsy will confirm a clinical diagnosis.
Treatment Depends on Diagnosis
Methods for treating thyroid disease vary, depending on the type of disease. Whereas cancerous lumps should be surgically removed, nodules may be left alone and monitored or surgically removed. Most other types of thyroid disease are treated with radioiodine therapy, medication, or surgery (thyroidectomy).
A hormone imbalance is not a simple thing to correct — it’s a bit like a science experiment — but once you and your physician find the perfect formula, you’ll be good as new.