Ruchi Mathur, MD, FRCP(C) is an Attending Physician with the Division of Endocrinology, Diabetes and Metabolism and Associate Director of Clinical Research, Recruitment and Phenotyping with the Center for Androgen Related Disorders, Department of Obstetrics and Gynecology at Cedars-Sinai Medical Center.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The thyroid gland is a
butterfly-shaped organ situated on the front of the neck that secretes two hormones, thyroxine (also known as T4) and
triiodothyronine
(called T3), that are important in the control of metabolism.
Hypothyroidism is a condition in which the thyroid gland does not produce
adequate levels of these critical hormones.
Hypothyroidism is very common and is estimated to affect
3%-5% of the adult population. It is more common in women
than in men, and the risk of developing hypothyroidism increases with advancing
age.
Hypothyroidism is most commonly a result of an
autoimmune condition known as Hashimoto's thyroiditis, in which the body's
own immune cells attack and destroy the thyroid gland.
Hashimoto's thyroiditis is the most common cause of hypothyroidism in the
United States. It is named after the first doctor who described this condition,
Dr. Hakaru Hashimoto, in 1912.
What causes Hashimoto's thyroiditis?
Hashimoto's thyroiditis is a condition caused by inflammation of the
thyroid gland. It is an
autoimmune disease, which means that the body inappropriately attacks the thyroid
gland--as if it was foreign tissue. The underlying cause of the autoimmune
process still is unknown. Hashimoto's thyroiditis tends to occur in families, and is
associated with a clustering of other autoimmune conditions such as Type 1
diabetes, and celiac disease. Hashimoto's
thyroiditis is 5-10 times more common in women
than in men and most often starts in adulthood. Blood drawn from patients with
Hashimoto's throiditis reveals an increased number of antibodies to the enzyme, thyroid
peroxidase an enzyme (protein) found within the thyroid gland. As result of the
antibodies' interaction with the enzyme, inflammation develops in the thyroid
gland, the thyroid gland is destroyed, and the patient ultimately is rendered
hypothyroid (too little thyroid hormone).
The thyroid gland is a
butterfly-shaped organ situated on the front of the neck that secretes two hormones, thyroxine (also known as T4) and
triiodothyronine
(called T3), that are important in the control of metabolism.
Hypothyroidism is a condition in which the thyroid gland does not produce
adequate levels of these critical hormones.
Hypothyroidism is very common and is estimated to affect
3%-5% of the adult population. It is more common in women
than in men, and the risk of developing hypothyroidism increases with advancing
age.
Hypothyroidism is most commonly a result of an
autoimmune condition known as Hashimoto's thyroiditis, in which the body's
own immune cells attack and destroy the thyroid gland.
The symptoms of Hashimoto's thyroiditis are similar to those of hypothyroidism in general, which are often subtle. They are not specific (which means
they can mimic the symptoms of many other conditions) and are often attributed
to aging. Patients with mild hypothyroidism may have no signs or symptoms. The symptoms
generally become more obvious as the condition worsens and the majority of these complaints
are related to a metabolic slowing of the body. Common symptoms are listed below:
As hypothyroidism becomes more severe, there may be puffiness around the eyes, a slowing
of the heart rate, a drop in body temperature, and heart failure. In its most
profound form, severe hypothyroidism may lead to a life-threatening coma (myxedema coma). In a
severely hypothyroid individual, a myxedema coma tends to be triggered by severe illness,
surgery, stress, or traumatic injury. This condition requires hospitalization and immediate
treatment with thyroid hormones given by injection.
Properly diagnosed, hypothyroidism can be easily and completely treated with thyroid
hormone replacement. On the other hand, untreated hypothyroidism can lead to an
enlarged heart (cardiomyopathy), worsening heart failure, and an accumulation of fluid around
the lungs (pleural effusion).
There are a few patients with Hashimoto's thyroiditis who may undergo a hyperthyroid phase (too much thyroid
hormone), called hashitoxicosis, before eventually becoming hypothyroid. Other
symptoms and signs include:
Swelling of the thyroid gland (due to the inflammation), leading to a feeling
of tightness or fullness in the throat
A lump in the front of the neck, (the enlarged thyroid gland) called a
goiter
Difficultly swallowing solids and/or liquids due to the enlargement of the
thyroid gland with compression of the esophagus
Hashimoto's Thyroiditis - Symptoms At Onset Of DiseaseQuestion: The symptoms of Hashimoto's thyroiditis can vary greatly from patient to patient. What were your symptoms at the onset of your disease?
Hypothyroidism is any state in which thyroid hormone production is below normal. Normally, the
rate of thyroid hormone production is controlled by the brain at the pituitary.
Hypothyroidism is a very common condition and the symptoms of hypothyroidism are
often subtle.
Diabetes mellitus is a chronic condition characterized by high levels of sugar (glucose) in the blood. The two types of diabetes are referred to as type 1 (insulin dependent) and type 2 (non-insulin dependent). Symptoms of diabetes include increased urine output, thirst, hunger, and fatigue. Treatment of diabetes depends on the type.
Sjögren's syndrome is an autoimmune disease involving the abnormal production of extra antibodies that attack the glands and connective tissue. Sjögren's syndrome with gland inflammation (resulting dry eyes and mouth, etc.) that is not associated with another connective tissue disease is referred to as primary Sjögren's syndrome. Sjögren's syndrome that is also associated with a connective tissue disease, such as rheumatoid arthritis, systemic lupus erythematosus, or scleroderma, is referred to as secondary Sjögren's syndrome. Though there is no cure for Sjögren's syndrome, the symptoms may be treated by using lubricating eye ointments, drinking plenty of water, humidifying the air, and using glycerin swabs. Medications are also available to treat dry eye and dry mouth.
Hyperthyroidism is an excess of thyroid hormone resulting from an overactive thyroid gland. Symptoms can include increased heart rate, weight
loss, depression, and cognitive slowing. Treatment is by medication, the use of
radioactive iodine, thyroid surgery, or reducing the dose of thyroid hormone.
There are four major types of thyroid cancer: papillary, follicular, medullary, and anaplastic thyroid cancer. Tumors on the thyroid are referred to as thyroid nodules. Symptoms of thyroid cancer include swollen lymph nodes, pain in the throat, difficulty swallowing, hoarseness, and a lump near the Adam's apple. Treatment usually involves chemotherapy, surgery, radioactive iodine, hormone treatment or external radiation and depends upon the type of thyroid cancer, the patient's age, the tumor size, and whether the cancer has metastasized.
There are many causes of scalp hair loss. This featured article covers the common ones such as patchy hair loss (alopecia areata, trichotillomania, and tinea capitis), telogen effluvium, and androgenetic alopecia (male-pattern baldness, female-pattern baldness).
Thyroid nodules are the most common endocrine problem in the United States. The term "thyroid nodule" refers to any abnormal growth that forms a lump in the thyroid gland. The vast majority of thyroid nodules are benign.
There are many types of thyroid disease. Some occur due to the function of the thyroid itself such as hypothyroidism, hyperthyroidism, Hashimoto's thyroiditis, etc. Some causes of thyroid disease occur due to problems with the structure of the thyroid gland such as goiters, thyroid nodules, and thyroid cancer. Treatment of thyroid disease depends on the cause of the disease.
Eye allergy (or allergic eye disease) are typically associated with hay fever and atopic dermatitis. Medications and cosmetics may cause eye allergies. Allergic eye conditions include allergic conjunctivitis, conjunctivitis with atopic dermatitis, vernal keratoconjunctivitis, and giant papillary conjunctivitis. Dry eye, tear-duct obstruction, and conjunctivitis due to infection are frequently confused with eye allergies. Eye allergies may be treated with topical antihistamines, decongestants, topical mast-cell stabilizers, topical antiinflammatory drugs, systemic medications, and allergy shots.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
Hypothyroidism during pregnancy can be treated with synthetic thyroid hormones to maintain the proper thyroid hormone balance. Hypothyroidism symptoms include fatigue, weight gain, lethargy, and constipation. Treatment of hypothyroidism in pregnant women is important, because inadequate levels of thyroid hormones may affect the fetus, and child during growth and development.
Thyroiditis is the inflammation of the thyroid gland. The inflamed thyroid gland can release an excess of thyroid hormones into the blood stream, resulting in a temporary hyperthyroid state. Some forms of thyroiditis can be diagnosed based on tenderness and enlargement of the thyroid gland. A thyroid scan sometimes is used in making the diagnosis. Thyroiditis can also be diagnosed with a biopsy of the thyroid gland.
The thyroid gland produces hormones that are essential for normal body metabolism.
Blood testing is now commonly available to determine the adequacy of the levels of
thyroid hormones. These blood tests can define whether the thyroid gland's hormone production is normal, overactive, or
underactive.
What are thyroid hormones?
Thyroid hormones are produced by the thyroid gland. This gland is located in the lower
part of the neck, below the Adam's apple. The gland wraps around the windpipe
(trachea) and has a shape that is similar to a butterfly - formed by two wings (lobes) and attached by a middle part (isthmus).
The thyroid gland uses iodine (mostly available from the
diet in foods such as seafood, bread, and salt) to produce thyroid hormones. The two most important
thyroid hormones are thyroxine (T4)
and triiodothyronine (T3), which account
for 99.9% and 0.1% of thyroid hormones pre...
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