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.
In diagnosing Hashimoto's thyroiditis, a physician should assess symptoms and
complaints commonly seen in hypothyroidism, examine the neck, and take a
detailed history of family members. Blood tests are extremely useful in
diagnosing Hashimoto's thyroiditis. The blood tests look at the thyroid function in general.
(With hypothyroidism, a high thyroid stimulating hormone and low thyroid hormone
would be expected.)
When hypothyroidism is present, the blood levels of thyroid hormones can be measured directly and
are usually decreased. However, in early hypothyroidism, the level of thyroid
hormones (T3 and T4) may be normal. Therefore, the main tool for the detection
of hyperthyroidism is the measurement of the TSH, the thyroid stimulating
hormone. As mentioned earlier, TSH is secreted by the pituitary gland. If a
decrease of thyroid hormone occurs, the pituitary gland reacts by producing more
TSH and the blood TSH level increases in an attempt to encourage thyroid hormone
production. This increase in TSH can actually precede the fall in thyroid
hormones by months or years (see the section on Subclinical Hypothyroidism below). Thus, the
measurement of TSH should be elevated in cases of hypothyroidism. However, there is one
exception. If the decrease in thyroid hormone is actually due to a defect of the pituitary
or hypothalamus, then the levels of TSH are abnormally low. As noted above, this kind of
thyroid disease is known as "secondary" or "tertiary" hypothyroidism. A special test, known
as the TRH test, can help distinguish if the disease is caused by a defect in the pituitary or
the hypothalamus. This test requires an injection of the TRH hormone and is performed by an
endocrinologist (hormone specialist).
The blood work mentioned above confirms the diagnosis of hypothyroidism, but does not point to
an underlying cause. A combination of the patient's clinical history, antibody screening (as
mentioned above), and a thyroid scan can help diagnose the precise underlying thyroid problem
more clearly. If a pituitary or hypothalamic cause is suspected, an MRI of the brain and other
studies may be warranted. These investigations should be made on a case by case basis.
If the gland is large- or there are symptoms of esophageal compressive, an
ultrasound may be performed to see if the gland is compressing either the
esophagus or the trachea (the food and breathing pipes).
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.
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