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.
Graves'
disease, which is caused by a generalized overactivity of the thyroid gland, is
the most common cause of hyperthyroidism. In this condition, the thyroid gland
usually is renegade, which means it has lost the ability to respond to the
normal control by the pituitary gland via TSH. Graves'
disease is hereditary and is up to five times more common among women than men. Graves'
disease is thought to be an autoimmune disease, and antibodies that are
characteristic of the illness may be found in the blood. These antibodies
include thyroid stimulating immunoglobulin (TSI antibodies),
thyroid peroxidase antibodies (TPO), and TSH receptor antibodies. The
triggers for Grave's disease include:
Graves' disease can be diagnosed by a standard, nuclear medicine
thyroid scan which shows diffusely increased uptake of a
radioactively-labeled iodine. In addition, a blood test may reveal elevated TSI levels.
Grave's disease may be associated with eye disease
(Graves' ophthalmopathy) and skin lesions (dermopathy
). Ophthalmopathy can occur before, after, or at the same time as
the hyperthyroidism. Early on, it may cause sensitivity to light and a feeling of
"sand in the eyes." The eyes may protrude and double vision can occur. The degree
of ophthalmopathy is worsened in those who smoke. The course of the eye disease
is often independent of the thyroid disease, and steroid therapy may be necessary
to control the inflammation that causes the ophthalmopathy. In addition, surgical intervention may be required.
The skin condition (dermopathy) is rare and causes a painless, red , lumpy skin
rash that appears on the front of the
legs.
Functioning Adenoma and Toxic
Multinodular Goiter
The thyroid gland (like many other areas of the body) becomes lumpier as we
get older. In the majority of cases, these lumps do not produce thyroid hormones
and require no treatment. Occasionally, a nodule may become "autonomous," which means that it does not respond to pituitary
regulation via TSH and produces thyroid hormones independently. This becomes more likely if the
nodule is larger that 3 cm. When there is a single nodule that is
independently producing thyroid hormones, it is called a functioning nodule. If there is more
than one functioning nodule, the term toxic, multinodular goiter is used. Functioning
nodules may be readily detected with a thyroid scan.
Excessive intake of thyroid hormones
Taking too much
thyroid hormone medication
is actually quite common. Excessive doses of
thyroid hormones frequently go undetected due to the lack of follow-up of patients
taking their thyroid medicine. Other persons may be abusing the drug in an
attempt to achieve other goals such as weight loss. These patients can be identified
by having a low uptake of radioactively-labelled iodine (radioiodine) on a thyroid scan.
Abnormal secretion of TSH
A tumor in the pituitary gland may produce an abnormally high secretion of TSH (the
thyroid stimulating hormone). This leads to excessive signaling to the thyroid gland to
produce thyroid hormones. This condition is very rare and can be associated with
other abnormalities of the pituitary gland. To identify this disorder, an
endocrinologist performs elaborate tests to assess the release of TSH.
Thyroiditis (inflammation of the thyroid)
Inflammation of
the thyroid gland may occur after a viral illness (subacute
thyroiditis). This
condition is association with a fever and a sore throat that is
often painful on swallowing. The thyroid
gland is also tender to touch. There may be generalized neck aches and
pains. Inflammation of the gland with an accumulation of white blood cells known as
lymphocytes (lymphocytic thyroiditis) may also occur. In both of these
conditions, the inflammation leaves the thyroid gland "leaky," so that the
amount of thyroid hormone entering the blood is increased. Lymphocytic
thyroiditis is most common after a pregnancy and
can actually occur in up to 8% of women after delivery. In these cases, the
hyperthyroid phase can last from 4 to 12 weeks and is often followed by a
hypothyroid (low thyroid output) phase that can last for up to 6 months. The
majority of affected women return to a state of normal thyroid function.
Thyroiditis can be diagnosed by a thyroid scan.
Excessive iodine intake
The thyroid gland uses iodine to
make thyroid hormones. An excess of iodine may cause hyperthyroidism.
Iodine-induced hyperthyroidism is usually seen in patients who already have an
underlying abnormal thyroid gland. Certain medications, such as amiodarone
(Cordarone), which is used in the treatment of heart problems, contain a large amount of iodine and may be associated with
thyroid function abnormalities.
Night sweats are severe hot flashes that occur at night and result in a drenching sweat. In order to distinguish night sweats that arise from medical causes from those that occur because one's surroundings are too warm, doctors generally refer to true night sweats as severe hot flashes occurring at night that can drench sleepwear and sheets, which are not related to an overheated environment.
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.
Dizziness is a symptom that is often applies to a variety of sensations including lightheadedness and vertigo. Causes of dizziness include low blood pressure, heart problems, anemia, dehydration, and more. Treatment of dizziness depends on the cause.
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.
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.
Vitiligo is a condition in which the skin turns white due to the loss of pigment from the melanocytes, cells that produce the pigment melanin that gives the skin color.
Premature ventricular contractions (PVCs) are premature heartbeats originating from the ventricles of the heart. PVCs are premature because they occur before the regular heartbeat. There are many causes of premature ventricular contractions to include: heart attack, high blood pressure, congestive heart failure, mitral valve prolapse, hypokalemia, hypoxia, medications, excess caffeine, drug abuse, and myocarditis.
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.
Insomnia is the perception or complaint of inadequate or poor-quality sleep because of difficulty falling asleep; waking up frequently during the night with difficulty returning to sleep; waking up too early in the morning; or unrefreshing sleep. Secondary insomnia is the most common type of insomnia. Treatment for insomnia include lifestyle changes, cognitive behavioral therapy, and medication.
Gynecomastia, an enlargement of the gland tissue in the male breast is the caused by an imbalance of hormones. Certain medical conditions may also lead to gynecomastia such as cirrhosis, malnutrition, disorders of the male sex organs, kidney failure, thyroid disorders, and medications. Gynecomastia is generally treated with medication, and if necessary surgery.
Dry skin (xeroderma) may be caused by external factors, like cold temperatures, low humidity, harsh soaps, and certain medications, or internal factors, such as thyroid disease, diabetes, psoriasis, or Sjogren's syndrome. Symptoms and signs of dry skin include itching and red, cracked or flaky skin. The main treatment for dry skin is frequent, daily lubrication of the skin.
Hypercalcemia is a condition in which calcium levels in the blood are elevated. Hypercalcemia is associated with other conditions such as hyperparathyroidism, lung cancer, breast cancer, kidney failure, and elevated levels of vitamin D. Symptoms of hypercalcemia include constipation, nausea, abdominal pain, kidney stones, to name a few. Treatment depends on the cause of hypercalcemia.
Graves' disease is an autoimmune disease that affects the thyroid. Some of the symptoms of Graves' disease include hand tremors, rapid heartbeat, trouble sleeping, enlarged thyroid, thinning of the skin or fine brittle hair. Causes of Graves' disease are thought to be multifactorial such as genes, gender, stress, and infection. Treatment for Graves' disease is generally medication.
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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