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.
Hyperthyroidism is suggested by several signs and symptoms; however, patients with mild disease usually experience
no symptoms. In patients older than 70 years, the typical signs and symptoms also
may be absent. In general, the symptoms become more obvious as the
degree of hyperthyroidism increases. The symptoms usually are related to an increase in
the metabolic rate of the body.
In older patients,
irregular heart rhythms and heart failure can occur. In its most
severe form, untreated hyperthyroidism may result in "thyroid storm," a
condition involving high blood pressure, fever, and heart failure. Mental changes, such as confusion
and delirium, also may occur.
How is hyperthyroidism diagnosed?
Hyperthyroidism can be suspected
in patients with:
tremors,
excessive sweating,
smooth velvety skin,
fine hair,
a
rapid heart rate, and
an enlarged thyroid gland.
There may be puffiness around
the eyes and a characteristic stare due to the elevation of the upper eyelids.
Advanced symptoms are easily detected, but early symptoms, especially in the
elderly, may be quite inconspicuous. In all cases, a blood test is needed to
confirm the diagnosis.
The blood levels of thyroid hormones can be measured directly
and usually are elevated with hyperthyroidism. However, the main tool for
detection of hyperthyroidism is measurement of the blood TSH level. As mentioned
earlier, TSH is secreted by the pituitary gland. If an excess amount of thyroid
hormone is present, TSH is "down-regulated" and the level of TSH falls in an
attempt to reduce production of thyroid hormone. Thus, the measurement of TSH should
result in low or undetectable levels in cases of hyperthyroidism. However, there is
one exception. If the excessive amount of thyroid hormone is due to a TSH-secreting
pituitary tumor, then the levels of TSH will be abnormally high. This uncommon
disease is known as "secondary hyperthyroidism."
Although the blood tests mentioned previously can confirm the presence of excessive thyroid
hormone, they do not point to a specific cause. If there is obvious involvement
of the eyes, a diagnosis of Graves' disease is almost certain. A
combination of antibody screening (for Graves' disease) and
a thyroid scan using radioactively-labelled iodine (which concentrates in the thyroid gland)
can help diagnose the underlying thyroid disease. These investigations are chosen on
a case-by-case basis.
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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