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.
A diagnosis of
hypothyroidism can be suspected in patients with fatigue, cold intolerance,
constipation, and dry, flaky skin. A blood test is needed to confirm the diagnosis.
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).
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 are usually
elevated with this disease. 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 control thyroid hormone production. 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 actually due to a TSH secreting
pituitary tumor, then the levels are abnormally high. This uncommon disease is known as "secondary
hyperthyroidism."
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.
Muscle spasms are involuntary muscle contractions that come on suddenly and are usually quite painful. Dehydration, doing strenuous exercise in a hot environment, prolonged muscle use, and certain diseases of the nervous system may cause muscle spasms. Symptoms and signs of a muscle spasm include an acute onset of pain and a possible bulge seen or felt beneath the skin where the muscle is located. Gently stretching the muscle usually resolves a muscle spasm.
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.
Fibromyalgia, formerly
known as fibrositis, causes chronic pain, stiffness, and
tenderness of muscles, tendons, and joints without detectable inflammation. Fibromyalgia patients have an unusually low pain threshold. Symptoms of fibromyalgia include fatigue, abnormal sleep, mental/emotional disturbances, abdominal pain, migraine and tension headaches, and irritable bladder. Treatment of fibromyalgia involves patient education, medication, exercise, and stress reduction.
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.
Fainting, also referred to as blacking out, syncope, or temporary loss of consciousness has many causes. Often a person will have signs or symptoms prior to the fainting episode. Diagnosis and treatment depends upon the cause of the fainting or syncope episode.
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).
Hashimoto's thyroiditis is the most common cause of hypothyroidism in the US. This conditions is caused by inflammation of the thyroid gland. Symptoms may include: fatigue, weight gain, cold intolerance, excessive sleepiness, dry or coarse hair, difficulty swallowing, a lump in the front of the throat, and many more. Treatment is usually hypothyroid medication.
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.
Fatigue can be described in various ways. Sometimes fatigue is described as feeling a lack of energy and motivation (both mental and physical). The causes of fatigue are generally related to a variety of conditions or diseases for example, anemia, mono, medications, sleep problems, cancer, anxiety, heart disease, drug abuse, and more. Treatment of fatigue is generally directed toward the condition or disease that is causing the fatigue.
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.
Myxedema coma is the loss of brain function due to severe longstanding low levels of thyroid hormone in the blood. Myxedema coma is a life-threatening complication of hypothyroidism. Examples of triggers of myxedema coma include medications, infections stroke, trauma and more. Some of the ymptoms of myxedema coma include: hypothermia, seizures, coma, difficulty breathing and more. Treatment of myxedema coma depend on the severity of the condition.
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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