Introduction – Thyroid Specialist in Rockville, Montgomery County, Maryland
As a thyroid specialist, practicing in Rockville, Montgomery County, Maryland, my main objective in the community is to diagnose, treat, and manage thyroid-related illnesses. I take a holistic approach, carefully analyzing patients’ medical history, symptoms, and laboratory results to gain a comprehensive understanding of their condition.
Prevalence & Symptoms of Thyroid Disorders
Prevalence: Thyroid disorders affect a large number of people worldwide, with approximately 200 million individuals experiencing some form of thyroid illness. Women are particularly susceptible, being up to eight times more likely than men to suffer from thyroid dysfunction, including hypothyroidism, hyperthyroidism, and autoimmune thyroid diseases like Hashimoto’s thyroiditis and Graves’ disease.
Symptoms: Thyroid illnesses can have profound effects on overall well-being, leading to symptoms such as fatigue, weight changes, mood swings, hair loss, and sleep disturbances, causing physical and emotional distress. If left untreated, thyroid conditions may result in serious complications like cardiovascular issues, fertility problems, and mental health disorders.
Below is a list of thyroid conditions that may be encountered in my practice. It’s crucial to note that the diagnosis and management of these thyroid anomalies require individualized treatment plans tailored to the patient’s specific medical history, symptoms, and test results.
- Hashimoto’s Thyroiditis
- Graves’ Disease
- Subacute Thyroiditis
- Postpartum Thyroiditis
- Toxic Adenoma
- Thyroid Nodules
- Thyroid Cancer
- Thyroid Eye Disease (Graves’ ophthalmopathy)
- Thyroid Myxedema Coma
- Thyroid Storm
- Euthyroid Sick Syndrome
- Central Hypothyroidism
- Thyroid Hormone Resistance
Hypothyroidism is a widespread thyroid disorder that affects millions of people globally. It occurs when the thyroid gland fails to produce enough thyroid hormones, which are essential for regulating the body’s metabolism and energy levels.
The most common cause of hypothyroidism is Hashimoto’s thyroiditis, an autoimmune condition where the immune system attacks the thyroid tissue. Other causes include radiation therapy, certain medications, thyroid surgery, or iodine deficiency.
The symptoms of hypothyroidism can vary in severity but often include persistent fatigue, weight gain, dry skin, constipation, cold intolerance, hair loss, and depression. The condition may also cause memory problems, muscle weakness, and a slow heart rate. If left untreated, hypothyroidism can lead to complications like goiter (an enlarged thyroid gland), heart problems, and myxedema coma (a life-threatening condition).
The diagnosis of hypothyroidism involves blood tests to measure thyroid hormone levels, especially TSH (thyroid-stimulating hormone) and T4. Treatment typically involves hormone replacement therapy with synthetic thyroid hormones, such as levothyroxine. In special situations, Armour Thyroid or Liothyronine may also be used. Regular monitoring and adjustments in medication dosage are necessary to maintain hormone levels within the normal range and alleviate symptoms effectively.
Hyperthyroidism is the opposite of hypothyroidism and occurs when the thyroid gland becomes overactive, producing excessive amounts of thyroid hormones. The most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder where antibodies stimulate the thyroid gland to produce more hormones than the body needs. Other causes may include toxic adenoma (a benign thyroid nodule), thyroiditis, or excessive iodine intake.
Hyperthyroidism symptoms are caused by an accelerated metabolism and may include rapid or irregular heartbeat (palpitations), anxiety, irritability, weight loss, heat intolerance, increased sweating, and trembling hands. In some cases, patients may also experience goiter or, in Graves’ disease, the characteristic bulging eyes known as Graves’ ophthalmopathy.
Diagnosing hyperthyroidism involves blood tests to measure thyroid hormone levels (TSH, T4, T3) and may include additional tests like thyroid ultrasound or radioactive iodine uptake scans to determine the cause. Treatment options include antithyroid medications (such as methimazole or propylthiouracil), radioactive iodine therapy, or thyroidectomy (surgical removal of the thyroid gland).
3. Hashimoto’s Thyroiditis
Hashimoto’s thyroiditis, named after the Japanese physician who first described it, is an autoimmune disease affecting the thyroid gland. In this condition, the body’s immune system mistakenly identifies the thyroid as foreign and launches an attack, leading to chronic inflammation. Over time, the inflammation damages the thyroid tissue, causing it to lose its ability to produce thyroid hormones adequately.
As the disease progresses, the thyroid gland becomes enlarged, leading to a goiter. Initially, Hashimoto’s thyroiditis can cause hyperthyroidism as stored hormones are released, but eventually, the gland’s function declines, resulting in hypothyroidism. Symptoms of Hashimoto’s thyroiditis are similar to those of hypothyroidism, including fatigue, weight gain, and sensitivity to cold.
Diagnosing Hashimoto’s thyroiditis involves blood tests to measure thyroid hormone levels and detect specific antibodies (TPO and Tg) related to the condition. Treatment primarily focuses on managing hypothyroidism with hormone replacement therapy and monitoring thyroid function regularly. In some cases, anti-inflammatory medications may be used if the inflammation is severe.
4. Graves’ Disease
Graves’ disease is an autoimmune disorder and the most common cause of hyperthyroidism. In this condition, the body produces antibodies called thyroid-stimulating immunoglobulins (TSI) or thyrotropin receptor antibodies (TRA) that mimic the action of TSH, leading to excessive thyroid hormone production. This results in an overactive thyroid gland and a cascade of symptoms related to increased metabolism.
Patients with Graves’ disease often experience an enlarged thyroid gland (goiter), weight loss, rapid heartbeat, sweating, anxiety, and trembling hands. Another hallmark of Graves’ disease is Graves’ ophthalmopathy, which affects the eyes and may cause bulging eyes, double vision, dryness, and irritation (see more below).
The diagnosis of Graves’ disease involves blood tests to measure thyroid hormone levels and detect the presence of TSI and TRA. Imaging tests may be used to assess thyroid function and evaluate the eyes in cases of ophthalmopathy. Treatment options for Graves’ disease include antithyroid medications (such as methimazole or propylthiouracil) to inhibit hormone production, radioactive iodine therapy to destroy overactive thyroid cells, or thyroidectomy to remove the gland.
5. Subacute Thyroiditis
Subacute thyroiditis is a self-limiting condition characterized by inflammation of the thyroid gland. It often follows a viral infection or an upper respiratory tract infection. The inflammation causes thyroid hormones to leak into the bloodstream, leading to temporary hyperthyroidism. As the inflammation subsides, the stored hormones are depleted, and the patient may develop hypothyroidism.
Symptoms of subacute thyroiditis include neck pain, tenderness, fever, fatigue, and mild hyperthyroid symptoms like rapid heartbeat. As the condition progresses to the hypothyroid phase, patients may experience weight gain, constipation, and cold intolerance.
Diagnosis is typically made based on symptoms, signs, and blood tests to measure thyroid hormone levels. Subacute thyroiditis is often managed symptomatically with pain relief medication during the hyperthyroid phase and thyroid hormone replacement therapy during the hypothyroid phase. In most cases, the thyroid gland returns to normal function once the inflammation resolves.
6. Postpartum Thyroiditis
Postpartum thyroiditis is a condition that affects some women after giving birth. It is believed to be an autoimmune response triggered by the changes in the immune system during pregnancy and the postpartum period. Similar to subacute thyroiditis, the condition starts with a period of hyperthyroidism, which may last for several months, followed by a period of hypothyroidism that can also be temporary.
Symptoms of postpartum thyroiditis vary depending on the phase, but during the hyperthyroid phase, women may experience palpitations, nervousness, weight loss, and fatigue. In the hypothyroid phase, symptoms are similar to those of regular hypothyroidism, including fatigue, weight gain, and depression.
Diagnosis is made through blood tests to measure thyroid hormone levels, and treatment depends on the phase of the condition. During the hyperthyroid phase, beta-blockers may be used to manage symptoms, while during the hypothyroid phase, thyroid hormone replacement therapy is often prescribed. Most women recover fully as their thyroid function stabilizes, but regular monitoring is essential.
7. Toxic Adenoma
A toxic adenoma is a type of thyroid nodule that is benign (non-cancerous) but produces excessive amounts of thyroid hormones independently of the body’s regulatory mechanisms. This can lead to hyperthyroidism, similar to what is seen in Graves’ disease.
The condition arises when a single nodule within the thyroid gland becomes overactive and starts to release excessive hormones. The rest of the thyroid gland remains unaffected and functions normally.
Symptoms of toxic adenoma are similar to those of hyperthyroidism, such as rapid heartbeat, nervousness, weight loss, and heat intolerance. The diagnosis is made through blood tests and thyroid imaging, such as radioactive iodine uptake scans or ultrasound. Treatment options include medication, radioactive iodine ablation of the overactive nodule, or surgical removal.
8. Thyroid Nodules
Thyroid nodules are common in the general population and are often discovered incidentally during routine medical examinations or imaging tests. They are abnormal growths or lumps that can form within the thyroid gland. Most thyroid nodules are benign and don’t cause any noticeable symptoms. In some cases, however, larger nodules can cause pressure on nearby structures in the neck, leading to swallowing difficulties or a visible swelling (goiter).
Thyroid nodules can be solid or fluid-filled, and they may be single or multiple. They can vary in size, with some being tiny and others being several centimeters in diameter. The vast majority of thyroid nodules are non-cancerous (benign), but a small percentage may be malignant (cancerous). Diagnosing thyroid nodules often involves a physical examination, blood tests to assess thyroid function, and imaging studies such as ultrasound.
Treatment options for thyroid nodules depend on factors such as their size, growth rate, and whether they are causing symptoms or are suspected to be cancerous. Small, non-cancerous nodules may simply be monitored over time, while larger or suspicious nodules may require further evaluation and treatment, which can include surgery or radioactive iodine therapy.
9. Thyroid Cancer
Thyroid cancer is relatively rare compared to other types of cancer, but its incidence has been increasing in recent years. Fortunately, thyroid cancer has a high cure rate, especially when diagnosed at an early stage. There are different types of thyroid cancer, with the most common being papillary thyroid cancer, followed by follicular thyroid cancer, medullary thyroid cancer, and anaplastic thyroid cancer.
The symptoms of thyroid cancer can be subtle or absent in the early stages. As the cancer grows, patients may notice a lump or swelling in the neck, hoarseness, difficulty swallowing, or enlarged lymph nodes. Thyroid cancer may be detected during routine imaging studies or while evaluating a thyroid nodule.
Diagnosing thyroid cancer involves a combination of fine-needle aspiration biopsy, imaging studies (ultrasound, CT scan, or MRI), and blood tests to measure thyroid hormone levels. Treatment options depend on the type and stage of the cancer but may include surgery (thyroidectomy), radioactive iodine therapy, targeted therapy, or external beam radiation.
10. Thyroid Eye Disease (Graves’ ophthalmopathy)
Thyroid eye disease (TED), also known as Graves’ ophthalmopathy, is an autoimmune condition that affects some individuals with Graves’ disease. It occurs due to inflammation and swelling of the tissues around the eyes, resulting in various eye-related symptoms.
Symptoms of thyroid eye disease can range from mild to severe and may include bulging eyes (proptosis), double vision (diplopia), dryness, redness, pain, and sensitivity to light. In severe cases, it can cause vision loss due to pressure on the optic nerve.
Diagnosing thyroid eye disease involves a thorough eye examination and imaging studies like orbital MRI or CT scans. Treatment depends on the severity of symptoms and may involve controlling the underlying hyperthyroidism with antithyroid medications, steroids to reduce inflammation, and supportive measures like artificial tears or eye lubricants.
In more severe cases, surgical interventions may be considered to relieve pressure on the optic nerve or to improve the eye appearance. It’s essential for patients with thyroid eye disease to be closely monitored by an ophthalmologist and a thyroid specialist to optimize management and prevent complications.
11. Thyroid Myxedema Coma
Thyroid Myxedema Coma is an extremely severe and life-threatening form of hypothyroidism. It is typically triggered by a severe illness, infection, or untreated hypothyroidism, which results in a precipitous drop in thyroid hormone levels. The condition is more common in older individuals with long-standing, untreated hypothyroidism.
Symptoms of Thyroid Myxedema Coma include extreme fatigue, hypothermia (low body temperature), mental confusion, and even unconsciousness. Breathing difficulties, low blood pressure, and decreased heart rate may also occur.
Thyroid Myxedema Coma requires immediate medical attention in an intensive care unit. Treatment involves administering thyroid hormone replacement intravenously or orally to restore hormone levels, along with other supportive care measures.
12. Thyroid Storm
Thyroid Storm, also known as thyrotoxic crisis, is a life-threatening condition that results from uncontrolled hyperthyroidism. It is often precipitated by severe stress, infections, or surgery in individuals with untreated or poorly managed hyperthyroidism.
During a Thyroid Storm, the body is overwhelmed with excessive thyroid hormones, leading to severe symptoms such as high fever, rapid heartbeat (tachycardia), extreme restlessness, confusion, and even delirium or coma. Other complications may include heart failure, shock, and organ failure.
Thyroid Storm is a medical emergency and requires immediate hospitalization and intensive care. Treatment includes administration of antithyroid medications, beta-blockers, and supportive measures to stabilize vital signs and prevent complications.
13. Euthyroid Sick Syndrome
Euthyroid sick syndrome, also known as non-thyroidal illness syndrome, is a condition in which thyroid hormone levels appear abnormal due to severe illness or systemic stress. In this condition, the body’s normal feedback mechanisms temporarily suppress thyroid hormone production as part of a protective response to the illness.
Despite the abnormal lab results, the thyroid gland itself is functioning correctly. As the underlying illness resolves, thyroid hormone levels typically return to normal without the need for specific treatment targeting the thyroid.
Euthyroid sick syndrome is common in critically ill patients, those with severe infections, or individuals experiencing significant stress. Once the underlying condition improves, thyroid function typically returns to normal without any specific intervention.
14. Central Hypothyroidism
Central hypothyroidism is a relatively rare form of hypothyroidism caused by a dysfunction in the pituitary gland or hypothalamus, which are structures in the brain that control thyroid hormone production. The condition results from a lack of adequate stimulation from the brain to the thyroid gland.
Unlike primary hypothyroidism, where the thyroid gland itself is malfunctioning, patients with central hypothyroidism typically have normal or smaller-than-normal thyroid glands. Symptoms of central hypothyroidism are similar to those of primary hypothyroidism and may include fatigue, weight gain, constipation, and cold intolerance.
Diagnosing central hypothyroidism involves blood tests to measure thyroid hormone levels and other pituitary hormones. Treatment usually involves hormone replacement therapy with levothyroxine to restore thyroid hormone levels. Patients with central hypothyroidism may require additional monitoring to ensure that other pituitary hormones are functioning adequately.
15. Thyroid Hormone Resistance
Thyroid hormone resistance is a genetic disorder in which the body’s cells are less responsive to thyroid hormones, even if they are present in sufficient levels in the blood. The condition is caused by mutations in the genes responsible for thyroid hormone receptors or their cellular signaling pathways.
As a result, cells do not adequately respond to thyroid hormones, leading to a compensatory increase in TSH levels as the body tries to stimulate the thyroid gland to produce more hormones. This can cause symptoms similar to hypothyroidism, despite normal or even elevated thyroid hormone levels in the blood.
The severity of thyroid hormone resistance can vary among affected individuals, with some experiencing mild symptoms and others displaying more significant hormone resistance. Treatment is often challenging, as hormone replacement therapy may not effectively alleviate symptoms. Management is focused on addressing specific symptoms and providing supportive care to affected individuals. Genetic counseling may also be helpful for affected individuals and their families.
As a thyroid specialist based in Rockville, Montgomery County, Maryland, I am dedicated to delivering expert care for thyroid disorders. With a strong emphasis on accurate diagnosis and personalized treatment, I am committed to enhancing the well-being of my patients through comprehensive thyroid health management.