Disorders of the Thyroid

Hyperthyroidism

Disorders of the Thyroid | Johns Hopkins Medicine

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Hyperthyroidism means your thyroid gland is too active. This tiny gland is found in your neck. An overactive thyroid gland makes too much thyroid hormone. This makes your metabolism work at a faster rate.

What causes hyperthyroidism?

Hyperthyroidism has several causes. These include:

  • Graves' disease. This is an autoimmune disorder. It is the most common cause of hyperthyroidism. It happens when an antibody overstimulates the thyroid. This condition is most often found in young to middle-aged women. It also tends to run in families.
  • Toxic nodular goiter. This condition happens when 1 or more lumps (nodules) of the thyroid gland become too active. Health experts don't know what causes this to happen.
  • Thyroiditis. It occurs when the thyroid becomes irritated. It temporarily causes the thyroid to be overactive. The thyroid then often becomes underactive.

Hyperthyroidism may occur for other reasons. These include:

  • Taking too much thyroid hormone medicine to treat an underactive thyroid
  • Having too much iodine in your diet
  • Having a noncancer (benign) tumor in the pituitary gland that makes your thyroid overactive

Who is at risk for hyperthyroidism?

These things may make it more ly for you to have hyperthyroidism:

  • You are a woman
  • You are older than age 60
  • You have had thyroid problems in the past
  • Your family has a history of thyroid problems
  • You have certain conditions, such as type 1 diabetes
  • You consume too much iodine. This can happen if you eat a lot of iodine-rich foods or take too much medicine that has this chemical.
  • You are pregnant or have had a baby in the last 6 months

What are the symptoms of hyperthyroidism?

Symptoms and signs are different for each person. Here are the most common ones:

  • Nervousness
  • Irritability
  • Sweating more than normal
  • Thinning of the skin
  • Fine, brittle hair
  • Weak muscles, especially in the upper arms and thighs
  • Shaky hands
  • Fast heartbeat (palpitations)
  • High blood pressure
  • More bowel movements than normal
  • Weight loss
  • Problems sleeping
  • Prominent eyes
  • Sensitivity to bright light
  • Confusion
  • Irregular menstrual cycle in women
  • Tiredness and lack of energy (fatigue)
  • Thyroid gland is larger than normal (goiter)

These symptoms may look other health problems. Always see your healthcare provider for a diagnosis.

How is hyperthyroidism diagnosed?

Your healthcare provider will ask about your medical history. You will also need an exam. Other tests that can help diagnose hyperthyroidism include:

  • Blood tests. They can measure the amount of thyroid hormone and thyroid stimulating hormone in your blood.
  • Thyroid ultrasound. This test can see if your thyroid gland has any nodules.
  • Thyroid scan. This test uses a radioactive substance to make an image of the thyroid.

How is hyperthyroidism treated?

The goal of treatment is to have your thyroid gland work as it should. The gland will then make normal levels of thyroid hormone. Your healthcare provider will figure out the best treatment for you :

  • Your age, overall health, and past health
  • How sick you are
  • How well you can handle certain medicines, treatments, or therapies
  • Your type of hyperthyroidism
  • Your opinion or preference

Treatment may include:

  • Medicine. It can help lower the level of thyroid hormones in the blood.
  • Radioactive iodine. It comes in the form of a pill or liquid. It can help slow down how much thyroid hormones are made.
  • Surgery. You may need to have all or part of your thyroid removed.
  • Beta blockers. These medicines block the action of the thyroid hormone on the body. That helps with rapid heart rate and palpitations.

What are the complications of hyperthyroidism?

If your hyperthyroidism is not treated, these complications may happen:

  • Thyroid crisis, when symptoms get worse because of stress or illness
  • Heart problems, such as an abnormal rhythm or heart failure
  • Weak, brittle bones (osteoporosis)
  • Pregnancy problems, such as miscarriage, early delivery, and preeclampsia or high blood pressure

When should I call my health care provider?

Tell your healthcare provider if your symptoms get worse or you have new symptoms. If you are a woman of childbearing age and want to become pregnant, talk with your provider first.

Key points about hyperthyroidism

  • Hyperthyroidism means your thyroid gland is too active. This tiny gland is found in your neck. If it is overactive, it makes too much thyroid hormone. Your body’s metabolism then begins to work at a faster rate.
  • This condition can be caused by Graves' disease, toxic nodular goiter, thyroiditis, and taking too much thyroid medicine.
  • Symptoms may include nervousness, irritability, extra sweating (perspiration), and fine, brittle hair.
  • Treatment may include medicine, radioactive iodine, surgery, or beta-blocking medicine.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hyperthyroidism

Thyroid Problems — Symptoms, Causes, and Diagnosis

Disorders of the Thyroid | Johns Hopkins Medicine

  • What Are Thyroid Problems?
  • What Causes Thyroid Problems?

Through the hormones it produces, the thyroid gland influences almost all of the metabolic processes in your body. Thyroid disorders can range from a small, harmless goiter (enlarged gland) that needs no treatment to life-threatening cancer.

The most common thyroid problems involve abnormal production of thyroid hormones. Too much thyroid hormone results in a condition known as hyperthyroidism. Insufficient hormone production leads to hypothyroidism.

Although the effects can be unpleasant or uncomfortable, most thyroid problems can be managed well if properly diagnosed and treated.

All types of hyperthyroidism are due to an overproduction of thyroid hormones, but the condition can occur in several ways:

  • Graves' disease: The production of too much thyroid hormone.
  • Toxic adenomas: Nodules develop in the thyroid gland and begin to secrete thyroid hormones, upsetting the body's chemical balance; some goiters may contain several of these nodules.
  • Subacute thyroiditis: Inflammation of the thyroid that causes the gland to “leak” excess hormones, resulting in temporary hyperthyroidism that generally lasts a few weeks but may persist for months.
  • Pituitary gland malfunctions or cancerous growths in the thyroid gland: Although rare, hyperthyroidism can also develop from these causes.

Hypothyroidism , by contrast, stems from an underproduction of thyroid hormones. Since your body's energy production requires certain amounts of thyroid hormones, a drop in hormone production leads to lower energy levels. Causes of hypothyroidism include:

  • Hashimoto's thyroiditis : In this autoimmune disorder, the body attacks thyroid tissue. The tissue eventually dies and stops producing hormones.
  • Removal of the thyroid gland: The thyroid may have been surgically removed or chemically destroyed.
  • Exposure to excessive amounts of iodide: Cold and sinus medicines, the heart medicine amiodarone, or certain contrast dyes given before some X-rays may expose you to too much iodine.You may be at greater risk for developing hypothyroidism if you have had thyroid problems in the past.
  • Lithium: This drug has also been implicated as a cause of hypothyroidism.

Untreated for long periods of time, hypothyroidism can bring on a myxedema coma, a rare but potentially fatal condition that requires immediate hormone treatment.

Hypothyroidism poses a special danger to newborns and infants.

A lack of thyroid hormones in the system at an early age can lead to the development of cretinism (intellectual disability) and dwarfism (stunted growth).

Most infants now have their thyroid levels checked routinely soon after birth. If they are hypothyroid, treatment begins immediately. In infants, as in adults, hypothyroidism can be due to these causes:

  • A pituitary disorder
  • A defective thyroid
  • Lack of the gland entirely

A hypothyroid infant is unusually inactive and quiet, has a poor appetite, and sleeps for excessively long periods of time.

Cancer of the thyroid gland is quite rare and occurs in about 5% of thyroid nodules. You might have one or more thyroid nodules for several years before they are determined to be cancerous. People who have received radiation treatment to the head and neck earlier in life, possibly as a remedy for acne, tend to have a higher-than-normal risk of developing thyroid cancer.

SOURCES: American Academy of Family Physicians. The American Thyroid Association. EndocrineWeb.com. The Norman Endocrine Surgery Clinic. Community Health Care Medicial Library. Johns Hopkins University. U.S. Food and Drug Administration Center for Food Safety and Applied Nutrition. Mary Shoman, patient Advocate – About.com.

WebMD Drug Reference from MedicineNet: “Llevothyroxine Oral.”

© 2019 WebMD, LLC. All rights reserved. Fatigued or Full Throttle: Is Your Thyroid to Blame?

Source: https://www.webmd.com/women/guide/understanding-thyroid-problems-basics

The Thyroid Gland

Disorders of the Thyroid | Johns Hopkins Medicine

Linkedin Pinterest Endocrine System Adrenal Gland Procedures

Thyroid nodules are growths in the thyroid gland, which is located in the front of the neck. The thyroid gland releases thyroid hormone, which regulates many of your body’s functions, including metabolism.

Thyroid nodules are very common in adults, and more than 70% of Americans over the age of 70 will have at least one. Most nodules are noncancerous (benign), but some can be cancerous. Thyroid nodules are less common in children and teens, but, if a child or a teen has a nodule, it is more ly to be malignant (cancerous).

There are several types of thyroid nodules: 

  • Colloid nodules are benign buildups of thyroid cells.
  • Follicular adenomas are also benign.
  • Thyroid cysts are balloon- growths inside of your thyroid gland that are filled with fluid. They are almost never cancerous.
  • Thyroid cancers can appear similar to any of the other types of thyroid nodules. An ultrasound and, sometimes, a biopsy are important to determine if a nodule is malignant.

Some nodules may affect the hormones produced by the thyroid gland, causing symptoms of hypothyroidism (underactive thyroid gland) or hyperthyroidism (overactive gland).

Thyroid Nodule Symptoms

Many thyroid nodules do not cause symptoms until they are large enough to affect the surrounding tissues and organs or to be visible on the neck. Depending on the type and cause of the nodule, symptoms may include:

  • Difficulty swallowing
  • Hoarseness or other voice changes
  • Pain in the neck
  • A swelling in the neck that you can see or feel (goiter)
  • Sudden, rapid weight loss
  • Fast or irregular pulse
  • Nervousness or anxiety
  • Cold intolerance
  • Fatigue
  • Dry skin
  • Weight gain
  • Facial swelling (edema)

Thyroid Nodule Diagnosis

  • Physical exam/palpation
  • CT scan
  • Ultrasound of the neck
  • Blood tests to measure the level of thyroid hormones in the blood
  • Biopsy of the nodule, which involves taking a small sample of the nodule and examining the cells under a microscope. This is the best way to determine whether a nodule is benign or cancerous.

When to See a Doctor for a Thyroid Nodule

If you or your child has any of the symptoms listed above, consult your health care provider.  

Thyroid Nodules: Treatment

Treatment will depend on the type and cause of the nodule. Sometimes observation (watchful waiting and regular follow-up) is all that is needed. Medication and surgery may also be necessary. Radio frequency ablation (RFA) is a nonsurgical procedure that can also reduce the size of a thyroid nodule. 

Head and Neck Endocrine Surgeon, Jonathon Russell, describes how Radiofrequency Ablation (RFA) is used to treat, who is an appropriate candidate and what is involved in this new treatment approach. Patients with thyroid or parathyroid conditions, including tumors, nodules and hyperparathyroidism, can rely on the expertise of our team. Our specialists offer expert imaging and diagnosis, along with medical and surgical management and personalized, compassionate care. We were among the first hospitals in the United States to offer scarless vestibular robotic thyroid surgery, and our teams were among the first to offer radiofrequency ablation (RFA). Our position as world leaders in the care of thyroid nodules and thyroid cancer ensures that you and your family will receive the most appropriate patient-centered care available. 

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/the-thyroid-gland

Hypothyroidism

Disorders of the Thyroid | Johns Hopkins Medicine

Linkedin Pinterest Endocrine System

Hypothyroidism is the most common type of thyroid disorder. It means your thyroid gland is not active enough. This tiny gland is found in the front of your neck. Its job is to make thyroid hormone. If the gland is underactive, it may not make enough thyroid hormone.

Thyroid hormones control how your body uses energy. They affect almost every organ in your body. When your thyroid doesn’t make enough of these hormones, parts of your body slow down.  

What causes hypothyroidism?

The most common cause of hypothyroidism is an autoimmune disorder. This means your immune system starts to attack itself. It makes antibodies against the thyroid gland. Another cause may be treatment for an overactive thyroid gland. That may include radioactive iodine therapy or surgery.

A condition called secondary hypothyroidism can also sometimes happen. It’s when your pituitary gland stops working. The pituitary gland then no longer tells the thyroid gland to make thyroid hormones.

Newborns are tested at birth for hypothyroidism. This condition must be treated immediately. It can affect a baby’s brain and nervous system.

Who is at risk for hypothyroidism?

You may be more ly to have hypothyroidism if you:

  • Are a woman
  • Are older than age 60
  • Have had thyroid problems or thyroid surgery in the past
  • Have a family history of thyroid problems
  • Have certain conditions, such as type 1 diabetes or rheumatoid arthritis
  • Have Turner syndrome, a genetic condition that affects women
  • Are pregnant or have had a baby within the past 6 months
  • Have an iodine deficiency. Your body needs iodine to make thyroid hormone.

What are the symptoms of hypothyroidism?

Symptoms are different for each person. They are usually hard to notice and start slowly. They may be mistaken for symptoms of depression. Here are the most common symptoms and signs:

  • Dull facial expressions
  • Tiredness (fatigue)
  • Being cold bothers you
  • Hoarse voice
  • Slow speech
  • Droopy eyelids
  • Puffy and swollen face
  • Weight gain
  • Constipation
  • Sparse, coarse, and dry hair
  • Coarse, dry, and thickened skin
  • Hand tingling or pain (carpal tunnel syndrome)
  • Slow pulse
  • Muscle cramps
  • Sides of eyebrows thin or fall out
  • Confusion
  • Increased or irregular menstrual flow in women

These symptoms may look other health problems. Always see your healthcare provider for a diagnosis.

How is hypothyroidism diagnosed?

Your healthcare provider will ask about your past health. You will also need an exam. Blood tests can also help diagnose hypothyroidism. They can measure the amount of thyroid hormone and thyroid-stimulating hormones in your blood.

How is hypothyroidism treated?

Your healthcare provider will figure out the best treatment for you :

  • Your age, overall health, and past health
  • How sick you are
  • How well you can handle certain medicines, treatments, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

The goal of treatment is to return your level of thyroid hormone back to normal. You may need to take medicine that gives you a dose of thyroid hormones. Your provider may need to change the dose over time. You will need blood tests to make sure you are taking the correct dose of thyroid hormone replacement. You will probably need to take this medicine for the rest of your life.

What are the complications of hypothyroidism?

If your hypothyroidism is not treated, these complications may happen:

  • Anemia
  • Low body temperature
  • Heart failure

When should I call my healthcare provider?

Tell your healthcare provider if your symptoms get worse or you have new symptoms. If you are a woman of childbearing age and want to become pregnant, talk with your healthcare provider first.

Key points about hypothyroidism

  • Hypothyroidism means your thyroid gland is underactive. It isn’t making enough thyroid hormone. The most common cause is when your immune system starts to attack itself. It makes antibodies against the thyroid gland.
  • Symptoms include dull facial expressions, tiredness, and weight gain.
  • Blood tests can help diagnose this condition. They can measure the amount of thyroid hormone and thyroid-stimulating hormones in your blood.
  • The goal of treatment is to return your levels of thyroid hormone back to normal.
  • Untreated hypothyroidism may lead to anemia, low body temperature, and heart failure.
  • Treatment may include medicine that replaces lost thyroid hormones. You usually will need to take thyroid hormones for the rest of your life.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/hypothyroidism

Core Faculty

Disorders of the Thyroid | Johns Hopkins Medicine

Home > Research > Centers and Institutes > Welch Center > Our People > Core Faculty

Research Interests: prevention and control of elevated blood pressure and its clinical consequences-cardiovascular disease and kidney disease; lifestyle modification and behavior change

Research Interests: epidemiology of obesity and diabetes, and their relationship with cancer

Assistant Scientist, Department of Epidemiology
 

Research Interests: Cardiovascular Disease and Hypertension, Kidney Disease, Aging

Professor of Medicine Course Director, Scholarly Concentrations Research Director, Division of General Internal Medicine Program Director, Predoctoral Clinical Research Training Program

Research Interests: health care quality for underserved populations; patient-clinician communication; sickle-cell disease; HIV and substance abuse; bioethics; respect

Associate Professor of Medicine Director of Research, Johns Hopkins Community Physicians Co-Director, The Johns Hopkins Center for Women’s Health, Sex & Gender Research

Research Interests: lifestyle and health behavior changes in pregnancy to promote healthy weight gain, and prevent adverse pregnancy outcomes and future chronic disease

Sr. Research Associate, Department of Epidemiology Associate Director, Methods & Shared Resources, Center for Health Equity

Research Interests: design and analysis of clinical trials; disparities research; cardiovascular disease and hypertension

Research Interests: obesity; diabetes mellitus; nonalcoholic fatty liver disease

Professor of Medicine James F. Fries Professor of Medicine Bloomberg Distinguished Professor, Equity in Health & Healthcare Director, Johns Hopkins Center for Health Equity

Research Interests:  patient-centered, community-engaged interventions to reduce health disparities and improve health outcomes among socially disadvantaged populations; patient-physician communication and relationships; primary care of patients with chronic conditions

Professor of Epidemiology George W. Comstock Professor Director, George W. Comstock Center for Public Health Research & Prevention

Research Interests: vascular disease in the heart, brain and kidney using cohort studies to understand risk factors and biomarkers that can guide prevention of cardiovascular disease and kidney disease

Associate Professor of Medicine Associate Vice Chair, Diversity & Inclusion, Department of Medicine

Research Interests: hypertension; kidney disease; health equity; social determinants of health; nutrition; older adults

Professor of Epidemiology and Medicine Associate Director, Johns Hopkins Clinical Research Scholars Program

Research Interests: psychiatric disorders; mental illness; alcohol and substance use disorders

Resesarch Interests: cardiovascular disease risk and premature mortality in persons with mental illness; lifestyle and health behavior interventions, health services research, implementation science, patient safety

David M. Levine Professor of Medicine Director, Johns Hopkins Institute for Clinical & Translational Research Vice Dean, Clinical Investigation

Research Interests: pragmatic clinical trials; clinical research informatics; smoking cessation; improving efficiency and quality of clinical trials

Professor of Medicine Hugh P. McCormick Family Professor of Endocrinology & Metabolism Vice President and Chief Diversity Officer, Johns Hopkins Medicine Executive Vice-Chair, Department of Medicine

Research Interests: diabetes mellitus; cardiovascular disease and endocrine epidemiology; inpatient diabetes health service research; mental health complications of diabetes; diabetes health disparities

Professor of Neurology
 

Research Interests: vascular contributions to cognitive impairment and dementia; cognitive consequences of stroke; cognitive deficits in congestive heart failure and other cardiac diseases

Associate Professor of Medicine
 

Research Interests: kidney disease; metabolomics and genetics; pharmacoepidemiology; risk estimation 

Associate Professor of Medicine Co-Director, Clinical Epidemiology Curriculum Education Director, Johns Hopkins Brancati Center for the Advancement of Community Care

Research Interests: health care quality and health equity among persons with chronic kidney disease and chronic kidney disease risk factors, including hypertension and diabetes; patient-physician communication; care coordination

Professor of Epidemiology Director, Environmental Epidemiology Track Co-Director, Center for Clinical Epidemiology, Samsung Medical Center

Research Interests: cardiovascular disease and chronic disease epidemiology; environmental risk factors for chronic diseases; nutritional epidemiology

Associate Professor of Medicine Clinical Director, Preventive Medicine Residency Program

Research Interests: influence of obesity on the healthcare experience; lifestyle modification and health behavior among populations at risk for cardiovascular disease and obesity; translation of behavioral interventions into clinical practice and community settings

Professor of Medicine Sr. Director, Population Health Research & Development, Johns Hopkins HealthCare Co-Lead, Behavioral, Social & Systems Science, Johns Hopkins Institute for Clinical & Translational Research

Research Interests: prevention and self-management of diabetes, cardiovascular disease, chronic kidney disease; health equity; population health improvement and management; global health

Dean Emeritus, Johns Hopkins Bloomberg School of Public Health Second Century Distinguished Professor

Professor of Medicine

Associate Professor of Medicine Director, General Internal Medicine Fellowship Program Director of Community Partnership, The Brancati Center for the Advancement of Community Care

Research Interests: diabetes prevention; type 2 diabetes; obesity; clinical trials

Associate Professor of Epidemiology
 

Research Interests: peripheral vascular disease, cardiovascular disease, kidney disease, and hypertension; obesity and diabetes

Research Interests: hypertension; kidney disease; nutrition

Assistant Professor of Epidemiology
 

Research Interests: microbiome, nutrition, life-course and environmental epidemiology; prevention of obesity, diabetes mellitus, hypertension and cardiovascular disease

Assistant Professor of Medicine

Associate Professor of Health Policy & Management Co-Director, General Internal Medicine Fellowship Program

Research Interests: cancer health services research with an emphasis on the role of provider and patient social networks to improve the quality of care; social determinants of health with a focus on housing policy and neighborhood environments

Assistant Professor of Medicine Director, Community & Stakeholder Engagement for the Epidemiology Research Group in Organ Transplantation Associate Director, Education & Training at the Johns Hopkins Center for Health Equity Research Interests: epidemiology and health services research related to kidney disease 

Research Interests: epidemiology and health services research related to kidney disease transplantation; health equity; cardiovascular disease, hypertension, obesity and diabetes 

Assistant Professor of Epidemiology​
 

Research Interests: cardiovascular disease and hypertension; kidney disease; biomarkers; omics; nutrition

Research Interests: diabetes and cardiovascular disease; diagnostics and biomarkers for screening and diagnosis of diabetes and cardiovascular disease; optimizing approaches to screening and management of prediabetes and diabetes; interface of epidemiology and clinical and public health policy

Assistant Professor of Epidemiology
 

Research Interests: pharmacoepidemiology; diabetes mellitus; chronic kidney disease; cardiovascular disease

Assistant Professor of Medicine
 

Research Interests: diabetes and obesity prevention

Assistant Professor of Medicine

Associate Professor of Medicine Director, Childhood Development After Cochlear Implantation Study Data Coordinating Center Director, Biostatistics Sub-Core & Clinical Trial Sub-Core, Health Care & Population Science Core Director, Biostatistics, Bayview General Clinical Research Unit

Research Interests: statistical and epidemiologic methods; pediatric cochlear implantation; epidemiology; kidney transplants; biostatics; weight loss; type 2 diabetes; multicenter studies; randomized controlled trials; longitudinal data analysis

Source: https://www.jhsph.edu/research/centers-and-institutes/welch-center-for-prevention-epidemiology-and-clinical-research/our-people/core-faculty/