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Endocrinologists provide treatment for a wide range of functions and disorders of the human body—diabetes, thyroid disorders, infertility, metabolism, glandular cancers, growth hormone deficiency, genetic dysfunction, heart disease, osteoporosis, obesity and hormonal imbalances.
When do you need an endocrinologist?
The skills of an endocrinologist are necessary for complicated disorders, such as uncontrolled diabetes, thyroid cancer, pituitary dysfunction, familial endocrine and auto-immune disease.
Thyroid Cancer
Although some people may experience such symptoms as difficulty swallowing or breathing, or pain or swelling in the neck, the majority of cases present without symptoms, explains Sharon E. Selinger, MD, FACE, FACP, chief of the endocrine section at Overlook. Instead, the initial sign may be a lump in the thyroid gland—detected during a routine physical exam—or an abnormal image of the thyroid, detected when an MRI or CT of the chest or spine is performed for an unrelated reason. Nodules on the thyroid are overwhelmingly benign; less than 15 percent turn out to be malignant. Diagnosis is confirmed with a combination of a detailed history, blood tests for hormone levels, imaging tests, and a fine-needle aspiration biopsy if necessary.
Risk Factors
External radiation to the head or neck, particularly during childhood, is a leading risk factor for the disease. To illustrate this point, Selinger, president of the New Jersey Chapter of the American Association of Clinical Endocrinologists, recalls the 1986 explosion at the Chernobyl Nuclear Power Plant in the Ukraine. “Toddlers from those days are showing up 20 years later with thyroid cancer,” she says.
Another risk factor is a genetic predisposition for medullary thyroid cancer (MTC), the rarest form of the disease. A simple blood test exists to determine increased risk for MTC.
Anaplastic thyroid cancer, which presents with rather aggressive tumors, is most typically seen only in the elderly.
So why is it that most thyroid-cancer patients are younger, otherwise healthy women? “A lot of thyroid diseases are autoimmune diseases,” explains Selinger. “Women have a propensity for autoimmune diseases to flare. For example, certain women may experience a flare post-pregnancy. Obviously, men don’t have that.”
Treatment
Papillary and follicular thyroid cancers—the most common and also least aggressive forms of the disease—respond well to surgery that removes the entire thyroid gland and any involved lymph nodes. Chemotherapy and radiation are usually not necessary. But surgery cannot always remove every last cancer cell, so subsequent therapy involves treatment with radioactive iodine to destroy any remaining malignant cells and decrease recurrence of the disease. Thyroid medication is then used to prevent hypothyroidism (underactive thyroid function).
At Overlook Hospital, additional monitoring with injections of Thyrogen, a new thyroid-stimulating hormone, helps to better detect recurring or leftover cancer cells, thereby resulting in better outcomes overall.
Prognosis … and Promise
According to the National Cancer Institute, the ten-year overall relative survival rate in the United States is greater than 90 percent for the most common forms of thyroid cancer. That’s a promising statistic, and one that Selinger backs up with optimism. “We’re picking things up earlier, and therefore we’re more aggressive,” she says. “People should understand that the best thing to do is get early attention. People who are treated early typically do really well.”
The Thyroid Gland Up Close
Where is it?
Shaped like a butterfly and slightly larger than a quarter, your thyroid
gland is located in the front of your neck, beneath the voice box.
What does it do?
Your thyroid gland helps your body function normally by producing hormones
that regulate how your body uses energy for such factors as heart rate
and body
temperature, as well as how energetic you feel overall.
Did you know …?
Your thyroid gland is the only part of your body that absorbs iodine,
so the use of radioactive iodine for cancer treatment does not affect
any other parts of the body.
From the 2005 issue of the Overlook View
Diabetes
There’s a growing problem in America. Each year nearly 800,000 people in the United States are diagnosed with diabetes. But millions more still have no idea they have it. What’s the big deal? Diabetes is the seventh leading cause of death in the United States. It has many complications, including heart attack and stroke, blindness, and kidney disease.(*The above statistics are from the Centers for Disease Control and Prevention.)
What is Diabetes?
People with diabetes have difficulty changing food into energy. Your body converts food into a sugar called glucose, which is carried by your blood to cells in your body. The cells need a chemical called insulin to help them process the glucose into energy.
When a person has diabetes their body may not produce enough insulin or their cells may not be able to use the insulin to convert the glucose into energy. So, the glucose builds up in the blood, where the cells can’t use it.
"Type 2" diabetes is the most common form of diabetes, accounting for 90-95 percent of all cases. Other types of diabetes include "type 1," which occurs in children and young adults, and "gestational diabetes," which can occur during pregnancy.
Risk Factors
You may be at risk to get type 2 diabetes if you:
- Are over age 45
- Have a family history of diabetes
- Are overweight
- Do not exercise regularly
- Have had gestational diabetes
- Have high blood pressure or high cholesterol
- Are African American, American Indian, Asian American, Hispanic, or Pacific Islander
Warning Signs
Diabetes symptoms may be mild or even nonexistent, but be sure to let your internist know if you experience:
- Extreme thirst and/or hunger
- Fatigue
- Frequent need to urinate
- Unusual weight loss
- Blurred vision
- Tingling or numbness in hands or feet
- Frequent infections
- Bruises that are slow to heal
Get Tested!
Your internist can prescribe a simple blood test to diagnose diabetes. You may need to take the test twice to confirm the results.
Prevention and Treatment
You can lower your risk of getting type 2 diabetes by taking a few steps. Eat a healthy diet high in fruits, vegetables, fish, poultry and whole grains. Exercise regularly. Lose weight if you are overweight.
Diabetes has no cure, but can be managed. Diet control and exercise are important, and home monitoring of blood glucose may be required. Pills or insulin injections may also be prescribed to help lower the blood glucose level.
Nearly 75 percent of people with diabetes also have high blood pressure, which can lead to many complications, including death. Blood pressure can usually be controlled with lifestyle modifications and prescription drugs.
Source: American College of Physicians, doctorsforadults.com
Hypothyroidism
Hypothyroidism, also known as "underactive thyroid disease," is a common adult condition of the thyroid, a gland that regulates the body's energy. It occurs when the thyroid gland stops producing enough of the thyroid hormones T3 and T4. When the thyroid does not produce enough hormone, it slows down the body's metabolism and the gland itself shrinks as its cells are destroyed by the subtle effect in the patient's immune system. The gland is shaped like a bow tie wrapped around the windpipe at the base of the throat.
What are its common causes?
- Thyroiditis and autoimmune disorder which runs in families (this is when the body produces antibodies that attack and damage the thyroid permanently)
- Certain types of thyroid inflammation or viral infection
- Complications of thyroid surgery
- A congenital thyroid defect (occurs in 1 in 5,000 babies)
- Treatments for hyperthyroidism (these treatments destroy part of the gland and the remaining tissue may not produce sufficient hormones)
What are its symptoms?
Symptoms may initially go unnoticed because they often mimic those of normal aging and may develop slowly over months and years. Symptoms include:
- Constant tiredness and lack of energy
- Forgetfulness
- Weight gain
- Inability to keep warm
- Dry skin and hair
- Hair loss or hair coarsening
- Hoarseness of the voice
- Heavy menstrual period in women
Who suffers?
- About 11 million Americans, particularly women over 50
- By age 60, an estimated 17 percent of women and 9 percent of men
- About one in 71 women over age 50 goes undiagnosed
How is it diagnosed?
Your internist can screen for hypothroidism with a simple blood test for Thyroid-Stimulating Hormone (TSH). Guidelines from the American College of Physicians (ACP) recommend hypothyroid screening for women over 50.
How is it treated?
Hypothroidism is easily treated with a daily pill containing a synthetic thyroid hormone, usually for life (unless hypothyroidism case is short-term).
Source: American College of Physicians, doctorsforadults.com
Osteoporosis
Osteoporosis, also called the "silent disease," is a common bone disease in which bones become thinner and more porous. Osteoporosis affects both men and women and occurs when the body fails to form new bone.
During the course of your life, the body needs the minerals phosphate and calcium to build bones. If your dietary intake of these minerals is not sufficient or if the body does not absorb enough of the minerals from the diet, bone production and bone tissue will suffer resulting in brittle and fragile bones. These bones are then subject to fracture.
You may have heard of osteoporosis referred to as the "silent disease" because it's a disease that occurs over the course of may years. The loss of bone mass does not occur overnight. It usually occurs gradually over an extended period of time. In fact, most people are not even aware that they have osteoporosis until they fracture a bone. And it's at that time that a person finds the disease is in its advance stages.
What are its symptoms?
Unfortunately, there are no symptoms associated with early signs of osteoporosis. Symptoms occurring late in the disease include:
- Fractures of the vertebrae, wrists or hips
- Low back pain
- Neck pain
- Bone pain or tenderness
- Loss of height over time
- Stooped posture
What are the causes of osteoporosis?
- Loss of estrogen due to menopause
- Hormonal disorder such as Cushing's syndrome, hyperthyroidism and hyperparathyroidism
- Diet low in calcium
- Family history of the disease
- Chronic liver disease and intestinal disorders
How is osteoporosis diagnosed?
A bone density test is used to diagnose osteoporosis. A bone density test measures bone mineral content and the strength of the bones. A low bone density test result can indicate that you may be at risk for future bone fractures. The test can also show the rate of bone mineral loss and bone gain for those receiving treatment.
How you can prevent osteoporosis
Eat a diet throughout life containing calcium, phosphorus and vitamin D. By the late 20s and into the early 30s peak bone mass is reached. You may want to talk to your doctor about taking calcium supplements when you reach this age bracket. Regular life-long exercise can also reduce the likelihood of bone fractures and weight-bearing exercise helps reduce bone mineral loss. Exercise such as walking, jogging, swimming, and skiing are all excellent for the bones, although they are not weight-bearing. Make sure you see your internist for general physical exams regularly and talk with him or her about your risk for osteoporosis and the need for a bone density test.
Is it treatable?
Yes. Although there is no cure for osteoporosis, it is a treatable disease. Many medications slow and sometimes stop bone mineral loss.
Source: American College of Physicians, doctorsforadults.com
Obesity and Weight Control
Nearly 100 million adults in America have a problem that puts them at increased risk of chronic disease: They are overweight or obese. Are you — or someone close to you — among them?
A person is considered obese if he or she weighs at least 20 percent more than the maximum healthy weight for his or her height. About three in 10 people in the United States are obese, and the condition is becoming increasingly common.
Obesity can cause many health problems due to the strain it puts on organs and joints. It increases the risk of some widespread and potentially fatal disorders such as diabetes, hypothyroidism, coronary artery disease, stroke and high blood pressure. It may also lead to psychological problems such as depression.
Causes of obesity
- Overeating and a sedentary lifestyle
- Hormonal disorders such as hypothyroidism (rare)
- Corticosteroid drugs
- Psychological problems
Are there complications?
- Increased risk of various chronic health problems such as high blood pressure levels
- Greater risk of gallstones
- Greater risk of developing diabetes
- Strains on the joints (osteoarthritis is common in obese people)
- Sleep apnea (a respiratory disorder)
- Greater risk of Coronary Heart Disease
Other overweight/obesity-related health complications
- Cancer
- Twice as many women with a body mass index (BMI) greater than 29 had colon cancer as women with a BMI less than 21
- A gain of more than 20 pounds, from age 18 to 40, doubles a woman's risk of postmenopausal breast cancer
- The risk of endometrial cancer is three times higher among women with a BMI of 30 or higher, compared to normal weight women
- Diabetes
- Twenty-seven percent of new cases of diabetes are attributable to weight gain of 11 pounds or more in adulthood
- The relative risk of diabetes increases by about 25 percent for each additional unit of BMI over 22
- Diabetes is associated with long-term complications that affect almost every major part of the body; it can cause blindness, heart disease, stroke, kidney failure, nerve damage and sometimes requires amputation(s)
- Osteoarthritis
- In a study of middle-aged women, every 2.2 pound increase in weight was associated with a 9.13 percent increase in the risk of developing osteoarthritis in the knees
- A drop in BMI of two units or more during a 10-year period decreased the odds for developing knee osteoarthritis by more than 50 percent
- The risk of endometrial cancer is three times higher among women with a BMI of 30 or higher, compared to normal weight women
Source: American College of Physicians, doctorsforadults.com