Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome, commonly known as PCOS, is one of the most common female endocrine disorders.

A syndrome is a group of signs and symptoms that occur together to characterize a particular condition. The definition of PCOS includes irregular periods, signs of excess androgenic hormones (masculine hormones) such as acne and excess hair growth, and an exclusion of other causes of an elevation of androgens. Although the name indicates the presence of cysts on the ovaries, not all women with PCOS have cysts (and not all women with ovarian cysts have PCOS). Read more

Osteoporosis: Keep Your Bones Dense!

Remember those skeletons that hung in many of our elementary school classrooms growing up? The one component of those models is bone: humans are born with up to 270 of them! It is clearly important for us to protect this crucial framework in order to preserve a high quality of life.

One concern as we get older is osteoporosis, a condition of thin and porous bones. Aging, which we cannot prevent (at least not yet!), is the greatest risk factor for osteoporosis. Bones thin over time because the hormones estrogen and testosterone—which are important to maintaining bone density—both decline with age. We all know bone fractures can be debilitating, especially for the elderly, so, as with all medical conditions, prevention is paramount. Read more

Understanding Your Thyroid Gland, aka “the Shield”

The thyroid gland got its name from the Greek word for “shield,” due to its physical appearance in the neck. In many ways, it acts like a shield by protecting our bodies from losing functional balance. The thyroid gland produces and releases thyroid hormone, which is crucial in regulating overall metabolism (the physical and chemical processes in the body that convert or use energy). Digestion, weight, temperature regulation and reproduction all are affected by the thyroid gland.

The thyroid gland works like a thermostat via its connection with the brain. If there is not enough thyroid hormone in the blood stream, the brain will stimulate the thyroid gland to produce and release more. Blood tests are an easy way to detect both the level of thyroid hormone circulating in the blood — generally free thyroxine (T4) — and the stimulating signal from the brain (TSH, or thyroid stimulating hormone). The most common thyroid problems involve abnormal production of thyroid hormone.

Hypothyroidism

Hypothyroidism is the term used to describe an underactive thyroid.

Symptoms

Symptoms include:

• Fatigue

• Feeling colder than usual

• Changes in skin and hair

• Weight gain

Causes

A common cause of hypothyroidism is Hashimoto’s thyroiditis, an autoimmune disorder in which cells in the body prevent the thyroid from producing and releasing enough thyroid hormone. Other causes include surgical removal of the thyroid gland for thyroid cancer; treatment of hyperthyroidism (an overactive thyroid gland) with radioactive iodine; or being born with an underactive thyroid gland.

Treatment

The treatment for hypothyroidism is to replace thyroid hormone in the form of a pill taken once a day, preferably by itself and on an empty stomach so that it is fully absorbed. The dose is easily adjusted based on blood tests.

Hyperthyroidism

Hyperthyroidism describes an overactive thyroid gland.

Symptoms

Symptoms include:

• Increased sweating

• Heart palpitations

• Increased anxiety

• Diarrhea

• Weight loss

Causes

A number of conditions can cause hyperthyroidism. Opposite to hypothyroidism, cells in the blood stream called antibodies make the thyroid gland secrete an excessive amount of thyroid hormone.

Treatments

The two most common treatments for hyperthyroidism are radioactive iodine and medication. Radioactive iodine works by destroying part of the thyroid gland to restore a normal level of thyroid hormone in the body; however, it is possible that hypothyroidism may then develop. Radioactive iodine has the benefit of generally being a more permanent treatment, although medications used to treat hyperthyroidism can be very effective in certain people, too. Just as in hypothyroidism, blood tests should be done routinely to monitor treatment.

Thyroid Cancer

Thyroid cancer can develop and, in the majority of cases, is curable by surgical removal of the thyroid gland by an experienced surgeon. Radioactive iodine may be used after surgery to destroy any small remaining cancer cells. An endocrinologist should be directly involved in monitoring care.

Extremes of thyroid function can certainly have an impact on your quality of life; the beauty is that with the correct diagnosis and management, these conditions can be greatly improved!

To find an excellent doctor who is right for you, please call our Physician Referral Service at 866.804.1007.

The So Called Golden Years…let’s hope so!

Aging is inevitable (We hope!), which is great because it means we get wiser, right? While our minds and souls are enriched by the collective wisdom of the preceding years, what about our bodies?

As both men and women transition into the later decades of life there is a relative decline in sex hormones. In women, the decline of estrogen may be marked by hot flashes, urinary symptoms, vaginal dryness and emotional lability-so called menopause. In men, there is not a defined stage whereby a decline in testosterone causes symptoms. However, there is certainly talk about “andropause,” male menopause, which may be associated with a decline in libido/sexual function, muscle mass, and an increase in abdominal obesity.

Logically, if these hormones decline with age and produce symptoms that negatively affect quality of life then why don’t we just replace them? Well, just like any area in medicine we must weigh the risks and benefits of the treatment prior to initiation.

Ladies first: Estrogen can be replaced as a pill, patch, topical lotion, or vaginal preparation. Hormone replacement therapy for menopause is the most effective treatment for the symptoms that many women experience during menopause. Large studies have evaluated the safety of replacing estrogen and the results demonstrate that long-term estrogen therapy (>10 years) may increase the risk for heart disease and strokes. Therefore, the guidelines recommend that estrogen therapy should be given short-term (2-3 years) with the goal of tapering off once the symptoms have improved.

For the men out there: It seems that the advertising for testosterone replacement has boomed in the last several years! The majority of us have seen the commercials for “Low T.” Your testosterone level can be checked via an early morning blood test. If the level is low, then referral to an Endocrine specialist should be considered for further evaluation. If deemed appropriate the testosterone level can be increased via a daily topical solution (preferred since it is more physiologic) or as an injection every 1-2 weeks. As stated with estrogen replacement in women, the risks and benefits of treatment should be discussed. Testosterone therapy may increase the risk for prostate enlargement, an elevation in red blood cell count, and worsening of sleep apnea. We do not recommend testosterone replacement in men with normal testosterone levels.

If any of these symptoms are impacting your quality of life please talk with your physician about possible therapies.

May all your golden years be GOLDEN!

 

 

 

The Impact of Sleep on Appetite and Metabolism

We have all heard of “beauty sleep,” but the impact of sleep quality and quantity goes way beyond our physical appearance. Research has begun to clearly delineate the importance of getting a good nights rest on health, so maybe we should start talking about “healthy sleep.”

A few facts for you from a National Sleep Foundation Poll:

* 1 in 3 American adults report having sleep problems.

* The percentage of young American adults sleeping less than 7 hours has doubled over the last 40 years.

* Cumulative sleep loss over the work week for many adults may account to one full night of sleep loss.

What do these statistics mean to me?

Research has demonstrated that sleep deprivation negatively affects several important hormones that directly regulate our appetite and metabolism. Our bodies are innately programmed to regulate our energy balance, essentially matching the energy we take in with the energy we expend.

The yin and yang of energy balance are ghrelin and leptin. Ghrelin is a protein that is produced mainly by the stomach that stimulates appetite; it is why your stomach growls when you are hungry. On the other hand, leptin is a hormone released by fat cells that signals when you are full (sometimes it’s hard to listen to this one!). Several research studies on sleep deprivation have shown that leptin levels decrease and ghrelin levels increase in response to a lack of sleep, which causes an increase in appetite (specifically for high-calorie and high-salt food) throughout the day. In a review of long-term research studies, short sleep duration is associated with a risk of being overweight or obese in the future.

Lack of sleep has also been shown to increase the release of stress hormones, specifically cortisol, which decreases the body’s sensitivity to insulin (a regulator of blood sugar). An elevation in stress hormone levels may also elevate blood pressure, a risk factor for heart attacks and strokes. Just as lack of sleep may be risk factors for these conditions, it may also make them more difficult to control so improving sleep may also be a valuable treatment.

Living in the “city that never sleeps” can make it difficult to shut it down at night. The good news is that it will still be there when you wake up! If you have trouble falling asleep or staying asleep at night, please talk to your doctor to evaluate if there is a possible medical reason.

Good night and sleep tight!

Gregory B. Dodell, MD, is an Endocrinologist ta St. Luke’s and Roosevelt Hospitals.

A Doctor Wears an Insulin Pump to Better Understand

Chronic disease is exactly that, chronic. Therefore, a diagnosis of any chronic disease is life altering. I spend the majority of my days doing my best to take care of patients with diabetes. For their sakes, I ask them to be compliant, that is, to follow the many guidelines carefully so they stay as healthy as possible and avoid long-term complications of their disease.

Many times, a patient’s condition is not well controlled due to barriers that are preventing his successful compliance such as depression, poor insight into the disease, failure to adjust to the change in lifestyle that comes with the condition, or denial. Addressing these compliance barriers will hopefully facilitate future success in preventing complications.

In an attempt to understand a patient’s challenges to stay compliant, I decided to live the life of one of my patients for a bit.  I recently wore an insulin pump for 72 hours. This was an extremely insightful experience! Read more