HOLLY ATKINSON, MD: Hello and welcome to our webcast. I'm Dr. Holly Atkinson. Hyperthyroidism is a condition that most women know little about. Much less than they should. Caused by an overactivity of the thyroid gland, it can lead to symptoms ranging from weight loss to visual problems, and it's often misdiagnosed. Joining me are two experts. Dr. Melissa Katz, from the Weill-Cornell Medical College, and Dr. Rick Haber, from Mt. Sinai School of Medicine. Welcome Rick. Rick, let's start with you. Give us a brief overview of what the function of the thyroid gland is.
RICHARD HABER, MD: The normal function of the thyroid gland in people and also in lower animals and all vertebrates, really, is to regulate the metabolism -- the rate that your body, the cells in your body burns fuel. When there's too much of it around, the metabolism is too fast, too high -- which is why people lose weight when they're hyperthyroidism, despite eating more, in many cases.
HOLLY ATKINSON, MD: Melissa, what exactly is hyperthyroidism?
MELISSA KATZ, MD: Hyperthyroidism is the overproduction of thyroid hormone by the thyroid gland. It can be due to Graves' Disease -- where the whole thyroid itself is diffusely enlarged and too much -- both T4 and T3, they're predominant thyroid hormones -- are made. It can also be due -- and this occurs more often in an elderly patients -- that they can have a toxic nodule. One nodule within the thyroid gland is overproducing thyroid hormone.
Regardless of the exact cause, the symptoms are usually fairly common. They can include weight loss, increased perspiration, palpitations -- including a rapid heartbeat -- and a tremor, is a very common presentation.
HOLLY ATKINSON, MD: Any difference in terms of how hyperthyroidism presents: age, old versus young, or gender, women versus men. Are certain groups prone to certain symptoms?
MELISSA KATZ, MD: Women are certainly much more prone to hyperthyroidism as a whole. And Graves' Disease occurs much more often in the younger female or male. And a toxic nodule is more common presentation in an elderly patient.
HOLLY ATKINSON, MD: Rick, she's been using the term "Graves' Disease." Why in the world is it called "Graves' Disease," and what exactly causes it, do we know?
RICHARD HABER, MD: It's not called "Graves' Disease" because it's considered "grave." It's named after an early nineteenth-century Irish physician, Robert Grave. So it's one of those things that's named after a doctor. And Graves' Disease is an overactivity of the thyroid gland, which is caused by the body's immune system making an antibody that stimulates the thyroid. It is as if there was too much stimulating hormone, but there's not.
HOLLY ATKINSON, MD: And do we know what triggers the immune system to do that?
RICHARD HABER, MD: It appears to be familial in many cases.
HOLLY ATKINSON, MD: So it runs in the family.
RICHARD HABER, MD: Right. And for that reason, it has been assumed that there must be some genetic predisposition and exactly what genes might be involved there is the subject of current research, but the answer is not in yet.
MELISSA KATZ, MD: Also, I think that there are many patients in whom there's a recent stressor, that tends to bring it on.
HOLLY ATKINSON, MD: How common is hyperthyroidism?
MELISSA KATZ, MD: Hyperthyroidism is actually quite common. It affects approximately 2% of the population.
HOLLY ATKINSON, MD: Underdiagnosed?
MELISSA KATZ, MD: I think it's often diagnosed at a later stage than would be optimal. But when somebody has severe hyperthyroidism, if they seek medical attention, it becomes quite apparent.
HOLLY ATKINSON, MD: Rick, how do you diagnose hyperthyroidism?
RICHARD HABER, MD: Well, the diagnosis of hyperthyroidism is made first when a physician suspects the diagnosis. That the symptoms and signs of the disease appear to be present. And that suspicion is then confirmed by using laboratory tests on the blood to show that the levels of thyroid hormone are too high.
HOLLY ATKINSON, MD: What should a patient do if he or she has self-diagnosed? Maybe they've seen symptoms listed on the Internet or elsewhere and they decide, "Indeed, I have hyperthyroidism." What should they do?
MELISSA KATZ, MD: I think they should see an endocrinologist, see if there's a concurrence there, and also have their TSH checked.
HOLLY ATKINSON, MD: Now, you are both endocrinologists -- give us a definition of what that specialty is involved with. A lot of people don't realize exactly what that term means.
MELISSA KATZ, MD: Endocrinology is really the study of hormones. Includes multiple hormones produced by the body -- certainly thyroid hormone, but it also includes pituitary problems, adrenal problems, metabolic, bone disease, osteoporosis, and certainly diabetes, including reproductive problems, both in men and women.
HOLLY ATKINSON, MD: Now, Rick, oftentimes, people's managed-care programs won't let them go directly to a specialist such as yourselves. You must often work with primary-care physicians in these kinds of situations?
RICHARD HABER, MD: I think usually the suspicion and the initial diagnostic testing for thyroid disease is usually carried out by a primary-care physician, such as an internist or an obstetrician-gynecologist. The symptoms are there, then the lab test is done to confirm the suspicion.
Once it's been documented by the lab tests -- perhaps done by a primary-care physician -- that there really is thyroid disease and not just a suspicion of thyroid disease, at that point referral to an endocrinologist may be necessary. And I think most people will -- the insurance plans that most people have will permit that when it's appropriate.
HOLLY ATKINSON, MD: Great. Thank you very much for being with me today. And thank you for being with me. I'm Dr. Holly Atkinson.