HypothyroidismShare on facebook Share on twitter Bookmark & Share Printer-friendly version Hypothyroidism is a condition in which the thyroid gland does not make enough thyroid hormone. This condition is often called underactive thyroid.

CausesThe thyroid gland is an important organ of the endocrine system. It is located at the front of the neck, just above where your collarbones meet. The thyroid makes hormones that control the way every cell in the body uses energy. This process is called metabolism.Hypothyroidism is more common in women and people over age 50.The most common cause of hypothyroidism is thyroiditis. Swelling and inflammation damage the thyroid gland's cells.Causes of this problem include:

The immune system attacking the thyroid gland Viral infections (common cold) or other respiratory infections Pregnancy (often called postpartum thyroiditis)

Other causes of hypothyroidism include: Certain medicines, such as lithium and amiodarone Congenital (birth) defects Radiation treatments to the neck or brain to treat different cancers Radioactive iodine used to treat an overactive thyroid gland Surgical removal of part or all of the thyroid gland Sheehan syndrome , a condition that may occur in a woman who bleeds severely during pregnancy

or childbirth and causes the destruction of the pituitary gland Pituitary tumor  or pituitary surgery

SymptomsEarly symptoms:

Hard stools or constipation Increased sensitivity to cold temperature Fatigue or feeling slowed down   Heavier and irregular menstrual periods Joint or muscle pain Paleness or dry skin Sadness or depression Thin, brittle hair or fingernails Weakness Weight gain

Late symptoms, if untreated: Decreased taste and smell Hoarseness Puffy face, hands, and feet Slow speech Thickening of the skin Thinning of eyebrows

Exams and TestsThe health care provider will do a physical exam and find that your thyroid gland is enlarged. Sometimes, the gland is normal size or smaller-than-normal. The exam may also reveal:

Brittle nails Coarse features of the face Pale or dry skin, which may be cool to the touch

Swelling of the arms and legs Thin and brittle hair

Blood tests are also ordered to measure your thyroid hormones TSH and T4.   You may also have tests to check:

Cholesterol levels Complete blood count (CBC) Liver enzymes Prolactin Sodium

TreatmentTreatment is aimed at replacing the thyroid hormone that you are lacking.Levothyroxine is the most commonly used medicine:

You will be prescribed the lowest dose possible that relieves your symptoms and brings your blood hormone levels back to normal.

If you have heart disease or you are older, your doctor may start you on a very small dose. Most people with an underactive thyroid will need to take this medicine for life.

When starting your medicine, your doctor may check your hormone levels every 2 to 3 months. After that, your thyroid hormone levels should be monitored at least once every year.When you are taking thyroid medicine, be aware of the following:

Do not stop taking the medicine when you feel better. Continue taking it exactly as your doctor prescribed.

If you change brands of thyroid medicine, let your doctor know. Your levels may need to be checked.

What you eat can change the way your body absorbs thyroid medicine. Talk with your doctor if you are eating a lot of soy products or are on a high-fiber diet.

Thyroid medicine works best on an empty stomach and when taken 1 hour before any other medications. Ask your doctor if you should take your medicine at bedtime. Studies have found that taking it at bedtime may allow your body to absorb the medicine better than taking it in the daytime.

Wait at least 4 hours after taking thyroid hormone before you take fiber supplements, calcium, iron, multivitamins, aluminum hydroxide antacids, colestipol, or medicines that bind bile acids.

While you are taking thyroid replacement therapy, tell your doctor if you have any symptoms that suggest your dose is too high, such as:

Palpitations Rapid weight loss Restlessness or shakiness Sweating

Outlook (Prognosis)In most cases, thyroid hormone levels return to normal with proper treatment. You will likely take a thyroid hormone medicine for the rest of your life.Possible ComplicationsMyxedema coma, the most severe form of hypothyroidism, is rare. It occurs when thyroid hormone levels get very low. It can be caused by an infection, illness, exposure to cold, or certain medicines in people with untreated hypothyroidism.Myxedema coma is a medical emergency that must be treated in the hospital. Some patients may need oxygen, breathing assistance (ventilator), fluid replacement and intensive-care nursing.Symptoms and signs of myxedema coma include:

Below normal temperature Decreased breathing Low blood pressure Low blood sugar

Unresponsiveness Inappropriate or uncharacteristic moods

People with untreated hypothyroidism are at increased risk of: Infection Infertility , miscarriage, giving birth to a baby with birth defects Heart disease because of higher levels of LDL ("bad") cholesterol Heart failure

Alternative NamesMyxedema; Adult hypothyroidism

Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often called overactive thyroid.CausesThe thyroid gland is an important organ of the endocrine system. It is located at the front of the neck just above where your collarbones meet. The gland makes the hormones that control the way every cell in the body uses energy. This process is called metabolism.Many diseases and conditions can cause hyperthyroidism, including:

Eating too much of foods that contain iodine Graves disease  (most cases of hyperthyroidism) Inflammation (thyroiditis) of the thyroid due to viral infections, after pregnancy, or other causes Noncancerous growths of the thyroid gland or pituitary gland Some tumors of the testes or ovaries Taking large amounts of thyroid hormone Getting medical imaging tests with contrast dye that has iodine

SymptomsCommon symptoms include:

Difficulty concentrating Fatigue Frequent bowel movements Goiter  (visibly enlarged thyroid gland) or thyroid nodules Hand tremor   Heat intolerance Increased appetite Increased sweating Irregular menstrual periods in women Nervousness Restlessness Sleep problems Weight loss  (or weight gain, in rare cases)

Other symptoms that can occur with this disease: Breast development in men Clammy skin Diarrhea Hair loss          High blood pressure Itching - overall Lack of menstrual periods in women Nausea and vomiting Protruding eyes  (exophthalmos) Rapid, forceful, or irregular heartbeat (palpitations) Skin blushing or flushing    Weakness

Exams and TestsThe health care provider will do a physical exam. The exam may find the following:

High systolic blood pressure (the first number in a blood pressure reading) Increased heart rate Enlarged thyroid gland Shaking of the hands Swelling or inflammation around the eyes

Blood tests are also ordered to measure your thyroid hormones TSH, T3, and T4.You may also have blood tests to check: 

Cholesterol levels Glucose     Radioactive iodine uptake

TreatmentTreatment depends on the cause and the severity of symptoms. Hyperthyroidism is usually treated with one or more of the following:

Antithyroid medications Radioactive iodine to destroy the thyroid gland and stops the excess production of hormones Surgery to remove the thyroid

If your thyroid is removed with surgery or destroyed with radiation, you must take thyroid hormone replacement pills for the rest of your life.Medicines called beta-blockers may be prescribed to treat symptoms such as fast heart rate, sweating, and anxiety until the hyperthyroidism can be controlled.Outlook (Prognosis)Hyperthyroidism is treatable. Some of its causes may go away without treatment.Hyperthyroidism caused by Graves disease usually gets worse over time. It has many complications, some of which are severe and affect quality of life.Possible ComplicationsThyroid crisis (storm), also called thyrotoxicosis, is a sudden worsening of hyperthyroidism symptoms that may occur with infection or stress. Fever, decreased alertness, and abdominal pain may occur. Patients need to be treated in the hospital.Other complications of hyperthyroidism include:

Heart problems such as fast heart rate, abnormal heart rhythm, heart failure Osteoporosis

Surgery-related complications, including: Scarring of the neck Hoarseness due to nerve damage to the voice box Low calcium level due to damage to the parathyroid glands (located near the thyroid gland) Hypothyroidism (underactive thyroid) 

When to Contact a Medical ProfessionalCall your health care provider if you have symptoms of hyperthyroidism. Go to an emergency room or call the local emergency number (such as 911), if you have:

Change in consciousness Dizziness Rapid, irregular heartbeat

Call your health care provider if you are being treated for hyperthyroidism and you develop symptoms of underactive thyroid, including:

Depression Mental and physical sluggishness Weight gain

Alternative NamesThyrotoxicosis

Cushing syndromeShare on facebook Share on twitter Bookmark & Share Printer-friendly version Cushing syndrome is a disorder that occurs when your body is exposed to high levels of the hormone cortisol. It may also occur if you take too much cortisol or other steroid hormones.See also: Cushing's disease (pituitary Cushing's)CausesCushing syndrome may be caused by taking too much corticosteroid medications, such as prednisone and prednisolone. These drugs are used to treat conditions such as asthma and rheumatoid arthritis.Other people develop Cushing syndrome because their bodies produce too much cortisol, a hormone normally made in the adrenal gland. Causes of too much cortisol are:

Cushing's disease , when the pituitary gland makes too much of the hormone ACTH. ACTH then signals the adrenal glands to produce cortisol. Tumor of the pituitary gland may cause this condition.

Tumor of the adrenal gland Tumor elsewhere in the body that produces cortisol Tumors elsewhere in the body that produce ACTH (such as the pancreas, lung, and thyroid)

SymptomsMost people with Cushing syndrome will have:

Upper body obesity (above the waist) and thin arms and legs Round, red, full face (moon face) Slow growth rate in children

Skin changes that are often seen: Acne  or skin infections Purple marks (1/2 inch or more wide) called striae on the skin of the abdomen, thighs, and breasts Thin skin with easy bruising

Muscle and bone changes include: Backache, which occurs with routine activities Bone pain or tenderness Collection of fat between the shoulders (buffalo hump) Rib and spine fractures (caused by thinning of the bones) Weak muscles

Women with Cushing syndrome often have: Excess hair growth on the face, neck, chest, abdomen, and thighs Menstrual cycle that becomes irregular or stops

Men may have: Decreased or no desire for sex Impotence

Other symptoms that may occur with this disease: Mental changes , such as depression, anxiety, or changes in behavior Fatigue Headache Increased thirst and urination

Exams and TestsBlood sugar and white blood cell counts may be high. Potassium level may be low.Laboratory tests that may be done to diagnose Cushing syndrome and identify the cause are:

Serum cortisol levels Salivary cortisol levels Dexamethasone suppression test 24-hour urine for cortisol and creatinine ACTH level ACTH (cosyntropin) stimulation test

Tests to determine the cause or complications may include:

Abdominal CT ACTH test Pituitary MRI Bone density , as measured by dual x-ray absorptiometry (DEXA)

High cholesterol, including high triglycerides and low high-density lipoprotein (HDL) may also be present.TreatmentTreatment depends on the cause.Cushing syndrome caused by corticosteroid use:

Slowly decrease the drug dose (if possible) under medical supervision. If you cannot stop taking the medication because of disease, your high blood sugar, high

cholesterol levels, and bone thinning or osteoporosis should be closely monitored.Cushing syndrome caused by a pituitary or a tumor that releases ACTH (Cushing's disease):

Surgery to remove the tumor Radiation after removal of a pituitary tumor (in some cases) You may need hydrocortisone (cortisol) replacement therapy after surgery, and possibly

continued throughout your lifeCushing syndrome due to an adrenal tumor or other tumors:

Surgery to remove the tumor If the tumor cannot be removed, medications to help block the release of cortisol

Outlook (Prognosis)Removing the tumor may lead to full recovery, but there is a chance that the condition will return.Survival for people with ectopic tumors depends on the tumor type. Untreated, Cushing syndrome can be life-threatening.Possible Complications

Diabetes Enlargement of pituitary tumor Fractures  due to osteoporosis High blood pressure Kidney stones Serious infections

When to Contact a Medical ProfessionalCall your health care provider if you have symptoms of Cushing syndrome.Alternative NamesHypercortisolism

Addison diseaseAddison disease is a disorder that occurs when the adrenal glands do not produce enough hormones.CausesThe adrenal glands are small hormone-releasing organs located on top of each kidney. They are made up of an outer portion, called the cortex, and an inner portion, called the medulla.The cortex produces three hormones:

Glucocorticoid hormones (such as cortisol) maintain sugar (glucose) control, decrease (suppress)immune response, and help the body respond to stress.

Mineralocorticoid hormones (such as aldosterone) regulate sodium and potassium balance. Sex hormones, androgens (male) and estrogens (female), affect sexual development and sex drive.

Addison disease results from damage to the adrenal cortex. The damage causes the cortex to produce hormone levels that are too low.This damage may be caused by the following:

The immune system mistakenly attacking the adrenal glands (autoimmune disease) Infections such as tuberculosis, HIV, or fungal infections Hemorrhage into the adrenal glands

TumorsRisk factors for the autoimmune type of Addison disease include other autoimmune diseases:

Chronic thyroiditis Dermatis herpetiformis Graves' disease Hypoparathyroidism Hypopituitarism Myasthenia gravis Pernicious anemia Testicular dysfunction Type I diabetes Vitiligo

Certain rare genetic defects may also cause adrenal insufficiency.SymptomsSymptoms of Addison disease include:

Chronic diarrhea, nausea, and vomiting Darkening of the skin in some places, causing the skin to look patchy Dehydration Dizziness when standing up Paleness Extreme weakness, fatigue, and slow, sluggish movement Mouth lesions  on the inside of a cheek (buccal mucosa) Salt craving Weight loss with reduced appetite

Exams and TestsLaboratory tests may show:

Increased potassium Low blood pressure, especially with a change in body position Low cortisol level Low serum sodium Low blood pH Normal sex hormone levels

Additional laboratory tests may be ordered.Other tests may include:

Abdominal x-ray Abdominal CT scan

TreatmentTreatment with replacement corticosteroids will control the symptoms of this disease. These medicines usually need to be taken for life.Never skip doses of your medication for this condition because life-threatening reactions may occur.Your doctor may increase your dosage because of:

Infection Injury Stress Surgery

During an extreme form of adrenal insufficiency, called adrenal crisis, you must inject hydrocortisone right away. Treatment for low blood pressure is usually needed as well.Some people with Addison disease are taught to give themselves an emergency injection of hydrocortisone during stressful situations. Always carry medical ID (card, bracelet, or necklace) that says you have adrenal insufficiency. The ID should also say the type of medicine and dosage you need in case of an emergency.Outlook (Prognosis)

With hormone therapy, most people with Addison disease are able to lead a normal life.Possible ComplicationsComplications can occur if you take too little or too much adrenal hormone.Complications also may result from the following related illnesses:

Diabetes Hashimoto thyroiditis  (chronic thyroiditis) Hypoparathyroidism Ovarian hypofunction  or testicular failure Pernicious anemia Thyrotoxicosis

When to Contact a Medical ProfessionalCall your health care provider if:

You are unable to keep your medicine down due to vomiting. You have stress such as infection, injury, trauma, or dehydration. You may need to have your

medication adjusted. Your weight increases over time. Your ankles begin to swell. You develop new symptoms. On treatment, you develop signs of Cushing syndrome

If you have symptoms of adrenal crisis, give yourself an emergency injection of your prescribed medication. If it is not available, go to the nearest emergency room or call 911.Symptoms of adrenal crisis include:

Abdominal pain Difficulty breathing Dizziness or light-headedness Low blood pressure Reduced consciousness

Alternative NamesAdrenocortical hypofunction; Chronic adrenocortical insufficiency; Primary adrenal insufficiency

Diabetes mellitusShare on facebook Share on twitter Bookmark & Share Printer-friendly version Diabetes is usually a lifelong (chronic) disease in which there is a high level of sugar in the blood.CausesInsulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested:

A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body. An organ called the pancreas makes insulin. The role of insulin is to move glucose from the

bloodstream into muscle, fat, and liver cells, where it can be used as fuel.People with diabetes have high blood sugar because their body cannot move sugar into fat, liver, and muscle cells to be stored for energy. This is because either:

Their pancreas does not make enough insulin Their cells do not respond to insulin normally Both of the above

There are two major types of diabetes. The causes and risk factors are different for each type: Type 1 diabetes  can occur at any age, but it is most often diagnosed in children, teens, or young

adults. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown.

Type 2 diabetes  makes up most diabetes cases. It most often occurs in adulthood. But because of high obesity rates, teens and young adults are now being diagnosed with it. Many people with type 2 diabetes do not know they have it.

There are other causes of diabetes, and some patients cannot be classified as type 1 or type 2.Gestational diabetes is high blood sugar that develops at any time during pregnancy in a woman who does not have diabetes.Diabetes affects more than 20 million Americans. Over 40 million Americans have pre-diabetes (which often develops before type 2 diabetes). If your parent, brother or sister has diabetes, you may be more likely to develop diabetes.SymptomsHigh blood sugar level can cause several symptoms, including:

Blurry vision Excess thirst Fatigue Hunger Urinating often Weight loss

Because type 2 diabetes develops slowly, some people with high blood sugar have no symptoms.Symptoms of type 1 diabetes develop over a short period. People may be very sick by the time they are diagnosed.After many years, diabetes can lead to other serious problems. These problems are known as diabetes complications and include:

Eye problems , including trouble seeing (especially at night), light sensitivity, blindness in the future

Painful sores and infections of the leg or foot, which if left untreated, leads to removal of the foot or leg 

Nerves in the body can become damaged , causing pain, tingling, and a loss of feeling, problems digesting food, erectile dysfunction

Kidney problems , which can lead to kidney failure Weakened immune system, which can lead to more frequent infections Increased chance of having a heart attack or stroke

Exams and TestsA urine analysis may show high blood sugar. But a urine test alone does not diagnose diabetes.Your health care provider may suspect that you have diabetes if your blood sugar level is higher than 200 mg/dL. To confirm the diagnosis, one or more of the following tests must be done.Blood tests:

Fasting blood glucose level  -- diabetes is diagnosed if it is higher than 126 mg/dL twice. Levels between 100 and 126 mg/dL are called impaired fasting glucose or pre-diabetes. These levels are risk factors for type 2 diabetes.

Hemoglobin A1c  test --o Normal: Less than 5.7%o Pre-diabetes: 5.7% - 6.4%o Diabetes: 6.5% or higher

Oral glucose tolerance test  -- diabetes is diagnosed if glucose level is higher than 200 mg/dL 2 hours after drinking a glucose drink. (This test is used more often for type 2 diabetes.)

Screening for type 2 diabetes in people who have no symptoms is recommended for: Overweight children who have other risk factors for diabetes, starting at age 10 and repeated

every 2 years Overweight adults (BMI greater than 25) who have other risk factors Adults over age 45, repeated every 3 years

Treatment

With type 2 diabetes, the disease may be reversed with lifestyle changes, especially losing weight through exercising and eating healthier foods.  Also, some cases of type 2 diabetes can be improved with weight-loss surgery.There is no cure for type 1 diabetes.Treating both type 1 diabetes and type 2 diabetes involves medicines, diet, and exercise to control blood sugar level.Getting better control over your blood sugar, cholesterol, and blood pressure levels helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.To prevent diabetes complications, visit your health care provider at least two to four times a year. Talk about any problems you are having. Follow your health care provider's instructions on managing your diabetes.Support GroupsAmerican Diabetes Association | www.diabetes.orgPreventionKeeping an ideal body weight and an active lifestyle may prevent type 2 diabetes.Type 1 diabetes cannot be prevented.

Diabetes insipidusShare on facebook Share on twitter Bookmark & Share Printer-friendly version Diabetes insipidus is an uncommon condition in which the kidneys are unable to prevent the excretion of water.CausesDuring the day, your kidneys filter all your blood many times. Normally, most of the water is reabsorbed, and only a small amount of concentrated urine is excreted. DI occurs when the kidneys cannot concentrate the urine normally, and a large amount of dilute urine is excreted.The amount of water excreted in the urine is controlled by antidiuretic hormone (ADH). ADH is also called vasopressin. ADH is produced in a part of the brain called the hypothalamus. It is then stored and released from the pituitary gland. This is a small gland at the base of the brain.DI caused by a lack of ADH is called central diabetes insipidus. When DI is caused by a failure of the kidneys to respond to ADH, the condition is called nephrogenic diabetes insipidus.Central diabetes insipidus can be caused by damage to the hypothalamus or pituitary gland as a result of:

Genetic problems Head injury Infection Loss of blood supply to the gland Surgery Tumor

Nephrogenic DI involves a defect in the kidneys. As a result, the kidneys do not respond to ADH. Like central DI, nephrogenic DI is very rare. Nephrogenic DI may be caused by:

Certain drugs (such as lithium) Genetic problems High level of calcium in the body (hypercalcemia) Kidney disease (such as polycystic kidney disease)

SymptomsSymptoms of DI include:

Excessive thirst  that may be intense or uncontrollable, usually with the need to drink large amounts of water or craving for ice water

Excessive urine volume Excessive urination, often needing to urinate every hour throughout the day and night

Exams and TestsThe health care provider will ask about your medical history and symptoms.Tests that may be ordered include:

Blood sodium  and osmolarity Desmopressin (DDAVP) challenge MRI of the head Urinalysis Urine concentration Urine output

TreatmentThe cause of the underlying condition will be treated when possible.Central diabetes insipidus may be controlled with vasopressin (desmopressin, DDAVP). You take vasopressin as either an injection, a nasal spray, or tablets.If nephrogenic DI is caused by medication, stopping the medication may help restore normal kidney function. But with some medications, such as lithium, after many years of use, nephrogenic DI can be permanent.Hereditary nephrogenic DI and lithium-induced nephrogenic DI are treated by drinking enough fluids to match urine output. Medicines that lower urine output also need to be taken.Nephrogenic DI is treated with anti-inflammatory medicines and diuretics (water pills).Outlook (Prognosis)Outcome depends on the underlying disorder. If treated, diabetes insipidus does not cause severe problems or result in early death.Possible ComplicationsIf your body's thirst control is normal and you drink enough fluids, there are no significant effects on body fluid or salt balance.Not drinking enough fluids can lead to dehydration and electrolyte imbalance.If DI is treated with vasopressin and your body's thirst control is not normal, drinking more fluids than your body needs can cause dangerous electrolyte imbalance.When to Contact a Medical ProfessionalCall your health care provider if you develop symptoms of diabetes insipidus.If you have diabetes insipidus, contact your health care provider if frequent urination or extreme thirst return.

AcromegalyShare on facebook Share on twitter Bookmark & Share Printer-friendly version Acromegaly is a condition in which there is too much growth hormone in the body.CausesAcromegaly is a rare condition. It is caused when the pituitary gland makes too much growth hormone. The pituitary gland is a pea-sized endocrine gland located at the base of the brain. It controls, makes, and releases several hormones, including growth hormone.Usually a noncancerous (benign) tumor of the pituitary gland causes the gland to release too much growth hormone.In children, too much growth hormone causes gigantism rather than acromegaly.SymptomsSymptoms of acromegaly may include any of the following:

Body odor Carpal tunnel syndrome Decreased muscle strength (weakness) Decreased peripheral vision Easy fatigue Excessive height (when excess growth hormone production begins in childhood) Excessive sweating Headache Hoarseness Joint pain , limited joint movement, swelling of the bony areas around a joint

Large bones of the face Large feet (change in shoe size), large hands (change in ring or glove size) Large glands in the skin (sebaceous glands) Large jaw (prognathism) and tongue (macroglossia) Sleep apnea Thickening of the skin, skin tags Widely spaced teeth Widened fingers or toes, with swelling, redness, and pain

Other symptoms that may occur with this disease: Colon polyps Excess hair growth in females (hirsutism) Type 2 diabetes Weight gain (unintentional)

Exams and TestsThe health care provider will perform a physical exam and ask about your symptoms.The following tests may be ordered to confirm diagnosis of acromegaly:

Blood glucose Growth hormone   High insulin-like growth factor 1 (IGF-1) level Spine x-ray MRI of the brain , including the pituitary gland Echocardiogram Prolactin  

TreatmentSurgery to remove the pituitary tumor that is causing this condition often corrects the abnormal growth hormone. Sometimes the tumor is too large to remove completely. People who do not respond to surgery may haveradiation of the pituitary gland.Medications are used after surgery. Some patients are treated with medicines instead of surgery.After treatment, you will need to see your health care provider regularly to make sure that the pituitary gland is working normally. Yearly evaluations are recommended.Outlook (Prognosis)Pituitary surgery is successful in most patients, depending on the size of the tumor and the experience of the surgeon.Without treatment, the symptoms will get worse. Conditions such as high blood pressure, diabetes, and heart disease may result.When to Contact a Medical ProfessionalCall your health care provider if:

You have symptoms of acromegaly Your symptoms do not improve with treatment

PreventionAcromegaly cannot be prevented. Early treatment may prevent complications of the disease from getting worse.Alternative NamesSomatotroph adenoma; Growth hormone excess; Pituitary giant (in childhood)