Endocrinology

Your endocrine system is a complex group of glands located throughout your body that produce different hormones. For example, there’s the pituitary gland in your brain, the thyroid gland at the base of your neck, the pancreas in your abdomen and your ovaries. The hormones that these and other glands secrete regulate a variety of bodily functions such as your metabolism and your reproductive system. Certain endocrine disorders, such as thyroid problems, are much more common in women, while other conditions are related to the female hormone estrogen and happen exclusively in women.

Menopause and Perimenopause

Menopause is a normal and natural life event that signals the end of a woman’s childbearing years. Doctors consider a woman to be in menopause when she hasn’t had a menstrual period for 12 consecutive months. The age at which women reach menopause can vary from anywhere between the early forties and late fifties, but the average age in the U.S. is around 51. In many cases, a woman will reach menopause at around the same age that her mother and sisters did. Studies show that smokers often reach menopause an average of two years earlier than nonsmokers. In rare cases, a woman’s ovaries may stop producing estrogen at a younger age, a condition known as premature ovarian failure.

The four to eight year transition phase leading up to a woman’s final menstrual period is known as perimenopause. Some women don’t have any symptoms during perimenopause, but in many cases, the first sign is a change in your menstrual periods. When you’re in perimenopause, your periods may be shorter and heavier, and the time between your periods may lengthen. Keep in mind that even though your periods are becoming more irregular, there is still a chance you can become pregnant, which is why birth control is still important in the perimenopausal years. Common symptoms that can occur during perimenopause and menopause include hot flashes, night sweats, vaginal dryness (which can make sex painful), sleep disturbances and mood swings. All of these symptoms are primarily due to fluctuating levels of the hormone estrogen. During the year after your last period, these symptoms will typically become more severe and can often continue for two or three years afterwards.

Treatment Options

Certain birth control options have the added benefit of regulating your menstrual periods and can make your flow lighter during perimenopause. Once you reach menopause, there are a variety of treatments that can help, depending on your symptoms.

  • Hormone therapy (HRT-estrogen plus progesterone or estrogen alone for women without a uterus) can help alleviate hot flashes, night sweats and other symptoms, but it may not be recommended for women with a history of breast cancer or for those with heart disease.
  • Lifestyle changes such as wearing lighter nightclothes or pajamas made out of material that wicks the sweat away from your body can help make night sweats and hot flashes more tolerable.
  • Over-the-counter vaginal lubricants and moisturizers and prescription estrogen creams can help relieve discomfort and painful sex due to dryness. An oral prescription medication that works like estrogen to counteract the dryness and thinning of your vaginal tissues has also recently become available.
  • Low-dose antidepressants can help combat mood changes and sleep disturbances.
  • Relaxation and stress-reducing techniques, such as meditation, yoga and deep breathing, can also help with menopause-related mood changes.

Thyroid Disorders

Your thyroid, a small, butterfly-shaped gland that sits near the base of your neck, is crucial to the functioning of many organs, including your brain, heart, liver, kidneys and skin. Thyroid disorders are five to ten times more common in women than in men. While there are several different thyroid disorders, the two most common conditions, especially in women, are an underactive thyroid (hypothyroidism) and an overactive thyroid (hyperthyroidism). An estimated 15 million people in the U.S. have an undiagnosed thyroid problem. When thyroid disease goes untreated, you’re at an increased risk of developing high cholesterol, heart disease, osteoporosis and infertility.

Hypothyroidism

The most common type of thyroid disorder is an underactive thyroid, also known as hypothyroidism. When your thyroid isn’t producing the amount of hormone it needs to function properly, many of your bodily functions can slow down. You may feel tired and cold all of the time or gain weight even though your eating habits haven’t changed. Hypothyroidism can also cause depression. One of the most common causes of hypothyroidism is an autoimmune disease known as Hashimoto’s thyroiditis, which is when your immune system mistakenly attacks and destroys your own thyroid gland. There is also a genetic component to hypothyroidism, and having a first degree relative with the disorder increases your risk. Certain medications, including lithium and amiodarone—a medication used to treat cardiac arrhythmias—can cause hypothyroidism.
Iodine is necessary for your thyroid gland to produce thyroid hormone, and in the past, many people developed hypothyroidism because they weren’t getting enough iodine in their diets. Today, many foods are fortified with iodine, so this deficiency rarely occurs anymore. Some women develop an underactive thyroid after giving birth, and while in many cases their thyroid functioning eventually returns to normal, it can also become permanent.

Signs and Symptoms

The most common symptoms of an underactive thyroid include extreme fatigue, drowsiness, memory problems, dry and brittle hair and nails, dry, itchy skin, unexplained weight gain and heavy menstrual periods. Doctors make the diagnosis by ordering a blood test to measure levels of thyroid stimulating hormone, or TSH.

Treatment Options

The standard therapy for an underactive thyroid is a single daily dose of a synthetic thyroid hormone known as levothyroxine. It can often take several months of adjusting the dose to hit on the right amount of thyroid hormone, which is enough to alleviate symptoms but not so much that you develop signs of an overactive thyroid.

Hyperthyroidism

When your thyroid gland produces more hormone than necessary, the result is an overactive thyroid, otherwise known as hyperthyroidism. In this case, it’s as if many of your body systems are working on overdrive. You may have a racing pulse, feel overheated and irritable, have trouble sleeping, and lose weight even though you’re hungrier than ever and eating all the time. The most common cause of an overactive thyroid is an autoimmune disorder known as Graves’ Disease, which results in an enlarged thyroid gland. Like all types of thyroid problems, it is much more common in women than in men, and tends to occur at younger ages. Graves’ Disease patients often develop bulging eyes and double vision, too.

Signs and Symptoms

Some of the most common symptoms of an overactive thyroid include anxiety, irritability, difficulty sleeping, fatigue, a rapid heartbeat, trembling hands, hair loss, muscle weakness, unexplained weight loss, increased hunger and diarrhea. As with an underactive thyroid, doctors make the diagnosis primarily with a blood test to check thyroid stimulating hormone (TSH) levels.

Treatment Options

If your thyroid is overactive, there are two main treatment options available to you. One option is to take a medication that slows down your thyroid’s production of thyroid hormone. The other option is to have a treatment with radioactive iodine, which will destroy your thyroid. This makes your thyroid become underactive, which means that you may need to take thyroid hormone daily.

Diabetes

Diabetes is a disease involving the way your body processes glucose, which is commonly known as blood sugar. Glucose is your main source of fuel, and provides energy for all the cells in your body. In order for the cells to process glucose they need insulin, which is a hormone that’s produced by your pancreas. If you have diabetes, either your body is making little or no insulin (as with type 1 diabetes) or it makes insulin but your cells aren’t able to use it (as with type 2 diabetes). In both conditions, glucose builds up in your bloodstream, and over time it can damage your heart, nerves, eyes and kidneys. Among adults, diabetes in the leading cause of blindness, limb amputation and kidney failure in the U.S. There are an estimated 24 million Americans living with diabetes today. Roughly 90 percent of them have the type 2 form, which is the type that’s related to obesity, and that number has risen sharply in the last decade.

Type 1 Diabetes

Type 1 diabetes is also known as juvenile diabetes because the disease most often develops in childhood. An autoimmune disease, it occurs when your body’s immune system attacks the cells in your pancreas that produce insulin. Roughly five to ten percent of people with diabetes have type 1, and it occurs equally in men and women. Having a parent of sibling with type 1 diabetes slightly increases your risk for the disease, and researchers also believe that exposure to certain viruses (such as the Epstein-Barr virus) may trigger the autoimmune response that destroys your pancreatic cells. Type 1 diabetes is more common among Caucasians than among African-Americans, Hispanics or Asians.

Signs and Symptoms

The symptoms of type 1 diabetes can come on very quickly and include excessive thirst and hunger, frequent urination, increased fatigue, blurred vision, unexplained weight loss and loss of feeling or tingling in the feet. If your blood glucose levels are extremely high, you may also have abdominal pain, nausea and vomiting and your breath may smell fruity. If your doctor suspects diabetes, he or she will order a blood glucose test. If the results are abnormal, you’ll need to have a second blood test to confirm the diagnosis, in which you have to fast for at least 8 hours before having your blood drawn.

Treatment Options

If you have type 1 diabetes, you will need to take insulin every day, usually in the form of injections. A newer option is a wearable insulin pump which monitors your blood sugar levels over the course of the day and gives you small amounts of insulin when you need it. Keeping your blood glucose levels well controlled by closely monitoring your carbohydrate intake and checking your glucose levels frequently is also necessary to avoid developing complications from type 1 diabetes.

Type 2 Diabetes

Type 2 diabetes occurs when the cells in your body become resistant to insulin. It’s often called adult-onset diabetes, but that has become a misnomer now that rising numbers of children and teens are being diagnosed with the disease. Having a family member with type 2 diabetes increases your risk, and doctors believe that there is a genetic predisposition towards developing the disease. Being overweight and getting little or no daily exercise are also significant risk factors for developing type 2 diabetes. People who carry excess weight around their waist (apple-shaped) rather than their hips and thighs (pear-shaped) are also at an increased risk. African-Americans, Hispanics, Asians, Native Americans and Pacific Islanders are all more prone to developing type 2. Another risk factor for women is developing gestational diabetes, or diabetes during pregnancy. Roughly half of all women who are diagnosed with gestational diabetes will continue to have it post-pregnancy or develop type 2 diabetes later in life.

Signs and Symptoms

The warning signs of type 2 diabetes are similar to those of type 1 diabetes— excessive thirst and hunger, frequent urination, increased fatigue, blurred vision, unexplained weight loss and loss of feeling or tingling in the feet. However, the symptoms can develop more slowly and some people may have no symptoms at all for several years. In fact, many patients find out they have type 2 diabetes after a routine blood glucose test. But if your doctor suspects type 2 diabetes, you’ll be given a fasting blood glucose test. Another diabetes screening is called an oral glucose tolerance test, which is generally given during pregnancy to check for gestational diabetes.

Steps to lower your risk

Unlike type 1 diabetes, type 2 diabetes is often preventable, even if you have a family history or other non-controllable risk factors. Taking steps to prevent diabetes is especially important if you’ve been diagnosed with pre-diabetes, which means your blood glucose levels are elevated but not high enough to meet the criteria for diabetes. An estimated 79 million Americans over the age of 20 have pre-diabetes. These healthy lifestyle habits are key:

  • Lose excess weight. A large national study known as the Diabetes Prevention Program showed that losing a relatively modest amount of weight — roughly 5 to 7 percent of your overall body weight (for example, 10 to 14 pounds if you weight 200 pounds) — can significantly reduce your risk of developing diabetes. Losing excess weight helps because it allows your body to process insulin more effectively.
  • Exercise regularly. The Diabetes Prevention Program revealed that doing some sort of physical activity for 30 minutes at least five days a week was a key factor in whether participants were able to lose excess weight.
  • Eat healthy. Aim to lower your total calories, eating less fat (especially saturated and trans fats), and eat a wide variety of fruits, vegetables, whole grains and lean sources of protein.

Treatment Options

The same lifestyle habits that can help prevent diabetes—losing excess weight, staying physically active and following a healthy diet—are critical for anyone who is diagnosed with type 2 diabetes. In fact, some patients are able to avoid taking medication altogether by following these steps. If medication is required, there are several drugs available, and they each work differently. For example, some drugs increase insulin production, others make the body more sensitive to insulin, and others decrease blood sugar production. As with type 1 diabetes, frequent monitoring of blood sugar levels can help patients better control their disease and prevent long-term complications such as heart attacks and strokes, nerve damage and blindness.

How North Shore-LIJ Can Help You

The combined Division of Endocrinology, Diabetes and Metabolism is staffed by recognized leaders in clinical endocrinology who have expertise treating a wide variety of endocrine issues, including menopause and polycystic ovarian syndrome, hypo/hyperthyroidism and thyroid cancers; pituitary disorders and adrenal disorders. Through the inpatient and outpatient care facilities, the Division provides state-of-the-art screenings and treatments including ultrasound-guided fine needle aspiration of the thyroid and thyroid ultrasonography. We also have an American Association of Diabetes Educators-accredited diabetes education program, provide insulin pump training and offer nutritional counseling. Our partnerships give us the ability to leverage skill, experience and cutting edge equipment, allowing us to best meet the needs of every individual patient.

Meet the North Shore-LIJ specialists who treat endocrine disorders.