Thyroid Disorders

The Thyroid Gland

After diabetes, thyroid disorders are the most common endocrine diseases seen in our office. They are prevalent in the population at large, although seen more often in women and in the elderly. As with most other endocrine disease, they cause a problem when there is either too little thyroid hormone (hypothyroidism), too much thyroid hormone (hyperthyroidism) or the thyroid gland is enlarged (goiter).


The most common cause of hypothyroidism is Hasimotos Thyroiditis where the body makes antibodies against its own thyroid tissue. Why this happens is unknown, but it often runs in families who may have thyroid disease or other autoimmune diseases such as rheumatoid arthritis, lupus, scleroderma, or Type 1 diabetes. In fact many of our thyroid patients are referred to us by other family members whom we treat for thyroid disease or diabetes. Other causes of hypothyroidism may be due to surgical removal of the thyroid, irradiation of the thyroid or diseases of the pituitary or hypothalamus. Symptoms of hypothyroidism include tiredness, depression, weight gain, dry skin, slow heart rate, constipation, and menstrual irregularities. The diagnosis of hypothyroidism is usually straightforward and made by many family physicians, but not infrequently more specialized testing is needed and may be performed in our clinic. The treatment of hypothyroidism is usually synthetic thyroid hormone (levothyroxine or T4) based on the American Thyroid Association, Endocrine Society, and the American Association of Clinical Endocrinology guidelines. However, we realize each patient is unique and may require other forms of thyroid hormone. We have wide experience with all brands and preparations of thyroid hormone and will work with patients to optimize their treatment outcome.


An overactive thyroid state can occur from several conditions. The most common cause is Graves Disease where antibodies cause the gland to become overactive. Thyroid nodules can also cause hyperthyroidism either from a single nodule (toxic nodule) or from multiple nodules (toxic multinodular goiter). When inflammation causes hyperthyroidism, it is called thyroiditis. This may occur from an infection (usually viral) or from medications and even sometimes after pregnancy. Hyperthyroidism can also occur when taking too much thyroid hormone and certain foods containing lots of iodine such as seaweed or kale. Symptoms of hyperthyroidism include nervousness, anxiety, increased sweating, a rapid and sometimes irregular heartbeat, excessive bowel movements, and tremors. To distinguish the various types of hyperthyroid in addition to blood tests, a thyroid scan and uptake at a local hospital is usually required. This is important, since medications used for Graves disease may not work for thyroiditis. A thyroid scan as well as some blood tests are necessary for an adequate diagnosis. Medications may be given for symptomatic relief for all types of hyperthyroidism and specific oral meds or radioactive I-131 can be used for Graves Disease or toxic nodules. Surgery is recommended occasionally. All possible treatment options and modalities will be carefully explained and thoroughly discussed with our patients so as to help the patient make the best decision for their individual situation.

Thyroid Nodules

Some patients may present with one or more thyroid nodules. The thyroid level may be normal, but sometimes thyroid hormone treatment is still indicated. Most thyroid nodules are seen on ultrasound and if large enough may require a biopsy. Occasionally these nodules turn out to be malignant and need to be removed. We see many patients with thyroid cancer and work closely with many surgeons in the area who frequently do thyroid surgery. After surgery, some patients may require a single dose of radioactive I-131. We will review with the patient all the information available regarding these recommendations and tailor our plan to the individual patient based on the current guidelines of the American Thyroid Association, American Cancer Society and other professional societies to ensure the best possible outcome. All patients with thyroid cancer are usually followed by their endocrine doctor for life to ensure they are on the correct thyroid medication and the cancer does not return.

Contact Stonesifer Endocrine Care & Clinical Research

Schedule your appointment by calling 253-927-4777. We serve all patients with thyroid disorders in Seattle, Federal Way, Tacoma and surrounding areas.