You can schedule an online consultation with Dr. Lisandra Damian, here.
A large part of the population, including those who follow prevention strategies and go to the doctor regularly, tend to ignore an important specialty: endocrinology. The reason? Symptoms are not always “obvious and loud”. To us it seems that simple fatigue has other causes or that dark circles under the eyes are just a sign of lack of sleep. Dr. Lisandra Damian, an endocrinologist who provides online consultations on the Digital Clinics platform, explained to us the importance of awareness of thyroid conditions. The most common endocrine condition in the endocrinologist’s office is autoimmune thyroiditis, with or without thyroid dysfunction.
Many health problems are actually related to the functioning of the thyroid gland and thyroid hormones. They control the entire metabolism, the heart rate, and influence the pace at which body processes occur. The endocrinologist basically aims to restore balance within the body's systems. There are a few important things that the public should know. First, many factors influence the thyroid gland, including environment, genetic factors, stress, pregnancy, but the causes of thyroid problems are still not well understood.
For this reason, routine thyroid evaluations are important, especially in women, especially after the age of 40. Women are 5 to 8 times more likely to develop thyroid problems, and statistics show that 1 in 8 women will develop a thyroid problem during their lifetime. Secondly, cardiovascular disease, osteoporosis, infertility/miscarriage are conditions that can occur if a thyroid disorder is not diagnosed and treated.
Many thyroid conditions are long-term, even lifelong, and require regular monitoring of treatment with tests and ultrasound. For example, thyroid nodules are very common in the general population: they are present in 60-70% of middle-aged women. About 5% of thyroid nodules can be malignant, but most thyroid cancers respond to treatment (mainly surgical). Therefore, regular monitoring with thyroid ultrasound/elastography is important for the early detection of suspicious nodules.
The symptoms of thyroid conditions are generally non-specific, meaning they can also occur in other conditions. These may include fatigue, physical/mental sluggishness, intolerance to heat or cold, increased nervousness, constipation/diarrhea, dry skin or excessive sweating in the absence of effort or heat, muscle weakness, drowsiness or insomnia, palpitations or very low heart rate, massive weight loss despite a normal diet.
The most important methods used in the diagnosis and monitoring of thyroid disorders are endocrinological consultation, together with thyroid function tests and thyroid ultrasound.
Ultrasound for me is essential. It is, in fact, an extension of the endocrinologist's capacity. I see and interpret the blood tests relevant to these conditions, but with ultrasound I receive additional information – I can tell the patient with great conviction that the treatment can be lifelong, for example. Also, in the case of nodules, it is very important to have an ultrasound. There are patients who have had nodules for a long time, but they did not know it. Of the thyroid nodules, only one in ten is palpable. A nodular pathology may or may not cause problems.
There are nodules that grow very slowly, but their characteristics and size are very important for establishing the suspicion of malignancy. However, there are also risks of compression: as the nodule grows, it can compress neighboring structures, such as the trachea, esophagus and the neurovascular bundle of the neck, and then it is very possible that patients develop hoarseness, swallowing, breathing and cerebral circulation disorders (dizziness, fatigue, headaches).
In autoimmune pathology, most of the time, thyroid dysfunction (hypo- or hyperthyroidism) sets in slowly, the patient can stay for a long time without discovering this condition. When it sets in slowly, the symptoms are difficult to see. In hypothyroidism, the patient is more tired, pale, the skin turns yellow, finds it harder to speak, has chronic fatigue, can gain weight without eating more (water retention). I have had patients who were hypothyroid for years - for example - which brings a decrease in the quality of life. In the case of hyperthyroidism, young people come for check-ups more quickly, because the symptoms are more "noisy", but in older people who are not diagnosed correctly, heart rhythm disorders appear, for example. If the cardiologist does not also send him to the endocrinologist and only treats the arrhythmia, the symptoms will not disappear.
The most important, but also the easiest to notice, are growth disorders. If, for example, a child has hypothyroidism, it slows down the growth in height. In addition, he is slower at school or kindergarten, is more apathetic, does not participate in activities with enthusiasm, stops learning, his grades drop and he is sleepier. I think that at every check-up with the family doctor it would be good for the child to be weighed and measured. If there are significant deviations from the standard height/weight – there are some development graphs, by age and sex – then the child can also be investigated on the endocrinological side.
There is also another factor – stress – that can slow down growth. Especially since the beginning of the COVID-19 pandemic, we have had child patients in whom an endocrine condition has begun. Most of them came to get tested because they had symptoms like "I feel a lump in my throat when I'm stressed and tired." It's good to be directed to endocrinology because many symptoms are "silent."
The pandemic also meant an increase in obesity cases - children and adolescents spent more time in front of the computer, exercised much less, consumed more fast food, the so-called "junk food", and these things negatively influenced their health. Studies show that an obese child will most often be an obese adult, with multiple health problems associated with this condition.
Yes, I think it's a very good option, as is the case with many chronic diseases. The patient no longer wastes time traveling to the clinic, saves a few important hours and can talk to the doctor from the comfort of their own home. The first consultation, however, is best done physically, in the office. I say this because I also have an ultrasound machine at hand. Thyroid ultrasound is what most often makes the difference in a diagnosis. Otherwise, endocrinology is a specialty that lends itself well to telemedicine. The patient takes the tests, the doctor can interpret them online, a treatment is established, which can then also be discussed during meetings on an online consultation platform. I have noticed, by the way, that young patients are very open to such consultations, given their ease with technology.
You can schedule an online consultation with Dr. Lisandra Damian, here.
