By skyforbes 
Updated June 9, 2025
Introduction – Thyroid Specialist in Rockville, Montgomery County, Maryland
As a thyroid specialist, practicing in Rockville, Montgomery County, Maryland, my main objective in the community is to diagnose, treat, and manage thyroid-related illnesses. I take a holistic approach, carefully analyzing patients’ medical history, symptoms, and laboratory results to gain a comprehensive understanding of their condition.
Prevalence & Symptoms of Thyroid Disorders
Prevalence: Thyroid disorders affect a large number of people worldwide, with approximately 200 million individuals experiencing some form of thyroid illness. Women are particularly susceptible, being up to ten times more likely than men to suffer from thyroid dysfunction, including hypothyroidism, hyperthyroidism, and autoimmune thyroid diseases like Hashimoto’s thyroiditis and Graves’ disease.
Symptoms: Thyroid illnesses can have profound effects on overall well-being, leading to symptoms such as fatigue, weight changes, mood swings, hair loss, and sleep disturbances, causing physical and emotional distress. If left untreated, thyroid conditions may result in serious complications like cardiovascular issues, fertility problems, and mental health disorders.
Thyroid Conditions
Below is a list of thyroid conditions that may be encountered in my practice. It’s crucial to note that the diagnosis and management of these thyroid anomalies require individualized treatment plans tailored to the patient’s specific medical history, symptoms, and test results.
- Hypothyroidism
- Hyperthyroidism
- Hashimoto’s Thyroiditis
- Graves’ Disease
- Subacute Thyroiditis
- Postpartum Thyroiditis
- Toxic Adenoma
- Thyroid Nodules
- Thyroid Cancer
- Thyroid Eye Disease (Graves’ ophthalmopathy)
- Myxedema Coma
- Thyroid Storm
- Euthyroid Sick Syndrome
- Central Hypothyroidism
- Thyroid Hormone Resistance
- Familial Dysalbuminemic Hyperthyroxinemia (FDH)
- TSHoma or Thyrotropinoma
1. Hypothyroidism
Hypothyroidism happens when the thyroid gland doesn’t produce enough hormone. This slows metabolism and affects nearly every system in the body. The most common cause is Hashimoto’s thyroiditis, an autoimmune condition. Other causes include iodine deficiency, medications, radiation, or prior thyroid surgery.
Symptoms often appear slowly. Fatigue, weight gain, cold sensitivity, dry skin, and constipation are common. Some patients also notice memory issues, hair thinning, or a slower heart rate. If left untreated, hypothyroidism can lead to goiter, heart disease, or—in rare cases—myxedema coma.
Blood tests measuring TSH and T4 confirm the diagnosis. Most people respond well to daily levothyroxine. In select cases, Armour Thyroid or liothyronine may help. Treatment requires regular follow-up to adjust the dose and relieve symptoms while keeping hormone levels in the optimal range.
2. Hyperthyroidism
Hyperthyroidism occurs when the thyroid gland produces too much hormone. This speeds up metabolism and overstimulates many body systems. Graves’ disease is the most common cause, followed by toxic adenoma, thyroiditis, and high iodine intake.
Symptoms reflect a revved-up system. Patients may feel anxious, lose weight, sweat excessively, or notice a rapid heartbeat. Some develop a goiter. Graves’ disease can also cause bulging eyes, known as Graves’ ophthalmopathy. These signs often prompt further evaluation.
Diagnosis involves checking TSH, T3, and T4 levels. Imaging studies, such as thyroid ultrasound or iodine scans, help identify the cause. Treatment includes antithyroid drugs, radioactive iodine, or thyroid surgery. Each approach aims to restore hormone balance and ease symptoms.
3. Hashimoto’s Thyroiditis
Hashimoto’s thyroiditis is an autoimmune disease where the immune system attacks the thyroid gland. This ongoing attack causes inflammation and gradually weakens the gland’s ability to make hormones. Over time, thyroid hormone production declines, leading to hypothyroidism.
At first, the gland may swell, forming a goiter. Some patients briefly experience hyperthyroidism as stored hormones leak out. Eventually, the gland slows down, triggering symptoms like fatigue, weight gain, cold sensitivity, and dry skin. The condition progresses slowly and may go unnoticed for years.
Diagnosis relies on blood tests that check TSH, T4, and thyroid antibodies like TPO or Tg. Treatment focuses on restoring hormone levels with levothyroxine. Most patients need lifelong monitoring and dosage adjustments. Anti-inflammatory medications may help if inflammation causes discomfort or visible swelling.
4. Graves’ Disease
Graves’ disease is an autoimmune condition that overstimulates the thyroid gland. The immune system produces antibodies—TSI or TRA—that mimic TSH. These antibodies trigger excessive thyroid hormone release, leading to hyperthyroidism and a sped-up metabolism.
Common symptoms include weight loss, rapid heartbeat, heat intolerance, anxiety, and hand tremors. Many patients develop a visible goiter. Some also experience Graves’ ophthalmopathy, which affects the eyes. Bulging, dryness, double vision, and irritation often signal eye involvement, which may persist even after thyroid levels normalize.
Diagnosis includes blood tests for TSH, T3, T4, and thyroid antibodies. Imaging may assess gland activity or check for eye complications. Treatment options include antithyroid drugs, radioactive iodine, or thyroid surgery. The choice depends on age, symptom severity, and long-term goals. Most patients do well with proper, tailored care.
5. Subacute Thyroiditis
Subacute thyroiditis is an inflammatory condition that often follows a viral illness. The thyroid gland becomes swollen and irritated. As inflammation damages the gland, thyroid hormones leak into the bloodstream, causing a brief phase of hyperthyroidism.
Patients often report neck pain, tenderness, fatigue, and fever. They may also feel anxious, sweaty, or notice a fast heartbeat. As hormone stores deplete, a hypothyroid phase may follow, marked by fatigue, weight gain, and cold intolerance. The progression varies, but most cases resolve fully.
Diagnosis relies on symptoms and thyroid function tests. Ultrasound may confirm inflammation. Treatment targets symptoms. Anti-inflammatory medications ease pain during the hyperthyroid stage. If hypothyroidism develops, levothyroxine may be used. Most patients regain normal thyroid function within months.
6. Postpartum Thyroiditis
Postpartum thyroiditis is an autoimmune condition that affects some women after delivery. Immune changes during and after pregnancy trigger inflammation in the thyroid. The condition often begins with a hyperthyroid phase, then shifts to hypothyroidism before resolving.
Symptoms depend on the phase. In the hyperthyroid stage, women may feel anxious, lose weight, or experience palpitations and fatigue. The later hypothyroid phase causes low energy, weight gain, and mood changes. Some women pass through both phases, while others notice only one.
Diagnosis involves blood tests that measure TSH, T3, and T4 levels. Treatment varies by phase. Beta-blockers help control symptoms during the hyperthyroid stage. Levothyroxine may be needed if hypothyroidism develops. Most women recover fully, but close follow-up ensures stable thyroid function.
7. Toxic Adenoma
A toxic adenoma is a benign thyroid nodule that produces excess hormones without input from the brain. Unlike Graves’ disease, it involves only one overactive area. The rest of the thyroid gland usually functions normally and remains suppressed.
This excess hormone causes hyperthyroid symptoms. Patients may feel anxious, lose weight, sweat excessively, or notice a fast heartbeat. These symptoms mirror other thyroid disorders but stem from a single, hormone-producing nodule. Blood tests and imaging—especially radioactive iodine scans—confirm the diagnosis.
Treatment depends on severity and patient preference. Options include antithyroid medications, radioactive iodine to shrink the nodule, or surgery to remove it. Each approach aims to reduce hormone levels and restore balance.
8. Thyroid Nodules
Thyroid nodules are abnormal lumps that form within the thyroid gland. Most are discovered during routine exams or imaging. These nodules are usually benign and cause no symptoms. However, larger nodules can press on nearby structures, leading to visible swelling or difficulty swallowing.
Nodules vary in number, size, and texture. Some are solid, others fluid-filled. They may appear as a single growth or in clusters. While most nodules are harmless, a small percentage may be cancerous. Evaluation begins with a physical exam, thyroid function tests, and an ultrasound to assess structure and risk.
Management depends on size, symptoms, and suspicion of cancer. Benign, small nodules may only need observation. Suspicious or growing nodules may require fine-needle aspiration, surgery, or radioactive iodine. Regular monitoring ensures prompt action if changes occur.
9. Thyroid Cancer
Thyroid cancer is uncommon but rising in frequency. It often has an excellent prognosis, especially when detected early. Most cases involve papillary thyroid cancer, followed by follicular, medullary, and the rare but aggressive anaplastic type. Each behaves differently and requires tailored treatment.
Early symptoms are often absent. As the tumor grows, patients may notice a neck lump, hoarseness, trouble swallowing, or swollen lymph nodes. Many cases are discovered during imaging for unrelated issues or after evaluation of a thyroid nodule. Subtle signs should never be ignored, even in healthy individuals.
Diagnosis relies on ultrasound and fine-needle aspiration biopsy. Additional tests may include blood work and cross-sectional imaging. Treatment depends on cancer type and stage. Most patients undergo thyroidectomy, sometimes followed by radioactive iodine. Advanced cases may need targeted drugs or radiation. Ongoing follow-up helps ensure long-term remission.
10. Thyroid Eye Disease (Graves’ ophthalmopathy)
Thyroid eye disease (TED), or Graves’ ophthalmopathy, is an autoimmune condition linked to hyperthyroidism. It causes inflammation in the tissues around the eyes. This immune-driven swelling often appears in people with Graves’ disease, though it may also occur independently of active thyroid hormone levels.
Symptoms vary in severity. Some patients experience dryness, irritation, or light sensitivity. Others may develop bulging eyes, double vision, or eye pain. In severe cases, swollen tissues compress the optic nerve, risking vision loss. The disease can progress rapidly or remain stable for months before changing.
Diagnosis includes a detailed eye exam and imaging like orbital MRI or CT. Treatment depends on severity. Mild cases respond to lubricants and thyroid control. Moderate or severe cases may need steroids, radiation, or surgery to reduce swelling or protect vision. Collaborative care between ophthalmologists and thyroid specialists ensures the best outcomes.
11. Thyroid Myxedema Coma
Myxedema coma is the most extreme form of hypothyroidism. It often strikes older adults with long-untreated thyroid disease. Triggers include severe infections, cold exposure, or other serious illnesses. The body’s thyroid hormone levels drop sharply, leading to system-wide failure.
Symptoms develop gradually, then worsen. Patients may become lethargic, confused, or unresponsive. Core body temperature falls. Breathing slows. Heart rate and blood pressure drop. Without treatment, the condition can lead to coma or death. The body enters a near-shutdown state due to lack of thyroid hormone.
Treatment must begin in the ICU. Physicians give thyroid hormone intravenously, along with warming, fluids, and respiratory support. Corticosteroids are often used to prevent adrenal insufficiency. Early recognition and swift action are vital for survival.
12. Thyroid Storm
Thyroid storm, or thyrotoxic crisis, is a rare but life-threatening complication of uncontrolled hyperthyroidism. It often occurs during severe illness, surgery, or trauma in patients with untreated or poorly managed thyroid disease. The body becomes overwhelmed by a sudden surge of thyroid hormones.
Symptoms appear rapidly and escalate. Patients may experience high fever, rapid heart rate, severe anxiety, confusion, or even coma. Without prompt care, complications like heart failure, shock, or multi-organ failure can occur. These symptoms reflect extreme overactivity of the body’s metabolism.
Thyroid storm requires immediate hospitalization. Treatment includes antithyroid drugs, beta-blockers, and supportive care to control heart rate, temperature, and fluid balance. Intensive monitoring helps prevent complications and supports recovery. Quick intervention can be life-saving.
13. Euthyroid Sick Syndrome
Euthyroid sick syndrome, or non-thyroidal illness syndrome, occurs during severe illness or systemic stress. The body reduces thyroid hormone activity as a short-term adaptive response. This protective mechanism slows metabolism and conserves energy during times of physical crisis or critical illness.
Lab tests often show low T3 or altered TSH levels. However, the thyroid gland itself remains healthy and intact. These changes result from disrupted hormone conversion or feedback, not gland failure. As the illness resolves, thyroid hormone levels usually normalize on their own.
This syndrome appears often in intensive care settings or during major infections, trauma, or fasting. Endocrinologists rarely treat it directly with thyroid hormones. Instead, the focus remains on resolving the primary illness. Once health stabilizes, thyroid function typically recovers without long-term consequences.
14. Central Hypothyroidism
Central hypothyroidism is a rare disorder. It arises from problems in the pituitary gland or hypothalamus—two brain structures that regulate thyroid function. These structures fail to send enough stimulation to the thyroid gland. As a result, the thyroid produces less hormone, even though it is structurally normal.
Unlike primary hypothyroidism, where the thyroid itself is damaged, central hypothyroidism stems from upstream dysfunction. The thyroid gland may appear small or normal. Symptoms often mirror primary hypothyroidism: fatigue, cold intolerance, weight gain, and constipation. But the root cause lies in the brain, not the gland.
Blood tests help confirm the diagnosis. They measure both thyroid hormones and pituitary hormones like TSH and ACTH. Treatment typically includes levothyroxine to replace missing hormones. Regular monitoring ensures stable thyroid levels and checks for other hormone deficiencies. Patients may need tailored care if other pituitary functions are impaired.
15. Thyroid Hormone Resistance
Thyroid hormone resistance is a rare genetic condition. The body produces enough thyroid hormones, but cells fail to respond properly. Mutations in thyroid hormone receptor genes or signaling pathways cause this impaired response. As a result, the brain increases TSH levels, trying to stimulate more hormone production—even though hormone levels are already high.
This creates a mismatch. Patients often show signs of hypothyroidism, despite normal or elevated T3 and T4 levels. Symptoms vary widely. Some people feel tired, gain weight, or struggle with focus. Others experience more severe issues, including developmental delays or abnormal growth patterns. The severity depends on which tissues resist the hormones and how strongly they resist.
Treatment remains challenging. Giving more thyroid hormone does not always help, since the receptors remain unresponsive. Endocrinologists usually focus on relieving symptoms and monitoring metabolic health. Some patients benefit from higher doses of T3. Others need supportive care based on their individual symptoms. Genetic counseling can also help affected families understand the condition and plan for the future.
16. Familial Dysalbuminemic Hyperthyroxinemia (FDH)
Familial dysalbuminemic hyperthyroxinemia (FDH) is a rare inherited condition. It causes elevated total T4 levels on lab tests without actual hyperthyroidism. The issue lies in altered albumin, a blood protein that binds thyroid hormone more tightly than usual. This skews lab results but leaves free hormone levels normal.
People with FDH typically have no symptoms. They feel well and show no signs of hyperthyroidism, such as weight loss, palpitations, or anxiety. Most cases are discovered incidentally when routine labs suggest thyroid hormone excess, prompting further evaluation.
Diagnosis requires careful interpretation. Free T4 and TSH levels remain normal, despite high total T4. Genetic testing or specialized binding assays can confirm the diagnosis. No treatment is needed, as the condition is harmless. Recognizing FDH prevents unnecessary testing, medication, or concern.
17.TSHoma or Thyrotropinoma
A TSHoma is a rare pituitary tumor that produces too much thyroid-stimulating hormone (TSH). This overproduction causes the thyroid gland to release excess thyroid hormones, leading to hyperthyroidism. Unlike more common thyroid causes, the problem begins in the pituitary, not the thyroid itself.
Symptoms include weight loss, rapid heartbeat, heat intolerance, anxiety, and tremors—classic signs of an overactive thyroid. However, standard thyroid tests often show both high TSH and high thyroid hormone levels, which is unusual and suggests a pituitary source.
A pituitary specialist confirms the diagnosis using hormone testing and MRI imaging. Treatment may involve surgery, medication, or radiation.
Summary
As a thyroid specialist based in Rockville, Montgomery County, Maryland, I am dedicated to delivering expert care for thyroid disorders. With a strong emphasis on accurate diagnosis and personalized treatment, I am committed to enhancing the well-being of my patients through comprehensive thyroid health management.
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About Dr. Gerti Tashko, MD
Dr. Gerti Tashko, MD, is a board-certified endocrinologist based in Montgomery County, Maryland. He is uniquely certified in endocrinology, lipidology, hypertension, and obesity medicine. His practice offers comprehensive, root-cause-focused metabolic and endocrine care, available both virtually and in person. He uses advanced diagnostics, personalized nutrition, and preventive medicine to optimize long-term health outcomes.
