Specialties

AUTOIMMUNE THYROID DISEASE

The thyroid is the motor of the body, and people can develop problems when the thyroid is either making too much thyroid hormone (hyperthyroidism) or not enough (hypothyroidism).  Often, the cause of the thyroid problem is an autoimmune disease.  An autoimmune disease is when the immune system mistakenly attacks certain tissues in the body.

We believe that testing for the presence of antibodies does make a difference. In our experience, it’s important to know if the cause of thyroid dysfunction. This knowledge allows us to consider if other autoimmune considitions may be involved in your health challenges.

We are eager and hopeful of the emerging science and treatment options that directly target the thyroid antibodies responsible for disease.

Hyperthyroidism:

When the thyroid makes too much thyroid hormone, the motor is sped up. Typical symptoms of hyperthyroidism include feeling shaky, anxious, and sweaty.  People may also experience weight loss, a racing heartbeat, or frequent loose stools.  Physical signs may be bulging eyes or a thicker neck when looking in the mirror.

Graves’ disease is the most common cause of hyperthyroidism in the Unites States. In Graves’ disease, antibodies (or proteins) in the blood travel to the thyroid to tell it to work harder, even when it’s not in the body’s best interest. The body produces too much thyroid hormone that it can’t manage on its own. Left untreated, it can put stress on the heart and bones. This is often an inherited condition that can be triggered at different points in a person’s life. The most common time a woman is diagnosed with Graves’ disease is after pregnancy.

For patients with Graves’ disease, there are a variety of treatment options which should be explored.  Our team extensively evaluates where a patient is in life, and specifically for females, their reproductive plans, before deciding on the proper course of treatment.

Hypothyroidism:

Hypothyroidism occurs when the motor of the body slows down and doesn’t produce enough thyroid hormone.  Regardless if hypothyroidism is caused by an autoimmune disease or not, many of the symptoms are the same. Common symptoms include fatigue, constipation, depression, colder temperature, and hair loss.

When antibodies block thyroid hormone production it’s called Hashimoto’s thyroiditis. In Hashimoto’s thyroiditis, some patients have additional causes or sources of inflammation that need to be addressed at the same time as thyroid hormone replacement. We find that without managing these additional sources of inflammation, patients may continue to feel unwell.

Dr. Barkoff’s innate understanding of thyroid and autoimmunity translates into a comprehensive approach to balancing the thyroid gland while also caring for the whole patient.

THYROID AND PREGNANCY

It is essential to consider a woman’s reproductive plans when treating her thyroid disease.  Pregnancy demands that a woman’s thyroid make extra thyroid hormone to pass it along to the developing baby.  When a woman’s thyroid is not well-balanced, there is an increased risk of miscarriage, poor fetal development, and pre-term delivery.  Dr. Barkoff has extensive expertise in the management of thyroid function in pregnancy.

Podcast: Thyroid health before and during pregnancy

Pre-conception:

We love meeting women to discuss their thyroid disease prior to becoming pregnant!  Our goal is to set people up for a successful pregnancy.  This includes making sure that thyroid hormone levels are at goal and that patients are on the right thyroid replacement medicine to support a healthy pregnancy. She advises her patients to contact her as soon as they have a positive pregnancy test to make the necessary adjustments in the first trimester. A woman with thyroid disease undergoing IVF would also benefit from meeting with our providers, as the hormones used during IVF can have a significant impact on a woman’s thyroid balance.

Pregnancy:

During pregnancy, the demand on a woman’s thyroid begins immediately upon conception because the developing baby needs thyroid hormone from the mother right away.   During the whole first trimester, all the thyroid hormone the baby needs for development comes from the mother, because the baby’s thyroid gland doesn’t start producing thyroid hormone until 14-weeks gestation.  For a woman with thyroid disease, she often needs help to meet this increased thyroid demand.  It is essential to have an expert like Dr. Barkoff and her team monitoring the thyroid levels starting early in the first trimester. If the mom’s thyroid is not balanced during a pregnancy, problems may arise. We order thyroid labs at frequent intervals in between visits to monitor levels closely.  She stays up to date with the latest research and employs different blood tests to monitor a pregnant woman’s thyroid balance.  She also makes sure that the patient is on the right prenatal vitamin to support thyroid health and explains how to minimize vitamin interference.  During the third trimester, she counsels patients on common post-partum thyroid changes and develops an individualized post-partum thyroid plan for the patient.

Post-partum:

The post-partum period poses unique challenges to a woman’s thyroid gland.  During pregnancy, a woman’s immune system slightly suppresses to protect the baby.  After pregnancy, the immune system wakes up and can become over-reactive. Because of this, many women who were predisposed to thyroid disease prior to pregnancy, start experiencing symptoms post-partum.  It is important for women to be aware of the symptoms of thyroid disease, both hyper and hypo, as they are often masked as typical post-partum symptoms.  Our medical team has a keen understanding of post-partum thyroid changes to help you regulate thyroid hormone levels during this often-challenging time.  For women who are already managing thyroid disease, it is key to educate them on how their thyroid regulation may need to be rebalanced during the post-partum period.

THYROID NODULES AND THYROID CANCER

The incidence of thyroid cancer has more than doubled since the 1970’s.  In women, it’s the fastest growing cancer in the United States as measured by number of new cases per year.

Thyroid cancer often arises from a thyroid nodule, or mass, in the thyroid gland. Although thyroid nodules are common, about 5-10% contain cancer cells. The first source of detection is an exam by a skilled-physician to detect subtleties in the gland.

All patients will receive a thorough physical exam, and if indicated, a thyroid ultrasound may be performed during your appointment.  Patients have peace of mind that any concern during the thyroid exam can be further evaluated immediately by an ultrasound without a need for an outside referral.  If a thyroid nodule is detected and appears suspicious, Dr. Barkoff can perform a minimally invasive biopsy in the office or refer to a trusted medical center.

If thyroid cancer is detected, our providers with hold your hand and guide you through the entire process of determining the best treatment option for you. We will assist with scheduling a surgical consultation, pepare you for the surgery, and monitor you closely in the post-operative period.

MAST CELL DISEASES

Mast Cell Diseases are an umbrella of immune conditions where mast cells are either overactive, overproduced, or both.  Mast cells are an important part of a healthy immune system because they defend against outside stressors. When mast cells react to a foreign invader (like a bee sting), there should be a protective response. Some people, however, have persistant mast cell reactivity that continues even after the initial trigger has passed. When mast cell activiation becomes chronic, a multisystem inflammatory response can develop, notably affecting the skin, gastrointestinal and nasopulmonary tracts, and the cardiovascular system.

In 2015, Dr. Barkoff began recognizing patterns in her patients with Autoimmune Thyroid Disease who continued to feel unwell even after their thyroid was balanced. She found that within this subset of patients, approximately 10% of those who continued to feel unwell were found to have elevated markers of mast cell activation and benefitted from targetted therapy.  Integrative Endocrinology was founded to be able to treat people with Mast Cell Diseases, including Mast Cell Activation Syndrome, Hereditary Alpha Tryptasemia, and Systemic Mastocytosis.

Dr. Barkoff is honored to serve on The Mast Cell Disease Society’s Medical Advisory Board.  She has also proudly served on the American Academy of Allergy, Asthma, & Immunology (AAAAI) Mast Cell Disease Committee and The Ehlers-Danlos Society Mast Cell Disease Committee.

To learn more about Mast Cell Diseases, visit The Mast Cell Disease Society  www.tmsforacure.org