Sierra Endocrine Associates

Endocrinology, diabetology & Metabolism
Joseph B Hawkins, Jr. MD, FACE

Serving the San Joaquin Valley

7230 N Millbrook Ave

Fresno, CA 93720


 Thyroid Disease Management

 What is a thyroid?
The thyroid gland is a small, butterfly-shaped gland located at the base of your neck just below your Adam’s apple. Your thyroid gland helps control the function of your body’s metabolism as well as the functions of many important organs, including your heart, brain, liver, kidneys, and skin. Making sure your thyroid gland is healthy and functioning properly is extremely important to your overall well-being.

Common Thyroid Problems
The thyroid gland is prone to several very distinct problems, some of which are extremely common. These problems can be broken down into four general groups:

  • Irregular production of hormone (too much or too little)
  • Inflammation or increased growth of the thyroid
  • Formation of nodules or lumps within the thyroid
  • Thyroid cancer

Hyperthyroidism means too much thyroid hormone. This disorder occurs in almost one percent of all Americans and affects women five to ten times more often than men. Current methods used for treating a hyperthyroid patient are radioactive iodine, anti-thyroid drugs, or surgery. Each method has advantages and disadvantages. We will select the method or combination of methods that is best suited for each patient. Surgery is the least common treatment selected for hyperthyroidism.

Hypothyroidism means too little thyroid hormone. Some studies have shown that as many as ten percent of women and three percent of men have hypothyroidism. In fact, Hypothyroidism is often present for a number of years before it is recognized and treated. Hypothyroidism can even be associated with pregnancy. The easiest and most effective treatment is simply taking a thyroid hormone pill once a day. In the beginning, the dosage should be re-evaluated and possibly adjusted monthly until the proper level is established. The dose should then be re-evaluated at least annually.

A goiter is a dramatic enlargement of the thyroid gland. Most small to moderate sized goiters can be treated by providing thyroid hormone in the form of a pill. This technique often will not cause the size of the goiter to decrease but will usually keep it from growing any larger. A large goiter can sometimes be seen as a mass at the neck. It can also compress other vital structures of the neck including the wind pipe and the esophagus making breathing and swallowing difficult. Surgical removal of large goiters is often recommended in cases where they are compressing other structures in the neck. They can also be surgically removed for cosmetic reasons.

Thyroiditis is the inflammation of the thyroid gland. There are several types of thyroiditis: Hashimoto’s Thyroiditis, De Quervain’s Thyroiditis, and Silent Thyroiditis. Treatment for Hashimoto’s Thyroiditis is thyroid hormone replacement. Treatment for De Quervain’s Thyroiditis is usually bed rest and aspirin to reduce inflammation; cortisone and thyroid hormone may be recommended in prolonged cases. Treatment for Silent Thyroiditis is usually bed rest with beta blockers to control rapid heart rates.

Solitary Thyroid Nodules
A thyroid nodule is a palpable swelling in a thyroid gland with an otherwise normal appearance. Although as many as 50% of the population will have a nodule somewhere in their thyroid, the majority of these are benign. Occasionally thyroid nodules can take on characteristics of malignancy and require either a needle biopsy or surgical excision. Doctors Hawkins, Punzalan, and Sajid-Crockett are all trained and certified in needle biopsy procedures, including ultrasound guidance which can be performed in the office.

Thyroid Cancer
Thyroid cancer usually appears as a painless lump in the area of the thyroid gland. Fortunately, most types of thyroid cancer can be diagnosed early and cured completely, but a comprehensive investigation is necessary. The usual approach is to remove the portion of the thyroid containing the lump, along with most of the remaining thyroid gland and any abnormal lymph glands. After surgery, radioactive iodine treatment is usually recommended in order to destroy any remaining malignant thyroid cells and to reduce the risk of recurrence of this disease.




At Sierra Endocrine Associates we  hold firmly to the principle that our greatest asset is the ability to listen to the needs of our patients. Each member of our team is committed to delivering care in a compassionate, patient-centered environment. You will meet with a member of our team who will take a thorough history of your heath, review available testing and information and explain the process  for going forward.


At Sierra Endocrine Associates we can perform a diagnostic ultrasound, ultrasound guided needle biopsy, and needed laboratory testing on site



After a thorough evaluation treatment options, risks, benefits and side effects of medications are discussed and then  recommendations are made. If Surgery is needed we will advise and refer to highly skilled and experiened surgeons.


After establishing a teatment plan a follow up and monitoring schedule will be discussed and initiated.