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.

Dr. Barkoff believes that testing for the presence of antibodies does make a difference. In her experience, it’s very important to know if the cause of the thyroid problem is autoimmune so she can integrate reducing inflammation along with targeted thyroid treatment.

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.  Dr. Barkoff extensively evaluates where a patient is in life, and specifically for females, their reproductive plans, before deciding on the proper course of treatment.

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. With Hashimoto’s, some patients have additional causes or sources of inflammation that need to be addressed at the same time as thyroid hormone replacement. Dr. Barkoff finds 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.


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.

Dr. Barkoff loves meeting women to discuss their thyroid disease prior to becoming pregnant.  Dr. Barkoff’s goal is to set her patients 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 Dr. Barkoff, as the hormones used during IVF can have a significant impact on a woman’s thyroid balance.

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 monitoring the thyroid levels starting early in the first trimester. If the mom’s thyroid is not balanced during a pregnancy, problems may arise. Dr. Barkoff draws labs at frequent intervals in between office 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.

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.  Dr. Barkoff has a keen understanding of post-partum thyroid changes, and she can evaluate and regulate thyroid disease 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.


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.

Dr. Barkoff has over 10 years of experience with thyroid nodules and cancer.  She conducts a very thorough physical exam and performs her own thyroid ultrasounds in the office when indicated.  Patients have peace of mind that any concern during the physical exam can be followed up immediately by an ultrasound without a need for an outside referral.  If the nodule appears suspicious, Dr. Barkoff will perform a minimally invasive biopsy in the office. She thoroughly explains the procedure to her patients and the reasoning behind her recommendations, which often puts her patients at ease. If the pathology returns suspicious or with evidence of cancer, Dr. Barkoff will counsel on all treatment approaches, including surgery.  She will provide recommendations for surgeons and create a personalized post-surgical plan.


Mast cell disorders are an umbrella of unique diseases 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), that’s a normal reaction. Some people, however, have mast cells that continue to respond to non-threatening stimuli in the same way as foreign invaders. This continued overreaction is called mast cell activation because the mast cell membranes keep breaking apart. Since mast cells are in most tissues in the body, mast cell activation can cause a multitude of both general and unique symptoms.

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 her patients, approximately 10% of those who continued to feel unwell were found to have elevated markers of mast cell activation.  In addition to the more general symptoms of hives, diarrhea, nasal congestion, and flushing, Dr. Barkoff has identified the following unique symptoms in her patients with Mast Cell Activation Syndrome:

  • Tired upon waking in the morning
  • Lightheaded when rising from a squat or seated position
  • Swelling in the upper eyelids, lips, or hands along the ring line
  • Matching red circles on the legs when uncrossing
  • Decline in concentration or memory, especially word-finding difficulty
  • Worsening anxiety and irritability
  • A pattern where the above symptoms are worse prior to the menstrual period


To learn more about Mast Cell Disorders, visit the following informative websites:
The Mastocytosis Society  www.tmsforacure.org
Mast Cell Aware  www.mastcellaware.com
Mastocytosis Society Canada  www.mastocytosis.ca