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Speaker 4: Oh hey, it's the guy at the library with that
Speaker 4: stack of survival books. Ali Ward, Let's talk about your thyroid.
Speaker 4: Do you still have one? If not, let's talk about
Speaker 4: how it did do dirty metabolism, libido, sweating, freezing. You're
Speaker 4: in the right place for all of it. So I
Speaker 4: went to New York because I'm sophisticated, and also your
Speaker 4: favorite diabetic diabatologist, doctor Mike Natter, was getting married to
Speaker 4: his bride Alice, And whilst there, NYU Langone Hospital hooked
Speaker 4: it up with a thyroid expert and a surgeon who
Speaker 4: was more than game to answer all my questions about
Speaker 4: this little hormonal organ that rules our lives. So this
Speaker 4: guest is a division chief of the NYU Langone Endercrensurgery
Speaker 4: Department and a professor in the Department of Biochemistry and
Speaker 4: Molecular Pharmacology of ODO Laryngology Head and Next Surgery. And
Speaker 4: we met up on a brisk afternoon in this tidy,
Speaker 4: elegant hospital conference room, and I asked so many questions
Speaker 4: and he didn't even bill us for them. He knows
Speaker 4: his stuff and he knows your so we'll talk about
Speaker 4: your stuff momentarily. But first let's say called the patrons
Speaker 4: at patreon dot com slash ologies who make the show
Speaker 4: possible and send in their questions. You can be one
Speaker 4: of them if you like, for just a dollar a month. Also,
Speaker 4: thanks to everyone in ologies Merch from ologiesmerch dot com
Speaker 4: and if you need a kid friendly version of the show,
Speaker 4: just a reminder that we launched smologies recently. It's a
Speaker 4: spinoff podcast in its own feed link in their show notes.
Speaker 4: So thank you also to everyone who leaves reviews for
Speaker 4: the show. It matters so much to us and it
Speaker 4: helps boost the show in the charts. And I read
Speaker 4: all of them, and this week Positive Steps PDX wrote
Speaker 4: that they look forward to listening every week and that
Speaker 4: it's been read to gain knowledge from fellow queer and
Speaker 4: trans folks. Positive Steps PDX, it's a joy to introduce
Speaker 4: the audience to all manner of ologists across all kinds
Speaker 4: of fields, including your thigh right now. Thyroidology comes from
Speaker 4: the Greek thyrodied eye. It means shield shaped, and that
Speaker 4: refers to the Adams apple of the throat, which is
Speaker 4: thyroid cartilage, and then the endocrine gland underneath it that
Speaker 4: provides hormones that keep your engine running. So let's get
Speaker 4: to it. Let's figure out just what the hell is
Speaker 4: happening with that lump in your throat, and if maybe
Speaker 4: it's making you depressed or cold or tired or sweaty
Speaker 4: or shaky or hot, when to ask your doctor to
Speaker 4: check it, How to decipher labs, as well as info
Speaker 4: on radioactive cats, stress and thyroids, surviving a nuclear bomb,
Speaker 4: how diet can affect your thyroid flim flam, and how
Speaker 4: being on TV might save your life. Please also remember, however,
Speaker 4: that we can neither diagnose nor treat you because this
Speaker 4: is a free audio show. We don't have access to
Speaker 4: your neck or your blood. Don't be weird about this,
Speaker 4: do be excited. So let's hear from surgeon, professor, endochronology
Speaker 4: specialist and thybroidologist, doctor Kempel Patel.
Speaker 3: Kpl Pate.
Speaker 4: And and I'll have you just kind of hold like
Speaker 4: an ice cream cul like if you were a stand
Speaker 4: up or doing karaoke.
Speaker 3: You can do some songs afterwards.
Speaker 4: Yeah, apologies and advance. Okay, first off, do I have
Speaker 4: an awful thyroid? I feel like that must be the question,
Speaker 4: everyone asks you, does my thyroid messed up? Must be
Speaker 4: something that you get constantly.
Speaker 3: Absolutely, I think the poor thyroid gland gets blamed for
Speaker 3: a lot of things in life, and it's not necessarily
Speaker 3: this poor little gland's fault. And the thyroid gland is
Speaker 3: it's an amazing organ. It's a small gland that sits
Speaker 3: right in the middle of your neck, right on top
Speaker 3: of your windpipe. It's shaped like a butterfly. You have
Speaker 3: a right side and the left side of the gland,
Speaker 3: and its sole purpose is to make thyroid hormone. And
Speaker 3: you know, you can think of thyroid hormone as like
Speaker 3: the gas for your engine. It really really regulates your metabolism,
Speaker 3: you know, and that's your primary organ that gives you
Speaker 3: the fuel that you need to basically do. Almost all
Speaker 3: the activities that you perform, you know, from temperature regulation
Speaker 3: to how you metabolize your food, to how you use
Speaker 3: your energy is all regulated by the thyroid glant. So
Speaker 3: anytime somebody feels off for whatever reason it may be,
Speaker 3: it's always is it my thyroid glant?
Speaker 4: Yeah.
Speaker 3: But the beautiful thing about the thyroid glant is it's
Speaker 3: an easy organ to check both physically and from a
Speaker 3: laboratory standpoint, it's easily palpable. You can see it. It's
Speaker 3: very much in the front of your neck. So if
Speaker 3: somebody does have a large thyroid or thyroid mass, you
Speaker 3: can almost always feel it. And then it's you know,
Speaker 3: the blood tests for thyroid function are pretty easy to obtain,
Speaker 3: so you get the blood test and it gives you
Speaker 3: a good idea if your thyroid glint is actually functioning
Speaker 3: normally or not. So that kind of gives your answer
Speaker 3: most of the time.
Speaker 4: What about your metabolism, How much of an effect does
Speaker 4: it have in terms of like how many calories your
Speaker 4: body burns at a basic metabolic rate, how much of
Speaker 4: your body composition is determined by it by.
Speaker 3: The thyrodorrmal When you're asking, yeah, absolutely, it's a significant
Speaker 3: portion of it. So your thyroid homone really does regulate
Speaker 3: a lot of that. So we see that in very
Speaker 3: sick patients. In patients that are admitted to the ICU
Speaker 3: for for weeks or months, you'll see that their thyroed
Speaker 3: homo levels start to change. And so we know that
Speaker 3: the thyroid glend is intimately involved in your metabolism, and
Speaker 3: so you know, depending on the situation, whether it's a
Speaker 3: stressful situation, whether it's a situation where where your body
Speaker 3: requires more energy. The third gland definitely plays a significant
Speaker 3: role in it.
Speaker 4: How often are people depressed but they think it's their
Speaker 4: thyroid or vice versa.
Speaker 3: Oh, it's very common. Part of the reason is people
Speaker 3: get online and they'll google it and thyroid will come
Speaker 3: up as one of the you know, one of the
Speaker 3: causes for fatigue or depression or not feeling energetic, and
Speaker 3: so that automatically is the first thing people think about.
Speaker 3: Often it's not just the thyroid glend. When you do
Speaker 3: have loss of function of the thyroid hypothyroidism.
Speaker 4: Hypo means under whereas hyper means above.
Speaker 3: And when you do have loss of function of the
Speaker 3: thought hypothyroidism, often it's autoimmune and it's associated with other
Speaker 3: symptoms as well. It's not just fatigue or lack of
Speaker 3: energy or depression. Patients often will feel cold, they'll start
Speaker 3: to gain weight, they may have some hair loss, the
Speaker 3: skin gets dry, the nails get brittle. I mean, that's
Speaker 3: classic what we call hashimotos thyroiditis or hypothyroism.
Speaker 4: And the difference between having let's say low thyroid hormone
Speaker 4: and having hashimotos. Hashimotos, from what I understand, is your
Speaker 4: immune system being like, let's get this thyroid out of here,
Speaker 4: get out here. We don't like you. You're an invader, and
Speaker 4: you're like, this is my own thyroid. So hashimotos is
Speaker 4: a type of autoimmune disorder where your body's immune system
Speaker 4: turns on itself and you're like, can you not? But
Speaker 4: hashimotos is not the cause of all underactive thyroids aka hypothyroidism.
Speaker 4: You can have low thyroid hormone without it being caused
Speaker 4: by autoimmune hashimotos. Just like all cacti are succulents, but
Speaker 4: not all succulents are cactie. So all hashimotos hypothyroidism, not
Speaker 4: all hypothyroidism as hashimotos do those present differently.
Speaker 3: The most common cause for hypothyroidism in this country is hashimotoves,
Speaker 3: but you can have low thyroid function or high TSH
Speaker 3: and not have hashimotos. Thyroiditis that does exist, but the
Speaker 3: most common cause is hashimotives. But the overall effect is
Speaker 3: probably the same because it's ultimately the effect of your
Speaker 3: thyroidegland not working the way it should be.
Speaker 4: Okay, So This is confusing, But how doctors measure your
Speaker 4: thyroid function is by checking your TSH. That's thyroid stimulating hormone.
Speaker 4: So this hormone is like a measure of how much
Speaker 4: your body is pressing the gas pedal to try to
Speaker 4: get enough thyroid action. So a low TSH means hyper
Speaker 4: thyroidism or an overactive gland because your body barely has
Speaker 4: to tap the gas pedal of TSH, but your thyroid
Speaker 4: is already off to the races. Now, high TSH means
Speaker 4: your body is floor it on the gas pedal so
Speaker 4: hard and not getting a lot of action to convert
Speaker 4: to energy. So a high TSH means low activity hypothyroidism,
Speaker 4: and a low TSH means high activity or hyper thyroidism.
Speaker 4: Just think everything's the opposite kind of So walk me
Speaker 4: through a backstage of the thyroid and the thyroid hormone.
Speaker 4: It squirts out what T four thyroxine tell me what
Speaker 4: is making and what does that effect.
Speaker 3: Yeah, so your TSH level, which is probably the most
Speaker 3: important blood test to assess thyroid function, is actually not
Speaker 3: released by a thyroid gland. TSH is actually released by
Speaker 3: a pituitary gland, which sits at the base of your brain.
Speaker 3: So when its senses that there's not enough thyroid hormone
Speaker 3: in the body, the petuitary gland, which is considered the
Speaker 3: master gland, releases TSH, which is thyroid stimulating hormone, and
Speaker 3: that's to stimulate the thigh gland to make more hormone.
Speaker 3: So if a TSH is high, that means your thyroid
Speaker 3: is not working well. That's how you know TSH is low,
Speaker 3: that means your thyrd's working too well. So when your
Speaker 3: TSH is you know, depending on what your TSAH levels are,
Speaker 3: it'll affect your thyroid gland and your thyroglane will make
Speaker 3: thyrod hormone. Now, thyrod hormone comes in two forms. It's
Speaker 3: something called T four, as you were alluding to an
Speaker 3: NT three. T three is your active form. That's the
Speaker 3: form that your body cells use to use it for
Speaker 3: the metabolism and the energy and to you know, and
Speaker 3: and to use it for all the functions that the
Speaker 3: cells need thyroid hormone for. But what your thyroid glant
Speaker 3: actually produces is T four. And then the T four
Speaker 3: is actually converted into T three as needed by your
Speaker 3: liver or your kidneys and other parts of your body.
Speaker 4: So the protuitary is at the wheel and at the
Speaker 4: gas pedal, and it makes that thyroid stimulating hormone or
Speaker 4: TSH that tells the thyroid to release more gas T four,
Speaker 4: and your organ say, thanks, man, I'm going to break
Speaker 4: this down a little into T three so we can
Speaker 4: use it for energy. So imagine your petuitary saying we're
Speaker 4: not going anywhere. Where's the gas pumping out more TSH
Speaker 4: to be like come on, come on, come on, Or
Speaker 4: if you have too much T four converted to T three,
Speaker 4: your petuitary is like whoa easy leadfoot, and it releases
Speaker 4: less TSH.
Speaker 3: So T three is the active form of the hormone.
Speaker 3: And it kind of makes sense even evolutionarily if you
Speaker 3: think about it, because if you just start putting out
Speaker 3: T three, your metabolism in a skyrocket, you're going to
Speaker 3: be bouncing off the walls. So so your body actually
Speaker 3: is smart in that sense. It says, you know, we're
Speaker 3: gonna make T four, and if you need T three,
Speaker 3: you'll convert it and you'll make as much T three
Speaker 3: as you need. But this way, we're not just pumping
Speaker 3: out T three.
Speaker 4: Where's the T four hanging out? When it's on call
Speaker 4: to be T three.
Speaker 3: In your thyroy gland. Ohs making it? Yeah, thire is
Speaker 3: making it, and it makes it as it needs it
Speaker 3: kind of and it secretes it okay, and then your
Speaker 3: body converts it to T three as needed.
Speaker 4: Do you know why they're called T three and teeth
Speaker 4: throw three teeth? Yep.
Speaker 3: It's it's the I dye. It's the amount of ide particles.
Speaker 3: So T four has four io dye part of on
Speaker 3: T three has three. So when when T four gets deiodonized,
Speaker 3: it becomes T three.
Speaker 4: So what happens when you've got T three in the body?
Speaker 4: Does it affect your adrino systems? Does it affect cortisol? What?
Speaker 3: Yeah, so that's a great question. So you know there's
Speaker 3: some over overlap with the other hormonal systems in the body.
Speaker 3: For the most part, it's really affecting you know, the
Speaker 3: cells that you need for for energy, so there's not
Speaker 3: too much hormonal interplay as there is much like the
Speaker 3: T three really affecting your cells for cellular metabolism. It's
Speaker 3: a cellular level, so it's you know, it's like I said,
Speaker 3: it's temperature regulation, digestion, your energy levels. You know, your
Speaker 3: the ability to think clearly, not be tired. Your heart rate,
Speaker 3: you know, that's all affected by thyroid.
Speaker 4: Hormone if you have a low heart rate. Speaking from experience,
Speaker 4: at some point my my doctors were like, Wow, you're
Speaker 4: athletically healthy. And then I was like, or does my
Speaker 4: rus I'm running as well as I used to. It
Speaker 4: turned out my thyroid such a little bit. But when
Speaker 4: you when someone comes to your office and they say,
Speaker 4: I think my thyroid is, let's say, sluggish, what are
Speaker 4: the first things you do if they have symptoms of
Speaker 4: hypothyroidism but their labs are within range? Where do you
Speaker 4: go from there?
Speaker 3: Yeah, that's a tough one. I mean, so you know,
Speaker 3: it's the first thing, Like getting back to your question.
Speaker 3: The first thing, you're going to take a full history, right,
Speaker 3: you want to make sure if somebody's complaining that the
Speaker 3: theroid may be sluggish, you want to ask all those
Speaker 3: pertinent questions. Are you tired, you know, do you feel cold?
Speaker 3: Are you gaining weight? Is your hair falling out? So
Speaker 3: you want to ask all the questions that would help
Speaker 3: you kind of identify what thyroid problem that they may
Speaker 3: be having. And then you're obviously going to do your
Speaker 3: physical examination, examine the thyroid. I mean, God forbid to
Speaker 3: having thyroid mass right that we need to worry about.
Speaker 3: And then the next step would probably be getting your
Speaker 3: laboratory studies and looking at your thyroid function.
Speaker 4: So for TSH, that thyroid stimulating hormone in range is
Speaker 4: typically set like zero point five to five point zero.
Speaker 4: You could be anywhere in between there, but it varies
Speaker 4: by lab And if a patient is feeling symptoms like
Speaker 4: for hypothyroid, dry skin, feeling cold, a lot, low energy,
Speaker 4: your guts are slow, you have brittle hair, maybe you
Speaker 4: feel like the embodiment of a cold limbstock of celery.
Speaker 4: That's sad, and you're in the upper end of the
Speaker 4: TSH range. Even though you're in range technically, some doctors
Speaker 4: might flag it and medicate with extra thyroid hormone or
Speaker 4: T four. Doctors can also see, no matter what your
Speaker 4: TSH is, how much T four you're actually making and
Speaker 4: test to see how well your organs are converting that
Speaker 4: to T three, which you can use. Now, there are
Speaker 4: medications like synthroid, which the generic name is lebathyroxine, and
Speaker 4: that is just T four, and it's kind of up
Speaker 4: to your body to make the T three you need
Speaker 4: from it. Now with hashimotos, the autoimmune issue where your
Speaker 4: immune system turns on your own thyroid that is rude
Speaker 4: and it's measured by high TSH as well as lab
Speaker 4: that measure antibodies to your own organ and.
Speaker 3: We do see that. We do see situations where the
Speaker 3: patients don't feel well, they have all the symptoms of
Speaker 3: thyroid kind of hypothyroid disease, but their blood tests come
Speaker 3: back relatively normal, they don't have any antibodies, and what
Speaker 3: do you kind of do with that? And you want
Speaker 3: to rule out other causes, right, so you want to
Speaker 3: do a full autoimmune work up, make sure there's not
Speaker 3: other causes, you know why this is happening. And at
Speaker 3: the end of that if even if everything else still
Speaker 3: comes back normal. You know, there are some individuals out there,
Speaker 3: including some of our experts in n NYU, will try
Speaker 3: to maybe start them in a little bit of thyroid hormone,
Speaker 3: see if that makes a difference, see if they feel
Speaker 3: better with that. But that's very kind of a case
Speaker 3: kind of a situation. It's not like a universal thing.
Speaker 4: Do people ever try to score a thyroid hormone is
Speaker 4: like a like an ozembic.
Speaker 3: I said it before you said it absolutely really? Oh yeah.
Speaker 3: The first question I always usually get what I talk about.
Speaker 3: I mean, I do. I do a lot of thyroid surgery, right,
Speaker 3: and so most of my patients will end up on
Speaker 3: thyroid medication. And it's it's a question I get almost
Speaker 3: every day is oh, that's great if I take two pills,
Speaker 3: but I lose weight. I'm like, no, it doesn't work
Speaker 3: that way. Unfortunately, it's not a weight gain a weight
Speaker 3: loss pill.
Speaker 4: Well would happen if you overdose yourself?
Speaker 3: Oh no, you would feel kind of miserable. Actually, you
Speaker 3: wouldn't feel good. I mean you'd feel hyperthyroid. Your heart
Speaker 3: will be racing, you'd be sweating, you'd feel anxious. You
Speaker 3: wouldn't you would not feel well.
Speaker 4: Yeah, So a word of the wise, don't do it.
Speaker 3: Throne over dose on, leave it the rouxcine.
Speaker 4: Yeah, just like get extra coffee. Does everyone's thy word
Speaker 4: kind of poop out as we age?
Speaker 3: Not necessarily, most patients A should do really well. I
Speaker 3: mean most people their fire function, you know, remains relatively normal.
Speaker 3: But as you get older in most organs in your body,
Speaker 3: as you get older, your tired gland you know often
Speaker 3: does become a little bit more sluggish bumber, And so
Speaker 3: it's not uncommon after the age of sixty and actually,
Speaker 3: and more common in women actually, And some of it
Speaker 3: may have to do with the autoimmune aspect of it
Speaker 3: and the hormonal aspect of it with menopause. But as
Speaker 3: you get older, the tired gland in women sometimes tends
Speaker 3: to get a little sluggish. It isn't important when you
Speaker 3: see your primary doctor to have those blood tests done
Speaker 3: because patients may come in they don't feel well, they
Speaker 3: feel like they don't have energy, and often they will
Speaker 3: chocol up to I must be going through menopause and
Speaker 3: I must be having other hormonal changes. And sometimes it's
Speaker 3: just that your thyroid glenn is getting a little weak
Speaker 3: and a little bit of thyroid hormon makes them feel better.
Speaker 4: When it comes to women and assigned female birth, what
Speaker 4: is the connection between autoimmune hashimotos and ovaries? What's going on.
Speaker 3: Auto So yes, autoimmune disease in general is more common
Speaker 3: in women, right, And when we talk about autoimmune thyroiditis,
Speaker 3: like I said, usually we're referring to this entity called
Speaker 3: hashimotos thyroididitis. So it's named after doctor Hakura Hashimoto I
Speaker 3: think it is. In nineteen twelve actually described it for
Speaker 3: the first time. He was a physician and a scientist
Speaker 3: in Japan. The concept of hashimotives is your body is
Speaker 3: now creating antibodies against thyroid peroxidase and thyroglobilin. These are
Speaker 3: your enzymes that your thigh glenn uses to make thyroid hormone.
Speaker 3: So when you create antibodies against those enzymes, now your
Speaker 3: theroid can't make the hormone anymore, so your thyroid starts
Speaker 3: to not function, and ultimately it's actually causing destruction of
Speaker 3: the theory of thyid actually starts to die. So many
Speaker 3: of these patients with hashimotives have shrivel thiry glands almost
Speaker 3: almost at a point with the gland almost disappear. Sometimes
Speaker 3: it becomes scar tissue.
Speaker 4: If you discovered a thyroid disease and they called it
Speaker 4: patels and then everyone complained about having tels, how would
Speaker 4: would you be like, yeah, I'll never like, oh my god,
Speaker 4: I'll never be forgotten in my field. Or would you
Speaker 4: be like bummered that my name.
Speaker 3: Is it's something nobody wants. Yeah, yeah, I don't know.
Speaker 3: Probably the ladder call a little column call me exactly.
Speaker 4: Well, okay, I have heard stories of people being diagnosed
Speaker 4: with thyroid disease just by someone seeing them, like across
Speaker 4: the room or on TV. I don't know if you
Speaker 4: remember there was a story where someone know, yeah, do
Speaker 4: you remember that story on TV? And so, yeah, you
Speaker 4: probably want to get your and they had a thyrity.
Speaker 3: So that was actually a surgeon at n YU stop it.
Speaker 3: Yeah yeah, yeah, yeah, So it was a surgeon at NYU.
Speaker 3: Is Doctor Eric Voyd, one of the anti surgeons here,
Speaker 3: actually noticed somebody on TV. It was an HGTV thing,
Speaker 3: I think.
Speaker 4: A small but noticeable lump on her throat. Doctor Eric
Speaker 4: Void was watching the show at his home in New York.
Speaker 3: He's an ear nosen throat surgeon.
Speaker 2: I was like, gosh, I feel obliged to let this
Speaker 2: person know.
Speaker 3: They may not know they have something, and as an
Speaker 3: expert in the field, I was concerned for her. I
Speaker 3: think it was this HGTV personality person And then he
Speaker 3: called into like the TV show where says, you know,
Speaker 3: by the way, I think one of your one of
Speaker 3: your presenters as a quator, you know, oryid mass and
Speaker 3: then she got treated.
Speaker 4: Yeah. Yeah, so for Nicole Mcinness being on Beachfront Bargain
Speaker 4: Hunt saved her life while having a doctor watch Beachfront
Speaker 4: Bargain Hunt saved her life. What an anomaly, right? How
Speaker 4: often would someone be watching an HGTV show and notice
Speaker 4: thyroid cancers? Like one in a million, one in a billion?
Speaker 4: Weight no hold on? Okay? I was fact checking Nicole's
Speaker 4: story and I found out maybe this was apocryphal, Maybe
Speaker 4: this was wrong because it was actually HGTV personality Taric
Speaker 4: l Musa who had thyroid cancer, and it was a
Speaker 4: nurse who spotted his enlarged gland.
Speaker 5: When I was watching Flipper Flop on TV at home,
Speaker 5: I noticed that at certain angles, at certain times, it
Speaker 5: just caught my eye that Tark had a lump on
Speaker 5: his throat, and I thought it was something that needed
Speaker 5: to be brought to his attention.
Speaker 4: Within a month, Tark had his thyroid and lymph nodes
Speaker 4: removed and began iodine radiation TREATMENTA what what Okay? I
Speaker 4: went on a deep dive about the health of a
Speaker 4: guy on HGTV. Turns out both of those stories are right.
Speaker 4: Nicole and Taric different shows, different thyroids, both on HGTV.
Speaker 4: So in addition to that lady looking for the cheap
Speaker 4: seaside cottage, Tarak el musa co host of HGTV's Flip
Speaker 4: or Flop, found out that he had thyroid cancer from
Speaker 4: that viewer's heads up. And this is after he'd been
Speaker 4: seeing a doctor for a while trying to figure out
Speaker 4: why his throat hurt and was tight, and his doctor
Speaker 4: just kept brushing aside as like allergies. Turns out it
Speaker 4: wasn't hay fever. It was stage two cancer, having spread
Speaker 4: to his nearby lymph notes. He had to get the
Speaker 4: thyroid removed and undergo radioactive iodine therapy, which we'll discuss
Speaker 4: in a bit, and then unrelated side note, Tarak's old
Speaker 4: doctor also was like, don't worry about that lump in
Speaker 4: your scroat, It's probably nothing. But it turned out it
Speaker 4: was testicular cancer, unrelated to the thyroid cancer at the
Speaker 4: same time, at which point I'd want to sue my
Speaker 4: doctor or my endocrine system or both of them. Now
Speaker 4: for the testicular stuff, it's not something that a doctor
Speaker 4: on the subway or something would notice in passing, hopefully
Speaker 4: depending on what kind of vibe you're running. But as
Speaker 4: for a goiter or an enlarged thyroid. Do you ever
Speaker 4: notice that on people?
Speaker 3: Yeah, it's one of the occupational hazards. I want to
Speaker 3: look at people's neck if I look at their faces,
Speaker 3: probably so it's unfortunate, you know, but yeah, no, I
Speaker 3: mean it's natural, right, because that's what I do. Yeah,
Speaker 3: every day I examine people's necks. Yeah, I mean, you know,
Speaker 3: large goiters are easy visible. I mean for people that know,
Speaker 3: like that's an abnormal neck.
Speaker 4: Does it cover the atoms? Apple?
Speaker 3: It does? So, you know, the term goiter is just
Speaker 3: basically an enlargement of your thyroid gland. It's almost always benign.
Speaker 3: It's an overgrowth of your thyroid. And you know, I
Speaker 3: think everybody at some point is probably seen pictures and
Speaker 3: like National geographic or whatever where you have these huge goiter's,
Speaker 3: huge you know, thyroid masses. And it's almost always either
Speaker 3: familial or iodine deficiency.
Speaker 4: So according to the twenty twenty paper Iodine Deficiency and
Speaker 4: Goiter in the Williams Textbook of Endochronology, seventy five percent
Speaker 4: of people with goiter live in less developed countries where
Speaker 4: iodine deficiency is prevalent. And this prevalence of Goiter is
Speaker 4: most common in mountainous areas, including the Himalayas and the Andes,
Speaker 4: where there is significant iodine deficiency, and it's also common
Speaker 4: in large parts of Africa, areas of Central Europe, and
Speaker 4: in Papua New Guinea. But this textbook notes that highly
Speaker 4: developed countries can also fall prey to goiter conditions and
Speaker 4: iodine deficiency, like the United Kingdom and Australia and the
Speaker 4: US had a real goiter ish back in the early
Speaker 4: nineteen hundreds, with up to seventy percent of American children
Speaker 4: in some areas having clinically apparent goiter seventy percent, that's
Speaker 4: like a higher percentage of kids mewing and class.
Speaker 3: And so, I don't know if you're familiar with the
Speaker 3: whole guiter belt story, yes, I mean fascinating. Yeah.
Speaker 4: Well, first off, is it goiter or goiters?
Speaker 3: Guiter?
Speaker 4: Okay, there's there's no.
Speaker 3: Goiters, there's no quatters multiple people.
Speaker 4: I guess you can't have more than one. Yeah? Have
Speaker 4: those changed it rates? Historically? Have we seen epidemics of goiter?
Speaker 4: What causes those?
Speaker 3: As I was saying, the most common cause for goiter
Speaker 3: still iodine efficiency. Worldwide, the rate of people having goiter
Speaker 3: in this country has dropped tremendously, and I think it's
Speaker 3: probably one of the most, if not probably the greatest
Speaker 3: success story for the US Public Health Service was in
Speaker 3: the nineteen twenties, they discovered that there was a good
Speaker 3: portion of the middle aspect of America, which was called
Speaker 3: the goiter belt, across the Midwest, where you didn't have
Speaker 3: access to fresh seafood, good sources of iodine, and patients
Speaker 3: had large thyroid that diary glands kind of really you know, enlarge,
Speaker 3: and they had goiters. And I think that became a
Speaker 3: real public problem. And the solution was easy to get
Speaker 3: these patients to take in iodine. But it was hard
Speaker 3: to administer iodin because idiine doesn't taste good number one,
Speaker 3: and how do you get people just to take iodine? So,
Speaker 3: I mean, it was a brilliant you know, there's a
Speaker 3: whole there's a big backstory to this, but it was
Speaker 3: basically a stroke of genius to say, hey, why don't
Speaker 3: we just put iodine into the salt. Salt is a
Speaker 3: known quantity everybody consumes salt. Salt doesn't spoil and iodine.
Speaker 3: You don't taste the iodine. The salt, you taste the salt,
Speaker 3: uh huh, And so you just iodize a salt, and
Speaker 3: all of a sudden, our rate of golids in the
Speaker 3: Midwest has dropped to basically average to what it was
Speaker 3: on each coast.
Speaker 4: So the gorid belt on trend for the Midwest in
Speaker 4: the nineteen twenties but has since thankfully gone out of fashion.
Speaker 4: Now when you see iodized salt, you can say, hey, thanks, guidbuster,
Speaker 4: that's why you're iodized. But don't overdo the salt, and
Speaker 4: don't panic. If you use uniodized kosher or sea salt.
Speaker 4: Chances are you have enough in the small amounts you're getting.
Speaker 3: It's no longer much of a problem anymore. Obviously, now
Speaker 3: you can get great sushi in the middle of the
Speaker 3: desert like in Vegas, but back then that wasn't available.
Speaker 4: So is the thyroid trying to compensate by enlarging in
Speaker 4: tissue size. What's going on.
Speaker 3: That's exactly it's hypertrophying.
Speaker 4: Hypertrophy hyper means it's growing bigger.
Speaker 3: That's exactly what's happening. The fired gland is hypertrophying because
Speaker 3: it needs iodine to make fireed hormone and it's not
Speaker 3: getting the idine, so it's actually increasing in size trying
Speaker 3: to get iodine, trying to accumulate iidine.
Speaker 4: And if you add iodine to someone's diet, does it
Speaker 4: just shrink down or does does it need a surgical intervention? Yeah?
Speaker 3: I think once you've developed it, it's probably not going
Speaker 3: to go away. If you give that patient iodine at
Speaker 3: that point, it'll probably prevent it from getting any bigger,
Speaker 3: but it's not going to shrink, okay. And so at
Speaker 3: that point they're stuck with the goid that they have. Yeah,
Speaker 3: either you take it out or if they're they're taking
Speaker 3: tolerated and it's not really bothering them, you can even
Speaker 3: leave it alone.
Speaker 4: Ah, I've always thought that it would just shrink. This
Speaker 4: is why you're a surgeon and not. But are certain populations,
Speaker 4: Let's say you're a seafaring person or you're a fishmonger
Speaker 4: on a coast. Do you ever see increases in iodine
Speaker 4: and therefore hyperthyroidism.
Speaker 3: Well, not necessarily hyper thyroidism per se, but you do.
Speaker 3: You can get id on toxicity for sure, and so
Speaker 3: you do have to be careful, right, I mean no,
Speaker 3: And you also mean depending how much fish you eat,
Speaker 3: not to sidine being get mercury toxicity, right, which is
Speaker 3: even more dangerous. So yes, so you gotta be a
Speaker 3: little careful. Yeah, but no, I think look at the
Speaker 3: bottom line, is a healthy diet, right, you know, good
Speaker 3: amount of fruits and vegetables and meats and fish, and
Speaker 3: I think you know and you should be fine.
Speaker 4: But again, if you're low on that thyroid hormone in
Speaker 4: your body, that T four and thus T three, what
Speaker 4: about hormone replacement? I've heard synthroid. I've also heard that
Speaker 4: sometimes they take desiccated pink thyroid, and there are two camps.
Speaker 4: And some people are very much like, don't give me
Speaker 4: the fake stuff, and other people are like that pig stuff.
Speaker 4: You never know what you're getting, what's the deal?
Speaker 3: So you're right about both. Most of us really prefer
Speaker 3: using leviathroxine, which is the brand name of Senria. Believe
Speaker 3: what the oroxin is the synthetic tea hormone. And I
Speaker 3: think the reason behind that it's easy to test, it's
Speaker 3: easy to regulate, it's a known quantity that you're giving
Speaker 3: them the patients that we know exactly what the patients
Speaker 3: are getting from a physician standpoint. You know, it's an
Speaker 3: easier drug to manage leave with the roxene. The flip
Speaker 3: side to that is that it is synthetic. Most patients
Speaker 3: tolerate it beautifully. I mean it's we're talking about a
Speaker 3: very small subset of patients that don't tolerate thyroid hormone.
Speaker 3: I would say ninety five percent plus they take their
Speaker 3: cin throid once a day and they're totally fine. But
Speaker 3: you know there are percentage of patients in whom that
Speaker 3: they don't do well. And the other formulation, as you
Speaker 3: were mentioning, is this, you know, this natural desiccated pig thyroid,
Speaker 3: which is a combination of T three and T four,
Speaker 3: So it's not just T four which leave with theroxine.
Speaker 3: Is so I think some patients do feel a little
Speaker 3: bit better with that extra T three as far as
Speaker 3: you know, feeling kind of like I feel normal again,
Speaker 3: I feel like I have my energy levels back because
Speaker 3: they're getting T four and T three.
Speaker 4: So remember T four is what the thyroid pumps out naturally,
Speaker 4: and then it's up to your body to convert it
Speaker 4: to T three. As for what your body is making
Speaker 4: and what medications might work best on you, if you're hypothyroid.
Speaker 4: There's that levothyroxine or the natural desiccated thyroid made from pigs.
Speaker 4: It's just what it sounds like. It's from ground up
Speaker 4: pig parts. Now, I have had some thyroid problems in
Speaker 4: the past that have now resolved, But I did take
Speaker 4: desicated pig thyroid for a while, and it has kind
Speaker 4: of a subtle flavor, kind of like a boiled pork
Speaker 4: chop water. Why put it in your mouth, you're asking
Speaker 4: the universe well. A twenty twenty four Frontiers in Endochronology
Speaker 4: paper titled Inquisitively Natural desicated Thyroid for the Treatment of
Speaker 4: Hypothyroidism noted that people with hypothyroidism who don't respond to
Speaker 4: levothyroxine T four are prescribed a natural desicated thyroid preparation
Speaker 4: which contains that mixture of T four and T three,
Speaker 4: but it could vary between batches. You're not quite sure
Speaker 4: what you're getting, and so that natural desicated thyroid may
Speaker 4: be better for some patients with hypothyroidism, but it's not
Speaker 4: the first go to for doctors in the US, especially
Speaker 4: because it's technically not green lit by the FDA, and
Speaker 4: it may not be right for some people. Who have
Speaker 4: heart disease or thyroid cancers or diabetes, and if crunched
Speaker 4: up pork thyroid is not for you, the paper does
Speaker 4: offer the suggestion of bovine thyroid for individuals who for
Speaker 4: religious or cultural reasons don't eat pork.
Speaker 3: Still not vegan, and so there's no right or wrong
Speaker 3: answer to this, Honestly, it's a lot of it that
Speaker 3: just deals with what the patient feels best taking. But
Speaker 3: there are two camps. With the natural desicated pick thyroid.
Speaker 3: It's hard to know exactly how much hormone you're taking
Speaker 3: in because it comes in granules and you don't know
Speaker 3: exactly how much hormone is in each granule per se,
Speaker 3: so it's not as well kind of calibrated. And that's
Speaker 3: why many of us don't feel comfortable giving it because
Speaker 3: I don't know if you're how much actually getting. Yeah,
Speaker 3: but if the patients feel well and they like it
Speaker 3: and they're doing well, then I think most physicians are
Speaker 3: okay with it.
Speaker 4: Okay, what about infections like does epstein bar have an
Speaker 4: effect on thyroid? Does covid have an effect on thyroid?
Speaker 4: Or is that just part of the pot like an
Speaker 4: autoimmune response?
Speaker 3: So, but yes, I mean, so it is part of
Speaker 3: the autoimmune response, but was the autoimmune response triggered by
Speaker 3: the virus And the answer is probably yes. Viral pathogens
Speaker 3: in general have been known to trigger autoimmune responses, and
Speaker 3: the Steinbar has been one that's been written about and
Speaker 3: people have studied it, and there is some data to
Speaker 3: support that it can trigger an autoimmune virat response.
Speaker 4: EBV or the epstein Bar virus is mono aka the
Speaker 4: kissing disease, which in my case, you can get in
Speaker 4: your twenties without even kissing anyone, but by sipping a
Speaker 4: friend of a friend's plumb wine at a party and
Speaker 4: then regretting it for the rest of your life, which
Speaker 4: is how long EBB stays in your body.
Speaker 3: It's fascinating and what we're looking at right now here
Speaker 3: in our institution and why we're actually looking at COVID
Speaker 3: and we've actually seen probably close to a dozen patients now,
Speaker 3: some after they actually got COVID, so they're exposed to
Speaker 3: some form of COVID antigen that had hyperthoritism transient. Really,
Speaker 3: so one of our own, you know, medical students here
Speaker 3: actually ended up with hypertheritism after COVID hyper hyper really Yeah,
Speaker 3: because it triggered some form of autoimmune response. It actually
Speaker 3: triggered the theory plan to make more hormone.
Speaker 4: So can an autoimmune response happen kind of with any
Speaker 4: exposure to a virus, and that it just says, hey,
Speaker 4: immune system, like, let's kick into gear.
Speaker 3: Exactly one of the you know, kind of theories out
Speaker 3: there at least, this is why women tend to be
Speaker 3: more prone to autoimmune disease. And it's a theory and
Speaker 3: nobody really knows perfect, but there are some data to
Speaker 3: support environmental toxins. Right, So, some certain environmental toxins, synthetic estrogens, cosmetics,
Speaker 3: you know, some chemicals are involved in some of those
Speaker 3: products can trigger an autoimmune response. And so I don't
Speaker 3: want to tell people not to, you know, use synthetic
Speaker 3: estrogens or cosmetics. But I'm just like, there are some
Speaker 3: thoughts out there that say that maybe that's why women
Speaker 3: are more exposed to somebody's environmental toxins which may lead
Speaker 3: them to develop these autoimmune problems.
Speaker 4: I used to drink my tea out of a plastic
Speaker 4: cup from the nine nine sens store hot Tea. Sometimes
Speaker 4: I think, wow, that was a terrible decision. I didn't realize.
Speaker 4: I was making every day sure that cup didn't break,
Speaker 4: but my body.
Speaker 3: Did and then you microwave it. So it's great, Yeah,
Speaker 3: that's fine, Absolutely fine, Absolutely fine.
Speaker 4: What about nodules? When I think of thyroid nodules, I
Speaker 4: think of like little like lumps and beads, and I'm like,
Speaker 4: do you pop them? What's going? What are they? Exactly?
Speaker 3: Now you're this is this is what I do on
Speaker 3: a day to day basis. Thyroid nodules. They're basically growths
Speaker 3: in the thyroid gland. Do you want to think of
Speaker 3: that it's a small tumor. So I like to think
Speaker 3: of thyroid nodules as as a true abnormal growth. Now,
Speaker 3: it doesn't mean it's cancer. Most of these, as a
Speaker 3: matter of fact, over ninety five percent of them are
Speaker 3: going to benign. Most diroy nodules are benign okay, But
Speaker 3: a small percentage of them can be malignant or a cancer.
Speaker 3: And so when you have a patient has a thyroid nodule,
Speaker 3: it needs to be appropriately evaluated.
Speaker 4: And what do you do do you stick a needle
Speaker 4: in there and check it out?
Speaker 3: Well, the first you're going to do is obviously examine
Speaker 3: the patient, get the appropriate history, ask the appropriate questions
Speaker 3: that they're having difficulties swallowing breathing, if they have any
Speaker 3: changes in their voice. Because a nodule, depending on where
Speaker 3: it is and what type of nodule it is, it
Speaker 3: could be compressing other vital structures in the neck. The
Speaker 3: nerve that controls your vocal cords and your voice runs
Speaker 3: right behind the thyroid glands. So it's very sensitive to
Speaker 3: any kind of thyroid disease. Oh yeah, so it's one
Speaker 3: thing that we really, you know, we really are worried about.
Speaker 3: Once you've done the appropriate evaluation, usually it's a ultrasound
Speaker 3: first thing. Okay, So look at a thyroid nodule. So
Speaker 3: you get an ultrasound exam, which is very easy to do.
Speaker 3: The thyroid is very superficially, you get a good look
Speaker 3: at the thyroid nodule, and then based on certain findings
Speaker 3: or characteristics of the nodule, you'll get an idea that
Speaker 3: nodule looks like it's benign, we don't need to stick
Speaker 3: a needle in it, or that nodule looks kind of concerning,
Speaker 3: let's stick a needle in it, okay, And so that's
Speaker 3: what we used to kind of decide what's.
Speaker 4: Under the microscope when you scored out whatever was in
Speaker 4: the needle cells.
Speaker 3: So we we do a needle biopsy, which I do
Speaker 3: in the office on a regular basis, and we put
Speaker 3: the needle into the nodule so we can see exactly
Speaker 3: where the needle's going, and we basically stuck out a
Speaker 3: couple of cells, put them on a slide, send them
Speaker 3: to our pathologists who will take a look at it
Speaker 3: and tell us what they see. And if they say
Speaker 3: these cells are benign and not concerning, then we'll probably
Speaker 3: just tell the patient, let's get another ultrasign in six months.
Speaker 3: Let's make sure it's not increasing in size or causing
Speaker 3: any problems.
Speaker 4: So if it's benign, they'll keep checking, maybe a couple
Speaker 4: times a year. But what if it's not great news.
Speaker 3: And if they call us back and say there's malignant cells,
Speaker 3: then we talk about surgery.
Speaker 4: Do you numb it up before you put the needle in.
Speaker 3: There, That's that's a great question. So we still do
Speaker 3: that all the time, always numb it up right. And
Speaker 3: I've had a couple of patients now that complain that
Speaker 3: the numbing medication actually hurts more than the actual needle
Speaker 3: does so because it gliadicated burns and the needles is
Speaker 3: such a small fine needles. It's what we call a
Speaker 3: twenty seven gage needle. It's actually than the needle that
Speaker 3: we used to draw blood.
Speaker 4: Oh is it somewhere in between a blood needle and
Speaker 4: like an acupuncture situation. Yeah.
Speaker 3: Most patients, honestly, like if I tell them, you know,
Speaker 3: here's a needle, they'll feel like I've felt like a
Speaker 3: small little.
Speaker 4: Pinch, but okay, not even painful. Oh, so don't freak
Speaker 4: out if you got a nodule, You're not freak out. Yeah,
Speaker 4: just and you said, what percentage would you say, are benign.
Speaker 3: Versus ninety five percent benign?
Speaker 4: That's what I thought you said. And then I thought
Speaker 4: there's no way I couldn't I could have heard that, right, Okay.
Speaker 3: So most diroy nodules are not cancerous.
Speaker 4: But you want to get them checked out in case
Speaker 4: they are, because that is not a good situation. If
Speaker 4: they are absolutely okay, when it comes to getting them out,
Speaker 4: do you just remove the nodule or do you have
Speaker 4: to take a chunk of thig roide?
Speaker 3: And this I love these questions. These are like these
Speaker 3: these are the question I get every day.
Speaker 4: I said, I figured, these are things either you think
Speaker 4: about when you're in the room or you're taking this
Speaker 4: subway home, and you go I.
Speaker 3: Should ask that question, know right, No, that's a fantastic question. Unfortunately,
Speaker 3: you can't just pluck the nodule out of the because
Speaker 3: one is it's embedded in the thyroid tissue. And two
Speaker 3: if it is a cancer, then you want to do
Speaker 3: a good operation. You don't want to leave any cancer
Speaker 3: cells behind. If you're just plucking the nodule out, there's
Speaker 3: a good chance that you may disrupt a nodule, that
Speaker 3: you may leave tumor behind, and then you have to
Speaker 3: go back potentially do another operation, which could be even
Speaker 3: more difficult because then you have scar tissue and the
Speaker 3: patient's already had one operation there before.
Speaker 4: So you can't pluck a thyroid nodule out like a
Speaker 4: pearl in an oyster. Doesn't work that way. That's news
Speaker 4: to me.
Speaker 3: So the right thing to do is actually remove that
Speaker 3: portion of the thyroid. It doesn't mean you need to
Speaker 3: your entire thyroid removed. As a matter of fact, I
Speaker 3: would argue that most thyroid surgeons now, unlike maybe even
Speaker 3: ten years ago, try to be more minimalistic as opposed
Speaker 3: to maximalistic in the sense that we don't try to
Speaker 3: take out the entire theories. If I can preserve as
Speaker 3: much thyrot tissue as possible, I'll preserve it. So I'll
Speaker 3: take out half your theiroid if I can, and try
Speaker 3: to preserve the rest of the theroid. So hopefully you'll
Speaker 3: can tinue to make enough hormone. Did you won't even
Speaker 3: need medication?
Speaker 4: Oh? I know people probably want to keep the nodule.
Speaker 4: Are you ever like, sorry, buddy, I gotta send this
Speaker 4: down to the lab.
Speaker 3: Yeah. They always want to take it home.
Speaker 4: I mean I recently had a hysterectomy and I was like,
Speaker 4: how much of this can I keep it?
Speaker 1: A gnar?
Speaker 4: And they're like, absolutely none of this zero. I lose
Speaker 4: mine ten minutes ago.
Speaker 3: It all gets unfortunate, get sent down to pathology because
Speaker 3: we need to know whether it's cancer or not or
Speaker 3: what stage it is, and so it all gets sent
Speaker 3: to pathologies. So no, you cannot take it home, but
Speaker 3: we can take a picture for you.
Speaker 4: That's nice. What percentage of people are like take a snap?
Speaker 3: Oh, I would say probably like thirty to forty percent Oh, yeah,
Speaker 3: they want to see what their thyroid looks like.
Speaker 4: I would want to see. Yeah, it's mine, after all.
Speaker 3: Well we'll take a picture.
Speaker 4: I think that's helpful. It's like when a mechanic is like,
Speaker 4: look at how bad your break pads. Good thing, you
Speaker 4: should have done it. What about let me see thyroid cancer?
Speaker 4: What causes the nodules? What causes a malignancy? Does thyroid
Speaker 4: cancer typically start as a nodule?
Speaker 3: Yes, So third cancers are third nodules that are malik Okay,
Speaker 3: got it.
Speaker 4: So it's not there's not a different kind of like
Speaker 4: spiderweb be cancer that starts.
Speaker 3: No. No, the fired cancers are basically thyroid nodules that
Speaker 3: are miligant nodules or thyrod cancers. It's actually one of
Speaker 3: I think one of the most interesting, and I'm not biased,
Speaker 3: I think is one of the most interesting cancers in
Speaker 3: human body. And the reason for that is really it
Speaker 3: really spans the entire spectrum from like being one of
Speaker 3: the most indolent cancers where the prognosis is excellent. So
Speaker 3: if you have what's called papillary thyroid cancer, classic popellary cancer.
Speaker 4: Like the woman shopping for the beach house on HGTV.
Speaker 3: The overall survival is ninety five twenty year survival. You
Speaker 3: almost don't get that in any cancer other than the
Speaker 3: small skin cancers. So you have on one end of
Speaker 3: the spectrum one of the most treatable cancers in the
Speaker 3: human body. And then you have something called anaplastic or
Speaker 3: undifferentiated thyroid cancers, which probably is the most aggressive thired
Speaker 3: cancer in the human body, with a basically a mortality
Speaker 3: of close to one hundred percent within six months to
Speaker 3: a year. So you really have this disease that spans
Speaker 3: this entire spectrum. Thankfully, the percentage of patients who have
Speaker 3: anaplastic cancer is very very low, and most patients have
Speaker 3: papellary cancer, which is very very treatable.
Speaker 4: Okay, so most people with thyroid cancer have a very
Speaker 4: treatable papillary type. Now antiplastic, that's diceier. It's pretty dangerous
Speaker 4: what happens if a person gets that diagnosis.
Speaker 3: So when you have a patient who has a malignant
Speaker 3: thyroid nodule thyroid cancer, most of these patients will undergo surgery.
Speaker 3: We have a program here now where we have an
Speaker 3: active surveillance program for really small thyroid cancers, but we
Speaker 3: won't even operate on the patients, will just follow them
Speaker 3: if if they're okay with that. We have a lot
Speaker 3: of minimally invasive ways of treating it. There are a
Speaker 3: lot of new technologies coming down the pipeline, interventional procedures
Speaker 3: where you can just stick a needle in it and
Speaker 3: ablate the cancer and do not even take out the
Speaker 3: thyroid anymore. One of my colleagues here does transoral thyroid surgery,
Speaker 3: so there's no scars in the neck. You could take
Speaker 3: out the thyroid through the mouth. There's a lot of
Speaker 3: like cool, real innovative, you know, new ways of doing things,
Speaker 3: but you know that requires you to see thyroid surgeon
Speaker 3: and go to a place where they have a direct
Speaker 3: program in place. Getting back to your question is so
Speaker 3: what causes this? So they're only really two known causes
Speaker 3: for thyroid cancer. One is genetic and familial. So we
Speaker 3: know that there are certain patients in whom it does
Speaker 3: run in their family and it's usually three first generation
Speaker 3: family members. So if you say, you know, my sister
Speaker 3: has diyroid cancer, my mother and my aunt all had
Speaker 3: thyroid cancer, and then you have it, it could be familiar.
Speaker 3: And the second one is radiation exposure. So, you know,
Speaker 3: in the early part of my career, we used to
Speaker 3: see a lot of patients who were exposed to Chernobyl.
Speaker 3: We have a huge Ukrainian population in Brooklyn, and so
Speaker 3: many of these patients, you know, they were say, yeah,
Speaker 3: I was, you know, I was somewhere in the Ukraine
Speaker 3: or in the southern border of Poland or Belarus. And
Speaker 3: they all remember, you know, when Chernobyl happened, and they
Speaker 3: weren't told what was going on, and they were all
Speaker 3: exposed to nuclear fallout, nuclear radiation, and we saw a
Speaker 3: lot of these patients had thyroid cancer. Wow.
Speaker 4: You know, with the earthquake in Japan in I want
Speaker 4: to say too that Yeah, March twenty eleven, my bad,
Speaker 4: there was a nine point zero undersea earthquake that led
Speaker 4: to a seaside nuclear reactor disaster. It was rated seven
Speaker 4: out of seven on the International Nuclear Event Scale, the
Speaker 4: worst since the Chernobyl disaster in nineteen eighty six, which
Speaker 4: also ranked a seven. Living on the West Coast, of course,
Speaker 4: there was more concern about radiation coming up with the Pacific.
Speaker 4: Our thyroid doctors are on coologists in general keeping an
Speaker 4: eye on that. Yeah.
Speaker 3: So Thankfully, we haven't seen any incidents at all from
Speaker 3: the Fukushima nuclear reactor meltdown, not even in Japan. There
Speaker 3: was very little radiation fallout from that, so thankfully, I
Speaker 3: don't think we're going to have any issues with that disaster.
Speaker 3: But if you notice, as soon as that happened, every
Speaker 3: single pharmacy on the West coast ran out of iodine
Speaker 3: really because people started hoarding the idine pills. Because you
Speaker 3: went in a pop eyedim as soon as you know
Speaker 3: the nuclear fallout, you take idone. You protect your thiroy
Speaker 3: exlam from getting thiroy cancer? Really? Yeah? Yeah?
Speaker 4: Is that why iodine pills are used in bunkers and stuff?
Speaker 4: Oh that's fascinating. I also can can iodine pills also
Speaker 4: be used to disinfect water? Or? Did I take? Okay? Okay,
Speaker 4: that's so interesting. Why does iodine protect against.
Speaker 3: It blocks the thiroid cells from obsorping the radiation. You're
Speaker 3: basically saturating your thyroid cells with iodine?
Speaker 4: Is that actually effective?
Speaker 3: Yeah? I mean it seems to help absolutely. I mean
Speaker 3: I mean even in ned the nuclear fallout in Chernobyl,
Speaker 3: I mean, you know, the people that knew what was
Speaker 3: going on, they started taking iodin bills.
Speaker 4: For no reason at all. I decided to bone up
Speaker 4: on what to do if World War three breaks out,
Speaker 4: and I found myself on the CDC site Radiation Emergencies,
Speaker 4: which let me know that a person must take potassium
Speaker 4: iodide before or shortly after being exposed to radioactive iodine,
Speaker 4: but before you risk feeling safe. The article mentions that
Speaker 4: this potassium iodide protects only against radioactive iodine. It doesn't
Speaker 4: protect against any other type of radioactive material, and then
Speaker 4: it breaks it to us gently that quote potassium iodide
Speaker 4: will not help in a nuclear bomb emergency. But I mean, hey,
Speaker 4: it's worth having these emergency tablets in your bug out bag,
Speaker 4: which we should all have. I mean, salt would be tastier,
Speaker 4: but you'd probably need a lot of super salt. Can
Speaker 4: I ask you listener.
Speaker 3: Questions please scoll less do But before we get to them.
Speaker 4: We'll donate to a cause chosen by doctor Patel, who
Speaker 4: selected the American Association of Endocrinsurgeons, and the AAES promotes
Speaker 4: research and education in the field of endocrin surgery to
Speaker 4: advance the science and the art of endocan surgery, so
Speaker 4: a donation was made to them. In doctor Petel's honor
Speaker 4: to further research in this area in your neck area.
Speaker 4: So thank you to sponsors of the show for enabling
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Speaker 4: Okay, your questions If you're a patron at patreon dot
Speaker 4: com slash ologies for just one dollar a month, you
Speaker 4: can submit these before we record, and we even have
Speaker 4: a tier to submit audio questions so you could hear
Speaker 4: your voice on the show, which is pretty sick in
Speaker 4: a good way. This is not your species. However, several
Speaker 4: people Timmy h Deborah Gray Scale bar Daniel Sucher, Devin,
Speaker 4: Jessica Chance. I mean a lot of people. Earl of
Speaker 4: Gramblekan Vanessa Adams Raikons wanted to know. In Devin's words,
Speaker 4: my vet once told me that kats in the seacoast
Speaker 4: this person is from Maine are more likely to develop
Speaker 4: hyperthyroidism overactive thyroid that is, were you aware of this
Speaker 4: through inner species thybroidologists? Ever chat and if cats on
Speaker 4: the sea coast are more likely to get it? Is
Speaker 4: that an iodine thing? You think?
Speaker 3: So the first part of your question is you know,
Speaker 3: you're you're probably They're probably right. We don't chat? We
Speaker 3: probably should? Yes, right, we should chat. This is fascinating.
Speaker 3: I need to talk to my vet. We have a
Speaker 3: nice little dog and yeah, so yeah, I you know,
Speaker 3: we don't chat with our veterinary colleagues unfortunately. Do I
Speaker 3: think it's related to I dine? Probably if I had
Speaker 3: to guess, As long as the cats are prone to
Speaker 3: you know, to other environmental toxins, as humans, we are not,
Speaker 3: you know, mm hmm.
Speaker 4: Earl of Gramblican said, I had a cat with hyperthyroidism
Speaker 4: who got the I one three one treatment and we
Speaker 4: had to keep her poop sequestered for a month.
Speaker 3: Yeah that's even for humans too.
Speaker 4: Actually, well, okay, this was my next question.
Speaker 3: Your poop for one mon I mean, but just a
Speaker 3: quest to yourself.
Speaker 4: Just get that box, go right to peco. So I
Speaker 4: checked out the Cornell School of Veterinary Medicines article feline hyperthyroidism,
Speaker 4: and ninety eight percent of the time it's benign. It's
Speaker 4: just from an enlargement in a kitty's thyroid as it ages.
Speaker 4: And treatment can involve restricting iodine in the diet, which
Speaker 4: also includes any outdoor hunting, which is good because that's
Speaker 4: bad for birds and lizards and such anyway, and other
Speaker 4: treatments might include surgical removal of the thyroid and yes,
Speaker 4: radioactive treatment, which cures ninety five percent of feline hyperthyroidism
Speaker 4: with one shot. But yeah, avoid that poop for as
Speaker 4: long as the vet tells you. Now, what about geography
Speaker 4: and your pets thyroids? So the Banfield Science and Quality
Speaker 4: News publish an article titled Feline hyperthyroidism common in Northwest
Speaker 4: and East Coast and it detailed that Yeah, the Pacific
Speaker 4: Northwest and the Eastern seaboard of the US have more
Speaker 4: kitty hyper thyroidism, but they don't know why. It could
Speaker 4: be that the cats there live longer than in southern States,
Speaker 4: maybe because of the weather, they might be kept indoors more.
Speaker 4: It could be dietary sources of too much iodine, could
Speaker 4: be endocrine disruptors in canned foods or scented kitty litter,
Speaker 4: or flame retardants. And only one hundred and seventy seven
Speaker 4: out of ten thousand cats will have the problem, though,
Speaker 4: and it's a relatively easy fix, So don't start sobbing.
Speaker 4: But you can hug your cat right now if it
Speaker 4: lets you so hyperthyroidism. Let's leave your kitty alone. Let's
Speaker 4: talk about the rest of your bod. Arilesenski, Sarah Man's,
Speaker 4: Dave Cannon, Hannahbale, Stephanie Lingard, Rachel May, sam Aker all asked,
Speaker 4: in Rebecca Fitchett's words, please talk about Graves disease with
Speaker 4: an exclamation point.
Speaker 3: Let's talk grapes.
Speaker 4: What's going on with it? What do you do? Where
Speaker 4: does radioactivity come into it?
Speaker 3: Absolutely so. Grave disease is kind of the opposite of
Speaker 3: Hashimoto's named after doctor Graves. For some scrived grave disease.
Speaker 3: And it turns out that in Graves disease, what's happening
Speaker 3: is you're you're actually a body is creating these what
Speaker 3: they call thyroid stimulating aminoglobulins, which is similar to the
Speaker 3: antibodies that your body makes, but these particular aminoglobulins end
Speaker 3: up stimulating your theoil as opposed to destroying your thyrol
Speaker 3: So in hashimoto is, your body is making antibodies that
Speaker 3: destroy the thyroid, and Graves disease, your body is making
Speaker 3: amminoglobulins that actually stimulate your thyroid. So grave disease is
Speaker 3: one of the most common causes of hyper thyroidism. And
Speaker 3: these are patients who present in the exact opposite fashion.
Speaker 3: They say that they're losing weight, they always feel hot,
Speaker 3: they have tremors, anxiety, they feel like their heart's racing,
Speaker 3: their eyes sometimes get a little bulgy, and that's all
Speaker 3: consistent with grave disease. And in those patients, your TSH
Speaker 3: level is going to be undetectable, it's gonna be super low.
Speaker 4: Remember that TSH is the inverse of how much thyroid
Speaker 4: function you actually have. If you're one step ahead, a
Speaker 4: low low TSH means what.
Speaker 3: And your T three and T four levels are going
Speaker 3: to be high, and so that's the way you make
Speaker 3: the diagnosis of Graves disease. The treatment for that, since
Speaker 3: your thyroid is hyperactive, is you take antithyroid medication, So
Speaker 3: you're actually taking drugs such as methemosol and PTU that
Speaker 3: actually block the thyroid from making thyroid hormone. And that
Speaker 3: medication works great, and so for a lot of patients
Speaker 3: that's all they'll need. Sometimes, if their heart is really
Speaker 3: racing fast, they may put the patient on a beta
Speaker 3: blocker to help reduce the heart rate, but for most
Speaker 3: patients that works really well. So the other two options
Speaker 3: for definitive treatment for Graves disease or radioactive iodine where
Speaker 3: you give the iodine. It's radioactive, the thyroid gland absorbs
Speaker 3: the iodine, and since it's radioctive, it kills the thyroid.
Speaker 3: So ultimately your thyroid's dead and you've treated the graves
Speaker 3: and you're probably gonna end up on thyroid medication for
Speaker 3: the rest of your life. Like leave it throxine because
Speaker 3: your theorid doesn't work anymore. And the other option is
Speaker 3: surgery take out the thyroid. So same exact result. You're
Speaker 3: taking out the thyroid, Your thiroi is no longer there,
Speaker 3: you no longer have graves, and now you're on thyroid
Speaker 3: medication or rest your life. But leave with thyroxene is
Speaker 3: such a safe drug that most patients would rather be
Speaker 3: on leave with theroxene than be on them with them
Speaker 3: asol or the other drugs that we treat or graves.
Speaker 4: Doctor Patel gives some advice if your doctor ops for surgery, if.
Speaker 3: You want to go somewhere for surgery, you want to
Speaker 3: go to a high volume center that does a lot
Speaker 3: of thyroid surgery with good results. Because also the same
Speaker 3: population of patients who want to get pregnant also don't
Speaker 3: want radiation, right because you take the ridictivide and you
Speaker 3: can't get pregnant for six months to a year.
Speaker 4: Yeah, I myself, if I had the chance to go
Speaker 4: night night and wake up with no thyroid versus sequestering
Speaker 4: myself with radioactivity, I would probably go night night and
Speaker 4: get a popsicle later. Why would someone choose the radioactivity, It's.
Speaker 3: Really a fear for surgery. Sometimes they don't want surgery.
Speaker 3: It could be a cosmetic thing. They may not want
Speaker 3: a scar you know, surgery does have his risks, right,
Speaker 3: There is risks of injury through the nerves that control
Speaker 3: your voice. There's injury potential injury to little glands called
Speaker 3: parathyroid glands that live next to the thyroid vector calcium level.
Speaker 3: So you know there are risks associated with surgery. But
Speaker 3: there are also risks with the radiactive iodine right right,
Speaker 3: it's radioactive. It can have fertility issues, it can cause
Speaker 3: other secondary malignant disease or cancers ten fifteen years down
Speaker 3: the line. So it's really it's a little bit of
Speaker 3: a what where the patient's comfort level falls. I would
Speaker 3: say the trend that we've seen here at least is
Speaker 3: more and more patients are opting towards surgery and less
Speaker 3: towards the radiactive viodine. But I think nationally still radiactividine
Speaker 3: is still pretty pretty common.
Speaker 4: Okay, what if you take the radioactive iodine, do you
Speaker 4: have to stay in any kind of lead bunker.
Speaker 3: No? Okay, the amount of iodine you're getting as minimal.
Speaker 4: So to treat Graves disease, it's not much radioactive iodine.
Speaker 4: But with thyroid cancer, you're bringing out the big guns.
Speaker 3: Those patients do have to be in quarantine for about
Speaker 3: a week, So for about a week, you know, they
Speaker 3: don't they can't go out in public, they can't be
Speaker 3: around pregnant women, they can't be around children. Everything. You
Speaker 3: kind of use your utensils, Probably disposable is better you
Speaker 3: want to it's a question in a certain space, you
Speaker 3: don't want to throw it on the regular garbage. So
Speaker 3: there's a whole protocol that we utilize for patients and
Speaker 3: we tell them how to kind of, you know, manage
Speaker 3: all their disposables. And you want to stay in a
Speaker 3: place that's kind of away from other people.
Speaker 4: What about betting and stuff like that.
Speaker 3: Yeah, I tell people, don't throw your beds away, don't
Speaker 3: throw your couches away. People do used to do that,
Speaker 3: got through everything away. But you know that to throw
Speaker 3: it away does a half life to radiation, right, just
Speaker 3: like does a half life to rate. So yeah, you know,
Speaker 3: once it's out of you, it's going to go out
Speaker 3: of your bed also, So yeah, maybe you may not
Speaker 3: want to use that bed for a few weeks, but
Speaker 3: then after that it's.
Speaker 4: Fine, Okay, Oh good to No, that's the idea that
Speaker 4: you're potentially turning into spider man is accepting now you
Speaker 4: know what kind of superpower is exactly if you are
Speaker 4: inspired to be the radioactive center of the Marvel universe,
Speaker 4: what do your labs have to look like? So many
Speaker 4: of you Daniel Johnston, Karen Kaala Brainley Mattea or Little Cside,
Speaker 4: Sarah Joe, Cassie Lebon, Caitlin Fitzgerald, Any Delas, Elliott, Brooklyn Baron,
Speaker 4: and Vanessa Adams all asked what's up with labs that
Speaker 4: are in the normal range but you still feel awful
Speaker 4: whether it's hypo or hyper? So did Elliott feeling first
Speaker 4: time question asker hyperthyroidism and Graves disease have her here
Speaker 4: wondering what exactly are those normal ranges and what's the
Speaker 4: difference between T four T three or rather in the
Speaker 4: free versions of them.
Speaker 3: Yeah, so the free versions just because the way the
Speaker 3: laboratory studies are designed, often these these molecules bind with
Speaker 3: other proteins. So the free version is just in theory,
Speaker 3: is supposed to be more accurate. The blood test that's
Speaker 3: actually the most important for it's still the TSH level
Speaker 3: because that's what the body is sensing right as your
Speaker 3: thyroid levels. That's what the brain. Your pituitary plan is
Speaker 3: is making TSH based on what it's sensing. You know,
Speaker 3: the need is because your T three and T four
Speaker 3: levels can vary even during times of stress or during
Speaker 3: times of a day, so you know it's not as
Speaker 3: consistent as your TSH level is going to be. So
Speaker 3: TSH is probably the best test for thyroid function. The
Speaker 3: range is a variable range, right, even from one to four,
Speaker 3: and it states making what lab you use could be
Speaker 3: a normal range. But the way I like to talk
Speaker 3: to my patients about this is that these are kind
Speaker 3: of population based ranges. But for each individual person, you know,
Speaker 3: just because you're in the normal range and your TSH
Speaker 3: maybe three, it's in a normal range, but you may
Speaker 3: still not feel well, yeah yeah, free because for you,
Speaker 3: maybe one is the normal, right, And so I think,
Speaker 3: you know, we have to treat each patient individually. So
Speaker 3: ranges are wonderful to have just to get an idea
Speaker 3: of whether somebody's falling and where they should be falling.
Speaker 3: But I don't go crazy overlooking at the exact number.
Speaker 3: Per se. If I have a patient who has a
Speaker 3: TSH of four but they feel fantastic, I probably won't
Speaker 3: give him firre and medication. They feel great. What am
Speaker 3: I treating? Yeah? You know?
Speaker 4: Why is Patrick? Jeffy wanted to know why is the
Speaker 4: normal range so.
Speaker 3: Long as Patrick? The actors?
Speaker 4: I don't know to ask, that would be amazing all Instagram. Sure,
Speaker 4: he's an actor from the nineteen eighties soaproper Dallas, which
Speaker 4: was its yellowstone of the era. But anyway, why is
Speaker 4: that normal range so large?
Speaker 3: Because it's a population straight, so it's for you know,
Speaker 3: looking at millions of people, you have a larger range.
Speaker 3: So if you have a TSH that's around three or four,
Speaker 3: which is a little bit on the higher side, you
Speaker 3: may still be slightly hypothyroid, but your blood work would
Speaker 3: be in the normal range.
Speaker 4: Do people then say, Okay, my TSH is normal, let's
Speaker 4: check the T three and teth.
Speaker 3: Yeah, we can do that and all likely if your
Speaker 3: TSH is normal, your teeth are probably going to be normal.
Speaker 3: And if you're still not feeling well, I think it's
Speaker 3: time to do other work up just to make sure
Speaker 3: they're not other issues, and make sure they're not anemic,
Speaker 3: and make sure they're not other things that are going on.
Speaker 4: And don't blame the thyroid.
Speaker 3: Don't blame the thyroid for everything. I should make t shirtspla.
Speaker 4: It's like, get off my back, off the thyroid. I
Speaker 4: would love to know. What about the metabolism. Is it
Speaker 4: the temperature gauge that is speeding it up? Is your
Speaker 4: body converting more energy to heat? Is that what's really
Speaker 4: contributing to the fluctuations.
Speaker 3: It's your ability to convert your food into energy. Right,
Speaker 3: So you know your cells at the cellular level, that's
Speaker 3: a whole oxidative process that occurs down at the mitochondria
Speaker 3: and at the cellular level, and it's the process of
Speaker 3: how much energy you are producing is regulated by the
Speaker 3: thyroid hormone. It's not even like your temperature level. Yeah,
Speaker 3: it's all regulated, but that's like the end product of
Speaker 3: what's going on at the cellular level. You're seeing an
Speaker 3: increase in energy expenditure across the board. So, like I said,
Speaker 3: your heartbeat would go up, your digestive system, your nervous system,
Speaker 3: everything is affected by that. So all of that encompasses
Speaker 3: what we call metabolism.
Speaker 4: Okay, so we have a whole episode on metabolism, the
Speaker 4: Evolutionary Anthropology episode with doctor Hermann Poncer. But some of
Speaker 4: y'all wanted to know if what you're eating, like cutting
Speaker 4: out inflammatory foods can help your thyroid get his shit
Speaker 4: together and I'm looking at you first time question askers
Speaker 4: Mikaela Ballard and Marianne Mazinski, Kelly Paul Felicia Chandler. A
Speaker 4: bunch of people wanted to know can diet help man
Speaker 4: thyroid issues? Amy wants to know, Amy Johnson, any support
Speaker 4: for the Autoimmune Protocol diet helping reduce inflammation levels with hypothyroidism.
Speaker 4: Any suggestions on foods you should avoid or you should eat.
Speaker 3: Since a lot of thyroid diseases autoimmune based, anything that
Speaker 3: you can do to decrease that kind of stress and
Speaker 3: your immune response can be potentially beneficial. So there are
Speaker 3: a lot of diets out there that are designed to
Speaker 3: decrease inflammation. I would definitely talk to a nutritionist or
Speaker 3: somebody who is more of an expert in that area.
Speaker 3: But my recommendation to my patients is, yes, you know,
Speaker 3: try to find a diet does work for you. I
Speaker 3: know there are a lot of things that if I
Speaker 3: decrease gluten and I get rid of this and eat
Speaker 3: more of that, try it. I mean, if it works
Speaker 3: that's fantastic. And I have had patients who had hashimotos
Speaker 3: thyroiditis and they change their lifestyle to be sleeping better,
Speaker 3: eating better, exercising, and you do see their antibodies go down.
Speaker 3: So whatever trigger there was that was causing it, you
Speaker 3: know you maybe you can try to undo some of
Speaker 3: that with your lifestyle. Is a curative? Hard to say.
Speaker 4: Would like alcohol and sugar also be included in that?
Speaker 3: Yeah, I'm meaning that up. I think sometimes not just
Speaker 3: the alcohol and sugar. I mean sometimes you know, you
Speaker 3: may be drinking and eating a lot of sugar because
Speaker 3: you're stressed. And so what comes first, right is the
Speaker 3: chicken of the egg kind of thing, right, And so
Speaker 3: if you decrease your stress levels, maybe that may help
Speaker 3: your immune system.
Speaker 4: That was my next question, Also on the minds of
Speaker 4: Maya Lecer who's a Graves disease Haver, Danielle Bowers, Anti Doulas,
Speaker 4: and Annie Sayers, who asked can stress make an underactive
Speaker 4: thyroid worse? Jen Oh wanted to know. So many symptoms
Speaker 4: associated with hypo or hyperthiroidism seem like they could also
Speaker 4: be caused by stress or other common mental or physical issues.
Speaker 4: When should a person start to suspect thyroid issues specifically
Speaker 4: and prompt a discussion with their physician, especially without being
Speaker 4: looked at as a hypochondriac who spends too much time online.
Speaker 4: Listening to that, they ask amazing question, but yeah, how
Speaker 4: much is stress and common mental or physical issues? How
Speaker 4: much does that have like an effect down the line?
Speaker 3: I think it does. I mean, you know, we're just
Speaker 3: learning more about this, you know, over the last ten
Speaker 3: twenty years. I think we're realizing how much our mental
Speaker 3: status plays a role in our immune system. Right, people
Speaker 3: that are depressed and don't feel well tend to get sick.
Speaker 3: The immune system gets weaker, and so there's definitely a
Speaker 3: lot of interplay between the two systems, you know. To
Speaker 3: answer her question, I think the easiest thing to do
Speaker 3: is to get your third function tests, right, get a
Speaker 3: blood test, see what your third levels are. If your
Speaker 3: they is if you're all your thiry levels are normal,
Speaker 3: then it's probably not your thiry planet, which point I
Speaker 3: would investigate further into, you know, what your mental health
Speaker 3: is and what else is going on stressors, et cetera,
Speaker 3: to see if that can help.
Speaker 4: Kelly Shaver had a funny question. They said, I'm fat,
Speaker 4: and every doctor I have keeps insisting on doing blood
Speaker 4: tests even though they're always fine. Why are they so
Speaker 4: obsessed with my thyroid?
Speaker 3: Yeah? I'm not sure why, but but you know, majority
Speaker 3: of our of our OBESIT issue in this country is
Speaker 3: not diroid related, right, There are so many other factors
Speaker 3: once again, that go into that as well, And so
Speaker 3: I think you know, if once you've ruled out the
Speaker 3: thyroid gland, you can kind of put that aside and
Speaker 3: it's probably not the thyroid and then focus on what
Speaker 3: other issues may be going on metabolically, because yes, diarid
Speaker 3: hormone is an integral component of your metabolism and when
Speaker 3: it's not functioning properly, it can affect your metabolism. But
Speaker 3: once again, metabolism is also based on other things as well, So.
Speaker 4: Right, so it's keep looking. If you suspect that there's
Speaker 4: something else going on, there are other tests to move
Speaker 4: on to. Right, Okay, I thought this was a great
Speaker 4: question Tiger Beauty and Greg Wallach. Greg asked, can you
Speaker 4: have Queen Anne eyebrows and your thyroid be fine? And
Speaker 4: Tigerauty wants to know do thin eyebrows really lean toward
Speaker 4: poor thyroid function. The last half of the eyebrow sort
Speaker 4: of pieces out early from what I understand, And I
Speaker 4: have a friend whose mom was like, never pluck your eyebrows. Never.
Speaker 4: Mine never grew back in the last portion. And then
Speaker 4: it turned out, she said, thyroid disease. I know, I'm
Speaker 4: checking my tails. I'm checking my tails.
Speaker 3: Yes, I mean hair loss in general is associated with
Speaker 3: thyroid disease, right, dry skin hair loss, and so the
Speaker 3: combination of the two may affect your eyebrows.
Speaker 4: I understand that there is a lot of blame for
Speaker 4: nineties eyebrows. When really get your thyroid check, I'll have
Speaker 4: to I'll have to do a little bit of an
Speaker 4: aside of that. Okay. This symptom is called eyebrow hypotrichosis,
Speaker 4: and a twenty twenty three paper titled Eyebrow Loss and
Speaker 4: the Queen and Sign in Hypothiritism said that loss of
Speaker 4: the outer third of the eyebrows is called the Queen
Speaker 4: Anne sign and it's an uncommon manifestation of hypothiritism. However,
Speaker 4: the exact mechanism of eyebrow loss only at the outer
Speaker 4: third portion, it's unknown. They don't know why it happens,
Speaker 4: and clinicians should consider hypothyroidism as a diagnosis for patients
Speaker 4: presenting with that loss of the outer third of the eyebrows,
Speaker 4: despite the fact that it doesn't happen very frequently. And
Speaker 4: I was like, who's Queen Anne? So this is named
Speaker 4: after Anne of Denmark, who was a sixteenth century hottie
Speaker 4: who was a patron of the arts and noted to
Speaker 4: be a woman of boundless intrigue, although others called her
Speaker 4: frivolous and self indulgent, and those people are haters. But
Speaker 4: according to her official portraits, her eyebrow tales were like
Speaker 4: seeya and the reason for that is lost in the
Speaker 4: sands of time. Maybe she was hypothyroid, maybe not. So
Speaker 4: it's possible if you didn't overpluck the outer tails of
Speaker 4: your eyebrows. But they are miia and you're also feeling cold, constipated,
Speaker 4: and dry all over. You might want to get that
Speaker 4: thyroid checked now. If you overplucked and you know it,
Speaker 4: let me direct you to the twenty twenty three Live
Speaker 4: Science article why don't overplucked eyebrows fully grow back? Which
Speaker 4: essentially says that you abused the follicles so much they
Speaker 4: don't want to come back to your eyebrow party. Like
Speaker 4: you know how sometimes old guys who wear tube socks
Speaker 4: for decades have bald shins. It's like that, but now
Speaker 4: you have like permanent Kate Moss eyebrows. Now there are
Speaker 4: worse things, but yeah, we have a whole episode on
Speaker 4: the drama of hair called trichology. Now browsebe damped. Let's
Speaker 4: talk about other hormones in the tomato soup of your body.
Speaker 4: Kara Young asked, is there a difference in thyroid functions
Speaker 4: between males assigned at birth and females assigned a birth.
Speaker 4: Midnight Cat and Brecon's also asked about female hormone systems
Speaker 4: and thyroids and what about jay ramsbaldlunch. Now, are there
Speaker 4: any thyroid implications for people assigned female at birth who
Speaker 4: are taking testosterone for gender affirming care? Does hormone replacement
Speaker 4: therapy have any role in thyroid issues? Yeah?
Speaker 3: I think in general, whenever you're doing any kind of
Speaker 3: hormone therapy or any hormonal changes in your body, your
Speaker 3: thyroid needs to be followed. And the prime example that
Speaker 3: is obviously during pregnancy. Right, so many women during pregnancy
Speaker 3: end up on thyroid medication. Really yeah, yeah, you get
Speaker 3: pregnancy induced hashimotos, not really hashimotive pregnancy deduced hypothyroidism.
Speaker 4: And even before pregnancy, hypothyroidism or low levels of T
Speaker 4: three can disrupt ovulation and egg release and hinder the
Speaker 4: ability to conceive, or if underlying causes like a pituitary
Speaker 4: issue or autoimmune disease is causing the hypothyroidism, it might
Speaker 4: also be thrown a wrench and getting a baby in there. Respectfully,
Speaker 4: speaking to those who asked, Rene Winger, Matty Dennison, Sarah
Speaker 4: Cassie Kenton, Danielle Sucher, and Amber McIntyre, why during pregnancy
Speaker 4: your thyroid can also cause a bit of a hullabaloo.
Speaker 3: So one of the few things that every obstrician is
Speaker 3: going to check during pregnancy is going to be just
Speaker 3: stational diabetes and your thyroid levels because those hormonal changes
Speaker 3: can affect your thyroid function. And so if you're undergoing
Speaker 3: any kind of hormonal therapy, I think it's smart just
Speaker 3: to get to a B eastline thyroid function tests and
Speaker 3: then while you're undergoing that therapy, just check the thyro
Speaker 3: to make sure it's not being affected.
Speaker 4: As someone who is on all kinds of hormones, who
Speaker 4: hasn't checked right? Can it go with the wind?
Speaker 3: Like?
Speaker 4: Are you typically on a trajectory where if you have
Speaker 4: a thyroid issue, it's never going to resolve on its own.
Speaker 3: No, I would say so when you have, for example,
Speaker 3: patients that show with Graves disease often knows come see
Speaker 3: me and they've had it like two or three months,
Speaker 3: and I'll tell them wait six months to a year,
Speaker 3: because it may resolve on its own. It may go away.
Speaker 3: Your body may whatever triggered it that you may untrigger
Speaker 3: at some point.
Speaker 4: So if your body calms down somehow and stops over
Speaker 4: provoking your poor exhausted, overworked thyroid, things can chill and
Speaker 4: return to normal pretty suddenly, which is a big ya.
Speaker 4: And for those on the other end of the seesaw
Speaker 4: whose TSH is too high and the thyroid function is
Speaker 4: hypo or low.
Speaker 3: In general, though, if you have somebody who's headed towards
Speaker 3: hashimotos where you know they already have the antibodies and
Speaker 3: your TSA just slowly going up and all likely they'll
Speaker 3: probably end up on thired medication at some point. But
Speaker 3: you know, once again, you know your thyroid function varies
Speaker 3: depending on what else is what other stressors are on
Speaker 3: you're going on in your life?
Speaker 4: What about ways to prevent thyroid nodules? And I'm asking
Speaker 4: literally for a friend who has them. Aaron, I got
Speaker 4: your back. She's like, I got another one. They got
Speaker 4: to go check out anything that she can do in
Speaker 4: her power.
Speaker 3: Third, nodules are really unfortunately, there's nothing you can do.
Speaker 3: There's nothing you do to cost thyroid nodules. Like I said,
Speaker 3: they can be genetic at times, they do run in families,
Speaker 3: and sometimes your thyroy glein is just prone to developing nodules.
Speaker 3: You know, some people get a very insists, some people
Speaker 3: get you know, there are many parts of your body
Speaker 3: that just tends to develop nodules and systs. But yeah,
Speaker 3: I mean, my only advice would be just to do,
Speaker 3: you know, annual testing, annual screening, just to make sure
Speaker 3: that none of these nodules are getting larger or none
Speaker 3: of them are starting to look suspicious.
Speaker 4: Can you when you power by the thyroid, can you
Speaker 4: really feel if there's.
Speaker 3: A nodule in there, if it's large enough, absolutely anything
Speaker 3: anything over you know, one to two centimeters, you should
Speaker 3: be able to feel. It depends on patient's neck their
Speaker 3: body side, if they have a larger neck and maybe
Speaker 3: a little bit harder to feel, but for the most part,
Speaker 3: if they have a large enough nodule, you should be
Speaker 3: able to feel it. The thyro glin is so anterior,
Speaker 3: it sits so out in the front of your neck.
Speaker 3: It's easy to feel.
Speaker 4: So BFF and recent birthday girl Aaron and patrons emmarn
Speaker 4: Lydia trom and Addie Cappello who says mine is just chillin.
Speaker 4: But I know they can become a problem for others.
Speaker 4: Keep an eye on them. Do people ever come in
Speaker 4: with just lymph nodes that are one hundred percent and
Speaker 4: they're like, I have cancer And you're like, that's a
Speaker 4: lymph node.
Speaker 3: You're good totally, but you have to make sure it's
Speaker 3: a benign node, not a not a cancerous node. Right,
Speaker 3: So we do see patients will present the lymph node
Speaker 3: lower in the neck and it's big, and those patients
Speaker 3: do worry me and scare me because that's probably a
Speaker 3: cancer that's spread, right, and so they'll probably stick a
Speaker 3: needle in it and see what's going on.
Speaker 4: You mentioned earlier thyroid cancer they could have spread. Are
Speaker 4: those like endometrioses is it like, is it like bits
Speaker 4: of thyroid tissue that are around that respond to radioactive
Speaker 4: iodine or so.
Speaker 3: The reason why the prognosis for papillari thyroid cancer so
Speaker 3: great and the patients do so well is because once
Speaker 3: we take out their cancer, we can actually treat them
Speaker 3: with the iodine. So even if the cancer is spread
Speaker 3: to the lungs to the bones, you give them the
Speaker 3: radiactive iodine, the idem will get into those cells and
Speaker 3: kill them. And so that's why the prognosis for thyroid
Speaker 3: cancer remains excellent. That's when I tell my patients, I'm like, yeah,
Speaker 3: you know, even if you do have cancer that spread,
Speaker 3: we can still treat you and you should still do
Speaker 3: very well.
Speaker 4: As opposed to like radiation gamminite for something that can
Speaker 4: just zap one area, this can actually systemically go and
Speaker 4: find it in.
Speaker 3: This is systemic. This is better than any chemotherapy out there.
Speaker 3: This specifically targets thyroid cancer cells and kills them nice.
Speaker 4: It's like they're kryptonite. I know, what about libido and thyroids.
Speaker 3: Yeah, that's a good question. I mean, you know they're
Speaker 3: not Your sex hormones are not directly related to the
Speaker 3: thyroid glam but if you are hypothyroid, you'll probably have
Speaker 3: a decreased libido. And like I said, it may not
Speaker 3: be a direct relationship. But if you're a fatig, do
Speaker 3: you have no energy, you don't feel well, you're tired.
Speaker 4: Do people with Graves disease get hornier?
Speaker 3: That's a graad And you're going to ask me that
Speaker 3: question next time.
Speaker 4: I didn't need to.
Speaker 3: It's curious, not that I know. Okay, they may also
Speaker 3: be really tired.
Speaker 4: Away right exactly? Yeah, what kind of a heart rate
Speaker 4: do you have if you've got Graves?
Speaker 3: It could be pretty high. Think, Yeah, people who have
Speaker 3: really bad hyperthiorism, they can have a pretty high That's
Speaker 3: what these patients often go on beta blockers. Heart rate
Speaker 3: go up to one twenty, one thirty, I've seen one fifty.
Speaker 4: Do you find that now that people have fitness trackers
Speaker 4: and I've got an aura ring that checks my heart
Speaker 4: rate Apple watches? Do you think people come in with
Speaker 4: more data being like, what the hell's up with this?
Speaker 3: One hundred percent? I've had patients who can track their blood.
Speaker 3: They show me their numbers, you know, like it was
Speaker 3: one ten, that's one twenty. Sometimes, you know, I don't
Speaker 3: know how accurate the data are. Yeah, but it's nice.
Speaker 3: It's actually it's actually a good tool, right because the
Speaker 3: more information we have, the more we can act upon.
Speaker 3: You know, we can see trends, is it happening more
Speaker 3: often a certain time of the day, what else is
Speaker 3: going on that time of the day, So, you know,
Speaker 3: it's good. I think those devices are actually very helpful.
Speaker 4: Right, Well, Okay, one more question Mercedes Teresovich Hannah at
Speaker 4: Serano Hudson. What's the connection between hypothiroidism and chronic uticaria
Speaker 4: which are hives? Right? What's up with hives and thyroids?
Speaker 3: I think it's all related to your immune system. Once again,
Speaker 3: it's autoimmune, right, So if you have hypothyroism from autoimmune thyroiditis,
Speaker 3: which is Hashimoto's. Once again, these are all kind of
Speaker 3: other side effects of the autoimmune process that's going on.
Speaker 3: So the dry skin, the hair falling out, the hives,
Speaker 3: these are all autoimmune problems. Right. This isn't a generalized
Speaker 3: immune thing that's where you get It's not like hives
Speaker 3: in one area. It's not like a contact dermatitis where
Speaker 3: you were allergic to something, you touched it and you
Speaker 3: broke out in hives. This is like systemic and so
Speaker 3: that's almost always autommune.
Speaker 4: Good to know. Hardest part about your.
Speaker 3: Job, hardest part about my job.
Speaker 4: What sucks the most. It can be anything. It can
Speaker 4: be petty, it can be huge.
Speaker 3: I actually love my job.
Speaker 5: I know that.
Speaker 4: Next, I that next.
Speaker 3: Actually, actually it's one of the beautiful things about coming
Speaker 3: to work is actually enjoy it. It's kind of sad and scary,
Speaker 3: I guess.
Speaker 4: But no, I have nothing else.
Speaker 3: No, no, no, no, I mean the hardest part of
Speaker 3: my job being honestly, I mean, and this is going
Speaker 3: to be a little bit more more of a you know,
Speaker 3: I love my patients. I love what I do. From
Speaker 3: a physician standpoint, The hardest part of this, I think
Speaker 3: most doctors will agree with this is is dealing with
Speaker 3: all the administrative stuff, right, I mean, you know, getting
Speaker 3: insurance authorizations and I mean stuff that where you just
Speaker 3: feel like this is not valuable time spent. I'd rather
Speaker 3: see more patients and do what I do than worry
Speaker 3: about administrative stuff, which is unfortunately necessary and we need
Speaker 3: to do it others we don't get paid. It's part
Speaker 3: of the job. Part of the job too. We need
Speaker 3: to get paid at some point, but just paperwork, paperwork, paperwork, paperwork,
Speaker 3: never ends, never ends.
Speaker 4: Rather be palpating thyroids and file and paper.
Speaker 3: Absolutely, yeah, right in the operating room, taking care of patients. Yeah.
Speaker 4: One insurance scholar Jay Feinman wrote in a recent Bad
Speaker 4: piece that in the murkiness of healthcare insurance, when consumers
Speaker 4: need coverage, they discover that there are significant protection gaps.
Speaker 4: And for an expos on how Fineman writes, the denial
Speaker 4: of valid insurance claims is not occasional or accidental, or
Speaker 4: the fault of a few bad employees. It's the result
Speaker 4: of an increasing and systematic focus on maximizing profits by
Speaker 4: major companies. You can see his twenty ten book Delay Deny,
Speaker 4: Defend Why insurance companies don't pay claims and what you
Speaker 4: can do about it. Best thing about your job? What
Speaker 4: do you love? I know you love your job, which
Speaker 4: is why I'm talking to you and some other.
Speaker 3: You love what you do? I love ny you. I
Speaker 3: got to say that before we get fired. I love
Speaker 3: it what I love about my job honestly on my patients.
Speaker 3: I love my patients, and I think most of us
Speaker 3: will probably give the same answer. I love talking to
Speaker 3: my patient. So I love getting to know them. I
Speaker 3: love taking care of them. There's nothing more fulfilling, you know,
Speaker 3: like going home and knowing that you did something and
Speaker 3: you know you made somebody's life even five percent better hopefully.
Speaker 3: You know, that's a It's a great feeling.
Speaker 4: Do you ever see someone come back after medication and
Speaker 4: they look and feel so much better?
Speaker 3: Absolutely?
Speaker 4: Yeah.
Speaker 3: Yeah, even from a surgical standpoint, right, I mean, I
Speaker 3: did whatever nine thyroid cancer operations is last week. And
Speaker 3: being able to tell somebody, you know, we took your
Speaker 3: cancer out and you're going to be fine. It's such
Speaker 3: a great feeling, right And and to see you know,
Speaker 3: the patient and their family members and they're all like,
Speaker 3: you know, just just happy.
Speaker 4: What about any myths that you would want to bust
Speaker 4: about thyroids? Any soapboxes you want to want to get on.
Speaker 3: I mean, the one thing that I said, don't blame
Speaker 3: the thirate for everything?
Speaker 1: Huh?
Speaker 3: You know that's that's number one. You know that a
Speaker 3: syroy disease is very treatable. I think you know, the
Speaker 3: one thing I think patients need to understand is that
Speaker 3: if you do have a fire problem, you should go
Speaker 3: see an expert, see somebody who really specializes in this.
Speaker 4: When should someone get a second opinion.
Speaker 3: Anytime they're not happy with the first opinion? Definitely you
Speaker 3: see a second opinion. No, I think I'm a huge
Speaker 3: proponent of second opinion. I would recommend you get one
Speaker 3: from somebody who's, you know, an expert in the field
Speaker 3: and who specializes in this. And I like to think
Speaker 3: that we have a fantastic program here, so you know,
Speaker 3: I think we offer the best care. But having said that,
Speaker 3: you know, I have no problems with getting a second opinion.
Speaker 3: If the patient feels like they just want to hear
Speaker 3: from other people, it's a more peace of mind and comfort.
Speaker 3: I think majority of the time, it's not that they
Speaker 3: don't trust you. I think most patients trust you one
Speaker 3: hundred percent. They just want to hear from somebody else
Speaker 3: as well.
Speaker 4: Yeah, so smart. Thank you so much for making me
Speaker 4: better friends with my own thigh right.
Speaker 3: My pleasure. This is great.
Speaker 4: I appreciate everything it's doing for me at the moment.
Speaker 3: Great, you can keep it, Thank you, doctor.
Speaker 4: So ask surgical people on serious questions, because sometimes those
Speaker 4: are the ones that most need the answers, and to
Speaker 4: find out more about doctor Keppel Patel see the links
Speaker 4: in the show notes, as well as one to the
Speaker 4: charity of his choice, the American Association of Endocin Surgeons
Speaker 4: or aa S. Thank you so much, NYU for loaning
Speaker 4: him to us for that hour. What a time we had.
Speaker 4: I loved it. Say hi to us On social media.
Speaker 4: I'm at Ologies on Blue Sky, still at Ologies on Instagram,
Speaker 4: and at Ali Ward on there too. We have shorter
Speaker 4: kid friendly episodes called Smologies in their own feed Now
Speaker 4: just search SMO l O, g I E S wherever
Speaker 4: you get podcasts, look for the new green artwork and
Speaker 4: hit subscribe. You can join Patreon at patreon dot com
Speaker 4: sash Ologies. You can find hats toads, teasanmore at ologiesmerch
Speaker 4: dot com too. Thank you so much to recent birthday
Speaker 4: girl and human Gem Aaron Talbert, who admins the Ologies
Speaker 4: podcast Facebook group. I love you, Aaron, I hate your thyroid.
Speaker 4: I'm sorry about it. Tell it to be nice. Aveline
Speaker 4: Malik makes our professional transcripts. Kelly ar Dwyer does the website,
Speaker 4: and while Dilworth steers our calendar as scheduling producer. Susan
Speaker 4: Hale is the pituitary Gland of a Managing director. Jake
Speaker 4: Chafee is our T four of an assistant editor, and
Speaker 4: the T three that gets the episode out of the
Speaker 4: garage is Mercedes Maitland of Maitland Audio Nick Thorburn has
Speaker 4: the ox and made the theme music. If you stick
Speaker 4: around to the end of the episode, I tell you
Speaker 4: a secret. And this week it's that social media doom
Speaker 4: scrolling has become a problem because I'm not learning vital
Speaker 4: info about current events. I'm just like piecing together fragments
Speaker 4: of what's happening in the world based on other people's
Speaker 4: reactions to them, and then the reactions to the reactions
Speaker 4: in the comments. And I spent all day Saturday on
Speaker 4: my phone on the couch, mindlessly locked in like a
Speaker 4: tractor beam of other people's front facing camera hot takes,
Speaker 4: not learning much. And so yesterday and today I told myself,
Speaker 4: I said, if I looked at social media, I would
Speaker 4: have to donate one thousand dollars to a political action
Speaker 4: committee that goes against everything I stand for and harms women,
Speaker 4: trans people, immigrants, people of color, and our environment. If
Speaker 4: I scrolled social media, I would have to do that.
Speaker 4: Not wanting to give one thousand dollars was a surefireway
Speaker 4: to keep me off of it, and I had a
Speaker 4: great day off social media, consuming more comprehensive news from
Speaker 4: reliable sources. So if you feel out of sorts and
Speaker 4: constantly scared, make a bet with yourself that you cannot
Speaker 4: afford to lose. Make the steaks so high that there's
Speaker 4: no way you will do the thing that you don't
Speaker 4: want to do. Cut bangs, texture, crush. We're all going
Speaker 4: to die, so chin up, keep going forebye. Pacodermatology, homeiology,
Speaker 4: crypto zoology, lithology, technology, meteorology, ptology, nathology, seriology, selenology.
Speaker 3: You're so right.
Speaker 4: Get value.
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