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Thursch ofcentis kent off smart all 19 00:00:55.200 --> 00:00:57.799 day electricity unitrates in twenty nine percent of Gassi unitrates 20 00:00:57.880 --> 00:00:59.920 Seaportcosh Energy dot E for Fullties and cis. 21 00:01:00.399 --> 00:01:02.359 Oh hey, it's the guy at the library with that 22 00:01:02.439 --> 00:01:06.400 stack of survival books. Ali Ward, Let's talk about your thyroid. 23 00:01:06.519 --> 00:01:08.920 Do you still have one? If not, let's talk about 24 00:01:08.920 --> 00:01:13.480 how it did do dirty metabolism, libido, sweating, freezing. You're 25 00:01:13.519 --> 00:01:15.079 in the right place for all of it. So I 26 00:01:15.120 --> 00:01:17.680 went to New York because I'm sophisticated, and also your 27 00:01:17.680 --> 00:01:21.079 favorite diabetic diabatologist, doctor Mike Natter, was getting married to 28 00:01:21.120 --> 00:01:25.640 his bride Alice, And whilst there, NYU Langone Hospital hooked 29 00:01:25.640 --> 00:01:29.239 it up with a thyroid expert and a surgeon who 30 00:01:29.519 --> 00:01:32.519 was more than game to answer all my questions about 31 00:01:32.519 --> 00:01:37.400 this little hormonal organ that rules our lives. So this 32 00:01:37.439 --> 00:01:41.120 guest is a division chief of the NYU Langone Endercrensurgery 33 00:01:41.159 --> 00:01:44.400 Department and a professor in the Department of Biochemistry and 34 00:01:44.480 --> 00:01:49.719 Molecular Pharmacology of ODO Laryngology Head and Next Surgery. And 35 00:01:49.760 --> 00:01:52.799 we met up on a brisk afternoon in this tidy, 36 00:01:52.879 --> 00:01:56.200 elegant hospital conference room, and I asked so many questions 37 00:01:56.560 --> 00:01:59.040 and he didn't even bill us for them. He knows 38 00:01:59.040 --> 00:02:01.120 his stuff and he knows your so we'll talk about 39 00:02:01.159 --> 00:02:03.519 your stuff momentarily. But first let's say called the patrons 40 00:02:03.560 --> 00:02:05.920 at patreon dot com slash ologies who make the show 41 00:02:06.000 --> 00:02:08.840 possible and send in their questions. You can be one 42 00:02:08.879 --> 00:02:11.719 of them if you like, for just a dollar a month. Also, 43 00:02:11.840 --> 00:02:15.080 thanks to everyone in ologies Merch from ologiesmerch dot com 44 00:02:15.199 --> 00:02:17.800 and if you need a kid friendly version of the show, 45 00:02:18.159 --> 00:02:20.960 just a reminder that we launched smologies recently. It's a 46 00:02:20.960 --> 00:02:24.240 spinoff podcast in its own feed link in their show notes. 47 00:02:24.360 --> 00:02:26.479 So thank you also to everyone who leaves reviews for 48 00:02:26.560 --> 00:02:29.159 the show. It matters so much to us and it 49 00:02:29.240 --> 00:02:31.240 helps boost the show in the charts. And I read 50 00:02:31.280 --> 00:02:35.080 all of them, and this week Positive Steps PDX wrote 51 00:02:35.280 --> 00:02:37.400 that they look forward to listening every week and that 52 00:02:37.479 --> 00:02:40.080 it's been read to gain knowledge from fellow queer and 53 00:02:40.159 --> 00:02:44.039 trans folks. Positive Steps PDX, it's a joy to introduce 54 00:02:44.039 --> 00:02:46.879 the audience to all manner of ologists across all kinds 55 00:02:46.879 --> 00:02:51.400 of fields, including your thigh right now. Thyroidology comes from 56 00:02:51.400 --> 00:02:55.639 the Greek thyrodied eye. It means shield shaped, and that 57 00:02:55.680 --> 00:02:58.560 refers to the Adams apple of the throat, which is 58 00:02:58.840 --> 00:03:03.000 thyroid cartilage, and then the endocrine gland underneath it that 59 00:03:03.120 --> 00:03:06.719 provides hormones that keep your engine running. So let's get 60 00:03:06.719 --> 00:03:08.439 to it. Let's figure out just what the hell is 61 00:03:08.439 --> 00:03:10.919 happening with that lump in your throat, and if maybe 62 00:03:10.960 --> 00:03:13.840 it's making you depressed or cold or tired or sweaty 63 00:03:13.919 --> 00:03:16.719 or shaky or hot, when to ask your doctor to 64 00:03:16.800 --> 00:03:20.280 check it, How to decipher labs, as well as info 65 00:03:20.280 --> 00:03:24.879 on radioactive cats, stress and thyroids, surviving a nuclear bomb, 66 00:03:25.080 --> 00:03:28.120 how diet can affect your thyroid flim flam, and how 67 00:03:28.159 --> 00:03:31.400 being on TV might save your life. Please also remember, however, 68 00:03:31.439 --> 00:03:33.599 that we can neither diagnose nor treat you because this 69 00:03:33.719 --> 00:03:36.280 is a free audio show. We don't have access to 70 00:03:36.319 --> 00:03:38.560 your neck or your blood. Don't be weird about this, 71 00:03:38.879 --> 00:03:42.759 do be excited. So let's hear from surgeon, professor, endochronology 72 00:03:42.800 --> 00:03:46.759 specialist and thybroidologist, doctor Kempel Patel. 73 00:04:04.719 --> 00:04:05.240 Kpl Pate. 74 00:04:05.520 --> 00:04:07.240 And and I'll have you just kind of hold like 75 00:04:07.280 --> 00:04:08.680 an ice cream cul like if you were a stand 76 00:04:08.759 --> 00:04:09.639 up or doing karaoke. 77 00:04:09.879 --> 00:04:11.120 You can do some songs afterwards. 78 00:04:11.199 --> 00:04:18.240 Yeah, apologies and advance. Okay, first off, do I have 79 00:04:18.279 --> 00:04:20.639 an awful thyroid? I feel like that must be the question, 80 00:04:20.720 --> 00:04:25.240 everyone asks you, does my thyroid messed up? Must be 81 00:04:25.279 --> 00:04:27.000 something that you get constantly. 82 00:04:27.240 --> 00:04:30.560 Absolutely, I think the poor thyroid gland gets blamed for 83 00:04:30.639 --> 00:04:33.360 a lot of things in life, and it's not necessarily 84 00:04:33.439 --> 00:04:36.079 this poor little gland's fault. And the thyroid gland is 85 00:04:36.079 --> 00:04:39.519 it's an amazing organ. It's a small gland that sits 86 00:04:39.639 --> 00:04:41.480 right in the middle of your neck, right on top 87 00:04:41.480 --> 00:04:43.879 of your windpipe. It's shaped like a butterfly. You have 88 00:04:43.959 --> 00:04:45.680 a right side and the left side of the gland, 89 00:04:46.199 --> 00:04:49.079 and its sole purpose is to make thyroid hormone. And 90 00:04:49.120 --> 00:04:51.120 you know, you can think of thyroid hormone as like 91 00:04:51.279 --> 00:04:54.879 the gas for your engine. It really really regulates your metabolism, 92 00:04:55.160 --> 00:04:57.560 you know, and that's your primary organ that gives you 93 00:04:57.600 --> 00:05:00.959 the fuel that you need to basically do. Almost all 94 00:05:01.000 --> 00:05:05.160 the activities that you perform, you know, from temperature regulation 95 00:05:05.439 --> 00:05:08.199 to how you metabolize your food, to how you use 96 00:05:08.240 --> 00:05:11.240 your energy is all regulated by the thyroid glant. So 97 00:05:11.879 --> 00:05:15.639 anytime somebody feels off for whatever reason it may be, 98 00:05:15.759 --> 00:05:17.279 it's always is it my thyroid glant? 99 00:05:17.360 --> 00:05:17.560 Yeah. 100 00:05:17.600 --> 00:05:19.480 But the beautiful thing about the thyroid glant is it's 101 00:05:19.480 --> 00:05:22.240 an easy organ to check both physically and from a 102 00:05:22.279 --> 00:05:25.680 laboratory standpoint, it's easily palpable. You can see it. It's 103 00:05:25.839 --> 00:05:28.040 very much in the front of your neck. So if 104 00:05:28.040 --> 00:05:30.959 somebody does have a large thyroid or thyroid mass, you 105 00:05:30.959 --> 00:05:33.319 can almost always feel it. And then it's you know, 106 00:05:33.360 --> 00:05:37.360 the blood tests for thyroid function are pretty easy to obtain, 107 00:05:37.519 --> 00:05:38.879 so you get the blood test and it gives you 108 00:05:38.920 --> 00:05:41.279 a good idea if your thyroid glint is actually functioning 109 00:05:41.319 --> 00:05:43.480 normally or not. So that kind of gives your answer 110 00:05:43.560 --> 00:05:44.120 most of the time. 111 00:05:44.600 --> 00:05:49.519 What about your metabolism, How much of an effect does 112 00:05:49.560 --> 00:05:52.800 it have in terms of like how many calories your 113 00:05:52.800 --> 00:05:56.399 body burns at a basic metabolic rate, how much of 114 00:05:56.439 --> 00:05:59.480 your body composition is determined by it by. 115 00:05:59.399 --> 00:06:02.079 The thyrodorrmal When you're asking, yeah, absolutely, it's a significant 116 00:06:02.120 --> 00:06:04.560 portion of it. So your thyroid homone really does regulate 117 00:06:05.000 --> 00:06:06.720 a lot of that. So we see that in very 118 00:06:06.759 --> 00:06:09.600 sick patients. In patients that are admitted to the ICU 119 00:06:09.839 --> 00:06:12.600 for for weeks or months, you'll see that their thyroed 120 00:06:12.639 --> 00:06:15.600 homo levels start to change. And so we know that 121 00:06:15.639 --> 00:06:19.319 the thyroid glend is intimately involved in your metabolism, and 122 00:06:19.399 --> 00:06:22.000 so you know, depending on the situation, whether it's a 123 00:06:22.040 --> 00:06:26.040 stressful situation, whether it's a situation where where your body 124 00:06:26.160 --> 00:06:29.160 requires more energy. The third gland definitely plays a significant 125 00:06:29.199 --> 00:06:29.480 role in it. 126 00:06:29.759 --> 00:06:32.600 How often are people depressed but they think it's their 127 00:06:32.680 --> 00:06:34.079 thyroid or vice versa. 128 00:06:34.519 --> 00:06:36.399 Oh, it's very common. Part of the reason is people 129 00:06:36.439 --> 00:06:38.600 get online and they'll google it and thyroid will come 130 00:06:38.680 --> 00:06:40.120 up as one of the you know, one of the 131 00:06:40.120 --> 00:06:44.279 causes for fatigue or depression or not feeling energetic, and 132 00:06:44.319 --> 00:06:46.759 so that automatically is the first thing people think about. 133 00:06:47.160 --> 00:06:49.759 Often it's not just the thyroid glend. When you do 134 00:06:49.959 --> 00:06:54.199 have loss of function of the thyroid hypothyroidism. 135 00:06:53.680 --> 00:06:57.439 Hypo means under whereas hyper means above. 136 00:06:57.639 --> 00:06:59.759 And when you do have loss of function of the 137 00:06:59.759 --> 00:07:04.079 thought hypothyroidism, often it's autoimmune and it's associated with other 138 00:07:04.600 --> 00:07:07.160 symptoms as well. It's not just fatigue or lack of 139 00:07:07.279 --> 00:07:11.839 energy or depression. Patients often will feel cold, they'll start 140 00:07:11.839 --> 00:07:14.319 to gain weight, they may have some hair loss, the 141 00:07:14.399 --> 00:07:16.839 skin gets dry, the nails get brittle. I mean, that's 142 00:07:16.920 --> 00:07:19.839 classic what we call hashimotos thyroiditis or hypothyroism. 143 00:07:20.519 --> 00:07:24.720 And the difference between having let's say low thyroid hormone 144 00:07:24.759 --> 00:07:28.360 and having hashimotos. Hashimotos, from what I understand, is your 145 00:07:28.399 --> 00:07:30.879 immune system being like, let's get this thyroid out of here, 146 00:07:31.040 --> 00:07:33.560 get out here. We don't like you. You're an invader, and 147 00:07:33.560 --> 00:07:36.360 you're like, this is my own thyroid. So hashimotos is 148 00:07:36.399 --> 00:07:39.399 a type of autoimmune disorder where your body's immune system 149 00:07:39.560 --> 00:07:42.319 turns on itself and you're like, can you not? But 150 00:07:42.399 --> 00:07:47.399 hashimotos is not the cause of all underactive thyroids aka hypothyroidism. 151 00:07:47.680 --> 00:07:51.040 You can have low thyroid hormone without it being caused 152 00:07:51.079 --> 00:07:55.759 by autoimmune hashimotos. Just like all cacti are succulents, but 153 00:07:55.800 --> 00:08:00.199 not all succulents are cactie. So all hashimotos hypothyroidism, not 154 00:08:00.279 --> 00:08:04.199 all hypothyroidism as hashimotos do those present differently. 155 00:08:04.959 --> 00:08:08.959 The most common cause for hypothyroidism in this country is hashimotoves, 156 00:08:09.360 --> 00:08:13.319 but you can have low thyroid function or high TSH 157 00:08:13.439 --> 00:08:17.240 and not have hashimotos. Thyroiditis that does exist, but the 158 00:08:17.240 --> 00:08:20.519 most common cause is hashimotives. But the overall effect is 159 00:08:20.680 --> 00:08:24.000 probably the same because it's ultimately the effect of your 160 00:08:24.000 --> 00:08:26.000 thyroidegland not working the way it should be. 161 00:08:26.519 --> 00:08:29.439 Okay, So This is confusing, But how doctors measure your 162 00:08:29.480 --> 00:08:35.200 thyroid function is by checking your TSH. That's thyroid stimulating hormone. 163 00:08:35.320 --> 00:08:38.440 So this hormone is like a measure of how much 164 00:08:38.519 --> 00:08:41.519 your body is pressing the gas pedal to try to 165 00:08:41.600 --> 00:08:46.919 get enough thyroid action. So a low TSH means hyper 166 00:08:47.200 --> 00:08:50.960 thyroidism or an overactive gland because your body barely has 167 00:08:51.000 --> 00:08:54.399 to tap the gas pedal of TSH, but your thyroid 168 00:08:54.519 --> 00:08:58.360 is already off to the races. Now, high TSH means 169 00:08:58.399 --> 00:09:01.720 your body is floor it on the gas pedal so 170 00:09:01.919 --> 00:09:05.720 hard and not getting a lot of action to convert 171 00:09:05.759 --> 00:09:11.039 to energy. So a high TSH means low activity hypothyroidism, 172 00:09:11.320 --> 00:09:15.919 and a low TSH means high activity or hyper thyroidism. 173 00:09:16.519 --> 00:09:19.879 Just think everything's the opposite kind of So walk me 174 00:09:19.960 --> 00:09:24.399 through a backstage of the thyroid and the thyroid hormone. 175 00:09:24.759 --> 00:09:30.960 It squirts out what T four thyroxine tell me what 176 00:09:31.159 --> 00:09:33.000 is making and what does that effect. 177 00:09:33.320 --> 00:09:37.720 Yeah, so your TSH level, which is probably the most 178 00:09:37.720 --> 00:09:42.240 important blood test to assess thyroid function, is actually not 179 00:09:42.279 --> 00:09:44.840 released by a thyroid gland. TSH is actually released by 180 00:09:44.840 --> 00:09:47.279 a pituitary gland, which sits at the base of your brain. 181 00:09:47.519 --> 00:09:51.320 So when its senses that there's not enough thyroid hormone 182 00:09:51.360 --> 00:09:54.399 in the body, the petuitary gland, which is considered the 183 00:09:54.440 --> 00:09:58.960 master gland, releases TSH, which is thyroid stimulating hormone, and 184 00:09:59.000 --> 00:10:01.360 that's to stimulate the thigh gland to make more hormone. 185 00:10:01.639 --> 00:10:04.480 So if a TSH is high, that means your thyroid 186 00:10:04.559 --> 00:10:07.759 is not working well. That's how you know TSH is low, 187 00:10:07.759 --> 00:10:09.879 that means your thyrd's working too well. So when your 188 00:10:09.879 --> 00:10:12.279 TSH is you know, depending on what your TSAH levels are, 189 00:10:12.320 --> 00:10:14.840 it'll affect your thyroid gland and your thyroglane will make 190 00:10:14.840 --> 00:10:17.840 thyrod hormone. Now, thyrod hormone comes in two forms. It's 191 00:10:17.879 --> 00:10:19.840 something called T four, as you were alluding to an 192 00:10:19.919 --> 00:10:23.320 NT three. T three is your active form. That's the 193 00:10:23.360 --> 00:10:26.600 form that your body cells use to use it for 194 00:10:26.679 --> 00:10:28.519 the metabolism and the energy and to you know, and 195 00:10:28.840 --> 00:10:30.360 and to use it for all the functions that the 196 00:10:30.399 --> 00:10:33.879 cells need thyroid hormone for. But what your thyroid glant 197 00:10:33.879 --> 00:10:37.480 actually produces is T four. And then the T four 198 00:10:37.519 --> 00:10:40.720 is actually converted into T three as needed by your 199 00:10:40.759 --> 00:10:42.759 liver or your kidneys and other parts of your body. 200 00:10:42.960 --> 00:10:45.519 So the protuitary is at the wheel and at the 201 00:10:45.519 --> 00:10:49.320 gas pedal, and it makes that thyroid stimulating hormone or 202 00:10:49.360 --> 00:10:54.519 TSH that tells the thyroid to release more gas T four, 203 00:10:54.840 --> 00:10:56.759 and your organ say, thanks, man, I'm going to break 204 00:10:56.799 --> 00:10:59.279 this down a little into T three so we can 205 00:10:59.360 --> 00:11:03.960 use it for energy. So imagine your petuitary saying we're 206 00:11:03.960 --> 00:11:07.799 not going anywhere. Where's the gas pumping out more TSH 207 00:11:07.879 --> 00:11:09.600 to be like come on, come on, come on, Or 208 00:11:10.080 --> 00:11:13.399 if you have too much T four converted to T three, 209 00:11:13.559 --> 00:11:18.000 your petuitary is like whoa easy leadfoot, and it releases 210 00:11:18.320 --> 00:11:19.399 less TSH. 211 00:11:19.600 --> 00:11:21.799 So T three is the active form of the hormone. 212 00:11:21.919 --> 00:11:23.960 And it kind of makes sense even evolutionarily if you 213 00:11:23.960 --> 00:11:25.519 think about it, because if you just start putting out 214 00:11:25.519 --> 00:11:27.720 T three, your metabolism in a skyrocket, you're going to 215 00:11:27.759 --> 00:11:31.159 be bouncing off the walls. So so your body actually 216 00:11:31.200 --> 00:11:32.759 is smart in that sense. It says, you know, we're 217 00:11:32.759 --> 00:11:34.840 gonna make T four, and if you need T three, 218 00:11:34.840 --> 00:11:36.600 you'll convert it and you'll make as much T three 219 00:11:36.600 --> 00:11:38.559 as you need. But this way, we're not just pumping 220 00:11:38.559 --> 00:11:39.279 out T three. 221 00:11:39.519 --> 00:11:42.080 Where's the T four hanging out? When it's on call 222 00:11:42.200 --> 00:11:43.120 to be T three. 223 00:11:43.080 --> 00:11:45.480 In your thyroy gland. Ohs making it? Yeah, thire is 224 00:11:45.519 --> 00:11:46.879 making it, and it makes it as it needs it 225 00:11:46.960 --> 00:11:49.039 kind of and it secretes it okay, and then your 226 00:11:49.080 --> 00:11:50.600 body converts it to T three as needed. 227 00:11:51.480 --> 00:11:52.960 Do you know why they're called T three and teeth 228 00:11:53.000 --> 00:11:54.919 throw three teeth? Yep. 229 00:11:55.200 --> 00:11:57.480 It's it's the I dye. It's the amount of ide particles. 230 00:11:57.480 --> 00:11:59.440 So T four has four io dye part of on 231 00:11:59.480 --> 00:12:02.879 T three has three. So when when T four gets deiodonized, 232 00:12:03.320 --> 00:12:04.360 it becomes T three. 233 00:12:04.799 --> 00:12:07.840 So what happens when you've got T three in the body? 234 00:12:07.879 --> 00:12:13.120 Does it affect your adrino systems? Does it affect cortisol? What? 235 00:12:13.399 --> 00:12:16.600 Yeah, so that's a great question. So you know there's 236 00:12:16.600 --> 00:12:19.960 some over overlap with the other hormonal systems in the body. 237 00:12:20.279 --> 00:12:23.279 For the most part, it's really affecting you know, the 238 00:12:23.320 --> 00:12:25.559 cells that you need for for energy, so there's not 239 00:12:25.559 --> 00:12:28.360 too much hormonal interplay as there is much like the 240 00:12:28.399 --> 00:12:31.320 T three really affecting your cells for cellular metabolism. It's 241 00:12:31.320 --> 00:12:32.919 a cellular level, so it's you know, it's like I said, 242 00:12:32.919 --> 00:12:36.879 it's temperature regulation, digestion, your energy levels. You know, your 243 00:12:37.240 --> 00:12:40.600 the ability to think clearly, not be tired. Your heart rate, 244 00:12:41.000 --> 00:12:42.960 you know, that's all affected by thyroid. 245 00:12:42.639 --> 00:12:45.679 Hormone if you have a low heart rate. Speaking from experience, 246 00:12:46.080 --> 00:12:48.799 at some point my my doctors were like, Wow, you're 247 00:12:49.120 --> 00:12:51.559 athletically healthy. And then I was like, or does my 248 00:12:51.960 --> 00:12:55.320 rus I'm running as well as I used to. It 249 00:12:55.399 --> 00:12:57.519 turned out my thyroid such a little bit. But when 250 00:12:57.559 --> 00:12:59.960 you when someone comes to your office and they say, 251 00:13:00.159 --> 00:13:04.080 I think my thyroid is, let's say, sluggish, what are 252 00:13:04.080 --> 00:13:07.799 the first things you do if they have symptoms of 253 00:13:08.720 --> 00:13:12.639 hypothyroidism but their labs are within range? Where do you 254 00:13:12.679 --> 00:13:13.279 go from there? 255 00:13:13.399 --> 00:13:15.240 Yeah, that's a tough one. I mean, so you know, 256 00:13:15.559 --> 00:13:17.360 it's the first thing, Like getting back to your question. 257 00:13:17.399 --> 00:13:19.159 The first thing, you're going to take a full history, right, 258 00:13:19.240 --> 00:13:21.240 you want to make sure if somebody's complaining that the 259 00:13:21.320 --> 00:13:23.200 theroid may be sluggish, you want to ask all those 260 00:13:23.240 --> 00:13:26.799 pertinent questions. Are you tired, you know, do you feel cold? 261 00:13:26.840 --> 00:13:28.679 Are you gaining weight? Is your hair falling out? So 262 00:13:28.759 --> 00:13:30.440 you want to ask all the questions that would help 263 00:13:30.480 --> 00:13:34.240 you kind of identify what thyroid problem that they may 264 00:13:34.279 --> 00:13:36.200 be having. And then you're obviously going to do your 265 00:13:36.200 --> 00:13:39.240 physical examination, examine the thyroid. I mean, God forbid to 266 00:13:39.320 --> 00:13:41.559 having thyroid mass right that we need to worry about. 267 00:13:42.120 --> 00:13:44.080 And then the next step would probably be getting your 268 00:13:44.159 --> 00:13:46.679 laboratory studies and looking at your thyroid function. 269 00:13:47.200 --> 00:13:51.759 So for TSH, that thyroid stimulating hormone in range is 270 00:13:51.879 --> 00:13:56.919 typically set like zero point five to five point zero. 271 00:13:57.200 --> 00:13:59.240 You could be anywhere in between there, but it varies 272 00:13:59.240 --> 00:14:03.519 by lab And if a patient is feeling symptoms like 273 00:14:03.600 --> 00:14:07.840 for hypothyroid, dry skin, feeling cold, a lot, low energy, 274 00:14:08.360 --> 00:14:12.120 your guts are slow, you have brittle hair, maybe you 275 00:14:12.159 --> 00:14:16.480 feel like the embodiment of a cold limbstock of celery. 276 00:14:16.639 --> 00:14:19.759 That's sad, and you're in the upper end of the 277 00:14:19.840 --> 00:14:23.440 TSH range. Even though you're in range technically, some doctors 278 00:14:23.519 --> 00:14:27.279 might flag it and medicate with extra thyroid hormone or 279 00:14:27.440 --> 00:14:30.200 T four. Doctors can also see, no matter what your 280 00:14:30.240 --> 00:14:33.600 TSH is, how much T four you're actually making and 281 00:14:33.720 --> 00:14:36.600 test to see how well your organs are converting that 282 00:14:36.919 --> 00:14:39.559 to T three, which you can use. Now, there are 283 00:14:39.759 --> 00:14:44.519 medications like synthroid, which the generic name is lebathyroxine, and 284 00:14:44.720 --> 00:14:47.159 that is just T four, and it's kind of up 285 00:14:47.200 --> 00:14:49.399 to your body to make the T three you need 286 00:14:49.480 --> 00:14:52.879 from it. Now with hashimotos, the autoimmune issue where your 287 00:14:52.919 --> 00:14:56.480 immune system turns on your own thyroid that is rude 288 00:14:56.759 --> 00:14:59.919 and it's measured by high TSH as well as lab 289 00:15:00.480 --> 00:15:03.799 that measure antibodies to your own organ and. 290 00:15:03.720 --> 00:15:06.799 We do see that. We do see situations where the 291 00:15:06.879 --> 00:15:09.960 patients don't feel well, they have all the symptoms of 292 00:15:10.080 --> 00:15:14.720 thyroid kind of hypothyroid disease, but their blood tests come 293 00:15:14.720 --> 00:15:18.080 back relatively normal, they don't have any antibodies, and what 294 00:15:18.120 --> 00:15:19.879 do you kind of do with that? And you want 295 00:15:19.919 --> 00:15:21.679 to rule out other causes, right, so you want to 296 00:15:21.720 --> 00:15:23.559 do a full autoimmune work up, make sure there's not 297 00:15:23.639 --> 00:15:27.080 other causes, you know why this is happening. And at 298 00:15:27.120 --> 00:15:28.720 the end of that if even if everything else still 299 00:15:28.759 --> 00:15:31.519 comes back normal. You know, there are some individuals out there, 300 00:15:31.559 --> 00:15:34.279 including some of our experts in n NYU, will try 301 00:15:34.320 --> 00:15:36.320 to maybe start them in a little bit of thyroid hormone, 302 00:15:36.399 --> 00:15:38.320 see if that makes a difference, see if they feel 303 00:15:38.320 --> 00:15:40.960 better with that. But that's very kind of a case 304 00:15:41.039 --> 00:15:42.919 kind of a situation. It's not like a universal thing. 305 00:15:43.720 --> 00:15:46.080 Do people ever try to score a thyroid hormone is 306 00:15:46.159 --> 00:15:47.960 like a like an ozembic. 307 00:15:49.639 --> 00:15:52.519 I said it before you said it absolutely really? Oh yeah. 308 00:15:52.519 --> 00:15:54.559 The first question I always usually get what I talk about. 309 00:15:54.600 --> 00:15:56.679 I mean, I do. I do a lot of thyroid surgery, right, 310 00:15:56.879 --> 00:15:58.360 and so most of my patients will end up on 311 00:15:58.399 --> 00:16:01.600 thyroid medication. And it's it's a question I get almost 312 00:16:01.600 --> 00:16:03.399 every day is oh, that's great if I take two pills, 313 00:16:03.440 --> 00:16:04.960 but I lose weight. I'm like, no, it doesn't work 314 00:16:05.000 --> 00:16:07.519 that way. Unfortunately, it's not a weight gain a weight 315 00:16:07.559 --> 00:16:08.080 loss pill. 316 00:16:08.759 --> 00:16:10.840 Well would happen if you overdose yourself? 317 00:16:10.879 --> 00:16:13.759 Oh no, you would feel kind of miserable. Actually, you 318 00:16:13.759 --> 00:16:16.840 wouldn't feel good. I mean you'd feel hyperthyroid. Your heart 319 00:16:16.840 --> 00:16:19.360 will be racing, you'd be sweating, you'd feel anxious. You 320 00:16:19.360 --> 00:16:20.679 wouldn't you would not feel well. 321 00:16:20.759 --> 00:16:23.879 Yeah, So a word of the wise, don't do it. 322 00:16:23.960 --> 00:16:25.840 Throne over dose on, leave it the rouxcine. 323 00:16:26.000 --> 00:16:30.000 Yeah, just like get extra coffee. Does everyone's thy word 324 00:16:30.080 --> 00:16:31.240 kind of poop out as we age? 325 00:16:31.519 --> 00:16:33.360 Not necessarily, most patients A should do really well. I 326 00:16:33.360 --> 00:16:36.039 mean most people their fire function, you know, remains relatively normal. 327 00:16:36.080 --> 00:16:39.279 But as you get older in most organs in your body, 328 00:16:39.360 --> 00:16:42.320 as you get older, your tired gland you know often 329 00:16:42.360 --> 00:16:45.320 does become a little bit more sluggish bumber, And so 330 00:16:45.960 --> 00:16:48.440 it's not uncommon after the age of sixty and actually, 331 00:16:48.440 --> 00:16:50.600 and more common in women actually, And some of it 332 00:16:50.600 --> 00:16:52.679 may have to do with the autoimmune aspect of it 333 00:16:52.720 --> 00:16:55.600 and the hormonal aspect of it with menopause. But as 334 00:16:55.600 --> 00:16:58.279 you get older, the tired gland in women sometimes tends 335 00:16:58.279 --> 00:17:00.559 to get a little sluggish. It isn't important when you 336 00:17:00.600 --> 00:17:03.279 see your primary doctor to have those blood tests done 337 00:17:03.360 --> 00:17:06.519 because patients may come in they don't feel well, they 338 00:17:06.559 --> 00:17:08.880 feel like they don't have energy, and often they will 339 00:17:08.960 --> 00:17:10.920 chocol up to I must be going through menopause and 340 00:17:10.920 --> 00:17:13.319 I must be having other hormonal changes. And sometimes it's 341 00:17:13.359 --> 00:17:15.799 just that your thyroid glenn is getting a little weak 342 00:17:15.920 --> 00:17:17.839 and a little bit of thyroid hormon makes them feel better. 343 00:17:18.039 --> 00:17:21.680 When it comes to women and assigned female birth, what 344 00:17:21.920 --> 00:17:29.960 is the connection between autoimmune hashimotos and ovaries? What's going on. 345 00:17:31.200 --> 00:17:34.279 Auto So yes, autoimmune disease in general is more common 346 00:17:34.680 --> 00:17:38.920 in women, right, And when we talk about autoimmune thyroiditis, 347 00:17:39.200 --> 00:17:41.319 like I said, usually we're referring to this entity called 348 00:17:41.319 --> 00:17:46.200 hashimotos thyroididitis. So it's named after doctor Hakura Hashimoto I 349 00:17:46.240 --> 00:17:48.799 think it is. In nineteen twelve actually described it for 350 00:17:48.839 --> 00:17:51.200 the first time. He was a physician and a scientist 351 00:17:51.200 --> 00:17:54.359 in Japan. The concept of hashimotives is your body is 352 00:17:54.400 --> 00:17:58.880 now creating antibodies against thyroid peroxidase and thyroglobilin. These are 353 00:17:58.960 --> 00:18:02.279 your enzymes that your thigh glenn uses to make thyroid hormone. 354 00:18:02.839 --> 00:18:06.400 So when you create antibodies against those enzymes, now your 355 00:18:06.440 --> 00:18:09.079 theroid can't make the hormone anymore, so your thyroid starts 356 00:18:09.079 --> 00:18:12.839 to not function, and ultimately it's actually causing destruction of 357 00:18:12.880 --> 00:18:15.119 the theory of thyid actually starts to die. So many 358 00:18:15.160 --> 00:18:17.519 of these patients with hashimotives have shrivel thiry glands almost 359 00:18:17.519 --> 00:18:19.680 almost at a point with the gland almost disappear. Sometimes 360 00:18:19.839 --> 00:18:21.000 it becomes scar tissue. 361 00:18:21.079 --> 00:18:25.240 If you discovered a thyroid disease and they called it 362 00:18:25.279 --> 00:18:28.480 patels and then everyone complained about having tels, how would 363 00:18:28.480 --> 00:18:32.119 would you be like, yeah, I'll never like, oh my god, 364 00:18:32.319 --> 00:18:34.880 I'll never be forgotten in my field. Or would you 365 00:18:34.920 --> 00:18:36.680 be like bummered that my name. 366 00:18:36.519 --> 00:18:41.200 Is it's something nobody wants. Yeah, yeah, I don't know. 367 00:18:41.240 --> 00:18:45.319 Probably the ladder call a little column call me exactly. 368 00:18:46.400 --> 00:18:49.920 Well, okay, I have heard stories of people being diagnosed 369 00:18:49.960 --> 00:18:53.799 with thyroid disease just by someone seeing them, like across 370 00:18:53.799 --> 00:18:55.720 the room or on TV. I don't know if you 371 00:18:55.759 --> 00:18:57.559 remember there was a story where someone know, yeah, do 372 00:18:57.599 --> 00:19:00.279 you remember that story on TV? And so, yeah, you 373 00:19:00.279 --> 00:19:02.960 probably want to get your and they had a thyrity. 374 00:19:03.400 --> 00:19:06.000 So that was actually a surgeon at n YU stop it. 375 00:19:06.119 --> 00:19:08.079 Yeah yeah, yeah, yeah, So it was a surgeon at NYU. 376 00:19:08.160 --> 00:19:10.319 Is Doctor Eric Voyd, one of the anti surgeons here, 377 00:19:10.359 --> 00:19:13.680 actually noticed somebody on TV. It was an HGTV thing, 378 00:19:13.680 --> 00:19:14.160 I think. 379 00:19:14.359 --> 00:19:18.000 A small but noticeable lump on her throat. Doctor Eric 380 00:19:18.079 --> 00:19:20.319 Void was watching the show at his home in New York. 381 00:19:20.680 --> 00:19:22.519 He's an ear nosen throat surgeon. 382 00:19:22.759 --> 00:19:24.880 I was like, gosh, I feel obliged to let this 383 00:19:24.920 --> 00:19:25.480 person know. 384 00:19:25.680 --> 00:19:29.160 They may not know they have something, and as an 385 00:19:29.160 --> 00:19:31.640 expert in the field, I was concerned for her. I 386 00:19:31.640 --> 00:19:34.599 think it was this HGTV personality person And then he 387 00:19:35.680 --> 00:19:37.720 called into like the TV show where says, you know, 388 00:19:37.720 --> 00:19:40.680 by the way, I think one of your one of 389 00:19:40.680 --> 00:19:45.039 your presenters as a quator, you know, oryid mass and 390 00:19:45.079 --> 00:19:46.480 then she got treated. 391 00:19:46.519 --> 00:19:50.279 Yeah. Yeah, so for Nicole Mcinness being on Beachfront Bargain 392 00:19:50.359 --> 00:19:53.920 Hunt saved her life while having a doctor watch Beachfront 393 00:19:53.960 --> 00:19:57.279 Bargain Hunt saved her life. What an anomaly, right? How 394 00:19:57.359 --> 00:20:01.319 often would someone be watching an HGTV show and notice 395 00:20:01.599 --> 00:20:04.519 thyroid cancers? Like one in a million, one in a billion? 396 00:20:04.559 --> 00:20:08.960 Weight no hold on? Okay? I was fact checking Nicole's 397 00:20:08.960 --> 00:20:13.319 story and I found out maybe this was apocryphal, Maybe 398 00:20:13.319 --> 00:20:17.359 this was wrong because it was actually HGTV personality Taric 399 00:20:17.519 --> 00:20:20.680 l Musa who had thyroid cancer, and it was a 400 00:20:20.839 --> 00:20:23.519 nurse who spotted his enlarged gland. 401 00:20:23.960 --> 00:20:26.359