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