Evo Terra (Host): This is BayCare HealthChat, the podcast from BayCare Health System. I'm your host, Evo Terra, and today's episode is all about the thyroid. Joining me is Dr. Dipan Desai, an ENT with BayCare Health System.

Dr. Desai, thank you very much for joining me today.

Dr. Dipan Desai: Thanks for having me, Evo. Evo Terra (Host): Now, for those of us who didn't take or simply failed their anatomy class, where is our thyroid gland and what does it do? 

Dr. Dipan Desai: So, the thyroid is a small gland. It's a butterfly shaped gland, and it's located at the base of the neck, just above the collarbone in the central portion of the neck. It's part of our endocrine system, meaning it produces hormones. And so the thyroid hormones are primarily T3 and T4.

These are excreted from the thyroid and worked throughout the body, to regulate all aspects of metabolism. So this is a variety of things. This is how our body processes energy, heart rate, breathing, body temperature, development in especially children and young adults, and even skin and bone health.

And so there's a lot of effects that this small gland and its hormones have across the entire body.

Evo Terra (Host): So it's an important gland. It regulates much of what we do as humans. I understand all that, but I also understand that there are some disorders. I mean, my wife sees an endocrinologist to help regulate her thyroid. So how common are disorders?

Dr. Dipan Desai: Thyroid disorders really come in two varieties. One is with the function of the thyroid, meaning how much thyroid hormone is being produced, and that can either be too little, which is called hypothyroidism, which is extremely common overall. Or hyperthyroidism, which is too much thyroid hormone. These are problems that often are seen by primary care doctors, endocrinologists, and our medical counterparts. 

On the flip side, the thyroid can also get lumps and bumps called thyroid nodules. And those thyroid nodules are more masses of the thyroid gland. They may or may not affect production of thyroid hormone and those are problems that usually endocrinologists or endocrine surgeons like myself are managing.

Evo Terra (Host): And let's talk about some of the symptoms. If we have a thyroid disorder, how does one know?

Dr. Dipan Desai: Yeah. So starting with thyroid function issues, meaning hormone problems, sometimes these are symptomatic. If you have too much thyroid hormone, meaning you have an overactive thyroid, you can have symptoms like palpitations and heart racing. You can feel warm, be prone to sweating or anxiety or tremors. Sometimes patients will present with those issues. 

On the flip side, if you have too little thyroid hormone, you'll have the opposite. You'll have fatigue, feeling cold sensitivity, weight gain, potentially slow metabolism. Oftentimes patients are concerned that they may have that as well. And usually the first step there is with your primary care physician obtaining thyroid hormone blood work, which we call thyroid function testing. And that can tell us very quickly if those symptoms are caused by a thyroid disorder underlying that, or if those are related potentially to something else.

 On the flip side, if you have a thyroid nodule, the vast majority of those nodules are found by accident, what we call incidentally today, as  we start to do more and more imaging of the body for various things in medicine, we tend to find these nodules in the thyroid by accident.

So now the vast majority of these nodules are found on a chest CT or a sinus CT that was never intended to find a thyroid nodule, but it's important to make sure we follow up on those and check out and figure out if that needs any further workup. Occasionally patients will find a thyroid nodule on their own as a lump or a bump in the center or base of their neck, and they'll present to their doctor's office after finding that.

Evo Terra (Host): Now as a lay person who's known many people over my, well, several decades of life, I've always heard that thyroid issues present with, I'm just gonna call it what I call it, bugged out eyes. You know, eyes that seem to protrude. Is that true?

Dr. Dipan Desai: So many of the overproductive or underproductive disorders of the thyroid, meaning hyper or hypothyroidism, are autoimmune disorders. And what you're referring to is one type of hyperthyroidism called Graves’ disease, and that one tends to affect both the thyroid and the antibodies, that are causing that, because it's an autoimmune disorder, meaning it's your body causing inflammation within the thyroid.

Also randomly tends to affect the eyes. And so you can get thyroid eye disease with hyperthyroidism and usually those patients will have a multitude of symptoms, not just the eyes. That can actually be something that's a little bit later downstream. But those patients will usually start with blood work and then additional testing with an endocrinologist.

Evo Terra (Host): Well, let's get into that. Blood work, testing, if someone has symptoms that might indicate a thyroid disorder and they would like to go to you, what does the diagnosis process look like?

Dr. Dipan Desai: Yeah, good question. So typically they'll start with their primary care doctor, and the workup of either thyroid, hormonal issues or thyroid nodule begins with thyroid function testing. For the vast majority of thyroid nodule patients, that thyroid testing will be normal, meaning that the nodule is growth on the thyroid, but it's not affecting the amount of hormone that the patient is creating.

And then those patients will usually get some form of imaging for their thyroid nodules.Thyroid nodules overall are extremely common. Roughly 60% of Americans at the age of 60 will have a thyroid nodule. So part of what we've tried to do in medicine over time is not to overreact and overtreat every thyroid nodule because we know that the vast majority of these are never going to cause a problem.

Roughly 90% of thyroid nodules are benign, meaning not cancerous, and never will turn into a cancer. So usually when we're evaluating a thyroid nodule, after we've completed the thyroid blood testing, we'll get a thyroid ultrasound. That ultrasound gives us a lot of characteristics of the nodule, and depending on those characteristics, it'll tell us how high risk the nodule is for the potential of thyroid cancer.

There's a few characteristics we look at. Is the nodule solid? Is it filled with fluid? That would be a low-risk nodule. Does the nodule have calcium deposits that can portend a higher risk of cancer? And overall, our radiologists who look at the ultrasound will give us a classification of how risky they think this nodule is, and that helps determine next steps.

Evo Terra (Host): And next steps is a good place to go. Now we have a diagnoses, a endocrinologist and a radiologist, and everybody else has looked at this and says, “Okay, we need to do something.” Obviously there are a lot of different conditions and some of them I assume, can be treated with medication and some might need something more.

So walk us through that.

Dr. Dipan Desai: And so as we continue to balance these two types of problems that the thyroid can have. We'll start with thyroid nodules. If that nodule has a sufficient size and a sufficient, you know, indication of risk on the ultrasound, we'll usually proceed with what's called a fine needle aspiration. This is a type of biopsy where we put a very small needle into the nodule through the skin and just with what we can collect within that needle, we can actually get enough tissue to give us a diagnosis often. And so that nodule, like I said, 90% of the time will be benign, meaning no chance of cancer, but 10% of nodules have thyroid cancer in them or are thyroid cancer.

And so those are the nodules we're trying to pick up. And so that's usually the next step if we're doing a thyroid nodule evaluation. If there's any sort of abnormality on the blood testing, those patients will usually see an endocrinologist and they'll usually be managed medically. That gets a little bit complicated pretty quickly, but broadly, if you have low thyroid levels, that can typically be very easily treated with medication that's called levothyroxine. It's a medication that's a thyroid hormone supplement or replacement.

It's been around for a long, long time and is very safe and easy to dose. 

If you have overactive thyroid levels, it gets a little bit more complicated and the treatment can be medical or potentially surgical.

Evo Terra (Host): And when we talk about surgical, do we mean removing the thyroid completely?

Dr. Dipan Desai: Correct. It can be either what we call a total thyroidectomy or a partial thyroid removal, which we call a thyroid lobectomy, and that's removing half of the thyroid. And typically we're doing that surgery as endocrine surgeons for those two conditions, either overactive thyroid glands or a thyroid nodule that is either thyroid cancer or suspicious for thyroid cancer.

And so we decide which of those two surgeries is appropriate based on what condition we're treating, the patient's own personal variables. There are pros and cons to either approach, depending on how suspicious we are of thyroid cancer or if they have multiple thyroid nodules. Some patients may have nodules on both sides of the thyroidand may benefit from removing the entire thyroid. Others, if they only have a small thyroid cancer can potentially benefit from just removing half of their thyroid.

Evo Terra (Host): And I want to finish up asking about the hyperthyroidism or hypothyroidism people out there, because I live with one. Is there a cure? Is this just something we just keep on medication forever? What does it look like?

Dr. Dipan Desai: Yeah. So this is not typically a condition, for hypothyroidism, that's cured. It's a chronic autoimmune condition, and for the majority of those patients, they begin a low dose of thyroid hormone and they actually start to feel pretty good pretty quickly, and it just becomes something they monitor over time. Almost like checking a vitamin D level or routine blood work for any other medication really becomes just part of their routine. 

Hyperthyroidism is a little bit more complicated. Oftentimes, there are treatments that can fully resolve the condition, but it depends very much so on what type of problem they have. With thyroid nodules and thyroid cancer especially is usually the one that patients are most concerned with and come to see me for.

It's important to note that this is actually a very treatable and curable thyroid cancer. For all comers, greater than 98% of patients can be cured and that typically, for thyroid cancer, is done with surgery. This is not typically a cancer that requires chemo or radiation. Typically, surgery with the appropriate surgery at the right time is typically curative and can last for decades with great results. And so we're really excited about that for those patients. And it makes doing this very rewarding because most of our patients do quite well. 

There's also newer treatments that have come out for a variety of the thyroid conditions we've talked about today, including one called radiofrequency ablation. For years, if you had a thyroid nodule, we would worry about it if it got big enough where it was starting to cause symptoms or become visible in the neck, even if it wasn't cancer or no matter how big it was if there was some risk of cancer within the nodule. Now for select patients, we can actually, rather than removing the thyroid. through the skin we can actually ablate the thyroid nodule.

Especially for really big benign nodules where those patients don't want to have surgery, we might be able to shrink those nodules through the skin without having to go under surgery or anesthesia.

Evo Terra (Host): Wow. What a time to be alive. We can do  all of these great, great things in medicine. I just want to circle back to one last thing. We've said it before, but I think it bears repeating at the end. If someone suspects they might have a thyroid disorder, who should they see first?

Dr. Dipan Desai: So if you have a good primary care doctor, obviously that's the right place to start for virtually anything. They can get you pointed in the right direction and do the initial workup and let you know if you need further care. If you don't, or you're able to get into a specialist directly, endocrinologists are the medical counterparts to me as a surgeon. They manage all of the conditions we've talked about today. And then select patients, if you have a big thyroid nodule or you've had a biopsy result that came back with some risk of cancer, totally appropriate to go see an endocrine surgeon, somebody who does a lot of thyroid or parathyroid surgery in your community or your area.

Evo Terra (Host): Excellent. Thank you for all of the information, Dr. Desai.

Dr. Dipan Desai: Absolutely. Thank you for having me.

Evo Terra (Host): Once again, that was Dr. Dipan Desai, an otolaryngologist with BayCare Health System. And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers.

I have been your host, Evo Terra. Please remember to subscribe or follow BayCare HealthChat on your favorite podcast listening app. If you found this episode informative, please share on your social media and while you're there, follow our BayCare Health System accounts for more healthy tips and updates.

Thanks for listening.