Transcription:

Scott Webb: Welcome to Check-up Chat with EvergreenHealth. I'm Scott Webb. And most of us probably think we know what the thyroid is and where it's located, but I'm joined today by Dr. Brandon Wei. He's a primary care and family medicine doctor with EvergreenHealth. And in addition to telling us exactly where the thyroid is and what it does, he's going to help us to understand hypothyroidism and hyperthyroidism.

Dr Wei, thanks for your time today. We were just kind of talking before we got rolling here that some of us may think we know what the thyroid is and where it is and what it does, but it's always good to have an expert on to answer these questions. And later on today, we're going to get to hypo and hyperthyroidism. But as we get rolling here, where is the thyroid and what is its function?

Dr. Brandon Wei: Yeah. So the thyroid gland is a very small organ. It's located just below the Adam's apple, which we also call the laryngeal prominence. It's butterfly shaped and it's divided into two connected lobes, connected by a small thin band in the middle. The thyroid is responsible for producing and secreting hormones called the thyroid hormones aptly. And they control many of the vital functions of the body and impact nearly every organ system. When we're infants, they're actually really important to regulate structure and growth as well. And if we think about the thyroid in more general terms, it's main job is to control your metabolism.

Not to get too much into the nitty gritty, but the thyroid is instructed to do his job by a hormone called the thyroid stimulating hormone that's produced by the pituitary, which is located at the base of your brain and it tells your body if you need more or less thyroid hormones to keep your metabolism working at the right rate. These hormones are called T4 or thyroxine and T3 or triiodothyronine. That last one is a mouthful.

Scott Webb: It sure is. That's a good foundation for us to get rolling here because again, you know, I think many of us kind of like, "Yeah, I think this is the thyroid right about here," and we kind of understand what it does, but always good to hear from an expert. So as we get now really into the nitty gritty, as you said, what are the differences between hypothyroidism and hyperthyroidism? And is one more common than the other?

Dr. Brandon Wei: Absolutely. So hypo and hyperthyroidism are kind of opposite. So they're differentiated by either the underproduction of thyroid hormone, which you get with hypothyroidism, or overproduction in hyperthyroidism. The hormones are T4 and T3 and they're produced by the thyroid. And when we get too much of one or both of these hormones, T4 and T3, we call that hyperthyroidism. And then if we get too little of one or both, we get hypothyroidism. There are a number of symptoms that are associated with each one, and these are often opposite, which you might expect.

If you're in a hypothyroid state, you might notice that your metabolism might be too slow. And then on the other hand, if you're hyperthyroid, your metabolism might be too fast. In the US, hypothyroidism is more common than hyperthyroidism. The thyroid disease can affect anybody, male, female, infants, teenagers, or the elderly. It can be present at birth or it can develop as we age. And it can affect more than 20 million people in the US. Women are five to eight times more likely to develop thyroid conditions than men.

Scott Webb: Yeah. I wanted to ask you when we think about the two types here, hyper and hypo, and you mentioned there that hypo is more common, more common with women, what are some of the other risk factors for just any thyroid condition? And is there a genetic or hereditary component to it?

Dr. Brandon Wei: That's a great question. There are a number of risk factors that can increase your risk to develop thyroid disease. And family history is absolutely one of these. Other medical conditions like autoimmune diseases can predispose you to having kind of an increased risk to develop thyroid issues as well. And then there are certain medications that can cause your thyroid function to change and increase your risk of having a thyroid issue. If you had a past treatment for thyroid issues like radiation or removal of the thyroid, that can leave you deficient or unable to produce those thyroid hormones. And then as you age, especially females above the age of 60, your risk of developing thyroid disease also increases.

Scott Webb: Okay. And so I'm thinking just kind of following along here, thinking, okay, well, if you lose a bunch of weight, and you can't explain it or you gain a bunch of weight and you can't explain it, that may be some of the ways, the initial ways, in which a thyroid condition is diagnosed. But then you also said that people can be born with it, right? And you said that there's a family history and genetic component. So let's go through how do you diagnose a thyroid condition.

Dr. Brandon Wei: There are a number of ways we can diagnose thyroid issues. But firstly, when you come into the primary care clinic, we're going to do a history and physical. So that means that we are doing an exam, asking a bunch of questions. That may lead us to believe whether you're producing too much or too little thyroid hormone like you said, whether you're losing weight unintentionally or even gaining weight.

These questions are really non-specific so they can kind of lead us down any number of paths, but at least kind of trigger us to think about thyroid as a potential issue. We'll then do a physical exam where we will palpate or feel your neck to see if we notice any unusual lumps or bumps along the front of your neck, which may be a sign of a thyroid nodule or thyroid enlargement. And then we'll get a blood test often that measures the thyroid-stimulating hormone or TSH. When we get the results of that blood test, it'll tell us whether that's high or low. And when TSH is high, it actually means that your body is trying to say, "Hey, I need more thyroid hormone." And so we'll then check to see if the thyroid hormones are indeed low. So we'll do a reflex test that shows T4 and T3. And if those values are low, then we may suspect that you have hypothyroidism or too low, even though that TSH is high. And then the opposite, if the TSH is low, we might be suspecting that your body is producing too much thyroid hormone and we'll recheck to see if your T4 and T3 are high.

Scott Webb: Got it. So it sounds like it is a fairly common condition and one that is fairly easy to diagnose. Besides the unintentional weight gain or loss, are there any other symptoms? We can go through maybe each one individually. You could start with hypothyroidism. But basically, other than the weight loss or weight gain, is there any other signs or symptoms for us?

Dr. Brandon Wei: So there are a bunch of symptoms, a large number of non-specific symptoms. And just because you have any one of these symptoms, doesn't necessarily mean you have a thyroid issue, but definitely clues us into thinking about thyroid as potentially being an issue.

So for hypothyroidism, you might have tiredness or fatigue, you may be gaining weight, experiencing some forgetfulness, having frequent or heavy menstrual periods or noticing dryer coarse hair, having a coarse voice or having some cold temperature intolerance.

Scott Webb: Yeah, that's good. And I see what you mean, that these could be associated with many other conditions. But at the very least, if you've got one or more of those, and in terms of hypo, if you're gaining weight unintentionally, that's probably a good time to mention this to your primary, right, and to move forward with some of the initial testing and diagnosis. So let's contrast that now with hyperthyroidism.

Dr. Brandon Wei: Yeah. So you just get a little bit of the flip side when you're talking about hyperthyroidism as compared to hypothyroidism. So when you have too much or hyperthyroidism, you get symptoms such as anxiety, irritability, or nervousness. You might have some trouble sleeping, losing weight rather than the gaining weight. You may have some muscle weaknesses or tremors, irregular or absent menstrual periods, and then feeling sensitive to heat. You may also notice that you may have some vision problems or eye irritation, or just feeling like that thyroid gland is enlarged, which can be known as a goiter.

Scott Webb: Yeah. And that's another one we could do a whole podcast on goiters, what we think waiters are versus what they actually are. But really interesting, you know, some of this, now that you've said this, hearing from an expert, you know, some of this seems like common sense because you've identified they really sort of are the opposite of each other, right? One is sort of your body may be working a little too fast, so you're more sensitive to heat. Let's say everything's just running a little fast versus cold -- I realize I'm oversimplifying. I apologize, doctor -- versus, you know, hypo where you're more sensitive to cold, everything seems to be running a little slower, you're gaining weight. And again, I'm sorry for oversimplifying, but I just want to make sure that I understand because I'm going to tell my wife afterward everything I learned from Dr. Wei.

So when we think about the treatment options for both hyper and hypothyroidism, is it the same thing? Is it that there's a sort of the opposite treatment options? Or are they similar?

Dr. Brandon Wei: You're absolutely not oversimplifying things. I think, at the very base level, we think of them as opposites and we treat them as opposites, but not entirely in equal ways. So for hypothyroidism, it's pretty simple overall. So we have a synthetic medication called levothyroxine and it's a replacement of the T4 thyroid hormone. And we can just replace that thyroid exogenously or from the outside. And then we measure and check your blood tests to make sure that we're doing correctly. And then we also check to see if your symptoms have improved.

And then on the flip side for hyperthyroidism, the treatments are a little bit more broad. So we have medications that stop your thyroid from making hormones. We can also damage the cells of your thyroid more specifically with radioactive iodine, which prevents it from making high levels of thyroid hormone, which are causing the issue. We have beta blockers, which are historically more blood pressure or heart medications, but these can help control the symptoms of hyperthyroidism. And then finally, there's a surgery called a thyroidectomy that we can perform that completely removes your thyroid.

Scott Webb: You know, this has been really educational today. And again, I don't want to oversimplify things and suggest that anybody would want one of these thyroid conditions. But, you know, the signs and symptoms, fairly obvious to recognize. It seems fairly easy to diagnose, the treatment options seem pretty, you know, fairly straightforward for most folks, although there could be some complicating factors and not the same in everybody, of course. So I guess what I'm saying is I think that there's room for optimism for folks if they are diagnosed with a thyroid condition. And, you know, I think that's how I want to wrap up here, is just ask you if someone suspects that they may be having an issue, may have a thyroid condition, what would be your encouraging words and your takeaways?

Dr. Brandon Wei: Obviously, establishing with your primary care provider is a great way to at least allow us to have that discussion, determine any risk factors you might have and do an exam. And we love to be able to build these connections with our patients at EvergreenHealth and just to be able to work with you closely to address any concerns that you might have and decide on a plan of action there, whether that means going through with the blood test or getting an ultrasound to evaluate if we find something that may be unusual. Thyroid diseases are very common, obviously, but they don't have to be scary or intimidating at all.

Scott Webb: That's perfect. Let your word stand. That's a perfect way to end. They don't have to be scary or intimidating. So folks should speak with their doctors. Let them know what you're experiencing or what you're feeling and so on. So really great advice from an expert today, doctor. Thank you so much for your time and you stay well.

Dr. Brandon Wei: You too. Have a great day.

Scott Webb: Getting your thyroid under control and in a normal range will lead you closer to living your healthiest best. Visit evergreenhealth.com/primary-care-physician to find a primary care provider that's right for you.

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