Scott Webb (Host): Our thyroid glands are relatively small, and when they're functioning properly, we generally feel fine and don't think much about them. However, when they're running too slow or too fast, we might be losing weight or gaining weight, along with other symptoms, and that might cause us to reach out to our providers.

And here to tell us more about the thyroid and how she helps patients when their thyroids are off is Carlyn Stone. She's a board-certified physician's assistant in Family Medicine, practicing at Franciscan Health. 

This is the Franciscan Health Doc Pod. I'm Scott Webb. Carlyn, it's nice to have you here today. We're going to talk all things thyroid, thyroid disease, disorders. But before we get too far along, let's make sure we all know what the thyroid is. So, tell us what is the thyroid and what does it do in our bodies?

Carlyn Stone: It actually kind of looks like a butterfly-shaped gland that sits right in front of your neck and it's very small. You know, most of the times, you can't even feel it there. But the main thing that it does for us is that it produces hormones, T3 and T4, and those hormones are responsible for our body's metabolism, our heart rate, temperature, energy, and our weight.

Host: Yeah. So, it's relatively small. We don't really know it's there, especially when it's doing its job. But I'm sure there are, or at least I'm aware of some of the common thyroid diseases and disorders. Maybe you can go through those for us.

Carlyn Stone: The two most common ones I will talk about today are hypothyroidism and hyperthyroidism.

Host: Okay.

Carlyn Stone: So, the first one, hypo, it's also called Hashimoto's thyroiditis, and that is basically when our thyroid is underactive. So, it's producing none or too little of T4. And then, the sister, I like to call it, the hyperthyroidism, that one's called Graves disease, and that is when your thyroid produces too much and it's overactive.

Host: All right. So, being the lay person here, so sometimes, it could be not doing enough. Sometimes it could be doing too much. Are there signs and symptoms of the disorders?

Carlyn Stone: Yeah. Hypothyroidism, it's when your body's, I like to say, it's moving slow mo. So, some of those symptoms that you would think you're having a lot of weight gain, you're very fatigued, experiencing depression, you're really sensitive to the cold, you're having dry skin, hair loss, constipation, muscle aches, brittle nails, and sometimes, this is more for women, but they experience heavier menstrual cycles.

So similarly, hyperthyroidism, those symptoms will be the complete opposite. So, you then would be experiencing weight loss, palpitations, anxiety, heat intolerance, sweating, diarrhea, insomnia, excessive hunger, tremor, and then same thing with the women, light or absent menstrual cycles. So, these symptoms, they're on like two very, you know, ends of the spectrum of your body's being in slo mo or your body's in overdrive.

Host: Sure. Yeah, that's a great way to put that. So, do we know what causes thyroid issues, disorders? Is it family history, genetics, age, all the greatest hits? Like, what causes these things?

Carlyn Stone: Most often, thyroid disorders, they kind of stem from an autoimmune process. Just for like simple terms, autoimmune, it's a disease process where the body, like your immune system, starts to attack itself. Like it's healthy cells, tissues. So for instance, the thyroid disorders will become autoimmune. And for some reason, your body thinks the thyroid is a problem and it starts to attack itself.

Another thing that I'd like to share is that hypothyroidism, it's underactive, so your body's in slow mo. And one thing, it doesn't have to be diagnostic, but could be shown up on lab results is that they would actually test positive for TPO antibodies. So, it's not required to make the diagnosis, but it is good to know that if you do have TPO antibodies, then it is most likely an autoimmune process. And then, similarly, hyperthyroidism, it's in the fight or flight mode, and those patients would actually test positive for TSI antibodies. But again, those aren't required for a diagnosis.

Host: Okay. Yeah. I want to talk a little bit about diagnosis. I'm assuming, you know, good patient history and probably some testing and things like that. So, how do you diagnose? Because when you were going through the signs and symptoms, I'm thinking about those lists of, you know, what's in either in slow mo or overdrive and thinking, well, those could be other things too, not necessarily thyroid or isolated to the thyroid. So, how do you diagnose thyroid disorders?

Carlyn Stone: When I am talking to patients, I think family history is the most important question you can have. A lot of times, if I'm hearing these symptoms, you know, I'll go ahead and ask does anyone in your family, like mom, sister, aunt, grandma, have a thyroid disorder? And they go, "Oh, yeah, my mom and my sister, they both have thyroid problems." So, that's also like a good kind of clue for me to know that we're heading in the right direction, because oftentimes thyroids like to stay in the family, and they also like to target women more than men.

Another thing that I actually like to ask is if the family has any autoimmune conditions. So, I'll ask like anyone in your family have a diagnosis of type 1 diabetes, lupus, psoriasis, Crohn's, rheumatoid arthritis. These are all other autoimmune conditions and oftentimes, if a family member gets diagnosed with one autoimmune condition, nine times out of ten, they will also develop more autoimmune conditions later on in life. And those play a big role in our genetics. So if there's a lineage of it, then oftentimes you can kind of make that inference that maybe we got an autoimmune condition. And a lot of times, thyroid is the first one to kind of show up in the family history.

Host: Yeah, interesting. So, yeah, family history, genetics, autoimmune, you know, disorders that run in the family, if you will. All right. Let's talk treatment options. I'm assuming, again, being the layperson here, Carlyn, you know, if it's running too slow, we speed it up. If it's running too fast, we slow it down. That seems simple enough to me, even for me. But I'm sure there's more involved.

Carlyn Stone: Actually, you're pretty much right on the money for those.

Host: Okay.

Carlyn Stone: So, one thing that's really nice is that if I'm having a patient come in, and they're explaining things and if it's been a while, and they're here for their yearly physical exam, one of the levels that I always order is the TSH. And that is basically our screening of how is our thyroid working.

So if you have hypothyroidism, you will have a really high TSH, but a very low T4. And that's because our pituitary gland is basically sending all of these signals to our thyroid of like, "Come on. Let's put in some work." And so, when that's happening, our thyroid's not doing its job, so then we actually have to do thyroid replacement therapy. And the most common medication for it is levothyroxine. And that medication is actually weight based. So if you're a person that fluctuates on their weight, normally every three months, they just draw the levels of the TSH and T4, just to make sure you're on an appropriate medication for your weight.

And for hyperthyroidism, it's the opposite. So, our TSH will be very low, but our T4 will be very high. Hyperthyroidism, there's kind of two different treatment options that we can do. The first one that's the most common, it's an antithyroid medication that's called methimazole. This one actually, most patients will be on for a couple of years of their life. And then, they kind of do a trial period to make sure like, "Is our thyroid okay or not?" And then, the other option is actually radioactive iodine. This one actually is more treated in the Endocrinology office rather than Family Medicine, but this one is used to reduce the T4 production and like restore normal function. So for me and Family Medicine, I work mainly on the methimazole, but if I have a patient who's, you know, the medication's not working and maybe they need the next step, then I would go ahead and send Endocrinology to do the radioactive iodine.

Host: Yeah. And you talked about the strong connection between family history and genetics and all that, but it makes me wonder if maybe thyroid disorders are more prevalent today. It seems like I hear about that more than I used to. And if I have that right, that they seem to be a little bit more prevalent than they used to be, do we know why that is?

Carlyn Stone: Yeah. So, you're absolutely correct that thyroid disorders are very much prevalent today, and it's increasing over the last few decades. But honestly, I'd say this is more due to increased awareness and we're improving our diagnostic criteria. One thing in Family Medicine that we have really I started to, you know, keen in on is an annual blood work screening for TSH, where years ago, this wasn't a very popular lab to order. But today, everyone that comes in my office, I screen their TSH. And so, I feel like I'm having people that used to never come to the doctors or I'm having them come in yearly and we just say, "Hey, I have the family history of it." And I say, let's screen your TSH yearly. That way, we can keep an eye on it. So, I wouldn't say it's more so of like your diet or your lifestyle. One thing I would say is that autoimmune conditions are becoming a lot more popular. And, you know, thyroid could be part of that answer of maybe why we're seeing more of it. But oftentimes, I'm saying it's just because we're catching it a lot earlier than we used to.

Host: Yeah, better screening, earlier diagnosis. It makes me wonder, you know, you talked about some of the medications, the issues, you know, too slow, too fast, is there anything else we can do with leading a healthier lifestyle, losing some weight, quitting smoking, you know, all those types of things. Is there anything else we can do besides medications?

Carlyn Stone: Unfortunately, most of these times, they are treated only with the medication. But one thing that I have noticed, a lot of these patients say, symptom-wise, they're like, "You know what I just feel really better now," is that they are doing an anti-inflammatory diet. So, autoimmune conditions, they're very inflammatory to us. And I started implementing, like, "Let's try doing some anti-inflammatory diets to kind of help with these symptoms." So, I'm telling patients, "Let's include more fruits, veggies, olive oil, nuts, seeds, fish, whole grains, ginger, beans, lentils, turmeric." These are good health foods that are known to be very like anti-inflammatory.

And when these patients are saying, "You know what, you know, I'm incorporating more of these," and they're avoiding the processed foods, the sugar, all the carbohydrates, alcohol. They're like, "I just feel like a whole new person." So along with the medication to just kind of like keep their levels in check, including this diet, it's just like a night and day difference for them.

Host: Yeah. Right. And even if it's just sort of, let's say, anecdotal on the feedback you're hearing from patients, I mean, I'm glad to hear that you're receptive to that, maybe sharing with other patients and there's never a bad time, I guess, right, Carlin, to eat better, healthier. But when we think about the things that can help these anti-inflammatory type foods, I mean, why not, right?

Carlyn Stone: I love it when, I have patients come in and they say, "Oh, like I tried doing this, this and this. And you know, "This helped or didn't help." I'm always wanting to say like, you know, "Do what you think helps because you are yourself and you know yourself best." So if they say cutting out alcohol, sugars, carbs, that, you know, they feel great, I mean, we also know that those are also foods that sometimes make us feel a little crummy. But if they say that this is great and this is helping them, then I'm all for it. Of course, be your best self. Like, I want you to feel the healthiest you can be. And if that's what it takes to help, like, I love it and I'm all for it.

Host: That's great. Yeah, great to learn more about the thyroid today. It's one of those things where it's like, yeah, I kind of know what the thyroid is and what it does, and then it can run too slow and too fast, but it's great to have an expert on. And I just want to give you a chance here at the end, final thoughts, takeaways about thyroid disease and disorders from your perspective.

Carlyn Stone: Just to reiterate some things, the thyroid, it likes to either move like slow mo or too fast. A good example I like to say is kind of like the Turtle and the Hare, that old children's tail. And that's kind of how sometimes our thyroid likes to work. Women are five to eight times more likely than men to develop a thyroid disorder in their lifetime. One in eight women will develop a thyroid disorder. And right now, there is an estimated 20 million Americans with a thyroid disorder. But currently, 12 million are unaware of their condition and without treatment.

So, just a little bit of what we said earlier, if you have a family history of thyroid disorders, autoimmune conditions, or if you've been experiencing any of these symptoms that we discussed earlier, I hope you take this as your sign to make an appointment with your primary care provider and get your annual blood work done to screen for thyroid disorders.

Host: Yeah, that's perfect. You know, we hope to educate folks with these podcasts, encourage them to speak with their own providers, and if they're listening to an expert like yourself, Carlyn, and going through a list of things, in this case for thyroid, and they're checking them all up, going, "Yep, yep, yep," well, if you get through that list, you're like, "Yeah, I have all those things," well, then it's probably this thing, and in this case, a thyroid disorder, so reach out to your provider, right?

Carlyn Stone: Yeah. And a lot of times too is that you don't need to check all the boxes to be diagnosed.

Host: To some of them maybe, right?

Carlyn Stone: Yeah. yeah. Yeah like sometimes I have patients come in and they're just like, "Man, I just feel cold all the time," and they say no to every other symptom and you do the annual blood work and you're like, boom, you know, there it is. So even if you have just have one of them, you know, just come in, just a screen on your annual blood work, and hopefully we catch it ahead of time.

Host: Yeah. As you say, the earlier screening, earlier diagnosis, all good things, of course, whether it's thyroid or just about anything else in medicine, so thank you so much for your time.

Carlyn Stone: Of course. Thank you for having me.

Host: And to learn more, visit franciscanhealth.org and search thyroid. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.