Maggie McKay (Host): Your thyroid works hard and is crucial to good health, but how much do we know about keeping it healthy? Here to tell us more about it is Dr. Jocelyne Karam, Director of Endocrinology at Maimonides Medical Center. Thank you so much for joining me today on Maimo MedTalk. I'm your host, Maggie McKay. Good to have you here, Dr. Karam.

Jocelyne Karam, MD: Thank you very much for having me.

Host: So to begin, what is the thyroid? Where is it on our body and what is its purpose?

Jocelyne Karam, MD: So the thyroid gland is a very important and small gland in our body. It's mostly located in the lower part of the neck in the front, right over the collarbone. It's in the shape of a butterfly, maybe the size of two thumbs. So the role of the thyroid gland is really crucial for our body because it does regulate the metabolism and the energy in all the tissues of our body.

Host: And what are the most common types of thyroid diseases?

Jocelyne Karam, MD: So the most common one is when the thyroid is not working enough, and we call that underactive thyroid gland or hypothyroidism, and where we need basically to supplement the body with thyroid hormone. The second common one that we encounter is when it is this time, the opposite way, overactive thyroid gland where it's secreting too much thyroid hormone.

And also, of course, there are ways to treat that. There are also some disorders where the gland is inflamed because of a viral infection or sometimes after pregnancy. And there is a whole other set of thyroid disorders that are not related to the function of the gland, but to like some growth that can happen on the thyroid gland that we call thyroid nodules.

 And we do assess them with imaging and we follow them and we biopsy them when needed.

Host: Are any of these life threatening?

Jocelyne Karam, MD: They can be life threatening in very extreme situations. And most of the time, the symptoms can be of slow or more rapid onset, but it's only when the thyroid hormone is very, very low or very, very high that this can be life threatening. And fortunately, it's a very rare situation where we get to that extreme.

Host: That's what I was going to ask you. How common is it to have a thyroid problem and is it more prevalent in men or women?

Jocelyne Karam, MD: It's a very common disorder. Actually, we think around 20 million people in the United States do have some thyroid issues, and many of them, probably more than half might not know about it. It's much more common in women for some reason, younger and middle aged women, maybe one out of seven or eight women might have some underlying thyroid abnormality.

Host: What about children?

Jocelyne Karam, MD: It can happen in children. In very rare cases, children can be born without a thyroid gland and it can happen. It's less incident than an adult, but it can of course happen. And in children, it can affect the growth in addition to all the other symptoms that people can encounter.

Host: Dr. Karam, what are the symptoms that you may have a problem with your thyroid or even thyroid cancer?

Jocelyne Karam, MD: Yeah. So the symptoms are mostly related to when the thyroid hormone is high or low. And because, as I said, it really regulates the energy in our body, it really affects all the tissues. So as you will see, the symptoms can be very widespread in the body. Some of the symptoms can include body weight changes; like patients gaining weight or losing weight despite eating the same way like they've always done. So they gain weight if the thyroid is underactive and they lose weight if it is overactive. Other symptoms can affect the body temperature. The patients who have too much thyroid hormone can feel hot and can sweat much more than their usual. Whereas the patients who have low thyroid hormone would feel more cold even when the other people in the same room don't.

Other symptoms also, as I said, other tissues that can be affected can be the gastrointestinal tract. Patients who have low thyroid hormone will have constipation. They have a slower basically GI tract movements, whereas the patients who have too much thyroid hormone will have very frequent bowel movements and might have diarrhea.

Also in women, menstruations can be affected. They can be lighter or heavier and they can be irregular when the thyroid hormone is not normal.

And one very important organ that I didn't mention is the heart. Especially when the patient have too much thyroid hormone, their heart can beat very fast and in some situations it can become irregular and this is what we mostly worry about in hyperthyroidism.

Host: Wow, it affects a lot in your body. I had no idea.

Jocelyne Karam, MD: Yeah, it affects everything. And, another organ also that I should mention is the brain. It can affect actually how we feel. In hypothyroidism, where we don't have enough thyroid hormone, patients might feel depressed or have a low mood. Whenever they have too much thyroid hormone in the opposite, they can feel very anxious, very nervous, very shaky, not sleeping well, like very irritable. Many times it's the people around them who notice these changes first.

Host: Are there ways to prevent thyroid issues?

Jocelyne Karam, MD: No, they usually happen without a specific cause. Like we know sometimes it's autoimmune disorders that cause them. Sometimes it's thyroid nodules. There is no specific cause that we can prevent. But, we can definitely treat all thyroid disorders and it's important to recognize the symptoms and diagnose the thyroid problem so we can treat it.

Host: uh, what's, How do you treat them?

Jocelyne Karam, MD: It depends on what's the hormone level. In patients who have low thyroid hormone or hypothyroidism, we just give levothyroxine, which is exactly similar to the thyroid hormone that our body produces. It's not like any regular medication. It's just exactly the same hormone that we are substituting in this case.

And we usually monitor the levels and adjust it to maintain the thyroid level normal. When the patients have overactive thyroid in the opposite situation, we can give medications that can slow down the thyroid hormone production. Sometimes if it persists, we can give what we call radioactive iodine ablation because the thyroid uses iodine to produce thyroid hormones.

And when we give radioactive iodine, that iodine will go to the thyroid gland and destroy the cells, without causing too much radiation to the body. And in some situations we need to just surgically remove the thyroid gland. Now there are some situations where we don't really need to do anything except for just give supportive therapy until it resolves on its own.

Like for example, when we have a viral inflammation of the thyroid gland, that usually goes away on its own. We just have to monitor the thyroid number, give medications for pain or to slow down the heart rate, but the actual thyroid itself would recover on its own.

Host: So, what are the chances that it will reoccur?

Jocelyne Karam, MD: Again, depending on the cause. If the cause of the thyroid problem is autoimmune, which is when our immune system basically has a blind spot and thinks that the thyroid is a foreign body or an invader body and attacks it. This actually can cause both hypothyroidism, which we call Hashimoto disease, or hyperthyroidism, which we call Graves disease.

So in these two situations, the antibodies cause the thyroid gland to be either destroyed or overactive. So when we treat this condition, in Graves disease, for example, it can go away, but then it can occur again in life. In hypothyroidism, most of the time the patients need therapy for life, they just need thyroid hormone.

Toxic nodules, if we treat them usually, either by surgery or radioactive iodine ablation, they do not recur.

Host: Dr. Karam, what does the future look like as far as treatment for thyroid problems? Any research on the horizon that might help us down the line?

Jocelyne Karam, MD: So far the treatment is very successful in both hypothyroidism and hyperthyroidism. There is a lot of recent advances in trying to diagnose thyroid cancer in a more accurate way. The thyroid nodules, where most of the time the thyroid function itself is normal they can, present as growth on the thyroid gland.

Most of them are benign, but there is a small percentage that can be cancerous. And what we're really seeing a lot of advances in are additional genetic testing when we biopsy these nodules to be able to tell us more accurately if this thyroid nodule is cancerous or not. So we avoid unnecessary surgeries and we only operate on the thyroid cancers.

Another, another field where we have a lot of advances recently is the field of thyroid eye disease. When the patients have overactive thyroid gland because of autoimmune system, which is the Graves disease; sometimes these same antibodies can cause problems in the eyes. And the treatment of this eye disease related to the thyroid has really advanced. And now we have medications that can really change the course of that.

Host: That's encouraging. I mean, that would be scary, I would think.

Jocelyne Karam, MD: Yes. I think it's a very stressful part of treating thyroid gland when it's associated with thyroid eye disease and it's really causing problems with the eyes bulging or sometimes with the vision itself or with the ability to move the eyes in all directions.

Host: Oh my gosh. Well, in closing, is there anything else you'd like to add?

Jocelyne Karam, MD: You had asked me about how to prevent eye disease. One thing I didn't mention is that we have to have enough iodine in our diet. In the United States, we have usually iodine sufficiency from the salt that we have that's strengthened with iodine. But in many other countries, there is not enough iodine in the diet.

So it's important that we make sure if we are in an iodine insufficient area to have iodine supplements. Usually we require 150 micrograms per day. And other than that, just recognize the symptoms. If someone has abnormal weight loss or weight gain or new onset of being very cold or very hot, irregular menstruation, the heart racing fast, growth on the thyroid gland.

All these symptoms are symptoms that we can discuss with the primary care doctors. It's very simple to screen for thyroid disorders. It's a simple blood test. And then the treatment can be offered afterwards.

Host: Thank you so much for sharing your expertise on thyroid health. It's been so informative and helpful.

Jocelyne Karam, MD: Thank you very much for having me.

Host: Again, that's Dr. Jocelyne Karam. If you'd like to find out more, you can make an appointment at 718-283-5923, 718-283-5923 to make an appointment. For general information, visit Maimo.org, M-A-I-M-O.org. If you found this Maimo Med Talk podcast helpful, please share it on your social media channels. To listen to additional episodes of Maimo Med Talk, please visit maimo.org. Thank you so much for joining me today on Maimo Med Talk. I'm your host, Maggie McKay.