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Everything You Need to Know About Your Thyroid
Some of those symptoms that are throwing you off in life could be the result of thyroid issues. Dr. Love Singh discusses what the thyroid does, how it may misbehave, and how to help it to heal.
Featuring:
Love Singh, MD
Dr. Love Singh is currently a Family Practioner at Southern Sierra Medical Clinic and has been a part of the medical staff at Ridgecrest Regional Hospital since July 2014. Dr. Singh's focus has been on a whole body-mind treatment plan for his patients with special areas of interest being obesity medicine ( currently undergoing fellowship training with the American Board of Obesity Medicine), endocrine disorders including hormone deficiencies and thyroid conditions, autoimmune disorders and behavioral/mental health issues. His training was at the rigorous University of California Riverside Health system at the Riverside County Regional Hospital, where he became prepared to deal with some of the most complex cases in a grossly underserved area. Transcription:
Alyne Ellis (Host): Fatigue. Sometimes it creeps up on you so slowly, you just assume you’re getting older. Or maybe you’re just anxious and irritable. Have you had your thyroid checked?
I’m Alyne Ellis and on this episode of the Ridgecrest Regional Hospital Podcast, we’re talking about some of the symptoms you may experience if your thyroid isn’t working right. And what tests and treatment you may need. Dr. Love Singh is a specialist in endocrine disorders including thyroid conditions. Dr. Singh is a Family Practitioner at Southern Sierra Medical Clinic, a service of Ridgecrest Regional Hospital. So, welcome Dr. Singh and tell me please, where is your thyroid gland located?
Love Singh, MD (Guest): Thank you very much Alyne. The thyroid gland is located pretty much right around your mid-neck portion. We have the trachea which is our windpipe and the thyroid gland sits right above it. it’s about the size of a small baby butterfly and weighs less than 15 grams.
Host: And yet, it’s incredibly important in the things that it does for us. Maybe you could sort of delineate some of those.
Dr. Singh: Well the thyroid gland is – I mean as small as it actually is, as diminutive in size that it is, it’s actually one of the most important regulators in the body. The thyroid gland will produce two major hormones, a T4 and T3. And these two hormones are essential to many, many functions in the body. The first and most important function from the thyroid gland is that it controls our ability to control our metabolic rate. So, that means that basically from everything that we eat to be able to burn those calories, whether it’s fat, carbohydrates or proteins into actual energy sources; the thyroid gland is what gives us that internal check in the ability to turn those calories into energy.
The second most important thing that the thyroid gland also does is it’s very essential to our nervous system, our neurologic system, our brain’s function as well as it is one of the most important developmental hormones especially as a person is still beginning life in the early years of their life. So, growth and maturation are very important for it as well. It controls our electrolytes and the ability to keep our sodium and potassium at a very regulated stage as well. It has big effects as well on the cardiovascular system. So, it increases the heart’s ability to contract, its heartrate, the oxygen consumption of our heart. It has effects also on the gastrointestinal system. So it can actually increase your motility of the GI system and so many different aspects can be affected by the thyroid.
Host: And in a lot of cases, obviously, if something goes wrong, it’s either that the thyroid is not producing enough of these hormones or it’s producing too much. Is that correct?
Dr. Singh: Well in a simple way of thinking of it, that’s exactly right. We have hyperthyroidism, which is the excess production of thyroid hormones, the T4 and T3 that I spoke of. And we have hypothyroidism, which is a general deficiency in either one of those hormones as well.
Host: I was very interested in this because I actually have a low thyroid condition and it snuck up on me. I had absolutely no idea that that was happening to me. And I gather that that’s somewhat normal, that you just don’t even realize it.
Dr. Singh: Well you’re 100% right. Hypothyroidism or an underactive low thyroid is much more common than hyperthyroidism. I usually joke with some of my patients. A lot of people wish they had hyperthyroidism because as I had spoken before, your metabolism is increased, you don’t gain weight even with eating more than usual. But hypothyroidism, the more common form, the low thyroid gives us pretty much very vague symptoms. It gives us a tiredness, a weakness, you see skin changes and hair loss and even simple things like being able to have decreased concentration. You accumulate a little bit more peripheral fat. You have different things that could easily be diagnosed as other disorders but can be as simple as a deficiency in your thyroid hormones.
Host: And what about if it’s the other way and you’re producing too many? What would your symptoms be when there are too many hormones?
Dr. Singh: Well hyperthyroidism will give you sweating, you are burning up more so you are going to be having a little bit more of a thin frame, you can feel a little hyperactive, irritable, you can have palpitations and because you are using up your calories and your metabolism is so high, you can also have more fatigue and weakness. And with the GI system, hyperthyroidism also cases diarrhea.
Host: That doesn’t sound pleasant. Well so tell me how do you have this checked? How do we know that we have something like this going on?
Dr. Singh: Well it’s very interesting that it’s quite an overlooked thing, but it’s a pretty simple way to diagnose this. If you have any of these symptoms, and you go into see your family doctor or your practitioner, all they have to do is run some simple blood tests and really it starts out with your what’s called a thyroid stimulating hormone and the thyroid stimulating hormone is released by our brain and it’s a signal that is sent to our actual thyroid gland. And if this thyroid stimulating hormone is elevated in the body; then we know for a fact that the thyroid is not producing enough hormones. And basically what we do at that point is we get the actual levels of your T4 and T3 hormones to see if it’s underactive.
Host: And let’s say whether it’s underactive or overactive; let’s start with underactive, what’s the treatment for that?
Dr. Singh: Well it’s pretty simple treatment as well, just like the getting it checked out. There are multiple different options. But the basic options are medications that can supplement. If you are underactive, you’re going to want to be on medications that supplement the actual hormones that are missing. So, a lot of times, the most common medications out there include Synthroid or levothyroxine which is a synthetic form of the T4 hormone that most people are missing. Or other options include combinations of T4 and T3. A common medicine called Armor Thyroid. There’s also synthetic T3 out there if you’re missing that hormone as well.
So, for underactive, there are multiple different options depending on how people take to them. For the other side though, for hyperthyroidism; you are going to be using medications in two ways. One to control some of the symptoms that you get so, if you’re having palpitations with a high thyroid; you are going to have something that’s going to control your heartrate a little bit better. If you’re having the diarrhea, you’ll have some medications out there but also there are medications to make that conversion of T4 to T3 slow down a little bit and that would help the symptoms as well.
Host: And I’ve heard that with the overactive thyroid, I don’t know if this is true now, but I know in the past, they used to actually have a surgery where they’d take part of your thyroid out. Is that still done?
Dr. Singh: Well yes, absolutely. See so the most common cause of hyperthyroidism or high thyroid is an autoimmune condition called Graves Disease. And this is where your body is producing antibodies that are fighting against your thyroid in a way a little bit of a battle here. And what is happening, with Graves Disease is you’re producing excessive – tremendous amounts of the hormones that are negatively affecting you and if you let this continue unregulated; what will happen is you will actually have long term complications. So, most of the time with Graves Disease, we have surgery to actually remove part or the entire thyroid gland.
Host: And how often let’s say now going back to the low hormone level for a minute; once you start on medication, how often should you be checked by a doctor?
Dr. Singh: Well, when we start a patient on a medication; usually the first thing we do is within six weeks, we check to see if there has been a change in the levels of the thyroid hormones, getting back to more of a therapeutic range but also taking into account the symptoms. Has there been a change in the patient’s symptoms that got them there in the first place? And usually after that first six week course, you will follow up every three months or so with your doctor to check on your thyroid as well.
Host: And what about if you have the kind that’s overactive?
Dr. Singh: Overactive is a lot more – it’s pretty much the same type of a treatment. If you have a hyperthyroidism or a high thyroid, once you start medications to kind of control the symptoms and also to see if you can bring the levels down; you will be checked very, very frequently, almost at the three month mark and if it’s not seen that you are having a good reaction or that you are continuing to have the symptoms; then the next step would be more of an invasive surgical kind of a procedure.
Host: Now, do these issues run in families? Are they inherited? Or do you see them mostly with older women or older men or when can we sort of expect something to show up if it’s going to?
Dr. Singh: Well that’s a great question Alyne, but the first thing that we see is usually with the autoimmune types which is hyperthyroidism caused by Graves Disease or hypothyroidism, low thyroid caused by Hashimoto’s thyroiditis. These are two autoimmune conditions and like many autoimmune conditions, like rheumatoid arthritis, or lupus; these can be partly hereditary and there are strong correlations in entire families where there are multiple members who get these issues as well.
But in general, when we have the nonautoimmune or more basic deficiencies in these things; the most common for the low thyroid, the hypothyroid is in elderly females usually around the age of 60 years old or so we see a big pick up in the number of hypo or low thyroid patients. In the other side with the hyperactive thyroid; we see it much more in younger populations, in the 20 to 30 years old being a very common age to have that diagnosed.
Host: And do you ever see children with anything like this?
Dr. Singh: Absolutely. Children can have very different kinds of variations. One of the most common things that I see in my office is kids who are not at the developmental milestones in terms of height, and in terms of their weight and they are either very under or over. And most of the time, the first thing I would do is I would check for that thyroid hormone level and then to see if there is a deficiency. Because it’s important for their actual development and maturation into puberty.
Host: Is there anything else that I may have missed that you would like to tell our listeners about the thyroid conditions?
Dr. Singh: The last thing I’d like to talk about is something that many, many people have probably been diagnosed with which is a thyroid nodule. And thyroid nodules can be very incidental findings. You may go in for some other procedure or something and you get something picked up on your scan that says it’s a thyroid nodule. This can be kind of a scary thing for most patients because they don’t understand what that quite means.
And what a thyroid nodule can mean is it’s either a small cyst, very benign, something that’s just growing on your thyroid that doesn’t have any sort of a real effect or it can be a nodule that’s secreting some of these hormones that we’ve been talking about. And so it’s making you become hyperthyroid or hypothyroid. And then finally, when you have a nodule, it’s very important for your doctor to check to see if this could possibly be cancerous. And so, when you have that thyroid nodule, it’s very important that you follow the guidelines set by your doctor.
Host: Well thank you very much Dr. Singh. It’s been a pleasure and it sounds like you’ve made it a lot less scary.
Dr. Singh: Oh, thank you so much.
Host: Our guest has been Dr. Love Singh, a specialist in endocrine disorders and a family practitioner at Southern Sierra Medical Clinic, a service of Ridgecrest Regional Hospital, as well as being on the staff at Ridgecrest Regional Hospital. Thanks for listening. I’m Alyne Ellis. For more information please visit Ridgecrest Regional Hospital’s website www.rrh.org/health-matters-podcast.
Alyne Ellis (Host): Fatigue. Sometimes it creeps up on you so slowly, you just assume you’re getting older. Or maybe you’re just anxious and irritable. Have you had your thyroid checked?
I’m Alyne Ellis and on this episode of the Ridgecrest Regional Hospital Podcast, we’re talking about some of the symptoms you may experience if your thyroid isn’t working right. And what tests and treatment you may need. Dr. Love Singh is a specialist in endocrine disorders including thyroid conditions. Dr. Singh is a Family Practitioner at Southern Sierra Medical Clinic, a service of Ridgecrest Regional Hospital. So, welcome Dr. Singh and tell me please, where is your thyroid gland located?
Love Singh, MD (Guest): Thank you very much Alyne. The thyroid gland is located pretty much right around your mid-neck portion. We have the trachea which is our windpipe and the thyroid gland sits right above it. it’s about the size of a small baby butterfly and weighs less than 15 grams.
Host: And yet, it’s incredibly important in the things that it does for us. Maybe you could sort of delineate some of those.
Dr. Singh: Well the thyroid gland is – I mean as small as it actually is, as diminutive in size that it is, it’s actually one of the most important regulators in the body. The thyroid gland will produce two major hormones, a T4 and T3. And these two hormones are essential to many, many functions in the body. The first and most important function from the thyroid gland is that it controls our ability to control our metabolic rate. So, that means that basically from everything that we eat to be able to burn those calories, whether it’s fat, carbohydrates or proteins into actual energy sources; the thyroid gland is what gives us that internal check in the ability to turn those calories into energy.
The second most important thing that the thyroid gland also does is it’s very essential to our nervous system, our neurologic system, our brain’s function as well as it is one of the most important developmental hormones especially as a person is still beginning life in the early years of their life. So, growth and maturation are very important for it as well. It controls our electrolytes and the ability to keep our sodium and potassium at a very regulated stage as well. It has big effects as well on the cardiovascular system. So, it increases the heart’s ability to contract, its heartrate, the oxygen consumption of our heart. It has effects also on the gastrointestinal system. So it can actually increase your motility of the GI system and so many different aspects can be affected by the thyroid.
Host: And in a lot of cases, obviously, if something goes wrong, it’s either that the thyroid is not producing enough of these hormones or it’s producing too much. Is that correct?
Dr. Singh: Well in a simple way of thinking of it, that’s exactly right. We have hyperthyroidism, which is the excess production of thyroid hormones, the T4 and T3 that I spoke of. And we have hypothyroidism, which is a general deficiency in either one of those hormones as well.
Host: I was very interested in this because I actually have a low thyroid condition and it snuck up on me. I had absolutely no idea that that was happening to me. And I gather that that’s somewhat normal, that you just don’t even realize it.
Dr. Singh: Well you’re 100% right. Hypothyroidism or an underactive low thyroid is much more common than hyperthyroidism. I usually joke with some of my patients. A lot of people wish they had hyperthyroidism because as I had spoken before, your metabolism is increased, you don’t gain weight even with eating more than usual. But hypothyroidism, the more common form, the low thyroid gives us pretty much very vague symptoms. It gives us a tiredness, a weakness, you see skin changes and hair loss and even simple things like being able to have decreased concentration. You accumulate a little bit more peripheral fat. You have different things that could easily be diagnosed as other disorders but can be as simple as a deficiency in your thyroid hormones.
Host: And what about if it’s the other way and you’re producing too many? What would your symptoms be when there are too many hormones?
Dr. Singh: Well hyperthyroidism will give you sweating, you are burning up more so you are going to be having a little bit more of a thin frame, you can feel a little hyperactive, irritable, you can have palpitations and because you are using up your calories and your metabolism is so high, you can also have more fatigue and weakness. And with the GI system, hyperthyroidism also cases diarrhea.
Host: That doesn’t sound pleasant. Well so tell me how do you have this checked? How do we know that we have something like this going on?
Dr. Singh: Well it’s very interesting that it’s quite an overlooked thing, but it’s a pretty simple way to diagnose this. If you have any of these symptoms, and you go into see your family doctor or your practitioner, all they have to do is run some simple blood tests and really it starts out with your what’s called a thyroid stimulating hormone and the thyroid stimulating hormone is released by our brain and it’s a signal that is sent to our actual thyroid gland. And if this thyroid stimulating hormone is elevated in the body; then we know for a fact that the thyroid is not producing enough hormones. And basically what we do at that point is we get the actual levels of your T4 and T3 hormones to see if it’s underactive.
Host: And let’s say whether it’s underactive or overactive; let’s start with underactive, what’s the treatment for that?
Dr. Singh: Well it’s pretty simple treatment as well, just like the getting it checked out. There are multiple different options. But the basic options are medications that can supplement. If you are underactive, you’re going to want to be on medications that supplement the actual hormones that are missing. So, a lot of times, the most common medications out there include Synthroid or levothyroxine which is a synthetic form of the T4 hormone that most people are missing. Or other options include combinations of T4 and T3. A common medicine called Armor Thyroid. There’s also synthetic T3 out there if you’re missing that hormone as well.
So, for underactive, there are multiple different options depending on how people take to them. For the other side though, for hyperthyroidism; you are going to be using medications in two ways. One to control some of the symptoms that you get so, if you’re having palpitations with a high thyroid; you are going to have something that’s going to control your heartrate a little bit better. If you’re having the diarrhea, you’ll have some medications out there but also there are medications to make that conversion of T4 to T3 slow down a little bit and that would help the symptoms as well.
Host: And I’ve heard that with the overactive thyroid, I don’t know if this is true now, but I know in the past, they used to actually have a surgery where they’d take part of your thyroid out. Is that still done?
Dr. Singh: Well yes, absolutely. See so the most common cause of hyperthyroidism or high thyroid is an autoimmune condition called Graves Disease. And this is where your body is producing antibodies that are fighting against your thyroid in a way a little bit of a battle here. And what is happening, with Graves Disease is you’re producing excessive – tremendous amounts of the hormones that are negatively affecting you and if you let this continue unregulated; what will happen is you will actually have long term complications. So, most of the time with Graves Disease, we have surgery to actually remove part or the entire thyroid gland.
Host: And how often let’s say now going back to the low hormone level for a minute; once you start on medication, how often should you be checked by a doctor?
Dr. Singh: Well, when we start a patient on a medication; usually the first thing we do is within six weeks, we check to see if there has been a change in the levels of the thyroid hormones, getting back to more of a therapeutic range but also taking into account the symptoms. Has there been a change in the patient’s symptoms that got them there in the first place? And usually after that first six week course, you will follow up every three months or so with your doctor to check on your thyroid as well.
Host: And what about if you have the kind that’s overactive?
Dr. Singh: Overactive is a lot more – it’s pretty much the same type of a treatment. If you have a hyperthyroidism or a high thyroid, once you start medications to kind of control the symptoms and also to see if you can bring the levels down; you will be checked very, very frequently, almost at the three month mark and if it’s not seen that you are having a good reaction or that you are continuing to have the symptoms; then the next step would be more of an invasive surgical kind of a procedure.
Host: Now, do these issues run in families? Are they inherited? Or do you see them mostly with older women or older men or when can we sort of expect something to show up if it’s going to?
Dr. Singh: Well that’s a great question Alyne, but the first thing that we see is usually with the autoimmune types which is hyperthyroidism caused by Graves Disease or hypothyroidism, low thyroid caused by Hashimoto’s thyroiditis. These are two autoimmune conditions and like many autoimmune conditions, like rheumatoid arthritis, or lupus; these can be partly hereditary and there are strong correlations in entire families where there are multiple members who get these issues as well.
But in general, when we have the nonautoimmune or more basic deficiencies in these things; the most common for the low thyroid, the hypothyroid is in elderly females usually around the age of 60 years old or so we see a big pick up in the number of hypo or low thyroid patients. In the other side with the hyperactive thyroid; we see it much more in younger populations, in the 20 to 30 years old being a very common age to have that diagnosed.
Host: And do you ever see children with anything like this?
Dr. Singh: Absolutely. Children can have very different kinds of variations. One of the most common things that I see in my office is kids who are not at the developmental milestones in terms of height, and in terms of their weight and they are either very under or over. And most of the time, the first thing I would do is I would check for that thyroid hormone level and then to see if there is a deficiency. Because it’s important for their actual development and maturation into puberty.
Host: Is there anything else that I may have missed that you would like to tell our listeners about the thyroid conditions?
Dr. Singh: The last thing I’d like to talk about is something that many, many people have probably been diagnosed with which is a thyroid nodule. And thyroid nodules can be very incidental findings. You may go in for some other procedure or something and you get something picked up on your scan that says it’s a thyroid nodule. This can be kind of a scary thing for most patients because they don’t understand what that quite means.
And what a thyroid nodule can mean is it’s either a small cyst, very benign, something that’s just growing on your thyroid that doesn’t have any sort of a real effect or it can be a nodule that’s secreting some of these hormones that we’ve been talking about. And so it’s making you become hyperthyroid or hypothyroid. And then finally, when you have a nodule, it’s very important for your doctor to check to see if this could possibly be cancerous. And so, when you have that thyroid nodule, it’s very important that you follow the guidelines set by your doctor.
Host: Well thank you very much Dr. Singh. It’s been a pleasure and it sounds like you’ve made it a lot less scary.
Dr. Singh: Oh, thank you so much.
Host: Our guest has been Dr. Love Singh, a specialist in endocrine disorders and a family practitioner at Southern Sierra Medical Clinic, a service of Ridgecrest Regional Hospital, as well as being on the staff at Ridgecrest Regional Hospital. Thanks for listening. I’m Alyne Ellis. For more information please visit Ridgecrest Regional Hospital’s website www.rrh.org/health-matters-podcast.