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Helen Dandurand (Host): Welcome Back to the Well Within Reach podcast. I'm your host, Helen Dandurand. And today, I'm going to be joined by Dr. Santosh Bhat, a Riverside Internal Medicine provider, to talk a little bit about thyroid disorders.

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Host: And we are back with Dr. Bhat. Thank you so much for joining me today.

Dr. Santosh Bhat: Thank you for having me.

Host: Of course. So, could you get started by telling us a little bit about yourself and your background?

Dr. Santosh Bhat: Recently, I started here at Riverside just last month, or rather, in September. I joined the internal medicine practice in Bourbonnais. Prior to that, I was practicing internal medicine in Indiana, in the Indianapolis area. But previously to that, I was finishing my training in New Jersey, which is where I grew up.

Host: Oh, great. That's awesome. So jumping in, can you explain a little bit about the role of thyroid in your overall health and why it's so important?

Dr. Santosh Bhat: So, the thyroid gland is very important for our endocrine system, which simply means that it's very important in terms of the hormone it produces, which is the thyroid hormone; in terms of regulating many aspects of our health. One of the key aspects would be our metabolism, as well as other things as it relates to even our heart and other aspects of our body.

In terms of how it's important for what I do in primary care, in primary care, we see many things that could be related to thyroid disease. I would say probably the two more important things that we look at is, to put in simple terms, either overactive thyroid or underactive thyroid, which we would call hypothyroidism or hyperthyroidism.

Host: Okay. So, you would say that those are kind of the two most common thyroid disorders that you see within primary care?

Dr. Santosh Bhat: I would say so, yes.

Host: Okay.

Dr. Santosh Bhat: There's some other things like thyroid nodules, and even thyroid cancer. But from a primary care standpoint, those would be the two probably most common things.

Host: Okay. Are there certain symptoms that should prompt someone to get their thyroid checked?

Dr. Santosh Bhat: Yes. And I would put this into two categories, again, for symptoms related to an overactive thyroid and symptoms with an underactive thyroid. So for overactive, if you're developing things like tremors, unexplained weight loss, looser bowel movements, anxiety, sweating more, becoming more intolerant to heat, irregular heartbeats, palpitations, and even menstrual cycle changes, these symptoms would be associated with an overactive thyroid. With an underactive thyroid, we're thinking more changing your skin texture, more dry skin, gaining weight, constipation, hair loss, feeling more tired and weak. And the menstrual issues, again, play a role in this as well, and a cold intolerance. So to think of it in simple terms, they're kind of the opposite in terms of their symptoms.

Host: Okay. Does gender play a role in that at all? Is there a certain gender that is more prone to have thyroid issues or not really?

Dr. Santosh Bhat: Yes. So, women are more prone to thyroid disease. And this is true for a lot of autoimmune diseases in general, that it is more prevalent with women. And in the United States, autoimmune disease is the most common cause of hypothyroidism. It's called Hashimoto's.

Host: Okay. So, how are thyroid disorders typically then diagnosed? What kind of tests might be involved?

Dr. Santosh Bhat: So based on the symptoms you present with and certain physical exam findings, these will kind of clue in the provider on to look for. But to really confirm the diagnosis, it would be with blood tests. The main blood test that's usually ordered is thyroid-stimulating hormone, which is called TSH. And that is actually a hormone released by your anterior pituitary gland. And what it does is it releases that, it goes down to your thyroid gland and stimulates your thyroid gland to make thyroid hormone. And so if this is off, this could probably indicate there's something wrong with your thyroid gland. And then, other blood tests would be to actually check for the thyroid hormone levels themselves more directly.

Host: Okay. And those are things that your primary care provider could put in an order for you to get and look into?

Dr. Santosh Bhat: Yes, absolutely. Yep.

Host: Okay. We are going to take a quick break to talk about primary care at Riverside.

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And we are back. So, a question that I had was, can lifestyle factors like diet, stress, or exercise affect that thyroid health?

Dr. Santosh Bhat: So, this is a good question. It's not commonly asked, but it's good to talk about. So yes, I would say all these different lifestyle factors do play a role in your thyroid health because all you have to remember your entire hormonal system is based on different external factors that could influence it. So, high levels of stress, a poor diet and, yes, things like exercise can affect it and especially with diet. And this is more true in other countries, but it's important to keep in mind, certain nutrients and minerals such as iodine, if it is deficient in your diet, could lead to thyroid disorders.

Host: Okay. So, would there be any world in which you'd go to your primary care and you have something going on, maybe we try some things before medication, or is it usually like, "Okay, we'll go to medication for that"?

Dr. Santosh Bhat: Typically, with thyroid disorders, the standard of care is to treat with medication. Now, there is something called like subclinical thyroid disease, in which case you might have slightly abnormal levels, but it's not at the point where you immediately need medication. But generally speaking, once you have the full-blown disease, it is treated with medication.

Host: Okay. And what kinds of medications do you use for that, like kind of between hypothyroidism and hyperthyroidism? What are people looking for for that?

Dr. Santosh Bhat: Yeah. So with hypothyroidism, it's usually treated with a synthetic version of the thyroid hormone because, essentially, you're just deficient in that hormone. Levothyroxine is a commonly used medication for that. And then, with hyperthyroidism, you're treating it with a medication that inhibits the production of thyroid hormones, so essentially the opposite mechanism. And an example of that would be methimazole, which is commonly prescribed.

Host: Okay, great. Are there any common misconceptions about thyroid health that patients should know? Maybe some patients have kind of asked you about typically?

Dr. Santosh Bhat: Usually with thyroid disorders, I haven't heard too many questions about it. So, I would say most patients don't have too many misconceptions. There are certain things where there is a lot of reservations, I should say, about the treatment for this disorder or if it even needs to be treated. I haven't had that issue with thyroid disease in my patients.

Host: Okay, cool. That's good. I guess a question that I had about thyroid issues are, is it typically genetic? Is that something you're kind of born with or it comes from a family history?

Dr. Santosh Bhat: Yes. So, there could certainly be a family history influence in that there are a lot of people where, it's commonly in their family. And it is mostly autoimmune disease, like I said before. And just to kind of understand what that means, it just means you have antibodies that are attacking your organs and it's causing these issues.

Host: Okay. I've heard of some people have to get parts of their thyroid removed or all of it removed. Can you tell me about why would someone have to have that happen?

Dr. Santosh Bhat: Sure. So, sometimes people might develop nodules in their thyroid. And these could sometimes be producing extra thyroid hormone. So, a surgeon could remove part of thyroid or that nodule that's active and thereby correcting the abundance of the thyroid hormone.

Host: Can that kind of come up at any time in a person's life, or is it common to have come up by adolescence or anything like that?

Dr. Santosh Bhat: It can come up anytime.

Host: Okay. Interesting. so when should a patient see a specialist instead of just managing through a primary care provider?

Dr. Santosh Bhat: Typically, a primary care provider can manage thyroid disease, especially hypo and hyperthyroidism pretty well. Obviously, if it's difficult to control even with medication to get your blood levels under control or get your symptoms under control, that's a good reason to seek out a specialist, specifically an endocrinologist.

And then, other issues like what we were just talking about with nodules, you probably want see a specialist for that as well, because it might require a biopsy and possibly surgical excision. And then, other factors such as pregnancy would make it a lot more important to get the thyroid disease under control, because that can affect pregnancy and fertility and issues like that.

Host: Okay, great. We kind of ran the gamut on the questions about thyroid disorders here. Is there anything that we missed or anything that you want to say?

Dr. Santosh Bhat: I think that was fairly comprehensive. I would just say from the perspective of what patients really need to know is if you're developing those symptoms that we talked about, even if it's not all of them, even just a few of them, it's worth seeking out a primary care doctor and just talking to them about it and even bringing up concern about thyroid disease and going from there.

Host: Great. I think this was a great educational episode. Thank you so much for joining us today.

Dr. Santosh Bhat: Thank you. It was a great time.

Host: Yeah, of course. And thank you listeners for tuning into the Well Within Reach Podcast, brought to you by Riverside Healthcare. For more information, visit riversidehealthcare.org.