The hormones the thyroid gland produces greatly influences almost all of the metabolic processes in your body. As a result, thyroid disorders can be varied and can range from nodules to hypothyroidism to life threatening cancer.
In this segment, Dr. Matthew Leach discusses thyroid disease, nodules and what treatment options are available at Temecula Valley Hospital.
Selected Podcast
Important Signs Your Thyroid May Not Be Working Well
Featured Speaker:
He is a San Diego native, received his undergraduate degree in Biology and Art History from Bowdoin College in Brunswick, Maine. He then spent two years doing cancer cell biology research at the Scripps Research Institute before attaining his medical degree from the Medical College of Wisconsin. He completed his surgical residency in Otolaryngology-Head and Neck Surgery at St. Louis University. He is thrilled to be providing excellent medical and surgical care back home in Southern California.
Learn more about Dr. Matthew Leach
Matthew Leach, MD
Dr. Matthew Leach, is an ENT and a member of the Medical Staff at Temecula Valley Hospital.He is a San Diego native, received his undergraduate degree in Biology and Art History from Bowdoin College in Brunswick, Maine. He then spent two years doing cancer cell biology research at the Scripps Research Institute before attaining his medical degree from the Medical College of Wisconsin. He completed his surgical residency in Otolaryngology-Head and Neck Surgery at St. Louis University. He is thrilled to be providing excellent medical and surgical care back home in Southern California.
Learn more about Dr. Matthew Leach
Transcription:
Important Signs Your Thyroid May Not Be Working Well
Melanie Cole (Host): Through the hormone it produces, the thyroid gland influences many or all of the metabolic processes in your body. As a result, thyroid disorders can be far-reaching and can range from nodules to hypothyroidism to life-threatening cancer. My guest today is Dr. Matthew Leach. He’s an EMT and a member of the medical staff at Temecula Valley Hospital. Welcome to the show. Give us a little basic physiology lesion of the thyroid. What does it do and where is it located?
Dr. Matthew Leach (Guest): You hit the nail on the head when you said it involves almost all major physiological processes in the body. There's really not a major organ system that it does not affect in a major way. In general, what it’s responsible for is regulating iodine metabolism. Essentially, getting iodine incorporated into other protein molecules that are then used for the most part in body metabolism, the metabolism of things that we eat and getting those things converted into energy molecules and also regulating cardiovascular health. It has major effects in growth and development, sleep regulation, your basic cognitive and mood functions, it’s been implicated in sexual and menstrual dysfunction, it regulates body temperature and it’s essential for your basic flight or fight stress response.
Melanie: How common is thyroid disease and what are some of the most common that you see?
Dr. Leach: It is relatively common, and to go back to your previous question you asked about where the thyroid is, the thyroid is a butterfly-shaped organ in the anterior neck and it wraps around the windpipe and the trachea, so in men, it would be located a few centimeters below the Adam’s apple. It’s pretty small, about maybe the size of a golf ball or slightly larger, but then shaped like a butterfly where it wraps around the windpipe with two lobes on either side and a connecting portion called an isthmus in the middle.
Thyroid conditions are generally treated by a team approach or multiple doctors can be involved. Often, the family doctor or an internal medicine doctor. A primary care physician is the first line physician who finds something wrong. In general, hyperthyroidism, not making enough thyroid hormones, manifests in fatigue. It can also often manifest in depression, just a feeling of not having enough energy, it can also manifest in skin conditions, poor GI function and dysfunction in cognitive behavior where you feel like you're not making the right connection. On the flipside, hyperthyroidism, too much thyroid hormones, is as you would expect the opposite where you have a feeling of nervousness, you feel like everything is moving at a fast pace. This may result in tremors or palpitations in the heart, increased sweating and increase GI or other metabolic processes.
Melanie: You’ve mentioned a bunch of symptoms, but some of these sound pretty normal for a lot of people in anxiety and such. What would actually send somebody to the doctor to get it checked?
Dr. Leach: Indeed. They can often mimic many of the other common conditions that primary care physicians see regularly. In general, in my experience, most primary care physicians incorporate basic thyroid laboratory tests into the yearly labs that a lot of patients get, and so what you're looking for there are two actual hormones that the thyroid creates, what we call T3 and T4 – the two main iodine incorporated proteins – as well as a molecule called TSH, which is a marker of how the brain, and specifically the pituitary gland portion of the brain, is controlling the thyroid gland. When we suspect thyroid disorder, we look at the amount of thyroid hormones, but also is the control of that hormone normal or abnormal.
Melanie: What is a thyroid nodule and how we would know if we have one?
Dr. Leach: A nodule is somewhat different in that the majority of patients with thyroid nodules do not have actual thyroid dysfunction or even symptoms of thyroid dysfunction. A nodule tends to present as an actual feeling of a lump in the neck and this can sometimes be something that you feel in your throat when you swallow or when you breathe, you have a sensation of tightness, or you can sometimes actually feel it with your hand on the outside of the neck. Primary care physicians may able be to feel it. Once the concern for a thyroid nodule comes up, the next step is to incorporate some form of imaging. It tends to be an ultrasound, which is often performed by an endocrinologist, although not always, and they are scanning the entire thyroid, both lobes and the isthmus to look for a nodule, which can either be a collection of fluid or a collection of solid cells that will look different from the surrounding normal thyroid tissue.
Melanie: People hear “nodule” and they think right away that it could be cancer. Does that necessarily follow or generally are they benign?
Dr. Leach: Generally, they're benign for the most part, and so, we have very structured guidelines on what we do when we find the nodule. For the most part, when they're found, they are observed. Once they reach a certain size and once they have certain characteristics on the ultrasound and there's a long list of things that ultrasound technicians and endocrinologists are looking for, once you reach the appropriate combination of size and ultrasound characteristics, you usually get what's called an FMA, or a fine needle aspiration, which is essentially a small biopsy of the nodule, which cells from that nodule are then sent off to a pathology lab to be examined with the goal of diagnosing cancer as early as possible.
Melanie: What is the treatment after you do a little bit of observation? When does it become surgical?
Dr. Leach: If the biopsy comes back as concerning for malignancy, the process is simple and streamlined. We proceed right to thyroid surgery, which generally consists of removing half of the thyroid gland where the nodule is and then we test that gland in the operating room, we send that gland to the pathology lab and they confirm whether it's cancer or not, and if that is confirmed, we take out the rest of the thyroid gland. If the biopsy comes back as concerning for malignancy but not necessarily conclusive or if it comes back as non-diagnostic, we essentially have between me, the endocrinologist and the patient to decide should continue to observe the lesion with repeated ultrasound, seeing if it's growing, do we repeat the biopsy or do we just proceed with the thyroid surgery where we remove the half of the gland where the nodule is and definitively tell whether it's cancer or not.
Melanie: After you've done that, what's it like for the patient to have either a portion or their whole thyroid removed? How do you approach patient care after thyroid surgery?
Dr. Leach: If they only need a portion of the gland removed, it's pretty simple. The half of the gland that is remaining is more than enough to compensate, especially if it was functioning normally to start with, so those patients tend to not need any long time thyroid hormone replacement. Intimately associated with the thyroid gland are very tiny glands known as the parathyroid glands, and these are completely separate as far as their function, and they are important in regulating body calcium. A very common and known side effect of any thyroid surgery is dysfunction of this gland afterward. Again, if you take out only half of the thyroid gland, even if you have dysfunction in the two parathyroid glands on the side you're operating on, the other two are more than capable of compensating. It becomes a problem when you take out the whole thyroid gland. In this situation, not only does the patient need long-term thyroid hormone replacement for life but they will often have prolonged dysfunction in their calcium metabolism. This can manifest in having to take calcium replacements for several months after surgery, and occasionally, that can be permanent.
Melanie: What can people do or expect if they are on thyroid medication for the rest of their life? Does that change anything – their energy levels, their weight, or any of those kinds of things?
Dr. Leach: It shouldn’t, and this is generally managed by the primary care physicians or the endocrinologist, but there are often little tweaks that go on through the lifespan of the patient after the thyroid gland has been removed. Generally, the physician managing that will do periodic laboratory studies looking into what the level of thyroid hormone is with the patient at a given dose. Often, that will need to be increased or decreased depending on laboratory values and in addition to how the patient is feeling.
Melanie: Are women more at risk for this than men?
Dr. Leach: In general, no, although there are certain exceptions to that. If a woman develops a thyroid nodule while pregnant, for instance, there is a much higher chance that is cancerous. In certain subgroups, it could be more concerning, that one specifically.
Melanie: Wrap it up for us. What would you like people to know about thyroid disease and thyroid nodules and why they should come to Temecula Valley Hospital for their care?
Dr. Leach: In general, thyroid nodules are mostly benign, and even in the worst-case scenario where a thyroid nodule becomes malignant, thyroid cancer is very treatable and curable with one of the highest long-term survival rates of solid organ malignancy. Certainly, we feel very good about our ability to give patients a long-term good prognosis, even in the worst-case scenario. At Temecula Valley Hospital, there are a number of surgeons who perform thyroid surgery and we do use state of the art techniques when doing that, one of those being the use of current laryngeal nerve monitoring, but this entails as monitoring the nerves that go to the vocal cords, which in a small percentage of patients can be damaged after thyroid surgery as they're tucked in behind the thyroid gland. It’s become standard of care to use this monitoring in thyroid surgery and we do that at Temecula Valley Hospital in the hopes of giving patients the best chance of having a good vocal outcome after thyroid surgery.
Melanie: Thank you so much for being with us today. It’s really great information. You're listening to TVH Health Chat with Temecula Valley Hospital. For more information, please visit temeculavalleyhospital.com. That’s temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.
Important Signs Your Thyroid May Not Be Working Well
Melanie Cole (Host): Through the hormone it produces, the thyroid gland influences many or all of the metabolic processes in your body. As a result, thyroid disorders can be far-reaching and can range from nodules to hypothyroidism to life-threatening cancer. My guest today is Dr. Matthew Leach. He’s an EMT and a member of the medical staff at Temecula Valley Hospital. Welcome to the show. Give us a little basic physiology lesion of the thyroid. What does it do and where is it located?
Dr. Matthew Leach (Guest): You hit the nail on the head when you said it involves almost all major physiological processes in the body. There's really not a major organ system that it does not affect in a major way. In general, what it’s responsible for is regulating iodine metabolism. Essentially, getting iodine incorporated into other protein molecules that are then used for the most part in body metabolism, the metabolism of things that we eat and getting those things converted into energy molecules and also regulating cardiovascular health. It has major effects in growth and development, sleep regulation, your basic cognitive and mood functions, it’s been implicated in sexual and menstrual dysfunction, it regulates body temperature and it’s essential for your basic flight or fight stress response.
Melanie: How common is thyroid disease and what are some of the most common that you see?
Dr. Leach: It is relatively common, and to go back to your previous question you asked about where the thyroid is, the thyroid is a butterfly-shaped organ in the anterior neck and it wraps around the windpipe and the trachea, so in men, it would be located a few centimeters below the Adam’s apple. It’s pretty small, about maybe the size of a golf ball or slightly larger, but then shaped like a butterfly where it wraps around the windpipe with two lobes on either side and a connecting portion called an isthmus in the middle.
Thyroid conditions are generally treated by a team approach or multiple doctors can be involved. Often, the family doctor or an internal medicine doctor. A primary care physician is the first line physician who finds something wrong. In general, hyperthyroidism, not making enough thyroid hormones, manifests in fatigue. It can also often manifest in depression, just a feeling of not having enough energy, it can also manifest in skin conditions, poor GI function and dysfunction in cognitive behavior where you feel like you're not making the right connection. On the flipside, hyperthyroidism, too much thyroid hormones, is as you would expect the opposite where you have a feeling of nervousness, you feel like everything is moving at a fast pace. This may result in tremors or palpitations in the heart, increased sweating and increase GI or other metabolic processes.
Melanie: You’ve mentioned a bunch of symptoms, but some of these sound pretty normal for a lot of people in anxiety and such. What would actually send somebody to the doctor to get it checked?
Dr. Leach: Indeed. They can often mimic many of the other common conditions that primary care physicians see regularly. In general, in my experience, most primary care physicians incorporate basic thyroid laboratory tests into the yearly labs that a lot of patients get, and so what you're looking for there are two actual hormones that the thyroid creates, what we call T3 and T4 – the two main iodine incorporated proteins – as well as a molecule called TSH, which is a marker of how the brain, and specifically the pituitary gland portion of the brain, is controlling the thyroid gland. When we suspect thyroid disorder, we look at the amount of thyroid hormones, but also is the control of that hormone normal or abnormal.
Melanie: What is a thyroid nodule and how we would know if we have one?
Dr. Leach: A nodule is somewhat different in that the majority of patients with thyroid nodules do not have actual thyroid dysfunction or even symptoms of thyroid dysfunction. A nodule tends to present as an actual feeling of a lump in the neck and this can sometimes be something that you feel in your throat when you swallow or when you breathe, you have a sensation of tightness, or you can sometimes actually feel it with your hand on the outside of the neck. Primary care physicians may able be to feel it. Once the concern for a thyroid nodule comes up, the next step is to incorporate some form of imaging. It tends to be an ultrasound, which is often performed by an endocrinologist, although not always, and they are scanning the entire thyroid, both lobes and the isthmus to look for a nodule, which can either be a collection of fluid or a collection of solid cells that will look different from the surrounding normal thyroid tissue.
Melanie: People hear “nodule” and they think right away that it could be cancer. Does that necessarily follow or generally are they benign?
Dr. Leach: Generally, they're benign for the most part, and so, we have very structured guidelines on what we do when we find the nodule. For the most part, when they're found, they are observed. Once they reach a certain size and once they have certain characteristics on the ultrasound and there's a long list of things that ultrasound technicians and endocrinologists are looking for, once you reach the appropriate combination of size and ultrasound characteristics, you usually get what's called an FMA, or a fine needle aspiration, which is essentially a small biopsy of the nodule, which cells from that nodule are then sent off to a pathology lab to be examined with the goal of diagnosing cancer as early as possible.
Melanie: What is the treatment after you do a little bit of observation? When does it become surgical?
Dr. Leach: If the biopsy comes back as concerning for malignancy, the process is simple and streamlined. We proceed right to thyroid surgery, which generally consists of removing half of the thyroid gland where the nodule is and then we test that gland in the operating room, we send that gland to the pathology lab and they confirm whether it's cancer or not, and if that is confirmed, we take out the rest of the thyroid gland. If the biopsy comes back as concerning for malignancy but not necessarily conclusive or if it comes back as non-diagnostic, we essentially have between me, the endocrinologist and the patient to decide should continue to observe the lesion with repeated ultrasound, seeing if it's growing, do we repeat the biopsy or do we just proceed with the thyroid surgery where we remove the half of the gland where the nodule is and definitively tell whether it's cancer or not.
Melanie: After you've done that, what's it like for the patient to have either a portion or their whole thyroid removed? How do you approach patient care after thyroid surgery?
Dr. Leach: If they only need a portion of the gland removed, it's pretty simple. The half of the gland that is remaining is more than enough to compensate, especially if it was functioning normally to start with, so those patients tend to not need any long time thyroid hormone replacement. Intimately associated with the thyroid gland are very tiny glands known as the parathyroid glands, and these are completely separate as far as their function, and they are important in regulating body calcium. A very common and known side effect of any thyroid surgery is dysfunction of this gland afterward. Again, if you take out only half of the thyroid gland, even if you have dysfunction in the two parathyroid glands on the side you're operating on, the other two are more than capable of compensating. It becomes a problem when you take out the whole thyroid gland. In this situation, not only does the patient need long-term thyroid hormone replacement for life but they will often have prolonged dysfunction in their calcium metabolism. This can manifest in having to take calcium replacements for several months after surgery, and occasionally, that can be permanent.
Melanie: What can people do or expect if they are on thyroid medication for the rest of their life? Does that change anything – their energy levels, their weight, or any of those kinds of things?
Dr. Leach: It shouldn’t, and this is generally managed by the primary care physicians or the endocrinologist, but there are often little tweaks that go on through the lifespan of the patient after the thyroid gland has been removed. Generally, the physician managing that will do periodic laboratory studies looking into what the level of thyroid hormone is with the patient at a given dose. Often, that will need to be increased or decreased depending on laboratory values and in addition to how the patient is feeling.
Melanie: Are women more at risk for this than men?
Dr. Leach: In general, no, although there are certain exceptions to that. If a woman develops a thyroid nodule while pregnant, for instance, there is a much higher chance that is cancerous. In certain subgroups, it could be more concerning, that one specifically.
Melanie: Wrap it up for us. What would you like people to know about thyroid disease and thyroid nodules and why they should come to Temecula Valley Hospital for their care?
Dr. Leach: In general, thyroid nodules are mostly benign, and even in the worst-case scenario where a thyroid nodule becomes malignant, thyroid cancer is very treatable and curable with one of the highest long-term survival rates of solid organ malignancy. Certainly, we feel very good about our ability to give patients a long-term good prognosis, even in the worst-case scenario. At Temecula Valley Hospital, there are a number of surgeons who perform thyroid surgery and we do use state of the art techniques when doing that, one of those being the use of current laryngeal nerve monitoring, but this entails as monitoring the nerves that go to the vocal cords, which in a small percentage of patients can be damaged after thyroid surgery as they're tucked in behind the thyroid gland. It’s become standard of care to use this monitoring in thyroid surgery and we do that at Temecula Valley Hospital in the hopes of giving patients the best chance of having a good vocal outcome after thyroid surgery.
Melanie: Thank you so much for being with us today. It’s really great information. You're listening to TVH Health Chat with Temecula Valley Hospital. For more information, please visit temeculavalleyhospital.com. That’s temeculavalleyhospital.com. Physicians are independent practitioners who are not employees or agents of Temecula Valley Hospital. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole. Thanks so much for listening.