If Your Thyroid Could Talk

Amanda Newman (00:00):

What supplements may support thyroid function? When does fatigue become a concern? Why are women more prone to thyroid issues? All that and more on this episode of The Healthiest You.

(00:12):

One in eight women will have a thyroid issue in their lifetime. The butterfly-shaped gland in your neck is responsible for producing hormones that affect your metabolism, heart rate, digestion, mood and more. When your thyroid is out of whack, it can lead to different health problems. We are focusing on women's health and wellness on The Healthiest You podcast. Whether you're on your way to work or enjoying a cup of coffee, take this time to focus on your health. Here to talk about thyroid issues is Dr. Andrew Brackbill, endocrinologist with Lehigh Valley Health Network, part of Jefferson Health. Dr. Brackbill, welcome to the show.

Andrew Brackbill, MD (00:55):

Thank you for having me.

Amanda Newman (00:56):

So the thyroid is a small but mighty gland affecting every cell and organ in your body. What is the main function of the thyroid and some common problems that you see?

Andrew Brackbill, MD (01:08):

I tell people it controls metabolism. So sort of how fast and slow your body does everything it does, so it impacts everything that your body does. There's nothing that's excluded, but it does tend to pop up in some aspects more than others. So we do commonly hear from our patients that they feel the speeding up or slowing down of their metabolism in their body temperature, their weight, their mood, their appetite, how frequently they're moving their bowels. And the severity of those things would all depend on the degree of the abnormality. But the primary issues that we see would be disorders of too much or too little thyroid hormone, the hormone that the thyroid gland makes. And then there's a variety of different tumors that can arise in the thyroid gland, and those tumors can sometimes be benign, most commonly. And then sometimes they're cancer, which can be a whole other bag of worms.

Amanda Newman (02:16):

Yeah. Now we know that women are five to eight times more likely than men to have a thyroid issue. So why are women more prone to having a thyroid problem?

Andrew Brackbill, MD (02:29):

Oh, well, there's not going to be a definite answer to that question. There's a number of different theories tossed out there. Probably the one I've seen most commonly put forward is that it's a reflection of the higher estrogen levels themselves that women have. Something to do with the way that that higher level impacts the growth and development of the thyroid, how the body reacts to it in terms of infection fighting, inflammation. There's probably some connection to things like pregnancy and delivery. Definitely thyroid hormone levels, thyroid function changes during pregnancy. Definitely after delivery it's very common for new thyroid problems to start. So that's probably connected as well. But it's one of those situations where for every study you can find that says there is a connection, there's another study that says that's not necessarily the case. So it's definitely not something where we have an open-and-shut answer. But there are many theories put forward, and it's probably a combination of all the above.

(03:41):

I've even seen some people talking about differences in the way that growing babies affect their mother's thyroid glands and leave behind changes, permanent changes. I've seen people talking about the differences in the way that the X chromosomes are activated versus deactivated as we're growing inside of our own moms. So, I mean, the theories are, there's a wide variety of different theories as to why women are more affected than men but nothing that rises to the level of being proof. Nothing that I could put forward and say, oh, this is the thing that does it. But it's more likely complex. It's more likely a combination of a variety of factors, and that's why the studies aren't so clear cut. That's why they're not open and shut is, because if you try to isolate to just one thing, it isn't just that one thing. It's a whole bunch of things added together that affect that susceptibility.

Amanda Newman (04:38):

That was a great answer, and I appreciate you shedding some light on that because there are so many different things that can impact it.

Andrew Brackbill, MD (04:44):

Oh, and you'll find that if you look online with even a question as simple as this, you'll find from different folks different answers because they're focusing on different things that strike a chord with them, particularly. So you'll find that the psychotherapist says, oh, it's stress, and here's the studies that show that it's stress that causes your thyroid to work improperly. And then you'll talk to the nutritionist and they'll say, no, no, no, it's iodine. It's a matter of how much iodine you get in your diet. Then they'll say at the very bottom of the webpage, buy my book, my book with the cookbook that shows you exactly what to eat and what not to eat to fix your thyroid problems. When anybody tells you, when it comes to thyroid disease, when anybody tells you that they have the answer, watch out for the sell is my advice. Watch out for what they're trying to get you to buy from them.

Amanda Newman (05:38):

That's a bummer. It's misleading because they're trying to reel you in and probably get you to buy a product that you may not even need.

Andrew Brackbill, MD (05:46):

And it's not that there's no evidence. You can pull evidence of a whole lot of different things. You can find evidence in scientific studies to support a wide variety of opinions. But proof, that's a different question. There's very little proof that any of those things is "the thing." That's why I say it's more likely a conglomeration of multiple factors and not something you can just simply put your finger on and say, oh, I'll do this, and this will be the effect.

Amanda Newman (06:14):

Now, many women accept being tired all the time and living off caffeine as normal, even though there may be an underlying health reason. At what point does fatigue become a concern?

Andrew Brackbill, MD (06:27):

The kinds of questions that you might be faced with when your doctor asks you how bad is this would be things like falling asleep at inappropriate times. So if you just happen to sit down during a calm moment of your day, do you just nod off during the middle of the day? Things like, are you nodding off at all while you're driving? Which would be a particularly bad situation. Things like waking up feeling rested, the hours of sleep that you're getting at night. But I don't have something that I could say, oh, this is the cutoff where you would go from this is not a big deal to suddenly this is, unless it was something obvious like falling asleep while driving.

Amanda Newman (07:06):

I feel like that's a common occurrence for some people is waking up after you get a seven-to-eight hours night of rest, but you're still tired. But it could be something with your thyroid, but it could not be.

Andrew Brackbill, MD (07:19):

Oh, yeah. I'm faced with this question, I would say half-a-dozen times every day in the office. In fact, I'd say that's probably one of the most, that and why can't I lose weight are probably the two most common questions I face in the office from people seeing me for thyroid disease. So this presents a very difficult question for doctors. Truth be told, I actually hear the same sorts of concerns from my patients with normal thyroid hormone levels, high thyroid hormone levels and low thyroid hormone levels. And they don't usually tell me they feel much better when I treat them properly. So even when I restore their levels to normal, many of them tell me they still struggle with the same kinds of weight and fatigue issues. And the jury is out on what that means, and it's not for lack of trying to find the answer.

(08:13):

In studies of people who had had thyroid surgeries, they found that before thyroid surgery, they had normal thyroid hormone levels. Perhaps they were doing their surgery for a tumor of some kind. After a thyroid surgery, they were able to treat them with thyroid hormone to produce exactly the same test results, normal hormone levels that are exactly the same as before the surgery. And yet they say they feel tired. We don't know why. We don't know why. A number of different things have been tried. There've been several experiments. Could there be something unique about some people's enzymes that don't handle thyroid hormone the same way? But if you try supplementing to compensate for that, it doesn't work. In studies, what they found was if they tested a bunch of normal, healthy people who said that they felt well, asked them a bunch of questions about thyroid disease, and then found that inevitably a certain percentage of them had low thyroid hormone levels. They went ahead and treated those people; made their levels normal.

(09:10):

Everybody got a pill, but the people who were normal just got sugar pills. The people who had low thyroid hormone levels, they got thyroid hormone. Two months later, their levels are all the same; they're all normal. They asked them the same questions, they still all feel the same. But then they tell the people who had low thyroid hormone levels, oh, by the way, two months ago when we tested you the first time, you had low thyroid hormone levels. And guess what they say? They say, we did feel tired. So something about the knowledge that there's a problem. Knowing in your head that you have a disease that makes you feel tired, makes you feel tired.

Amanda Newman (09:49):

Interesting.

Andrew Brackbill, MD (09:50):

So the question then becomes, where does the brain connection to physiology, where does that thinking end and the actual problem begin? And it's not always obvious. So as the person who's handling the hormone level of things, if I have a very accurate test saying hormone levels are normal. Then someone says, I still feel tired. Then unfortunately I'm sort of left holding the bag with, well, I don't know why that would be when we fixed the problem as best we can. But maybe there is something that we're missing. I can't deny those patients who had thyroid surgery who still have the same test results they did before surgery. Something changed, but was it learning that they had a problem? Was it making them have a problem that caused that feeling? I don't know. And there's not really a way to figure that out.

Amanda Newman (10:44):

So you're saying it's that awareness of knowing, hey, I have a problem, and now it's almost kind of making me think ...

Andrew Brackbill, MD (10:50):

Maybe.

Amanda Newman (10:51):

... I'm tired.

Andrew Brackbill, MD (10:52):

There's some studies that seem to point to that.

Amanda Newman (10:54):

A unique perspective.

Andrew Brackbill, MD (10:56):

So it makes it difficult for us because, like I said, I'm getting faced with this question all the time. And to have to tell people, well, I don't think it's because doing something wrong with your thyroid, leaves everyone dissatisfied. I want my patients to feel better, of course. They would love to have me tell them, oh, well take this pill and I'll solve your problems. But unfortunately, it generally doesn't work like that. So yeah, fatigue is a really tough one. I'll often tell my patients that it could be some other kind of hormone condition. Commonly they've been tested for all the common ones. I'll consider things that are rare, but they're rare. And then, of course, the elephant in the room would be things that aren't easily tested. I mean who's to say it's not something to do with their sleep. I don't have a way of measuring that, not with a blood test anyway. Who's to say it's not something to do with their mood. So it is a source of ongoing frustration, and that's why it's led to so many scientific studies. It's not just me. The endocrinology community as a whole would love to stop people from feeling so tired.

Amanda Newman (12:09):

Of course, fatigue can come from so many different things, and that's what makes it so challenging when diagnosing.

Andrew Brackbill, MD (12:16):

Yeah.

Amanda Newman (12:18):

What are some other symptoms that may be a sign of a thyroid problem?

Andrew Brackbill, MD (12:22):

If it's something that's affecting the size or shape of the thyroid, you could potentially feel a change in your neck. I actually very commonly get people referred to me about thyroid concerns discovered as part of a swallowing issue. Thyroid concerns don't usually cause swallowing issues, but it does lead to an evaluation that commonly finds a thyroid problem. Thyroid problems are very common, after all. So I wouldn't actually say ... the thyroid commonly causes swallowing problems. But I would say that if you feel a lumpy, bumpy feeling in the front of your neck, generally closer to your clavicles than most people expect – it's not usually as high as most people are feeling things – then that would suggest potentially an issue. Thyroid tumors and thyroid cancer commonly produce no symptoms at all. So if you do feel a bumpiness, then that's a reason to have something like a thyroid ultrasound done.

Amanda Newman (13:17):

What about temperature intolerances?

Andrew Brackbill, MD (13:20):

Oh, absolutely. I mean, again, it depends on the severity of the condition. Very mild thyroid conditions often are asymptomatic, completely asymptomatic, and even severe ones can actually be asymptomatic. It's not at all unusual for people to have very high or even very low thyroid hormone levels and say they feel well. So it often impacts people less than they think it will. But with increased thyroid hormone, a faster metabolism, people will usually feel warmer. Whereas with a slowing, a lower metabolism, they'll usually feel cooler. In a persistent kind of a way, not as episodic as it might be with other conditions.

Amanda Newman (13:58):

So, two of the common conditions are hypothyroidism and hyperthyroidism. What are the differences between the two?

Andrew Brackbill, MD (14:08):

Classically described, hypothyroidism will be more of the slowing of metabolism from low thyroid hormone levels such that you feel colder, tireder, sadder, and find it easier to gain weight. In more severe cases, you might notice things like joint aches or muscle weakness, perhaps dry skin or even sometimes hair thinning. In very severe cases, it actually can be life threatening. You can get so cold and become so fluid filled that you can actually die. That's unusual. You can actually die. With high thyroid hormone levels, it's just generally the opposite. Things are sped up, so you feel generally warmer. You usually lose weight without trying. You feel more energized. Classically, not always, but classically. You may be shaky. You may be anxious, find it difficult to sleep. Your heart may race. Things like palpitations and fast heartbeats are not at all unusual. So again, rarely, I've seen this a few times, but not every day, you will die from high thyroid hormone levels as well. Although there it's commonly mixed in with some kind of precipitating event. And that's why I bring up car accidents. If you get into a car accident and fly through your windshield, if you already have high thyroid hormone levels on top of that, well, things may not go well for you. Yeah, because now you're not just facing the same kind of car accident that anybody might have. You have very high thyroid hormone levels on top of that, and that can be life threatening.

Amanda Newman (15:45):

How are both of these conditions diagnosed?

Andrew Brackbill, MD (15:50):

If it's a really clear-cut case, you might actually diagnose high or low thyroid hormone levels without blood tests. But in general, you're always going to use blood tests to diagnose this because they're very easily accessed. They're very accurate. You can actually get a thyroid hormone level blood test from HNL [Lab Medicine], [Lehigh Valley] Health Network's lab, without a doctor's order. Just buy it online and then go have your blood drawn for, I believe, it's $20. So it's not at all difficult to simply do a very accurate thyroid hormone level. The most accurate test is actually not a thyroid hormone level. It's a pituitary hormone called TSH, the thyroid stimulating hormone. And it's called that because it controls the thyroid gland. So it's actually the most accurate test. It's extremely sensitive. It overreacts to the situation. So it tends to make problems look a lot worse than they really are in some cases. But it's because of that that it's so accurate, it's so sensitive that, in general, that will always be the first thing that we reach for.

Amanda Newman (16:57):

Now, let's say you find out that you have either hyperthyroidism or hypothyroidism. How do each of these disorders start to impact someone's everyday life?

Andrew Brackbill, MD (17:08):

Well, again, it's going to depend on how bad it is. There's a wide range of degrees of severity that could come into play. For somebody who's having trouble focusing on things, I mean, that could make work very difficult. But the kinds of things that people come to me most frequently to ask about do fall into those kinds of concerns we've already talked about. So tiredness/energy problems, weight gain are the two most common things by far. Again, how much they respond to fixing the problem, if there is one, is not always satisfying to people. And then changes in the neck itself. So things that you feel here that perhaps they bother you, generally they don't. So it does really depend on how big of a problem you're talking about. In the most severe problems with thyroid tumors, you might see things like trouble breathing and trouble swallowing developing over a matter of days, and those patients will generally go to the emergency room. Obviously a problem, not usually something they ask me about. And when it comes to the hormone levels, it is pretty individual. Even though I said classically with high thyroid hormone levels, people will feel more energized, more awake, a lot of people feel more tired. It doesn't always fit the mold. So these kinds of changes in metabolism increased and decreased. I would say for every patient I have who says that high thyroid hormone levels make them feel more energized, there's another patient who says it makes them feel more tired.

Amanda Newman (18:44):

Every person is so different, and the symptoms can actually overlap between the two.

Andrew Brackbill, MD (18:48):

Oh, easily, to a surprising degree.

Amanda Newman (18:52):

What about Hashimoto's disease? How does this condition affect your health?

Andrew Brackbill, MD (18:57):

About a hundred years ago, there was a Japanese guy named Hashimoto, who in Germany at the time, looked at the thyroid glands of people who had died with low thyroid hormone levels. And lo and behold, he said, well, shoot, there's a whole bunch of infection-fighting cells in here. There's a lot of inflammation. Maybe that's why they're having low thyroid hormone levels. And the name stuck. So basically, Hashimoto's is, it's simply saying there's inflammation happening in your thyroid gland. That's all that means. It doesn't have anything to do with thyroid hormone levels until it produces so much damage from the inflammation that the levels become typically low. High levels are possible, but generally short-lived. So classically, you would describe that as a low thyroid hormone problem once the damage had progressed enough that the thyroid couldn't keep up with the body's needs.

Amanda Newman (19:49):

What is the connection between Hashimoto's disease and hypothyroidism?

Andrew Brackbill, MD (19:54):

Well, Hashimoto's is the most common cause, at least in civilized countries like the United States. In iodine-deficient areas of the world, it might be low iodine levels. But in the United States and other First-World countries, you're going to see Hashimoto's because for some reason we get more autoimmune disease. So infection-fighting cells, our own body's infection-fighting systems, for some reason identifying the thyroid gland as the bad guy and trying to kill it. So it fills with infection-fighting cells. They do the damage they're designed to do, and you end up with, usually over many years, low thyroid hormone levels. And it progresses so slowly that the American Thyroid Association, actually in their guidelines, they say when you have Hashimoto's you really only need to check thyroid hormone levels once a year. It progresses so slowly that you don't generally need checked more often than that.

Amanda Newman (20:49):

So we've been talking about hyperthyroidism, hypothyroidism and Hashimoto's. How might having one of these conditions impact fertility?

Andrew Brackbill, MD (20:59):

So there is a little controversy here. Mildly high and mildly low levels of thyroid hormone probably don't have much impact. But some people do believe, and I might be one of them, that even slightly low thyroid hormone levels do impact fertility, decrease fertility. Severely high or severely low generally will. Not high as much as low. But yes, they generally will. But even slightly low thyroid hormone levels do seem to impact fertility in my patients. I've seen too many people where just giving them a little bit of thyroid hormone and getting their levels just a touch higher seems to do the trick. But that isn't backed up well in studies. So there's some controversy there, how intimately that's involved. Once they're pregnant, thyroid hormone levels definitely change, and people with preexisting conditions need to see their doctor about that. But yeah, in general, most thyroid problems get better in pregnancy.

Amanda Newman (22:10):

They get better?

Andrew Brackbill, MD (22:11):

They usually get better.

Amanda Newman (22:12):

Oh, that's good news.

Andrew Brackbill, MD (22:14):

For some reason, autoimmune conditions, probably because the infection-fighting system is designed to calm down when you're pregnant, you don't want your infection-fighting system fighting the baby. So that would obviously be pretty bad. So that's designed to calm down. So that might also calm down other things it's doing that it really shouldn't be doing, like attacking your thyroid.

Amanda Newman (22:36):

Is there anything else you'd like to add?

Andrew Brackbill, MD (22:39):

I'd say if someone has been trying to become pregnant for a matter of probably at least several months and they haven't had a thyroid test, it's not a bad idea to test. Thyroid disease is very common. But, I mean, it's not going to be causing most fertility issues. But it is a very common thing and it's very easily treated, and I have seen it work.

Amanda Newman (23:03):

Well, thank you for expanding upon that because I think that's a big question for a lot of women who have a thyroid issue. Immediately they're thinking about fertility, if that's the phase of life that they're in or planning to be in the coming years. Thank you so much.

Andrew Brackbill, MD (23:17):

Oh, sure.

Amanda Newman (23:18):

Now, because of overlapping symptoms, another question women may be asking, is it menopause or is it my thyroid? So the opposite spectrum.

Andrew Brackbill, MD (23:30):

Yeah, I mean a lot of the symptoms of these two conditions will overlap. Many women undergoing menopause will say that they get the weight gain, sort of a foggy, a mental fogginess kind of a feeling. They'll often get joint aches. The combination of one of those kinds of things with hot flashes, though, would not be as typical for thyroid disease because again, thyroid hormone levels will be high or they'll be low, but they won't be both at the same time. So you won't generally talk to somebody who's saying, I'm feeling tired and gaining weight and I'm getting hot flashes. You wouldn't expect that. So pathognomonic No. 1 symptom would be hot flashes and sweats for menopause. So if you're not getting those, it's less likely to be that. But of course there's premenopause, when symptoms are milder. So it's not always easy to pick apart. Menopause is one of those things where until it's done, you really can't diagnose it very well. Sure, you can do hormone levels, but they fluctuate so much, you can never really feel certain until it's done with. And you can have symptoms for many years before the final period. So it is often tough to pick apart. Thankfully, we do have very accurate blood tests. They're not all very accurate, but we do have some that are very accurate. So if those are pointing toward normal levels and you do still have symptoms that could be from menopause, then yeah, that is the elephant in the room.

Amanda Newman (25:01):

Aside from hormonal health, how does diet affect the thyroid? Are there foods you should eat regularly and ones that you should avoid?

Andrew Brackbill, MD (25:10):

So the short answer is no. So the American Diet Association guidelines say there is no specific diet recommendation for high or low thyroid hormone level prevention or treatment. Now, those are American Thyroid Association guidelines. In America, things like iodine deficiency are exceptionally rare. In other parts of the world, that would not be the case. So Sub-Saharan Africa, central China, you might worry quite a bit about your patient having enough iodine in their diet. Here in the United States, that's basically not happening. I mean, unless, because we have iodine added to our salt, most people get roughly double what they need every day. And unless you're intentionally avoiding prepared foods, you're probably getting a lot of iodine. So yes, you need that for normal thyroid hormone level. It just isn't something that I bother talking to my patients about because unless they're vegan and literally only eating fresh fruits and vegetables a hundred percent of the time, they're fine. So I have tested people for low iodine levels occasionally. I've never actually had an abnormality arise. So it's something that it feels silly to ignore because it is so critical, but I basically ignore it. It's just not realistic in our society. You can find studies that would connect thyroid disease to things like gluten intake.

Amanda Newman (26:43):

Yes, I've heard that.

Andrew Brackbill, MD (26:45):

But those studies don't arise to a level that we would call proof, and that's one of the problems. So if you see me in the endocrinology office, I'm going to say, no, there's no diet recommendation that I have to give you. But my next sentence is going to be: But if you Google this, you'll find a lot of diet recommendations, and a lot of them will have scientific references that you can look up and read for yourself. But what you'll find is that a lot of them don't have sufficient numbers of patients or track them for a sufficient length of time, or test the kinds of things that actually prove that what they're doing is doing the right thing. So unfortunately, it's that way with a lot of dietary aspects too. Should you be avoiding certain flours? Should you be adding more iodine? Iodine is something I would say in general, you should not be adding more of.

Amanda Newman (27:38):

OK.

Andrew Brackbill, MD (27:38):

If you're using iodized salt, I would not tell my patients you need to add more. If you're drinking lots of iodine drops you're getting from Amazon, you should stop. That's not good for you.

Amanda Newman (27:48):

So that's not a good supplement option.

Andrew Brackbill, MD (27:49):

That's not a good idea.

Amanda Newman (27:50):

OK.

Andrew Brackbill, MD (27:50):

Your body can handle a lot of things. But if there's underlying thyroid disease in particular that might be so mild you're not aware of it yet, taking iodine can trigger it. So I wouldn't do that.

Amanda Newman (28:02):

That's good to know because I think that's something that you see a lot of advertisements for, is take these iodine drops.

Andrew Brackbill, MD (28:08):

I wouldn't.

Amanda Newman (28:09):

Don't do it. OK. As far as weight gain or loss, as we already kind of touched on, the thyroid is often blamed as the reason. What is the connection?

Andrew Brackbill, MD (28:23):

Well, I mean, slowing your metabolism with hypothyroidism generally does promote weight gain. I see this in patients all the time. Both yesterday and today, I had patients who had high thyroid hormone levels. We treated them in the last couple of years, and both of them told me they had gained significant weight since they were treated. And I said, well, of course you did. We slowed your metabolism. That was on purpose. You came to us with a high thyroid hormone level, we fixed it. Your metabolism slowed down so you gained weight. That's normal. That's what's going to happen. So if your metabolism slows down for any reason, that's going to promote weight gain. That isn't necessarily a side effect in terms of the treatment that we had engaged in for high thyroid hormone levels. Giving people treatment and bringing their metabolism down to normal, that's not a mistake. That was on purpose. With hypothyroidism, slowing someone down slower than normal, sure, that promotes weight gain. Unfortunately, fixing it does not really promote weight loss. In studies of people who had very low thyroid hormone levels, when doctors fixed it, people lost a few pounds.

Amanda Newman (29:37):

That's disappointing.

Andrew Brackbill, MD (29:39):

It's not that easy.

Amanda Newman (29:41):

So then I'm interested to see what you say about this question. How can weight issues be addressed if you do have a thyroid problem?

Andrew Brackbill, MD (29:51):

Well, if you have a thyroid problem, certainly you do want to keep your levels normal, if you can.

(29:58):

You definitely wouldn't advise that you pursue high levels to try to lose weight, even if that might be possible. And low levels do promote weight gain, so you don't want to let that happen for no reason. But since adjusting thyroid hormone levels doesn't usually produce the kind of loss that people want, I usually tell people that they're stuck with trying to lose weight like everybody else. So unfortunately, that means cutting calories, which you might not be able to see on camera, but I'm not very good at. In terms of where I point people, I mean, usually I point them to the bariatric clinic. Once you get in there, they've got a number of different ways that they can attack this problem, be that dietary changes. And they even have a variety of different options that they offer. Medical therapies, which are more and more effective all the time. And even weight-loss surgery, which they wouldn't do there, but they would refer you to the surgery service.

Amanda Newman (30:57):

What's your favorite snack? I saw your excitement over junk food there.

Andrew Brackbill, MD (31:04):

Oh boy. Well, last night I found some Toblerone bars on my desk.

Amanda Newman (31:12):

Oh, no. Those are good.

Andrew Brackbill, MD (31:13):

Unavoidable. Something about hazelnut plus chocolate lights my fire.

Amanda Newman (31:18):

I'm anything with chocolate for me. Chocolate and peanut butter.

Andrew Brackbill, MD (31:21):

Oh, chocolate and mint.

Amanda Newman (31:22):

Ooh, that's really ...

Andrew Brackbill, MD (31:23):

I'm sold.

Amanda Newman (31:23):

... good too. Mint chocolate chip ice cream.

(31:25):

We know how bad stress is for our overall health, but how detrimental is stress to your thyroid?

Andrew Brackbill, MD (31:36):

Well, so there's a connection. There's a connection between thyroid function and stress, for sure. If you check thyroid hormone levels in people down the street in the ICU [intensive care unit], they're going to be all kinds of weird. Being critically ill is a well-recognized cause of very unusual thyroid hormone changes. So it's not something that I would say we have figured out to the extent that I could tell you exactly how stress changes things, but stress of the physical kind. So again, getting into car accidents, getting an infection, those kinds of things will certainly have an impact on thyroid hormone in a variety of ways. It's very complex. Emotional and psychological stress, it's hard to say. We don't have enough proof that I could tell you that we've got that figured out. I would say that I'm completely open to the idea that those kinds of things are a part of thyroid problems, but I couldn't tell you exactly how much. It's just we don't really know. That kind of thing is tough to judge.

Amanda Newman (32:45):

If you are someone that is very stressed, though, most of the time, what are your tips for managing that stress?

Andrew Brackbill, MD (32:53):

I would say that I try not to let myself eat when I'm more stressed. I like to read in general, and I also tinker on things. But I don't have a recipe for this is how you do it. That's not a question I face very often.

Amanda Newman (33:14):

OK. Yeah, everyone kind of has their own thing that they go to for stress relief, whether that's working out, reading ...

Andrew Brackbill, MD (33:20):

Working out, I don't do.

Amanda Newman (33:23):

Oh, no. Should you admit that?

Andrew Brackbill, MD (33:27):

It's obvious.

Amanda Newman (33:28):

But I mean, well, do you park far out on the lot at least?

Andrew Brackbill, MD (33:31):

Oh yeah, I do.

Amanda Newman (33:32):

OK. So there you go. You get some steps. Some movement.

Andrew Brackbill, MD (33:34):

Thank you. I appreciate that.

Amanda Newman (33:35):

Now, if you have a thyroid condition, how can your mental health be impacted? We've talked a lot about all the physical problems that can come with having a thyroid issue, but what about that mental health aspect?

Andrew Brackbill, MD (33:50):

That one's tough because we know that the thyroid hormone changes that people go through will have an impact on their levels of anxiety, their levels of depression and their energy levels. Things like fatigue, their ability to focus on things and perform tasks. But knowing you have a disease also has an impact. And where exactly that line falls can be tricky. But in general, I would say that many of my patients with thyroid problems of any kind, any stripe, will tell me that they feel tired. And I commonly hear both anxiety and depression, no matter what the thyroid disease is. Again, it's something people have made this connection for themselves. It's so common. Half my patients will say, oh, my family member says this is why they feel so down all the time. Or my neighbor says, that's why they're so anxious they can't sleep at night. So it's hard to say for sure exactly where the thyroid problems begin and end and our expectations take over. But yeah, I mean there definitely is an impact. It's just it's generally less than people want it to be. I'll say that too. A lot of my patients ... I'll ask them questions like, how much did changing your thyroid dose, your pill dose, affect how you feel? I would say nine out of 10 times they say it didn't make a difference.

Amanda Newman (35:32):

Really?

Andrew Brackbill, MD (35:33):

Oh, yeah, yeah. I asked that question on purpose. I want them to realize that that's not what it was. I want them to think, oh, that really didn't help, because the implication I'm trying to make is there's something else wrong. And if that's a mood problem, well, those aren't exactly rare, and figuring those out might not be easy. Again, you're not going to do a blood test to figure that out, but it's possible to improve those things.

Amanda Newman (36:03):

And at that point, then you'd probably refer them to behavioral health.

Andrew Brackbill, MD (36:06):

Yeah.

Amanda Newman (36:06):

Living with a chronic condition like the ones that we've covered today, we know is challenging. So what are some wellness strategies that can help women feel better emotionally, physically and socially?

Andrew Brackbill, MD (36:21):

The kinds of things that I am hearing from my patients, in general most of them are not related to the thyroid. So again, you may find that if you look online, you can find, or even down at the grocery store, shoot, in the pharmacy section, you can find all kinds of things marketed to people to treat their thyroid problems.

Amanda Newman (36:43):

Yes, tons of options. Thyroid this, thyroid that.

Andrew Brackbill, MD (36:47):

Yes, and maybe this is selection bias. So maybe I'm not seeing the people who do benefit from those things. They're coming to me because it didn't work, but it doesn't work for my patients. I'll tell you right now, those kinds of things, they're not helping my patients. The kinds of supplements that are marketed to these people, they're not working. Again, maybe that's why they're coming to me. But yeah, I've got plenty of patients who are telling me that they're trying these kinds of things without benefit. Now again, I have had some patients tell me that they did a gluten-free diet or they tried a lactose-free diet or an elimination diet, or they went keto.

(37:27):

I'm not going to say that those things are crazy or wrong. If they feel better, hooray, I'm the first to congratulate them. But is that because they've done something to affect their thyroid? No, generally not. I would say the patients who tell me that they feel the most difference, the patients who really come to me and say, thank you, Dr. Brackbill, you really helped me, are the patients I refer for weight-loss surgery. Those patients come back and give me a hug because they feel so much better, and they thank me for referring them to lose significant weight.

Amanda Newman (38:03):

So what treatment options do you recommend for hypothyroidism, hyperthyroidism and Hashimoto's disease?

Andrew Brackbill, MD (38:11):

Well, Hashimoto's disease is an easy one. There's no accepted treatment. As far as we know, there's nothing outside of experimental treatments that would ever be beneficial for Hashimoto's. They have actually done studies of doing surgery for Hashimoto's. It turns out that some people do feel better when you just get rid of it.

Amanda Newman (38:31):

Surgery. OK.

Andrew Brackbill, MD (38:33):

Sounds pretty extreme to me. But there really isn't great evidence that anything we do is going to impact the course of that disease. So be aware of people who tell you, oh, well, you should be tracking your antibody levels. This, that, or the other will make your antibody levels go up or down. As far as we know, there's no impact on the level of antibodies on a test and how quickly the disease progresses. It's either high or it's low. It's either normal or it's high. So it's not a matter of how high. It's high, so you've got this. So that one's easy. Treating hypothyroidism is, in a sense, easy as well, because if you don't have enough thyroid hormone, we give you a thyroid hormone. And we have thyroid hormone that is exactly the same as what the human body naturally makes. There's different thyroid hormones in the body. There's a handful of them, not just one or two. And we don't supplement all of them because it turns out that if we only give the one, then the body will self-regulate and produce all the others in the amounts that it needs.

(39:44):

We don't have to give each and every one, thankfully. And the one that we give is a very slow-going and easy-to-use cheaply made medicine. Some years it's the most prescribed medicine in the United States. So low thyroid hormone levels is actually the No. 10 reason people see a doctor. So an extremely common pill, you hear people talk about it as being levothyroxine, the generic name, or Synthroid is a common brand name. Tirosint, Levoxyl or others. Unithroid. And the beauty of that medicine is that when we give it to people and get the dose right, their hormone tests will all be normal the vast majority of the time. All normal, whether we're testing the common hormone levels or the uncommon ones, because the body will automatically regulate the other hormones that aren't being given. Now, you can get a variety of other thyroid hormones.

(40:39):

You can get more, how should I put this, active thyroid hormone. The version that we usually give people is, it's not the active form. Now, you can still take enough of it to sort of force your body ... to increase your metabolism. But in general, because the body is regulating that on its own, as long as the dose is right, you're just going to have a normal metabolism. But if you take enough of the active thyroid hormone, which is sold as liothyronine or Cytomel when it's in its pure form. But it can also be extracted from animals and is available as things like NP Thyroid, Armour Thyroid. Because those contain so much of the active thyroid hormone, you're basically taking a stimulant just like any other stimulant. You can make yourself feel more awake. You can make yourself lose a little bit of weight.

(41:37):

But the problem with taking a stimulant is, No. 1, you're taking a stimulant. So that's probably not good for you to take something like that, for instance, the rest of your life. And it's tougher to regulate. The hormone levels that the active thyroid hormone produce fluctuate so much more that our measurements of it become a lot trickier to understand. When you have a Synthroid or levothyroxine pill that you're taking, it makes the levels basically the same morning, noon and night. They change very little. But when you take active thyroid hormone – liothyronine, Cytomel or Armour – the levels change from hour to hour. And unless you time your blood test just right, you could be fooled into thinking that there's something going well or not going well. And again, we really don't know how safe those are to take long term. There's been studies, but they're all real short.

Amanda Newman (42:33):

Well, thank you for explaining all those different options. Going back to Hashimoto's, so I know you had said that there is no treatment. What do you recommend then? Like management techniques or anything?

Andrew Brackbill, MD (42:48):

There's really nothing that can be done. It is an autoimmune disease. So just like Crohn's disease, rheumatoid arthritis, lupus, you don't just change your diet and make it better. I mean, it'd be nice if it worked that way. I have lots of patients who wish it worked that way. But as far as we know, there's no good evidence that it does. So I mean, there may be some autoimmune diseases like celiac, gluten sensitivity that do really revolve around the things that you eat. But as far as we know, it doesn't work that way for Hashimoto's.

Amanda Newman (43:21):

It's disappointing to hear that. It'd be nice if we could get a cookbook and ...

Andrew Brackbill, MD (43:26):

Oh, those cookbooks exist.

Amanda Newman (43:27):

They do.

Andrew Brackbill, MD (43:27):

They surely do.

Amanda Newman (43:28):

They are all over the internet. And it's great if it helps at least one person to some degree, but it's not maybe the cure-all for it.

Andrew Brackbill, MD (43:37):

Oh, yeah. I mean, if it helps you to feel better to take a particular thing that's recommended by some online guru, fantastic. It's unlikely to be harmful to take a B12 supplement, but is that necessary? Well, I don't know. That's the problem. I just don't have the proof to tell you this is what you need to do. So some people believe they do, and maybe they're right. I don't agree. I don't know. Until I have proof, I'm not going to tell you that I know.

Amanda Newman (44:12):

Now, how often should you have a thyroid panel done? We've talked a lot about the different treatment options, but when it comes to having that thyroid panel done, is that something we do yearly?

Andrew Brackbill, MD (44:25):

If you have Hashimoto's, you should have it done yearly, yes. If you're on any type of therapy, I would say definitely at least once a year, depending on how things are going, how stable are things. But in somebody who's otherwise healthy and feels well, usually every few years I think is what most primary doctors are doing. In somebody who becomes pregnant – a little controversy here – but generally people are checking a thyroid hormone level as soon as you become pregnant. Generally, shortly after pregnancy, I think it's a good idea to check a thyroid hormone level. But again, just in sort of people who are well, a lot of primary doctors will just check them every year. Again, thyroid hormone disease, it's so common that it's never really wrong to check. And again, so many people feel the same kinds of symptoms that thyroid disease produces, that doctors are rarely begging for a reason to check a thyroid hormone level.

Amanda Newman (45:20):

Can you break down for our listeners what is shown in a thyroid panel?

Andrew Brackbill, MD (45:25):

There's a variety of different thyroid panels out there. The one that I think I mentioned earlier that you can order your own thyroid panel over at HNL Health Networks labs [HNL Lab Medicine] for, again, it's like 20, 25 bucks. There you'll get a TSH, a thyroid stimulating hormone. And if that's abnormal, you'll get a thyroid hormone level, a T4 level. T4 free is an actual thyroid hormone. T4 is a thyroid hormone. T3 is another thyroid hormone that can be tested but is less accurate. Now, you might think, oh, well, if I want to know if I have a high or low thyroid hormone level, I want to check the more accurate of the two, the T4 test. But you'd be wrong. The most accurate test is the TSH, the thyroid stimulating hormone. For a variety of reasons I won't go into, although this has been thoroughly studied, the TSH test is so sensitive. It reacts so strongly to even the slightest of changes that with very rare exception that is the test that I will do first. So the one that's 20, 25 bucks at HNL [Lab Medicine], that's the one that I generally do on my patients day in, day out. And it isn't always the fastest to change, so there's certain situations in which it might lag behind. And there are sometimes reasons to do – especially if the pituitary gland in the brain that makes TSH – if that's believed to be abnormal, then you might have to rely on the less accurate T4 or T3 tests. But in general, those tests are so much less accurate. I generally don't do them.

Amanda Newman (47:02):

Well, that was very helpful. But what do you think about at-home tests? There's a lot of ads out there for a variety of companies that target thyroid health: "Here, get your panel done and you get results within two days."

Andrew Brackbill, MD (47:18):

Yeah, and some of those may actually be quite accurate. I know from experience that the home hemoglobin A1C tests for diabetes are actually pretty good. But it doesn't make sense. In my mind, it doesn't make sense to do a test like that if I can go to HNL [Lab Medicine] down the road and literally just pay online with a credit card and have a well-qualified lab, who does a good job, do the best test there is for me at the drop of a hat. I mean, I could go order my test online from my phone right now, have it drawn when we're done, and I'd have a result this afternoon.

Amanda Newman (47:51):

That's amazing. Why wouldn't you?

Andrew Brackbill, MD (47:53):

Yeah, I mean, why bother with the home? I looked up some home tests. They tend to cost about a hundred dollars. Why would you do that?

Amanda Newman (48:01):

Yeah, I think it's those ads. They just draw people in. But if you have an HNL [Lab Medicine] right down the street from you, why not just do that? And then you can look at it very closely with your physician.

Andrew Brackbill, MD (48:15):

Some of them might involve panels of other tests. So panel is such a nonspecific word. I mean, there might be a lot of other things in there that would make that hundred dollars worthwhile, but not if you're just checking your thyroid. You really only need the TSH test. That's a very accurate test.

Amanda Newman (48:32):

OK. TSH test. All right. To wrap up today's episode, what tips do you have for staying ahead of your health, and is there anything women can do to prevent having thyroid issues?

Andrew Brackbill, MD (48:47):

Sadly, no. There isn't anything you can do.

Amanda Newman (48:49):

That's not the answer we were hoping for Dr. Brackbill.

Andrew Brackbill, MD (48:52):

I'm sorry, but unfortunately the most common thyroid conditions are out of your hands. Whether they're autoimmune or genetically caused or due to things like radiation from the rocks, the sun, the trees, these things are really out of our hands. A lot of things probably do contribute to thyroid disease. Studies showing connections to, like I mentioned earlier, estrogen levels. I already brought up iodine, brought up radiation, viruses, things like giving birth. There's a number of things that probably have an impact, but those aren't things that you're going to do away with out of fear. In general, the kinds of things that people are already doing to watch their health are probably the kinds of things that are helpful. But again, I don't have great proof. For every study that says you could benefit from this, there's another study that says no, you don't. It's just not that simple. I would love to tell my patients, oh well, this is what you do and you won't have that. It just doesn't work like that. It's not that simple.

Amanda Newman (50:01):

But you can work side by side with them to find something that will work for them.

Andrew Brackbill, MD (50:08):

Oh, yeah. The kinds of things that really bother my patients most, many of them are hormone conditions. Not all of them are easily diagnosed and treated. We talked about menopause earlier. I mean, a lot of women with menopause feel much better when they take estrogen, but there's so many side effects they don't want to. So then, what do you do? Well, none of the other treatments work, as well. So you're kind of stuck.

Amanda Newman (50:34):

Yeah, it's frustrating. As a woman, you're like, there should be some answer, but it's not clear cut.

Andrew Brackbill, MD (50:41):

I agree. With thyroid disease in particular, unfortunately it is kind of a matter of the luck of the draw to a large degree. Obvious things like making sure you don't have low iodine levels. It's kind of silly in the United States. If we were having this discussion in Sub-Saharan Africa, I would say, oh yeah, that's a big deal. But here, no, it just isn't. And there really isn't much else that you can do. I do think that seeing a primary doctor regularly, letting your doctor know if you become pregnant – those would certainly be ways that you could be vigilant for problems because they're going to be checking these things almost always to some degree. But otherwise, no. It's not really something that we can control.

Amanda Newman (51:28):

Well, Dr. Brackbill, thank you so much for joining us today.

Andrew Brackbill, MD (51:31):

My pleasure. Thank you for having me.

Amanda Newman (51:32):

This has been great. We learned so much information. Really appreciate you being here.

Andrew Brackbill, MD (51:37):

Oh, sure. I get these questions all the time.

Amanda Newman (51:40):

To learn more health tips, visit LVHN.org/healthyyou. Remember to leave us a review, subscribe or follow The Healthiest You wherever you get your podcasts, so you never miss an episode. And remember, be safe, be smart and be the healthiest you.