August 3, 2025 • 32 mins
08/03/25
The Healthy Matters Podcast
S04_E21 - The Small, but Mighty ... THYROID!
With Special Guest: Dr. Sreekant Avula, MBBS
Sometimes, the why behind how we feel is a little hard to pinpoint. Are you feeling sluggish and tired all the time, even though you're getting enough rest? Are you gaining or losing weight without even trying? Well, it could have something to do with your small, but mighty, butterfly-shaped gland in your neck - the thyroid. Turns out this gland is responsible for quite a bit in the body!
But what exactly does it control? What happens to us when something goes wrong? And, of course, how do we fix it when something does? On Episode 21 of our show, we'll be joined by endocrinologist Dr. Sreekant Avula to get the basics on this essential piece of the human puzzle. We'll go over what makes it tick, what it makes tick, why we need it, and what can be done when something goes wrong with it. We've all got a thyroid, so there's something here for everyone. Join us!
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_00 (00:01):
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare,
and what matters to you.
And now, here's our host, Dr.
David Hilden.
SPEAKER_03 (00:19):
Hey, everybody, and welcome to episode 21.
I am David Hilden, your host,and today we're getting to know
one of the most underappreciatedand maybe underrated organs in
the body, the thyroid.
It's small, it'sbutterfly-shaped, and it packs a
huge punch when it comes to howyour body functions.
If you ever wondered why you'refeeling sluggish or moody, hot,
(00:42):
cold, or just off...
Maybe your thyroid has somethingto say about it.
So joining me today is someonewho knows this stuff inside and
out, Dr.
Srikanth Avila.
He's an expert endocrinologistat Hennepin Healthcare in
Minneapolis who knows thethyroid like the back of his
hand.
Srikanth, welcome to the show.
Thank you.
It's great to have you here.
Now start us off.
(01:02):
What's the thyroid and what doesit do?
Our
SPEAKER_02 (01:05):
body has like many organs and which are very
important for our survival.
So among them, thyroid is one ofthe most important organ I would
say that it's like a CEO of ourorgan.
It's the CEO of
SPEAKER_03 (01:18):
the organs?
Oh, I haven't heard it calledthat before.
I've heard it called thethermostat
SPEAKER_02 (01:21):
before.
Yeah, thermostat.
Like, it's not just about thethermostat.
Like, okay, it's just notcontrolling your heat and cold,
but...
It's like controlling each andevery cell of your body.
So, as a CEO, you control eachand every system in the
organization, and everythingruns on the orders of your CEO.
(01:42):
In the same way, the thyroid isalso like controlling each and
every cell of your body and howthey respond.
So, for the normal functioningof your cells, you need your
thyroid.
So, you're saying it controlsthe heart, controls the
SPEAKER_03 (01:55):
kidneys, controls everything?
SPEAKER_02 (01:57):
Yes, territory.
indirect it controls
SPEAKER_03 (02:00):
each and every organ of a body so you're saying we
need it it's not like yourspleen you kind of need your
thyroid
SPEAKER_02 (02:06):
yes spleen is something like okay you need it
but again if you remove it it'sfine but Thyroid is very
important.
If you don't have thyroid, it'sokay.
But again, you need thehormones, whatever it produces,
for
SPEAKER_03 (02:21):
our survival.
Yeah.
Listeners, that's kind of arunning joke in medicine.
It's like, what's a spleen?
What does that thing do?
No, nobody knows.
Nobody knows what the spleendoes.
Let's get rid of that uselessthing.
That's not true, but it's sortof like this running joke.
So, the thyroid makes hormones.
Really basic, where is thething?
So,
SPEAKER_02 (02:37):
Let me just give us like brief history about
thyroid, how the name came in.
Okay.
So, it dates back to firstcentury AD.
That's when like we have someliterature on that discussing
about thyroid.
Ancient Egyptians, Chinese,Greeks, they all talked about
(02:57):
thyroid.
And they also talked aboutmanaging it.
So, thyroid.
At the time, it was talked aboutguiter, like a swelling in front
of your neck.
And they used to treat it withseaweeds.
You ate the seaweed or you putit on there?
You ate it.
So I'll come to that, like whythe seaweed's important, like it
(03:18):
does make sense.
The term thyroid was named in17th century by Thomas Wharton,
derived from the Greek word,which was the meaning for
shield.
It does kind of look like ashield.
Yeah.
So it's located.
in front of our neck just likewe have a prominent spot in our
neck in front of our neck calledAdam's apple so it just sits
(03:41):
below that it's the shape of abutterfly so you have a narrow
part in the between and then youhave two wings which spread out
to one on the left side, on theright side.
So we call them as a left lobeand a right lobe.
And there is a small bridgewhich connects these two lobes,
and we call that as isthmus.
SPEAKER_03 (04:00):
So it sits in your neck.
It makes hormones.
It's the CEO of the body.
And it does kind of look like ashield.
I don't think I knew that.
That's where the thyroid is.
Before we talk about why ithappens, what happens when it
goes wrong?
When someone's thyroid's notworking, what symptoms might
people experience?
SPEAKER_02 (04:19):
As I said, the thyroid Thyroid affects in each
and every system of your body,whether it's directly or
indirectly.
Let's start with like yourbrain.
Like you feel like mental fog.
You can feel depressed.
You can feel tired coming downyour heart.
So if you're producing too muchof your thyroid hormone, then it
(04:40):
makes your heart beat very fast.
Then again, you have symptomsbecause of that.
Like you feel some chestdiscomfort, some pain.
some difficulty in breathing, orit can reduce your heart rate.
So if your heart rate is low,then you don't pump enough blood
for your body.
So there is no enough bloodsupply in your body.
(05:01):
Then again, all the organs startgetting tired.
They don't function normally.
There is no enough energy ingeneration for them.
When it comes down to yourstomach, intestines, it's needed
for the normal motility of yourintestines.
So if it is less, then you haveconstipation.
(05:21):
When you are producing too muchof the hormone, then you have
increased movement of yourbowel, then you have diarrhea.
It also has effect on yourbones.
So if you have too much ofthyroid hormone producing, it's
like an acid.
So it starts eating up yourcalcium
SPEAKER_03 (05:37):
from your bone and it starts making It really can
affect just about everything.
So you've talked about when it'smoving too fast or when it's
overactive.
You've talked about when it'smoving too slow and it has
symptoms then and they can bequite different.
So let's break that down alittle bit.
Let's start out with theunderactive one, otherwise known
as hypothyroidism.
(05:58):
What causes that?
SPEAKER_02 (05:59):
There are many causes for your thyroid to not
function well and underperform,but the most common is an
autoimmune disease.
Autoimmune disease is acondition where your body is
producing antibodies andfighting your own organ.
For some reason, it justproduces these antibodies and
(06:22):
starts attacking your thyroid,and it starts destroying the
cells, which actually produces ahormone, and then it shuts
itself.
So that's why now you're notproducing any hormone, and then
you have underactive thyroid.
So that's called Hashimoto'sthyroiditis.
That's what you will hear veryfrequently, a lot of people
talking about saying, hey, Ihave Hashimoto's.
SPEAKER_03 (06:44):
I suppose that was named after somebody named
Hashimoto.
Yes.
Hashimoto's thyroiditis is theterm.
And is that what causes allhypothyroidism?
Because you mentioned autoimmunedisorders.
It's an autoimmune disorder.
And listeners to the podcast, ifyou've been listening carefully
over the last four years, you'veprobably heard the word
autoimmune, where your own bodyattacks one of its organs.
(07:07):
So that's a common cause ofhypothyroidism, probably the
most common.
How common is that, by the way?
SPEAKER_02 (07:13):
I'd say it's about 70 to 80% of the chance of your
hypothyroidism, like underactivethyroid, is due to Hashimoto's.
SPEAKER_03 (07:20):
What are the other causes of an underactive
thyroid?
SPEAKER_02 (07:22):
The other cause would be is like you had some
surgery, your thyroid wasremoved for some reason.
Yeah, So that would be thesecond common cause.
Then the other cause would be iswhen you were treated for
overacting thyroid, one of thetreatment is radioactive iodine.
We give radiation and itdestroys your thyroid.
And since now your thyroid isdestroyed, we are treating for
(07:44):
one reason, now you have linedup
SPEAKER_03 (07:46):
with another.
It's a known consequence.
So you said 70-80% ofhypothyroidism is due to
Hashimoto's or autoimmunities.
Who gets this?
Who in the population's at risk?
Is it everybody equally?
Men, women, young, old?
Who gets it the most?
And how common is it?
SPEAKER_02 (08:02):
Right now...
or any autoimmune disease, wereally don't know exactly why we
develop these antibodies.
But most of the times when itcomes to autoimmune, it's
genetic.
So it gets transferred fromfamily to family.
So you are more prone forautoimmune disease.
And if you have any autoimmunedisease, any other autoimmune
(08:23):
disease, there is high chancethat you will develop And this
isn't just a thing of olderadults, is it?
No, it can affect anyone.
(08:45):
I would say like around 15, 18years and it can go up to 20.
80 years, 90 years later in yourlife, also you can develop these
antibodies.
So there is no specific time foryou to develop these antibodies.
SPEAKER_03 (08:57):
And before I move on to an overactive thyroid, so
those who are experiencingunderactive thyroid, those are
the ones having the slowed downsymptoms like you mentioned,
correct?
Yes.
They're the ones having the slowheart rate, constipation.
What about weight?
Is weight involved in anunderactive thyroid?
SPEAKER_02 (09:14):
Yes.
Because it's the main hormonewhich controls your metabolism.
And that energy is driven fromyour thyroid.
It's like a spark plug whereit's igniting your fuel to
produce that energy.
If you don't burn your calories.
Then you accumulate thosecalories and then you land up
(09:34):
having increased weight.
So, underactive thyroid willmake you to gain
SPEAKER_03 (09:39):
weight.
I've heard the metaphor of likeyour thyroid sort of like the
gas pedal and the brake on yourcar.
And when it's overactive,someone's standing on the gas
pedal.
And when it's underactive,someone's standing on the brake.
So, you can't go fast.
You can't move.
Everything's sluggish.
You gain weight.
Your heart's slow.
You have constipation.
Everything's in low gear.
Okay.
So, shift to hyperhyperthyroidism.
(10:00):
And in medicine, folks, hypomeans low, hyper means high.
So hyperthyroid is it'soveractive.
What causes that?
SPEAKER_02 (10:09):
Again, the most common cause when it comes to
hyperthyroidism, again, that'sagain, it's an autoimmune
disease.
So again, your body is producingantibodies, which here, it's not
destroying your thyroid.
So We talked about Hashimoto'swhere your body is producing
antibody.
It destroys your thyroid.
Here, it's actually stimulating,overstimulating your thyroid to
(10:33):
produce more hormone than whatis required.
So usually our thyroid is undercontrol of your brain.
So there is a muscle glandcalled pituitary.
So it produces a hormone calledTSH.
The name itself, it's thyroidstimulating hormone.
TSH, yeah.
Yeah.
So that, stimulates your thyroidand controls how much you need
(10:55):
to produce and when to stop andwhen to start.
But here, your body is producingantibodies which doesn't listen
to anyone and it just does itsown job.
SPEAKER_03 (11:06):
It's out of control thyroid.
Yeah.
Producing its own hormoneswithout that signal from the
brain.
Yes.
Dang it.
So those of you whose thyroid'sworking right in the normal
range, you know, you gotsomething to be thankful for
because it can go eitherdirection.
It can be a little bit rogue andproducing too much hormone.
What's that called?
What's an overactive one called?
SPEAKER_02 (11:27):
The overactive thyroid, because of the
autoimmune condition, we call itas a Graves' disease.
Again, it's named after theperson who actually first
described.
Grave.
It's called as Graves' disease.
SPEAKER_03 (11:39):
Somebody, Dr.
Grave or Mrs.
Grave, I don't know who it was,
SPEAKER_02 (11:43):
Graves' disease.
Graves' disease, but don't go bythe name, like saying Graves'
means, okay, do I go toGraveyard?
Yeah, exactly.
I
SPEAKER_03 (11:50):
thought that too.
You know, here's another littlesidebar.
We've stopped naming thingsafter people and places kind of
in medicine because it's nothelpful.
It's not helpful to name itafter some guy named Graves who
stuck his name on it.
I assume it's a guy because,frankly, that's what happened.
Unfortunately, it could havebeen his wife that found it.
(12:11):
He put his name on it.
So we're getting away from that.
So it doesn't mean you're goingto the grave.
It was named after somebodynamed Dr.
Graves.
Okay, so that's one cause of it.
Are Are there other causes foran overactive thyroid besides
this autoimmune Graves disease?
SPEAKER_02 (12:25):
The other causes for overactive thyroid is when you
have some inflammation becauseof some viral infection.
So when you have someinflammation, it destroys.
So here your body is not, likeyour thyroid is not producing.
Your thyroid already hasproduced some hormone and it has
stored and it's just releasingwhen you need it.
It's like a dam, right?
(12:46):
Like where you have your waterreserves, but when you need, you
just open the gates.
Here, during the inflammation,the gates get damaged and then
the whole hormone which wasstored is just released.
Just flooded into your body.
Yeah.
So that's transient.
So it's temporary because itjust empties whatever the
hormone is there.
And it has a shelf life.
(13:07):
After some time, it just have tobe excreted and metabolized from
your body.
So it disappears.
So initially, you will have thesymptoms of like
hyper-functioning thyroid.
Then once the inflammationsettles down, your thyroid
levels comes to normal.
But there is a possibilitybecause if there was too much of
inflammation or too much ofdestruction, then you can land
(13:30):
up having an underactivethyroid.
So that's the other cause.
The other cause is pregnancy.
So after pregnancy, like afterdelivery, we call it as
postpartum thyroiditis.
After delivery up to one year,there is a chance that your
Thyroid gets inflamed andproduces more thyroid harm.
SPEAKER_03 (13:50):
So it occurs after pregnancy, Shikhat.
It's not the pregnancy didn'tcause it, but it is some
consequence of some women'spregnancies?
SPEAKER_02 (13:59):
Yeah, so...
During pregnancy, you know, likea lot of physiological changes
happen.
So your body needs more ofthyroid hormone during pregnancy
than what you required in like anormal life.
You deliver a baby.
So now your thyroid has toreadjust to the new- To the new
metabolic requirements.
Requirements.
So your thyroid just is tryingto get adjusted to it.
(14:22):
And that time, whatever thehormone it's producing, it's
like it's more than what'srequired.
And again, that's transient.
So slowly- It starts settlingdown, and then it just comes
back
SPEAKER_03 (14:33):
to normal.
We're going to talk abouttreatments of these conditions
after the break.
But before we do that, I want totalk just for a moment or two
about thyroid nodules.
We're not going to get intodepth about that, but they can
be a big nothing.
They could be producing hormone,making you hyperthyroidism, or
they can even be cancer, right?
SPEAKER_02 (14:55):
Yes.
SPEAKER_03 (14:55):
Okay, so let's talk for a moment.
If you do have a thyroid nodule,so your doctor told you or you
felt a lump in the front of yourneck, could you just talk us
briefly through thyroid nodulesand what people should know
about them?
SPEAKER_02 (15:10):
Yeah.
You actually are asking one ofthe favorite topics in thyroid
for me.
So I do a lot of, see a lot ofthyroid nodules patients.
I actually do biopsies also.
Yeah, this
SPEAKER_03 (15:21):
guy puts needles in your neck, folks.
For a good reason.
For a good reason.
Not very far.
That's a little bit of kind oflike maybe humor that the public
doesn't do.
We talk about stuff like this.
So you're going to put a needlewhere?
It's just in the front.
It's not very deep.
Okay, so you do that a lot inyour clinic.
Talk about that.
SPEAKER_02 (15:40):
Thyroid nodules, the name itself, it's a nodule.
Nodule is something, an abnormalgrowth in your thyroid.
So that's what's called athyroid nodule.
Why they grow, we don't have anyclear answers.
The most common hypothesis islike because of a hormonal
imbalance where there is adifference in the growth of one
(16:02):
particular area in your thyroidand the other one.
So one is outgrowing the otherpart.
and outgrow and form nodules,they're usually non-functional.
And they're not doing anything.
Yes, they're usuallynon-functional.
I just like to frame, put it asan usually because I'll tell you
sometimes they do producehormones or they can affect your
(16:23):
thyroid to produce less harm.
So these nodules, again,whenever we listen, oh, there is
something growing in my thyroid,we all panic thinking, oh,
something is growing.
Is it a cancer or something?
Let me put it in a very simpleway.
These thyroid nodules are verycommon.
As your age increases, theincidence of these nodules
(16:46):
increase.
So just to put it very simple,at the age of 30, It's about 30%
chance.
Like if you scan anyone who isin 30s, there is a 30% chance
that you might find an audio.
SPEAKER_03 (16:59):
30%?
That's a lot.
SPEAKER_02 (17:00):
Yeah.
So that's why it's a prettycommon.
It's common.
It's not uncommon.
SPEAKER_03 (17:03):
Yeah.
SPEAKER_02 (17:04):
At the age of 50, it's a 50% chance.
Age of 80, it's an 80% chance.
Anyone is 90 and above, there'sa 100% chance.
If you're
SPEAKER_03 (17:11):
90 years old, you probably got a nodule in your
SPEAKER_02 (17:13):
thyroid.
Yes.
So- That's that common.
That's fascinating.
I didn't know that.
Yeah.
Yeah.
So that's why we don't, again,they don't grow.
They grow very slow.
Like, you don't know when youhave developed a snordial.
You probably haven't.
You don't feel it.
Yeah, you don't feel it unlessit becomes very big and obvious.
You don't feel it.
Most of the times, thesesnordials show up when you went
(17:33):
for some scan for some reason.
We see in your thyroid, there issome snordial.
You had
SPEAKER_03 (17:39):
a CAT scan of your lungs because you were short of
breath.
Some totally different reason.
Totally different.
And it's what they call it inIncidental finding.
Yes.
Oh yeah, we saw this too.
SPEAKER_02 (17:49):
So that's 70% to 80% of the times we find this
incidentally because you havegone for some other scan and we
found this that there is athyroid nodule.
But again, when we see a nodule,we always want to make sure
that, okay, is this a cancer ornot?
So does all nodule need ourattention?
(18:11):
No.
There are criterias which havebeen set in line by American
Thyroid Association and then theradiology, they have their own
association.
So they have set in guidelinesand Based on the guidelines, we
decide, okay, this nodule seemsa little concerning.
Let's do some further workup.
This nodule doesn't seemconcerning.
(18:32):
It's okay.
Let it live.
We don't need to do anything.
Let it be there.
Or there are some other noduleswe just say, okay, it's not
concerning, but let's watch forit if they grow or not.
So that's the
SPEAKER_03 (18:42):
take-home message, I think, from this whole little
segment about nodules.
They're common most of the time,or at least a lot of the time,
you don't have to worry aboutthem.
But we do have to look into itand see if it's one of the
concerning ones to see if ithappens to be one of those
thyroid cancers.
We are talking with Dr.
Srikanth Avila.
We've covered the basics and thecommon thyroid disorders.
(19:04):
When we return from a shortbreak, we're going to discuss
how these conditions arediagnosed and treated, and
importantly, how you can manageyour daily life if your thyroid
is acting up or maybe I shouldsay acting down.
Stay with us.
We'll be right back.
SPEAKER_01 (19:19):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(19:41):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_03 (19:56):
And we're back talking with Srikanth Avila
about thyroid disorders.
And in that first half, wecovered a lot of ground.
So our break came a little bitlater.
Now what I'm going to do is askyou to talk about the conditions
that we started with.
Hypothyroid, Hashimoto's,hyperthyroid, Graves' disease,
and related disorders.
How were they
SPEAKER_02 (20:15):
diagnosed?
It's a basic, simple blood test.
So you are...
It's called a thyroid functiontest.
So the name itself describes it.
So we are trying to look aboutthe function of your thyroid.
So it's the TSH, the thyroidstimulating hormone.
And the thyroid hormone whichyour thyroid produces is called
(20:37):
T4 and T3, which always bug me.
SPEAKER_03 (20:40):
It is T4 and T3.
They don't come sequentially.
Your body changes one to theother.
They go in opposite order.
And where the heck are T1 andT2?
I always wanted to know that inmed school.
Anyway, T4 and T3 are thehormones that circulate through
your body and do their job.
SPEAKER_02 (20:55):
Yes.
That's what we're going to checkwhen initially looking for your
thyroid functions, whethernormal or abnormal.
And when they are abnormal, sowhen we say like underactive
thyroid, So we would expect yourthyroid hormone to be low.
Obviously, since your thyroid isnot producing enough hormone,
then your brain is sensing that,hey, your thyroid is not
(21:19):
producing enough hormone as it'ssupposed to produce.
So then your brain, thepituitary, is producing this TSH
in more, trying to stimulate,trying to override and say, hey,
try to produce.
It's cracking the whip a littleharder,
SPEAKER_03 (21:33):
isn't it?
Yes.
So high TSH means a lowunderactive thyroid.
Yes.
And the opposite is also true, Iassume?
SPEAKER_02 (21:41):
Yes.
in the hyperactive thyroid, wewould expect your thyroid to
produce too much of hormone, butyour pituitary is sensing that,
saying, hey, you're producingtoo much of a hormone.
Let me not stimulate you.
So that's why you will expectyour TSH to go down and you will
(22:02):
see your T3 and T4 levels goingup.
So now we know that, okay, youhave an underactive thyroid and
you have an overactive thyroid,but we need to establish what's
causing this.
So we need to find the reason sothat is there any particular
reason which we can prevent,treat that, remove that cause,
(22:23):
then your thyroid wouldnormalize.
SPEAKER_03 (22:26):
One thing I like about thyroid disease and maybe
a lot of endocrinology ingeneral is that there's a blood
test.
You know, a lot of things thereisn't.
or there's blood tests that aresupportive, you can diagnose
pretty accurately with a TSH, aT3, and a T4 as the initial
tests.
Yes.
As the initial tests.
And then if they're abnormal,there's additional tests.
(22:47):
And endocrinologists can getpretty specific about what's
wrong.
They can check antibodies, andyou can check other hormone
levels, and you can figure out,do you have Graves' disease?
Do you have Hashimoto's?
Do you have all these things?
So this is something you can getdiagnosed relatively readily.
Very common one, underactivehypothyroidism.
Autoimmune, Hashimoto's,hypothyroidism.
(23:10):
There's jillions of people, andjillion is the correct term,
running around with that.
How is it treated?
SPEAKER_02 (23:17):
It's an underactive thyroid, so you're not producing
enough thyroid hormone.
So we have a synthetic thyroidhormone, which is nothing but
your T4, and that's all youneed.
T4.
T4.
You don't need T4.
T3 replacement.
So there are some instanceswhere we can give T3
replacement, but otherwise it'sjust a
SPEAKER_03 (23:38):
T4 you need.
And that's the levothyroxine.
But I want to delve into that alittle bit more.
There's, like I said, a wholebunch of our listeners are
taking levothyroxine right now.
If your body has T3 and T4running through it, why when we
treat it, do we only give T4?
Why don't we also give T3 moreoften?
Because that is asked of us.
(23:59):
People want to take ground upthyroid or they want to take
thyroid from some animal orwhatever because it's more Thank
you for
SPEAKER_02 (24:07):
asking that because that's the most common question
we get.
Reason is very simple.
So your thyroid produces, yes,your thyroid produces of T3 and
T4, but the ratio amount of yourT4, which your thyroid produces,
is actually 16 is to 1.
So it's 16 times more thanyou're producing.
16 molecules of T4, then you'rejust producing one molecule of
(24:31):
T3.
And what your thyroid producesas a T3 is actually around 5 to
10% of what actually your bodyneeds.
The other organs, like yourliver, muscles, also produces
T3.
Tatooine.
your body cells take up T4 andthey convert your T4 into T3.
So that's why you don't need T3because your other organs, it's
(24:54):
not just thyroid.
They take
SPEAKER_03 (24:55):
care of it.
They take care of it.
People think that when I tellthem, you don't need to take T3,
they think that I've got likesome stake in the pharmaceutical
company that makes T4.
Believe me, folks, I don't.
It's been around forever.
I don't.
Doctors don't.
It's just that it's unnecessary.
So when you're You're taking allthese pain out of your pocket,
(25:16):
all these expensive things, andyou're going and you're taking
all these extra thyroids.
Almost certainly.
There's always exceptions, butyou almost certainly don't need
that.
So I'm just trying to save yourwallet that when I tell you,
just take your T4, you'll beokay.
So that's underactive thyroid.
And there's loads of people whotake their thyroid med every day
and they're doing just fine.
What about the overactivethyroid?
(25:37):
Because in that case, you'reproducing too much thyroid
hormone.
So you don't want to take more.
What do you do in that case?
SPEAKER_02 (25:44):
Yes.
Now you are producing too muchof a thyroid hormone.
So now we need to calm yourthyroid.
So we have a which act insideyour thyroid and prevent the
excess production of yourthyroid hormone.
Is that the only way to treat?
No, we have other options, butthat's the most common and easy
(26:06):
way to treat.
There are some people who don'ttolerate.
It's a medicine.
It's a chemical, right?
So when you take somemedication, you always have some
side effects.
So some people don't toleratebecause of the side effects.
When they develop those sideeffects, then we...
stop that medication.
We try other forms of thatmedication and see if they
tolerate.
If they don't tolerate, then wehave other treatment options
(26:28):
like radioactive iodine.
SPEAKER_03 (26:30):
Yeah, that sounds like a walk in the park.
What's radioactive iodine?
And don't let me forget, I'mgoing to ask you about seaweed.
I'm going to ask you aboutseaweed.
SPEAKER_02 (26:38):
The name itself suggests it's a radioactive
iodine.
Iodine is a molecule and that'sa radioactive one.
That's what we give to treatyour hyperactive thyroid.
Why iodine?
The reason is because Becauseyour thyroid hormone is made up
from iodine.
So, it's nothing but iodine.
It's iodine, yeah.
Yeah.
So, it's nothing but iodine.
(26:58):
Your thyroid is the only organ,major organ, which utilizes your
iodine to produce this hormone.
It's the reason it's in salt.
So, that's why we give thisradioactive iodine because it's
mainly taken up by your… Itdoesn't go to
SPEAKER_03 (27:11):
any
SPEAKER_02 (27:11):
other organ.
There are some… place where it'ssecreted in minute quantities,
like in your saliva and yourlacrimal glands.
But otherwise, it's majorconcentration
SPEAKER_03 (27:22):
is in your thyroid.
I actually love this aboutmedicine.
So your thyroid is kind of theonly place in your body that
uses iodine.
So let's nuke it.
That's what we're doing.
Yes.
Let's make the iodineradioactive.
It only goes, it doesn't, youknow, the rest of your body is
relatively unaffected.
And we basically blast the crudout of your thyroid with this
little, but it's safe, folks.
(27:42):
It's safe.
It is one way to ablate yourthyroid with a chemical method,
and then it's not overactiveanymore.
But then you get to takemedicine to replace the hormone
after you've had that done,right?
SPEAKER_02 (27:54):
Yes, because now we are destroying your thyroid.
So then there is no functionalthyroid tissue left because your
thyroid is still there.
It doesn't disappear.
It's there, but it's notworking.
We microwaved it.
Yeah.
UNKNOWN (28:10):
I'm kidding.
SPEAKER_03 (28:11):
Okay, before I let you go, Dr.
Avila, Egyptians or somebody wasfeeding seaweed to people.
SPEAKER_02 (28:17):
What the heck?
So, seaweed, there are goodstores of iodine.
In seaweed.
Seaweed, yes.
So, as I talked about at thetime, we talked about a term
called goiter.
Goiter is nothing but there isenlargement of your thyroid.
Goiter is simply an enlargedthyroid.
Yeah.
So, that happens if you don'tconsume enough iodine.
(28:40):
And that happens in people whoare in hilly areas where...
Usually, your soil is deficientin iodine because of the
rainwater.
It just washes off.
So, hilly areas are deficient iniodine.
Yes.
SPEAKER_03 (28:54):
Who knew?
Sorry, folks in Denver.
SPEAKER_02 (28:57):
That was like an earlier thing.
But right now, the simple sourceof iodine is your salt.
SPEAKER_03 (29:03):
Yeah, around here, at least in the Western
Hemisphere, they stick it insalt.
SPEAKER_02 (29:07):
Yeah, so almost everywhere now, that's the
easiest way where all the saltis iodinized.
And that's where you get enoughiodine from your salt.
So in ancient times, we don'thave this.
all this manufacturing unitwhere we could separate iodine
and salt and mix them and sellthis iodinized salt.
(29:27):
So at that time, the good sourceof your iodine was your seaweed.
Your seawater is a good sourceof iodine.
It has really good quantity.
So I'm not telling, okay, go anddrink seawater.
You don't need to.
But you are saying next time yougo to your
SPEAKER_03 (29:41):
sushi restaurant, get the seaweed salad.
SPEAKER_02 (29:43):
I wouldn't definitely say that.
But yeah, because again, youneed to eat tons of seaweed.
Okay.
So here in sushi, when we gothere, it's just very little
seaweed there.
That's not enough.
Like you have to eat a greatquantity, good quantity of
seaweed every day.
SPEAKER_03 (30:02):
So maybe that isn't your sole solution.
But if you like the seaweedsalad, get it anyway.
Okay, Dr.
Srikanth Avila, we've beentalking about thyroid disease.
If you could leave us with onemessage for listeners, what
would it be?
SPEAKER_02 (30:13):
I would like to tell our listeners, if you see any
thyroid nodule, don't freak out.
As I said, it's pretty common.
Just talk to your doctor to getthat evaluated and see if it is
concerning or not.
If you also notice any symptoms,like if you feel very tired,
mental clouding, you don't feelright, get your thyroid checked
(30:37):
and see if it is normal.
If it is abnormal, thenobviously we do have very simple
measures to treat it and so thatyou can feel better and you can
be what you were before that.
SPEAKER_03 (30:48):
Yeah, it's reassuring.
You don't have to freak It'scommon.
There's things to be done.
Dr.
Srikanth Avila, thanks forjoining me today.
SPEAKER_02 (30:55):
Thank you, Dr.
Hillen.
And this was a wonderful sessionand it was nice talking to you.
SPEAKER_03 (31:00):
It's been great chatting with you.
We have been talking about yourthyroid.
It's sort of endocrinologymonth.
We've covered diabetes.
We've covered your thyroid.
We got your hormones covered,listeners.
Thanks for tuning in.
I hope you'll join us in twoweeks' time for our next
episode.
And in the meantime, be healthyand be well.
SPEAKER_00 (31:17):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(31:38):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota and engineered and
produced by John Lucas atHighball.
Executive producers are JohnLucas, and Christine Hill.
Please remember, we can onlygive general medical advice
during this program and everycase is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(32:00):
Until next time, be healthy andbe well.
Welcome to the Healthy Matters Podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare,
and what matters to you.
And now, here's our host, Dr.
David Hilden.
SPEAKER_03 (00:19):
Hey, everybody, and welcome to episode 21.
I am David Hilden, your host,and today we're getting to know
one of the most underappreciatedand maybe underrated organs in
the body, the thyroid.
It's small, it'sbutterfly-shaped, and it packs a
huge punch when it comes to howyour body functions.
If you ever wondered why you'refeeling sluggish or moody, hot,
(00:42):
cold, or just off...
Maybe your thyroid has somethingto say about it.
So joining me today is someonewho knows this stuff inside and
out, Dr.
Srikanth Avila.
He's an expert endocrinologistat Hennepin Healthcare in
Minneapolis who knows thethyroid like the back of his
hand.
Srikanth, welcome to the show.
Thank you.
It's great to have you here.
Now start us off.
(01:02):
What's the thyroid and what doesit do?
Our
SPEAKER_02 (01:05):
body has like many organs and which are very
important for our survival.
So among them, thyroid is one ofthe most important organ I would
say that it's like a CEO of ourorgan.
It's the CEO of
SPEAKER_03 (01:18):
the organs?
Oh, I haven't heard it calledthat before.
I've heard it called thethermostat
SPEAKER_02 (01:21):
before.
Yeah, thermostat.
Like, it's not just about thethermostat.
Like, okay, it's just notcontrolling your heat and cold,
but...
It's like controlling each andevery cell of your body.
So, as a CEO, you control eachand every system in the
organization, and everythingruns on the orders of your CEO.
(01:42):
In the same way, the thyroid isalso like controlling each and
every cell of your body and howthey respond.
So, for the normal functioningof your cells, you need your
thyroid.
So, you're saying it controlsthe heart, controls the
SPEAKER_03 (01:55):
kidneys, controls everything?
SPEAKER_02 (01:57):
Yes, territory.
indirect it controls
SPEAKER_03 (02:00):
each and every organ of a body so you're saying we
need it it's not like yourspleen you kind of need your
thyroid
SPEAKER_02 (02:06):
yes spleen is something like okay you need it
but again if you remove it it'sfine but Thyroid is very
important.
If you don't have thyroid, it'sokay.
But again, you need thehormones, whatever it produces,
for
SPEAKER_03 (02:21):
our survival.
Yeah.
Listeners, that's kind of arunning joke in medicine.
It's like, what's a spleen?
What does that thing do?
No, nobody knows.
Nobody knows what the spleendoes.
Let's get rid of that uselessthing.
That's not true, but it's sortof like this running joke.
So, the thyroid makes hormones.
Really basic, where is thething?
So,
SPEAKER_02 (02:37):
Let me just give us like brief history about
thyroid, how the name came in.
Okay.
So, it dates back to firstcentury AD.
That's when like we have someliterature on that discussing
about thyroid.
Ancient Egyptians, Chinese,Greeks, they all talked about
(02:57):
thyroid.
And they also talked aboutmanaging it.
So, thyroid.
At the time, it was talked aboutguiter, like a swelling in front
of your neck.
And they used to treat it withseaweeds.
You ate the seaweed or you putit on there?
You ate it.
So I'll come to that, like whythe seaweed's important, like it
(03:18):
does make sense.
The term thyroid was named in17th century by Thomas Wharton,
derived from the Greek word,which was the meaning for
shield.
It does kind of look like ashield.
Yeah.
So it's located.
in front of our neck just likewe have a prominent spot in our
neck in front of our neck calledAdam's apple so it just sits
(03:41):
below that it's the shape of abutterfly so you have a narrow
part in the between and then youhave two wings which spread out
to one on the left side, on theright side.
So we call them as a left lobeand a right lobe.
And there is a small bridgewhich connects these two lobes,
and we call that as isthmus.
SPEAKER_03 (04:00):
So it sits in your neck.
It makes hormones.
It's the CEO of the body.
And it does kind of look like ashield.
I don't think I knew that.
That's where the thyroid is.
Before we talk about why ithappens, what happens when it
goes wrong?
When someone's thyroid's notworking, what symptoms might
people experience?
SPEAKER_02 (04:19):
As I said, the thyroid Thyroid affects in each
and every system of your body,whether it's directly or
indirectly.
Let's start with like yourbrain.
Like you feel like mental fog.
You can feel depressed.
You can feel tired coming downyour heart.
So if you're producing too muchof your thyroid hormone, then it
(04:40):
makes your heart beat very fast.
Then again, you have symptomsbecause of that.
Like you feel some chestdiscomfort, some pain.
some difficulty in breathing, orit can reduce your heart rate.
So if your heart rate is low,then you don't pump enough blood
for your body.
So there is no enough bloodsupply in your body.
(05:01):
Then again, all the organs startgetting tired.
They don't function normally.
There is no enough energy ingeneration for them.
When it comes down to yourstomach, intestines, it's needed
for the normal motility of yourintestines.
So if it is less, then you haveconstipation.
(05:21):
When you are producing too muchof the hormone, then you have
increased movement of yourbowel, then you have diarrhea.
It also has effect on yourbones.
So if you have too much ofthyroid hormone producing, it's
like an acid.
So it starts eating up yourcalcium
SPEAKER_03 (05:37):
from your bone and it starts making It really can
affect just about everything.
So you've talked about when it'smoving too fast or when it's
overactive.
You've talked about when it'smoving too slow and it has
symptoms then and they can bequite different.
So let's break that down alittle bit.
Let's start out with theunderactive one, otherwise known
as hypothyroidism.
(05:58):
What causes that?
SPEAKER_02 (05:59):
There are many causes for your thyroid to not
function well and underperform,but the most common is an
autoimmune disease.
Autoimmune disease is acondition where your body is
producing antibodies andfighting your own organ.
For some reason, it justproduces these antibodies and
(06:22):
starts attacking your thyroid,and it starts destroying the
cells, which actually produces ahormone, and then it shuts
itself.
So that's why now you're notproducing any hormone, and then
you have underactive thyroid.
So that's called Hashimoto'sthyroiditis.
That's what you will hear veryfrequently, a lot of people
talking about saying, hey, Ihave Hashimoto's.
SPEAKER_03 (06:44):
I suppose that was named after somebody named
Hashimoto.
Yes.
Hashimoto's thyroiditis is theterm.
And is that what causes allhypothyroidism?
Because you mentioned autoimmunedisorders.
It's an autoimmune disorder.
And listeners to the podcast, ifyou've been listening carefully
over the last four years, you'veprobably heard the word
autoimmune, where your own bodyattacks one of its organs.
(07:07):
So that's a common cause ofhypothyroidism, probably the
most common.
How common is that, by the way?
SPEAKER_02 (07:13):
I'd say it's about 70 to 80% of the chance of your
hypothyroidism, like underactivethyroid, is due to Hashimoto's.
SPEAKER_03 (07:20):
What are the other causes of an underactive
thyroid?
SPEAKER_02 (07:22):
The other cause would be is like you had some
surgery, your thyroid wasremoved for some reason.
Yeah, So that would be thesecond common cause.
Then the other cause would be iswhen you were treated for
overacting thyroid, one of thetreatment is radioactive iodine.
We give radiation and itdestroys your thyroid.
And since now your thyroid isdestroyed, we are treating for
(07:44):
one reason, now you have linedup
SPEAKER_03 (07:46):
with another.
It's a known consequence.
So you said 70-80% ofhypothyroidism is due to
Hashimoto's or autoimmunities.
Who gets this?
Who in the population's at risk?
Is it everybody equally?
Men, women, young, old?
Who gets it the most?
And how common is it?
SPEAKER_02 (08:02):
Right now...
or any autoimmune disease, wereally don't know exactly why we
develop these antibodies.
But most of the times when itcomes to autoimmune, it's
genetic.
So it gets transferred fromfamily to family.
So you are more prone forautoimmune disease.
And if you have any autoimmunedisease, any other autoimmune
(08:23):
disease, there is high chancethat you will develop And this
isn't just a thing of olderadults, is it?
No, it can affect anyone.
(08:45):
I would say like around 15, 18years and it can go up to 20.
80 years, 90 years later in yourlife, also you can develop these
antibodies.
So there is no specific time foryou to develop these antibodies.
SPEAKER_03 (08:57):
And before I move on to an overactive thyroid, so
those who are experiencingunderactive thyroid, those are
the ones having the slowed downsymptoms like you mentioned,
correct?
Yes.
They're the ones having the slowheart rate, constipation.
What about weight?
Is weight involved in anunderactive thyroid?
SPEAKER_02 (09:14):
Yes.
Because it's the main hormonewhich controls your metabolism.
And that energy is driven fromyour thyroid.
It's like a spark plug whereit's igniting your fuel to
produce that energy.
If you don't burn your calories.
Then you accumulate thosecalories and then you land up
(09:34):
having increased weight.
So, underactive thyroid willmake you to gain
SPEAKER_03 (09:39):
weight.
I've heard the metaphor of likeyour thyroid sort of like the
gas pedal and the brake on yourcar.
And when it's overactive,someone's standing on the gas
pedal.
And when it's underactive,someone's standing on the brake.
So, you can't go fast.
You can't move.
Everything's sluggish.
You gain weight.
Your heart's slow.
You have constipation.
Everything's in low gear.
Okay.
So, shift to hyperhyperthyroidism.
(10:00):
And in medicine, folks, hypomeans low, hyper means high.
So hyperthyroid is it'soveractive.
What causes that?
SPEAKER_02 (10:09):
Again, the most common cause when it comes to
hyperthyroidism, again, that'sagain, it's an autoimmune
disease.
So again, your body is producingantibodies, which here, it's not
destroying your thyroid.
So We talked about Hashimoto'swhere your body is producing
antibody.
It destroys your thyroid.
Here, it's actually stimulating,overstimulating your thyroid to
(10:33):
produce more hormone than whatis required.
So usually our thyroid is undercontrol of your brain.
So there is a muscle glandcalled pituitary.
So it produces a hormone calledTSH.
The name itself, it's thyroidstimulating hormone.
TSH, yeah.
Yeah.
So that, stimulates your thyroidand controls how much you need
(10:55):
to produce and when to stop andwhen to start.
But here, your body is producingantibodies which doesn't listen
to anyone and it just does itsown job.
SPEAKER_03 (11:06):
It's out of control thyroid.
Yeah.
Producing its own hormoneswithout that signal from the
brain.
Yes.
Dang it.
So those of you whose thyroid'sworking right in the normal
range, you know, you gotsomething to be thankful for
because it can go eitherdirection.
It can be a little bit rogue andproducing too much hormone.
What's that called?
What's an overactive one called?
SPEAKER_02 (11:27):
The overactive thyroid, because of the
autoimmune condition, we call itas a Graves' disease.
Again, it's named after theperson who actually first
described.
Grave.
It's called as Graves' disease.
SPEAKER_03 (11:39):
Somebody, Dr.
Grave or Mrs.
Grave, I don't know who it was,
SPEAKER_02 (11:43):
Graves' disease.
Graves' disease, but don't go bythe name, like saying Graves'
means, okay, do I go toGraveyard?
Yeah, exactly.
I
SPEAKER_03 (11:50):
thought that too.
You know, here's another littlesidebar.
We've stopped naming thingsafter people and places kind of
in medicine because it's nothelpful.
It's not helpful to name itafter some guy named Graves who
stuck his name on it.
I assume it's a guy because,frankly, that's what happened.
Unfortunately, it could havebeen his wife that found it.
(12:11):
He put his name on it.
So we're getting away from that.
So it doesn't mean you're goingto the grave.
It was named after somebodynamed Dr.
Graves.
Okay, so that's one cause of it.
Are Are there other causes foran overactive thyroid besides
this autoimmune Graves disease?
SPEAKER_02 (12:25):
The other causes for overactive thyroid is when you
have some inflammation becauseof some viral infection.
So when you have someinflammation, it destroys.
So here your body is not, likeyour thyroid is not producing.
Your thyroid already hasproduced some hormone and it has
stored and it's just releasingwhen you need it.
It's like a dam, right?
(12:46):
Like where you have your waterreserves, but when you need, you
just open the gates.
Here, during the inflammation,the gates get damaged and then
the whole hormone which wasstored is just released.
Just flooded into your body.
Yeah.
So that's transient.
So it's temporary because itjust empties whatever the
hormone is there.
And it has a shelf life.
(13:07):
After some time, it just have tobe excreted and metabolized from
your body.
So it disappears.
So initially, you will have thesymptoms of like
hyper-functioning thyroid.
Then once the inflammationsettles down, your thyroid
levels comes to normal.
But there is a possibilitybecause if there was too much of
inflammation or too much ofdestruction, then you can land
(13:30):
up having an underactivethyroid.
So that's the other cause.
The other cause is pregnancy.
So after pregnancy, like afterdelivery, we call it as
postpartum thyroiditis.
After delivery up to one year,there is a chance that your
Thyroid gets inflamed andproduces more thyroid harm.
SPEAKER_03 (13:50):
So it occurs after pregnancy, Shikhat.
It's not the pregnancy didn'tcause it, but it is some
consequence of some women'spregnancies?
SPEAKER_02 (13:59):
Yeah, so...
During pregnancy, you know, likea lot of physiological changes
happen.
So your body needs more ofthyroid hormone during pregnancy
than what you required in like anormal life.
You deliver a baby.
So now your thyroid has toreadjust to the new- To the new
metabolic requirements.
Requirements.
So your thyroid just is tryingto get adjusted to it.
(14:22):
And that time, whatever thehormone it's producing, it's
like it's more than what'srequired.
And again, that's transient.
So slowly- It starts settlingdown, and then it just comes
back
SPEAKER_03 (14:33):
to normal.
We're going to talk abouttreatments of these conditions
after the break.
But before we do that, I want totalk just for a moment or two
about thyroid nodules.
We're not going to get intodepth about that, but they can
be a big nothing.
They could be producing hormone,making you hyperthyroidism, or
they can even be cancer, right?
SPEAKER_02 (14:55):
Yes.
SPEAKER_03 (14:55):
Okay, so let's talk for a moment.
If you do have a thyroid nodule,so your doctor told you or you
felt a lump in the front of yourneck, could you just talk us
briefly through thyroid nodulesand what people should know
about them?
SPEAKER_02 (15:10):
Yeah.
You actually are asking one ofthe favorite topics in thyroid
for me.
So I do a lot of, see a lot ofthyroid nodules patients.
I actually do biopsies also.
Yeah, this
SPEAKER_03 (15:21):
guy puts needles in your neck, folks.
For a good reason.
For a good reason.
Not very far.
That's a little bit of kind oflike maybe humor that the public
doesn't do.
We talk about stuff like this.
So you're going to put a needlewhere?
It's just in the front.
It's not very deep.
Okay, so you do that a lot inyour clinic.
Talk about that.
SPEAKER_02 (15:40):
Thyroid nodules, the name itself, it's a nodule.
Nodule is something, an abnormalgrowth in your thyroid.
So that's what's called athyroid nodule.
Why they grow, we don't have anyclear answers.
The most common hypothesis islike because of a hormonal
imbalance where there is adifference in the growth of one
(16:02):
particular area in your thyroidand the other one.
So one is outgrowing the otherpart.
and outgrow and form nodules,they're usually non-functional.
And they're not doing anything.
Yes, they're usuallynon-functional.
I just like to frame, put it asan usually because I'll tell you
sometimes they do producehormones or they can affect your
(16:23):
thyroid to produce less harm.
So these nodules, again,whenever we listen, oh, there is
something growing in my thyroid,we all panic thinking, oh,
something is growing.
Is it a cancer or something?
Let me put it in a very simpleway.
These thyroid nodules are verycommon.
As your age increases, theincidence of these nodules
(16:46):
increase.
So just to put it very simple,at the age of 30, It's about 30%
chance.
Like if you scan anyone who isin 30s, there is a 30% chance
that you might find an audio.
SPEAKER_03 (16:59):
30%?
That's a lot.
SPEAKER_02 (17:00):
Yeah.
So that's why it's a prettycommon.
It's common.
It's not uncommon.
SPEAKER_03 (17:03):
Yeah.
SPEAKER_02 (17:04):
At the age of 50, it's a 50% chance.
Age of 80, it's an 80% chance.
Anyone is 90 and above, there'sa 100% chance.
If you're
SPEAKER_03 (17:11):
90 years old, you probably got a nodule in your
SPEAKER_02 (17:13):
thyroid.
Yes.
So- That's that common.
That's fascinating.
I didn't know that.
Yeah.
Yeah.
So that's why we don't, again,they don't grow.
They grow very slow.
Like, you don't know when youhave developed a snordial.
You probably haven't.
You don't feel it.
Yeah, you don't feel it unlessit becomes very big and obvious.
You don't feel it.
Most of the times, thesesnordials show up when you went
(17:33):
for some scan for some reason.
We see in your thyroid, there issome snordial.
You had
SPEAKER_03 (17:39):
a CAT scan of your lungs because you were short of
breath.
Some totally different reason.
Totally different.
And it's what they call it inIncidental finding.
Yes.
Oh yeah, we saw this too.
SPEAKER_02 (17:49):
So that's 70% to 80% of the times we find this
incidentally because you havegone for some other scan and we
found this that there is athyroid nodule.
But again, when we see a nodule,we always want to make sure
that, okay, is this a cancer ornot?
So does all nodule need ourattention?
(18:11):
No.
There are criterias which havebeen set in line by American
Thyroid Association and then theradiology, they have their own
association.
So they have set in guidelinesand Based on the guidelines, we
decide, okay, this nodule seemsa little concerning.
Let's do some further workup.
This nodule doesn't seemconcerning.
(18:32):
It's okay.
Let it live.
We don't need to do anything.
Let it be there.
Or there are some other noduleswe just say, okay, it's not
concerning, but let's watch forit if they grow or not.
So that's the
SPEAKER_03 (18:42):
take-home message, I think, from this whole little
segment about nodules.
They're common most of the time,or at least a lot of the time,
you don't have to worry aboutthem.
But we do have to look into itand see if it's one of the
concerning ones to see if ithappens to be one of those
thyroid cancers.
We are talking with Dr.
Srikanth Avila.
We've covered the basics and thecommon thyroid disorders.
(19:04):
When we return from a shortbreak, we're going to discuss
how these conditions arediagnosed and treated, and
importantly, how you can manageyour daily life if your thyroid
is acting up or maybe I shouldsay acting down.
Stay with us.
We'll be right back.
SPEAKER_01 (19:19):
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life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
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They provide all of the primaryand specialty care you'd expect
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(19:41):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
SPEAKER_03 (19:56):
And we're back talking with Srikanth Avila
about thyroid disorders.
And in that first half, wecovered a lot of ground.
So our break came a little bitlater.
Now what I'm going to do is askyou to talk about the conditions
that we started with.
Hypothyroid, Hashimoto's,hyperthyroid, Graves' disease,
and related disorders.
How were they
SPEAKER_02 (20:15):
diagnosed?
It's a basic, simple blood test.
So you are...
It's called a thyroid functiontest.
So the name itself describes it.
So we are trying to look aboutthe function of your thyroid.
So it's the TSH, the thyroidstimulating hormone.
And the thyroid hormone whichyour thyroid produces is called
(20:37):
T4 and T3, which always bug me.
SPEAKER_03 (20:40):
It is T4 and T3.
They don't come sequentially.
Your body changes one to theother.
They go in opposite order.
And where the heck are T1 andT2?
I always wanted to know that inmed school.
Anyway, T4 and T3 are thehormones that circulate through
your body and do their job.
SPEAKER_02 (20:55):
Yes.
That's what we're going to checkwhen initially looking for your
thyroid functions, whethernormal or abnormal.
And when they are abnormal, sowhen we say like underactive
thyroid, So we would expect yourthyroid hormone to be low.
Obviously, since your thyroid isnot producing enough hormone,
then your brain is sensing that,hey, your thyroid is not
(21:19):
producing enough hormone as it'ssupposed to produce.
So then your brain, thepituitary, is producing this TSH
in more, trying to stimulate,trying to override and say, hey,
try to produce.
It's cracking the whip a littleharder,
SPEAKER_03 (21:33):
isn't it?
Yes.
So high TSH means a lowunderactive thyroid.
Yes.
And the opposite is also true, Iassume?
SPEAKER_02 (21:41):
Yes.
in the hyperactive thyroid, wewould expect your thyroid to
produce too much of hormone, butyour pituitary is sensing that,
saying, hey, you're producingtoo much of a hormone.
Let me not stimulate you.
So that's why you will expectyour TSH to go down and you will
(22:02):
see your T3 and T4 levels goingup.
So now we know that, okay, youhave an underactive thyroid and
you have an overactive thyroid,but we need to establish what's
causing this.
So we need to find the reason sothat is there any particular
reason which we can prevent,treat that, remove that cause,
(22:23):
then your thyroid wouldnormalize.
SPEAKER_03 (22:26):
One thing I like about thyroid disease and maybe
a lot of endocrinology ingeneral is that there's a blood
test.
You know, a lot of things thereisn't.
or there's blood tests that aresupportive, you can diagnose
pretty accurately with a TSH, aT3, and a T4 as the initial
tests.
Yes.
As the initial tests.
And then if they're abnormal,there's additional tests.
(22:47):
And endocrinologists can getpretty specific about what's
wrong.
They can check antibodies, andyou can check other hormone
levels, and you can figure out,do you have Graves' disease?
Do you have Hashimoto's?
Do you have all these things?
So this is something you can getdiagnosed relatively readily.
Very common one, underactivehypothyroidism.
Autoimmune, Hashimoto's,hypothyroidism.
(23:10):
There's jillions of people, andjillion is the correct term,
running around with that.
How is it treated?
SPEAKER_02 (23:17):
It's an underactive thyroid, so you're not producing
enough thyroid hormone.
So we have a synthetic thyroidhormone, which is nothing but
your T4, and that's all youneed.
T4.
T4.
You don't need T4.
T3 replacement.
So there are some instanceswhere we can give T3
replacement, but otherwise it'sjust a
SPEAKER_03 (23:38):
T4 you need.
And that's the levothyroxine.
But I want to delve into that alittle bit more.
There's, like I said, a wholebunch of our listeners are
taking levothyroxine right now.
If your body has T3 and T4running through it, why when we
treat it, do we only give T4?
Why don't we also give T3 moreoften?
Because that is asked of us.
(23:59):
People want to take ground upthyroid or they want to take
thyroid from some animal orwhatever because it's more Thank
you for
SPEAKER_02 (24:07):
asking that because that's the most common question
we get.
Reason is very simple.
So your thyroid produces, yes,your thyroid produces of T3 and
T4, but the ratio amount of yourT4, which your thyroid produces,
is actually 16 is to 1.
So it's 16 times more thanyou're producing.
16 molecules of T4, then you'rejust producing one molecule of
(24:31):
T3.
And what your thyroid producesas a T3 is actually around 5 to
10% of what actually your bodyneeds.
The other organs, like yourliver, muscles, also produces
T3.
Tatooine.
your body cells take up T4 andthey convert your T4 into T3.
So that's why you don't need T3because your other organs, it's
(24:54):
not just thyroid.
They take
SPEAKER_03 (24:55):
care of it.
They take care of it.
People think that when I tellthem, you don't need to take T3,
they think that I've got likesome stake in the pharmaceutical
company that makes T4.
Believe me, folks, I don't.
It's been around forever.
I don't.
Doctors don't.
It's just that it's unnecessary.
So when you're You're taking allthese pain out of your pocket,
(25:16):
all these expensive things, andyou're going and you're taking
all these extra thyroids.
Almost certainly.
There's always exceptions, butyou almost certainly don't need
that.
So I'm just trying to save yourwallet that when I tell you,
just take your T4, you'll beokay.
So that's underactive thyroid.
And there's loads of people whotake their thyroid med every day
and they're doing just fine.
What about the overactivethyroid?
(25:37):
Because in that case, you'reproducing too much thyroid
hormone.
So you don't want to take more.
What do you do in that case?
SPEAKER_02 (25:44):
Yes.
Now you are producing too muchof a thyroid hormone.
So now we need to calm yourthyroid.
So we have a which act insideyour thyroid and prevent the
excess production of yourthyroid hormone.
Is that the only way to treat?
No, we have other options, butthat's the most common and easy
(26:06):
way to treat.
There are some people who don'ttolerate.
It's a medicine.
It's a chemical, right?
So when you take somemedication, you always have some
side effects.
So some people don't toleratebecause of the side effects.
When they develop those sideeffects, then we...
stop that medication.
We try other forms of thatmedication and see if they
tolerate.
If they don't tolerate, then wehave other treatment options
(26:28):
like radioactive iodine.
SPEAKER_03 (26:30):
Yeah, that sounds like a walk in the park.
What's radioactive iodine?
And don't let me forget, I'mgoing to ask you about seaweed.
I'm going to ask you aboutseaweed.
SPEAKER_02 (26:38):
The name itself suggests it's a radioactive
iodine.
Iodine is a molecule and that'sa radioactive one.
That's what we give to treatyour hyperactive thyroid.
Why iodine?
The reason is because Becauseyour thyroid hormone is made up
from iodine.
So, it's nothing but iodine.
It's iodine, yeah.
Yeah.
So, it's nothing but iodine.
(26:58):
Your thyroid is the only organ,major organ, which utilizes your
iodine to produce this hormone.
It's the reason it's in salt.
So, that's why we give thisradioactive iodine because it's
mainly taken up by your… Itdoesn't go to
SPEAKER_03 (27:11):
any
SPEAKER_02 (27:11):
other organ.
There are some… place where it'ssecreted in minute quantities,
like in your saliva and yourlacrimal glands.
But otherwise, it's majorconcentration
SPEAKER_03 (27:22):
is in your thyroid.
I actually love this aboutmedicine.
So your thyroid is kind of theonly place in your body that
uses iodine.
So let's nuke it.
That's what we're doing.
Yes.
Let's make the iodineradioactive.
It only goes, it doesn't, youknow, the rest of your body is
relatively unaffected.
And we basically blast the crudout of your thyroid with this
little, but it's safe, folks.
(27:42):
It's safe.
It is one way to ablate yourthyroid with a chemical method,
and then it's not overactiveanymore.
But then you get to takemedicine to replace the hormone
after you've had that done,right?
SPEAKER_02 (27:54):
Yes, because now we are destroying your thyroid.
So then there is no functionalthyroid tissue left because your
thyroid is still there.
It doesn't disappear.
It's there, but it's notworking.
We microwaved it.
Yeah.
UNKNOWN (28:10):
I'm kidding.
SPEAKER_03 (28:11):
Okay, before I let you go, Dr.
Avila, Egyptians or somebody wasfeeding seaweed to people.
SPEAKER_02 (28:17):
What the heck?
So, seaweed, there are goodstores of iodine.
In seaweed.
Seaweed, yes.
So, as I talked about at thetime, we talked about a term
called goiter.
Goiter is nothing but there isenlargement of your thyroid.
Goiter is simply an enlargedthyroid.
Yeah.
So, that happens if you don'tconsume enough iodine.
(28:40):
And that happens in people whoare in hilly areas where...
Usually, your soil is deficientin iodine because of the
rainwater.
It just washes off.
So, hilly areas are deficient iniodine.
Yes.
SPEAKER_03 (28:54):
Who knew?
Sorry, folks in Denver.
SPEAKER_02 (28:57):
That was like an earlier thing.
But right now, the simple sourceof iodine is your salt.
SPEAKER_03 (29:03):
Yeah, around here, at least in the Western
Hemisphere, they stick it insalt.
SPEAKER_02 (29:07):
Yeah, so almost everywhere now, that's the
easiest way where all the saltis iodinized.
And that's where you get enoughiodine from your salt.
So in ancient times, we don'thave this.
all this manufacturing unitwhere we could separate iodine
and salt and mix them and sellthis iodinized salt.
(29:27):
So at that time, the good sourceof your iodine was your seaweed.
Your seawater is a good sourceof iodine.
It has really good quantity.
So I'm not telling, okay, go anddrink seawater.
You don't need to.
But you are saying next time yougo to your
SPEAKER_03 (29:41):
sushi restaurant, get the seaweed salad.
SPEAKER_02 (29:43):
I wouldn't definitely say that.
But yeah, because again, youneed to eat tons of seaweed.
Okay.
So here in sushi, when we gothere, it's just very little
seaweed there.
That's not enough.
Like you have to eat a greatquantity, good quantity of
seaweed every day.
SPEAKER_03 (30:02):
So maybe that isn't your sole solution.
But if you like the seaweedsalad, get it anyway.
Okay, Dr.
Srikanth Avila, we've beentalking about thyroid disease.
If you could leave us with onemessage for listeners, what
would it be?
SPEAKER_02 (30:13):
I would like to tell our listeners, if you see any
thyroid nodule, don't freak out.
As I said, it's pretty common.
Just talk to your doctor to getthat evaluated and see if it is
concerning or not.
If you also notice any symptoms,like if you feel very tired,
mental clouding, you don't feelright, get your thyroid checked
(30:37):
and see if it is normal.
If it is abnormal, thenobviously we do have very simple
measures to treat it and so thatyou can feel better and you can
be what you were before that.
SPEAKER_03 (30:48):
Yeah, it's reassuring.
You don't have to freak It'scommon.
There's things to be done.
Dr.
Srikanth Avila, thanks forjoining me today.
SPEAKER_02 (30:55):
Thank you, Dr.
Hillen.
And this was a wonderful sessionand it was nice talking to you.
SPEAKER_03 (31:00):
It's been great chatting with you.
We have been talking about yourthyroid.
It's sort of endocrinologymonth.
We've covered diabetes.
We've covered your thyroid.
We got your hormones covered,listeners.
Thanks for tuning in.
I hope you'll join us in twoweeks' time for our next
episode.
And in the meantime, be healthyand be well.
SPEAKER_00 (31:17):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(31:38):
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota and engineered and
produced by John Lucas atHighball.
Executive producers are JohnLucas, and Christine Hill.
Please remember, we can onlygive general medical advice
during this program and everycase is unique.
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
(32:00):
Until next time, be healthy andbe well.
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