Dr. Kepal Patel
Appearances
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
The concept of Hashimoto's is your body is now creating antibodies against thyroid peroxidase and thyroglobulin. These are the enzymes that your thyroid gland uses to make thyroid hormone. So when you create antibodies against those enzymes, now your thyroid can't make the hormone anymore. So your thyroid starts to not function. Okay.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And ultimately, it's actually causing destruction of the thyroid. The thyroid actually starts to die. So many of these patients with Hashimoto's have shriveled thyroid glands. Almost to the point where the thyroid gland almost disappears sometimes. It becomes scar tissue.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Associated with something nobody wants. Yeah. Yeah, I don't know. Probably the latter.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So that was actually a surgeon at NYU.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, yeah, yeah. So it was a surgeon at NYU. It was Dr. Eric Voigt, one of the ENT surgeons here, actually noticed somebody on TV. It was a HGTV thing, I think.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I think it was this HGTV personality person. And then he called into like the TV show or says, you know, by the way, I think one of your... One of your presenters has a goiter, you know, or a thyroid mass.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, it's one of the occupational hazards. I want to look at people's neck before I look at their faces, probably. So it's unfortunate. But yeah, no, I mean, it's natural, right? Because that's what I do every day. I examine people's necks. Yeah, I mean, you know, large goiters are easily visible. I mean, for people that know, like, that's an abnormal neck.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
It does. So, you know, the term goiter is just basically an enlargement of your thyroid gland. It's almost always benign. It's an overgrowth of your thyroid. And, you know, I think everybody at some point has probably seen pictures in National Geographic or whatever, where you have these huge goiters, huge thyroid masses. And it's almost always either familial or iodine deficiency. Yeah.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And so I don't know if you're familiar with the whole goiter belt story.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
There's no goiters. No, this is multiple people.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
As I was saying, the most common cause for goiter is still iodine deficiency worldwide. The rate of people having goiter in this country has dropped tremendously. And I think it's probably one of the most, if not probably the greatest success story for the U.S. public health service was in the 1920s.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
They discovered that there was a good portion of the middle aspect of America, which was called the goiter belt, across the Midwest where you didn't have access to fresh seafood, good sources of iodine, and patients had large thyroid. That thyroid gland's kind of really enlarged and they had goiters. And I think that became a real public problem.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And the solution was easy to get these patients to take in iodine, but it was hard to administer iodine because iodine doesn't taste good, number one. And how do you get people just to take iodine? So I mean, it was a brilliant, you know, there's a big backstory to this, but it was basically a stroke of genius to say, hey, why don't we just put iodine into the salt? Salt is a known quantity.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Everybody consumes salt. Salt doesn't spoil. And iodine, you don't taste the iodine. The salt, you taste the salt. And so you just iodize the salt. And all of a sudden, our rate of goiters in the Midwest has dropped to basically average to what it was on each coast.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
But back then that wasn't available.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
That's exactly, it's hypertrophying.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
That's exactly what's happening. The thyroid gland is hypertrophying because it needs iodine to make thyroid hormone and it's not getting the iodine. So it's actually increasing in size, trying to get iodine, trying to accumulate iodine.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah. I think once you've developed it, it's probably not going to go away. If you give that patient iodine at that point, it'll probably prevent it from getting any bigger, but it's not going to shrink.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And so at that point, they're stuck with the goiter that they have. Yeah. Either you take it out or if they can tolerate it and it's not really bothering them, you can even leave it alone.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Well, not necessarily hyperthyroidism per se, but you can get iodine toxicity for sure. And so you do have to be careful, right? I mean, depending on how much fish you eat, not just iodine, but you can get mercury toxicity as well, which is even more dangerous. So you got to be a little careful. But no, I think, look, the bottom line is a healthy diet, right?
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
You know, good amount of fruits and vegetables and meats and fish. And I think, you know, you should be fine.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
What's the deal? So you're right about both of them. Most of us really prefer using levothyroxine, which is the brand name of Synthroid, but levothyroxine is the synthetic T4 hormone. And I think the reason behind that, it's easy to test. It's easy to regulate. It's a known quantity that you're giving them, the patients, so that we know exactly what the patients are getting.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
From a physician standpoint, it's an easier drug to manage, levothyroxine. The flip side to that is that it is synthetic. Most patients tolerate it beautifully. I mean, we're talking about a very small subset of patients that don't tolerate thyroid hormone. I would say 95% plus, they take their Synthroid once a day and they're totally fine.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
But there are a percentage of patients in whom they don't do well. And the other formulation, as you were mentioning, is this natural desiccated pig thyroid, which is a combination of T3 and T4. So it's not just T4, which leave with thyroxine. So I think some patients do feel a little bit better with that extra T3 as far as, you know, feeling kind of like I feel normal again.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I feel like I have my energy levels back because you're getting T4 and T3.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And so there's no right or wrong answer to this, honestly. It's a lot of it that just deals with what the patient feels best taking. But there are two camps. With the natural desiccated pig thyroid, it's hard to know exactly how much hormone you're taking in because it comes in granules. And you don't know exactly how much hormone is in each granule per se. So it's not as well kind of calibrated.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And that's why many of us don't feel comfortable giving it because I don't know how much you're actually getting.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
But if the patients feel well and they like it and they're doing well, then I think most physicians are okay with it.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So yes, I mean, so it is part of the autoimmune response, but was the autoimmune response triggered by the virus? And the answer is probably yes. Viral pathogens in general have been known to trigger autoimmune responses. And Epstein-Barr has been one that's been written about and people have studied it. And there is some data to support that it can trigger an autoimmune thyroid response.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
What's fascinating and what we're looking at right now here in our institution, we're actually looking at COVID. And we've actually seen probably close to a dozen patients now, some after they actually got COVID. So they're exposed to some form of COVID antigen that had hyperthyroidism, transient. Really? So one of our own medical students here actually ended up with hyperthyroidism after COVID.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, because it triggered some form of autoimmune response that actually triggered the thyroid gland to make more hormone.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Exactly. One of the, you know, kind of theories out there, at least this is why women tend to be more prone to autoimmune disease. And it's a theory and nobody really knows for a fact, but there are some data to support environmental toxins, right? So some certain environmental toxins...
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
We can do some songs afterwards.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
synthetic estrogens, cosmetics, some of the chemicals that are involved in some of those products can trigger an autoimmune response.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And so I don't want to tell people not to use synthetic estrogens or cosmetics, but I'm just saying there are some thoughts out there that say that maybe that's why women are more exposed to some of these environmental toxins, which may lead them to develop these autoimmune problems.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And then you microwave it, so it's great.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Now you're, this is what I do on a day-to-day basis.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
They're basically growths in the thyroid gland, if you want to think of it that way. So small tumors. So I like to think of thyroid nodules as a true abnormal growth. Now, it doesn't mean it's cancer. Most of these, as a matter of fact, over 95% of them are going to be benign. Most thyroid nodules are benign. Okay. But a small percentage of them can be malignant or cancer.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And so when you have a patient who has a thyroid nodule, it needs to be appropriately evaluated.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Well, the first thing you're going to do is obviously examine the patient, get the appropriate history, ask the appropriate questions. Are they having difficulty swallowing, breathing? Have there any changes in their voice? Because a nodule, depending on where it is and what type of nodule it is, it could be compressing other vital structures in the neck.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
The nerve that controls your vocal cords and your voice runs right behind the thyroid gland, so it's very sensitive to any kind of thyroid disease.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, so it's one thing that we really are worried about. Once you've done the appropriate evaluation, usually it's an ultrasound first thing to look at a thyroid nodule. So you get an ultrasound exam, which is very easy to do. The thyroid is very superficial. You get a good look at the thyroid nodule. And then based on certain findings or characteristics of the nodule, you'll get an idea.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
That nodule looks like it's benign. We don't need to stick a needle in it. Or that nodule looks kind of concerning. Let's stick a needle in it.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And so that's what we use to kind of decide it.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Cells. So when we do a needle biopsy, which I do in the office on a regular basis, we put the needle into the nodule so we can see exactly where the needle's going. And we basically suck out a couple of cells, put them on a slide, send them to our pathologists who will take a look at it and tell us what they see.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And if they say these cells are benign or not concerning, then we'll probably just tell the patient, let's get another ultrasound in six months. Let's make sure it's not increasing in size or causing any problems.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Absolutely. I think the poor thyroid gland gets blamed for a lot of things in life. And it's not necessarily this poor little gland's fault. The thyroid gland is an amazing organ. It's a small gland that sits right in the middle of your neck, right on top of your windpipe. It's shaped like a butterfly. You have a right side and a left side of the gland.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And if they call us back and say there's malignant cells, then we talk about surgery.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
That's a great question. So we used to do that all the time. Always numb it up, right? And I've had a couple of patients now that complain that the numbing medication actually hurts more than the actual needle does.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Because it's gladicated burns. And the needle is such a small, fine needle. It's what we call a 27 gauge needle. It's actually smaller than the needle that we use to draw blood.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Most patients, honestly, like if I tell them, you know, here's a needle, they'll feel like, I felt like a small little pinch, but it's not even painful.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So most thyroid nodules are not cancerous.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I love these questions. These are the questions I get every day.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I should ask that question. No, right? No, that's a fantastic question. Unfortunately, you can't just pluck the nodule out of the thyroid because one is it's embedded in the thyroid tissue. And two, if it is a cancer, then you want to do a good operation. You don't want to leave any cancer cells behind.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
If you're just plucking the nodule out, there's a good chance that you may disrupt a nodule, that you may leave tumor behind, and then you have to go back and potentially do another operation, which could be even more difficult because then you have scar tissue and the patient's already had one operation there before.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So the right thing to do is actually remove that portion of the thyroid. It doesn't mean you need your entire thyroid removed. As a matter of fact, I would argue that most... Thyroid surgeons now, unlike maybe even 10 years ago, try to be more minimalistic as opposed to maximalistic in the sense that we don't try to take out the entire thyroid gland.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
If I can preserve as much thyroid tissue as possible, I'll preserve it. So I'll take out half your thyroid if I can and try to preserve the rest of the thyroid. So hopefully you'll continue to make enough hormone that you won't even need medication.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, they always want to take it home.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
It all unfortunately gets sent down to pathology because we need to know whether it's cancer or not or what stage it is. And so it all gets sent to pathology. So no, you cannot take it home. But we can take a picture for you.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Oh, I would say probably like 30 to 40%. Really? Oh yeah, they want to see what their thyroid looks like.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And its sole purpose is to make thyroid hormone. And you can think of thyroid hormone as like the gas for your engine. It really regulates your metabolism. And that's your primary organ that gives you the fuel that you need to basically do almost all the activities that you perform.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yes. So thyroid cancers are thyroid nodules that are malignant.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
No, no. So thyroid cancers are basically thyroid nodules that are malignant nodules of thyroid cancers. It's actually one of the, I think one of the most interesting and I'm not biased. I think it's one of the most interesting cancers in the human body. And the reason for that, it really spans the entire spectrum from like being one of the most indolent cancers where the prognosis is excellent.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So if you have what's called papillary thyroid cancer, classic papillary cancer.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
the overall survival is 95%, 20-year survival. You almost don't get that in any cancer other than small skin cancers. So you have on one end of the spectrum, one of the most treatable cancers in the human body.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And then you have something called anaplastic or undifferentiated thyroid cancers, which probably is the most aggressive thyroid cancer in the human body with basically a mortality of close to 100% within six months to a year. So you really have this disease that spans this entire spectrum. Thankfully, the percentage of patients who have anaplastic cancer is very, very low.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And most patients have papillary cancer, which is very, very treatable.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So when you have a patient who has a malignant thyroid nodule, thyroid cancer, most of these patients will undergo surgery. We have a program here now where we have an active surveillance program for really small thyroid cancers where we won't even operate on the patients. We'll just follow them if they're okay with that. We have a lot of minimally invasive ways of treating it.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
There are a lot of new technologies coming down the pipeline, interventional procedures where you can just stick a needle in it and ablate the cancer and to not even take out the thyroid anymore. One of my colleagues here does transoral thyroid surgery. So there's no scars in the neck. You could take out the thyroid through the mouth.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So a lot of like cool, really innovative, you know, new ways of doing things. But, you know, that requires you to see a thyroid surgeon and go to a place where they have a thyroid program in place. Getting back to your question as to what causes this. So there are only really two known causes for thyroid cancer. One is genetic and familial.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So we know that there are certain patients in whom it does run in their family. And it's usually three patients. first generation family members. So if you say, you know, my sister has thyroid cancer, my mother and my aunt all had thyroid cancer, and now you have it, it could be familial. And the second one is radiation exposure.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
From temperature regulation to how you metabolize your food to how you use your energy is all regulated by the thyroid gland. So anytime somebody feels off for whatever reason it may be, it's always, is it my thyroid gland? Yeah. But the beautiful thing about the thyroid gland is it's an easy organ to check. both physically and from a laboratory standpoint. It's easily palpable. You can see it.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So, you know, in the early part of my career, we used to see a lot of patients who were exposed to Chernobyl. We have a huge Ukrainian population in Brooklyn. And so many of these patients, you know, they were saying, yeah, I was, you know, I was somewhere in the Ukraine or in the southern border of Poland or Belarus.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And they all remember when Chernobyl happened and they weren't told what was going on and they were all exposed to nuclear fallout, nuclear radiation. And we saw a lot of these patients had thyroid cancer.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah. So thankfully, we haven't seen any incidents at all from the Fukushima nuclear reactor meltdown, not even in Japan. There was very little radiation fallout from that. So thankfully, I don't think we're going to have any issues with that disaster. But if you notice, as soon as that happened, every single pharmacy on the West Coast ran out of iodine. Really?
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Because people started hoarding the iodine pills because you wanted to pop iodine as soon as you know there's a nuclear fallout. If you take iodine, you protect your thyroid gland from getting thyroid cancer.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
It blocks the thyroid cells from absorbing the radiation. You're basically saturating your thyroid cells with iodine.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, I mean, it seems to help. Absolutely. I mean, even when you had a nuclear fallout in Chernobyl, I mean, you know, the people that knew what was going on, they started taking iodine pills.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
It's very much in the front of your neck. So if somebody does have a large thyroid or thyroid mass, you can almost always feel it. And then it's, you know, the blood tests for thyroid function are pretty easy to obtain. So you get the blood test and it gives you a good idea if your thyroid gland is actually functioning normally or not. So that kind of gives you an answer most of the time.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So the first part of your question is, you know, you're probably, they're probably right. We don't chat. We probably should. Yes, right? We probably should chat. This is fascinating. I need to talk to my vet. We have a nice little dog. Yeah. So yeah, I, you know, I, we don't chat with our veterinary colleagues, unfortunately. Do I think it's related to iodine? Probably, if I had to guess.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Because unless the cats are prone to, you know, to other environmental toxins, as humans, we are not, you know.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah. That's even for humans, too, actually.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
But not necessarily your poop for one month or for a month.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
But you have to sequester yourself.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Absolutely. So Graves' disease is kind of the opposite of Hashimoto's. So it's named after Dr. Graves, who first described Graves' disease. And it turns out that in Graves' disease, what's happening is you're actually, your body is creating these, what they call thyroid-stimulating immunoglobulins, which is similar to the antibodies that your body makes.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
But these particular immunoglobulins end up stimulating your thyroid as opposed to destroying your thyroid.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So in Hashimoto's, your body is making antibodies that destroy the thyroid. In Graves' disease, your body is making immunoglobulins that actually stimulate your thyroid. So Graves' disease is one of the most common causes of hyperthyroidism. And these are patients who present in the exact opposite fashion. They say that they're losing weight. They always feel hot. They have tremors, anxiety.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
They feel like their heart's racing. Their eyes sometimes get a little bulgy. And that's all consistent with Graves' disease. And in those patients, your TSH level is going to be undetectable. It's going to be super low.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And your T3 and T4 levels are going to be high. And so that's the way you make the diagnosis of Graves' disease. The treatment for that, since your thyroid is hyperactive, is you take antithyroid medication. So you're actually taking drugs such as methimazole and PTU that actually block the thyroid, from making thyroid hormone. And that medication works great.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And so for a lot of patients, that's all they'll need. Sometimes if their heart is really racing fast, they may put the patient on a beta blocker to help reduce the heart rate. But for most patients, that works really well. The problem with some of these drugs, especially in younger women, is that they're not necessarily safe during pregnancy.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So if you have a young female patient who is deciding to start a family, wants to get pregnant, or is planning on getting pregnant, they really can't be on those medications.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So the other two options for definitive treatment for Graves' disease are radioactive iodine, where you give the iodine, it's radioactive. The thyroid gland absorbs the iodine. And since it's radioactive, it kills the thyroid. So ultimately your thyroid's dead and you've treated the Graves'.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And you're probably going to end up on thyroid medication for the rest of your life, like levothyroxine, because your thyroid doesn't work anymore. And the other option is surgery. Take out the thyroid. So same exact result. You're taking out the thyroid. Your thyroid is no longer there. You no longer have graves. And now you're on thyroid medication for the rest of your life.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
By the thyroid hormone, you're asking? Yeah. Absolutely. It's a significant portion of it. So your thyroid hormone really does regulate a lot of that. So we see that in very sick patients. In patients that are admitted to the ICU for weeks or months, you'll see that their thyroid hormone levels start to change. And so we know that the thyroid gland is intimately involved in your metabolism.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
But levothyroxine is such a safe drug that most patients would rather be on levothyroxine than be on the methimazole or the other drugs that we treat for graves.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
If you want to go somewhere for surgery, you want to go to a high volume center that does a lot of thyroid surgery with good results. Because also the same population of patients who want to get pregnant also don't want radiation. Right. Because you take the reductive iodine, you can't get pregnant for six months to a year.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
It's really a fear for surgery sometimes. They don't want surgery. It could be a cosmetic thing. They may not want a scar. Surgery does have its risks, right? There is risks of injury to the nerves that control your voice. There's potential injury to little glands called parathyroid glands that live next to the thyroid that can affect your calcium level.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So there are risks associated with surgery, but there are also risks with the radioactive iodine. It's radioactive. It can have fertility issues. It can cause other secondary malignancies or cancers 10, 15 years down the line. So it's a little bit of where the patient's comfort level falls.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I would say the trend that we've seen here, at least, is more and more patients are opting towards surgery and less towards a radioactive iodine. But I think nationally, still, radioactive iodine is still pretty common.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
No. Okay. The amount of iodine you're getting is minimal.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Those patients do have to be in quarantine for about a week. So for about a week, you know, they can't go out in public. They can't be around pregnant women. They can't be around children. Everything you kind of use, your utensils, probably disposable is better. You want to sequester it in a certain space. You don't want to throw it on the regular garbage.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So there's a whole protocol that we utilize for patients. We tell them how to kind of, you know, manage all their disposables. And you want to stay in a place that's kind of away from other people.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, I tell people, don't throw your beds away. Don't throw your couches away. People used to do that. Like, I threw everything away. You don't have to throw it away. There's a half-life to radiation, right? Just like there's a half-life to radiation. So, yeah, you know, once it's out of view, it's going to go out of your bed also.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So, yeah, maybe you may not want to use that bed for a few weeks, but then after that, it's fine.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And so, you know, depending on the situation, whether it's a stressful situation, whether it's a situation where your body requires more energy, the thyroid gland definitely plays a significant role in that.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, so the free version is just because of the way the laboratory studies are designed, often these molecules bind with other proteins. So the free version is just, in theory, is supposed to be more accurate. The blood test that's actually the most important for us is still the TSH level, because that's what the body is sensing, right?
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
As your thyroid levels, that's what the brain, your pituitary gland is making TSH based on what it's sensing, you know, the need is. Because your T3 and T4 levels can vary even during times of stress or during times of the day. So, you know, it's not as consistent as your TSH level is going to be. So TSH is probably the best test for thyroid function. The range is a variable range, right?
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And even from one to four in the United States, depending on what lab you use, could be a normal range. But the way I like to talk to my patients about this is that these are kind of population-based tests. ranges. But for each individual person, you know, just because you're in the normal range and your TSH may be three, it's in a normal range, but you may still not feel well at level three.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Because for you, maybe one is the normal, right? And so I think, you know, we have to treat each patient individually. So ranges are wonderful to have just to get an idea of whether somebody's falling and where they should be falling. But I don't go crazy overlooking at the exact number per se.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
If I have a patient who has a TSH of four, but they feel fantastic, I probably won't give them thyroid medication. They feel great. What am I treating? Yeah.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Is this Patrick Duffy the actor?
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Oh, because it's a population. So for, you know, looking at millions of people, you have a larger range. So if you have a TSH that's around three or four, which is a little bit on the higher side, you may still be slightly hypothyroid, but your blood work would be in the normal range.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, you can do that. And all likelihood, if your TSH is normal, your T3 and T4 are probably going to be normal. And if you're still not feeling well, I think it's time to do other workup just to make sure there's not other issues and make sure you're not anemic, make sure there's not other things that are going on.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Don't blame the thyroid for everything. I should make t-shirts, don't blame the thyroid.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Oh, it's very common. Part of the reason is people get online and they'll Google it and thyroid will come up as one of the causes for fatigue or depression or not feeling energetic. And so that automatically is the first thing people will think about. Often it's not just the thyroid gland. When you do have loss of function of the thyroid, hypothyroidism,
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
It's your ability to convert your food into energy, right? So, you know, your cells at the cellular level, there's a whole, you know, oxidative process that occurs down at the mitochondria and at the cellular level. And it's that process of how much energy you are producing is regulated by the thyroid hormone. It's not even like your temperature level.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, it's all regulated, but that's like the end product of what's going on at the cellular level. You're seeing an increase in energy expenditure across the board. So like I said, your heart rate would go up. your digestive system, your nervous system, everything is affected by that. So all of that encompasses what we call metabolism.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Since a lot of thyroid disease is autoimmune-based, anything that you can do to decrease that kind of stress and your immune response... can be potentially beneficial. So there are a lot of diets out there that are designed to decrease inflammation. I would definitely talk to a nutritionist or somebody who's more of an expert in that area.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
But my recommendation to my patients is, yes, try to find a diet that does work for you. I know there are a lot of things that if I decrease gluten and I get rid of this and I eat more of that, try it. I mean, if it works, that's fantastic. And I have had patients who had Hashimoto's thyroiditis and they changed their lifestyle to be sleeping better, eating better, exercising.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And you do see their antibodies go down. So whatever trigger there was that was causing it, you can try to undo some of that with your lifestyle. Is it curative? Hard to say.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, I mean, I think sometimes it's not just the alcohol and sugar. I mean, sometimes, you know, you may be drinking and eating a lot of sugar because you're stressed. And so is it what comes first, right? Is it the chicken or the egg kind of thing? Right. And so if you decrease your stress levels, maybe that may, you know, help your immune system.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I think it does. I mean, we're just learning more about this over the last 10, 20 years. I think we're realizing how much our mental status plays a role in our immune system, right? People that are depressed and don't feel well tend to get sick. Your immune system gets weaker. And so there's definitely a lot of interplay between the two systems. To answer her question, I think
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
The easiest thing to do is just get your thyroid function tests, right? Get a blood test, see what your thyroid levels are. If all your thyroid levels are normal, then it's probably not your thyroid gland, at which point I would investigate further into, you know, what your mental health is and what else is going on, stressors, et cetera, to see if that can help.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And when you do have loss of function of the thyroid, hypothyroidism, often it's autoimmune and it's associated with other symptoms as well. It's not just fatigue or lack of energy or depression. Patients often will feel cold. They'll start to gain weight. They may have some hair loss. The skin gets dry. The nails get brittle.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, I'm not sure why, but the majority of our...
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
obesity issue in this country is not thyroid related right there are so many other factors once again that go into that as well and so i think you know if you once you've ruled out the thyroid gland you can kind of put that aside and it's probably not the thyroid and then focus on what other issues may be going on metabolically because yes thyroid hormone is a is a integral component of your metabolism and when it's not functioning properly it can affect your metabolism but once again the metabolism is also based on other things as well so
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I'm looking at my eyebrows now. I know.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yes. I mean, hair loss in general is associated with thyroid disease, right? Dry skin, hair loss. And so the combination of the two may affect your eyebrows.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I mean, that's classic what we call Hashimoto's thyroiditis or hypothyroidism.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, I think in general, whenever you're doing any kind of hormone therapy or any hormonal changes in your body, your thyroid needs to be followed. And the prime example of that is obviously during pregnancy, right? So many women during pregnancy end up on thyroid medication. Really? Yeah, you get pregnancy-induced Hashimoto's. Not really Hashimoto's, but pregnancy-induced hypothyroidism.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So one of the few things that every obstetrician is going to check during pregnancy is going to be gestational diabetes and your thyroid levels. Because those hormonal changes can affect your thyroid function. And so if you're undergoing any kind of hormonal therapy, I think it's smart just to get a baseline thyroid function test.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And then while you're undergoing that therapy, just check the thyroid and make sure it's not being affected.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
No, I would say so many of you have, for example, patients that show up with Graves' disease, often they'll come see me and they've had it for like two or three months and I'll tell them, wait six months to a year because it may resolve on its own. It may go away. Your body may, whatever triggered it, that may untrigger at some point.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Hashimoto's where, you know, they already have the antibodies and your TSH is slowly going up and all likelihood they'll probably end up on thyroid medication at some point. But, you know, once again, you know, your thyroid function varies depending on what else is, what other stressors are going on in your life.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Thyroid nodules are really under, unfortunately, there's nothing you can do. There's nothing you do to cause thyroid nodules. Like I said, they can be genetic at times. They do run in families. And sometimes your thyroid gland is just prone to developing nodules. Some people get ovarian cysts.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Some people get, you know, there are many parts of your body that just tends to develop nodules and cysts. But yeah, I mean, my only advice would be just to do, you know, annual testing, annual screening, just to make sure that none of these nodules are getting larger or none of them are starting to look suspicious.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
If it's large enough, absolutely. Anything over one to two centimeters, you should be able to feel. It depends on the patient's neck, their body size. If they have a larger neck, it may be a little bit harder to feel. But for the most part, if they have a large enough nodule, you should be able to feel it. The thyroid gland is so anterior. It sits so out in the front of your neck.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Totally, but you have to make sure it's a benign node, not a cancerous node, right? So we do see patients who will present the lymph node lower in the neck and it's big. And those patients do worry me and scare me because that's probably a cancer that's spread, right? And so we'll probably stick a needle in it and see what's going on.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So the reason why the prognosis for papillary thyroid cancer is so great and the patients do so well is because once we take out their cancer, we can actually treat them with the iodine. So even if the cancer is spread to the lungs, to the bones, you give them the radioactive iodine, the iodine will get into those cells and kill them.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And so that's why the prognosis for thyroid cancer remains excellent. That's what I tell my patients. I'm like, yeah, you know, even if you do have cancer that spread, we can still treat you and you should still do very well.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
This is systemic. This is better than any chemotherapy out there. Yeah. This specifically targets thyroid cancer cells and kills them.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, that's a good question. I mean, you know, they're not, so your sex hormones are not directly related to the thyroid gland, but if you are hypothyroid, you will probably have a decreased libido. And like I said, it may not be a direct relationship, but if you're fatigued, you have no energy, you don't feel well, you're tired.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
That's a great, I knew you were going to ask me that question next.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Not that I know of. They may also be really tired and exhausted.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
It could be pretty high. Yeah, people who have really bad hyperthyroidism, they can have a pretty high. These patients often go on beta blockers. Heart rate go up to 120, 130. I've seen 150.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I've had patients who can track their blood. They show me their numbers, you know, like, oh, it was 110, that's 120. Sometimes, you know, I don't know how accurate the data are sometimes. Yeah. But it's nice. It's actually a good tool, right? Because the more information we have, the more we can act upon. You know, we can see trends. Is it happening more often at a certain time of the day?
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
What else is going on that time of the day? So, you know, it's good. I think those devices are actually very helpful.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I think it's all related to your immune system. Once again, it's autoimmune, right? So if you have hypothyroidism from autoimmune thyroiditis, which is Hashimoto's, once again, these are all kind of other side effects of the autoimmune process that's going on. So the dry skin, the hair falling out, the hives, these are all autoimmune problems, right? This isn't a generalized immune thing.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
That's where you get, it's not like hives in one area. It's not like a contact. dermatitis where you were allergic to something and you touched it and you broke out in hives. This is like systemic. And so that's almost always autoimmune.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
The most common cause for hypothyroidism in this country is Hashimoto's. But you can have low thyroid function or high TSH and not have Hashimoto's thyroiditis. That does exist. But the most common cause is Hashimoto's. But the overall effect is probably the same because it's ultimately the effect of your thyroid gland not working the way it should be.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Actually, it's one of the beautiful things about coming to work is I actually enjoy it. It's kind of sad and scary, I guess. But...
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
No, no, no, no. The hardest part of my job, I mean, honestly, and this is going to be a little bit more of a, you know, I love my patients. I love what I do from a physician standpoint. You know, the hardest part of this, I think most doctors will agree with this, is dealing with all the administrative stuff. Wow. Right.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I mean, you know, getting insurance authorizations and I mean, stuff that where you just feel like this is not valuable time spent. I'd rather see more patients and do what I do than worry about administrative stuff, which is unfortunately necessary. And we need to do it. Unless we don't get paid.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
It's part of the job, too. We need to get paid at some point.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Paperwork. Paperwork, paperwork, paperwork. Never ends. Never ends.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Absolutely, yeah. Right? Rather be in the operating room taking care of patients, yeah.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
You love what you do. I love NYU. I got to say that before I get fired. No, I'm just kidding. So you have your communication team. What I love about my job, honestly, are my patients. I love my patients. And I think most of us will probably give the same answer. I love talking to my patients. I love getting to know them. I love taking care of them.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
There's nothing more fulfilling, you know, like going home and knowing that you did something and, you know, you made somebody's life even 5% better, hopefully, you know, it's a great feeling.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Absolutely. Yeah. Yeah. Even from a surgical standpoint, right? I mean, I did whatever, nine thyroid cancer operations this last week and being able to tell somebody, you know, we took your cancer out and you're going to be fine. It's such a great feeling, right? And to see, you know, the patient and their family members and they're all like, you know, just happy.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Um... I mean, one thing, don't blame the thyroid for everything. You know, that's number one. You know, like a thyroid disease is very treatable. I think, you know, the one thing I think patients need to understand is that if you do have a thyroid problem, you should go see an expert, see somebody who really specializes in this.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Anytime they're not happy with the first opinion, definitely not going to see a second opinion. No, I think, I'm a huge proponent of second opinions. I would recommend you get one from somebody who's, you know, an expert in the field and specializes in this. And I like to think that we have a fantastic program here. So, you know, I think we offer... the best care.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
But having said that, you know, I have no problems with getting a second opinion. If the patient feels like they just want to hear from other people, it's more peace of mind and comfort. I think majority of the time, it's not that they don't trust you. I think most patients trust you a hundred percent. They just want to hear from somebody else as well.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, so the TSH level, which is probably the most important blood test to assess thyroid function, is actually not released by the thyroid gland. TSH is actually released by your pituitary gland, which sits at the base of your brain. So when it senses that there's not enough thyroid hormone in the body,
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
The pituitary gland, which is considered the master gland, releases TSH, which is thyroid stimulating hormone. And that's to stimulate the thyroid gland to make more hormone. So if your TSH is high, that means your thyroid's not working well. That's how, you know, TSH is low, that means your thyroid's working too well.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So when your TSH is, you know, depending on what your TSH levels are, it'll affect your thyroid gland and your thyroid gland will make thyroid hormone. Now thyroid hormone comes in two forms. It's something called T4, as you were alluding to, and then T3. T3 is your active form.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
That's the form that your body cells use to use it for the metabolism and the energy and to use it for all the functions that the cells need thyroid hormone for. But what your thyroid gland actually produces is T4. And then the T4 is actually converted into T3 as needed by your liver, your kidneys, and other parts of your body.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So T3 is the active form of the hormone. And it kind of makes sense, even evolutionarily, if you think about it, because if you just start putting out T3, your metabolism is going to skyrocket. You're going to be bouncing off the walls. So your body actually is smart in that sense. It says, you know, we're going to make T4.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And if you need T3, you'll convert it and you'll make as much T3 as you need. But this way, we're not just pumping out T3.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, thyroid's making it and it makes it as it needs it kind of and it secretes it.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And then your body converts it to T3 as needed.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
It's the iodine. It's the amount of iodine particles. So T4 has four iodine particles and T3 has three. So when T4 gets deiodinized, it becomes T3.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, so that's a great question. So, you know, there's some overlap with the other hormonal systems in the body. For the most part, it's really affecting, you know, the cells that you need for energy. So there's not too much hormonal interplay as there is much like the T3 really affecting your cells for cellular metabolism at the cellular level.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So it's, you know, like I said, it's temperature regulation, digestion, your energy levels, you know, your ability to think clearly, not be tired, your heart rate, you know, that's all affected by a thyroid hormone.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Yeah, that's a tough one. I mean, so, you know, the first thing, like getting back to your question, the first thing you do, you're going to take a full history, right? You want to make sure if somebody's complaining that their thyroid may be sluggish, you want to ask all those pertinent questions. Are you tired? You know, do you feel cold? Are you gaining weight? Is your hair falling out?
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So you want to ask all the questions that would help you kind of identify what thyroid problem that they may be having. And then you're obviously going to do your physical examination, examine the thyroid. I mean, God forbid, to having thyroid mass or anything that we need to worry about. And then the next step would probably be getting your laboratory studies and looking at your thyroid function.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And we do see that. We do see situations where the patients don't feel well. They have all the symptoms of thyroid, kind of hypothyroid disease, but their blood tests come back relatively normal. They don't have any antibodies. And what do you kind of do with that? And you want to rule out other causes, right?
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So you want to do a full autoimmune workup, make sure there's not other causes as to why this is happening. And at the end of that, even if everything else still comes back normal, you know, there are some individuals out there, including some of our experts at NYU, will try to maybe start them on a little bit of thyroid hormone, see if that makes a difference, see if they feel better with that.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
But that's very kind of a case kind of a situation. It's not like a universal thing.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
A weight loss. I said it before. You said it. Absolutely. Really? Oh, yeah. The first question I usually get when I talk about, I mean, I do a lot of thyroid surgery, right? Mm-hmm. And so most of my patients will end up on thyroid medication. And it's a question I get almost every day is, oh, that's great. If I take two pills, will I lose weight?
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
I'm like, no, it doesn't work that way, unfortunately. It's not a weight gain or weight loss pill. What would happen if you overdosed yourself? Oh, no, you would feel kind of miserable, actually. Really? Yeah, you wouldn't feel good. I mean, you'd feel hyperthyroid. Your heart would be racing. You'd be sweating. You'd feel anxious. You would not feel well.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Don't overdose on levothyroxine.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
Not necessarily. Most patients actually do really well. I mean, most people, their thyroid function remains relatively normal. But as you get older, like in most organs in your body, as you get older, your thyroid gland often does become a little bit more sluggish. And so it's not uncommon after the age of 60, and actually more common in women, actually.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And some of it may have to do with the autoimmune aspect of it and the hormonal aspect of it with menopause. But as you get older, the thyroid gland in women sometimes tends to get a little sluggish. It is important when you see your primary doctor to have those blood tests done because patients may come in They don't feel well. They feel like they don't have enough energy.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
And often they will chalk it up to, I must be going through menopause and I must be having other hormonal changes. And sometimes it's just that your thyroid gland is getting a little weak and a little bit of thyroid hormone makes them feel better.
Ologies with Alie Ward
Thyroidology (THYROID GLAND) with Kepal Patel
So autoimmune disease in general is more common in women, right? And when we talk about autoimmune thyroiditis, like I said, usually we're referring to this entity called Hashimoto's thyroiditis. And it's named after Hashimoto's. Dr. Hakura Hashimoto, I think it was 1912, actually described it for the first time. He was a physician and a scientist in Japan.