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July 4, 2020

Hormone Helper: Endocrinologist Dr. Kerem Ozer Explains Hyper/Hypothyroidism

Speaker 1: 

Welcome back to the Armor Men’s Health Hour with Dr. Mistry and Donna Lee.

Dr. Mistry: 

Hello, welcome back to the Armor Men’s Health Hour. I’m Dr. Mistry, your host here with my cohost Donna Lee.

Donna Lee: 

Hello, how are you?

Dr. Mistry: 

I’m good.

Donna Lee: 

Welcome back.

Dr. Mistry: 

Welcome back for those of you that are new to the show or just joined us today, I am a board certified urologist. Dr. Mistry is my real name.

Donna Lee: 

M-I-S-T-R-Y.

Dr. Mistry: 

This is a show that’s brought to you by NAU Urology Specialists, the urology group I had the pleasure of starting in 2007.

Donna Lee: 

That’s right. That’s a long time ago.

Dr. Mistry: 

That’s a long time ago now.

Donna Lee: 

13 years.

Dr. Mistry: 

For me it feels like a long time ago.

Donna Lee: 

And we are the second largest urology clinic in town.

Dr. Mistry: 

Second biggest!

Donna Lee: 

That’s right, you know what that means–cuter on the weekends!

Dr. Mistry: 

We try a little harder. So today, we are again joined by one of the partners that I’ve had in this town to help us with all the work that we do, Dr. Kerem Ozer from Texas Diabetes and Endocrinology. Thanks a lot for coming today.

Dr. Ozer: 

Great to be here.

Dr. Mistry: 

If you didn’t hear the last segment, we talked about thyroid disease. An endocrinologist is a specialist in all the little hormones in our body. I mentioned that we do lots of hormone therapy in our office, and that’s an overlap between our specialties. And these hormone abnormalities can really affect everything about how we feel, how our bodies are functioning, our weight and things like that. And we talked about thyroid function. Kerem, how do people generally go about getting their thyroid checked?

Dr. Ozer: 

You know, there are two ways. One is, it just comes up as a routine blood test as part of most annual visits. So it’s more of on a screening basis. You’re you’re feeling well. You’re good. You’re just a blood test and a number pops up and says, “Hey, you may have something going on with your thyroid.” The second thing is people who present with symptoms that make us think of, “Hey, is there something wrong with the thyroid? Let’s run the thyroid tests.” Again, these would be blood tests, and those could be signs and symptoms related to an overactive thyroid. These would be things like anxiety increase in temperature, heat sensitivity, palpitations, heart racing, tremors, shakiness, or these could be potential signs or symptoms of an underactive thyroid–things like feeling very cold all the time, feeling very tired all the time, constipation, dry skin, lack of concentration, focus.

Dr. Mistry: 

A lot of overlap with symptoms that people would classically attribute to low testosterone.

Dr. Ozer: 

Absolutely.

Dr. Mistry: 

If they’re going to get treated a hyperactive thyroid, you probably see a lot of it. I don’t see that much of it because those people can sometimes be very obvious and sometimes a little less obvious. What is the general treatment for a hyperactive thyroid?

Dr. Ozer: 

Hyperactive thyroid, which is a general nice umbrella term for any condition where someone has too much of those thyroid hormones. There are three different ways of treating this, and we pick the treatment with it. We sit down with our patients and we say, “Hey, here are three methods. Here are the pros and cons of each. And here’s, you know, this may work better for you versus another one.” So it really depends on what the cause of the overactive thyroid is. But basically we can use medications; we can use something called radioactive iodine treatment, which is a relatively low dose of radiation that’s delivered to go to the thyroid tissue in a focused way; or surgery, especially in people where the overactive thyroid is due to nodules, lumps, or bumps in the thyroid–we usually refer our patients to our surgeon friends.

Dr. Mistry: 

So I’m a big fan of questions that used to be on the MCAT or on tests.

Dr. Ozer: 

Wonderful!

Donna Lee: 

Oh, no!

Dr. Mistry: 

Okay. What is the most common cause of hyperthyroidism?

Dr. Ozer: 

The most common cause of hyperthyroidism would be Graves.

Dr. Mistry: 

It is a trick question. It is overuse of medication.

Donna Lee: 

Oh boy.

Dr. Mistry: 

And so it’s a trick question, because it’s like one of those things where like “What’s the most common cause of bleeding after a prostate surgery?” It’s a, you know, an incomplete surgery. You know, like you should have been a better surgeon. And so when it comes to hypothyroid, which is probably the more commonly seen kind of condition, we use lots of medicines, right? What are the most common medicines? I’ve also seen people use kind of natural versions of things and people want bio-identical…Maybe just briefly talk about how we do that.

Dr. Ozer: 

Absolutely. So the whole idea behind treating hypothyroidism is replacing or supplementing what the body’s not making enough of. So we use thyroid hormone supplements, and these have been around for decades. Then just like you said, we either use levothyroxine, which is the equivalent of the main thyroid hormone T4. Our listeners may have heard of different brand names like Synthroid, Tirosint, Levoxyl, Unithroid–these are all preparations, which have the exact same T4 hormone that the body normally makes. In people who don’t have quite enough of the T3 hormone, we may use another prescription, a medicine called Liothyronine and people may know of that as Cytomel.

Dr. Mistry: 

So Cytomel is for T3, which is the more metabolically active version.

Dr. Ozer: 

Correct.

Dr. Mistry: 

And something like Synthroid would be a T4, which is, I guess, more of a more chronic, more longer acting kind of thyroid hormone?

Dr. Ozer: 

Absolutely. And some people do perfectly fine on just using one. Some people may need both. And then just like you mentioned, there are other preparations which people refer to as natural thyroid supplements. And the reason for this is many of these medications, prescriptions are made by using dried up or desiccated animal thyroids, mostly pig thyroids, and some of the brands you may have heard there are Armour, NP Thyroid, or Nature Thryoid.

Dr. Mistry: 

Do you need prescriptions for the natural ones too?

Dr. Ozer: 

You do need prescriptions, these natural ones as well.

Dr. Mistry: 

So they take a pig thyroid and dry it and then crunch it up and put it into a pill? Oh boy, we have a new business. You know what I’ve heard? Goat thyroids are amazing! [inaudible] We would call it goat-throid.

Dr. Ozer: 

You would have a little baby goats jumping around.

Dr. Mistry: 

I don’t even know if they have thyroids. So, you know, in our practice because of the overlap between low T and your low T, right, your low thyroid and my low testosterone issues, we frequently test it. Sometimes we’ll get people who are borderline, but they are highly symptomatic and we’ll still treat them. And sometimes people are low in testosterone and we still don’t treat them because they’re not symptomatic. Talk to me about that. What is the correlate in thyroid medicine?

Dr. Ozer: 

The exact same idea. And I’m really glad you were checking the thyroid levels as well. Because as you know, there’s a ton of data showing that since most of these conditions are, have auto-immune backgrounds, you actually have an increased incidence of one, if you have the other one.

Dr. Mistry: 

That’s right.

Dr. Ozer: 

So I’m, I’m really glad you’re doing that. You’re doing that screening. As far as treatment goes, there are different classes of thoughts here. We do know that some of the tests that we run to check thyroid function have quite a wide range of normal levels when you think about the lab tests. For different people, different people may feel differently at different points in that space.

Dr. Mistry: 

What’s normal may not be normal for you.

Dr. Ozer: 

Exactly. That’s a really nice way of putting it. So in some people, if we have those typical symptoms and their levels are borderline there’s plenty of studies showing that you can do a brief trial, maybe three months, three to six months, of a thyroid supplement and we would usually start with a lower dose here, and see if that supplement is addressing the symptoms. If it is then we’re good, as long as we’re not over-treating and making that person hyperthyroid, we can continue to monitor and adjust things as we go.

Dr. Mistry: 

How often do you check and then adjust the medicine dose?

Dr. Ozer: 

It depends on the patient, but mostly once you start something, it takes about four to eight weeks for those levels to balance out. So depending on how severe the symptoms are, depending on what dose we’re starting, we would usually check the levels in about four to six weeks.

Dr. Mistry: 

Now, when you give testosterone, it cuts down your normal feedback pathway. So if you abruptly stop the testosterone, you can get very low levels for a time. Does that also happen with the thyroid?

Dr. Ozer: 

That’s actually not true for thyroid, and that has to do with the feedback, the different kinds of feedback loop that the hormones use. As you know, with testosterone is a steroid hormone, of course. So it very easily suppresses the feedback loop from the brain. So if you have an external source of testosterone, your brain through your pituitary gland says, “Okay, we have enough of this. We don’t need to make it anymore.” The thyroid hormones are immuno acid based hormones, so they worked through a different kind of feedback loop. Your thyroid continues to make its own hormone, and the thyroid that you’re putting into the system ends up being a true supplement.

Dr. Mistry: 

So if you were to go through a little trial of thyroid hormone, you could stop it and not necessarily kind of cause a real decrease or detriment to your system?

Dr. Ozer: 

Correct. It will be very short lived, your TSH, the hormone that the brain makes us stimulate thyroid function would still go down when you’re on a supplement, but thyroid hormone supplements have very short half lives.

Dr. Mistry: 

So your bounce back quick.

Dr. Ozer: 

So you’ll bounce back very quickly.

Dr. Mistry: 

Well, that’s wonderful. Briefly, can you tell people how to get ahold of you and make an appointment with you?

Dr. Ozer: 

Absolutely. So we’re Texas Diabetes and Endocrinology. We have three offices: South Austin, Central Austin and Round Rock. Our phone number is (512) 458-8400, and our website is www.texasdiabetes.com.

Dr. Mistry: 

That’s wonderful. And I would encourage our listeners–if you have a health condition that people just can’t get their arms around, really take a deep dive into your hormones, because it can affect you from the top of your head, to the tips of your toes. Donna Lee, how do people get ahold of us?

Donna Lee: 

You can call us during the week at (512) 238-0762. Our website is armormenshealth.com. You can send an email through the website or you can email us directly and we will answer your questions anonymously on armormenshealth@gmail.com. And you can listen to our podcasts wherever you listen to podcasts. Thank you guys. That was amazing.

Speaker 2: 

The Armor Men’s Health Hour is brought to you by Urology Specialists. For questions, or to schedule an appointment, please call (512) 238-0762 or online at armormenshealth.com.

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