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July 4, 2020

The Thyroid, Your Body’s Thermostat: Dr. Kerem Ozer Explains Endocrinology and Common Thyroid Issues

Speaker 1: 

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

Dr. Mistry: 

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

Donna Lee: 

Right, hello everybody!

Dr. Mistry: 

And you know, Donna Lee, I got a big smile on my face today…

Donna Lee: 

…because I’m sitting next to?

Dr. Mistry: 

No. Because of our guest today.

Donna Lee: 

Oh, the other person sitting next to you.

Dr. Mistry: 

That’s right. I am a board certified urologist, and you are certifiable as a professional comedienne.

Donna Lee: 

That’s right. And a little bit crazy.

Dr. Mistry: 

I cannot wait until we get those videos on YouTube.

Donna Lee: 

Sure.

Dr. Mistry: 

Eventually. One of the partners here, Dr. Christopher Yang, also thinks that he needs to upload some of his fun YouTube videos when he was a Chinese dragon dancer in high school.

Donna Lee: 

Really?

Dr. Mistry: 

Yes.

Donna Lee: 

I would love to see that.

Dr. Mistry: 

I am also excited. It’ll probably be one of those that gets posted and then taken down quickly by him.

Donna Lee: 

I will look forward to that. We’ll put that on the Facebook page and the website.

Dr. Mistry: 

We look forward to that too. You know, people ask me all the time why I became a urologist, and you know what I tell them? The jokes.

Donna Lee: 

That’s right.

Dr. Mistry: 

Really. There’s a deeper reason. As a urologist, I get to be a lot of things. I get to be a surgeon, which I love. I love that part. I get to deal with the most advanced technology on the planet–surgical robots, lasers. I mean, it’s cool. And then I get to be a medical professional. I get to deal with hormone issues and chronic pain issues and all these great things like medical stone disease in the clinic. I get to be a counselor for patients with sexual dysfunction or difficulty with fertility.

Donna Lee: 

And you’re holistic. We love that part.

Dr. Mistry: 

That’s right. And you get to be like this extra level of care. That’s why I love being a urologist.

Donna Lee: 

We should give you a real last name…

Dr. Mistry: 

Yeah, instead of this makeup “Dr. Mistry” last name. And one of the things that I get to do a lot of is become an endocrinologist…because we do so much hormone work. And for those of you that don’t know, endocrinology is a field of medicine in which…

Donna Lee: 

…you are not specialized.

Dr. Mistry: 

That’s also correct. That would also, I am not board certified in endocrinology.

Donna Lee: 

No you’re not. You just know how to spell it and that gives you a leg up.

Dr. Mistry: 

That’s right. So we have had a very strong relationship with Texas Diabetes and Endocrinology since I started practice 13 years ago. And one of our really great friends and partners, Dr. Kerem Ozer is here today. Hey, thank you so much for coming in.

Dr. Ozer: 

Thank you very much for having me. I’m a fan of the show, so I’m excited to be here.

Dr. Mistry: 

Well, good. You are a board certified endocrinologist. What does that mean in terms of what kind of schooling and training you went through?

Dr. Ozer: 

So a board certified endocrinologist, like you said, basically specializes in endocrinology. I need to learn practice my pronunciation here. So endocrinology basically looks at and deals with all issues related to hormones and hormones of course, are the little messengers in our body, in our system. There are several specific organs that produce hormones like thyroid glands, parathyroid glands. We’re all familiar of course, with female hormones–estrogen, progesterone; male hormones–the main male hormone, testosterone. And endocrinology just by its nature of dealing with these massive messengers, one of the biggest things we also deal with is metabolism. That is of course how our body processes feels, processes, carbs, fats, proteins, and the main hormones, the main messengers that regulate that aspect of endocrinology are hormones like insulin and glucagon, and now we have a whole slew of fancier, newer hormones, like ghrelin, which regulate things like appetite. So when you think of preventative approaches and wellbeing, endocrinology has a lot to do with how the body normally regulates its processes. And if you think of disease processes, we deal with thyroid problems, diabetes, osteoporosis, low testosterone is something I know we share, and pituitary gland issues. And of course the pituitary gland is that little gland that sits under the brain and regulates all the other hormones in the body.

Dr. Mistry: 

So what’s an interesting thing about endocrinology is that there’s so much perceived overlap between what you would think a primary care doctor does and the kinds of medicine that an endocrinologist does. Your comment about them being little messengers…endocrinology, there are hormones that you can check levels of. So you have numbers on a piece of paper. But it really affects everything in your body, from how you’re thinking and feeling to how your body looks, to how your heart rates working, to how strong you are. I mean, these little messengers are really what make us work, right?

Dr. Ozer: 

Absolutely. And that’s what I love the most about endocrinology. It’s really about how everything talks to each other and how we can optimize different things to help people achieve their best potential.

Dr. Mistry: 

Well, it’s too bad you can’t cut on people, because then…

Dr. Ozer: 

That I’ll leave to you.

Dr. Mistry: 

….it would be the first best field of medicine to go into. What I wanted to talk to you today about were thyroid issues. The thyroid has always been like a complex confusing organ to me. Why don’t you tell us, what does the thyroid do? And what does it make?

Dr. Ozer: 

Of course. So the thyroid is a butterfly shaped gland. It’s it’s right in the middle of the neck, kind of sits right on top of the Adam’s Apple. It makes two main hormones called T4 and T3. T4 and T3 are the key players in how our body regulates metabolism. They influence body temperature. They help regulate heart rate. They may influence things like blood pressure and especially T3, which is a smaller, more active type of thyroid hormone, influences things that are a little less tangible, like energy levels, focus, concentration through its effects on the brain.

Dr. Mistry: 

That’s amazing. When you have low levels or high levels, both of those extremes can cause symptoms, right?

Dr. Ozer: 

Exactly. So you could think of the thyroid as the accelerator and the brake. And you can think of if your thyroid is overactive, if it’s making too much of its hormones, you can think of your body as being on overdrive. So everything gets faster. Your temperature may go up, heart rate goes up, you start seeing sort of nervous system related issues like tremors…

Dr. Mistry: 

…weight loss.

Dr. Ozer: 

…heart palpitations, weight, loss, and diarrhea. Not good.

Dr. Mistry: 

I was excited about the weight loss part of it. Then you throw in the diarrhea part.

Dr. Ozer: 

I know, I had to spoil it.

Dr. Mistry: 

Diarrhea spoils everything.

Dr. Ozer: 

And then of course the other end of the spectrum is if you don’t have enough thyroid hormone–which I actually personally have, I, as an endocrinologist, I’m a proud hypothyroid patient as well–if your thyroid levels are too low, then everything slows down. So people start feeling very sensitive to cold, you start seeing a tendency to gain weight, dry skin, constipation, sort of the body’s now really on a, almost like a hibernation-type slower track.

Dr. Mistry: 

When I have a patient with low testosterone, sometimes their number may be on the low end of the normal range, but they still are very highly symptomatic. And so those are people that we often will treat just to see if they feel better. Would you say that that sometimes happens with thyroid disease, that people could be kind of borderline, but still highly symptomatic?

Dr. Ozer: 

So there are a couple of different schools of thoughts here, and I, I’m going to tread lightly here. I want to make sure I get out of here alive. If my, any of my colleagues are listening. And some of this…Oh boy, indeed! And some of this has to do with how the field evolved, and how the normal ranges, the standard ranges, were developed. So the current TSH…so the other hormone I want to talk about before we go into that is TSH, which is thyroid stimulating hormone, which is the hormone the brain makes through the pituitary gland to regulate thyroid function. And this TSH is so sensitive to what the thyroid is doing, that it is traditionally used as a really good, sensitive marker of thyroid function. Sometimes the brain senses that the thyroid is working slower before the T4 and T3, the actual thyroid hormone levels go down. Now, if you think about, if we are defining thyroid function by using normal levels of TSH, we need to think about how the normal ranges for TSH were set. And a lot of these numbers came from studies in the sixties, seventies, mainly in Germany, and these were general population, average based studies.

Dr. Mistry: 

Which take into account symptomatic and asymptomatic people.

Dr. Ozer: 

Symptomatic and asymptomatic people. And these studies, the ironic thing about these studies is that the incidence of thyroid disease, prevalence of thyroid disease, in the general population is about 5% to 10%, depending on who you read, where you look. So these general population studies had quite a bit of patients, quite a large amount of patients who may be on the extremes of thyroid function. More recent studies show that, especially for someone who’s younger, more active, you may actually need to define normal TSH ranges in a tighter range.

Dr. Mistry: 

Just like with testosterone.

Dr. Mistry: 

Just like the testosterone. Well, I, you know, I think these hormone debates are something that are going to be a similar theme. And I think right after this break, we’re going to talk more about thyroid disease. Donna Lee, how do people get ahold of us?

Donna Lee: 

You can call us during the week…and this reminds me though, when I meet a friend who’s gained a lot of weight and I’m like, “Why don’t you gain all this weight?” And she says, “I have a thyroid condition.” And I’m like, “Did you ever get it checked?” “No.” So they just gained weight. That’s basically what it is.

Dr. Mistry: 

Well there you are.

Dr. Ozer: 

They do need to get their thyroid checked.

Donna Lee: 

Call us at (512) 238-0762. Our email address is armormenshealth@gmail.com and our website is armormenshealth.com. You can also listen to our podcasts wherever you listen to podcasts for free because of this award. We’ll be right back.

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The Armor Men’s Health Hour will be right back. If you have questions for Dr. Mistry, email him at armormenshealth@gmail.com.

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