Thyroid Health 101 with Dr. Stelin George

In this episode, we sit down with Dr. Stelin George, a board-certified family physician based at MedLink’s Athens location, to demystify thyroid health.

Together, we explore the critical role of the thyroid gland, common signs of thyroid disorders like hypothyroidism and hyperthyroidism, and the diagnostic process. Dr. George provides an in-depth look at treatment options, including medication and advanced procedures like thyroid ablation, while offering insights into how these conditions affect overall well-being.

Whether you're curious about symptoms like fatigue, weight changes, or palpitations, or you're interested in staying informed about proactive health measures, this episode delivers valuable information in a clear, approachable way. Tune in to understand how the thyroid impacts your health and learn how to take control of your well-being.

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Transcript

SPEAKER_00 0:01

Welcome to the Medlink Health Connections podcast, where we share expert insights to help you live your healthiest life. I'm Tangela, and today we're diving into thyroid health, an often misunderstood topic that affects millions. Joining me is Dr. George, a board-certified family doctor based at our Athens location. Dr. George sees patients five enough and brings a wealth of experience to today's conversation. Dr. George, welcome to the podcast.

SPEAKER_01 0:31

Happy to be here. Great to be able to sit down and talk about some of our common medical conditions.

SPEAKER_00 0:37

I think we want to focus on thyroid health. And let's kind of start with some basics. So, what is the thyroid gland and why is it so important for your overall health?

SPEAKER_01 0:51

Yeah, uh honestly, it's um hard to overestimate how important the thyroid gland is. Uh, basically, it's the master endocrine gland. It's the master gland of the body that helps control basically every function that we know of, and every kind of disease can be tied back to it in some way, shape, or form. It's roughly about a, you know, one or two centimeter, maybe three centimeter gland, uh, about uh, I'd say an eight-shape that lies for uh visual purposes, I'd say close to where most men's atom apples would be. However, most of the time it is not visible with the eye, and we could barely feel it on palpation. Something that doctors can kind of will keep an eye on, but especially for someone who doesn't have thyroid issues, very common to not feel it. So definitely don't feel like you have to go home and look in a mirror and try to find it today.

unknown 1:44

Yeah.

SPEAKER_00 1:44

What are some of the most common signs and symptoms of thyroid problems that people should look out for?

SPEAKER_01 1:51

Definitely. I would say for low thyroid or hypothyroidism, one of the most common things can be low energy or fatigue. That tends to be the more common presentation of it, I'd say. The thyroid controls so many functions within the body. So people that also notice that they're prone to constipation, um, having a lot of dry skin, or for looking at cosmetically if we're having issues with poor hair growth or hair thinning, hair falling out. Um, these are all kind of the biggest signs, I would say, of a overact of an underactive thyroid. Now, they can also be true for an overactive thyroid. So, hyperthyroidism, a lot of times it would be fatigue, but fatigue because we're feeling wired all the time, like we're running on fumes. Sometimes those patients have really bad issues with sleep as well. They might be struggling to fall asleep and stay asleep because the body is in this perpetual kind of fight or flight mode. So it really depends on which end of the spectrum that we're talking about. But most of the time, I tell people a good starting point is if you're feeling really run down, low energy, trouble sleeping in our society as well, we see a lot of issues with our metabolism. So if you feel like you've also been struggling to either lose weight or gain weight, these can all be great indications that you should probably get plugged in with your family doctor or your primary care provider to try to run some thyroid tests if it's not already been looked at recently.

SPEAKER_00 3:20

So, how are thyroid conditions like hypothyroidism and hyperthyroidism typically diagnosed?

SPEAKER_01 3:26

Yeah, so the good thing is we have pretty good lab testing in this day and age. So it is a blood test. Um that would be the only caveat, is it's there's no rapid swab. You can't tell just by looking at somebody usually unless they have really, really full-blown symptoms. But usually it's a certain blood test that looks at a marker called TSH just as a screening method, and most labs will reflex to kind of check uh some subsequent values after that. But a blood test, usually every 12 months, is a pretty good way of keeping an eye on the thyroid.

SPEAKER_00 4:00

Okay. Um, if you know you get the blood test and something comes back negative, what are some of the main treatment options for thyroid disorders and how effective are they?

SPEAKER_01 4:13

Yeah, so what I would say is it is nuanced because it does depend on which family we're in, if we're in the hypo or the hyper state, the low or the high um thyroid states. What I will say that we commonly see more of is, at least in primary care, a lot of hypothyroidism, usually just the genetic variant or um the familial variant, I should say. Um it does tend to affect women usually in a three to almost 10 timefold um frequency. Unfortunately, women are more predisposed for thyroid issues, but we see men with thyroid issues as well. So if it's a low-acting thyroid or hypothyroidism, um, typically, and and while I won't go too much into the specifics of which subclass of it um is causing that hypothyroid state, really, it's going to be about giving the body what it's lacking. So when your thyroid is not strong enough and it's not making enough thyroxine, which is the main product of the thyroid, then for someone who has hypo or underactive or low-functioning thyroid, we have to give them levothyroxine, which is our synthetic version of thyroxine. And so what that is, it's replenishing the body with what it's lacking. And so that over time, and of course, when you start that path, it is highly successful. Uh, it just is something you have to commit to. Usually you'd be on levotheroxin then for a good amount of time, probably indefinitely, to be honest with you. And you would get routine blood work with your provider um every few months at least until we get the dose correct. And also then at that point, just for maintenance, probably at least annually getting blood work. But level thyroxine then would be the mainstay of how we treat that. Now, very briefly, I'll say the kind of more flashier variant is folks that have hyperactive thyroid or hyperthyroidism. Because that cause is usually something more autoimmune or something that might be related to uh inflammatory nodule or what we call a toxic goiter, then sometimes we do have to send folks in this day and age for ablations or consultations with specialists, endocrinologists. And sometimes what we have to do is we have to consider either putting someone on pills or therapies that, especially when it's more of an autoimmune disease, can control the thyroid by itself, and you would be on that for probably quite a while. In years past, it used to be that that was also the mainstay, and we would just keep people on it for years. Now we try our best to not use it for more than a few months at a time while we're getting you plugged in with a specialist who would most likely want to do an iodine ablation, or if it's something that they think was maybe a goiter or a toxic nodule or a mask. If that's a surgical route, they'll discuss that separately. But basically, in this day and age, a lot of times we just kind of stabilize hyperactive thyroids, get it to the point where we might want to just artificially or through medical means shut down that thyroid. When we do shut it down, we flip it. We flip the switch from hyper to hypo. Because hypo is very frankly a lot easier to manage than hyper. Hypo is not usually something that gets people into the hospital. Hyper patients can definitely end up in the ER. So we try our best to change the name of the game, to put it onto our terms. What we'll do is do an ablation of the thyroid, get it down to a hypostate, and then at that point, you're managed just like our patients that we first talked about who had run-of-the-mill hypothyroidism, and you're just on oral level thyroxine indefinitely at that point, with just frequent blood monitoring going forward. So it's a lot less involved at that point. So uh generally, I would say that for I would say in primary care, 90% of probably what we see is all hypo, because statistically it's more common. Hyperthyroidism patients do exist, and they are definitely uh more fascinating, I would say, in terms of the causes of it, because we are usually going into the weeds looking at autoimmune diseases at that point. And the management is a little bit more nuanced, a little bit more delicate, but still very satisfying when you're able to treat those patients and ultimately get them to a stable point.

SPEAKER_00 8:22

Interesting. Okay. Um, can you kind of explain what the ablation of the thyroid would be? Like what does that process look like?

SPEAKER_01 8:30

Yeah, so an ablation actually is where it's usually done in a in an endosuite. So they'll and it's using a radioactive iodine to actually um turn off the function of the thyroid. And so uh it's something that has been around for a few decades now, a lot more workup than um in years, more most recent years. We used to try to delay that, and now we realize that actually, if we can get people from a hyperthyroid state, especially if they have an autoimmune disease where we know that okay, this disease is not going anywhere, we got to do something about it because it's genetic, it's gonna be with them until probably for the rest of their life, honestly, or until they pass away. So we try our best to get people that procedure to where it can slow down the function of thyroid and actually it'll just basically kill it at that point. Now, I would say that it may sound crude, but rest assured that these are all highly explained professionals. Um family doctors do not do that type of procedure. One is you need special equipment and setups and laboratories and procedure rooms to do it. Um, but that is something that a lot of endocrinologists do. And so by the time you're getting to the endocrinologist, at that point, if you had a good family doctor who was working you up, they would at least be able to run all the serologies, all the blood tests, be able to tell you what type of autoimmune disease it is. Uh, Graves disease is one of the most common autoimmune causes of uh hyperthyroidism. They could at least give you that peace of mind, give you that diagnosis, probably get you started on some oral pills to try to slow down the thyroid on its own, or pills to help treat some of the symptoms of an overactive thyroid, which another one that we may not have mentioned at the beginning, palpitations. Come to think of it, that's another big one actually. We kind of forget about a lot. But when I have a patient come in with palpitations, it could actually be hyper or hypothyroidism causing it. And so um classically, classically, it would be a lot of hyper, but you'd be surprised. So I have cardiac patients that when they come in, I'm doing a cardiac eval on them and they got palpitations going on. Um, if their thyroid is off, and if it is hypo, which is more common, a lot of times I correct the thyroid and then goes away on its own, as far as the cardiac manifestations. And so yeah, that may have been a little bit of a rant there, but uh that's kind of you know, it's a little bit involved as far as what ablations look like. But when you get to that point, it's usually going to be the endocrinologist who are doing that.

SPEAKER_00 10:54

Okay, okay. And so, with all of that being said, are there also any like lifestyle or dietary changes that can help maintain um a good thyroid health?

SPEAKER_01 11:08

This may sound sad to say, but truthfully, not really. It sucks because even if you didn't have any family history of thyroid disease, there's always somebody who can be the first in their family to be diagnosed with it. It is largely genetic, to be honest with you. We used to see, especially in different parts of the world, that had access to certain kinds of nutritional um supplements or nutritional entities like iodine. Iodine is a great healthy molecule. It's uh it's a precursor actually to a lot of the synthesis of thyroxine. And so, in some parts of the world where they didn't actually have iodine-infused or fortified foods, that we would see higher rates of hypothyroidism. But in the US, it's really hard to find anybody with an iodine deficiency. Um, you probably will notice next time you buy table salt that it says iodine table salt. So for a few decades now, the FDA has had iodine supplemented into a lot of our foods, which is great actually, because um that might be the only kind of lifestyle thing that maybe decades passed or in other parts of the world we were noticing. Now, what I will tell you is um general advice always for everybody is eat less carbs, more protein and vegetables, probably less processed foods, but I can't say with any kind of high degree of accuracy that any of the studies have shown a clear link between certain kinds of foods or substances and thyroid disease aside from iodine, which again is really that's really just kind of going the way of the dodo since hardly anybody sees a true iodine deficiency in disdain age.

SPEAKER_00 12:45

Okay. Is there any myths or common questions or anything like that that you'd like to talk about before we wrap everything up?

SPEAKER_01 12:58

Just the thyroid is important, but it's not the explanation for everything. So I'll say that as a healthcare provider, sometimes we would love to assume that everything's from the thyroid, and we do very diligently check the thyroid, and sometimes it comes back as completely normal. But I will say that I have had patients who have had it checked once six years ago or once through a year ago, and then they think they're good for the rest of their life. And then I've had patients who got it checked last month who think it's time to recheck it. So if there's any one thing I'd say as far as the monitoring of the thyroid, traditionally and typically I would say that it's worthwhile checking. It's not the explanation for every disease in the world. So you always need to consult with your PCP to get a better picture of what's necessary to test for and what else is going on with your symptoms, with your overall health. But once you do check, you can definitely revisit that and check it again after enough time has passed, which usually gonna be no less than I'd say six months. A lot of docs check it probably annually, just part of a routine physical. And then the flip side is also true that uh once you um do check it, then you're good for a while. So we don't have to over-check it, we don't have to undercheck it. And it's also not the end of the world, but it is very important. So somewhere in there, hopefully that makes sense.

SPEAKER_00 14:23

But no, I think that makes sense. Okay, well, I enjoyed talking to you today. Thank you so much for all of your insights and knowledge. It was actually very informational for me because I know the thyroid is important, but I never realized just how important. And but then also on the flip side, I'm like, okay, note it, it's not 100% going to be the answer to all of your problems.

SPEAKER_01 14:51

If only it was that simple. Um so always always talk to your doctor, always um have as much transparency as possible, let them know what's going on and let it reveal itself. What I'll tell people is the thyroid is usually not subtle. And so if it's gonna be the thyroid, it's probably gonna obviously be the thyroid and it's gonna pop up on the blood test and it's gonna be staring the provider right there in the face to where if they need to address it, rest assured it'll probably get addressed regardless.

SPEAKER_00 15:20

Okay, good to know. That's good to know. Thank you for tuning in to the Medlink Health Connections podcast. We hope you found today's episode informative and inspiring. If you enjoyed the show, please subscribe, rate, and leave a review on your favorite podcast platform. Remember, the information shared in this podcast is for educational purposes only and should not replace professional medical advice. Always consult with your healthcare provider for any medical concerns. Stay connected with us on social media and visit our website at medlinkga.org for more resources and updates. Until next time, stay healthy and take care.