A Woman's Journey: Thyroid Disease - Often a Surprising Diagnosis

[Music] hi i'm kelly geripkin national chair of a woman's journey on behalf of johns hopkins medicines and women's journey thank you for joining us this evening for our monthly webcast series conversations that matter a woman's journey strives to improve your well-being through health education and this evening we're focusing on an issue that is very personal for me thyroid disease i was in my 20s when i was diagnosed with graves disease tonight we will learn more about graves disease and other thyroid disorders i am pleased to introduce our speaker my physician and personal friend dr paul ladinson he is john edgar howard professor of endocrinology and metabolism and professor of medicine pathology oncology and radiology following our conversation dr ladenson will respond to many of your questions so please use the q a at the bottom of your screen to pose a question throughout the evening our webcast will conclude at 8pm i want to take this opportunity to acknowledge and thank johns hopkins universities program hopkins at home for their production assistance you can visit their website for additional lectures and courses throughout the year and now i am pleased to begin tonight's conversation with dr levinson dr ladenson hi kelly thank you for inviting me to join you this evening um the topic of thyroid disease is one that's affected most families and that's because of its high prevalence and we talked earlier about some of the topics that the audience might want to hear about i thought we'd preface the discussion of an overactive thyroid gland and an underactive thyroid gland with a presentation of some of the basic facts of what the thyroid does and where it's located the thyroid is about as big as your two thumbs and it's located beneath your atom sample above the top of the breastbone in front of the windpipe and it has a critical job making two chemicals t4 and to a lesser extent t3 the thyroid hormones that travel from the thyroid gland in the blood to every tissue in the body the thyroid glands responsible for regulating our rate of metabolism the rate at which we burn calories and to some extent it regulates then our energy our weight our body temperature and in addition to those generalized metabolic effects the thyroid hormones have critical actions in every tissue of the body the strength of heart contraction and the rate of the heartbeat is regulated by thyroid hormone the clarity and rapidity of our thinking is regulated by thyroid hormone the dryness or oiliness of our skin the speed with which our gastrointestinal tracts move things along the functions of our kidneys all of these are regulated by thyroid hormone and the production of thyroid hormone is a very precisely controlled process as a result with a relatively narrow range that is maintained by a second gland the pituitary gland right between your eyebrows sometimes called the master gland because it controls not only the thyroid but also the adrenal glands atop the kidneys the testes in men and ovaries in women and other functions related to water balance and growth in children and the way that the thyroid control is controlled by the pituitary is a negative feedback loop so among the places that the thyroid hormones t4 and t3 go are back to the pituitary gland where specialized cells constantly monitor how high or low the thyroid hormone levels are and in response those cells make a hormone a chemical of their own called thyroid stimulating hormone tsh that then travels in the blood uh to the thyroid gland the pituitary thyroid controlling cells you can think of as the thermostat constantly monitoring the level of thyroid hormone the way uh thermostat measures the temperature in your home and when it senses even a slight decrease in thyroid hormone levels it spritzes out more tsh to crack the whip on the thyroid gland and get it to make more hormone and conversely if some abnormal process leads to an increased production of thyroid hormone above normal the pituitary senses that excess of thyroid hormone and shuts off thyroid stimulating hormone that makes the tsh level not only a physiologic cornerstone of thyroid function but it makes it also an extremely important tool for doctors to detect thyroid dysfunction in people with an underactive thyroid gland as you can figure out the tsh level is actually high and in people with an excess of thyroid hormone the tsh level will be low most testing of thyroid function begins uh with the measurement of the tsh level in blood now the thyroid disorder that brought the two of us together was hyperthyroid graves disease it is a disorder in which the body's immune system does something it should not it turns against a part of yourself in this case the thyroid gland in a special way producing antibodies that stimulate the thyroid gland in this same way that tsh from the pituitary normally does but without the careful regulation that the pituitary gland exerts on the thyroid this autoimmune inflammation and stimulation of the thyroid gland leads to its enlargement and overproduction of both of the thyroid hormones t4 and t3 the most common kind of hyperthyroidism is graves disease the autoimmune form of hyperthyroidism called graves disease because it was described in the 19th century by a british physician robert graves not because it can send you to your grave although in severe cases it can hyperthyroidism due to graves disease is a disorder that's about 10 times more common in women than in men it can affect people of any age from newborn infants to octogenarians but its peak incidence is in young adulthood in the 20s 30s and 40s the symptoms of an overactive thyroid gland can include feeling warmer than others insomnia trembling of the hands palpitations the heart beating hard fast or irregularly losing weight uh despite having a hearty appetite other symptoms can be related to the effects of thyroid hormone excess on the central nervous system it can be hard to stay organized and calm anxiety is a common symptom of hyperthyroidism now some of those things that i just mentioned are pretty common in people in general there are a few of our viewers out there tonight who haven't had a sleepless night or perhaps particularly in the summer months felt like they were the hottest person in the room perhaps they've even noticed a tremor of their hands after drinking a strong cup of coffee so how is one to know whether one's symptoms uh complaints that are non-specific that is they're caused by many conditions and life circumstances how can you know if it's possibly due to your thyroid or not i think there are uh three things that a patient can ask themselves is this a new symptom for me um second is this something that i can explain my tremor for example caused by that cup of coffee uh and third is this a symptom that has lasted 10 to 14 days and i think if any of the things we've just talked about are new to you not explained by your life circumstances and exposures and have lasted for 10 to 14 days it's worth thinking with your doctor about testing to be sure your thyroid gland is not overactive and as i mentioned a moment ago that testing begins with a measurement of the serum tsh level in all forms of hyperthyroidism that are common that tsh level will be suppressed low and then additional measurements of the t4 and t3 levels can help determine what the underlying specific cause of hyperthyroidism is how severe it is and lead your doctor to make a recommendation about how to cure it that's the really good news about hyperthyroidism and that is that this is a condition that we can treat effectively without exception and for hyperthyroid graves disease there are three alternatives that are effective and only infrequently associated with side effects the first that's often considered is a medication like methymizole to block the function of the thyroid gland and take a gland that is overactive and bring its function down to normal these medications like any other can cause a rash or itching rarely in one out of 2000 patients cause more serious problems like a lowering of the white blood cell count but in most patients they're tolerated well used for a period of 9 to 12 months with the hope that the underlying autoimmunity causing graves disease will blow over and the medication can be stopped the two other treatments for an overactive thyroid gland are permanent treatments the first treatment for an overactive thyroid was surgery and a minority of patients today still choose to have their thyroid glands surgically removed there are drawbacks to this approach it requires hospitalization general anesthesia in most patients an incision in the front of the neck and removal of the gland it's very important that any procedure on the thyroid gland be undertaken by a surgeon with the training skills and experience to do it safely because right behind the thyroid gland are the nerves that control our gross box and the four small parathyroid glands that keep our calcium levels normal those two structures are endangered by thyroid surgery and it's vital to have a surgeon who can recognize and preserve those structures and then the third treatment and the second permanent treatment for an overactive thyroid gland is radioiodine we haven't talked yet about iodine in the thyroid but the two thyroid hormones t3 and t4 earned their names because they refer to the building blocks of iodine that make up the thyroid hormones three iodines in t3 and four in t4 and physicians in the early 1940s when radioisotopes were first becoming available recognized that we can fool the thyroid gland into taking up radioactive iodine in the same way that it takes up normal iodine and in doing so for a patient with an overactive thyroid gland uh deliver radiation to the thyroid gland with a very low level of radiation exposure to the rest of the body this decision about which treatment anti-thyroid drugs surgery or radioactive iodine is best is one that each patient needs to have with their physician and the physician's best position to advise one about the approach to treating hyperthyroidism is an endocrinologist well that's a a brief picture of what the thyroid gland does and what hyperthyroidism is like kelly are there other questions you think our uh viewers might have yes thank you dr ladenson um actually there's many questions but i'm going to just pop off a couple of them right now when you were speaking about graves and hyperthyroidism so um what is the difference with graves there's you mentioned there's antibodies so if you have graves you have the antibodies which one means what and the second thing would be if you just are diagnosed with hyperthyroidism so the viewers would like to know is there what is the difference right there and then the long-term effect of that well that's an excellent question and uh the comments that i've made so far relate largely to that autoimmune form of hyperthyroidism due to graves disease but there are other causes not related to antibodies that stimulate the thyroid gland one can have a growth within the thyroid gland almost always a benign tumor of the thyroid gland called a toxic adenoma which over produces thyroid hormone without regard to tsh stimulation there may be multiple autonomously functioning nodules in the thyroid a condition called toxic multi-nodular voider another group of disorders that can cause hyperthyroidism are have their basis in thyroid gland inflammation thyroiditis a dramatic form of thyroiditis is called subacute thyroiditis or decay veins thyroiditis thought to be a viral infection of the thyroid gland where damage to thyroid tissue leads to the uncontrolled release of thyroid hormone from the gland i just last month saw a patient with a form of subacute thyroiditis i'd never encountered before a case of subacute thyroiditis almost certainly instigated by the patient's cova-19 infection there are other even rarer forms of hyperthyroidism that are actually due to a problem not primarily with the thyroid but with the pituitary gland a tsh secreting pituitary tumor can stimulate the thyroid gland and look for all the world like graves disease except for the absence of antibodies stimulating the thyroid to secondarily over produce thyroid hormones another condition i want to be sure and mention because of its common occurrence is a disorder called postpartum thyroiditis as the name uh implies a kind of transient thyroid overactivity that affects women in the year after delivery i think it's easy to imagine how a new mother sleepless caring for her child losing weight after pregnancy perhaps anxious and stressed by the need to manage both their new child and perhaps face the prospect of returning to work it's easy to imagine in this circumstance how hyperthyroidism due to postpartum thyroiditis might be overlooked and just chalked up to life absolutely that definitely makes sense and i can relate to that actually so just to clarify one thing on the antibodies so once you have treatment either from graves or hyperthyroidism um but if you have the antibodies are they with you for life even if you're treated well um the antibody levels after resolution of hyperthyroidism whether it's brought about after let's say a one year course of methymizole surgical removal of the thyroid gland or radioactive iodine in general the level of those thyroid stimulating antibodies falls and of course uh in the case of radioactive iodine therapy and surgery even if there remains a low level of those thyroid stimulating antibodies they have no functioning gland to stimulate and they have no other direct deleterious effects on a person's health affect other uh parts of the body the antibodies yeah that's a great question and i think many of our viewers know that hyperthyroidism is only one aspect of graves disease a second aspect of graves disease is the involvement of the eye each of us have uh behind our eyes six muscles that turn our eyes very precisely and uh concordantly uh to look at things normally those extra ocular muscles are thin like a large rubber band but in graves disease another set of related antibodies can cause inflammation of those extraocular muscles producing swelling of the muscles and since the eye sits at the front of a bony cone called the orbit where there's not a lot of extra room that swelling of muscles can push the eye forward causing a prominent appearance of the eyes that we call proptosis interfering with the coordinate regulation of vision causing double vision causing irritation of the cornea with dryness and photophobia light bothering a person's eyes due to that exposure sometimes eyes push so far forward that the lids are actually unable to close completely and then most concerning pressure on the optic nerve and even threatening vision curing hyperthyroidism is the first step in controlling eye disease but bringing the thyroid aspect of graves disease under control doesn't guarantee that the eye involvement is over and we're actually involved now in an exciting era of thyroid treatment where a new drug is becoming available to control that inflammation around the eye in a more effective way than we've ever had before well that's wonderful news i know it's been in the news lately i think we've seen you know some commercials and things about drugs for thyroid eye disease um what would you say about that would you uh how do you think that a person with hyperthyroidism or graves where it's affected their eyes probably have a good conversation with their physician because i know other people have talked about having surgery and then there's there's many risks with that as well what would you recommend well first of all the good news is that the majority of patients with graves disease do not have the kind of severe eye disease that we've been talking about where surgery steroid therapy or this new drug called topeza may be required this is a decision uh the approach to treatment that a patient with graves disease needs to make with an ophthalmologist who has a special interest in graves disease it may be a neuro ophthalmologist it may be an oculoplastic ophthalmologist that specializes in eyelid disorders but that ophthalmologist and the endocrinologist need to work hand in hand to give patients the best advice possible as they wind their way through the treatment of graves eye disease for patients with severe graves eye disease it can be the worst part of graves disease absolutely yep that's very true well i think we will now maybe move on and talk about um the counterpart of this hypothyroidism or hashimoto's so i'm going to turn that back to you well i don't want to give hypothyroidism short shrift because it's actually yes because it's actually 10 times more common than hyperthyroidism yes it is yes and uh you know the most common cause of an underactive thyroid gland is also an autoimmune disorder called hashimoto's thyroiditis named after a japanese pathologist who described it in the 1920s in this condition like graves disease the immune system has a blind spot forgets that it needs to tolerate one's thyroid gland inflames the thyroid gland but does so without stimulating it so there's in most patients with hashimoto's no overactivity but that inflammation ultimately leads to destruction of thyroid tissue a decline in thyroid hormone levels sensed by the pituitary gland which makes more tsh detectable in blood tests as a sign of hypothyroidism but tsh that is ineffective in stimulating a thyroid gland that's been damaged by hashimoto's this is a condition that seven to ten percent of american women have a condition that can be diagnosed by detecting in blood the antibodies directed against the thyroid gland antibodies against tpo antibodies against thyroglobulin this hashimoto's thyroiditis is like graves disease more common in women than in men it rises in incidents as women get older and is particularly likely to occur in the 40s 50s and 60s often around the time a woman's going through the menopause when symptoms related to estrogen deficiency and symptoms related to thyroid dysfunction may be misattributed the complaints that are typical for people with an underactive thyroid gland are feeling colder than others weight gain without eating more constipation dry skin slowed thinking low mood and muscle cramps now if you and i went down uh tomorrow morning to the outpatient center and went into a waiting room that used to be full of people waiting to see their doctor and we said how many of you are feeling tired how many of you are gaining weight and not eating anymore how many of you have some constipation well i think you and i both know that about 40 of the people sitting there would have their hands up and so the symptoms of an underactive thyroid gland are very common and they are also very non-specific the majority of those people if they have a tsh blood test will not be found to have an underactive thyroid gland and thyroid hormone therapy will not be the key to helping them feel better um that next step for a patient with any of those symptoms that are new for them unexplained and lasting 10 to 14 days is to seek a tsh blood test and even the mildest degree of thyroid hormone deficiency even if a person's level of thyroid hormone drops within the normal range but low for their set point that will lead to a rise in the tsh level and the ability to diagnose an underactive thyroid with confidence the good news about hypothyroidism under activity of the thyroid gland it's that there is a solution to the problem and it is a natural solution a solution that is uh taking levothyroxine levothyroxine t4 made synthetically as a medication is identical to the t4 that's made by a person's own thyroid gland the level of thyroid medication can be adjusted not only by how a person feels but also by serial measurements of their tsh level to assure that we find the spot within each person's normal range where their energy uh weight maintenance alertness mood uh will all be optimized right well we've got a lot of questions paul excuse me dr ladies and i apologize out there we've known each other for so long so um apologize for the familiarity anyway um let's how about we start to take some questions from the viewers how do you feel about that okay great let's start with uh justin um justine she'd like to know why is it so challenging to maintain the correct medication well um for patients uh and i presume that justin is talking about someone with hypothyroidism taking levothyroxine medication to restore normal thyroid status why do people drift out of the normal range and justin you're quite right in recognizing that it's common for hypothyroidism to be sub-optimally treated in large uh studies of levothyroxine treated patients one out of five are on an inadequate dose of medication and one out of five are receiving too much of thyroid medication another cause of thyroid toxicosis of hyperthyroidism what why does this happen well uh life changes it can lead to differing thyroid hormone requirements the dose of thyroid medication is related to a person's weight and if someone with an under active thyroid gland who's put on 20 pounds starts on thyroid hormone medication and loses that weight the initial dosage of thyroid medication that was prescribed may after significant weight loss proved to be excessive as we get older uh the rate at which our body breaks down thyroid hormone and disposes of it slows down so in a woman perhaps diagnosed with hashimoto's thyroiditis and an underactive thyroid gland when she was 32 and needed 150 micrograms a day of levothyroxine that same 150 micrograms may be excessive when she's 78 and perhaps needs only 88 micrograms a day another common reason that people drift above or below the normal range can be interfering medications and there are a couple of medications or really nutritional supplements that people with an underactive thyroid gland may also be taking relatively commonly calcium and iron both calcium and iron can interfere with the absorption of a patient's levothyroxine medication and if you've been prescribed both by your doctor it's important that the levothyroxine be separated from those calcium and iron nutrition supplements even the small amount of iron in a multi-vitamin that they be separated by at least four hours another culprit interfering with the absorption of thyroid hormone can be soy products and uh i've had patients who were perfectly balanced on their dose of levothyroxine who uh mysteriously uh became under treated and when we talked together it turned out that they had begun having soy milk on their cereal or in their coffee in the morning soy can interfere with the dosage of levothyroxine so other medications can interfere with perfect control and then unfortunately the most common reason that under active thyroid glands are not adequately treated is because patients don't take their medications faithfully across the country uh of 365 days of medication that should be prescribed and used it's uh kind of disturbing to hear that only 204 days of pills are actually dispensed so just like other medications it can be hard to take one's thyroid hormone faithfully there are some forgiving aspects of levothyroxine therapy if you miss it in the morning it's fine to take it later in the day if the morning is a busy time for you uh taking levothyroxine at bedtime if that's two hours after your dinner is a satisfactory solution if you miss your levothyroxine dose on monday because you're traveling and your luggage is lost you can take two on tuesday let's see very good or bring it put it in your purse or take it on your carry-on right don't check don't check your medication um with that in mind so we have a question from marlese and she would like to know so why does your thyroid suddenly malfunction and i i think i know it doesn't necessarily suddenly malfunction um so can you talk a little bit about that and and then also um if you have a family history of any type of thyroid uh issues what's the most effective way to monitor that well those are both super questions you know what has gone wrong with someone's immune system that it would turn against their own thyroid gland and uh a good part of the predisposition to thyroid disorders is as you just implied uh kelly one's family history among women who have uh hashimoto's thyroiditis uh one in seven of their daughters will develop an underactive thyroid gland um we recognize that there are multiple genes that contribute to the risk of developing hypothyroidism but unfortunately there's no one single gene that we can interrogate to determine in a given person whether they're predisposed to an underactive thyroid gland uh it's believed in a broad population sense that the amount of iodine in a population's diet can uh determine the risk of developing an underactive thyroid with too much iodine in the diet making it more likely that the immune system will turn against the thyroid there is some evidence that overweight is a risk factor for developing an underactive thyroid gland in terms of why a given individual let's say with a genetic background that predisposes them to an underactive or overactive thyroid gland gets it at a soup at a certain point in their life uh we're still baffled by that in most cases i mentioned earlier the predisposition of postpartum women to thyroiditis and temporary hyperthyroidism due to thyroid gland inflammation after delivery women are also more predisposed to both graves disease and hyperthyroidism and hashimoto's thyroiditis and hypothyroidism perhaps because the immune system which has been put to sleep just a bit during pregnancy so that foreign being entire inside a woman is not rejected after delivery as the immune system wakes up there may be a rebound and a tendency not to tolerate a person's own thyroid gland there are other theories less well established such as stress great stress a death in the family a terrible uh accident a financial reversal and uh certainly we hear stories about patients who developed either graves disease and hyperthyroidism or hypothyroidism after an event like that but it's often hard to sort out which is the heart which is the horse and which is the card right whether perhaps their thyroid problem may have made them vulnerable to some misfortune in life right so with with that in mind then so how often then should you get your thyroid check which is the blood test if you're kind of you have these symptoms and you're not quite sure how often should a person actually go and get their blood tests done either before they're diagnosed and then also um you know afterwards well given the importance of the thyroid gland and uh the ease with which uh thyroid gland over activity and under activity can be diagnosed and treated you may be surprised to hear what i'm going to say next but that is that screening for thyroid dysfunction remains a controversial topic the american thyroid association recommends that in adults 35 years and older a tsh blood test be done every five years to detect the appearance of thyroid gland dysfunction and of course that a tsh blood test be done any time a person has symptoms that are new unexplained and lasting that might reflect a thyroid problem authorities the american college of physicians the american college of obstetrics and gynecology the u.s preventive services task force have uh so far been less convinced that routine thyroid screening is justified interesting i would i would almost think that boy it should just be mandatory in your annual checkup it should just be in there but maybe one day um so we have another question from ellen and she would like to know is there a relationship between thyroid disease and other autoimmune disorders yes well thyroid disease autoimmune thyroid disease was actually the very first autoimmune disorder recognized and it was recognized by someone who became a johns hopkins professor and dr noel rose was the man who before he came to johns hopkins began studies in mice of how immunizing a mouse against certain proteins in their own thyroid gland could lead to a condition that was exactly like hashimoto's thyroiditis in people and at that time it was a revolutionary notion that the immune system could become deranged and attack a part of oneself now we know there are many autoimmune diseases like rheumatoid arthritis and lupus the autoimmune diseases that are linked to graves disease are sjogren syndrome a disease where there's autoimmunity against the salivare guns causing dry mouth and against the lacrimal glands causing a dry eye a very serious autoimmune disease called systemic sclerosis that can cause a waxy like thickening of the skin and problems with the esophagus and other parts of the gastrointestinal tract working properly ultimately cause kidney failure and then there is another uh condition celiac disease which probably a number of viewers have heard of in which inflammation of certain cells lining the intestines can lead to malabsorption now the good news is that the vast majority of people who have autoimmune thyroiditis hashimoto's fortunately don't suffer any of these other autoimmune diseases but about three percent of people with hashimoto's thyroiditis may have one of those diseases i mentioned or another one called pernicious anemia where antibodies against stomach cells lead to malabsorption of vitamin b12 so i think it's important for any patient with an underactive thyroid to be aware of those associated conditions sjogren systemic sclerosis celiac disease and vitamin b12 deficiency to make sure that their doctor is thinking about those possibilities so that in the right setting or the wrong setting perhaps unexplained weight loss and diarrhea suggesting celiac disease or tingling in one's extremities and an anemia suggesting vitamin b12 deficiency so that the appropriate tests are done to recognize those associated autoimmune disorders early and treat them great thank you dr ladenson our next question uh is from fran um she would like to know you spoke about the importance of thyroid testing are normal rages ranges the same for everyone fran that's an excellent question um there are three settings where are really four settings where what we call the reference range the values for tsh that 97 of people have are different the first is in newborns and some of our viewers may not know that every child born in the united states and in all western industrialized countries have a thyroid blood test at the time of birth that's very important because one in four thousand children are born without a thyroid gland and if that condition is not recognized it can lead to irreversible mental retardation a consequence that can be completely avoided by early diagnosis and treatment of neonatal hypothyroidism and the normal range for tsh and t4 in adults is not the same as the normal range for tsh in newborns at the other end of the age spectrum we're now recognizing that in older people particularly significantly older people let's say above the age of 75 or 80 that there is also a somewhat different normal range with tolerance of a tsh level that is higher than the tsh you would recognize as hypothyroidism in someone in their 30s during pregnancy over the past decade doctors have recognized there is a different normal range very important that obstetrician gynecologists and pregnant women be aware of that because recognizing either an underactive or an overactive thyroid gland during pregnancy is vital one-third of women with an overactive thyroid during pregnancy will suffer a miscarriage and there's good evidence that in pregnant women with an underactive thyroid gland that complications like pre-eclampsia and premature delivery of fetal respiratory distress are more common if an underactive thyroid is not treated so the very young the very old the pregnant woman and then there are racial differences in the tsh normal range with a narrower normal range in african americans because there is less autoimmune thyroid disease in african americans than there is in caucasians interesting thank you dr ladenson what uh karen has a question what is the relationship between thyroid disease and any heart issues karen that's another good one um both an overactive thyroid and an underactive thyroid can have serious consequences for the heart and circulation uh an overactive thyroid gland even one that's just mildly overactive can predispose to a fast irregular heart rhythm called atrial fibrillation some of the older viewers tonight might remember that when the first president bush presented with an overactive thyroid gland he did so uh presenting with atrial fibrillation it's vital particularly when thyroid hormone excess causes that kind of cardiac complication for treatment to be started promptly and the patient monitored carefully unrecognized and untreated hyperthyroidism can lead to heart failure and even death due to heart disease at the other end of the spectrum one of the consequences of an underactive thyroid gland is a rise in the cholesterol level in blood and an increased risk of developing atherosclerotic vascular disease narrowing of blood vessels to the heart brain or extremities causing serious problems like heart attack stroke and limb loss in doctors practices around the world it's been found that one out of seven patients who have a high cholesterol level have it because they have an underactive thyroid layer so it's an important part of evaluating people with a high cholesterol to check their thyroid function uh the solution to their problem may be uh treating their hypothyroidism with levothyroxine rather than starting a statin right oh and one thing actually i've learned from you um being a patient but as you get older you just can't assume that staying on the same dose might be okay for you uh even though you might feel well um but the levels do need to get checked and if they're off it could affect your heart yep yep good point kelly and uh you know i talked earlier about how metabolism the thyroid hormone slows down in the very old but you're right to point out that even in one's 50s and 60s a generous dose of thyroid medicine may become too much and even if you're not experiencing trembling hands palpitations and insomnia that excess thyroid hormone may be evidenced in blood tests only by a low tsh level can predispose to atrial fibrillation in the famous framingham study among people who at age 60 had a low tsh level the risk of developing atrial fibrillation between age 60 and 70 was three-fold higher than it was in people who had a normal tsh level another respect or another consequence of even subtle thyroid hormone excess of importance to women is osteoporosis and again even a mild degree of thyroid hormone excess still within the reference range but too high for that person evidenced by a low tsh that kind of so-called sub clinical hyperthyroidism is associated with the two to three-fold higher risk of hip and spinal vertebral body fracture so um keeping one's thyroid status in check making sure that the dose of levothyroxine you took last year is right this year is a really important issue yes and that goes back to having your again having a good relationship with your position and um and even if your physician doesn't remember it to have yourself maybe remind to say hey i need to get my thyroid checked just for that reason because i'm getting older so um thank you uh we have just a couple more minutes so i want to focus on a question here what is the current hot quote hot research about thyroid disease right now do you think well um we're excited about some uh recent work that we've been doing using serum samples from the u.s armed forces of ceramic when you join the army navy marines coast guard you get a blood sample drawn and they draw one every year when you retire and are deployed and they keep them all in a big deep breeze here in maryland and we've been uh privileged to be able to access some of those samples and use them to see what precursors of thyroid disease we can find in a person's blood a work by a professor cater regularly at johns hopkins has shown that among people who develop an underactive thyroid gland say at age 45 often when they were 35 and having their blood drawn in the army that the antibodies predicting their future thyroid gland failure were already present we have a study that i'm eager to soon hear the results about where we're looking at the predisposition to graves disease that stress might represent and we're comparing uh servicemen who were deployed to iraq and afghanistan with servicemen servicemen who are age and gender matched a really exciting area of research right now is one that we touched on a moment ago and that's this new treatment for graves eye disease that's been one of the unsolved problems in thyroid allergy and thyroid disease so it's exciting to see research turning the tide with regard to thyroid eye disease well dr ladinson i we have so much more we could talk about but it looks like we're running out of time so i would really like to thank you very much for joining us this evening and to thank all of you for joining us as well and dr ladenson has graciously agreed to respond to any unanswered questions that we've asked this evening so you also will find relevant articles available on our website and in a couple of weeks you'll receive an email outlining the outstanding questions and answers and tomorrow you receive an email asking you to complete a brief survey about tonight's webcast in the coming days a video of tonight's live streams will be available on the a woman's journey website hopkinsmedicine.org a women's journey under conversations that matter if you've enjoyed tonight's discussion please check out our website again hopkinsmedicine.org a woman's journey to watch for announcements about future conversations podcasts and special programs brought to you by a women's journey in the meantime we hope you will find our monthly email informative and engaging conversations that matter is brought to you in part through a non-restrictive educational grant from bristol myers club good night and stay well thank you

Channel: Johns Hopkins University

Views: 83,400

Keywords: johns hopkins university, baltimore, maryland, Thyroid, School of Medicine

Id: zsiile229D0

Length: 60min 51sec (3651 seconds)

Published: Thu Jul 15 2021