The thyroid gland creates hormones that regulate metabolism. When the thyroid produces too many or too few necessary hormones, overall health can be affected.
Dr. Alan Farwell, discusses common thyroid disorders and treatment options available at Boston Medical Center.
Alan Farwell, MD
Alan Farwell, MD is an Endocrinology Specialist in Boston, Massachusetts. He graduated with honors from University Of Massachusetts Medical School in 1984. Having more than 34 years of diverse experiences, Dr. Farwell practices at Boston Medical Center. He is the Chief of the Section of Endocrinology and the Diabetes and Nutrition Director of the endocrine clinics.
Learn more about Alan Farwell, MD
Melanie Cole (Host): Through the hormones it produces, the thyroid gland influences many of the metabolic processes in your body. As a result, thyroid disorders can be far reaching and can range from nodules, to hypothyroidism to life threatening cancer. My guest today, is Dr. Alan Farwell. He’s the Chief in the section of Endocrinology, Diabetes and Nutrition and the Director of the Endocrine Clinics at Boston Medical Center. Dr. Farwell tell us a little bit about the thyroid gland. Give us a brief overview of what it even does.
Alan Farwell, MD (Guest): Sure, the thyroid gland is a butterfly like gland that is in the front of your neck and it produces a hormone that regulates your metabolism call thyroid hormone. And when I say regulates your metabolism; it can regulate your temperature to some degree, it regulates your weight and when the thyroid is not working normally; it can disrupt pretty much every system in your body.
Melanie: So, what are some of the most common thyroid issues that you see?
Dr. Farwell: So, basically the three most common disorders that the thyroid can develop is an underactive thyroid or called hypothyroidism, an overactive thyroid called hyperthyroidism or lumps or bumps in the thyroid called thyroid nodules. Thyroid nodules are actually the most common problem, it can be seen in up to 50% of people that have imaging tests in their neck. But the one that gets a lot of discussion about how to treat is hypothyroidism.
Melanie: Then let’s talk about hypothyroidism and what are some of the signs and symptoms that people would notice and is this something that strikes one gender more than another?
Dr. Farwell: Yes, actually both hyper and hypothyroidism and thyroid disorders in general affect women more than men. Hypothyroidism or when the thyroid is not working well or is underactive; you get symptoms that are very, very nonspecific but together are things like being slow, sluggish, tired, gaining weight, cold, constipated, dry skin. All those symptoms are very common in people who have an underactive thyroid. What makes hypothyroidism a challenge is that most of the people that complain of those symptoms do not have hypothyroidism. So, it is something that is definitely much more common in women than men about 8-9 to 1. The most common cause of an underactive thyroid is it’s an autoimmune disorder known as Hashimoto’s thyroiditis. This is caused by your body making an antibody that attacks the thyroid and tries to destroy it. Antibodies usually attack infection and viruses, but they get confused with Hashimoto’s and attack the thyroid and destroy it. And that is by far the most common type of hypothyroidism.
Melanie: So, how do diagnose it? If a woman or a man is having some of these symptoms and they are not sure what it is and as you say sometimes that’s not what it is. How is it diagnosed as sometimes doctor, is it diagnosed just during a physical or when the doctor goes to kind of give you your annual well-checkup?
Dr. Farwell: So, the way to diagnose thyroid dysfunction in general, specifically hypothyroidism is through symptoms of how you are feeling and if you have symptoms that would making your doctor concerned about being hypothyroid, but it has to be confirmed with thyroid blood tests. And there are two specific thyroid blood tests. The most common to diagnose thyroid problems is something called TSH or thyroid stimulating hormone. TSH is produced by the pituitary gland and it turns on or turns off the thyroid depending on how much thyroid hormone your body needs at any one time. The other blood test that is done is on the actual thyroid hormone, predominantly T4 or thyroxin which is the main hormone that the thyroid makes. Also, T3 which is the main active form of thyroid hormone which T4 gets converted to in target tissues and in other parts of the body. So, it can be very confusing because the thyroid hormone levels and the TSH levels are opposite each other. So, when the thyroid is underactive the thyroid hormone levels are low, but the TSH levels are high. So, oftentimes patients will say well my tests were low, or my tests were high, and you don’t really know what that was- what that really means. Because it could mean the exact opposite thing. But if you get blood tests that will tell you whether the hormone levels are normal or are abnormal and if they are abnormal whether the symptoms you have are consistent with hypothyroidism or any other thyroid dysfunction.
Melanie: So many of the symptoms that people experience and especially women when they have thyroid disorders such as hypo or even hyper could be depression or thinning hair or any of these things that also could be the same as going through menopause or perimenopause. So, what do you say to women when you are treating them about treatment options available and how long they might have to be on these treatments?
Dr. Farwell: So, for the vast majority of people diagnosed with hypothyroidism, when you start on thyroid hormone replacement, then that pretty much is lifelong. There are some situations of things called thyroiditis that may get better, but the vast majority once you get diagnosed with hypothyroidism; you are going to be on thyroid medication for the rest of your life. Now the way we treat hypothyroidism predominantly is with the actual hormone that the thyroid makes called thyroxin. And we can give it to you in a synthetic form called levothyroxine and that’s the generic form of thyroid hormone. The brand names are things like Synthroid and Levoxyl and Tirosint. But levothyroxine, they are all essentially the same active component which is that thyroxine medication. And the vast majority of patients that get diagnosed with hypothyroidism going on the levothyroxine, they do fine and they feel fine and the symptoms that they initially had when they were diagnosed improve and sometimes completely resolve all together. There are times though, especially with women, during their life where they may need more or less thyroid hormone and one of the most important times is during pregnancy because the requirements for thyroid hormone go up when a woman is pregnant. So, frequently, if someone is on thyroid hormone and they get pregnant; we always tell them to get a blood test right away and they may need a higher dose of thyroid hormone. It’s also something that mild hypothyroidism that was undiagnosed can become much more severe when a woman gets pregnant. So, symptoms of hypothyroidism and family history of thyroid problems would oftentimes indicate getting a blood test once they know that they are pregnant. Conversely, when a woman delivers a baby, the thyroid hormone requirements drop. So, I have seen women have to increase their thyroid hormone levels two to three-fold during a pregnancy, but if you take everyone, it’s probably about a 25% increase in dose and then after delivery, cutting back on the dose. The other time that is very common to have dose changes is what you had mentioned earlier around menopause because again, there are changing hormones specifically estrogen levels that can affect the amount of thyroid hormone that the body makes and needs.
Melanie: So, in just the last few minutes, doctor, give a little bit of your best advice and what questions you would like your patients to ask you if you determine that they have got some sort of thyroid disorder and let them know what you would like them to know about the treatment options available.
Dr. Farwell: So, I think certainly as I mentioned earlier, the vast majority of people with weight gain and fatigue and those nonspecific symptoms will not have a thyroid problem, but it certainly if you develop these symptoms or are concerned about these symptoms, those are reasons to ask your doctor about testing for thyroid problems. If you are already on treatment and have been diagnosed with hypothyroidism and you are not feeling well; then that is the time that you could ask your doctor about potentially referring you to see an endocrinologist to see if things need to be adjusted. There are also other options for treatment. I had mentioned T3 is the other hormone that the thyroid makes and sometimes small doses of T3 are needed and can be helpful, but these are best done under the watch of an endocrinologist. So, I think that if you – the goal is to feel back where you were before you developed the thyroid problem. And I think the biggest thing to let people know is that the vast majority of people that are diagnosed with hypothyroidism or any type of thyroid disease; get better and feel better and feel normal and live normal lives. If you are one of the unfortunate individuals that continue to have symptoms; then I think that’s where you should be asking your doctor to see a specialist and if the specialist that you see, the endocrinologist you see, if you are not happy with their advice; then see someone else. Because patients are ultimately responsible for their own health and really need to be their biggest advocate. But I think there’s pretty much hope for pretty much anyone with thyroid dysfunction that they should be able to get back to feeling normal and feeling well and back to the usual state of how they are feeling.
Melanie: Thank you so much Dr. Farwell for being with us today and sharing your expertise. It’s a topic that is of interest to so many people and they don’t really understand what the thyroid does and how some of these treatments can really help with symptoms they may be experiencing. This is Boston Med Talks with Boston Medical Center. For more information you can go to www.bmc.org, that’s www.bmc.org. This is Melanie Cole. Thanks so much for listening.