Understanding the Thyroid with Ossama Lashin, MD, PhD

Podcast Transcript

John Horton:

Hello and welcome to another Health Essentials Podcast. I'm John Horton, your host.

The thyroid catches a lot of blame for health issues. Having trouble sleeping? It could be your thyroid. Constantly feeling cold? It might be your thyroid. Are you exhausted? Yep, thyroid. But can this small gland in the front of your neck really be the source of all this trouble? I mean, it's shaped like a butterfly — that hardly seems threatening. So today, we're going to take a closer look at your thyroid and the mayhem it's accused of causing. Endocrinologist Ossama Lashin is joining us to chat about the gland and address what it can and can't do. Dr. Lashin is one of the many experts at Cleveland Clinic who pop into our weekly podcast to help you better understand your body and how it works.

Now, let's get started so we can stay on schedule. Though, if we fall behind, it sounds like we can just blame the thyroid. I'll have to ask Dr. Lashin about that. Welcome to the podcast, Dr. Lashin. Thanks for taking some time out of your busy schedule to come in and talk shop.

Dr. Lashin:

Thank you, John. Glad to be here and thanks for having me on the show.

John Horton:

Well, let's start things off with just a basic question: What is the thyroid? It seems like one of those body parts where people know it's in there somewhere, but they don't really have a firm understanding of what it does.

Dr. Lashin:

Well, the thyroid gland is part of the endocrine system, and the endocrine system is a group of endocrine glands. And to our viewers who do not know what the endocrine system is, it's a group of glands that manufacture and secrete substances called hormones. And those hormones are the body's means of command and control. Those hormones go somewhere else in the body through the bloodstream. They're secreted from these glands directly in the bloodstream and they spread through the body, through the bloodstream, to reach target organs, target cells in specific organs and create a specific action when they reach their target organ.

So there are several hormones in the body and each is tasked to perform a certain function or relay a certain order for a function to be performed.

You can think of it … if you think of the nervous system, the brain and the spinal cord as the wired ordering system, the wired command and control system. The endocrine system is the wireless command and control system, where it sends these proteins that are called hormones to do the job or give the order for something to happen, as opposed to an electrical signal coming from the brain through a wire to relay an order for performing something.

John Horton:

What a great way to explain that. I love the idea of it being a wireless system in your body that's just kind of sending out these commands.

Dr. Lashin:

And it's a nice simple analogy that I usually use when I'm either explaining that to … on the professional level in medical school or to our junior colleagues or even when I'm speaking to my patients in the outpatient clinic and explaining to them their situation or the problem that we're trying to deal with.

So going back to your question about the thyroid. So the thyroid is one of the glands in that vast system of endocrine glands. It plays a specific role, which is secreting mainly one hormone called thyroid hormone. And that thyroid hormone has receptors, or you can say the hormone to a receptor is like a key to a lock. So the hormone is secreted by the thyroid.

It goes to its specific receptor on all the cells of the body and fits inside that receptor to trigger a cascade of events within these cells and tissues that lead that cell or tissue to perform its function at the optimal level. So this is why we always need the right amount of thyroid hormone. We don't want too much, we don't want too little.

Now, where is the thyroid gland? The thyroid gland sits right here in the neck, right behind the knot in my tie. So about … if you feel that your chest bone, there is a notch here above your chest bone, and about an inch above that notch in your chest bone in the lower neck sits a butterfly-shaped small gland that is about maybe 15 grams or 12 grams in normal mass or weight. So in men, it's a little below the Adam's apple, same level in women, and it is where that thyroid hormone comes out of directly in the bloodstream to do its function.

John Horton:

Wow. It's amazing that that hormone, that it's secreting … just, is key to … it sounds like everything in your body. I mean, it's critically important to how everything works and functions.

Dr. Lashin:

It is, and it really dictates … if you think about, we have about 3 trillion cells in the body, and if you think of each cell as a small, tiny little factory or an operation that has a specific task to perform, the thyroid hormone really is kind of what dictates the growth and development and rate of production and rate of function in each of these cells. So every cell in the body requires thyroid hormone to function optimally.

John Horton:

That is a lot of locks and keys to keep track of that. I remember my janitor in my elementary school always had that big set of keys, and that puts that the shame.

Dr. Lashin:

Yeah, it's a wonderful system and it's actually one of the things that intrigued me decades ago when I was studying human biology, and I thought, This is the system that I want to understand more and I want to really be working in that field.

John Horton:

So this gland, this tiny gland, just sounds amazing with what it can do and what it does for our body. So why does it get blamed for so much?

Dr. Lashin:

Yeah, because as we mentioned, thyroid hormone is important for optimal function of the body in general, and it affects almost every cell in the body with nonspecific symptoms. Usually, as human beings, we usually look for one solution to relieve all our ailments. So somebody who wakes up one morning tired, has a headache, their back hurts, their joint hurts, they don't feel like doing anything today, all are nonspecific symptoms and all can happen from an abnormal thyroid hormone level. But the majority of time, it is not related to the thyroid hormone level. It's just the usual fatigue from life, if you will. I would say nonspecific symptoms … if you are married and you have a job and you have children, you will have all these nonspecific symptoms.

John Horton:

Yeah, I'm pretty sure I was tired for 25 years. I just blamed the kids. I didn't realize I could have just blamed my thyroid.

Dr. Lashin:

Yeah. So the problem is thyroid disorders and consequently, abnormal thyroid hormone levels due to thyroid dysfunction can present in nonspecific symptoms that can be similar to certain symptoms that you would get normally from day-to-day living without a medical problem. So when somebody has that going on for a while, they are struggling. One of the main things that they think of and they go online and read about, what could that be? The first thing that pops up, sometimes, is that it may be your thyroid.

John Horton:

Yeah.

Dr. Lashin:

It may very well be, but until you look into that, the chances are not that high, as much as people think.

John Horton:

Yeah, Dr. Google tends to send people down rabbit holes, and it sounds like this was one of those cases.

Dr. Lashin:

Yeah. Although sometimes we do appreciate Dr. Google's input in directing our patients to where they should be looking at seeking help. But sometimes, it is misleading, especially when the description of the ailments that the patient is complaining of is vague. So when you say “fatigue,” well, there are several types of fatigue, several reasons, and you can't really narrow it down to just one issue, which is a thyroid issue until you go down the list of possibilities, which actually include several things that are way more common than a thyroid condition that would cause fatigue, for example. So I don't want to bash Dr. Google, but sometimes, it misleads; sometimes, it is useful.

John Horton:

Well, let me ask you this, since so many of these symptoms are common, and like you said, it could be any number of things, including a thyroid sort of issue — how common is it that somebody actually has a thyroid problem when they have some of these problems?

Dr. Lashin:

Well, to be honest, it's hard to conclude from the presenting symptoms. So because most of the presenting symptoms, as I mentioned, are nonspecific and can happen due to other conditions, even conditions that do not involve actually a medical problem. For example, somebody who finished running a marathon is tired. There's no doubt in my mind that they would be tired and they would be tired for a few days, maybe even a week or two until they fully recovered from running the marathon. That doesn't mean they have a medical problem. But at the same time, most endocrine disorders are gradual and persistent and progressive. So when I see that, that raises a red flag.

And then the second thing is when you have an endocrine disorder, in this example, a thyroid disorder, there are investigations that you would do that can easily define whether the manifestations that are nonspecific are related to a thyroid dysfunction or not.

And third, if you have a problem that is related to the thyroid not working well, meaning it's overperforming, producing too much hormone or underperforming, producing too little hormone, the manifestations of that resolve once you normalize the hormone level. So anything that doesn't resolve when you have a normal thyroid level, or normalized thyroid level, probably is not related to the thyroid.

John Horton:

And as far as numbers of cases, what are we looking at in the United States, even worldwide?

Dr. Lashin:

So it depends on which category of thyroid disorders you're talking about. So in general, somebody I would say, in the United States, for example, the recent estimates of structural thyroid disease, meaning somebody has a lump in their thyroid, it puts half the population in the view here. So we're talking about 1 in every 2 people have a thyroid abnormality. If we ultrasound the whole country, the 300 and some million people, half of them will have a thyroid abnormality on ultrasound. That doesn't mean that all these abnormalities need medical attention. As a matter of fact, the majority of thyroid nodules we see in 95 or 96% of them are just benign blemishes of the thyroid, if you will. They're not something that would affect somebody's health.

John Horton:

Yeah, we're not all perfect. So it comes down to that.

Dr. Lashin:

Yeah, yeah. And if you're talking about functional problems, like a problem with how the thyroid works rather than the structure of the gland, it's less common than having a lump or a nodule. But I would say, in the United States, that reportedly, we're talking about somewhere between 20 and 40 million people with thyroid disorders. But that figure is probably underreported because there are so many people who may have mild thyroid disease or thyroid disease that is not manifesting as really profound symptoms that led them to the healthcare professionals to get checked, and, consequently, they're living with it without knowing about it.

John Horton:

Well, now let's get into some of the issues that often get linked to thyroid disease, starting with a lack of energy, which I know you brought up a little earlier. Can thyroid issues really just steal someone's zip?

Dr. Lashin:

Yes, and it can happen both ways, although many people think, If my thyroid is sluggish, lazy, underactive, I'm going to have fatigue. But if my thyroid is overactive, producing too much thyroid hormone, I'm going to be full of energy. I'm going to be jumping out of my seat, I'm going to be doing everything I need to do throughout the day. In three hours, I'm going to sit back and relax the rest of the day. But the reality is, an underactive thyroid or an overactive thyroid, meaning producing too much thyroid hormone or too little thyroid hormone, both can cause fatigue, but different forms of fatigue.

John Horton:

Yeah, it sounds like with the one, if it speeds it up, you crash. It sounds like you're revved up and then you just kind of inevitably slow down.

Dr. Lashin:

Well, with an overactive thyroid — and that would require another show, John, so we'll have to talk about an overactive underactive thyroid in a different show — but just to be brief this time, yeah, if you have too much thyroid hormone, then you're basically asking all your cells and all your organs to work overtime and they'll get exhausted and you'll be like that marathon runner without running a marathon. That's the type of fatigue that you will be suffering from. And add to that, that excess thyroid hormone is not going to make you sleep, it's going to make you wired. You're not going to have a nice restful sleep at the end of the day, so you'll wake up the following day even more tired. So excess thyroid hormone is not that great either.

An underactive thyroid producing less than the body's needs of thyroid hormone will also have a different consequence. Still, the person will feel tired, but a different form of fatigue. They will be … all their body systems are going to slow down. And that gives us a clue when we're assessing our patients with an underactive thyroid because it's affecting different body systems. So it's never just fatigue. There are other things going on that we ask about and look for that can give us clues that that fatigue may be due to a thyroid disorder.

John Horton:

Well, in looking things up on the whole blame-game thing with everything that the thyroid gets accused of causing, I also saw where some link it to acne. Can your thyroid really cause zits?

Dr. Lashin:

Well, as the skin is, by the way, the biggest organ of the body, it has many cells and all these cells have thyroid hormone receptors. So if those cells are not functioning normally or optimally, because there is thyroid dysfunction leading to abnormal levels of thyroid hormone, they will suffer. And consequently, the skin is not going to have the normal metabolism growth and development in its tissues to maintain its normal function. That affects many aspects of the skin function, including its ability to prevent these skin lesions and acne and stuff like that. In addition, changes in thyroid hormone, in endocrinology, we always see hormone stocks.

So when an endocrine gland producing a certain hormone in an abnormal amount, that leads to another hormonal issue elsewhere, and that can lead to changes also in other hormones that can affect the skin in a different way, such as sex hormones, testosterone in men and estrogen in women. And those hormones are known to play a role in the development of acne as well. So it's a multifactorial issue that can be related just to the abnormality in thyroid hormone, but can also involve the effect of abnormal thyroid hormone on other hormones in the body that can affect the skin negatively.

John Horton:

Well, really starting to see why the thyroid gets accused of causing so many of these issues. It's just so interlinked. Another one that I saw, too, was hair loss. And it seems like the finger gets pointed at the thyroid for that, too. Is that accurate?

Dr. Lashin:

Well, John, you've touched on a very hairy subject, and as you can tell, I'm no expert, but when it comes to hair loss, there is a majority of complex reasons for hair loss. And the reasons in men are different than reasons in women. Most of the patients that I see in clinical practice who are complaining of some degree of hair loss, and they attribute it to the thyroid, are understandably females. Men do not really get bothered if they're losing some hair, although some of us do. I don't fall in that category. But the usual hair loss that females see is rarely related to a thyroid condition. And the reason I'm saying that is the thyroid hormone level has to be quite abnormal, to the point where it's causing a multitude of other manifestations before it causes or be the reason for a specific type of hair loss.

And as I mentioned before, an abnormal thyroid hormone level, whether it's too high or too low, can cause problems. In this situation, too high of a thyroid hormone can cause some hair loss and too little. Thyroid hormone can also cause some hair loss for different reasons. But the effect on the hair follicle is, at the end, a negative effect that leads to some hair thinning. But there are way, way more common reasons for hair loss than a thyroid condition. So I wouldn't begin by blaming the thyroid for the hair loss before excluding the other possibilities.

John Horton:

All right, well, that's one that sounds like we can sort of left it … let it off the hook, but not completely. There's a whole laundry list of things that the thyroid is accused of. So let's just do a few quick answer-style and run through them. I saw where the thyroid is accused of making you feel cold, true or false?

Dr. Lashin:

It's not a black-and-white answer because it is, to an extent, true, if your thyroid condition is severe and it has been undiagnosed for a while and it hasn't been treated. And it's mainly related to the fact that you do not have enough thyroid hormone in your system to keep your metabolic rate at the optimal level of energy production. So your core body temperature is getting low, and consequently, as your body tries to maintain your core body temperature, it minimizes heat loss as much as possible. It causes other vascular changes that would make you feel cold all the time, even in the summer. But it's not the usual reason for people feeling cold because that same person, they would be in a situation where the weather is actually warm outside and they wouldn't be feeling cold. They are cold in certain situations, but that's not a thyroid-related sense of feeling cold. It really needs a severe form of hypothyroidism to be feeling cold all the time because of a thyroid reason. So I would look first at other causes of why you're feeling cold.

John Horton:

What about weight gain? I see that's another thing that the thyroid is occasionally accused of.

Dr. Lashin:

Yeah, it can and it can be a factor. It is almost never the only factor. There are usually … because weight gain is also a complex condition.

John Horton:

There's a lot, I know we've had podcasts on that. There's so much that factors into that. So it sounds like it could be a potential cause, but probably not the leading one.

Dr. Lashin:

Yeah, the nice thing about thyroid condition that it’s suspected of causing or being part of the process of gradually gaining weight, it's easy to exclude. You do a blood test and you find out if the thyroid hormone levels are optimal or not. If it's optimal, then it's not a factor to worry about this, you got to worry about other factors.

John Horton:

What about, let's go through a few more of them, depression. Can thyroid problems lead to that?

Dr. Lashin:

In some individuals, it can. And the opposite also is true. So people with an underactive thyroid have low thyroid hormone levels in their system, and it can contribute to low mood and depression, although by itself, it is never the only factor. The person has maybe been predisposed for it or there's something else going on from a mental health standpoint that the thyroid can exacerbate having a low thyroid hormone level. Also, high thyroid hormone levels can lead to exacerbation of another spectrum of mental health disorders, such as psychosis and so forth. So another reason why the thyroid hormone level has to be optimal.

John Horton:

What about … I saw a lower libido sometimes gets tied to thyroid problems.

Dr. Lashin:

Yeah, and as I mentioned before, hormones talk. So when the thyroid hormone level is abnormal, it affects … it can affect sex hormones and, consequently, it can lead to low sex drive.

John Horton:

What about everyone's always worried about their ticker? So if you have an issue with your thyroid, can it affect your heart rate or cause some heart problems?

Dr. Lashin:

Yeah, and the heart is like any other tissue in the body, has cells that has thyroid hormone receptors and it requires optimal level of thyroid hormones to function appropriately, and too much thyroid hormone would make the heart work overtime. You don't want your heart to work overtime. It's already working overtime. So that can cause maybe more risk of having heart arrhythmias and stuff like that if the thyroid hormone level is high.

Also, thyroid hormone levels that are low have a negative effect on the function of the thyroid muscle or the, I mean, I'm sorry, the heart muscle. And if it's severe enough, it can cause fluid buildup around the heart and stuff like that. So it has another set of negative effects on how the heart works. So the heart would appreciate having an optimal thyroid level.

John Horton:

All right. And since my producers aren't listening here, when I fall behind on a podcast, can I blame my thyroid for any issues that kind of come up or word stumbles?

Dr. Lashin:

Well, it's up to your producers, but I would not blame the thyroid in that situation.

John Horton:

Oh, come on, Dr. Lashin, I was hoping for an out there. Well, in all seriousness here, after hearing everything you just said, it does seem like the thyroid can sometimes be behind certain issues, and that's kind of the big caveat here. So what should folks do if they have some of these symptoms or these bodily issues that we've been talking about and they suspect it's a thyroid problem? What's the first step that you should take?

Dr. Lashin:

Well, if you do suspect a thyroid problem, or for that matter, any medical problem, you should visit your primary care doctor, have a physical exam and have what we call preliminary screening tests. We have great tools at our disposal at the moment in measuring many things in our body, including hormone levels and electrolyte levels and stuff like that.

Also, the questions and the history that your healthcare professional is going to ask you and get answers from you is going to give them broader information to not just diagnose a thyroid condition when it's there, but also to populate the list of the set of possibilities that could be the reason for your ailment. If a thyroid issue is excluded, because we see, OK, we're not doubting that you are going through something, but is it related to the thyroid, for example, or not? That is to be proven. And if it's disproven, we still have to go to other possibilities. So I would generally begin by visiting the primary care physician, getting a physical exam and getting just preliminary screening tests.

John Horton:

And what kind of screening tests do you get? Is that just like a simple blood test and you can see if there's some issues going on?

Dr. Lashin:

Yeah, we have very accurate thyroid tests, which is a simple blood draw. It gets run in the lab. We get the results in 24 hours, and if there is a thyroid problem, it will show on the test. It may not say, or it may not define what the problem is, but it will indicate that there is a thyroid problem. So at least we will check off step one that it is the thyroid. Then, we can move to step two to define what is it that is ailing the thyroid. What is it that is making it dysfunctional, and how can we manage it and improve the condition.

John Horton:

So to kind of wrap things up, Dr. Lashin, how suspicious should somebody be about their thyroid when they experience any of these health issues that we've been talking about? It seems like sometimes, we might be a little too quick to blame that internal butterfly.

Dr. Lashin:

Yeah, and it's hard. Everybody's threshold of concern about a medical problem is different, but I would say if you feel a global change in your body in general, I wouldn't think the direction of the thyroid being a reason unless there is a global change. If I have one symptom like, I feel tired or I have a headache or my joint is aching or I'm constipated, or even if I have some degree of a racing heart, but it's only one symptom that I'm experiencing and it's not a global change in how I feel every day, then I think the likelihood that it is a thyroid condition is low, but it's not off the table as a possibility.

So you still need to go through that investigational route of seeing your primary care physician, making sure everything is right. I commonly advise my family members, my friends, my colleagues, people who I know, do not dismiss anything. Even if it's small, look into it. If it's nothing, great, it's nothing. But if it's something that, then you've discovered it early — and discovering medical issues early and dealing with them early is way better than waiting until it's really a complex situation and you're trying to solve it.

John Horton:

Dr. Lashin, that seems to sum it up perfectly. So thank you for shedding some light on the thyroid for us and really kind of explaining how it affects so much that is happening within our body.

Dr. Lashin:

Thank you, John, for having me, and it's always a pleasure. Thanks.

John Horton:

All right. Look forward to having you back.

The thyroid gets blamed for a lot of health issues, and let's be honest here, it's a legitimate suspect. But while it might be the cause of certain symptoms, it's no guarantee. Talk to your healthcare provider about getting thyroid tests if you have concerns.

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Speaker 3:

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