Thyroid disease: Symptoms to look for [Music playing] [Text on screen: Ohio State Health & Discovery Health Talks] Gail Hogan: Thyroid disease can cause any number of symptoms. Dr. Jennifer Sipos is here to share what to look for and why. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: Dr. Sipos, there are two kinds of thyroid disease, as you explained to me. What are the two types of thyroid disease? [Music fades] [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: So there's generally the disorders of anatomic dysfunction, and so we think about thyroid nodules and cancers, and those fall into the anatomic category. And then the biochemical category, where the thyroid isn't working properly and we think about hypo and hyperthyroidism or underactive thyroid or overactive thyroid disorders. Gail Hogan: So there's different types of disorders from the thyroid? Jennifer Sipos, MD: Yes, ma'am. Gail Hogan: Where is a thyroid? I know this is going to sound... Because if I remember, it's small. Jennifer Sipos, MD: Yes, ma'am. It's about 15 grams or the size of a ketchup packet, and it lives in your neck, at the base of your neck, at the top of your chest. Gail Hogan: And what does it do? Jennifer Sipos, MD: So it has a lot of important roles in metabolism. It controls how fast your heart beats, how fast your gut moves, your temperature regulation, your overall metabolic rate, your ability to concentrate. So it has its hands in a lot of different things. Gail Hogan: It really does a lot for the body, even though it's such a small little, I wouldn't say organ, but- Jennifer Sipos, MD: Gland. Gail Hogan: Gland, yeah. When you talk about some of these disorders, how do people know if they have problems with their thyroid? And I suppose with the two different disorders, there'd be different symptoms. [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: Yes, ma'am. Absolutely. So with anatomic disorders, patients may notice a bulge in their neck, in the lower part of their neck, in the front side, or a primary care provider or a dentist may feel something on a routine physical examination. Sometimes if the nodule's particularly big, patients may notice some issues with swallowing or compressive symptoms, like feeling like they're being choked. Occasionally, patients can have some hoarseness if the mass is particularly large. Gail Hogan: How often is it diagnosed? Jennifer Sipos, MD: So if you go looking for thyroid disorders, particularly anatomic disorders, it's extremely common. So up to 60% to 70% of people might have thyroid nodules as they age. They become more common as we get older. And so if we go looking for them with ultrasounds or other imaging modalities, we will find them. Fortunately, most folks don't have any issues that need those to be detected, so we don't go looking for them or do screening tests to try to identify them for the majority of people. If someone's having symptoms or something is detected on examination or someone feels something themselves as a patient, then we'll go and do further investigation with imaging, particularly ultrasound of the neck. Gail Hogan: So that's for the physical part. What about the part of the thyroid where people just notice changes in their body? [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: Right. So with the anatomic issues, they may not notice anything outside of the neck particularly, but for the biochemical bucket of disorders, patients may notice if they're underactive, everything kind of slows down. So they may feel cold where they used to not feel cold and tolerant. They're always wanting to have blankets or wear sweatshirts when they normally wouldn't do that. They may have a difficult time with concentrating. Constipation. Their heartbeat might be a little slow, or they may notice some puffiness or swelling just in general. When the thyroid is overactive, it's like everything gets turned up. So patients feel anxious, jumpy, jittery. Their heart might be racing. They can get short of breath with minimal exertion and they may notice some weakness in their muscles, in particular the muscles of their forearms or their thighs. Gail Hogan: It sounds like there are so many different symptoms, it might be hard to detect. [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: Yes. And the symptoms often are nonspecific, meaning if somebody presents with fatigue, which is common in both over or underactive thyroid disorders, there's thousands of things that can cause fatigue, but that may be the only symptom that patients present who have a thyroid dysfunction. Gail Hogan: When people have a disorder, either biological or physical, why is it important for folks to seek out expert care at Ohio State? Jennifer Sipos, MD: Because it could be a thyroid disorder or it could be some other condition, and so finding someone who can sort through some of those details and order the appropriate tests is very important to be able to begin the journey to starting to feel better and to fix the underlying problem. Gail Hogan: Even if it's not thyroid, you can direct them in that. Jennifer Sipos, MD: Absolutely, yeah. And I think it's fair to think about the thyroid with a lot of various conditions that patients may present with, because the thyroid does have, as you said, such a diverse number of roles that it plays. Gail Hogan: Are there certain ages or certain sex that are more vulnerable to any... Either physical or biological? [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: So generally speaking, women are more prone to having thyroid disorders, particularly over or underactive thyroid disorders, but women are also probably more likely to have thyroid nodules as well. There's a slight increase in prevalence in women compared to men for nodular disorders and cancers. Gail Hogan: Age have anything to do with this? Jennifer Sipos, MD: For sure. So depending on the underlying cause of the thyroid problem, so in anatomic disorders as we get older, we're more likely to develop nodules. And with the functional disorders, generally speaking, these are autoimmune disorders, so they tend to be predisposed to women, and women in their 20s to 50s are more likely to have that. Gail Hogan: Oh, really? That young? Jennifer Sipos, MD: Yes, ma'am. [Text on screen: Gail Hogan Host Health Talks] Gail Hogan: Can you explain what kind of research is going on in this area? [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: There's a ton of research going on in the thyroid arena. And in our institution in particular, we have a very strong interest and a very strong program for thyroid disorders, both benign nodules and cancer. We have a number of clinical trials with different agents, depending on the type of thyroid cancer that a patient has, so we have at any given time three or four clinical trials with various drugs to address different types of aggressive thyroid cancers. Gail Hogan: So just out of curiosity, if you have thyroid cancer, you can't remove the thyroid? Is that the idea, is to keep it so that it can still function? [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: So when patients have thyroid cancer, we do most of the time remove the thyroid. There are a few exceptions to that. One, if it looks like it's a particularly low-risk cancer, we are now offering observational trials of just watching those cancers rather than removing them, because the majority of those cancers do not go on to become more aggressive. If we look for thyroid cancers with screening ultrasounds, we can find that up to one in 10 patients in the United States have thyroid cancer, but they die with it, not from it. With such a high prevalence of cancer and so few people getting really aggressive disease, we're now offering observational trials. So that's some of the clinical investigation piece of thyroid cancer. [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: It's similar to prostate, where patients have prostate cancer and we just watch them. We're a few years behind that research, but those studies are ongoing. So those folks who have less aggressive disease, we may not remove their thyroid. We may watch them very carefully to make sure the disease isn't progressing. And if it does, then we remove it. Then the other group of patients for whom we don't always remove the thyroid is those who have much more aggressive disease that it's critical that we get in front of it without having to wait for the healing time from a surgery. That fortunately is less common, but there are occasions where we have to do that. So for the majority of patients with thyroid cancer, they undergo usually, some component of their thyroid is removed, whether it's half or all of it. So that's the primary treatment, and then we have additional therapies with radioactive iodine, which targets thyroid cells. It's like a targeted chemotherapy just for thyroid cells. And most patients respond very well to that, but if they don't and their disease continues to progress, that's when we start to use these clinical trials. Gail Hogan: If there's only part of the thyroid, can it function? [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: Yes. So now, we are doing more and more surgeries with saving some thyroid tissue and doing half of a thyroidectomy, taking out just half of the thyroid, leaving the other half intact. That reduces complications. It reduces the likelihood to need thyroid hormone medication postoperatively. But if you do need medication, it's like a supplement. It's just to give you a little bit more than what your thyroid is able to make by itself. So if you get all of your thyroid removed, then you will need a supplement and a thyroid hormone supplement, or levothyroxine. But if you only take out half, it's about a 50/50 chance you'll need medication. Gail Hogan: So if you have thyroid problems, why is it important for someone to come to some place like Ohio State? [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: So we have a really strong program here that involves a multidisciplinary clinic, where we have our surgeons, our endocrinologists, our oncologists, our geneticists all in the same space sharing and collaborating and working across the hall to help all of these same patients all in one center. And these experts are world-class specialists in their respective fields. We're all doing research together, working together to come up with a common solution for these complicated cases of thyroid cancer and talking about these cases collaboratively in various settings in our clinics and in tumor boards and creating ideas and networking for various research projects and opportunities to continue to expand the science and the understanding of what leads to these cancers. Gail Hogan: So it's not just one doctor treating someone. It's a group of physicians, researchers. [Music playing] [Text on screen: Jennifer Sipos, MD Endocrinologist OSUCCC - James] Jennifer Sipos, MD: It is absolutely. And we work very closely together, and so when we communicate with each other regularly so the patient doesn't have to worry about transitions in care from the endocrinologist to the surgeon to anyone else involved in their care, it's a seamless process. It's all in one area, and I think that improves the patient's experience and outcomes. And all of us have a tremendous amount of experience in just treating patients with thyroid disorders, so I think that that allows for a better opportunity for good outcomes for our patients. [Text on screen: Ohio State Health & Discovery Health Talks health.osu.edu] [Music fades]