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Scott Benner 0:00
Hello friends, welcome to episode 616 of the Juicebox Podcast.

In 2019, The Endocrine Society said that thyroid dysfunction diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorder in patients with diabetes, and vice versa. It is with that in mind, and in the spirit of the defining diabetes episodes. This is the first in a series with Jenny Smith and I, where we will define the terms that you need to understand to deal with thyroid dysfunction. And please, if you're thinking right now, I don't have any problem with my thyroid. Just listen to them anyway, because some of the symptoms mask themselves as normal everyday maladies. Just please listen, they're just a couple of minutes long and you might need them down the road if you don't need them today. It's important. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin.

If you're a US resident who has type one diabetes, or is the caregiver for someone who has type one, you could take the survey AT T one D exchange.org. Forward slash juice box in fewer than 10 minutes. When you do this, it will be completely anonymous. They will be HIPAA compliant, you will be helping people with type one diabetes, and you will be supporting the podcast T one D exchange.org. Forward slash juicebox. If you're looking for the defining diabetes series, they're available in your podcast player or at Juicebox Podcast calm. At that website, you'll also find the diabetes Pro Tip series. Ask Scott and Jenny. The diabetes variables episodes, after dark episodes, algorithm pumping based episodes, how we eat series. It's all right there. It's either in your podcast player, or at juicebox podcast.com. At the end of this episode, and at the end of every defining thyroid episode, I will list the symptoms of hypothyroidism, hyperthyroidism, and Graves disease. I think that one of the episodes of the podcast that I'm very proud of, besides the ones that we've done together is number 413. It's the talking about thyroid disease in general with Dr. But I think I'm proud of it because it's complete and thorough. It's easy to listen to. But moreover, I think this is something that might be happening to a number of people and they don't know, or they don't bother to look into it. Or in the case of a person I met more recently, it was in my private life. I forget we were together somewhere. And this person was like I'm always cold. Bla bla bla, like, you know, she just said it a couple of times next time I saw her. I said, Hey, you said the last time we were together, you said I'm always cold hands and feet. And she goes, Yeah, my whole body. Sometimes they said, Do you have trouble getting arrested? And she said, Yeah, and I'm like, no matter how much you're asleep, you just never feel rested. She goes right, right. And I said, Listen, you know, I don't want to be the bearer of bad news. But I think you have hypothyroidism. And a simple blood test would tell you if this is the case. And if it is, you would take this tiny little like hormone replacement, you know, and you'd feel significantly better. And the vibe I got from her was weird. It was there's nothing wrong with me. I'm not sick. I don't, I'm not gonna do this. Right. I thought I felt very sad. Because I mean, three of the four people in my house, take a thyroid medication in the morning, or in the evening, with the case of one of them. It's not a big deal. And it's significantly helps them and I thought I wonder how many people just think, like, I'm older now. That's why I or you know, my life is hard. That's why I can't get rested. And I mean, right, so many people with you know, autoimmune disease, listen to this podcast. I wanted to take a chunk out of the time that I have for people and make sure that they understand, you know, a thyroid condition so that maybe they'll think to take care of it for themselves. Well, and it's

Jennifer Smith, CDE 4:41
really applicable in terms of autoimmune thyroid disease, it's very applicable. If you live with any autoimmune disorder, you are more likely to potentially have another one. Right, right. So and thyroid disorder and type one are very common. commonly linked together. So, again, I think you're also right on the I don't know how many people are undiagnosed, that really depending on what their levels come back like, and or if they're even being tested, right. And you might glance sort of mentioned something in a visit with your doctor. And unless they catch that, or like this person who's talking to you, it says it a couple of times, it may be completely dismissed.

Scott Benner 5:30
If I wasn't me, and this wasn't my job, I wouldn't have, I would have just thought that girl's hands get cold. You know, you don't I mean, like, it never occurred to me. And I think to that. The other problem is that even if you have seen this happen, I was once helping a woman with her child who was in the hospital. So her kid was in the hospital, she had the kid had type one. And she was trying to figure out the insulin because the hospital just wasn't like helping and things were getting worse and worse. Sure. And while we were talking, it became clear to me that the mom, you know, something happened, it was about insulin usage. And I said, does she have Hashimotos? Or, or hypothyroidism? She's like, I'm gonna ask them to test. And they did. And then during the conversation, she said to me, you know, all that stuff you described to me, I feel that way, too. Ah, and I was like, okay, and then she tested and she sent me an email months later and said, I, you know, I have it too. And I'm taking thyroid replacement now. And I was like, you know, I just wonder, I don't know, it's such a simple thing, because then, you know, she got it sorted for herself. But you know, she had trouble with a child, when the child was in the hospital because of the whole, you're in range problem, where you when they they measure your TSH, and then you're like, some, some institutions, if you're not over 1010, they won't give you medication, they'll start me know, maybe around eight, but in this one to 10 testing, you know, zone. We found that my son had significant medical issues when his TSH was over two. And so interesting. Yeah. And so

Jennifer Smith, CDE 7:13
as the reference ranges, much wider, the reference ranges between like point four and like five, depending on what doctor you're talking to, and what you know, lab did the results and gave you the normal range and everything so

Scott Benner 7:27
well. Well, Dr. BENITO manages, but the people in my family to keep their TSH under two. And it's a and they're not hyper. And see now here's the thing, we've been talking for three minutes, we've used words like hyperthyroid, hypo thyroid, Hashimotos, you know, all this stuff, but you know, thyroid replacing hormones, I want people to understand what they are. Right. So my what my hope is that these episodes will be short, digestible, and either make people think, ooh, I might have that, or my kid might have that. Or if they know they have it. I hope it helps them believe. Maybe I'm not being medicated correctly, because I still have some of these symptoms. So I appreciate you doing this with me. Cool. Yeah. Well, where should we start? If you like?

Jennifer Smith, CDE 8:14
Ah, well, I think I mean, if we started with just the list and went down, did you you didn't. I was gonna say, I was gonna ask if you actually like alphabetize these

Scott Benner 8:26
I believe they were in alphabetical order, but I just moved them around. I started sorting them and putting them together. Like for instance, I put, you know, Hashimotos and hypothyroidism together. Right, I started putting TSH and thyroid storm THX testing and thyroid stimulating hormone I put together that kind of thing. So I mean, I'm just trying to think of it functionally for people listening, like what do they want to know? First, we just define Hashimotos. And hyperthyroidism may be in one episode. Sure. Does that make sense? Yeah. Okay, now, I'm going to leave this in so people can recognize.

Jennifer Smith, CDE 9:05
Recognize that we don't pre plan any discussions, right?

Scott Benner 9:08
It's pretty much like a road rally race, like we just got in the car, like we're supposed to go to California.

Unknown Speaker 9:14
Okay, where where's the map? Let's

Scott Benner 9:16
figure it out. So why don't we just start with, you know, the idea that Hashimotos thyroiditis and hypothyroidism while they will, are not necessarily the same thing, and we might even be hammering through some of my understanding. So let's start with hypothyroidism. Tell me what it is.

Jennifer Smith, CDE 9:36
Well, it's essentially a condition where the thyroid doesn't make enough thyroid hormone, right? I mean, that's the easiest definition of hypo thyroid. And so we need a certain level of thyroid hormone to essentially maintain sort of metabolic things in our body, right. They play important roles in weight. temperature management and how strong you are and how you feel energy levels and all of that. So

Scott Benner 10:06
it is hypothyroidism and Hashimotos two different things or does Hashimotos create hypothyroidism?

Jennifer Smith, CDE 10:18
It's kind of like a chicken in the egg right? Well, you know, antibodies tests can be done to determine the hypothyroid like definition. You know, the, the condition right? Hashimoto is is relative to an antibody or an autoimmune disorder. Okay. Whereas hypothyroidism without from what I understand without the antibodies present, hypo thyroid isn't Hashimoto.

Scott Benner 10:51
So a person can have hypothyroidism but not have an autoimmune disease. Yes. Okay. All right. But but if you have Hashimotos, well, let's let's define Hashimotos thyroiditis, then, like I have it as inflammation of the thyroid gland described by Dr. Hashimoto, it is the it is the most common cause of hyper hypothyroidism.

Jennifer Smith, CDE 11:14
Correct. And it's actually eight times more common in from what I remember eight times more common in women than in men.

Scott Benner 11:22
And it's one of those things that anecdotally, from talking to people. So I do this thing, I hope people don't get bored by it. But when I interview somebody, we're not talking about something specific. I always ask about auto immune in their family. And you'll be surprised how many people go no, no, no, there's no auto immune of my family. You go celiac hypothyroidism. And they go, Oh, yeah. And then the more you name, they're like, oh, wait, and then you find out there's 345 autoimmune diseases and their family happens a lot. Yes. You know, so I like to bring it up, because I'm trying to get a I'm trying to make the podcast a repository, you know, for for information. And I think that the one of them that comes up the most it's got to be it's a horse race between celiac and thyroid hypothyroid. Yeah, yes. You know, it's what I hear most from people. So hot. So Hashimotos. And again, go to Episode 413. To get a really deep dive on it. Dr. BENITO will explain it very, very thoroughly. But like, for instance, my wife has hypothyroidism. My son has Hashimotos. Okay, my daughter has type one diabetes, and hypothyroidism. My son has Hashimotos and no other issues, and no other issues. I mean, wow, I should knock on 19 pieces of wood. But, but

Jennifer Smith, CDE 12:51
my desk is made of wood on that guy.

Scott Benner 12:53
I appreciate it. And, and so my son's thyroid was immense imaged, I guess, MRI. And

Jennifer Smith, CDE 13:05
yeah, they do a kind of a scan and or a deeper imaging with dye and Yes, right.

Scott Benner 13:10
And she found some nodules on his, on his thyroid. At his age, I think we figured it out when he was about 21.

Jennifer Smith, CDE 13:19
Well, could she feel the nodules? Or could he feel them as well? Because often, I mean, from an endo standpoint, those with type one, which I know your son doesn't have, but from a standpoint of evaluation, they should be checking that low level in the throat and having you swallow. That's a first more visual sign that something is going on.

Scott Benner 13:41
And I'm just smiling because that happened, but it happened over zoom because of COVID.

Jennifer Smith, CDE 13:47
Oh, yeah. So there was no touching there.

Scott Benner 13:51
He was turning his head and doing weird things and jamming his face up to the camera and, you know, that kind of stuff. But yeah, so. Okay, so Hashimotos disease, when the immune system attacks the butterfly shaped gland of the neck, which is your thyroid, initially, inflammation of the thyroid causes a leak resulting in excess thyroid hormone, so you could get hyper thyroid ism for a little over time the inflammation prevents the thyroid from producing enough hormone hypothyroidism symptoms can include, I'll put all the symptoms I'm gonna put the symptoms in every episode, so we won't have to hear okay, so I I'm still, I'm very much more you know what, this is good news. I've always been a little like I'm not sure. And now I feel very clear. Hypothyroidism could come up in your life without you having an autoimmune disease. Correct. But you

Jennifer Smith, CDE 14:49
know, Hashimoto is is the most common form of hypo thyroid. Yes, but

Scott Benner 14:54
if you have Hashimotos thyroiditis, you're going to you you will then have hypo thyroid All right isn't at some point. Yes. Okay. We did that. That's good. Right? Cool. Yeah. See, see this disease. Jenny and I are just gonna jump right to the next thing. Maybe I won't even edit out all of our banter in the middle. I'll just when they pick up the next week, they'll hear us just go to the next thing.

Unknown Speaker 15:18
Be like those crazy people frequently

Scott Benner 15:26
for more episodes of The Juicebox Podcast and to continue with the defining thyroid series. If you like Jenny, she's for hire. You can find her at integrated diabetes.com She helps people with their type one diabetes, she really good at it. So if you're enjoying the Juicebox Podcast, and you're listening in an app, but you're not subscribed or following, please hit subscribe and follow on that app. And don't forget to tell a friend. Hey, if you find the podcast on YouTube, we started putting up animated versions of the defining diabetes series. They're really cute, great for kids. Very visual. Go find it. Alright, now let's go through the symptoms. We will start with hypothyroidism. Hypothyroidism signs and symptoms may include fatigue, increased sensitivity to cold, constipation, dry skin, weight gain, puffy face hoarseness, muscle weakness, elevated blood cholesterol level, muscle aches, tenderness and stiffness, pain stiffness or swelling and your joints heavier than normal or irregular menstrual periods. thinning hair slow heart rate depression impaired memory enlarged thyroid gland. In infants you're looking for a yellowing of the skin and whites of the eyes which is commonly called jaundice. In most cases this occurs when a baby's liver can't metabolize a substance called bilirubin, which normally forms in the body recycles old or damaged red blood cells. You also might see a larger protruding tongue, difficulty breathing, hoarse crying, or an umbilical hernia. As progression happens in infants, you may move on to constipation, poor muscle tone, or excessive sleepiness. Hypothyroidism in children and teens may indicate with por growth, resulting in a short stature, delayed development of permanent teeth, delayed puberty, poor mental development. That list is from the Mayo Clinic. Let's move on now to hyperthyroidism. This list is from the Cleveland Clinic. Hyperthyroidism may present with rapid heartbeat are palpitations, feeling shaky and or nervous weight loss, increased appetite, diarrhea and more frequent bowel movements, vision changes, thin warm and moist skin menstrual changes, intolerance to heat and excessive sweating, sleep issues, swelling and enlargement of the neck from an enlarged thyroid gland. Hair loss and change in hair texture. It would get brittle bulging of the eyes as seen with Graves disease and muscle weakness. Okay, back to the Mayo Clinic for Graves disease, you're looking for anxiety and irritability. A fine tremor of the hands or fingers heat sensitivity and an increase in perspiration where warm or moist skin weight loss despite normal eating habits, enlarged thyroid gland change in menstrual cycle erectile dysfunction or reduced libido. frequent bowel movements, bulging eyes, fatigue, thick red skin usually on the shins or tops of the feet. Rapid or irregular heartbeat palpitations, sleep disturbance. If you your child or someone you love has any of these symptoms, please seek medical attention. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.