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Scott Benner 0:00
Hello friends, welcome to episode 624 of the Juicebox Podcast.

Today's episode is the third in the defining thyroid series. And today Jenny Smith and I will be talking about TSH testing. The defining thyroid series will be a short but important series of information about living with thyroid disease, also about how to identify it, test it, get your doctor to take you seriously how to get the medication, right, and all kinds of other stuff. It's possible that thyroid is going to come up in your life with type one. And knowing what to do if it happens is a big deal. Wasted diagnosis time is wasted lifetime. 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. We're 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 juicebox 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. Start here just TSH testing right is this is described here is the first line of testing for hypothyroidism. Your doctor will measure your thyroid stimulating hormone, which is TSH levels with a blood test. TSH is secreted by the pituitary gland to stimulate thyroid hormone. If Ts, if TSH levels are too high, you will likely be diagnosed with hypothyroidism. Now, this is where people get confused. Yeah, and they get screwed a little too, because, you know, I'm gonna I'm gonna drop this story here a little real quickly. After my wife had Arden, she started having a ton of symptoms of hypothyroidism,

Jennifer Smith, CDE 3:24
and pretty common post pregnancy. And it got

Scott Benner 3:27
worse and worse. And she'd go to doctors. And as it was happening to her, she was also gaining weight. And so she'd go to a doctor, the doctor would hear her, you know, I have, you know, trouble sleeping, I'm not rested, I feel you know, my hair's falling out like this stuff. I'm gaining a bunch of weight. And the doctors would tell her, I feel terrible, but they would over and over again they go, we'll lose weight, and we'll see what happens. So she'd go home and kill herself trying to lose weight, but she couldn't because her thyroid wasn't working. Now, her tests would come back elevated, but not out of range, quote unquote, like not out of range. And so no doctor ever would offer her the medication. Now we're, you know, we were smart enough to figure out that this is what Kelly had. But we're younger, and we just couldn't get someone to do it. Right. So one day we were in the we just started doctor shopping at that point. Yeah. And we're in an office one day, and the guy looks at her and says you should try losing weight. And I looked him in the face and she punched you know, I know I honest that she was still calm. One of the one of the symptoms that that Kelly had when she was untreated was that she was kind of nasty. Like, I don't know another way to put it. And I looked at the doctor and I said listen, I don't know anything about this, but this medication that treats hypothyroidism can it hurt her if she doesn't have hypothyroidism. And he goes, and not really. And I was like, well then give it to her. And let's see what happens. Right? Like, I mean, we'll just use it for a month, you know, and just find out, right? Two weeks later, I've said, you know, privately to my wife, like, she was like the person I remembered again. Yeah. And it was bad. Like, I had dug a hole out back in case I had to, you know, get rid of her. She was she was becoming really, really

Jennifer Smith, CDE 5:28
know that we joke all the time. So clearly,

Scott Benner 5:31
there's no real hole. But I mean, like it was, it was to the point where I was like, I don't know, like what to do for this person? Yeah, like, she was just unreasonable. She wasn't

Jennifer Smith, CDE 5:41
herself. Really, the attitude that was there was relative to a hormone that was,

Scott Benner 5:46
yeah. Yeah, you know, and this is an aside, but we, at that time, knew, you know, our kids were younger, and Arden used to, like play, like some sport where we'd all to get, you know, parents would get together on the weekends. And I'm, you know, I'm not making this up. There was one mom, who was just known around town to be, like, nasty, and it was nasty. Like, she was a mean, lady, you know. And years later, we bumped into her somewhere, and she just wasn't. And my was so obvious that someone said, hey, you know, you look great. What's going on? And she said, I'll I found out, I had hypothyroidism, and I'm treating it now. And I'm telling you, different person, and we got in the car, and I was like, that's what happened to you.

Jennifer Smith, CDE 6:39
You are a mean person.

Scott Benner 6:41
And not all the time and sometimes just out of nowhere, and I don't, you know, I mean, listen, I don't understand everything that the thyroid controls, but

Jennifer Smith, CDE 6:50
that was mood is definitely one of them. Yeah,

Scott Benner 6:53
no kidding. Because it struck my son the same way when he got Hashimotos to, like, he was like, we were like, What is that's what God has to test them was just his personality seemed to shift them anyway. So okay, so the TSH Test is super simple, right? You get a blood test, you're going to come back, but the next step is when your TSH which we'll let's talk about here, thyroid stimulating hormone, the hormone produced by the pituitary gland that stimulates the thyroid gland to inhibit or release hormones, you're going to get that back in a range? Correct? Under two, they're going to call normal. Correct. Right.

Jennifer Smith, CDE 7:34
And in some cases under two and a half, they're considering that normal? Yes, I misspoke. Okay. Yeah, usually above like, point 4.5. Potentially all the way up to like a four or a five range may be considered normal. There are some ages and some timeframes like pregnancy, first trimester under 2.5. Second and third trimester under three years, kind of what's looked at in terms of, you know, management goals for those age can make a difference, because as you age, TSH increases with age. So there are some different says in, I guess what it brings in is the need to individualize as we're already used to doing with diabetes. So thyroid needs to be individualized to

Scott Benner 8:30
Yeah, I listen, I'm clearly not a doctor. But if you asked me privately, I will tell you that if you have symptoms of hypothyroidism, I don't care if that test comes back. 345678 like you make someone give you, you know, the, I mean, I mean, it is a drug, but it's a little hormone replacement. It's like not a big deal. It's the tiniest little pill, and make somebody give it to you because because these problems become cumulative. And they can get they can get heavier on your on your body after time. You know what I mean? It's not It's no joke, right?

Jennifer Smith, CDE 9:08
Yes. And some, as you mentioned, in terms of that range, and you went forward, especially with your symptoms, you know, with your wife. If your TSH looks normal, but you have symptoms, you're not crazy, right? Your range may very well not be what is preferred by your body. So it's always important to like always step out and say, Hey, I am feeling this way, despite these levels looking this way. And you know, then another step could definitely be things like the antibody testing and things like looking at T four T three, three, T four, three, T T three, all of those can be additional steps in looking further

Scott Benner 9:53
and if you have if you have Hashimotos and they can, they can, you know, look at your thoughts roid or touch your thyroid and see that, then the number they're not going to argue so much about it usually just happens to those people who just have hypothyroidism. And you know, I'm just gonna say this here, and I don't mean for it to be, you know, I don't want to be harsh, but I think it's pretty, pretty well known that doctors can ignore women's health concerns. A lot of time. Absolutely. Yeah. So,

Jennifer Smith, CDE 10:27
I mean, it's a big reason that even in type one, diabetes is considered management strategy, whether you're male or female, and that we know that that's not the case. Yeah, females have different management needs they do. So

Scott Benner 10:42
I just think that it's simple. I mean, you see, even with, you know, it's a bias you see with with diabetes, too, right? If an adult goes in to an endos office and has elevated blood sugars, they look them up and down. And if you look thin and fit, then you're type one, you know, if you if you look heavy, oh, then you're type two, these things have nothing to do with whether you're type one or type two.

Jennifer Smith, CDE 11:06
Right? Yeah. And sometimes often, it's even the opposite. Regardless of how you look, they don't even look at you. It's just you got elevated levels, your type two, because you're an adult,

Scott Benner 11:16
yeah, you're certain age. And that's it, you're certain age, there's a lot of human biases that exist. And I think that my, my wife, by way of an example was, was hit with them when she was trying to because she's taller, and curvy to begin with. And so Oh, you're gaining weight, eat less, exercise more, you know, like, and then you start thinking, why did you start a new job? I sit at a desk a lot, maybe it is, and that's the thing, we you said, like, don't think you're crazy. Because like, you start thinking, like, well, maybe I'm wrong. But, you know, my wife had a ton of symptoms, like it was obvious to anybody what was wrong with her right. And, you know, just nobody did anything for

Jennifer Smith, CDE 11:59
you. I think the bigger picture there too, is while you bring in some of the things like oh, I sit at a desk, and, you know, maybe it is that I'm not very active. But if that hasn't changed, and you have these symptoms, your body has changed. You haven't changed your eating habits. It's not like you're going, you know, to some donut shop every single day and you weren't doing it before, and now you're gaining weight will clearly stop eating the donuts then. But, you know, if you haven't, and you've got all these symptoms, there's a problem that needs to be addressed. Because you haven't shifted anything.

Scott Benner 12:30
I'll tell you right now, with hindsight, I look back, Kelly had Arden and then suddenly got skinny, like, which just was not her vibe ever. Like she was just always kind of like she kind of like a classic American Girl look like if that makes sense. And suddenly, she was thin in places. And now I realized, I mean, as we talk about these, you know, these episodes, she probably it came on, she got hyper first, then then the inflammation took over and she got hypo and that

Jennifer Smith, CDE 13:01
is exactly what happened to my mom, right after my brother was born. Really? Yes, she had all of those. I mean, she had the like, she had the like goiter she had the like, eyes were like, you know, much more pronounced. And they did. I mean, they did a what was at that point, it was like an iodine burnout. It was like a thyroid burnout. And now she has, she takes a typical levothyroxine. And so she's technically got hypo thyroid now, because of earlier, what was hyper? So

Scott Benner 13:36
just for kicks, does your brother have any autoimmune diseases?

Jennifer Smith, CDE 13:42
So interestingly, he has the same issue with his parathyroid that my dad's sister has. And so that's the autoimmune disorder that he drew the straw for, I guess, in which, you know, they, they manage that very interestingly and very differently, and he's got to take interest, just he doesn't have diabetes and doesn't take an injection for anything like that. But he takes a daily injection of a medication that helps to manage the problems with his parathyroid hormone. So

Scott Benner 14:24
in another episode, we will go over this parathyroid gland because that was the first like, when when Cole was diagnosed with as he was being diagnosed with Hashimotos. The doctor thought they saw something on his parathyroid. And we were starting to talk about having his parathyroid removed. And it was very scary for a minute, like, you know, yes.

Jennifer Smith, CDE 14:47
And they try really hard not to remove the whole parathyroid. My brother actually had that done and that's the reason he's on this really expensive medication. When he got a second opinion to the Mayo Clinic, they're like, I don't know why this was done, blah, blah, blah. There's a whole bunch of mess of management for that. So

Scott Benner 15:08
yeah, okay, so we'll get into that. We'll dig into that in another episode. Okay, so I'm dizzy now about thyroid stuff. So we so the TSH testing is a simple blood test. I'll tell you that once you're, once you know that you have hypo hyperthyroidism, Graves' disease, whatever. The next thing to really be clear about is to keep up with the testing, you should get blood work done. I mean, in the beginning, it's pretty frequently like until that so they can dial the medication. And But afterwards, I don't know how, how frequently do you think somebody who's well maintained should still be checking those levels,

Jennifer Smith, CDE 15:44
I would expect every six to at least six months to at least a year should be checked. I mean, I because of my family history of thyroid disorder, and also having type one myself, I get them checked just once a year myself. My mom typically gets them checked about every six months, but she's also you know, over 65. So she does a lot of other type of but if you're managed well, the dose is working for you. And you don't have a return of symptoms. Right? Then testing at least once a year I would expect is probably the baseline.

Scott Benner 16:20
It's also important like my son actually just yesterday, it's so weird how things line up when I'm recording this podcast, he came to me and he said, Hey, I have to send an email to the doctor. He goes, I'm grinding my teeth, which could be a side effect of some of the medication. Oh, so he's think is so it's what he's saying is I think I got to get a blood test to see if my TSH is too low. And we have to back this medicine off a little bit.

Jennifer Smith, CDE 16:43
Yeah. And how adult of him to make that decision on his own.

Scott Benner 16:49
Good job. I was actually gonna, like, tell him again, I'm proud of him for paying attention. Because yeah, that's the next thing is very much like diabetes. I'm sad to say you're not going to get a thyroid problem. Take a pill one day and just forever. Never think of the fact that you're gonna write. I mean, it doesn't

Jennifer Smith, CDE 17:08
involve the micromanagement day to day considerations that diabetes does. But it is always something that in the background again. You should be paying attention to your body awareness.

Scott Benner 17:22
Yeah. Alright, so we did TSH testing, thyroid stimulating hormone, TSH, which is a word you're going to hear a lot if you have it. You want to do t 43. Next. Sure. All right.

Thanks so much for listening today. Please stop back frequently 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's 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 in large 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 when 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, where excessive sleepiness hypothyroidism in children and teens may indicate with poor 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 or 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, or warm or moist skin. Weight loss despite normal eating habits, enlarged thyroid gland change and 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. I want to thank you so much for listening and remind you again to please go to T one D exchange.org. Forward slash juicebox. If you're a US resident who has type one, or you're a US resident who is the caregiver of someone with type one, your quick and easy answers that are HIPAA compliant and completely anonymous will be of great value to people living with type one diabetes. It will take you fewer than 10 minutes at T one D exchange.org. Forward slash juicebox to make a huge difference in someone else's life. And you'll be supporting the podcast. Thanks so much again for listening. I'll be back very soon with another episode of The Juicebox Podcast