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Scott Benner 0:00
Hello friends, and welcome to episode 628 of the Juicebox Podcast.

Today is the fourth in the defining thyroid series. And today Jenny Smith and I will be talking about T three and T four. 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. Want to do t 43? Next? Sure. All right. Okay, Jenny, my wife has explained this to me 16 different times. I had Dr. BENITO explained it to me once. And I'm still confused by it. So I'm not sure how much help I'm gonna be here. But when you have hypothyroidism most doctors are just going to test your T for and you're free to wait, right? See, am I right? And All right, hold on thyroxin t for the primary hormone produced and secreted by the thyroid gland. In treating hypothyroidism manmade forms of T four are the standard method along with T three, T four controls your body's metabolism. If you don't have enough of them, then your metabolism slows down. In essence, T three and T four are in charge of how your body uses energy. Correct, but most people are just on a T for replacement.

Jennifer Smith, CDE 3:41
Well, T four is really that's where potentially based on where your levels go after you start using some type of hormone you know, replacement therapy, therapy right? Or some assistive medication right. Essentially, T four is the storage form of the active version of thyroid hormone you want to get to and so it needs to be converted into T three to get used. Right? Okay. So, three, T four is a more active form of just T four. And then once activated, this is like the baseline like in a nutshell, right? I'm certainly not a hormone therapy specialist, but right and then it has to move to be sort of T four. And the second hormone that's essentially you know, created and put out by the thyroid gland again regulation by TSH, which is being put out by your pituitary gland, right.

Scott Benner 4:52
So free a free T four test is a measure of the level of free T four in your bloodstream. This test is complimentary is a complimentary test to TSH if you're, if you're free T four levels are too low. It's a strong indicator that you have hypothyroidism. So let me let me see if I understand a little bit. Your body makes T four, and then from T four, it derives T three. Is that fair? That's fair. Yes. So T four is crude oil. T three is gasoline. Yeah, there you go. Okay.

Jennifer Smith, CDE 5:27
All right. That's a good yes.

Scott Benner 5:29
I don't put this to a picture. I'm never going to understand because you're being clear. And I'm like, my brains going. Oh, Scott, You're a dummy. You don't understand. I can hear her talking to me. So okay, so yeah, so. So you make

Jennifer Smith, CDE 5:44
and also, I guess, one another with the T for specifically, it's a good one to get a check if you're symptomatic, but your TSH is showing normal. Okay, an additional to check if it hadn't been checked at the same time would be a T four.

Scott Benner 6:02
Okay, that's good to bring up here. I am going to get that information real quick. So a thyroid panel. Right. So you can get a thyroid test. Even have at home tests, by the way, but fun. I didn't know that. Yeah. thyroid stimulating hormone TSH, free thyroxin, which is free tea for right Give me learning. And then well, I don't know this one free trial. Dr. Ryan, Holy God,

Jennifer Smith, CDE 6:35
three days just call it T three T's much easier.

Scott Benner 6:39
So that would be a thyroid test. But you could get a thyroid antibody test these are you know, which is free thyroxin free T three thyroid stimulating hormone. And then I actually know this one thyroid globulin antibodies, thyroid para oxidase. Yeah, antibodies. Right. So

Jennifer Smith, CDE 7:00
and that one is really specific. Hashimotos.

Scott Benner 7:03
Okay. But I think my point was, is that don't just let the doctor send out for your TSH and nothing else. No, right. At least correct. Yeah. Okay.

Jennifer Smith, CDE 7:13
I would say especially then now, I always, I mean, knowing what I know, obviously, from a clinical standpoint, I still always ask for those along with a TSH, even though I don't have any diagnose that, you know, thyroid disorder whatsoever. I still want to know that where TSH is, where are my T three and T four because also, if I ever did have a movement towards symptoms, I have a baseline of this is where I was, this is where these have moved to now and I am symptomatic. So clearly something is not right.

Scott Benner 7:51
Okay. All right. So, okay, so now, let's, let's say, we'll give a definition for T three here. Sir, that long word that I don't know. triode daugther. Okay, I'm not saying that T three. The second hormone produced by the thyroid gland is more active than thyroxin, which is T four. But most medications from hypothyroidism do not include T three. It says then kind of in quotes here, your body can make T three from T four and taking for a loan is usually sufficient to achieve normal thyroid function. Along with T four, T three controls your body's metabolism. If you don't have enough of them, then your metabolism slows down. In essence, T three and T four are in charge of how your body uses energy. Now, correct. Interesting. My wife used to take T four and T three. And it was very valuable for her but eventually gave her like heart palpitations. Oh, yeah. So she had to get off of it. Yeah, I'm wondering which I mentioned in another episode, my son said, I might have mentioned this one where he's grinding his teeth. I'm wondering if they're not going to take away a little bit because my son takes so our doctors a bit of a she's an outside of the box thinker. So my son takes here Osint which is a T for replacement. Very clean T for replacement. It's Yes, che and he takes Armour Thyroid. Oh, yeah, the more I think that's derived from a pig,

Jennifer Smith, CDE 9:26
like more natural version. Yes, exactly.

Scott Benner 9:29
And I'm wondering if she's going to adjust it around a little bit. So this one because I'm because I'm not following? Well, this one's a little like scattered but your body makes T four, T three. When you have hypothyroidism your doctor is likely going to replace your T four with a medication. I'm going to give you a couple of like it's Synthroid I think Synthroid is pretty much the most

Jennifer Smith, CDE 9:56
correct and armor I've actually heard a lot more in probably the past five years, I've heard more people using the armor.

Scott Benner 10:04
Yeah, you might you most commonly might see it this there's a synthetic form of of the, you know of the, of the hormone like we're just saying that armor or natural but you might you might see a called Synthroid, which I think is so named a name brand, you'll probably more often see it as Levo thyroxin. Think is the combat it's that's the actual molecule name, I believe, right?

Jennifer Smith, CDE 10:30
Yeah, it's, yeah, it's essentially Synthroid. Yeah, it's just that, yeah,

Scott Benner 10:34
I can tell you that Synthroid works for my wife, but the generic of Synthroid doesn't.

Jennifer Smith, CDE 10:41
And that's a really important piece, too. I mean, there are lots in terms of talking about those hormones, and then the replacement therapy meds for them. Because there's a whole bunch about the medication, that's really important to pay attention to for yourself, like you just brought up. If you've been using the brand named product, and you switch over and something doesn't feel right. To go back, something's not right, and that you might even need to have your prescriber write the order as no substitutions on the prescription, please prescribe only this brand, this dose, etc. I mean, that also goes into like, how to take the medication, foods that might interact with the medication. I mean, there's a lot with the thyroid meds, you can't

Scott Benner 11:33
take your right and we're going to do we'll do an episode probably at the end of this where we just talk about how to take the medication, cool time of day, what you can't take around it, you know, there's,

Jennifer Smith, CDE 11:45
yes, there's a list. Ready, get your notebook out.

Scott Benner 11:51
Vitamins, you can't take at the same time, you know, like all kinds of stuff and

Jennifer Smith, CDE 11:54
how many hours between taking the vitamins and things? I mean, it's

Scott Benner 11:58
Yeah, yeah, it's um, it's really something. Nothing else fits with this one, right? I don't think so. No. Okay. So we did teeth for T three.

Jennifer Smith, CDE 12:13
On my list here,

Scott Benner 12:14
we're doing really well. I'm very proud of us. Because, you know, we'll get the thyroid. I don't think we have enough time to do thyroid hormone replacement right here. I'm looking for something that fits in the time you have left. We could do antibodies, which I think this, I think they deserve their own.

Alright, now I feel like we've given away that we record these in big bunches. But hey, Jenny, I was hoping today that I was hoping today that we could define antibodies in general and around thyroid disease. So I'll read

Jennifer Smith, CDE 13:03
you how to read the definition. Yeah, sure.

Scott Benner 13:05
Why not? proteins produced by your body's immune system that attack invaders such as a virus. However, antibodies may also mistakenly attack healthy tissue. When it when antibodies attack the thyroid, it can stunt thyroid hormone production, this may result in hypothyroidism. So I think everyone listening who has type one diabetes, if you don't know, this is what happened to you. And you have type one now, right? So these so antibodies are, I mean, what's it? What's a simple way to think of it so that, you know, make it cartoonish for me so I can follow?

Jennifer Smith, CDE 13:46
Make it cartoonish? Um, it's like an invader, right? Okay. So if you think about an antibody, it's essentially something that your body produces to attack the invader. Okay. So you're, it's like calling out the troops, right? They're sitting and just like playing cards and doing whatever. And then they're like, oh, my gosh, they've got this strange looking blob floating around in the body, we have to take care of this, right? But sometimes, it's, your body gets overboard, right, especially with autoimmune disorder, and those, it doesn't know when to stop that sort of attack on what it sees as a foreign body and in somebody with autoimmune disorder. Unfortunately, that foreign body isn't really foreign. It's a part of your body that's supposed to be there such as the beta cells or such as, you know, different parts of the thyroid gland, etc. So,

Scott Benner 14:46
so these antibodies are a good thing. Until they get confused, or supercharged maybe by

Jennifer Smith, CDE 14:54
supercharged Yes, they've had way too much Red Bull or whatever is the newest thing.

Scott Benner 14:59
All right, so I think I so I understand so. So an antibody is Superman, right? Until all of a sudden it turns into that like creepy version of Superman. What was that called? Oh,

Jennifer Smith, CDE 15:14
he was like the bizarro world. His

Scott Benner 15:16
name was good. Yes, Jedi. Thank you.

Jennifer Smith, CDE 15:18
Well, you know, I do have two little boys as well. They love the superheroes.

Scott Benner 15:23
Really well done. Yank that right out of your S.

Jennifer Smith, CDE 15:31
Let me do get the superhero comic books from the library. And we read them many times. Okay,

Scott Benner 15:37
well, that's obviously stuck in your head, because I couldn't think of it. I could picture in my head. I couldn't come up with a name. So okay, so generally speaking, my antibodies are a good thing. Get a little. Yeah, correct. Right? Yes,

Jennifer Smith, CDE 15:49
there we want. I mean, that's obviously also how our body deals with attack from typical viruses, right? You build up an antibody. And then if your body encounters that, again, essentially, it's supposed to be able to manage it either better, or it manages it, and you never actually get symptomatic.

Scott Benner 16:06
Yeah. But yeah, sometimes things go crazy, especially if you have autoimmune disease. And these antibodies will do the wrong thing. So you know, just because we're here right now. And it's such a super simple thing, but I bet you we've never said it out loud. It's the antibodies in the in, in the situation of type one diabetes, they actually go after the beta cells in your pancreas like this, I think people just think of the pancreas is being

Jennifer Smith, CDE 16:32
a pancreas is not dead, just because you have type one diabetes,

Scott Benner 16:35
it actually still does things that are very important. They're actually alpha cells also in the pancreas, look at them. So it left them alone. It just went and got the beta cells takes care of the beta cells. And there are people to who I mean, there's researchers that believe that the beta cells aren't destroyed as much as they're frozen in inflammation. The Have you ever heard people talking about it that way? I've not

Jennifer Smith, CDE 16:57
I've not heard it talked about that way. Although I have. I mean, even years ago, when I was working endocranial in DC, there were tests that were being done on people with 20 plus years with type one diabetes. And what they were finding is that their what's called C, C peptide levels, were actually not nothing. Your C peptide levels are nothing essentially means that no, you no longer have any assisted beta cell action happening in the body. But many of those tested actually did have a small level of continued insulin secretion from the betas that are left essentially working in the body. The problem being the auto immune system continues over time to identify those as foreign bodies. Right, right.

Scott Benner 17:48
They don't just come in and attack once though. They keep coming back. If you know, if the beta cells relight their campfire, they're like, oh, no, no, no. There we come again. I got it. So anybody's little invaders. Are there actually do attack the invaders nearby, they're there to attack the invaders sometimes get confused and attack the good stuff. So just think of antibodies as Superman until you have an autoimmune disease when they become bizarro? There.

Jennifer Smith, CDE 18:16
We call that the bizarro episode,

Scott Benner 18:19
if I hear anyone in the diabetes community refer to that like this. I'm going to assume that you and I did that. So I have never heard anyone talk about it that way before my life so. Alright. Well, Jenny, thank you very much for doing this.

Jennifer Smith, CDE 18:31
Absolutely. Bizarre was planted a square by the way, if you didn't know that either. Sounds like it'll let you know.

Scott Benner 18:37
Is it really? Yes. All right. I'll look that up. Hold on a second. Thank you very much. I appreciate this very much. Thank you. Yes. Cool. So we got through a good

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 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 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, or 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 changing 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 juice box 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.