Full Transcripts

Hello everyone and welcome to episode 413 of the Juicebox Podcast. On today's show, I have Dr. Addy Benito. And he's gonna share so much information today about thyroid disease, you're going to just understand it front and back by the time you're done. If you're living with type one diabetes, and don't currently have thyroid disease, I still think this episode has a lot to offer you. Please remember 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. Dr. BENITO is board certified in endocrinology, diabetes and metabolism. And he attended medical school in Spain and completed a residency in internal medicine at Pennsylvania Hospital at the University of Pennsylvania health system, and a fellowship in endocrinology, diabetes and metabolism at the University of Pennsylvania. She has also completed a two year fellowship in Integrative Medicine at the University of Arizona Center of Excellence in integrative medicine, where she is a guest faculty member, and has developed the curriculum for an integrative endocrinology module, which has been incorporated to the fellowship this episode of The Juicebox Podcast is sponsored by the Omni pod tubeless insulin pump, you can get yourself a free no obligation demo of the Omni pod today by going to my Omni pod.com Ford slash juice box. And to learn more about the Dexcom G six continuous glucose monitor, go to dexcom.com Ford slash juice box become acquainted with the great work that's done at touched by type one at their website on Facebook or Instagram touched by type one.org

My name is Avi Benito, I am an endocrinologist and I in particular practice what are called integrative endocrinology, which is using hormones as well as nutrition, herbs, botanicals and supplements. I studied herbal medicine, as well as integrative medicine. And that's that's what a practice. All right now, I found you because my daughter was diagnosed with hypothyroidism a number of years ago. And people who listen to the podcast knows she's had other ailments like just joint soreness and things like that. So we have tried to thoughtfully break Arden down into segments and go through them slowly and try to pick through them because I found that when you try to go with everything at the same time, it gets confusing, right there's you never know if if the success or failure seeing is anecdotal or if you're misunderstanding where it's coming from. So we obviously I mean the podcast is wrapped around using it. So when we first figured that out, Arden's a onesies been five, two to six for about six years now. She eats whatever, you know, she we don't limit her, her nutrition to get her to that. Which might mean like yesterday, Arden had a pretty big salad for dinner and the day before she had a waffle. So she'd survived a wide variety of foods. But our first run in Well, before we knew you was she got her she started with Synthroid, she got Synthroid, all of her symptoms went away and art and symptoms by the way, when when we figured out she had hypothyroidism was she basically couldn't hold her head up anymore. It was just like she was on a dimmer and someone was turning her down slowly and she just didn't have the energy to come back up again. The Synthroid brought her right back.

Yeah. So when she started having these joint issues, we thought, oh, it's because she's growing so quickly. And then she stopped growing. And that didn't end up being it. And, you know, then you kind of go back to your endocrinologist that handles the diabetes, like maybe you know, is the thyroid medication not right. I hear from a lot of people that it's more of a science, it's more of an art than a science and, and no, no, it's fine. Her labs look good, which was always the answer, right? She's in range, right?

And then a person who listens to the show, who I've had come a little friendly with Vicki said to me one day that her thyroid issue was always a mess until she started to think outside of the box and she told me that the way she did that was to Find a Doctor Who would be more thoughtful and holistic about it. And that idea led us to finding you. So I told people, I was gonna ask you to come on the show, and I know I sent you the questions and they asked a ton of questions, but I think before we get to them, and maybe like you said in your note, possibly a lot of these questions are going to get answered while you're speaking. Can you can you please just do what you do? Explain hypothyroidism, hyperthyroidism? Hashimotos this whole thing that no one seems to understand.

Yeah. So, if you think of thyroid, thyroid disorders, the most common are those of thyroid function. So this function of the thyroid and that includes both hypo low thyroid and hyper high thyroid. So within dos hypo is more common hypo low thyroid is more common than hyper thyroidism. In the whole world, when we talk about hypothyroidism, the most likely cause is Iodine deficiency in the entire world. Now in the US, because we still are considered iodine sufficient, meaning we still have enough iodine in our diets in general, the most likely cause of hypothyroidism is autoimmune thyroid disease. And that is Hashimotos thyroiditis. The second most likely cause is actually radiation, both external beam radiation so when we you would have you had cancer or your neck or lymphoma, but also radioactive iodine, which patients with hyperthyroidism actually are treated with many, many times. So within the realm of owning immune, thyroid disease, hyperthyroidism is one aspect hyper is the other. So premium thyroid disease encompasses both Hashimotos thyroiditis and Graves disease. Hashimotos thyroiditis tends to cause hypothyroidism. Graves disease always causes hyperthyroidism, until later on in the disease, or because of the treatment, you can end up with hypothyroidism. There are some patients who have Hashimotos thyroiditis, who will develop hyperthyroidism, and we call that Hashi. toxicosis, toxicosis meaning just too much. So, autoimmune thyroid disease, like any other autoimmune condition, is partly genetic and partly environmental. Off the genes that cause autoimmune thyroid disease, we've have really advanced tremendously. And if you look at the genes that actually are linked between autoimmune thyroid disease and type one diabetes, there are many common genes. And that's why actually, those two conditions happened in clusters in families to have one member with type one diabetes, and a different member of the family with autoimmune thyroid disease. If you think of the risk of autoimmune thyroid disease in the general population is close to 10%. If you have a relative with type one diabetes, that risk is 48%. Much higher.

That's almost almost.

Yeah. And if you yourself have type one diabetes, the risk of having autoimmune thyroid disease is 50%. And if you have autoimmune thyroid disease, the risk of developing clinical disease so the hypo or hyper is also 50%. So think of for people with type one diabetes, two of them will have autoimmune thyroid disease, one out of the four will develop clinical thyroid disease. Now, autoimmune thyroid disease, usually is characterized by antibodies. So again, this protein that your body makes, usually to defend yourself, but in the case of autoimmunity is sort of like attacking your own body. Right? So antibodies are sort of the hallmark of autoimmune thyroid disease. However, there is up to 20% of people with Hashimotos who don't have antibodies. So not having antibodies doesn't mean you don't have holding your thyroid disease. But if you have the antibodies is a marker for autoimmune thyroid disease. So finding them is helpful. Not finding them not that helpful.

That makes your job interesting.

It does. Yeah. Because then you have to think, Am I seeing autoimmune thyroid disease that is not showing with the antibodies? And sometimes I'm gonna use an ultrasound to tell me that or am I seeing nutritional deficiency? So are you then deficiency and maybe iron which is a cofactor? For iodine in the production of thyroid hormone?

Yeah. I have to say that, given that I'm beginning to understand why most people can't seem to get to a resolution that is valuable, completely valuable for them, because having worked with you for Arden and for Kelly, the entire intensity of our interaction in time and and information and there not being large gaps in between when we spoke I found to be it was exciting actually, because I felt like this was the I felt like my our interaction with you was sort of like other people's interaction with a podcast in that it wasn't, I'll go to the Endo, they'll test my agency, I'll make some adjustments come back in three months notice nothing happened. Try again two years later, my a Wednesday, still seven and a half. It was the intensity and the ability to get to you more directly, because you have a an uncommon practice if you're a completely private practice, right? So, like, we paid you in cash, like you don't take insurance. But with that comes the ability to send you an email, which is lovely, because then there's no big gaps, and you can move along kind of quickly. I guess my question to you is, why is what you know, so difficult to find? When the issue is so common?

It's a good question. I don't really know the answer, to be honest. I mean, I practice I was part of Penn for me, I turned up pen, and then I worked a pen. And I have to tell you that when I worked up pen, yeah, we usually with somebody with hypo or hyperthyroidism, we assume that it's autoimmune. We don't tend to test for antibodies. I don't even remember testing people for other autoimmune conditions, which now is part of my routine practice. If I find somebody with autoimmune thyroid disease, even with that type one diabetes, I will be screened those patients for celiac as well as for something called autoimmune gastritis, which can lead to low iron lb 12. And many times, it's actually the cause of their symptoms, not to disarm himself. So you have to think of the person in its entirety. It's not just one aspect, especially when you're thinking about immunity. Because it can affect many parts of your of your body. And if you're like,

I don't know how much of the history of this disease that you're aware of, I'm assuming more than me. So I'm going to ask, How is this becoming more common as time goes on? Or is it? Or is it just we're noticing it now? No,

no. So even type one diabetes, we're finding that is, you know, people are calling that an epidemic in the 21st century. And you would think, you know, when we talk about autoimmune conditions, we're talking about genes, but we're talking about environment, there's a complex interaction between genes and the environment. Now, the genes don't change that quickly. You know, in just 100 years, the genes are not going to change that are going to make somebody have more likely to have type one diabetes, and, you know, 100 years ago, so there's something in the environment that we are, we're not, we're not sure what it is, you know, it can tell you that we definitely think of viruses, we think of bacteria as triggering those genes to sort of manifest and cause the conditions. We, for in the case of the thyroid, having too much iodine, we know is a risk factor for developing both autoimmune thyroid disease. And for developing hypothyroidism, maybe you have Hashimotos. So just making sure that you don't take any one supplement from the store just because it says iodine, and you think it's good for you. Now, it's a little hard to overdose with, you know, food. So you don't have to worry about whether you're eating too much fish or shrimp or you know, normally that's not going to happen is more with sampling. So it's that complex interaction between the environment and the genes, and we're still trying to understand, we've made some advances in the genes, we don't really understand what in the environment is causing people to develop more autoimmune diseases? I would bet that there's a lot of endocrine disrupting chemicals we call them. So these chemicals in the environment that disrupt how hormones work, that probably have a role in this increased prevalence of autoimmune conditions. But

it builds you imagine it builds over generations, not just like, my mom used Tupperware, so my daughter has diabetes, like, yes, okay. No, no,

he actually goes, Yeah, you can see that transgenerational, you can see that so you actually see in there's definitely studies in the grandmothers that use these Teflon pans. So this coated pans, the nonstick ones, and then their granddaughters developing it. I mean, these obviously, so they actually go through generations. Wow, that's, that's the really difficult piece about this endocrine disrupting chemicals is not just what you're exposed to is what your grandparents might have been exposed to. And that it transmits to you. Have

you tried to make a ridiculous example to make a different point you're like, No, that's

right. Yeah, you're, you're onto something. Okay.

All right. So but it is it is that is it more prevalent here? Because I guess that makes sense. And if it's more prevalent in the US the auto immune piece of this, it's probably because we're more quote unquote advanced and things like, like you just said, like a nonstick pan or I mean, should people be throwing their nonstick pans away? Do you own an ounce Like, man is my question.

I don't know. I don't know. I don't know. I don't I actually think people should throw my way. I think, yeah, I think you can use other pans that are nonstick. Yeah.

I did that with. It's funny, like, like, 10 or so years ago, I just said to Kelly, I'm like, I'm getting rid of all these nonstick pans. I'm just gonna buy like, just regular, you know, stainless steel pans. And she's like, but I like them because they don't stick and I'm like, I don't care. I'm like, well wash them. It'll be okay. You know, like, it just it. And I don't know why I didn't know anything. When I did it. It was really just a feeling like, you know, your daughter gets type one diabetes. All right. Well, I guess let me start thinking about how people live before this happened all the time, you know, and try to go backwards a little bit anyway. Alright, so obviously, the people listening to the podcast are into the, you know, in the sweet spot for, for this issue as well. And I'm hard pressed to know, you know, anybody who doesn't have type one diabetes, who doesn't also have another autoimmune issue. It's not always thyroidism but different different issues with their thyroid, but when people are diagnosed with type one, it's sometimes the very first time they realize that there's autoimmune problems in their family line. It's one of the questions I asked every time I talked to somebody I'm like, you know, were you the first one. And oh, yeah, I was definitely the first one. Nobody has celiac. Oh, well, my grandmother does have celiac. Oh, like and then you start finding you can see it, you know, but anyway, when it becomes obvious to them that there's an issue. They start becoming more hyper aware of other things, they start paying attention. So what are the kind of telltale signs that people should be looking for if their thyroids on its way out?

So what do you notice with Arden is pretty common lack of growth. So that's pretty typical, both actually in Taiwan, or even with that type one diabetes, kids who have thyroid disease will not grow. So that's pretty common. If you have a child with type one diabetes, in addition to not growing, they actually may develop more hypoglycemic episodes. Hypoglycemia is a big one. And that's really that's a pretty big one for almost any other autoimmune condition, which is celiac, whether it's Addison's disease, which is the lack of adrenal hormone, thyroid, actually both even hyperthyroidism sometimes can cause hypoglycemia. It can also goes into the ketoacidosis part. But so hypoglycemia, when before you had a child that was well controlled silently with the same, you know, whatever you're using is causing hypoglycemia using more episodes. That should be a sign that something is not quite right. Either your kid is not absorbing glucose well from their gut, and there's some gut issue like celiac or autoimmune gastritis, or your metabolism has changed and metabolism is affected by thyroid. Wow.

Okay. All right. So now, here comes the issue, right? I noticed that I go to the doctor, hey, I was listening to a podcast. These people told me that if this was happening, it might be thyroid. My kids seems to fit the bill. I fit the bill. And I test and then the doctor comes back and says, No, I'm sorry, you're in range. Now, we knew what to do when Arden was tested, quote, unquote, in range and had symptoms but we only knew because my poor wife went untreated for I think, seven years, while while honestly while hypothyroidism ravaged my wife, it really it just it just really decimated her. We would go to doctors say look, he she has all the obvious signs of this. They test her and say she's in range. It's not that it was was honestly one day in an office. We were so desperate. I wouldn't say I threatened the doctor. But what I said what I said was Will the medicine hurt her if she doesn't have hypothyroidism? And he said no. And I'm like, well, then for God's sakes, give it to her. You know, and I'm not going to I there's no reason to over exaggerate between four days in a week, turned back into the person I know. It was it was really, really fascinating. But some of the stuff that happened to her she just she's having trouble like still to this day rebounding from, but because of that experience, when the doctor said no Arden's and range, I said I don't care. Give her Synthroid and boom, she came right back. But not most people. Most people aren't asking like me, I guess is what I'm saying is they're not gonna sit there and just be like, No, I don't care. Because that's a real problem, that white coat problem, right, like people won't stand up, they won't push back. What do you use? Like if you were a doctor in that position? What argument would get you to think all right, I will say these people and try this.

So the first one I will look for is goiter with a personal had a good or an enlarged thyroid gland that to me will be a sign that the body's really trying to do something they can't. Right so you think of a goiter. The theory has become enlarged and there's a reason for that either. You don't have enough iodine. You don't have enough thyroid hormone. Something is going on. If you have a history of autoimmunity, if you have either autoimmune thyroid disease already, you already have antibodies. And I see nothing else, you know, I'm going to be looking at so what I want to make sure when it says somebody who has, as you say, maybe perfectly normal thyroid, and we'll talk about what normal really means. I want to make sure that I'm not missing something else that I could be treated. So whether it's iron deficiency, which I think is very common in women, not just anemia, you don't have to be anemic, to have iron deficiency. And iron deficiency causes many symptoms that you see with hypothyroidism. So brain fog, fatigue, muscle fatigue, ability, hair loss, all this happened with low iron, similar to low thyroid so that I'm going to look for definitely my practice. But then if somebody comes to me, and I've looked at everything, and I don't see anything, I just saw a woman recently who was feeling really not well, she was having joint pains. I actually sent it to a rheumatologist. And he was an autoimmune, rheumatoid condition. And I knew that this woman had Hashimotos, she doesn't have antibodies, but she has the look of autoimmune thyroid on her ultrasound of the thyroid. So when she came up in Toronto, with tears in her eyes, and, you know, she didn't find anything, I said, Let's just give you that reformer, it's not gonna hurt you. I know how to do that. I'm not going to hurt you. Let's see how this works. Let's give your trial there's nothing wrong. Just like with Kelly with your wife, you know, within a few weeks, she was feeling better. So sometimes you have to bite the bullet and say, you know, have we looked elsewhere? And we have and we have no answer. Would it be like you said, Would it be wrong to do thyroid hormone? Would it be wrong? Again, if you know how to treat with our hormone, there's, there's no wrong, there really isn't?

Well, after Arden's big growth spurt, she began to say interesting, I'm kind of telling the story. So people understand how your brain will trick you, she starts having the same symptoms again. But because in my mind, now she's on Synthroid, this must be a new thing. It has nothing to do with a thyroid hormone. I don't know why still, in retrospect, can't figure out why it didn't occur to us that she'd put on so much weight that her dose probably wasn't high enough. But there she was, again, struggling to get out of bed, struggling to make it through the day at school, she'd come home and call, like, I have so many pictures of Arden asleep at a countertop, like sitting in a bench chair, wow. Weighing forward asleep on a piece of stone, you know, which is, you know, just out. And then her blood pressure started to fall. And we went to the doctor. And then the doctor saw the low blood pressure and their mind went right to heart. And now we're spending weeks going to specialists giving art and tests. Maybe she has I forgot one of the things pots maybe or something. They had a raising her legs and doing all this stuff. And it took me a couple of weeks. And I finally said to Kelly, I'm like, this is just the thyroid medication. Like why did we not think of this? So I said to the doctor, well, let's test for this first and check on this. Maybe we should get her down to children's. And I'm like, well, we'll wait a minute. Why don't we just adjust this? No, no, her labs are okay. And so one day I just said I don't care. And I took a bunch of her pills. I didn't know what I was doing. I cut some of them in half. And I started giving her a pill and a half. And in a few days, she was okay. And I called her endocrinologist back before you and I said look, like it or not. This is what I did. She's alright. Now I need a different prescription for. Again, I don't think that's something most people would do. But I don't think you're right. I just have this. And it's the diabetes. I think I've been trained by having a child so young with type one diabetes in another medical area where people don't give you a ton of good actionable advice, right? So it just has come to me and I'm like, Look, I'm not waiting anymore. Like I'm not I just I took everything I knew when I thought I'm not going to hurt her. I'll give her a tiny bit more. She pepped up. Now it's really important after that to like find out, you got to get labs done, because too much as we you know, throws to the other direction, which is obviously not not good for as well. And I'm not saying people should just willy nilly take their medication. This is just what happened here. It was a you know, it's a good example of my labs look good. So it can't be bad. And this just seems like one of these issues that doesn't play by those rules frequently. What else goes into it say we have our thyroid medications good. Talk about the supplements and the vitamins that that you like to incorporate as well.

Yeah, so somebody has autoimmune thyroid disease. We now have several studies, looking at the use of supplements, minerals, vitamins to help and I'm going to say that none of these have been shown to help prevent thyroid disease. So in other words, if you have antibodies and you're looking for ways to protect yourself from developing thyroid disease, these have not studied haven't been and studied and so we don't know that will prevent you from developing thyroid disease. But once you have autoimmune thyroid, and your thyroid levels start to be a little bit off. Things like Selenium. Selenium has a lot of studies on autoimmune thyroid disease and particularly Hershey motors, but they're also studies on Graves disease. Most of the studies on selenium are positive studies, meaning they have a beneficial effect. They help with the antibodies, they help with the way the thyroid looks on the ultrasound. And they also help with well being. So to me, that's usually something that I will use the people with autoimmune thyroid disease. In the beginning, when the studies were done, the doses that were used of selenium were quite high with about 200 micrograms. And in this part of the country, we're not really deficient in selenium. So the concern was, could selenium because high selenium can also be linked to type two diabetes, not type one, type two, but also glaucoma. Most Recent studies don't seem to indicate that that's too much of a concern as we initially thought. But it's still you know, one issue I'm not giving somebody too much selenium. Most Recent studies on selenium have even used 80 micrograms, which is what you probably find in a multiple vitamin with Selenium. And that's a pretty nice those for autoimmune thyroid disease. There are studies now using a combination of selenium in something called Myo inositol. inositol is substance is something that beef isn't exactly a B vitamin, but it's in the beef family. And it's both a thyroid hormone sensitizer and an insulin sensitizer. So it's been also used in patients with Hashimotos thyroiditis, and the combination of selenium about 80 micrograms with inositol, it really helps people bring the TSH down and also lowers the antibodies. There of course, we know about the connection between vitamin D can thyroid as well as type one diabetes or something with a vitamin D receptor, that there's something that is not completely right. So I'll also use vitamin D to help with this or immunity of the body. And then there's there's a study a couple of studies on something called black cumin seeds, and that is the, the herb or the seed itself is called me, Gala. sativa. In black cumin seed, as a seed itself as a powder has been used in people with Hashimotos to help them with their TSH also help with their cholesterol. And as well as weight, it helps people lose weight. When that was used after two months. Those are probably the ones that we have the most data for. And the ones that I will use more commonly, I also talked to people about not having too much iodine as a supplement. But enough iodine because again, I get that it's important for thyroid hormone production. So just enough, not too much.

I have to say, I just want to stop you for a second. It's so nice to hear information like this coming from someone with your background. And I not that other people saying things like this, you know aren't right or, or well informed. But when we hear supplements, I think people tend to think Oh, hippies quacks you don't like that kind of thing. Nobody really thinks about the medical field paying attention to stuff like this. And you're, you're a legit doctor who has a has a has a really impressive background and through some of the institutions, you've been out as well. And so I'm glad you're talking about it. Because it really is. I mean, look, I know nothing about nothing but COVID came, and I went out and found a good source of vitamin D, zinc, and a couple of other basic vitamins. And I was like, I'm taking these I don't care, you know, like, and I've done really well over the last nine months or so.

Yeah, I think you know, it's always the question. And that's one of the answers when I study that university is on our mind to medicine fellowship. You know, it's, it's always about risk versus benefit, sort of the same idea. We're talking about the thyroid hormone before for argon, you know, or for my patient. What's the risk? What's the benefit? The same thing with supplements? What's the risk? What's the benefit? My concern with, especially with botanicals is are you taking other medications? And are they botanicals going to interfere with your medications are they going to interact? That to me is a big concern. I treat herbs like a treat medicine, they are medicine, they should be treated as equal. I think it's really funny when somebody will say Oh, this herb is gonna cause some interaction with your medicine, but it's not really worth it, it's not really going to do anything. My point is like if it's able to cause an interaction is able to do some action. So you know, it there. I think when I started working more different integrative integrative practice. There was not a whole lot that I could actually offer patients. I mean, I could often botanicals that have used you know, the herbalist have used for millenia, but there wasn't a lot of there were not a lot of studies that you know, except for selenium and vitamin D, there was not a whole lot that have come out. Now we have studies like a talk on inositol we actually have studies on ashwagandha and in particular for hypo for asking me for Hashimoto for hypothyroidism. Ashwagandha seems to work. You know, up to a few years ago, we only have studies on animals that we have studies on humans. So I think there's actually more of an interest as well in the in the researchers in trying to understand how these botanicals and supplements do work.

Well, I I'm, I'm, what you said just makes a ton of sense to me. I think it's labeling that confuses people, right. So if if a substance is controlled by the government, and therefore it can be, you know, manufactured by a pharmaceutical company and then sold to you through your insurance, that's a reasonable thing to take. But, you know, this thing over here that, you know, we can't make any money off of that must not be valuable at all. And I just don't think that that's the case. And maybe it is for some things and not for others. I'm sure there are plenty of prescription medications that are not as valuable as people say they are. And vice versa, but that it's being looked at by people who are thoughtful about it, is the part that makes me excited. You know, it's not just somebody yelling, try some dandy lion. You know what I mean? Like? Yeah, you know, I took it, yes. And I felt there's a basis for it. Right? Right. There's a real reason to think this thing, like you said, is causing an action, and is that action, something that's valuable for the person taking it, and if it is great, and if it's not, whatever, great, you know, like, why he was told. And you know a bit about this, because we've had to talk about it about art. And but over the last two years, I've been struggling with not being able to retain the iron in my, in my system, my ferritin drops really, really low. And I was told this is genetic, you're not going to be able to impact this with with don't even try, you know, with any kind of supplements. But what I did was I researched, well made vitamins. And I started taking an iron supplement along with an absorbing acid at the same time. And while it turns out, I can absorb iron. If I take a supplement, right? I was being told you can't you can't, your body won't do that. And it was true. I was taking the iron and nothing was happening. Add an absorbent acid to it, boom, suddenly, my body can take it up. Why don't even care why it just works. So I'm now I actually had to be careful. Like, I got my next blood test back in my heart and was so high, it was like, well, it's working too well. And you know, and so I cut it back. But it's an example.

I mean, that's something. Yep, it is. And I think if you if you understand a bit about how people who have autoimmune thyroid disease or type one diabetes, sometimes you're both this at risk for these are premium gastritis, which is really the lack of stomach acid. And because you don't have stomach acid, you actually don't absorb. So that sort of what you just said, Yes, brings me to think of, you know, people also thinking about that potential complication or another quick system, autoimmune condition that may not allow them to absorb iron or B 12. Or, you know, anything else really, right. So it's really important to be aware

of that. Absolutely. It's, I feel like I'm doing better now. Like, I feel like I'm slowly moving into the best health of my life, which is ridiculous, because I'm not in like, I'm not, you know, not working out constantly. I'm not one of those people. I'm not like micronutrients and things like that. I'm just living a pretty normal existence. But just prior to this, I had issues. And I had such a blue collar mentality about it, like, and by that I mean, like, put your head down, keep moving forward, don't stop do this till you die. Like don't give up, you know, naming like that hurts. Don't think about it, can't lift your head up. Don't worry, keep going, keep going, you know, and, and now I'm like, you know, I'm not gonna make it much farther like that. Like, it'll be an impressive story for the five people to remember me. But I'd like to say, you know, I want to keep going. Yeah, it turns out he had no, we do take that as like, we're badges of honor to you go to the doctor. And they say something like, I don't even know how you're standing. And you're like, that's right. person was 13. Skirt. Yeah, right, right. But meanwhile, I wasn't standing. I ended up in the emergency room eventually, because I bent over to pick something up in my head almost went to the floor along with my hand. I was like, I just couldn't stay out more. And then, speaking of anecdotally, then we started having everybody in the family tested, just to see what's up, you know? And Arden's ends up being really low too. But then we kind of realized that might be because of heavy bleeding from her periods. So we get her jacked back up again with an infusion, and she is still drifting down. But she's not falling the way I was. She's not going from up to down. And so I think the assumption is going to be after one more blood test that Arden is going to need to take an iron supplement, as well probably along with an absorbing acid maybe a couple of times a week, but and I say Do this all the time about the podcast itself. And I know you don't listen to the show, but this podcast helps people use insulin. It's really valuable to them. But I only came to the information because of luck. stay at home dad, my background aligned with being able to kind of figure things out. Most people, this stuff is just coming at them a million miles an hour, they do what they're told when it doesn't work, they go that didn't work. They walk away from it. Most people don't come to an answer. And that's the that's why I wanted to have you on like, I want to teach people how to come to some sort of a resolution when they find that they have a thyroid issue. And most people aren't going to find you. I mean, I I basically had to beg you to see Arden you were full? You know what I mean? When when I found you? Yeah, and most people aren't thinking about these things. So where do you think the conversation should go from here? Do you think we should jump into people's questions? Or do you have one that you'd like to add? Yeah, no, you're just

then we can do that.

The Dexcom G six continuous glucose monitor is the tool that I lean on the most for making decisions about my daughter's insulin. We use the information that Dexcom provides. And that's what her blood sugar is. And what direction if any, it's moving in, not just what direction, but how fast in that direction. So I can tell, is this an 85 blood sugar that's super stable, where is it falling, or rising? Knowing that makes bolusing Basal adjustments and mealtimes so much easier. You can learn more about the Dexcom G six continuous glucose monitor@dexcom.com Ford slash fuse box. If you can't remember that there are links right there in the show notes of your podcast player. And at juicebox podcast.com. Check out the Dexcom GS six today are using pens or syringes and thinking about trying an insulin pump. My suggestion would be to try the Omni pod tubeless insulin pump. It's the only pump without tubing. And it's super simple to wear discreetly if you'd like. The great thing about Omni pod is that you don't have to take my or someone else's word for it. You can actually try Omni pod, we'll send you a free no obligation demo of their insulin pump so that you can wear it around the house or wherever else you are. Although let's be honest, we're all pretty much around the house right now. And see if you like it, you'll be able to put it on. Go about your days. bave Oh yeah, you can bathe with it. And you could actually swim with it if you wanted to. On the pod allows you to continue to get your insulin, even during bathing and swimming. It's the only insulin pump that can say that. So if you're currently on MDI, and you're thinking, Yeah, I mean, I'd like a pump, but I don't like that idea of not having my basil on some all the time. With Omni pod, you absolutely can. And you will. My daughter has been using an omni pod tubeless insulin pump since she was four years old, and she's 16 right now. I mean, she's been wearing it on the pod every day, for over 12 years, check it out, it's super simple to do, it'll take you five minutes at my Omni pod.com forward slash juice box to get that demo sent directly to you. Last thing if you love watching people do nice stuff. For other people with type one diabetes, you should check out touched by type one.org. They're a great organization, doing wonderful things for people living with type one touched by type one.org. Or check them out on Instagram, or Facebook.

Once again, the people that listen to this podcast were really great, and asked a ton of questions that I think most of them are valuable. Why are thyroid antibodies seen in so many kids with audio immune disorders who don't have thyroid disease? And subsequently, do you expect that those will eventually end up with thyroid disease.

So antibodies might be the first sign of these autoimmune thyroid disease that again, in only 50% of the cases will lead to thyroid disease, the other 50% and will never develop thyroid disease. At the same time, you actually could have antibodies that are positive just because your body has an orange immunity in it. In other words, you think of your immune system sort of like almost like fireworks and it's almost like throwing little you know, these sort of fireworks in different directions. And one of them could be an antibody for thyroid without you having the disease without you really having autoimmune thyroid disease. So that can happen. I'm going to look at what level of antibody you have If you're like, you know little bit high, I might not really worry that much, I may keep an eye on it. If you're high, I'm going to say that most likely is true autoimmune thyroid disease, and I'm going to keep a closer eye on you. In general, when people have autoimmune markers, so antibodies sort of thyroid and their TSH is a bit off, is more likely for them to develop 30 sees that if they only have antibodies, but not an abnormal TSH. So it's worth it's worth keeping an eye on both over time just to make sure that you've detected

but if you see those antibodies, you're about a coin flip to end up with thyroid disease.

Correct? Yeah. Okay. And it gets a diabetes it is it make us with type one diabetes? It is okay.

And then how common is it to have happened? What happened to Arden and Kelly, which is they're in range, but they're experiencing symptoms? So I guess the first question is, is that common? As a as what people notice? And can we talk about what in range really means and how to interpret that?

So both good questions. So I don't think there are any studies looking at range, how likely to have you have actually a cold for disease? Is it the autoimmunity itself, that is affecting you and if you treat with our hormone, the immune system will actually do better and you feel better? So we don't really know the answer to if you're in range. You know, how likely it is that you that you find people who need thyroid hormone, or benefit from thyroid hormone, we don't have that data. We do definitely know that TSH, which is our main marker for thyroid function, and TSH is a pituitary hormone. So the pituitary gland which is our master gland, makes TSH and TSH stimulates the thyroid gland to make thyroid hormones T four and T three, I think of TSH as the thermostat of the house. So think of your third house. TSH, your thermostat in the house is called your thyroid not making a thyroid hormone. The thermostat goes up so TSH goes up. So a high TSH is usually an indicator of thyroid dysfunction. And we'll use that because of the relationship between thyroid hormones. And TSH, there is this relationship that makes whenever you have a very small change in your thyroid hormone from the thyroid gland is going to make a high a big change in your TSH. So it's going to be reflected in a much larger change. So when you look at the reference range for TSH, most labs will give you a 0.45 to 4.5. That's your range. That's a reference range, and I call it reference normal. If you look at what we think is ideal, probably 2.5 For TSH is ideal. Alright, so 0.45 to 2.5. So we think it's ideal. If you start to see a TSR is over two, for 2.5. That may be an indicator that something is about to happen or could happen or it's likely to happen. You don't know when but it could happen. We definitely are much more strict with that TSH, when a woman is trying to get pregnant, we definitely don't want that TSH to be anywhere above 2.5. Sometimes they're even above two. So when you look at a reference sheet, and you say I'm in range, my question is always Are you really in? Are you optimal for TSH? Are you in range, but not really optimal? Are you 3.5? Are you four? I don't think that's really optimal. I think people have at least a four as we may have symptoms. So it's good to keep in mind, where exactly are you just being normal doesn't mean that you truly are normal. And that would have been my first question with both Arden and Kelly, when they were when they were diagnosed.

So try to think of it as the reference range, which just means where most people fall when they're tested. And an optimal range, which is more indicative of where your body's going to do.

Yeah, and if you if you if I give you a bit of the background of how that reference range was, you know, came about you'll you'll see exactly what you're seeing. The bad data comes from a big large study in the US where they took a lot of people in the US and they just asked them Do you have thyroid disease now? Okay, you get tested, you have a resist. Now you get tested. So this session everybody, and that's what they came up with that rate 0.445 to 4.5. Then they said okay, let's test people who have antibodies, this thyroid antibodies. Alright, let's remove those from now arrange. When they did that the range went from 0.5 to 2.5. That's where the race comes from. So you don't have antibodies, you have a tear. So that is usually more in range than if you have antibodies because you probably have already developed mild thyroid disease. So the progression of thyroid disease is that you develop first the autoimmunity you have the antibodies or the look of the thyroid disease is maybe an ultrasound over time that develops into having a higher TSH maybe still within range but higher and then over time the TSH guys are both rage and as When you usually get diagnosed and treated, or

you said that it's very important while you're pregnant, can you give me why that is? Yeah.

So first for conception so to get pregnant, you need a good TSH, women with higher TSH will usually have. They're not able to make enough progesterone, which is actually what helps, you know, keep the baby or, you know, hold to the baby. But there's also higher risk that higher risk of miscarriage there's a higher risk of complications later in pregnancy with preeclampsia or other there are complications in pregnancy when the TSH is high, so yeah. So

there's a question here that I think leans into what I said earlier about just soldiering on. And the question is, what are the health implications of poorly managed thyroid disease? And this person says, it would also be great to get an explanation of the different types of hypothyroidism, which, obviously, we've covered already. So what are the implications of just ignoring this?

Yeah, so I don't think it's good to ignore it. We definitely have now sets of levels of TSH to when we think it's actually dangerous to ignore it. So if you're over seven, don't ignore it and you're young and young, I mean, younger than 65. So younger than 65 to six or seven that increase your risk for stroke and heart disease, as simple as that. So, if you are in like I said, before, you know, TSH affects fertility, it affects women cycles, women's probably tend to have cycles that are a bit heavier when the TSS is higher. But definitely heart heart is a is a big one high TSH usually also affects insulin resistance, the higher TSH the more insulin resistance you are. And that's also been shown now with a TSH again, that is in that reference range, but it's at the high end of the reference range, because again, we know that that's not really an optimal TSH is building to insulin resistance is being linked to fatty liver, which is quite common in the population as well. Fatty

livers. Yeah. Okay, so if the TSH is too high, then I could see insulin resistance. And that's especially for this population. It makes everything more difficult again, there's another question here. That's interesting. Most of it's been answered already. But at the very end, this person says that my daughter has t one D and celiac. I have T one D and hypothyroidism. But the last part of the question is where I want to ask the question, and she says, Did one cause the other? And I know that one doesn't cause the other. I know that you already said that, that autoimmune diseases kind of, you know, cluster together. But it's such a common question for people people have such an anecdotal relationship with what they see, like I got this, and then this happened. So this must have caused that. That's not the case, though, right?

No, the they have been a concern and have been actually some initial research into whether celiac actually could cause autoimmune thyroid disease. And the third was, could people with celiac disease not absorbed selenium? And then we talked before selenium modulate thyroid? Could it be that when you have celiac, you don't have enough selenium? And then selenium causes autoimmune thyroid is never really been explored further in that initial sort of question study. I think, you know, it's really interesting, right? Is celiac, you know, somebody has a question as well on leaky gut. And if you think of, you know what leaky gut represents, basically, if you think of cells in the gut, the cells are tight to each other, right there next to each other, there is tight junctions between the cells. And when you absorb nutrients in your gut, from the gut into the bloodstream, they don't get absorbed in between the cells, they get absorbed through the cells. Now imagine that those cells are not tightly together, they're separated. There's a gap between the cells, that leaky gut that says your cells have a gap in between them. So things that were not able to come through the cells not coming between the cells, things meaning proteins or other anything that you're you're taking those trigger a reaction in the body that is an inflammatory reaction. And those is where the idea of molecular mimicry comes in. Meaning there are things that can look like other things that your body will react against. So something comes into through the gut, in the body things that is to be something foreign, a toxic and in the process of doing that is creamy Asante by the Havana tuck your thyroid and other organs. That's the idea of molecular mimicry and leaky gut. Could it be that silly up that something like it? We don't know that? Is it a possibility shortly could be we just don't know enough?

That's fascinating that the chain of events feels like it's so far away from the thyroid, you know, right. But the one thing creates the antibodies, the antibodies, then go do the wrong thing. That's fascinating. Our bodies are amazing and scurvy. You Do not play not right. And so the idea really is, if you're more, listen, if you have auto immune issues, you're not going to stop them most likely. But there is hopefully a way to tame them or to draw them more into into line just to give yourself better outcomes. And not just think, because I think that happens a lot, you know, to people who, you know, for instance, don't listen to the podcast, who have type one diabetes, they do this thing I talked about all the time, I'm always telling people, please don't just say, oh, that's just diabetes. Oh, my blood sugar just goes to 350 and stays there for a few hours. This is what happens. I have type one diabetes, I'm like, No, that's not what happens. Like, you didn't use the insulin correctly, we can stop that, you know, but it becomes, again, it happens over and over. And it makes them feel like well, this is just part of it. So if you have these thyroid issues, yes, you're going to run into a lack of understanding very likely at your doctor. And there may be more for you to do to to get through the process. What I'm thinking as we're talking is that I'm going to bug you for like a checklist for people to take with them, like like talking points, checklists, or something like that, to put along with this, because that really is my concern. Like, we can educate people as much as we want. But if they hit a firewall at their physician, none of this is going to matter. You know, understand, they're just gonna understand what's wrong. It's not going to help them fix it. Yeah,

I so my, my thought process, and this is my just the way it worked. But this is actually from guidelines by the European thyroid Association. They talk about how when somebody has this or somebody has a perfectly normal TSH, they're being treated with a requirement to have a perfectly normal TSH, but you don't feel well. So now what right? What do you do with that? So first thing, you have to make sure that your TSH is truly in range that you're really in that you know, one to two, maybe up to 2.5, you're really within the optimal range. In spite of that, we do know that patients with thyroid disease, up to 15% of patients who have a perfectly normal TSH will not feel well. And they're still have some especially neurocognitive deficits. So what's next? So first, look for other other things that can actually come along with thyroid that could be causing the symptoms. And the first one I will look for will be iron and B 12. And you could ask your doctors, could this be an iron and a Bucha? of deficiency? Could I have anything like that? I know that they're more likely in people with thyroid disease, and autoimmune thyroid could have that. And that's a blood test, you can check like you did, it's called your ferritin. And you could also take a B 12. Level, that's pretty easy. Then you could ask, could this be that I have another autoimmune condition. And again, Celia can be silent, you may not have any symptoms of celiac. You know, as a kid, you might not grow up as an adult, you might not have any symptoms. Same with autoimmune gastritis, you may have no symptoms except the lack of absorption of certain minerals and vitamins. So it's always worthwhile asking your doctor, could this be a different autoimmune? I know that I'm at risk for autoimmune conditions, should I be checked for celiac or autoimmune gastritis or something else? And then I will go back, if all this has been checked, and you have no other autoimmune, your iron is perfectly fine. And I'd like to talk a bit about iron in a little bit. Then, the question is, could you be some bio? Lee, who in addition to taking levothyroxine, which is the standard of care for hypothyroidism, should you be treated with like your 32? Three, is that is that a rule 43. In general guidelines, from many societies do not recommend using T three, however, there is a little spot in one in a task for by the American Heart Association, where they say that an individual case to case basis 43, could be not maybe not encouraged, but could be thought of, let's say. So some of the there was perhaps a discussion within the group that were in the task force. And some of the people in the test for writing this guidelines really thought that if you're not feeling well, in everything has been looked at, you could consider taking two three. Now. T three is the active hormone in thyroid. So your body, our bodies make tea for our thyroid make tea for a little bit of T three, mostly T four and then T four, which is again levothyroxine. And pills if you wish to sort of the equivalent, T four gets converted to T three in the cells. T three is what gives you your actual energy. So we don't understand exactly why. But there are certainly people with thyroid disease with hypothyroidism who in spite of taking before in spite of having normal levels do not feel well. It's a subset of those people feel better when they take 234 Along with T four. So you could then ask the question, Am I a candidate for T three? Could this be something that we could explore? Could I add some T three to my T four, could I just take some T three, maybe a little bit less T four, just to make room for the T three, it's always a consideration. If you're somebody who's pregnant, I would, I would not recommend that the baby spray needs teeth for and it's a bit, sort of partially impermeable to T three. So if you're pregnant or trying to get pregnant, I would not recommend T three. But if you're somebody who has cardiac arrhythmias, meaning your heart goes into an irregular heartbeat, especially when you go fast, two, three is not recommended as to what's going to make them more likely to come back and to happen. But in spite of is when you don't have those is something that you could think of asking your doctor.

And for prospective T three works for my wife, but didn't work for her.

So it's exactly right. And it's completely an individualized approach. It's not really based on blood tests. So I can check somebody's T three level before they given T three, and they have a perfectly normal T three. So it's a T three level doesn't tell me somebody needs it doesn't need it. T three is actually inside your cells. So you really don't get to measure that is more of a clinical decision, and is almost like a trial, basically, is what you have

to do, as you're explaining it. And I see how detailed it is. And I have to be honest with you, I've had this conversation for years now around my wife around my daughter here today. I still think if you gave me a quiz about T three and T four, and what's making what and what my I think I'd get maybe like 70% of it right? I do wonder if that's not part of the issue at the physician side. And especially because endocrinology is interesting, right? Like, it's such a blanket, you know, they do so much like how do you be, you know, a thought leader on this one tiny piece of it. I can see that. And for the people listening, it's confusing, you know, TSH, T, three, T four, thyroid goitre, you're like, wow, there's a lot of lingo, there's a lot of like, you know, it can be overwhelming a little bit. And especially in a society, like, let's be honest, we're a light switch society, we want a pill, we want the pill to go in, we want everything to be done. And that should be that you know, so having to put in the work, I think is incredibly valuable. I'll tell you that. I'm so passionate about this. Because I see the other side of it, like I know, what happens to my wife, and what happens to my daughter, if they're not managed well with this? And it really is, it's a dampening of their life. Like it really it really is it takes significantly away from them. And

perhaps they Yeah, sorry, the message is to say, don't give up, you know, if you're not feeling well, you know, fight for what you think, you know, you know how to feel well is if you're not feeling well, nobody's going to be in your body to know you're feeling well or not. But if you if you don't feel well keep at it. So if it's not one condition, it could be another and if it's not that then, you know, go back and say Could it be managed differently in the way that I've been treated?

Don't give up it look for information in different places. And, and I will, I will say this, there is a thing that happens when you haven't felt well, for so long. You do forget a little about what well is because I have to say that when someone gave me an iron infusion, and I could feel its full effects, which takes a little bit of time because your red blood cells have to pick it up and remake cells again, with sufficient iron, it takes a little while. It's then hard to remember how bad you felt so resilient. We are you know what I mean? Like, yes, it's hard to go apples. And like, I know, I was tired. I know, I would run up the steps and be out of breath, which was ridiculous. But that's how bad my low iron was like I if I ascended the stairs, I couldn't talk on the phone at the same time. And you know, but yeah,

so I want to talk about about about that a little bit. You know, when most people talk about iron, they'll talk about, have your doctor talk about it and talk about red cell count. It's not what you and I are talking about, we're talking about ferritin and ferritin is how your body stores iron. So the average ferritin in us women is 22. Now I'll tell you, adolescent girls who have levels less than 35 pass out. There's definitely data on that. And we think based on one study that for women, a level of 55 Zero is perhaps optimal for energy, if you're looking for hair growth, that's about 70 to 84 ferritin. And again, I'm telling you average women are around 22 That's the average because we menstruate because we you know, children, we grow and we mistreat them we have kids and all that takes iron. Yeah.

Yeah, women's bodies are they get used up by by life in a way that doesn't get replenished all the time. And I don't know if that's some nature plan or anything but I call bullshit on that. You don't have to walk around tired and I had a bunch of kids, it's okay. This is not great. You know, like, I agree, do something for yourself help out. Medicine has improved. You should you should take advantage of it. i It changed my life getting an iron infusion. And I

think it's just a lot of my patients lives. I've definitely seen a lot of my patients for iron infusions, when I can not get there on your knob or they're really really low in iron.

It goes, it's not pleasant. As my iron gets lower, I lose my ability to I don't know I'm not measured anymore. Everything either makes me upset or sad. Or like I just It's fascinating to watch how I devolve when it goes down

I find it really fascinating do you think of all the things that lack of iron can do so for women lack of iron is actually more linked to PMS premenstrual syndrome. Lack of hunger is definitely has to do with depression lack of atmosphere with low libido in women you know lack of iron can really cause muscle the muscles not to feel right you know somebody who's running and the starts to get tired like you did you know, you're gonna have to stare some be short of breath, passing out feeling lightheaded? You know, all those things? are due to lack of iron. It's really important.

No kidding. I'm a huge fan of paying attention. Question is, Can hypothyroidism Hashimotos hide symptoms of a slow or late onset of type one diabetes, like Lata? If type one has started making Hashimotos antibodies, but it's not symptomatic, is just a waiting game at that point.

So definitely type one diabetes and Hashimotos are linked through these same genes. Again, Hashimotos, if you don't have if you're not hypothyroid, I don't think Hashimotos by itself is going to affect your glucose metabolism. But having hypothyroidism definitely can affect your glucose metabolism, you know, just think of if you think of hypo as being low, just think of a low metabolism. So you're going to absorb things more slowly, you're gonna not be able to clear medications as fast from your body. So all of that is going to play a role into how your sugars are gonna get affected. Basically, Lada is actually further of a risk factor for Hashimotos. They don't seem to have the same genes, it's more of a risk factor. So a little bit different than actually, even when it's close to a type one, it's not exactly a type one, the genes don't seem to be the same. And again, we talked before the waiting game is yes, a 50% chance of developing thyroid disease. If you are type one, you have type one diabetes.

So this next question is interesting, because they think we covered some of it, but not the whole thing. The question is my son's bloodwork shows he has the markers. So the endo has put him on a low dose of thyroid. Is this a protocol because he has no symptoms? So we've talked about if you're, if your range is, quote unquote, good, but you have symptoms, yes, you need it. But what about if you don't have symptoms, but you have the markers?

Right, so maybe that's it? And again, I would like to go back and take a look at that TSH was a TSH at the high end of normal. does that person have actually a goiter enlarged thyroid gland, that actually is an indication to treat even without symptoms. If somebody has antibodies, and they have an enlarged thyroid gland, there's an indication to treat even without symptoms. And that's at that point where things are the body's really trying to push to work too hard. What

do you recommend? Like once people get their medications set up? What's the maintenance for? Because this person asks, is it good enough to just test my teeth, TSH every year, or should I be doing other things?

Right? So guidelines are that you check once a year, I'm a little bit more OCD. And I'll check people twice a year, I still see them in my office once a year, you know when we can meet in person, but I'll take them twice a year and I have a very low threshold, I do tell them if you feel different. And I just say that different than what you normally feel and it doesn't go away, just have have a low threshold, we'll check your levels. I also tell them if you're taking a new medication or a new supplement, I want you to tell me what you're going to be to get for that I know there are certain medications that can actually interfere with it either the absorption or the metabolism of thyroid hormone. So that we can even a birth control pill can actually affect you know, Homoserine hormone you need. So there are things that we know can have an interruption or have an effect on thyroid. So I want to know about them so that we can you know, be more proactive about them.

Yeah. Well, I think that one of the most amazing things about working with you is is that there's no there's only enough pausing to see what works. So if it's get a blood test, find out where we are, add the medication, wait an appropriate amount time, it's usually just about 30 days blood test again, keep moving like that is such a valuable perspective on it. And

if you know that we will say Roxane, which is what sort of care is, takes about six weeks to take any effect. That's all you're gonna you know, that's that's all you have to wait if you're changing your dose or something is introduced just six weeks doesn't take that long. Yeah,

no. And actually, interestingly enough COVID making people's connection connections more instantaneous, right? Not having to wait for as long for an appointment, right? Being able to get in and out of conversations, I actually think there's a couple of things that are going to come from all of this. That's good. And I think this is one of them. Doctors, seeing people like this, I think is going to speed people up to resolutions, because it gives them the access at the at the intervals that I think are more necessary. So I definitely found that. Yeah. This one's interesting. Do people tell you not to eat soy sauce?

If you have? Oh, yes, a good question Is it so you so few things on so one is if you take the fabric hormone, if you take levothyroxine, whether generic or Brandon, we talk about that as well, generic and brand, you should not take your thyroid hormone at the same time as taking soy. So it does affect the absorption of thyroid hormone. So not at the same time. If you're already take thyroid hormone, you can take you can have your miso soup, or your tofu or, you know, at a different time, that's perfectly fine. There have been many studies on soy and thyroid, the initial concern was actually babies who were fed soy milk, you know, when they were infants, I guess, in soy actually is if you don't have enough iodine is actually going to affect thyroid function. So but if you have enough iodine, soy will not cause any problem with the thyroid. There has been only one study where they use quite a bit of, of soy soy, there were people having soy for breakfast, lunch and dinner. Those people had an under a mildly underactive thyroid, they became much more underactive after eating a lot of soy. And again, it was so breakfast, lunch and dinner. It was a lot of soy, right? So if you're somebody who has a mild dysfunction in your thyroid, you're trying to avoid taking, forming, forming, you really want to try to do this naturally for yourself. Don't overdo it on soy is what I would say.

Okay, that's interesting. So like, I can't think I don't want to, well, let's talk about the medication for a second because you just alluded to something that we found. Synthroid works fine for my wife, that generic, Synthroid doesn't touch her at all, for some reason. We've bounced through multiple medications for art and just looking to see if she had an interaction with one of them, which she didn't end up having. But she now takes terrassen, which is, I think, has no fit even. I don't think Synthroid has that many fillers, but Cireson has none of them nothing. Yeah. So, you know, do you see that first of all between generic and non generic?

Right, so generic, it's levothyroxine. Same and the concern with generics, if I write a prescription for generic just for, I guess, right levothyroxine, the pharmacist will give you what they have in stock, which means that the first time you fill is generic A, then the next one could be generic B and then extension, C, each one of the generics gets absorbed differently. So from going from A to B to C, your levels are going to change just because you're sorted differently. Same is true for brands, if you go on scene for the first month, and then the box will the second time and the unit for the third month. That's also going to change. So if we write brand, like Synthroid, let's say, the pharmacy will honor that and they always give you a Synthroid. Now I have a way sometimes somebody has a hard time paying for medication from brand on right levothyroxine by x, and my x will be the same mainline, which I like it because it's gluten free and lactose free. So what I tell my patients is just like, you know, be an advocate, right. So thyroid hormone pills, tablets are color coded and shape coded. The color tells you the dose, every single 50 microgram pill is white, every single 100 is yellow 112 is pink 137 years Brown, you know, they all have a color, that's the dose doesn't matter what the brand is, doesn't matter what the generic is, the color tells you the dose. Now the shape tells you who makes it. So central user which round, the voxel is almost like a thyroid shape. So I'm like a butterfly type thing. You know, so if you go to the pharmacy, and now you pick your pills, and last month, they were white and round, and now they are purple and oval. They give you a different dose and a different manufacturer. And that's how you know and if your doctor didn't tell you that we're changing it you better call back your pharmacist and your doctor and tell them they gave me something that I was not supposed to be taking. That

is rock solid real life advice. I did not realize so maybe Kelly's issue back then when she was using generic wasn't so much that generic wouldn't work for it was the cheapest give me beginning something different every time so there was no consistency.

Right? And some dinners will have gluten or lactose which many patients with Hashimotos I don't So if not silly up fully, they might be intolerant, there's more likelihood of being intolerant to gluten and to lactose when you have Hashimoto, someone you don't have Hashimotos.

So there's a question here that I feel like has been answered. But the second part of it, again, is valuable to still bring up. It sounds like this person has a doctor who tells them that you should try to get off of all medications, which obviously, if you need this hormone, you need it. Right. But it does beg the question. If you're are there safe ways to titrate? Up titrate? Down? Are there ways to take medication that they this medication that you can't like, can I just pop them in or doing like, how does that work, like if you're moving up in a dose or switching from one to the other, right,

so usually, when we need to change somebody's dose, because their thyroid levels are not right or not optimal? Usually we go one level up and one level is about 12.5 micrograms up, and most of the your, your thyroid medications have those levels, most not all. So for instance, you have 75, you have 88, you have 100, you have 112 120 537 150. So usually go about in 12.5 13 microgram increments, 50 to 75, there's no nothing in between 15 to 25, you know, going down, there's nothing in between. So there are a couple of them have been nothing in between. But usually one level up is to a point five micrograms. And that's usually how we go up, I'm gonna somebody started, there was a really, really off, and you had to go up quite a bit. Fabric hormone levothyroxine is long acting. Meaning if you miss one pill one day, take to the next day, that's perfectly fine. It's not a problem, you go away for the weekend, you forgot your pills, when you come back, make up what you missed. So make up your Saturday or Sunday, that's not a problem. Let's say somebody is has been given thyroid hormone, and they want to see whether because I've heard that was wear off, and they want to see if they actually need it, and can they come off it. So if you have been taken thyroid hormone, and you suddenly stop it, your thyroid levels are going to rebound, you're actually going to have a high TSH, and that's just a normal physiologic effect. Even if you don't need it, your body's going to do that. So it's going to bump up your TSH. So instead of getting off abruptly, what I have people do is actually have them take one pill less per week. So one day a week, they Mr. Pill, they'll do that for about two months. I'll test them and see whether TSH is either standard range, I'd say okay, take one pill away again. And now that smythson, two pills per week, two months later, we'll do the same thing. So very slow process, but it really works. And he tells me, what's the dose you need if you need it? Or can you actually be without it? So and that's particularly true, because sometimes when you have a high TSH, it doesn't always mean you have a thyroid disease, high TSH could happen because you're sick, could be thyroiditis, not the chronic that is Hashimotos, but sub acute. So something that actually is caused by a virus that causes your TSH to go high for a couple of months, and the utilities will go back to normal. But if somebody gets given FabriK mark that point, then do you still need it two months later? Or could you actually come off it?

Can we talk about that for a second? Because I think you believe that happened to art in this year, right? Yes. Right. So she gets some sort of a virus. She fights it off. But then she starts having real impactful thyroid, like issues. And as we track them, medication wasn't the answer. Not that time was the answer. Right. Yeah. So is that what people call a thyroid storm?

Oh, no. So that was to me is what happens when you have Graves disease, and suddenly your thyroid releases a lot of the fabric hormone that you've had in storage that happens on graves that is not treated, which is why Graves disease should always be treated. You know, we talked before about when you treat when you're hyperthyroidism, Graves disease in my mind should always be treated because firestorms are they can really, you can end up dead with a fat restore. So to prevent that, so that's different. That's sorry, data's which is what we call this will be a sub acute thyroiditis mean it's sub acute means it lasts for a short time, they're usually painless, meaning you don't have any pain in your thyroid. A virus happens about two months prior, a Cold Flu something usually some cold like virus about two months before and then suddenly your body starts to release a lot of thyroid has been stored. So it's just a lot of releasing your personal making more fabric which is released in what's has been stored and you really just a lot of it and once that makes the person hyperthyroid because the thyroid gland has only about two months storage of thyroid hormone, once the thyroid has released everything that's in storage, now the thyroid got hypo thyroid and then the body sort of kicks in and regulate itself and you normally usually go back to normal sometimes people actually end up a bit hypothyroid to bad habits so it's usually hyper hyper normal Something a bit Hybl. That's a typical pattern. That's

interesting. And that can that not happen to people who don't have thyroid disease? Is that not just, you know, if I don't have thyroid disease, I would never see any of this happen?

No, actually sorry. You can still have it. If you don't have, how would you see?

It could happen still, it could happen. It's fascinating, too, because like you said, it's months of one direction and then swing back the other way, and then a leveling eventually. And

I don't know why. But I've seen a lot of those cases this year. I have to say, I don't usually see as many cases I've had. Many, many, many of my patients have actually had that happen to them this year, where they became hyperthyroid. And then we went to work months. I mean, we adjusted their thyroid dose, and they wouldn't be as hyperthyroidism, we had to readjust back. Because they were getting hypothyroid. It's been interesting.

Are you inferring COVID? or No?

No, that's people. That's why we're testing them. Many of them did not have COVID. So is it stress that we're not going to affect thyroid? Did the stress affect the immune system? And then effect was another virus that was happening to the sintomas? COVID? I really don't have an answer.

No kidding. Yeah. Because we did check Arden for COVID to during this whole process, and she's never had it. So really. You talked about leaky gut earlier, and this person is asking, Does healing leaky gut help thyroid symptoms? Which I think the question the answer, there's pretty clearly yes. But how do you go about that? And what kind of a doctor do you see? And how do you even know that's happening?

Yeah, so I was still not into the, you know, completely accepted by more of the Western medicine, if you wish. So probably a functional medicine provider is the one that will test for leaky gut, there are some blood tests that can help that are sometimes stool tests that will do it. But it's not a routine that you can go to a LabCorp request and you know, at a hospital and get tested for

let me jump in for a second. I think what I learned by watching you help the girls was that doctors in a western situation, they look for results, numbers that tell them for sure this is a thing. What I watched you do was test a bunch of different stuff, and then use your knowledge to infer a little bit from it. Yeah. Is that fair? It is yeah. Okay. Yeah.

So you're looking at and sometimes I will not treat, I will not buy, I will not make the testing for the leaky gut. But I will say, you know, could this be leaky gut and in the way I think of leaky gut sometimes that if you start to have reactions to almost anything that you're, you're either eating or taken. That to me suggests pretty strongly leaky gut, because it means that things are just coming into your body, your body's reacting against it, why would your body do that? It shouldn't do that normally, right? There are, you know, stress can trigger leaky gut infections can trigger leaky gut. So if you have any of those a history of having had significant stress in your life, or just a recent gut infections, and I'm going to be more suspicious of leaky gut, there's, you know, people will use even bone broth, we can be very much nutritious for leaky gut that there are some some of the protests in the in the bone broth actually help with leaky gut. Glutamine is one of the big ones for leaky gut. Interestingly, there's one herb that is used for leaky gut call, it's not an herb is a is a is a semi so called an alkaloid that comes from plant it's called Berberine. Berberine, comes from goldenseal and Chinese copters. And respiratory blocking minimal the other one. But anyway, Berberine is, is this chemical that has been shown to help leaky gut, but it also has stayed actually, for Hashimotos. The data actually is not in, in clinic goals so that we're not doing the study to see whether your symptoms got better. The studies itself, so some of the self study, so like to be called, you know, petri dish, if you will studies. But it's interesting that that same compound helps both Hashimotos only keyguard. And, you know, the question is, could this be because you're helping me get out of your house and then the Hashimotos unclear, but it's, uh, you know, it's definitely a question that it's worth exploring in the future.

Okay. I feel like we've done a lot. Did we miss anything? That you're like thinking, Oh, how did we not talk about this one thing?

Alright, so I'm gonna go back a little bit to the generic versus brand versus terrorism. I just want to make a mention on that. So when we talk about generics and how as long as you stay the same generic that may not be so much of an issue as long as you're okay with all the fillers and the colors. Again, White doesn't give you a color. So usually whites are easy terrorists and is sort of the newest levothyroxine on the market. And terrassen is beautiful, because a capsule and it means that by being a capsule doesn't mean it's not like acid to be absorbed. So it also has the fewest ingredients it has gelatine and water. So as long as you're okay with gelatin, then you could take 2% terrorism is usually not covered by insurance companies unless If you failed levothyroxine or if you have gut issues that don't allow you to make enough stomach acid, so my patients with celiac disease, I put them on terrorists and my patients with autoimmune gastritis when they don't have enough stomach acid I put them on terrorism. Even if you're taking one of those proton pump inhibitors are my personal prayer looks like one of those does actually block your stomach acid. Terrorism is the is the way to go. Otherwise, your your absorption is too erratic. I'm going to say that I have even patients who if I can get to rescind approve, they'll feel a ton better in tears, and they felt only will thyroxin. Perhaps you prefer the absorption difference? Perhaps he doesn't have as many fillers. Okay.

And what about just the taking of the medication? Because it's a I mean, we've talked about a lot of like, down deep ideas say this is a really basic one. But I see people ask all the time, does it need to be the same time of day should absolutely be without food? How long before? If so, all that stuff?

Okay, so the ideal is that you take them around the same time every day around, so morning, afternoon or evening. Ideally, the the thought is that you take it about 30 minutes before breakfast. And that's because if you have food with it is going to decrease the absorption a little bit. There's a recent study where they looked at whether you took your thyroid hormone, half an hour before breakfast, an hour before your main meal, or three hours after dinner. Most of those were very similar, the best time was actually before breakfast, then three hours after dinner, and then the one hour before your meal. You know, when I trained, my mentor would say to the patients who were taking thyroid hormone, do whatever you do get a rhythm while adjust your thyroid hormone, meaning if you take your levothyroxine or Synthroid with breakfast, what it might mean is that I might need to give you a bit of a higher dose to compensate for your thyroid hormone being sort of bound to that what you're eating. If you're eating about the same thing, every breakfast, your levels will get, you know will even out. If you're eating different things, it might be a difference. So what I usually tell my patients, I don't have it with something that has a lot of fiber. If you have a high fiber breakfast, if you have a smoothie with a fiber supplement, that's really going to bind your thyroid hormone. Don't do that. Right. So you're having that type of breakfast, definitely do it half an hour before your breakfast. Again, if you miss one pill take to the next day. The things that really are no no, for thyroid hormone, when you take it is any minerals, you cannot see karma with magnesium, or with iron or calcium, that are going to bind your thyroid hormone that not going to let it get absorbed. Those have to be separated about three hours, even chromium. Some people take chromium, or you know, it's between type two diabetes, or insulin resistance. So those has to be three hours away from your thyroid hormone so that you have enough time to let the thyroid hormone be absorbed and then put the minerals in the in the gut.

Can I have it in the morning with my vitamins like? Or is it just those things you just mentioned? I shouldn't mix them with I could have

exactly yeah, vitamin B, vitamin B 12. For D, they're gone. You know, I always have people look on the bottle mission, there's nothing else in that there is no deal with calcium, or there's not a beach well with a prebiotic that is fiber base and you know, something like that just take a look at the bottle measure there's nothing else What about birth control pills, you can take them at the same time. So the effect of the birth control pill on thyroids, not really, because they bind in the stomach, it's actually a binding issue by with the protein. So our bodies make these, what we call thyroid binding global, these are proteins that help you carry the thyroid hormone throughout the blood into the cells. So when you take a birth control pill or women take a birth control pill, their thyroid binding globulin goes up. So now you have more of these proteins binding to the thyroid hormone. So let's say that your body is taking a certain amount of fabric hormone, you're gonna if you take a birth control pill, you have now more of those binding proteins, you have less free hormone available to you. Which is why if you were not taking a birth control pill and suddenly you go on a birth control pill, you might need a higher dose of your thyroid hormone. Because with the same amount now you're binding more you have less free.

This is probably a good time to tell you that I might need a blood test in a month that

that's what I always tell people you might not affect it. But just to make sure give it four to six weeks, take your salary levels, you can even increase mobility because

so the one thing that Arden also has, by the way, we joke about it all the time on the podcast, so don't feel weird about this. I know it's kind of a strange intersection because you're helping Arden too. But we always joke that the whole world knows about Arden's SoulCycle, but so ardent gets her her period too frequently. It'll sometimes come twice in a month or it'll last a long time so long that it feels like the next time It came as twice in a month. So we did just start on Monday with the first day of recycle of low Leicester in the very, very low birth control bill. And we're treating it the same way as everything else. We're going to try it and see if it breaks or any kind of relief. And if it does great, and if it doesn't, she'll Stop faking it. But

yeah, Lisa will help her iron in obsessional bleeding as often or as or as much she will, you know, her iron will stay up a little bit more than, you know, just always been, you know, consumed.

Right? So, again, we're just we're taking a very small pieces at a time even, uh, you know, you've suggested ardency, a rheumatologist which we're, I meant to get back to you actually, it's odd, but it's not as easy as you would think for a younger person. Like, you know, I'm having trouble finding a doctor that wants to help somebody under 18. It's very interesting. And you know, for things like like, this morning, Arden woke up, she's in the middle of her period. She's like, my ankle hurts, my knee hurts, like, you know, can you just make it but it's not both of her. It's not both of her legs. It's one of them. You know? So you just, it's, I'll tell you, I have to tell you, like, aside of all the great information that you shared with everybody today that I really want to thank you for the part that nobody can make you ready for? Is that horrible feeling? Like you're not finding the answer? And that every day you're thinking about this stuff? And that not finding the answer is leaving somebody at one or multiple different deficits in their life. And I try really hard because, you know, she's my daughter, I don't know if I would try this hard for myself. I have to be honest, I don't I don't know. I have got a few more years with her. And it's my goal to set her on the best path possible for when I'm assuming she leaves here never talking. And

just think that with Arlen, you know, because we know that she had this iron deficiency. If she's having her cycle, she's going to drop iron versus having her cycle. And that actually, by itself can actually cause her to have some pain. Usually it's more muscle than joint. But I wouldn't put it past that, that it could be an iron deficiency,

why actually have come to the conclusion now that I've seen my body pick the iron up with the absorbing acid, I'm going to start her on, maybe just once a week, and then twice, and then we'll check her again and see, you know, where she gets to, because I think there is a way with the supplements, the holder in that range, like, in my mind, tell me if I'm wrong. I'm shooting for that, like 70 range where you said hair growth?

I would, I wouldn't I think I think every single woman who's having cycled should take some iron. I really think so. I mean, unless you have an iron issue in your own body, that your body sort of makes too much iron, right? If you have that, then don't, but most people don't have that issue. So you're a woman and you haven't cycled, you know, have iron. You know, iron can get absorbed easily every other day. You don't have to take it every day. It also allows your gut not to get so constipated with it if you wish. And yet using vitamin C or something acidic. Something with vitamin C will help you absorb the iron better.

Well, I can't thank you enough for doing this. I I have to tell you that the idea of you being on is the most excited. I've seen the people online for a while. And I knew how good you are. So I've been super excited to do it. I've been very worried that I was going to screw this up, but I feel like I did. Alright, so

Well, I think it's great. We answer people's questions. You know, happy to come back if people have more questions or something we didn't touch upon. And if somebody had asked about nutritional deficiencies, we talked a bit a little bit about that. You know how Yeah, definitely iodine can be you know, it's still the USS I've done sufficient. But until you're vegan and you have no dairy, you could be even deficient. And if you do that you could also be iron deficient in iodine and iron are both really important for thyroid production.

You know, I was going to ask you, if you could pick a style of eating and you have thyroid disease, is there one that lends best to it?

You know, it's interesting people have actually look at that. There's a lot of talk about Palio, as well as premium Palio. Not many studies, there's actually one study was done many years ago using pelea for people who have high TSH and the TSS got better now, I don't know those people actually have thyroid disease or they will just inflamed because inflammation can also cause a high TSH. So, Palio, you know, if you take away a lot of your past us and your processed foods, you're going to lower inflammation. To me, it makes sense that you decide for yourself what I would call an anti inflammatory diet. So one when you have lots of vegetables, lots of different colors of the rainbow, mostly because in addition to being anti inflammatories, and each color giving you a different anti inflammatory compound, they also help you make good gut flora and how good gut flora is. Let's say you have a leaky gut. In addition to the rest of balls, you can use you know healthy protein, whatever that protein is for you. Whether it's fish may be a bit of a chicken, maybe your grass fed beef. And then nuts, seats, healthy oils, avocados, things that are very rich in this polyunsaturated fats are the healthy fats if you wish, that's also beneficial for us. So then you figure out what works for you. I think we're all different. And we all have a best way of eating, you know, I don't think burgers and chips and you know, pasta, our way of eating. And so you never eat those, but I don't think it's healthy. Yeah,

I've been I've just started doing a series where people come on and talk about different ways they've been we've had a person come on talk about carnivore plant based, I just interviewed a flexitarian the other day, which, you know, so I'm trying to, as the podcast has grown, it's grown beyond my expectation. So when I was first doing it, I was like, Look, I'll show people how to use insulin. So they can have lower, like more stable, a one season less variability. And then my, I feel like my responsibility has grown, because I always start with the idea. Like, I'm a very, I guess this makes me a capitalist in some way. But But, but the way I think about it is, is there's probably a better way for people to do things. But I don't have the power to influence that. So at its core, I want them to know how to use insulin. So if they decide to eat a cupcake, they can use insulin, if they want to be a vegan, they know how to use their insulin, if they want to eat a carnivore diet, they understand that protein breaks down and gets picked up as glucose and they'll need insulin for that. And so as it's been growing, I was like, wow, I I start feeling that responsibility of like, now I've told them they can do this. Now I should, you know, illuminate other ideas. So, and thyroids been one for a while, the way thyroid is talked about is kind of criminal. It seriously is like the the lack of understanding that most people or physicians have. It breaks my heart. So I'm thrilled you did this. I want to ask one last question before I let you go, and I will end up I will take you up on it and have you back someday for a follow up. But how do I find the you where I live? Do you know what I mean? Like I know, it's easy to say like, you know, but it's not that easy, isn't it? No.

You know, and I don't you know, I don't think that you need to find somebody who will tell you about Selenium or vitamin D or vitamin, it's really quite common but or inositol or ashwagandha. It's not really what you I think the most important part of your journey is it's not really the supplements, I think it's having somebody who will listen, and who you like you said, even with your thyroid levels not looking off, that we'll be willing to explore. And we're willing to look outside the box, and we'll take the journey with you. I think that's what we all want is to have somebody who's our partner, who is not just somebody who has a knowledge but who also is willing to partner with us and trying to figure out what's what's going on. I think I'm looking for somebody who's more compassionate, and is going to be word of mouth is going to be between the people either within the podcast or outside of the podcast, just knowing what doctors both listened to in sit down with you for an extra five minutes even just to get to know you and to get to know what is not right, and how can they help you.

That's to tell you, I'm watching you work. I have this tiny bit of connection with how the podcast makes me feel because I know right now that I could gather up 10 People who are having no success with their blood sugars, and I can fix it. Like I know how I know how to like, I know how to explain it to them. I know how to put them on the right path. I know how to get them going in the right way. But I only have so much time. And so I use the podcast to try to reach more people. And it's you know, I think that somebody who has such good has so much good knowledge the way you do, you must run into that too. Just the idea of like you could talk to people all day, but really at what point do you have a life as well? And and how do you help more people?

You know, people with type one diabetes are really the masters of their own condition of their own, you know, disease, if you wish. And really many times you with type one diabetes no more than their doctors know, my mind and anybody. I think that's very clear.

Well, I definitely believe that it's easier to ask for forgiveness than permission. That's for sure. I tell people all the time like I'm like, what are you waiting for? You need more Basal insulin, and like, Well, I'm gonna wait to see what the doctor says. I was like you're looking at it right there. You don't have enough Basal insulin. You know, you don't ask the doctor before you Bolus at a meal. But they want to but they want to it's you have so I think that's a great thing to end on. Because I felt like you said something really important that there are doctors out there that may not have your level of understanding. But if you can be a partner in the situation, and hopefully something in here leads you to ask the right questions. And to be a little more direct. I think you'll find that most physicians want you to be better. They're not like you know, unless you get one of those old crotchety guys is like this is how I've been do it forever and just leave me alone. You know, like, but if you say to somebody, look, I'd like to test my blood more frequently, every four to six weeks. I want to get an idea of what's really happening here. I don't think anyone's gonna say no, you know, you just have to have the nerve to, to ask and and when people say no, I'm a proponent of why, if somebody says no to me, ask them why because sometimes they don't know why they're saying no other than that's just how we do it. And you've asked something outside of our norm, but that doesn't mean you can't. Anyway, that's the that's what you get. If you listen, I really, really appreciate this. Thank you so much. It was my pleasure. I want to first thank Dr. BENITO because she has a thriving practice that's full. She's not looking for new patients. She's not selling a book. She's not out doing anything trying to drum up attention for herself. She was just very willing to spend the last hour and a half sharing what she knows about thyroid with you. I just can't thank her enough. I also want to thank on the pod Dexcom and touched by type one for being longtime sponsors of the show. Check out that Dexcom G six@dexcom.com Ford slash juice box. Get your free no obligation demo of the Omnipod to Bolus insulin pump at my Omni pod.com Ford slash juice box and of course touched by type one. Is it touched by type one.org. They're also on Facebook and Instagram.

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

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.

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

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

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?

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

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.

Recognize that we don't pre plan any discussions, right?

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

Okay, where where's the map? Let's

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.

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

it is hypothyroidism and Hashimotos two different things or does Hashimotos create hypothyroidism?

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.

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.

Correct. And it's actually eight times more common in from what I remember eight times more common in women than in men.

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

my desk is made of wood on that guy.

I appreciate it. And, and so my son's thyroid was immense imaged, I guess, MRI. And

yeah, they do a kind of a scan and or a deeper imaging with dye and Yes, right.

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

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.

And I'm just smiling because that happened, but it happened over zoom because of COVID.

Oh, yeah. So there was no touching there.

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

know, Hashimoto is is the most common form of hypo thyroid. Yes, but

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.

Be like those crazy people 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 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.

Hello friends, welcome to episode 619 of the Juicebox Podcast. Today's episode of the podcast is the second in the defining thyroid series. And today Jenny Smith and I are going to talk about the glands pituitary, and thyroid, the thyroid and pituitary glands. Now I know you're thinking, oh my god, Scott, so exciting. What are you doing to me? I know. But listen, it's important. If you have autoimmune, you very well may run into hyper or hypothyroidism at some point. Hashimotos disease, in fact, could be around the corner, you need to know what to look for. So, while you might not think this is exciting, it is very needed necessary. Listen and educate yourself. You'll be glad you did. While you're listening, please remember 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. This episode of The Juicebox Podcast is sponsored by touched by type one, learn more about my favorite diabetes organization at touched by type one.org. You can also find them on Facebook, and Instagram. And I heard recently a little birdie told me that I will be speaking at their next event. I think it's an August. That's a ways away. But anyway, go orient yourself with their webpage so that when I say to you, I'm speaking at the next touched by type one event, you'll go, Oh, I know right where to go touch by type one.org and you can go get yourself some tickets. 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. Do you want to do the glands now thyroid and pituitary? Sure, okay. The weirdest part is the starting over because you have to remember it's another episode. I used to remember the defining diabetes idea. Hey, Jenny. Like like we like we just seen each other for the first time. Yeah. Well, hey, Jenny. Today I'd like to define what a thyroid gland and a pituitary gland are. Sure you want to start or should I read a definition and then we'll talk

you can read the definition. I think it's the most specific thyroid gland

is an endocrine gland located in the neck that produces hormones to regulate metabolism. The thyroid gland is controlled by the pituitary gland which secretes TSH in effort to trigger thyroid hormone production. But sometimes the thyroid simply won't release enough hormones. An underactive thyroid gland, one that doesn't produce enough hormones will result in hypothyroidism. That's not a bad reaction. I felt pretty good.

Oh, that was a very good read.

I didn't even like I'm very proud. Two years old, I read two sentences. And I'm like, wow, look at me. Yay.

You get the gold star reading award today.

So so let's go over it. First. Thyroid is where in your body. So it's

located in your neck, kind of like this. Beside that bumpiness that you could feel going down in the middle of the front of your neck, right? But you would consider your throat and on either side. That's why it's called like a butterfly type gland because if you imagine the butterfly body being the middle, the wings sort of spread to the sides of your neck, right? So that's why If you've ever had an evaluation by a doctor, they will put two fingers typically on both sides of that middle of your neck and ask you

to swallow. Okay, what happens when you swallow? They can find bumps then on it.

Correct? Yeah. So if there are bumps present, indicating something is not going the right way with the gland, then they would essentially do more testing to reveal, you know, what might be the potential problem.

Right. And will they feel but they won't feel bumps if I'm, if I'm hypothyroid. Without Hashimotos, though, is that correct?

I don't correct. I believe that the bumps come specific to the autoimmune Hashimotos. Yes.

Okay. All right. Well, it's a win. And sometimes when you see people who have that little like scar on their neck, that could be that they had thyroid cancer, right. Or, or that their or their Hashimotos was so a lot of work for graves, right.

Graves disease. Mm hmm. Yep. Yep. Which is kind of the opposite in terms of hypo hyper, I mean, we all talk about hypose and hypers. Right. But this is a very different specific reason for that. But hyper would be, you know, the potential for having like a thyroidectomy or surgical removal of some parts, but most often it's, it's cancer.

Yeah, we'll talk about that when we define Graves disease, I think. Yeah. Okay. So that's where the, that's where the actual

the thyroid hormones come from and

the gland is right there. Right? The gland is right, though we understand that. Okay, now the pituitary gland is a small gland, the size of a peanut that is located behind the eyes of the base of the brain. It secretes thyroid stimulating hormone, TSH, which helps control thyroid function. I didn't realize that so yes,

so TSH does not. TSH is regulated by the way that the pituitary gland talks to the thyroid gland. Essentially,

they're nowhere near each other. The body is amazing.

No, isn't the body I know.

Really? If they were talking, you think you'd make them neighbors? But I guess?

I guess not. I know.

I include a pituitary in here, because I don't think it gets talked about much when you actually have hypothyroidism. Nor do I think anybody's ever gonna bring it up to you while you're treating it or living with it. But

because most people just think that there's an issue here, right? And so while the issue does lie in the thyroid, the way that the pituitary gland responds to the signals, it's getting, they work together. So they're, they're both important to understand. Definitely.

Okay, is there anything else people need to know? I mean, that's pretty cut and dry and simple, but they should know their thyroid gland is in their neck, and that it can be looked at manually by their doctor visually, or they could have an MRI taken over as well. Those are the ways that would be looked at. Right. Okay. All right, I will put some more important stuff that people need to know after I let you go at the end of this. Alright, hold on a second. Now I need to keep track of what we've done. Because that is. While I'm moving to the next one, I'll tell people that one check them off. There was one time in 2021 where I had Jenny do a diabetes variable. And then like three weeks later, we saw each other and we did the same exact variable again. Neither of us knew that it happened. And that's all right. I was very amused by that. Why don't we now talk oh, what

would be interesting would be to listen to both of those episodes and see where they similar

it. And I did Jenny and I put them together in their variable. I forget which one it was. Because interestingly enough, we we sort of built on what we said previously without knowing it. Oh, okay. It was very interest, maybe

with a subconscious realization that we've already talked about this, but these are the additional pieces to it, right? No one said

it out loud. So I put them together. All okay. Okay, so let's put together here. Let's

put well I think maybe the next thing would really be since we talked about like Hashimotos hypo, the glands that are specifically involved, maybe the types of tests like the hormone that would be being produced and how they work. Okay,

so talk about,

you think T sh t four T three. Yeah, that kind of stuff.

A huge thanks to touched by type one for sponsoring this episode of The Juicebox Podcast. Don't forget to check them out on Facebook and Instagram touched by type ones mission is to elevate awareness of type one diabetes, raise funds to find a cure and inspire those with diabetes to thrive, touched by type one.org. And if you're a US resident who has type one, or is the caregiver of someone with type one, please go take the survey AT T one D exchange.org. Forward slash juicebox. Looking for community around type one diabetes, look no further than Juicebox Podcast, type one diabetes on Facebook. It's a private group with 20,000 people just like you. Thanks so much for listening today. Please stop back frequently for more episodes of The Juicebox Podcast and to continue with a 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 where 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 feed, 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.

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,

and pretty common post pregnancy. And it got

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

know that we joke all the time. So clearly,

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

herself. Really, the attitude that was there was relative to a hormone that was,

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.

You are a mean person.

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

that was mood is definitely one of them. Yeah,

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.

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

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?

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

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,

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

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.

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,

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

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.

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

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

just for kicks, does your brother have any autoimmune diseases?

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

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.

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

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,

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.

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.

Yeah. And how adult of him to make that decision on his own.

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

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.

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

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.

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.

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.

All right. That's a good yes.

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

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.

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,

three days just call it T three T's much easier.

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

and that one is really specific. Hashimotos.

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.

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.

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,

like more natural version. Yes, exactly.

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

correct and armor I've actually heard a lot more in probably the past five years, I've heard more people using the armor.

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?

Yeah, it's, yeah, it's essentially Synthroid. Yeah, it's just that, yeah,

I can tell you that Synthroid works for my wife, but the generic of Synthroid doesn't.

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

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,

yes, there's a list. Ready, get your notebook out.

Vitamins, you can't take at the same time, you know, like all kinds of stuff and

how many hours between taking the vitamins and things? I mean, it's

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.

On my list here,

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

you how to read the definition. Yeah, sure.

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?

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,

so these antibodies are a good thing. Until they get confused, or supercharged maybe by

supercharged Yes, they've had way too much Red Bull or whatever is the newest thing.

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,

he was like the bizarro world. His

name was good. Yes, Jedi. Thank you.

Well, you know, I do have two little boys as well. They love the superheroes.

Really well done. Yank that right out of your S.

Let me do get the superhero comic books from the library. And we read them many times. Okay,

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,

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.

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

a pancreas is not dead, just because you have type one diabetes,

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

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.

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.

We call that the bizarro episode,

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.

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

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.

Hello friends, and welcome to episode 632 of the Juicebox Podcast. Welcome back for the fifth installment of the defining thyroid series. Today Jenny Smith and I are going to discuss autoimmune disease. So far in the defining thyroid series, we've tackled hypothyroidism, and Hashimotos thyroiditis. That's an episode 616. In Episode 619, we define pituitary and thyroid glands. In Episode 624, we defined P S H testing, and in Episode 628, we define T four and T three. Again, today we're going to talk about autoimmune and how it impacts your life with thyroid disease. 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 healthcare plan, or becoming bold with insulin. If you have type one diabetes, or are the caregiver of someone with type one, and are a US resident, please go to T one D exchange.org. Ford slash juicebox. And take the survey this episode of The Juicebox Podcast is sponsored by Omni pod makers of the Omni pod dash, the Omni pod promise and the upcoming Omni pod five. Learn more about that Omni pod dash and see if you're eligible for a free 30 day trial at Omni pod.com forward slash juicebox. Welcome back, Jenny.

Hi, how are you today? Oh, you know how I am? You're always full of energy. So

Oh, sure. Sure.

I could never tell what happened in the night before. Does he always talk in the morning too, right. So

I always do. So I overslept, and was a woken, luckily, by a text from my neighbor wondering if our power was out. It is not by the way, obviously. And then I looked at the clock and realize that it was four minutes before you were going to call.

And it's time to get up and get going.

So I'm just gonna leave it at that and tell you that I may or may not be wearing pants. So today we're going to

say good, that's a good thing about you know, stuff like this, or you could have fuzzy

slippers, I look perfect. And this these headphones are holding my hair down. So

we're all good. Nobody cares.

Alright, so we're gonna define, I mean, you know, it goes along with the thyroid terms, but autoimmune disease. I have it here as a disease caused by a defect in the body's immune system. Instead of protecting the body it attacks and destroys a healthy part of the body. Having an autoimmune disease is considered a risk factor for hypothyroidism. Correct? Okay. hypothyroidism, of course, is defined in another episode, but a condition in which the body's immune system mistakes its own healthy tissue as foreign and attacks them. Most autoimmune disease cause inflammation that can affect many parts of the body. Inflammation to the real, is the real bandit in all this, isn't it?

For most of the autoimmune diseases, it really is. Yes. I mean, if you look at just the simple ones that are very inflammatory kinds of conditions, it's rheumatoid arthritis and lupus and even, you know, like, the fibromyalgia and all of those types of things, the inflammatory bowel diseases. I mean, it all relates to inflammation.

Yeah, I'm gonna, you know, well, I guess the first let's tackle this here, right. So I'll tell you that I think Arden has type one diabetes, because obviously she was born with or developed markers for the first two years of her life. Antibodies, and then she got sick. So for Arden, in my you know, listen, I don't have a crystal ball. I think Arden got coxsackievirus she got coxsackievirus it was this thing that our pediatrician was like, oh, kids get this don't worry, it clears out. This is how long it takes a protracted amount of time passed, which I don't remember how long anymore because I was not a person who tracked the illness back then. And, and then suddenly, Arden had Coxsackie virus again. Hmm. So I took her to the doctor. And I remember him saying this This is weird. I was gonna say that's, that is weird. You're not supposed to get this more than once. It's like chickenpox. I remember saying you get it and you don't get it again. And when I look back now, I wonder if it ever really went away the first time. Like, maybe she got it, and her body just

was like, what's what hibernated for a bit and

ran her body ran right past the coxsackievirus right into our pancreas is what I'm thinking. And, and so that was kind of how it started. And you know, people who pay attention, you talk to them, they have any number of stories about an illness they had before they were diagnosed with type one or sometimes, right stress, stuff like that. Anyway, you know, in the, in the course of looking into this, if you Google auto immune disease, what is it, you'll get? Here's the top five, here's the top seven, here's the top 10. You know, there are so many lists of things that people like you blew through a couple, one that's more common than then you think once you get involved with people with the type one like I see vitiligo on a lot of Yes. Right? Celiac almost feels like sometimes it goes hand in hand with people with type one. Which one do you think you so you see most frequently?

I would say, quite honestly, thyroid and celiac are the primary that I see. In fact, I would say that the majority of kiddos that I work with, or families that I work with, the celiac has already been, like tested at diagnosis. At this point, I'm quite certain that when I was diagnosed, I I would probably guess that when Arden was diagnosed, she probably wasn't tested for celiac. Was she at the same time? Yeah. But those are pretty common. And then it's like a retest, because many markers can actually be higher at a diagnosis where everything is out of order, right? And you've got this high blood sugar level, your body has been kind of attacked, so to speak, and is trying to do, okay. So in terms of celiac, oftentimes, even if there is a positive result, originally, those may, may or may not come back down into what they consider normal. And or they may also do like the biopsy, which is considered the most diagnostic in terms of true positive celiac condition. But thyroid is the other one, definitely. I mean, those three, very much go hand in hand, I would say, you know, along with it, but I don't, I don't see it as frequently is RA or rheumatoid arthritis. So, you know, I think a lot of times too, with rheumatoid arthritis, it takes it takes really digging into the symptoms that you've been having, and finding the right doctor to analyze things, and it helps you figure out what it is, you know, that could be causing some of those, like more telltale signs for RA, because it could certainly be something else to

well, you know, I go back and forth on the show, hinting around that Arden has other issues, but I don't talk about them because we haven't figured them out yet. You know, it's years and years of, you know, looking and watching and writing things down and talking to doctors and then to oh, you know what, this all sounds like her thyroid and then we, I mean, Arden's thyroids now managed to with an inch of its life, and it didn't help her for some of the other problems, right. And we just did find a doctor very recently, actually, as I gone to her. So Arden has an endo that manages her thyroid, the woman who's on the thyroid episode, Dr. Benito. And then Dr. BENITO suggested another. Another doctor, which we saw recently actually Arden's getting bloodwork today to check into the things that that this doctor is is wondering about, and it's just important to know that we've gone to the Children's Hospital with these concerns. They do a fairly I don't know what I want to call it, uh, you know, gosh, it was, I'm trying to make a very in depth panel. Well, you would think it would have been in depth, but instead it was like it was blood work. And she they saw her for 20 minutes. They're like, Ah, she doesn't have that. And that was

the Oh, yeah, that was the doctor that was not this new doctors do doctors

talk we were in there for I think I told Jenny privately, almost three hours to two and a half, three hours in a doctor's appointment, where she was just talking to her and pulling things out that a regular doctor would not and you kind of have to do that because these things so clearly mimic each other all the time. In my heart, it's about the, it's about the inflammation. Yeah, you know, like this, this, the autoimmune diseases and inflammation give you a lot of feedback in your body that's similar. You know, joint pain could be any number of autoimmune, yes. As an example. So I just wanted to bring it up here because I think we've got people's attention on the thyroid thing. I'm getting a ton of nice feedback online, saying thank you for involving thyroid in the in the podcast. We'll definitely do this again. I mean, I imagine we're going to end up doing this with celiac in the future and give giving a little deeper look into that. But you know, I'm looking at a list here, pernicious anemia, alopecia that a Lago type one Graves disease, celiac, rheumatoid arthritis Hashimotos. These are what this one place calls the top 10.

Ms. I mean, yeah, you know, I know, there are there is a bigger list than I think, the last time that I looked. So I think things have either been added or they've been clarified a little bit better, which is a good thing. Because sometimes you feel a little bit lost in terms of, well, what's wrong with my body that this is happening? You know, and I think that's the unknown thing about autoimmune disorder is that it really isn't, the trigger isn't really known. Why does one person's body react so well, and not have any problems to whatever this trigger is that then for somebody else, completely gets this ball rolling, of inflammation and immune attack, that's a completely incorrect immune attack on healthy cells that are supposed to be doing what they're, you know, meant to do?

Well, what I Google just now, I never would have if I didn't make this podcast, but because of the after dark episodes, I've now been in contact with three and I have one more on the books, people with type one diabetes who want to come on and talk about their bipolar disorder. Ah, I never would have thought of that. But you know, a quick Google search bipolar disorder, autoimmune, just those three words. Bipolar disorder are strongly associated with immune dysfunction. You know, it goes on after that to say replicated. Epidemiologists, epidemiological studies have demonstrated that bipolar has high rates of inflammatory medical comorbidities, including autoimmune disorders, chronic infections, cardiovascular disease, and metabolic disorder.

Well, then getting bipolar diagnosed the right way. Again, another whole topic because bipolar one, there's bipolar two, there's from the little that I know about, it's, it's another world of management.

Yeah, people can get people can get medic medicated, completely wrong. Wrong, they get close to Okay. And then the doctors accept that as we want. So we can do, I've seen a couple of older adults that have been working with, you know, their bipolar disease for years, almost stand up one day and go, I don't think this is right, and then start over with another doctor, and they completely change their medications around it changes their life. So yeah, yeah, these are just things that I mean, listen, I think I mean,

as a as to interrupt, it's kind of a hallmark of a lot of these autoimmune conditions. It's the reason that it's not a cut and dry, open up the textbook, Here's your medicine, take it and everything's going to be great. Autoimmune disorders, they really require individualized management. What works for one person may not be the quote, unquote, cocktail that works for the next person.

Well, when I was sick a few years ago, and I had a problem with iron, you know, you know, anemia is on this list, too. And when I was tested, they told me I was celiac sensitive, not they didn't call me they didn't say I had celiac disease. They said, I said, I'm sensitive. You are gluten sensitive, it'll send a little sensitive to some glutens. Right? And, you know, I mean, listen, we've known each other a long time you see me, I'm not a thin or lean person, and I'm not an obese person. But I don't. Let's see how this sounds. My lifestyle doesn't reflect my body. Meaning, right, I don't, I don't eat a ton of food, and my body holds on to weight. And I do wonder sometimes too, if that's even, you know, some sort of inflammation somewhere, maybe I don't know, like, I have no idea but you know, it makes me wonder as I get older, so, you know, if it's all just bad luck, or, or why well

I don't think so I think it also speaks somewhat to, I guess what's been hinted at in terms of inflammation, right? A good portion of our immune system lies in our gut, our gut, not like some fancy little gland somewhere like in our digestive system. If we keep our digestive system healthy, that goes a huge way in keeping us immune to our body reacting the incorrect way to something, right. And a lot of study has been done, especially in autoimmune disorder type one and celiac very specifically, in terms of like, the the term has been thrown around so much I hate using it, but like this leaky gut type of potential for somebody who has that type of body that may have the potential to let something sneak through, right, the digestive system, which then causes this reaction in the body, that allows the body to then go the wrong way with how it responds to that, right.

Yeah, well, I'm hoping I'm gonna I should, I'm hoping that this. I'm hoping the rheumatologist that aren't seeing now is going to work out. And this is as hopeful as I've ever been after visiting somebody for art and right. Because I'm going to get that person on this podcast too. If this all works out. I'm going to get her because here's how they started with Arden's treatment. It wasn't you know, I mean, there's a blood panel, like, you know, three prescriptions long, like don't get me right there that route. But she looked at her and she's like, Honey, you're a very healthy person, we're going to figure out what's wrong here. And what they started her on was a quality multivitamin. Fish oil, you know, bumping up her vitamin D significantly by giving her oral drops to hold her mouth instead of tablets to take and a couple of probiotics and not like, you know, not like go to the pharmacy and get us a chewable probiotic. Like this stuff smells a little like poo when it comes out of the container here. And it's refrigerated I bet Oh, it's it's something else is what it is. And so, and she's like, for a month, take this cocktail. And then we'll do your blood work in the meantime, and we'll come back and talk again. Right? It's like, but she's like, what makes sense to me is that your gut is unbalanced. And now we were we had we were on to that already. So I've been I've been taking my diabetes brainon appointment at Arden for other reasons for a while. And I'm not a doctor. So it goes a little slow. But we had just gotten Arden about two months ago, a study of her gut, which by the way, comes from pooping in a box. Yes, and sending it away in the mail. Not easy to get a 17 year old girl to do, but we did it, my wife did it, I actually want to give her all the credit. Anyway, at some point, I'm gonna figure this out and then we're gonna add it into this podcast. So for all for today, I appreciate you helping me define autoimmune disease. Of course, if you're tired of injecting your insulin with a pen, or a syringe, or you have a pump with all kinds of crazy tubing attached to it, that you really don't like this next bit is for you. The Omni pod tubeless insulin pump does not have any tubing. That's why they call it tubeless. I know you're thinking that's not possible Scott, but it is Omnipod doesn't have tubing. Other insulin pumps have a controller with a cartridge connected the tubing that kind of you know, goes all over the place to an infusion set. And then that's how you get your insulin through that long tube. But with Ali pod, there is no tubing, no tubing to get caught on door handles. And nothing to disconnect when you're bathing or swimming. Because the Omni pod is, you know, it's happy in the water. You can go in the bathtub, in the shower in the local lake. You can go wherever you want wearing your Omni pod tubeless insulin pump. That's pretty important because then you don't lose your insulin during those times. How many of you have disconnected for a shower only to forget to reconnect to your tube insulin pump? When do you find out an hour or two later when your blood sugar sky high because you haven't had any insulin for a while? Why? Because you had to disconnect for a shower. That shouldn't be the way and with Omni pod it isn't. Now if this all sounds magical or different to you, and you're not sure what to do, I understand that but you may be eligible for a free 30 day trial of the Omni pod dash. Now go to Omni pod.com forward slash juicebox to find out if you're out Trouble Omnipod we'll send you a free 30 day supply. You can check it out and see what you think. And even if you decide to stick with what you're doing after the trial, you still got our free 30 days. How often do you get a free month of anything? So the Omni pod dash is tubeless it's waterproof, you can shower with it, or you know, swimming the pool. Right? The pool the pool, are you thinking about summer, I just made me think about summer, it's not here yet kids slipped through this cold a little longer anyway, swim in the pool, don't get your tubing caught anything, don't have any tubing to be sneaking through your clothing. It's all pretty great. And no multiple daily injections. With the Omni pod, you just pull out the PDM that's the personal diabetes manager's little handheld device kind of looks like a cell phone. And you you just you say I'm gonna have 12 carbs, he talks a little thing 12 carbs and says I think you should have this much insulin, you know, based on your settings, and you go okay, push a button, and boom, boom, here comes the insulin. No injections. I love it. Now, you might be thinking, Alright, Scott, I want it on the pod. But I've been hearing about this on the pod five and I'm just gonna wait for that. Hmm, I would say in a normal circumstance, I understand. But with the Omni pod promise, you don't have to do that. Here's what the Omni pod promise says. You get the Omni pod dash today. And you start using it and you love it. And then I don't know, a month from now two months from now whenever on the pod five is available for you and covered by your insurance. You just move up to the Omni pod five. That's the Omni pod promise. The Omni pod promise says you can go to new technology that Omni pod has, when it's available to you and covered by your insurance. That's it, you want to change, you can change. That's a pretty good promise on the pod.com forward slash juice box. You might as well go pick around the website and figure it out a little bit. See if you're up for it. Check to see if you know you're eligible for that free trial and get started today. Omni pod.com forward slash juice box. There are links in the show notes of your podcast player and at Juicebox Podcast comm to Omnipod and all of the sponsors if you're wondering what signs and symptoms to look for in hypothyroidism, hyperthyroidism, Graves' disease and Hashimotos I'm going to list them all for you right now. If you already know what they are. Well then thanks so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. But if you're waiting for the signs and symptoms they're gonna happen like right now. symptoms of hypothyroidism Feri the Mayo Clinic list of possible symptoms as 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 in your joints heavier than normal or irregular menstrual periods. thinning hair slow heart rate depression impaired memory enlarged thyroid gland, which could be known as a goiter. If you're looking for this in infants, you might also look for a large protruding tongue difficulty breathing hoarse, crying and umbilical hernia, or yellowing of the skin and whites of the eyes. As the disease progresses and infants You may also notice constipation, poor muscle tone and excessive sleepiness. In teens, you may notice poor growth resulting in short stature, delayed development of permanent teeth, delayed puberty or poor mental development. Let's move on to hyperthyroidism. Still on the Mayo Clinic's website, they say of course, that hyperthyroidism can mimic other health problems. We've been talking about this through all these episodes, you know that unintentional weight loss even when your appetite and food intake stay the same or increase, rapid heartbeat, irregular heartbeat, pounding of your heart, increased appetite, nervousness, anxiety, and irritability. Tremors usually a fine trembling in your hands or fingers, sweating changes in menstrual patterns. increased sensitivity, heat, changes in bowel patterns, especially more frequent bowel movements, and enlarged thyroid gland of course called a goiter, which may appear a swelling at the base of your neck, fatigue, muscle weakness, difficulty sleeping, skin thinning, fine embrittle hair. For Graves disease, you're looking for dry eyes, red or swollen eyes, excessive tearing or discomfort in one or both eyes, light sensitivity, blurred or double vision, inflammation or reduced eye movement, protruding eyeballs. Just quickly Hashimoto Disease, which as we know, is an autoimmune version of hypothyroidism. Hashimotos disease progresses slowly over the years you may not notice signs or symptoms of the disease eventually the decline in thyroid hormone production can result in any the following. There gonna be a lot of duplicates here from hypothyroidism, fatigue and sluggishness, increased sensitivity to cold, increased sleepiness, dry skin, constipation, muscle weakness, muscle aches, tenderness and stiffness, joint pain and stiffness, irregular or excessive menstrual bleeding, depression, problems with memory or concentration, swelling of the thyroid, the goiter of puffy face, brittle nails, hair loss, enlargement of the tongue. I'd like to just finish by saying that if you have any of these, please see a doctor get a simple blood test and get yourself some answers. Don't forget a TSH over two is enough reason to be concerned. Treat your symptoms, not the lab values. Thanks again for listening. I'll be back very soon with another episode of The Juicebox Podcast.

Hello friends and welcome to episode 636 of the Juicebox Podcast. Today I bring you the sixth installment of the defining thyroid series today Jenny Smith and I are going to talk about goiter, and supplementing, and some other stuff. So far in the defining thyroid series, we've tackled hypothyroidism, and Hashimotos thyroiditis, that's an episode 616. In Episode 619, we define pituitary and thyroid glands. In Episode 624, we defined P S H testing, and in Episode 628, we define T four and T three. In episode 632. We talked about auto immune, and today we're gonna be talking about goiter, supplementing and some other stuff. It's kind of a, I don't want to call today a free for all but today is sort of a building conversation. You'll well you'll see in a minute. While you're listening today, please remember 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 have type one diabetes, or are the caregiver of someone with type one, and are a US resident, please go to T one D exchange.org. Ford slash juicebox. And take the survey. This episode of The Juicebox Podcast is sponsored by Omni pod makers of the Omni pod dash, the Omni pod promise and the upcoming Omni pod five. Learn more about that Omni pod dash and see if you're eligible for a free 30 day trial at Omni pod.com forward slash juicebox. Today's episode is short. So at the end, I'll explain how you may be eligible for that free 30 days of the AMI pod dash. Alright, Jenny, we're gonna we're gonna do a quick All right, I'm already laughing ready? Goyder?

I know it's such a funny word. Funny Little word. Really goitre. Like, couldn't. There are many medical terms that I think are hilarious. But definitely goiter is one of them. It is. It's funny.

I don't know. I'm just I always wonder still. Why, you know, we didn't find out what Hashimotos first name was before they named it?

Well, I think the thing about goiter, too, is the fact that like there's a visible part of Goyder, right? It's not just like the name. That's right. That's funny. Like there's a visible piece that on your body, you're like, ooh, that doesn't look normal. shouldn't really be there.

Well, and some people can get them. I mean, they can look like real like lumps in your neck, right?

Yes, yes, my mom. In fact, when I've seen pictures of my mom, I mean, they're the really old like fading types of pictures before she was diagnosed or within the process. She had a very visible I was on both sides of her neck, she had a very visible she had kind of like the protruding sort of like eyes. There were a lot of things that were very like, that's diagnostic there for her. But, but yes, goiter is essentially an alert and enlargement of the thyroid gland. If that all that we just said did, like, bring that up. That's what it is enlargement of the thyroid gland.

goiter also called enlarged thyroid probably by a doctor who laughed every time he said goiter. You know, when it's um, gosh. Do you remember I'm really gonna date myself. There used to be this. People used to shop on TV. I don't know if that's the thing that everyone knows. But there were like infomercials or longer commercials that some guy would come on with a deep voice and tell you about the the heartbreak of psoriasis, you know, or something? Yes. And it's the word terror, which has nothing to do with anything we're talking about here but sticks in my head since I'm a child, because you know, the heartbreak of surprises you and he runs through these lists of other things you might see. And then he goes terror. And it's like stuck in my head. I don't know why I can't get rid of it. I don't even know what it means. That's really funny. So, goiter says abnormal enlargement of the butterfly shaped gland, below the Adam's apple, which is called the thyroid. Of course, a goiter commonly develops as a result of iodine deficiency or inflammation of the thyroid gland. Not all goiters cause symptoms symptoms that do occur might include swelling cough. Rarely, symptoms may include throat tightness or trouble breathing A small goiter that doesn't cause symptoms may not need treatment. In some cases, medication or surgery is needed. Doesn't have. So it's so funny because I'm actually learning something here today. So it shows me we're on the right track, Jenny. Yes. So goiter. I mean, not that I'm just repeating myself. But goiter is an enlarged thyroid. It's not a thing. It's not like a new thing that appears in your neck. It's, it's the enlarged,

it's the thyroid and large and really reason. I mean, the reason is because your thyroid gets kind of signaled too much by the pituitary gland to bring out more thyroid hormone, right, I mean, that's the gist of it. And so that over stimulation can cause the thyroid to get larger. And to some people get large enough that you could visibly see that see the change,

and the reason in the United States that you would kind of pretty much think thyroid hormone problem or nodules, when you see a goiter. But I guess Believe it or not, is because we have iodized salt in the United States.

Yes, we do. As long as you truly get iodized salt,

right. Yeah. Can you get it non right.

But I mean, if you look, and it's interesting, since we started doing all of these about thyroid specifically, I've started paying attention to salt at the grocery store. I like the grocery store anyway, so. But I was noticing like at Costco specifically, there are big things of sea salt, specifically state on the label. This is not a valuable source of iodine in the diet. So does Himalayan sea salt. I mean, there are many salts that have now become this as the preferred to use that no longer have enough of it in it.

Yep. And it's so so in a past episode, I think in the goitre episode, I talked about No, not in the greater episode in the autoimmune episode. This is the goiter episode I talked about. I talked about a new rheumatologist that that ardency she spent 10 minutes talking about iodine and how it's interesting, not in our diet anymore. You know, and and then she went into talking about, I think this kind of fits, she went into talking about even when you eat well, in a factory farming society, you're not eating as well as you think you are. And she used an example of she chose a very popular grocery store chain and said, they, some of their fruits, they they flash freeze, and they don't deliver them to you for months afterwards. And she's like, they have ways of delivering foods where they show up to you with not nearly as much nutritional quality and quality believe that they have because you're like, Ooh, I'm eating a piece of fruit or I'm eating a vegetable. She said but the they've been decimated for nutrition all the time. And she started talking about having to supplement things that you just even if you have a certain diet, you might not know you need to supplement and that that's what made me think of this, which is you know, we all use salt and things. So if you used iodized salt and you have a goiter, it's likely not because of iodine, it's likely because of thyroid, but in other places in the world or if you've gotten all Fifi and you're using sea salt which I say jokingly because I realized this we're talking I switched to pink salt like years ago years ago right? I absolutely don't use much of the other people might have still use the salt shaker but I I have a little salt

pig you like that you like the pink salt.

I like to take a little pinch and just like you know let it go over top of things and and now I'm realized that I better just shake this the shaker a little bit myself once in a while. Okay, glitters did not look pleasant in the photographs.

No, they don't. Yeah.

And your mother had one. My mother

had one. Yes, a noticeable one again from pictures and whatnot from that time and then once her thyroid was well managed, and she actually had thyroid burnout and everything because she was hyperthyroid and now she actually takes the typical levothyroxine because she has hypothyroid because of everything wise

I have to say when I when I just Googled for pictures of goiter when they come back with like no not drawings but like but actual therapy. Following photographs, a lot of them do look like they don't live in the United States. That's interesting. That is interesting. Yeah. And while they can get massive in some Yeah. Oh, that's horrible. Okay. All right. Fun times here on the podcast.

Yes, exactly. From time.

There's nothing else to add to this one, right?

I don't think so. No, there's certainly things that I could add, but I don't think that they're as 13. I'll

just read this last piece that I had here in larger the thyroid gland, when your thyroid is bombarded by signals from the pituitary in an effort to trigger the thyroid into making more hormones. The excessive stimulation may cause the thyroid gland to enlarge to the point where you have a bulge in your neck. So this seems like that means in the case of an actual thyroid issue, but not an iodine deficiency, correct? Exactly. All right. Well, let's never speak of this again. Seriously,

unless somebody comments, just like I want to learn more about guider, and

we'd be happy to talk about it. But my goodness, that is that is very unpleasant, we'd

have to find a greater ologists, I think.

I'll tell you what, if my life gets down to that, Jenny, I'm not, I can't do this anymore. That's fine. I'm trying to outline the fact that I think that if I don't get Arden straightened out, and everybody else doesn't just stay healthy for five minutes, I'm gonna like light my underwear on fire and start running around the streets much longer.

Everybody just needs to well, and what it actually goes along with something that I It sounds like you really found a quite good physician, because a lot of what she was telling you about the quality of food, I mean, it's the big reason that I take or spend the extra to buy non farm raised fish, okay, because the difference between farm raised salmon and actual wild salmon, there's a major difference. If you look at farm raised salmon, and you look at the package, you will see color added that color is added because they haven't been being fed the wide diet that they would eat in the wild to actually get the quality or megas that your body the benefit of eating salmon or tuna is for the omegas which in your daughter's case, the doctor was like, hey, you need more omegas right? Well, don't buy farm raised fish then because that's not going to help her anymore.

I want to say too, she spent a lot of time showing us how to read labels on supplements, vitamins, and she said there are overwhelmingly more useless vitamins on the market, then, you know, she's like, and they're very good at marketing it to make it sound like they're good, but she's like there's nothing in them. It's just a it's just a waste of your money.

So my original naturopath when I saw her years ago, um, she actually did the same thing. What supplements are you using? How are you using them, and she actually recommended very minimal list of quality, just multivitamins, and at that time I had needed to start taking like a prenatal vitamin, right in terms of preparation for getting pregnant. And she was like these are the ones and don't pick outside of those this list. These are quality they come actually the nutrients come from real food sources, not from synthetic something something she's like otherwise you paying for a bottle of what's actually getting peed out into the toilet.

He also told me that the real popular vitamins that people know are good get knocked off online, so you have to be careful about even buying them from Amazon. And what else did she say? Oh yeah, anything that you can absorb to the lining of your mouth is preferable over swallowing it. So she gave Arden vitamin D drops instead of like sardines, one of those people that takes 50,000 I use a vitamin D a week, like once a week. And she's like No, she's like, just do these drops instead.

Again, it goes back to the gut and absorption and they know very well that the gut and absorption and people who have type one is lacking. My my naturopath did the same thing. My vitamin D was 18 Yeah, the doctor had given me a supplement, huge dose like pills, supplements. And he was like, I don't know I started seeing a naturopath. She said you need to drop you need to put it under your tongue every single day, get things retested in eight weeks and come back and they were up already.

You know, it's funny I'll add here before we end this one and move on to the next that if you would have found me before Arden had type one diabetes and before I knew anything about all this stuff, and had this conversation with me, I would have said oh I met a hippie lady today that was talking about vitamins and how they're not all the same and you know, you got to take vitamin D under Your tongue and I think she was high on the weed is what I would have thought, you know, they mean like, oh well, lovely cookie woman, you know, but now I know you're not cookie, and I'm not either. Thank you. So there's way more to this than, than most people would think, Oh, just just getting your supplements, right? It's not coming from your food. I mean, everybody, look when this is over today, take five minutes, close your eyes, be honest with yourself and think about what you've eaten this week. And tell me if there's food in any of it. Or if you're just keeping yourself alive and not nurturing yourself. You know, so I, I was on a road trip yesterday. I got up very early in the morning, I did not feel like eating, I drove a couple of 100 miles. I saw my son, I drove a couple of 100 miles back, I drank two bottles of water in the morning. I peed in a sketchy rest stop. I went to get my son. We went to lunch, where we went to a English pub, and I had fish and chips. So I had cod, probably not deep fried, but I stay away from the oil. So I picked all the breading off of it. And then I had fries and a little bit of ketchup. And then I got in a car and drove home and ate a peppermint patty, because that's what I could find it a rest stop. And then I got home and that is what I'd eaten that day. You know, and if you asked me, How do I eat? I'd probably say I'm fine. Because the day before I didn't eat well, but I didn't. I didn't on Sunday. And you really do have to start asking yourself, Am I I'm fueling myself and I'm not hungry, and I'm staying alive. But am I bringing in the nutrition that my body actually needs to maintain itself and to rebuild itself from problems? You know, and I think for most of us, I really I hate to say it, I'm not coming down on people. I think most of us, I don't think we do really?

Right? Well, and I think if you ask many people who have enough resources and whatnot to actually have enough food in their life, it's quantity of food seems enough. So they would say yes, I'm well fed. Well, what's the quality? Not the quantity of what you're eating? Because quite honestly, here in our United States, we have enough quantity,

right? It's almost hard to go hungry at this point. Yeah.

So you know, and I mean, there are certainly people who do struggle for enough. But even them unfortunately, what they can have then access to doesn't have a quality piece to it. It's what they can have is what they can have, because this is what's affordable. And unfortunately, there's not much quality there.

Yeah, no, I mean, if you are a person who's listening to this in the hopes of fine tuning your health, there's nothing in a Dorito that's going to help with that, I guess is the message. Even though I will say this of all the longtime foods from my childhood, the junk foods, Doritos has done the best job of keeping the experience of a Dorito the same as it was 20 years ago. Here's a short list of people who have not Fruity Pebbles, Apple Jacks, just using. There are some junk foods that people have just messed up over the years. For funny, Fruity Pebbles is my biggest disappointment. Jenny's like I don't know what a fruity Pebble is that? I'm not eating it.

I don't Well, the funny thing is I do but we didn't have we didn't have those. I think I've had 30 pebbles, maybe once in my life. And it was just because my parents just didn't buy that kind of stuff. If we did have cereal, it was way way up camping. And it was like honey nut cheerios, right. I mean, that was like, and I mean, it still has sugar added to it. Obviously it's still you know what it is? But yeah, I think we just we didn't get that kind of stuff. I was actually talking to somebody the other day and I were talking about like kids and what they eat and whatever and it was like my children have never been enough Donald's

like we can pass and Donald's and there is no Mama Mama Mama.

They don't really I mean, my nine year old now obviously knows what it is but he would have no desire to stop there. Because we just don't that's not a regular thing for us to do.

Yeah, in my house. It was soccer because Kelly did not did not want our children to play soccer we gave them no context for when they were growing up. I know I've told this story before but it I don't think to me that's interesting. We bears it bears repeating because you can you can impact how your children go up and what they think to do and what they think to don't do you know, food being the example but when my son was like two or three years old, we were stopped at a traffic light and there was a men's league and they were playing soccer. I'm talking about like hundreds of people spread out over five soccer fields. My son says, Mommy, what are they doing? And Kelly looks out the window and looks back and goes I have No idea and the light turned green. And we drove away. Because Kelly's sisters played soccer growing up, and Kelly hated going to soccer games. Ah, she's like I didn't, she didn't want to have a kid who played soccer. So we just didn't tell him what it was. And he just didn't, he never asked about it. And that that was it. And I, I'm dialing that back to your, you can, you can move your children in the right direction with a lot of different things. Even taking a supplement every day, you know, like just a multivitamin. You can make that part of their life to the point where they get older, they just, they just do it. You know, because not every older kid just you know, if you you realize when you're 20 years old, you need a a multivitamin or something. It's not going to be easy to get everyone to integrate that into their life. You know, most people are gonna have a hard time adding things as adults. So,

right. I mean, even my five year old can go to the refrigerator and pick something like he'll often want and want to do it himself. An apple cut up with peanut butter. That's like his favorite thing ever. He can he make his own egg salad. I think it's pretty awesome. It's not pretty. And it certainly is kind of messy on the counter. But you know what? He can make his own eggs

to do it. Well, that's, that's the, that's the takeaway from this one is you can make decisions about how you eat and how you get. There you go. Alright, Jen, do we have time for one more? Yeah, absolutely. If you're tired of injecting your insulin with a pen, or a syringe, or you have a pump with all kinds of crazy tubing attached to it, that you really don't like, this next bit is for you. The Omni pod tubeless insulin pump does not have any tubing. That's why they call it tubeless. I know you're thinking that's not possible. But it is Omni pod doesn't have tubing. Other insulin pumps have a controller with a cartridge, connected the tubing that kind of you know, goes all over the place to an infusion set. And then that's how you get your insulin through that long tube. But with Ali pod, there is no tubing, no tubing to get caught on door handles. And nothing to disconnect when you're bathing or swimming. Because the Omni pod is, you know, it's happy in the water. You can go in the bathtub, in the shower in the local lake. You can go wherever you want wearing your Omni pod tubeless insulin pump. That's pretty important because then you don't lose your insulin during those times. How many of you have disconnected for a shower only to forget to reconnect to your tubed insulin pump? When do you find out an hour or two later when your blood sugar's sky high? Because you haven't had any insulin for a while. Why? Because you had to disconnect for a shower. That shouldn't be the way and with Omni pod it isn't. Now if this all sounds magical or different to you, and you're not sure what to do, I understand that, but you may be eligible for a free 30 day trial of the Omni pod dash. Now go to Omni pod.com forward slash juicebox to find out. If you're eligible, Omni pod, we'll send you a free 30 day supply. You can check it out and see what you think. And even if you decide to stick with what you're doing after the trial, you still got our free 30 days. How often you get a free month of anything. So the Omni pod dash is tubeless it's waterproof, you can shower with it, or you know swimming the pool. Right the pool the pool. Are you thinking about summer I just made me think about summer. It's not here yet kids slipped through this cold a little longer anyway. swim in the pool. Don't get your tubing caught anything, don't have any tubing to be sneaking through your clothing. It's all pretty great. And no multiple daily injections. With the Omni pod, you just pull out the PDM that's the personal diabetes manager's little handheld device kind of looks like a cell phone. And you you just say I'm gonna have 12 carbs, he talks a little thing 12 carbs and says I think you should have this much insulin, you know, based on your settings and you go okay, push a button and boom, boom, here comes the insulin. No injections. I love it. Now you might be thinking, Alright, Scott, I want it on the pod but I've been hearing about this Omni pod five, and I'm just gonna wait for that. Hmm, I would say in a normal circumstance, I understand. But with the Omni pod promise, you don't have to do that. Here's what the Omni pod promise says. You get the Omni pod dash today. And you start using it and you love it. And then I don't know, a month from now two months from now whenever Omni pod five is available for you and covered by your insurance. You just move up to the Omni pod five. That's the Omni pod promise. The Omni pod promise says you can go to new technology that Omni pod has, when it's available to you and covered by your insurance. That's it, you want to change, you can change. That's a pretty good promise on the pod.com forward slash juice box, you might as well go poke around on the website and figure it out a little bit. See if you're up for it. Check to see if you know you're eligible for that free trial and get started today. Omni pod.com forward slash juice box. There are links in the show notes of your podcast player and at Juicebox Podcast comm to Omnipod and all of the sponsors if you're wondering what signs and symptoms to look for in hypothyroidism, hyperthyroidism, Graves' disease, and Hashimotos, I'm going to list them all for you right now. If you already know what they are. Well then thanks so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. But if you're waiting for the signs and symptoms they're gonna happen like right now. symptoms of hypothyroidism Farey the Mayo Clinic list of possible symptoms such as 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 in your joints heavier than normal or irregular menstrual periods. thinning hair slow heart rate depression impaired memory enlarged thyroid gland, which could be known as a goiter. If you're looking for this in infants, you might also look for a large protruding tongue difficulty breathing, hoarse, crying, an umbilical hernia, or yellowing of the skin and whites of the eyes. As the disease progresses in infants, you may also notice constipation, poor muscle tone and excessive sleepiness. In teens, you may notice poor growth resulting in short stature, delayed development of permanent teeth, delayed puberty were poor mental development. Let's move on to hyperthyroidism. Still on the Mayo Clinic's website, they say of course, that hyperthyroidism can mimic other health problems. We've been talking about this through all these episodes, you know that unintentional weight loss even when your appetite and food intake stay the same? We're increase, rapid heartbeat, irregular heartbeat, pounding of your heart, increased appetite, nervousness, anxiety, and irritability. Tremors, usually a fine trembling in your hands or fingers, sweating changes in menstrual patterns, increase sensitivity he changes in bowel patterns, especially more frequent bowel movements, and enlarged thyroid gland of course called a goiter, which may appear a swelling at the base of your neck, fatigue, muscle weakness, difficulty sleeping, skin thinning, fine embrittle hair. For Graves disease, you're looking for dry eyes, red or swollen eyes, excessive tearing or discomfort in one or both eyes, light sensitivity, blurred or double vision, inflammation or reduced eyes movement, protruding eyeballs just quickly Hashimotos disease which as we know is an autoimmune version of hypothyroidism. Hashimotos disease progresses slowly over the years you may not notice signs or symptoms of the disease eventually the decline in thyroid hormone production can result in a the following. There going to be a lot of duplicates here from hypothyroidism, fatigue and sluggishness, increased sensitivity to cold increase sleepiness, dry skin, constipation, muscle weakness, muscle aches, tenderness and stiffness, joint pain and stiffness, irregular or excessive menstrual bleeding, depression, problems with memory or concentration, swelling of the thyroid, the goiter of puffy face, brittle nails, hair loss, enlargement of the tongue. I'd like to just finish by saying that if you have any of these, please see a doctor get a simple blood test and get yourself some answers. Don't forget a TSH over two is enough reason to be concerned. Treat your symptoms, not the lab values. Thanks again for listening. I'll be back very soon with another episode of The Juicebox Podcast.

Hello friends, and welcome to episode 640 of the Juicebox Podcast. In this the seventh installment of the defining thyroid series, Jenny Smith and I will define thyroiditis. So far in the defining thyroid series, we've tackled hypothyroidism, and Hashimotos thyroiditis. That's an episode 616. In Episode 619, we define pituitary and thyroid glands. In Episode 624, we defined P S H testing, and in Episode 628, we define T four and T three. In episode 632. We talked about auto immune episode 636 was goiter, and today in Episode 640 thyroiditis. While you're listening today, please remember 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 are becoming bold with insulin? If you have type one diabetes, or are the caregiver of someone with type one, and are a US resident, please go to T one D exchange.org. Forward slash juicebox. And take the survey. This episode of The Juicebox Podcast is sponsored by Dexcom, makers of the Dexcom G six continuous glucose monitor, learn more and get started today@dexcom.com forward slash juicebox. It's at that very link that you'll be able to say hello to Dexcom. Let's define thyroiditis

I was checking off. So I remember which of these as well. I'm sure you probably

Well, I I appreciate that we've known each other long enough that you're not 100% sure if I'm doing it so that you're handling it to which I really appreciate. Thyroid is is interesting because my wife has hypothyroidism my daughter's had it for years. My son has Hashimotos now and until I met Dr. BENITO nobody ever said the words thyroiditis to me ever. And she used it so much. While she was talking to us that I thought Well, this must be important because she has said it a number of times. Can you tell me what it is?

It's the swelling, right? Just swelling of the thyroid gland. Correct? Yeah. And which can either cause high or low levels of the thyroid hormones kind of into the bloodstream or in circulation. That's my general idea of what thyroiditis and I mean, itis is really inflammation. So that's anything that ends in itis is an inflammatory type of condition. Okay.

Interestingly enough around this because I don't think there's a ton to talk about around this. When when she was saying it, I I had no like I said, I had no context and I jumped a thyroid storm, in my mind in my head for some reason. But those are not the same thing. No, right. So I'm going to blend those two here together just because why not keep my confusion together. thyroid storm also referred to as a thyrotoxic crisis is an acute life threatening hypermetabolic state induced by excessive release of thyroid hormones, T H s in individuals with thyroid toxicity, Tyro Toxis store, thyroid storm may be the initial presentation of thyroid Toxis. I know I'm not saying that right. firerock thyroid talk. Holy God,

is it there? Is it there a toxic Kosis Is there a sea of courses? Yes, yes. thyrotoxicosis.

If I were gonna say that word, thyroids. I'll do it again, thyroid store and maybe the initial presentation of thyroid toxicosis in undiagnosed children. Okay. All right. So a thyroid storm, is I didn't realize this is much more serious than thyroiditis, thyroiditis is inflammation. thyroid storm is is a real like legitimate problem. That's interesting. So these are just words you may hear while you're talking about your thyroid issues in the doctor's office, and I didn't want people like I don't think they're like, I don't think thyroid thyroiditis and thyroid storm are things that you're going to need to know day to day while you're managing your thyroid issues. But I don't want you to be in the situation I was in where I was sitting there with a dumb look on my face gone. Uh huh, uh huh, uh huh. Yeah, sure, sure. Yeah, thyroid is right.

Once every storm from what I know, is very, it's rare. Yeah. Right. That is not a it's not, you know,

it's not likely something you're going to see. But I think it's I do think it's a phrase that people know. Because, yes, I know it. Then other people have to know because I'm not like, you know, I mean, prior to this, I wasn't digging around for words like that. And I remember when I said it the first time privately, Dr. BENITO was like, no, no, no, she put her hand up like it was COVID time. So we were talking through video, she put her hand up, she was that is not the same thing. And I was like, Oh, well, there goes me sounding like I know what I'm talking about. But I just wanted to have them here in the series, because, you know, I think you're going to hear them. And if you do, you should.

Well, and I. Yeah, I was gonna say in in from what I remember about just the term thyroid storm, which again, I think it's a general enough term that some people may not know enough about it or may misunderstand, from what I know about it, just the general it's much more relative to treatment, that has not gone the right way for Graves disease. Okay. I believe, again, rare as it is, if you're treating hyperactive thyroid with what they it's like a, it's like a radioactive iodine that's used. It can result in thyroid storm. But that's again, it's rare to happen. So it's not something to be concerned if that's the therapy that they're going to use for your greatest disease. But it can occur I

see. Yeah, because it's saying here that your heart rate your blood pressure, your body temperature can all soar to dangerously high levels during a thyroid storm. So this is not something that people who just have hypothyroidism or hyperthyroidism are gonna see this this is yeah, very specifically very specific. Yeah, to you. Oh, wow. That's really crazy. While the symptoms are insane, fever, sweating, vomiting, diarrhea, delirium, severe weakness, seizures, irregular heartbeat, yellow skin, jaundice. Yeah, this is not I want to be clear, this is not something that most any of you are going to run into. If you have it, it's good to

clear up what it is to be able to say, you know, definitively, you're very likely, you're more unlikely to have this ever happened to you. But this is what it is just in case somebody, you know, sort of strangely uses the term and you're like, I don't know, I don't know exactly what that is.

I'll tell you the one thing that switching back to thyroiditis, when Dr. BENITO was talking to us about it privately, you know, Arden had a swing in her health at one point, and she kind of the doctor kind of couldn't figure out what it was a couple years. Okay. And she just said, Well, this just might be thyroiditis, and we're gonna have to wait for it to pass and calm and like she almost made it sound like you know, you can get a swelling of you know, and it can happen. It says the, the most common cause of thyroiditis. Some of the agents known to cause thyroiditis are antibodies. This is the most common cause drugs, radiation organisms like viruses or bacteria, conditions in which the body attacks itself, or autoimmune disease. thyroiditis can be an autoimmune disease while we know that, but the way she made it sound was like, well, maybe Arden just had a virus and it and her thyroids acting up because of it. And we'll we'll get on top of it with medication, retest her later and see if we can move we'll move the medication back when it's time. That could I guess that, you know, for most people, I mean, I really love bringing this up, because I'm a very strange person. I don't have a thyroid issue. And I am really enjoying talking about this. But but it's because you

live, you live with enough thyroid issues. Right?

I did I know how important it is to really understand it so that you can see what's happening around you and make adjustments. And moreover, because of my job, and the amount of people I see who have, you know, some sort of hyper hypothyroidism Graves disease who live in this in this bubble. I see how many people are not managing it well, don't understand it and are struggling very needlessly and correct. That's why I wanted to do this because it's just, it's just it's not it's this tiny little pill, you take it once a day. It's not that hard, you know, and it's a huge help for

you. I think the hard thing is finding somebody who can manage that medication well for you and that the other hard part is paying close enough attention to your own body. You know, when something is not right anymore, that you can say, you know, my meds have been working really great. Everything's been in line, Hey, Doc, I'm getting this symptom back or I've got this like new and it's just sort of started and otherwise I feel okay, but this is not right. So it's always important to bring up anything that doesn't seem right once medications are well managed, because it could mean that something has changed. And you may need more or less.

Jenny is doing a great job of getting us ready to talk about the next topic. Very good, Jenny, that's awesome. Look at you just segwaying away. Seriously, you should put this on your CV. Thinking

about doing that. It's just what was in my mind in terms of our context.

But it works, because the next thing we're going to talk about is how to treat your thyroid. So you did Oh, all right. Awesome. Thank you. I'll talk to you soon. Yeah. Cool. I think you should put podcaster on your CV.

I think, you know, I actually I probably should, I mean, I've done this enough with you. I mean, that I probably

really good. I like to see it on your I want to see it on there. Let's get it in. Before I tell you about the sponsor Dexcom. I'd like to thank you for listening to the defining thyroid series. It's not over yet. There are a few more episodes, but I'm getting a crazy amount of positive feedback from the listeners. And I appreciate it. This is a little bit of a departure from the diabetes stuff. But I thought it was really important. And I'm glad you're enjoying it. You can say hello to dexcom@dexcom.com forward slash juice box. I'm going to give you an example a real life example of something that's going on in our house right now. So my daughter has to be on a steroid pack for six days. And as you will know, if you've ever tried to take steroids, and you have type one diabetes, those steroids can make your blood sugar go up significantly. And with my daughter, they tried, but I knew I was going to combat it with a significant Basal increase. But that's a scary thing to do, isn't it? Right? As an example, my daughter's Basal is 1.1 An hour during the day, right now. And I didn't know how much I was going to have to increase it. So what do I do? Well, I use the data that was coming back from the Dexcom to make adjustments almost in real time to Ardens. Basal needs to know how much she ended up needing per hour to combat those steroids. four units an hour, I can tell you right now, that without seeing my daughter's blood sugar in real time, right in front of me on my phone, I would never have had the nerve to go from 1.1 to four. But that ends up being what she needed. And I was assisted by the data that came back from the Dexcom G six. That is just one example of how having that constant feedback of blood sugar data is valuable. I mean, just imagine the same situation, but a growth spurt. Or maybe some female hormones are in play. You can make adjustments and see their impacts in real time. You can see your blood sugar on the Dexcom receiver or on an iPhone or an Android phone. That was a big help to me today. Being able to see my daughter's blood sugar's when she wasn't with me when I sent her off to school with a Basal rate that was four times normal. That gave me a lot of pause. But I felt comfortable because a I knew it was working. It had been working for a number of hours at home and be I knew if something went crazy, I'd see it right on my phone. And I'd be able to do something about it right away. The Dexcom G six shows you what your blood sugar is. It shows you what direction it's moving if it's moving, and it tells you how quickly it's moving in that direction. This information is of key importance dexcom.com Ford slash juice box. These are my results. Yours may vary of course. But I'm going to tell you right now, the speed, direction and number of your blood sugar right there on your phone. There's nothing like it. There are links in the show notes of your podcast player, and links at juicebox podcast.com. For Dexcom. And all of the sponsors. When you click on the links, you're supporting the show, head over now and say hello to Dexcom dexcom.com forward slash juicebox. Thank you so much for listening to this episode of The Juicebox Podcast. I'll be back very soon, with much much more If you're wondering what signs and symptoms to look for in hypothyroidism, hyperthyroidism, Graves' disease and Hashimotos I'm going to list them all for you right now. If you already know what they are. Well then thanks so much for listening. I'll be back very soon with another episode of The Juicebox Podcast, but if you're waiting for the signs and symptoms they're gonna happen like right now. symptoms of hypothyroidism Farey the Mayo Clinic list of possible symptoms as 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 in your joints heavier than normal or irregular menstrual periods. thinning hair slow heart rate depression impaired memory enlarged thyroid gland, which could be known as a goiter. If you're looking for this in infants, you might also look for a large protruding tongue difficulty breathing, hoarse, crying, an umbilical hernia, or yellowing of the skin and whites of the eyes. As the disease progresses in infants, you may also notice constipation, poor muscle tone and excessive sleepiness. In teens, you may notice poor growth resulting in short stature, delayed development of permanent teeth, delayed puberty or poor mental development. Let's move on to hyperthyroidism. Still on the Mayo Clinic's website, they say of course, that hyperthyroidism can mimic other health problems. We've been talking about this through all these episodes, you know that unintentional weight loss even when your appetite and food intake stay the same or increase, rapid heartbeat, irregular heartbeat, pounding of your heart, increased appetite, nervousness, anxiety, and irritability. Tremors usually a fine trembling in your hands or fingers, sweating changes in menstrual patterns. increased sensitivity, heat, changes in bowel patterns, especially more frequent bowel movements, and enlarged thyroid gland of course called a goiter, which may appear a swelling at the base of your neck, fatigue, muscle weakness, difficulty sleeping, skin thinning, find embrittle hair. For Graves disease, you're looking for dry eyes, red or swollen eyes, excessive tearing or discomfort in one or both eyes, light sensitivity, blurred or double vision, inflammation or reduced eye movement, protruding eyeballs. Just quickly Hashimotos disease which as we know is an autoimmune version of hypothyroidism. Hashimotos disease progresses slowly over the years you may not notice signs or symptoms of the disease. Eventually the decline in thyroid hormone production can result in any the following. There gonna be a lot of duplicates here from hypothyroidism, fatigue and sluggishness, increased sensitivity to cold increase sleepiness, dry skin, constipation, muscle weakness, muscle aches, tenderness and stiffness, joint pain and stiffness, irregular or excessive menstrual bleeding, depression, problems with memory or concentration, swelling of the thyroid, the goiter of puffy face, brittle nails, hair loss, enlargement of the tongue. I'd like to just finish by saying that if you have any of these, please see a doctor get a simple blood test and get yourself some answers. Don't forget a TSH over two is enough reason to be concerned. Treat your symptoms, not the lab values. Thanks again for listening. I'll be back very soon with another episode of The Juicebox Podcast.

This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com forward slash juicebox Hello friends and welcome to episode 641 of the Juicebox Podcast Today's episode is a short one, it is also the second to last in the defining thyroid series. Today Jenny Smith and I are going to define Graves disease. While you're listening, please remember 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 are becoming bold with insulin. The defining thyroid theories began at episode 616 with hypothyroidism and Hashimotos thyroiditis. In episode 619. We defined pituitary and thyroid glands in Episode 624 T sh testing Episode 628, T four and T three and episode 632 auto immune episode 636 goitre episode 640 thyroiditis today in Episode 641 will be defining Graves disease. Then there's one more episode coming that episode number is 644 and it will be all about how to take your thyroid medication. G voc hypo pan has no visible needle, and it's the first premixed auto injector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is G voc hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G voc glucagon.com Ford slash juicebox. G voc shouldn't be used in patients with insulinoma or phaeochromocytoma. Visit G voc glucagon.com/risk. Can you just very quickly can we talk about Graves disease? Yes. All right. Well, I have always

just ask and we'll talk about it.

Nothing even years from now if I send you a note and I say Jenny, I just really want to talk about Graves disease, you'll say hold on I'll call you.

Right I'll call you. Let's get on the

phone and we'll chat about it. Well grave Graves is the one around thyroid that you don't hear about as much in my experience. But I have it here as Graves disease is caused by a malfunction in the body's disease fighting immune system so it's autoimmune. It is unknown why this happens. The immune system normally produces normally produces antibodies designed to target a specific virus bacterium or other foreign substance. But as we all know, once in a while it gets weird and goes after you

which is so much fun and it does

make my life perfect. It's an immune system disorder that results in the overproduction of thyroid hormones. That of course is called hyperthyroidism. Although a number of disorders may result in hyperthyroidism Graves' disease is a common cause thyroid hormones affect many blood systems so signs and symptoms of Graves disease can be wide ranging so Graves disease isn't isn't hyperthyroidism which is always how I had it mixed up in my head Graves disease is a thing that happens and then hyper hyperthyroidism comes from it. Am I understanding that right? Or no,

I guess I mean, that's kind of a simplified, I guess. I'm trying to like digest what you just said to make sure. It's kind of like it's kind of like diabetes, right? Or type one diabetes specifically, right? I mean, it's the body's in auto immune system that is improperly doing something. And the result is a diagnosis of type one. So the result of the immune disorder and in Graves disease is specifically the immune disorder. That's named because your body over produces thyroid hormones, right hyperthyroidism? Essentially,

I'm wrong about what I just said then so Graves disease is something that you that happens, it's autoimmune, and when it happens, you get hyperthyroidism. It's not like Arden got Coxsackie virus and then she got type one diabetes, it's Graves disease. It's not its own separate thing. Right, right. Okay.

Yes. That's Yes, I'm good. Re Yes. redefinition there. Yes.

Yeah, I'm just trying to understand it along because, you know, I have very simple brain I hear Graves disease, and I think, oh, they named it because it killed you. But I'm assuming probably some doctor that discovered it, but Right. But that

I mean, Graves disease is a common. It's a common cause of hyperthyroidism, but it's not the only reason that you may have hyperthyroidism, right. Graves disease is specifically an immune system like an autoimmune disorder. Okay, one of the hype, one of the reasons for hyperthyroidism. So

interesting. This You see, there's a first of all, by the way, Robert Graves, an Irish doctor who first described the condition in the 1800s, not because it put people in the grave, but I guess then all the diseases would be called Graves disease in the church, if that's

especially those that had no treatment other than just, you know, go to bed and put a warm blanket on your body, I guess.

He broke his knee, he's got Graves disease. So, you know, I'm going to give a couple symptoms here of it just because it's, you know, anxiety, irritability, a fine tremor of the hands or fingers, heat sensitivity, an increase in perspiration, warmer moist skin weight loss, despite normal eating habits, enlarged thyroid, which could be called a goiter, and a change in menstrual cycles are some common ways to know something's up, I'll tell you those things. In general, if those things are happening to you, my brain goes thyroid right away, they just write hair falls.

And it's, and especially if you're a, a woman, again, most thyroid conditions are much more prevalent in women or in females than in the male population. Not that you can't be you know, male and have thyroid disorder, but it is much more common in women, and especially under the age of, I think it's under the age of 40 is much more common for it to, you know, come into play. And a lot of women especially around the time of a pregnancy, that change in hormones, especially in somebody who already has an autoimmune disorder to begin with. Much more common to have the potential for thyroid disorder, both hyper and hypo around that time to

the bulging eyes are a real common sign of graves, right?

It was something that was my mom's one of my mom's diagnostic along with obviously, you know, the goiter there's that word again, which we defined before. So no listen to

everything was just sticking out of your mom's head. You guys thought something's wrong with mom. Yes, we

were well, and we were I was it was actually after my before my brother was born. So I was my brother's younger than I am. So it must have been after I was born. So

yes. So okay, so if you're seeing these symptoms, get to a doctor and then in the next episode, we'll explain how to how to take the medication because it's easy but you can miss time it and really take away from its effectiveness. Right. Am I making sense here? Yes. Yes. Good. Ah, hold on. See, Graves is one of those things like i don't i don't know like there's, you know what I'm saying right? Like there's, you get cancer, you have cancer, you lose weight, you your body dies, like cancer makes these things happen. But I know what cancer is. Right? I know that it's cells that are you know, that have mold doing the wrong thing. Wrong thing multiplied incorrectly, they've become diseased etc. I understand what cancer is. But I still don't in my heart know what Graves disease is.

Yeah, I mean, I think it's just Graves disease is the autoimmune hyperthyroid sort of term, right? I mean Graves disease, you have hyperthyroidism, but the reason it is happening is because of your your immune system.

So is Graves disease, the hyper thyroidism version of Hashimotos and Hashimotos

is correct. They're both autoimmune derived, right?

So you can shoot I know this is I know at this point, you're thinking like, Why can't this guy get this straight, but I don't know why it doesn't roll right in my head. So, hyperthyroidism, hypothyroidism, you can have hypothyroidism without Hashimotos. But if you have Hashimotos, that's an autoimmune disease that causes hypothyroidism. However, there yes there. So yes, you however, you could have hypothyroidism without having Hashimotos. Similarly, you can Couldn't have hyperthyroidism without graves. But if you have graves, you're going to have hyperthyroidism.

Yes. There. Yes.

I think I talked myself through it finally, my God. Alright, I'm going to leave this part in because my confusion is has to be other people's confusion

there people's confusion. Absolutely. Because somebody you know, I know family member for you wise have issues with their thyroid, but not everybody in your family with thyroid disorder has an autoimmune thyroid disorder. Correct. So these are just the two main potential hypo or hyper that comes because their auto immune system is creating the problem. There are many other reasons you could have an Under or overactive thyroid issue that is not from autoimmune derived like problem

yeah, to speak about. Oh my gosh, hold on. I don't know what's wrong, Amelia.

Some water. Maybe it's winter, you know, dry house, I

need hot tea. That's what I'm gonna get next time. So using my family as an example. My wife has hypothyroidism so does Arden. Neither of them are auto immune. My son had a real crazy like bout of like, like, I don't know, like it was a tough year in COVID. stressful and all that stuff. And then he got Hashimotos. As I look back on it now, we know because he did trial that when he was like 12 that Cole doesn't have any markers for type one diabetes, but I bet you if he did, he would have got type one diabetes. When this thing happened in his life. It's possible, you know,

it's possible, just the body with the way that his body would deal with whatever environmental factor came in that turned it on.

Right. So So then my kids are auto immune. Sensitive, let's just call it which is not a real thing. But it but probably and Oh, that's interesting.

So yeah, well, and the other interesting thing is that Arden's thyroid disorder is not she has no autoimmune she that she has no antibodies for thyroid, right? So if those antibodies as we've defined kind of before, if those aren't there, then the reason for per thyroid problem is from something else, something else is going on, that's creating the havoc within her thyroid, right? Because, again, antibody positive would be autoimmune related in terms of like Hashimotos. So I'm gonna that's very interesting for her because she has an autoimmune disorder already.

I'm gonna guess. Inflammation. Like I know that's such a word that people just throw around. But I think people with autoimmune issues have inflammation in their bodies and things go wonky because of it. And that is going to be my guess you have to treat our guts better than we do. We're doing that right now. For Arden are this take? Yes. All kinds of stuff. So I enjoy everyday arguing with her about taking the supplements.

I'm sure that you do if she's still taking I'm curious if she's still taking or maybe one of you was taking Berberine for sensitivity my

son was but but it stopped when we figured out those they were throwing at it before they realized he had Hashimotos Gotcha. Yes, she's um, she's just taking a couple of different probiotics like very, like, Target and Target potent probiotics. Fish oil. She's, we've had she's getting a blood draw today, actually. And then after that her vitamin D supplementation is going to go from pill form to liquid drops. Yeah, and some other things. So hopefully I'll report on that later with some success. Oh, well, there there we go. Now we're done with Graves disease, for sure. We muddled through. Yes. Well, that's my confusion. But I again, you know, I think that's what these these conversations are for to try to talk through this stuff because I don't know. Anyway. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Kibo pen at G Vogue glucagon.com Ford slash juicebox you spell that GVOKEGL You see ag o n.com. Forward slash juicebox. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. And hey, if you like Jenny and you'd like to hire her, she works at Integrated diabetes. dot com

Hello friends, and welcome to episode 644 of the Juicebox Podcast. Before I start the last episode of the defining thyroid series, like to take a moment to thank you for your support of the podcast makes these little side endeavors possible. What I mean by that is that I couldn't do 123456789 episode series about thyroid. If you guys weren't going to support it, by downloading it and listening to it, it would be hard for me to tell the advertisers I'm going to put a bunch of content in nobody's going to listen to it. So I appreciate you guys clicking and downloading and subscribing, you allow me to do things like this defining thyroid series. Today is the last episode in this series so far unless I think of something in the future. But today's topic is about how to take the medication. And it's a bit of a wrap up too. But taking your thyroid medication is not as easy as just popping it in your mouth. There are some things you need to know. If you take these medications incorrectly, they don't work. So settle in. Listen to Jenny and I go over how to take your thyroid meds, and the reasons why I think you'll find them interesting. Speaking of great sponsors of the podcast, this episode of The Juicebox Podcast is sponsored by the Dexcom, G six, continuous glucose monitor, head over to dexcom.com Ford slash juice box and say hello to Dexcom. Alright, Jenny, we've learned that we have hyper or hypothyroidism, and we're going to start taking medication. Somehow we've gotten lucky and found a doctor who understands it. Thank goodness, we're on our way. But it's not that easy. It is a little tiny pill, you have to take it once a day. But there are a lot of things you can't take the pill with. And there are timing issues about how to take it. So how would you? How would you describe to somebody to take their thyroid medication?

It would be good. A good long discussion in terms of I would first ask how are you taking it? And what are you aware of in terms of your intake around that medication? Timing and everything. And a lot of people like I said before, a lot of people are probably doing the really like the very basic that their doctor has said which is don't take it with other pills or supplements. Take it first thing in the morning and take it at least an hour before you eat anything else. That's that's like the general idea of taking your taking your thyroid medications, specifically like the level thyroxin or Synthroid or the the typical names that are what most people are using. Yeah,

same time of day every day. I guess most people say the morning because their stomachs empty. Right? Right, Arden takes hers at the end of the day, like before.

And if she's not taking any other supplements at the end of the day, and it's well past her dinner time, then for some people, that is another really good time of day to take it. Because they don't have time to wait in the morning time. They don't have that like either they're not going to get up in enough time before they have to leave or go to school or whatever is on their docket for the day. But yes, same time of day is really, really important. And then the other things that, you know, we'll talk about as, as we discussed, will give you a good idea that the time taking it is probably not the it's not the best idea at all. So same time of day. Definitely. I think another one is and this would come from your doctor if you found the type or meaning like the brand that works for you. Make sure that your doctor is always writing on your prescription no substitutions. Yeah. Because I know myself like I've been changed from my typical like, human log branded insulin to the generic human log, which is made by the same company it's just not called human log on the label any longer. Right. And that was my insurances, you know, decision to go to the generic. Um, I have found no issue with that at all. It works exactly the same as my name branded homolog worked so fine and dandy, but for something like thyroid medication it's a really it's something I've heard many people say I tried This substitution it did not work for me. So just have your doctor write no substitutions on the prescription Yeah,

the compounding of the medication especially when you're taking Levo thyroxin which is the which is the medication name, but you'll see it as brand names like Synthroid Yuna, thyroid, Tierra sin levoxyl. So those compounds things are really specific, like, correct. I've I saw, my wife was just cruising along on Synthroid, and the same thing happened that you're saying, like, one day, it just got substituted for the generic. And yeah, no one noticed, you know, like, no one noticed. And then suddenly, weeks later, my wife was like having problems. And then you don't, you don't mean like you don't, it takes a long time to figure out again, now you figured out this issue for yourself, you're cruising along, and then someone just doesn't write no substitutions. And just like that, you're having a problem you can't even figure out. So Synthroid is taken by my wife Arden used to take Synthroid, but in the, you know, we were trying to find reasons why she might be having other problems and, you know, we're down to like maybe she's having a drug interaction, which it wasn't but she's switched to tears. And at that point tears since actually, it's not a pill like, like Synthroid to drive like compounded pill. It's here since a liquid inside of gel cap. Oh, interesting. Yeah. And because she had good success on it when my son started something they just gave him to listen to because it worked for her and that was the idea. Other medications that you might be taking, if you have hypothyroidism is a word I can't say low thyroid mean, it doesn't matter. It's cite a military sentence A T three mm in synthetic form. My wife had a ton of success with cider mill until it started giving her palpitations. Like one night, I swear one night we were sitting in bed and she's like, I'm having a heart attack. Something's going I remember

you telling me I think we talked like the next day or something. You mentioned that she's like,

she grabbed a there's an Apple Watch in the house that basically nobody uses it's mine. But my eyes went I can't see it anymore. I don't like just looking at my wrist going. I wish I could see this. So we it was charged up we put it on her and used it for it has like a little EKG thing on it and everything. Sure she was actually in. Oh, gosh. So I think so whatever that thing measures? I'll find out. I'll put it in here. But we were like, like, are we going to the hospital kind of thing. Like it was like right along there. You're very worried. And then she removed the cider mill. And it just went away. Interesting. You told her endo and and then there's like, take this item away. Now the problem was she was getting a lot of benefit from the side of metal. So you know, there was something to do there my son takes. So my son sees Dr. Benito. And she's a little more of a integrative doctor, I guess. I don't know what

he looks at everything. And she pays attention to everything that might impact. Yeah,

yes. So my son actually takes a mix of terrassen and armor thyroid. So then the third kind of thyroid medication you might see is a more natural version. Armor I think is made from glands of a pig, right? Dry thyroid glands have a pig. And I think there's another brand name, nature thyroid to or nature throw, I forget how they say it. Okay, it might be the generic of it. So my son takes up blending of terrassen. And a very small amount of armor seems to be working really well for him. But

and again, what you're emphasizing is just really making sure that you know, how you've been doing on what you've been using, and continue to use it and make sure that it even if you change doctors, which does happen, right plans change things change doctors leave practices, that you really just have them have a definite list of this is what I was using, and even like symptoms and things like your wife, I can't use this, I had to switch to this because these were the problems that I experienced. So keeping some really good notes about what is working, what doesn't work, what you've tried. And kind of even the doses that you know, you find that definitely work for you. And then you know in terms of medications, especially around taking, you know, just the first step is the timing of when you take your thyroid medications. I mean, talking just about medications, you have to also really be good about knowing which other meds you're taking, that might interact with the thyroid medication in a way that you don't want and And there are, I mean, there are a host of other meds that can change the way that your thyroid med gets absorbed. And then your thyroid meds because you're taking these other medications may need specific adjustments based on how these other meds are helping you as well. So it becomes really important to pay attention. I mean, the the list is extensive i There's antidepressants, and there are the blood thinners and some of the statins, even some of the birth control pills, some of them oral medications for diabetes, reflux, anti acid types of medication, I mean, again, yeah, many that you need to pay attention

to, like you said things that you might be taking already, because you have type one, like for instance, an iron supplement or a multivitamin with an iron supplement. Same with calcium, calcium supplements or multivitamins, with calcium supplements, if you took those as the same time as your Synthroid or tiersen, it would just block the uptake of it. And now you're going through the effort of taking this pill anyway. And sort of like what we were talking about with my wife when when she got switched to generic and nobody knew you're going to start having problems and you're not going to know why. Because your brains not gonna say to you like, oh, it's the thyroid pill because in your mind, you take that every day you're doing it right, you know, right, right. So, so to me, thyroid is getting it diagnosed. And then finding a doctor who understands it, who will do the right blood work and mess with your levels. Somebody who's going to treat your symptoms and not your lab results, and then direct you properly about how to take the medication because you're going to go through all these steps and then take the meds wrong. And that is such a prevalent complaint online, which it is, which is about my thyroid meds don't work. But yeah, it could be something stupid, like, like, did you know if you take an acid, like even over the counter and acid I'm saying Did you know Jenny's gonna know this, but maybe I don't know. It blocks iron absorption? Oh, yeah, yeah, so people who have low iron but are taking in acid they don't realize that and then you could take your iron supplement at the same time as you take your an acid and then you might as well just flush the iron supplement down the toilet instead.

You know, if you think about Summit, some people take some other meds with like their Frappuccino or their iced mocha.

I know it's not fair to put the ad here because you're thinking I drink iced mocha, which I MP doing that now. You'll find out in a second when Jenny finishes her thought. But I need you for a moment to focus focus focus on the Dexcom G six continuous glucose monitor. I'm going to tell you a story from this week in our house. Arden had to go on a steroid pack for six days, I believe this steroid pack monkeyed with her blood sugar pretty bad at times are needed. For units of Basal an hour, I was able to use the information that I got back from Ardens Dexcom G six to make quick and accurate adjustments so that she didn't suffer for days upon days. After starting the steroid pack, we were able to get things dialed in about eight hours. And then as the pack tied traits away, she gets fewer steroids as the days go on. The impact on her blood sugar changed, and we were able to change with it. Now tonight as the steroids disappeared from our system. We also had to change a pod and then go right into a meal. Well, we Bolus pretty good. I'd say aggressively for the meal. And about 45 minutes after the Bolus, it was clear that Arden had too much insulin. It was not a problem because of the Dexcom it immediately showed Arden's blood sugar dropping. It showed us the arrows that indicated a fast drop. It made alarms so that we couldn't ignore it. And Arden was able to take in some food without rushing and she avoided a low blood sugar. Her blood sugar kind of stopped right around 69 held held held the food kicked in. And right now she's 111 Without a Dexcom G six continuous glucose monitor. What I'm gonna guess would have happened instead would have been that we would not have had the nerve to be aggressive at dinner. And instead of a drop, Arden probably would have seen a significant rise in her blood sugar based on what she ate. I'm guessing that we would have then fought with for many hours this evening. Because we would just be testing randomly to see where she was. But with the Dexcom you're seeing her blood sugar in real time, now, okay, Fair's fair, we used a little too much insulin. But it was never a problem. Never a panic situation, because Dexcom was right there to say BBB, your blood sugar is getting low. And we were able to react calmly, rationally with a measured amount of carbohydrates and stop her low before it ever happened. kind of magical. Trust me, I raised the child without CGM, and I've raised one with them. I prefer this way. dexcom.com Ford slash juicebox. These are our results. And yours may vary. But there's nothing better than seeing it live. It really gives you a chance. There are links in the show notes of your podcast player to Dexcom. And all the sponsors. There's links at Juicebox Podcast COMM But you can always just go to a browser and type dexcom.com forward slash juicebox This is a piece of technology you want on your side, go check out the website. And when you try to leave it, it's going to give you a little pop up banner that says hello ducks calm, that's your opportunity to maybe get a free 10 day trial, give it a whirl.

In the morning time, okay, that might be great and fine for other medications. But for thyroid medications, things like fiber, and caffeine, caffeine and even some of the macro micronutrients, just in food, which is why we recommend not taking it along with food and just with water is because it can really impair the absorption, again, of the dose of thyroid medication that you're supposed to be getting. So don't take it with your caffeine in the morning. Just take a glass of water,

plenty of plenty of distance between them. If if you are taking an iron supplement, and thyroid ours, like you're gonna have to make a plan. And then that becomes an issue for people to you know, making a plan.

And one interesting thing, especially in terms of diabetes, and a lot of the change that we've seen in just fueling plans, right, I hate the word diet. But the way that people choose to eat with diabetes to manage their blood sugar's better, you might be going from a typical, you know, diet to more high fat, or maybe you're going the complete opposite. And now you're just doing an all vegan, very low fat type of diet. Well, if you had been eating really high fat, and you go to a really low fat eating plan, you may actually need to change your dose of thyroid medication, it the dose might actually be too high. If you had gone from really high fat eating to really low fat eating, you might have to adjust your doses. So I you know, all those kinds of things. These, these are not on the printout list of how to take your thyroid meds when the doctor tells you the the majority of time what I hear. When I ask people how they're taking it is I take it first thing in the morning and then I wait to eat until I get to the office which is like an hour later because that's what the doctor told me to do. Just give it an hour. Well. Another one that often comes up on the list too, if you're really looking how to properly take it is foods that are high in calcium, calcium can impair the absorption of their thyroid meds. And actually the timeframe from calcium intake to taking your thyroid med is much longer than an hour. It's like you're supposed to wait like three to four hours.

You know? Because if you're not getting the absorption, then you're not getting the medication and you really do need it. Listen, there's a great example Arden's been applying to colleges, right. She's done now, thank God, like my wife and I got in bed last night. We're like, Oh, like that was something, you know, just Yes. So Arden is applying to fashion schools. So she doesn't just apply. You know, it's not just an application. She's portfolios. Some schools want, like they were samples of things. They were making dresses in my house last week because of that, right? And so it's been a lot. She's got high school on top of this on top of everything else. She's been going to bed exhausted every night. And about, I don't know about four or five days ago. She comes by my office, she's going to bed she goes, Hey, I just realized I ran out a terrassen and I didn't go get it. And I was like when she goes I don't know like five days ago maybe. I was like Great. So. So we did, what we did was we did two terrorists and that night, and then we did two terrorists and the next night, and then we went back to a regular thing, because that is the other thing. If you miss it one night, just take to the next day is definitely that's how it's been explained to us. My doctor even told Arden, if you go away for the weekend and come back and go, Oh, I didn't bring it with me. She's like, just take it all.

Oh, interesting. Yeah. And again, that would be something definitely to go over with your doctor of the what if this? What do I do? Because again, Arden's dose may be very specific to that works really well to double up the next day after you missed it the day before for somebody else, that might not be the case,

it also brings up the problem is that some people then might think to skip it for seven days and take seven of them, which is not going to work. And I'm not saying that you should make a plan around skipping your medication. But if you do it, there's kind of a way to catch back up again. But the point is, is that yesterday, yesterday, about three days after she told me this happened, and probably about seven days after she stopped taking it. She was exhausted. And she's like, she's like, I can't I'm so tired. And I was like, Yo, you didn't take your thyroid medication for free. It's got to play catch up. And then finally, it caught up to you. And I said, your this is why it's important to know I'm trying to explain to a kid who's been taking thyroid medicine since she was little, she just thinks it's part of her life. She doesn't even I don't even think half the time knows what the hell it's for. You know? Yeah. So yeah, anyway, it's really important. You don't have to live like that. And if you're taking that medication, and it's not helping, there, there should be a mixture of amounts or T three and T four arm or whatever, that a doctor can get you to that will really help you you shouldn't have to struggle with this. So right, you know, exactly. Alright. Well, that's my passion project Jenni, thyroid disorder.

Awesome.

I think I think we've covered a lot. We I think we're done actually,

we done with our thyroid stuff.

I think we got through it all. I hope people listen to this, and that they're just like,

well actually, I've heard from a couple of people that I work with that they've enjoyed. Although they don't have or they already have and they knew enough but they just like the explanation a little bit better. I've heard a couple of people say that it's nice that we're delving into something related to type one but a side note of how to manage something that could also be impacting your diabetes management if you're not managing your thyroid stuff well to begin with, so

I know we've gone over it over and again but let's just leave it here at the end of this episode if your thyroid is mismanaged or are not working properly, and you're not managing it at all that does impact your your insulin 100%

Yes, your dose of insulin your glucose control your sensitivity everything is impacted if your thyroid is not well managed.

I'll take I'll tell you to the other thing is that you know when you I think that one of the things that might be keeps people away from looking into this stuff is that they don't want there to be another thing wrong with them. Like I say it's psychological sometimes like they just like we just found out we have type one I don't want to find out about this next thing

well you know, the funny thing about it is I mean I keep really good I feel like visual on all of my health parameters right? When I get things tested, my lab results come back. Even if the note to me is like all parameters are in Target. I look at all the parameters I don't just go by that note that says everything looks good. I look at each of them. Well, since we started like doing this thyroid stuff. I actually went back like I think it was like six years just to see what have my like thyroid checks look like over the past six years. How have they flocked How have they changed and quite honestly, I'm very thankful and I should knock on some piece of wood somewhere. I mean, they don't mind don't really change. But everybody is doing right Yay, it's doing thyroid right

just keep doing it that's all like I do think there's a spot like with diabetes that you do get into you know, he just get into a rhythm you take the pill at the right time your your life kind of goes like that. Like I want people to understand like if you're you know if you're doing this well over and over again and one night you take your multivitamin and your thyroid medication at the same time. Like don't beat yourself up just go DX day, but you're doing it every day at the same time. You could you could be completely crap. Yeah, just just making the thyroid medication. Again, it might as well you might as well not even be taking it because you're blocking its absorption.

The other one that comes to mind just briefly, because of everything we've had going on in the past couple of years. People have really tried to get enough Back stash of products and even medications. Make sure your thyroid medication is not expired. Make sure it's not expired, don't take expired, get new.

We you needed to work like you need to do what it's supposed to do. I think we Yes, Jenny, I'm, I think it's cool. We're done. Yay for us. Yay for us. For us, like I, you know, I'm gonna tell you that I think we're gonna be doing this more with other things like I want to, I do want to talk about just iron specifically, you know, people's iron levels are generally not high enough. Vitamin D, maybe we're going to go down a little supplement trail at some point,

what I think kind of a piece of that, as we've kind of already gotten into even with some of the thyroid discussion is really gut level absorption. And really, maybe doings I know people like more like, link to this, like research. Why is this the information that you're kind of, you know, telling us, there's a lot of good information about gut health, specific to autoimmune disorder, and very specific to type one. That leads to the reason that your daughter's doctor is like, hey, get rid of those oral supplements for vitamin D, you need to be taken it under your tongue, so it gets absorbed through your oral mucosa. It doesn't get absorbed. For many people with type one through the gut, it just doesn't

know. So I'm looking into the right people to talk to about some of this stuff. I there's one doctor I'm considering I'm actually also considering contacting the company that we sent the gut testing off to, like maybe they've got a medical who did you because I

did that to Cat it was probably four years ago. Because I think Conan was like, a year or so old. Maybe he was like 18 months, so it was probably about four ish years ago that I did it. I'm curious what company you guys used

to have the information downstairs? I don't have it here at my desk. Okay, I'm not sure. But I that's what I'm trying to figure out. Like, who do you get, they can really talk about this stuff, right down deep.

And isn't just like a fufu kind of like, Oh, we're doing this fancy. Like, send us your poop and like, give you you know, you shouldn't be eating broccoli anymore. And you know, I was, you know, how did you nail it down to broccoli? I didn't even have broccoli for the past week, so it wouldn't have been in my poop Where are you getting that

from? I'd like to know I definitely do and understand it better as well. So okay, yeah. All right. Cool. Thank you. Awesome. Yeah how about that Jenny Smith huh? Round of applause. I'm not gonna clap because it mess up your audio. But I mean, like, she's terrific. Jenny's for hire if you're interested, she works at integrated diabetes.com. I'd like to thank Dexcom very much for being a longtime sponsor of the Juicebox Podcast and remind you that you may be eligible for a free 10 day trial of the Dexcom G six, head over to dexcom.com Ford slash juice box and say hello Dexcom Thanks again for listening to my defining thyroid series. I hope you found it valuable. Please don't forget I ran right in that music there. owe me a drink. Please don't forget there's a fantastic episode at episode 413. It's called thyroid disease explained is with myself and Dr. Addy, Benito. She's terrific. And if you really really want to dig down deep and understand thyroid, it's a great place to to keep going. All right. You guys good? Did you like this episode 616 Defining thyroid hypothyroidism and Hashimotos thyroiditis episode 619. Defining thyroid pituitary and thyroid glands 624 TSH testing 628 T four and T three 632 auto immune 636 goitre 640 thyroiditis 641 Graves disease and of course this the last episode 644 I think I'm going to call this one I don't know I didn't really think about it till now. And I got me on the spot. I mean, defining thyroid Alright, let's think about the other defining thyroid taking your medicine know how to take the meds, how to take the meds. proper dosing. We got that I got it Defining thyroid proper dosing, Episode 644. I hope you've enjoyed it. Hope you've gotten something out of it. I've enjoyed bringing it to you. I'll be back very soon with another episode of The Juicebox Podcast. If you're enjoying the show, please share it with someone else who you think may enjoy it. And my goodness, if you're not already subscribed, subscribe. Subscribe in your favorite audio app, Apple podcasts, Spotify. I don't care which app you use, hit subscribe please helps the show immensely.