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Hypothyroidism (transcript)
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(Dr. Peter Salgo) 
Welcome to Second Opinion, where each week our healthcare team solves a real medical mystery.  When we close this file in a half an hour from now, you'll not only know the outcome of this week's case, but you'll be better able to take charge of your own healthcare and doctors will be able to listen to patients more effectively.  I'm your host, Dr. Peter Salgo.  You've already met our special guests, who are joining our primary care physician, Dr. Lisa Harris.  Welcome back, Lisa.

(Dr. Lisa Harris) 
Hello, Peter.

(Peter)  
Nice to see you.  No one on this team knows this case, so it's time to get right to work.  Today I want to tell you a little bit about Hannah.  Hannah is fifty-five years old and she's at her - you guessed it - primary care physician's office, Lisa.

(Lisa)   
Mm-hmm.

(Peter)  
And she says she's feeling sluggish.  She has low energy.  She's gaining weight and she's so tired that she's losing her sharpness at work.  What do you want to do, Lisa?

(Lisa)  
Well, we want to get a little bit more history from her.  How long has this been going on?  Is - are there other things going on with her?

(Peter)  
Well, I don't have a time here.  I can give you a little bit more about Hannah.  Hannah's five-four.  She weighs a hundred eighty-eight pounds.  Blood pressure's one oh five over eighty, cholesterol's one eighty-nine.  Her LDL cholesterol, nasty stuff, is one twenty-one, and her cholesterol HDL ratio is three point nine.  She is on Lipitor, by the way.

(Lisa)  
Okay.

(Peter) 
She's postmenopausal.  Any of this help?

(Lisa)  
A little bit.  Her main complaint is that she's very tired, so there's a laundry list of things that you want to think about, so postmenopausal issues, whether or not she's on appropriate hormone replacement therapy, if she's anemic, if she has thyroid problems, if she's depressed.  I mean, all of that would fit into the category of her current symptomatology.

(Peter) 
Well, here's what's written in the chart.  This is what the patient said.  Hannah says, "I have a lot of friends at work who feel the same way that I do, and they went to their doctors and got thyroid pills.  Now they feel great.  I want what they've got."  Lisa, what are you going to do?

(Lisa)  
Yeah.  I mean, unfortunately I get a lot of this in the office, where, "I've gained weight.  You know, I think it's my thyroid gland," when many times it is, many times it isn't.  It's, you know, some lifestyle issues, where people need to push back from the table and learn how to change their lifestyle.

(Dr. Peter Salgo) 
But don't we hear this a lot?  What is a thyroid gland, anyway?

(Dr. Robert Heinig) 
Well, a thyroid gland is a gland that's in the center of your neck, very important in controlling metabolism of the body, and usually it does so very nicely, but it can get overactive, it can get underactive.  And as Lisa pointed out, many, many people have symptoms that really sound like they could be thyroid, but the typical hypothyroid-type patient with the symptoms like you just described, Peter, has a normal thyroid level.

(Peter) 
Hypothyroid means the thyroid gland is not working hard enough, it's producing too little stuff?

(Robert) 
That's correct.

(Peter) 
So what exactly happens when good thyroids go bad?

(Dr. Lawrence Wood) 
Well, the thyroid stops making enough of this hormone, and so you feel generally run down, tired, as if you don't have enough blood.  And one of the things you would be checking, of course, is to see if the person is anemic or has some sort of infection, but it's just feeling run down, and you've got to find out if there's something emotional going on.  But the most helpful thing would be to know about the family, because it's a hereditary kind of a situation.

(Peter) 
Well, in Hannah, or in anybody whose thyroid isn't working hard enough, what body organs does that affect?  Does it affect your brain?  Does it affect your arteries?  Give me some examples.

(Lawrence) 
Affects everything.  If your brain isn't working right, you feel stupid.  You can't get things organized.  You tend to retain fluid.  Your heart beats slower and, therefore, less effectively.  Your liver, your kidneys, really everything sooner or later starts to run down.

(Peter) 
You've had thyroid trouble?

(Ann)    
Yes.  Absolutely.

(Peter) 
You're the one here who can tell us, from the inside out, what it feels like.  Tell me a little bit about the story.

(Ann)    
I just thought for years, well, I'm getting older.  I had various things happen.  My hair was falling out.  I had progressive muscle weakness.  I was a smoker, was having difficulty breathing, so I just thought these were all things that happened as you get older, until it became a crisis.

(Dr. Peter Salgo) 
So they're - the things that, in terms of your physical appearance, that changed were what?  You mentioned your hair was getting thinner.  What else was going on?

(Ann)    
The crisis was when I lost twenty pounds in a month without trying to.

(Peter) 
Of course, that's not Hannah's issue; she's gaining weight -

(Ann)    
Right.

(Peter) 
She thinks.  When a doctor does a physical exam looking for evidence of thyroid disease, either too high, in your case perhaps, or too low, which is what Hannah thinks is wrong, Lisa, what would you be looking for?

(Dr. Lisa Harris)  
One of the things you want to look for, you can have a delayed response in the DTR's or in the reflexes in the knee, so when you

(Peter) 
DTR's being deep tendon reflexes.

(Lisa)  
Deep tendon reflexes.

(Peter) 
Those things with the hammer and -

(Lisa)  
So if you tap it, you see a delay in the upstroke, and that's a very subtle finding, but it's an easy thing to do.  Certainly, a goiter or an enlarged gland, a mass in the neck, a swelling in the neck is the easiest thing to see.  Have the patient lean their head back, or what we should do in a correct physical examination is have them tilt their chin down a little bit, have them swallow drinking water, not just trying to swallow spit, and feeling the gland itself in all aspects of the neck.  So picking up a goiter is one of the easiest things to do.  Looking to see if the eyes are enlarging, if there's lid lag and very subtle features.

(Peter) 
What's lid lag?

(Lisa)  
Meaning that you've got the deer in the headlights look, so that -

(Dr. Peter Salgo) 
You don't blink normally, is that it?

(Lisa)  
You do blink normally, but the eyelid is retracted over the orbit of the eye, so you have this very wide-eyed appearance.  You see more of the white of they eye than you do of the regular eye.

(Peter) 
So you want to know what Hannah's physical showed?

(Robert) 
Probably normal.

(Peter) 
Absolutely nothing.  You were right, but her heartbeat was slow.  I don't have a number for you, and of course she is overweight.  Lisa, what's wrong with Hannah?

(Lisa)  
Well, she may have an underactive thyroid gland or she may be someone who's had some lifestyle changes, where she's not eating appropriately and she's depressed and there's something else going on.  So it'd be an easy thing to check a TSH, a thyroid stimulating hormone - that's the screening test - and a blood count.

(Peter) 
So right now if I ask you what's wrong with Hannah, the answer is we don't know?

(Dr. Lisa Harris)  
I don't know yet.

(Peter)
But Hannah's pretty sure she's got thyroid disease.

(Lisa)  
Yep.

(Peter) 
Now, you want to check her thyroid.  Hannah goes to her doctor and says, "Look, I want thyroid medicine."

(Lisa)  
Absolutely not.

(Dr. Peter Salgo) 
"I want my thyroid checked, at least."  Are you all going to check it?

(Lawrence) 
Yeah.  Any woman over fifty should have it checked for sure.

(Peter) 
Well, I'll tell you what -

(Kathy)  
On every routine physical is what you're saying?

(Robert) 
No, once a year or especially if it runs in the family.

(Peter) 
Hannah's doctor - I could tell you what he wrote in the chart.  He was rather dismissive and says, "I think she's just gaining weight as she gets older."  Lisa, this is older woman's syndrome?

(Lisa)  
Absolutely not.  You know, as they say, aging is not a disease. 

(Peter) 
Uh-huh.

(Lisa)  
It's what we do to ourselves that manifest themselves in old age.

(Peter) 
But he says - and this is because of patient request.  He goes ahead and gets some blood tests, and they come back with a supersensitive TSH or thyroid-stimulating hormone twelve point four.  Interpret that.

(Lawrence) 
That's the -

(Lisa)  
That's a problem.

(Lawrence) 
That's at least one of her diagnoses. 

(Peter) 
What?

(Dr. Lawrence Wood) 
The TSH should be around three to five - two to five, let's say.  And if it's twelve, that's enough to say she's hypothyroid.

(Dr. Peter Salgo) 
Okay.  But this just as high.

(Lawrence) 
Because - right.

(Peter) 
And you're telling me that her gland is not working well.

(Lawrence) 
Right.  When -

(Peter) 
How does that compute?

(Lawrence) 
When the thyroid hormone levels drop, your pituitary gland tries to make the thyroid work harder by making more TSH.  But twelve is kind of a borderline figure for somebody as sick as this person is.

(Peter) 
So -

(Lawrence) 
And I think we've got to keep our mind open, as you were suggesting
that we need to look for other things, too, but this is at least one diagnosis.

(Robert) 
Peter, that's a - I've had someone explain to me years ago that the thyroid - a great gland, but isn't a real smart gland, and it gets told what to do by the pituitary that is very sensitive.

(Lawrence) 
Yes.  That's well put.

(Robert) 
And the pituitary looks at what that thyroid level is and there are normal levels for a thyroid hormone that we all measure, but the level may be well within the normal range and the TSH be high.  And for that individual, that means that the thyroid is not acting in an appropriate way.  That person is hypothyroid.

(Peter) 
What is the difference between measuring thyroid-stimulating hormone and super sensitive thyroid-stimulating hormone?

(Dr. Lawrence Wood) 
Pretty much everywhere right now is measuring super sensitive and that's because we want - there's a narrow range of normal and we'd like to know for sure whether we're in that narrow range, and pretty much every lab now is measuring a very super sensitive level of TSH.

(Dr. Robert Heinig)  
It is super sensitive, and while we were all taught about deep tendon reflexes in medical school and so forth, most patients today with modest hypothyroidism have a fairly normal physical exam.  They may have complaints, but we're very dependent upon the laboratory measurements.

(Peter) 
We've jumped to an assumption here, at least I did, that she is - Hannah is hypothyroid; is that fair?

(Lawrence) 
Fair.

(Dr. Lisa Harris)  
Well, we're assuming that would - I mean -

(Dr. Peter Salgo) 
Well, her TSH is high, right?

(Lisa)  
Yeah.  So have we gotten the rest of her thyroid function tests?

(Kathy) 
So, guys, can I kind of recap a little bit?  So we're saying that her thyroid gland isn't working properly, so the pituitary gland, which is the smart gland, I gather -

(Robert) 
That's right.

(Kathy) 
- is making more -

(Lawrence) 
TSH.

(Kathy) 
- TSH than she should have in her body.

(Robert) 
Right.
(Lisa)  
Well, it's trying to send a message to the thyroid gland to say, "Wake up, you stupid idiot, and make more."

(Peter) 
Now that we've established, at least for the sake of this discussion, this moment, that we can accept that her thyroid isn't working right, that she's hypothyroid, my question coming back to you, since you mentioned genetics, is what causes hypothyroidism?  Family history should be one thing you should check, right?

(Lawrence) 
Usually it's antibodies damaging the thyroid gland.  You're born with the ability to make antibodies against various tissues, and the thyroid is a common one, but you can also have trouble with your hair turning gray young.  So one question I always ask is anybody in your family begun to gray before thirty?  One gray hair is enough as a clue, and that's a common one people know about.

(Peter) 
Okay.  So let's accept genetics and the predisposition because of your genetics, too.  Let's say an autoimmune problem, which can affect your thyroid, put that aside and we'll accept that as a differential, one of the things.  What else causes hypothyroidism or any kind of thyroid disease?

(Robert) 
Well, as Lisa mentioned, one of the aspects when you're hyperthyroid, the treatment of it ultimately, many patients receive radio iodine and become hypothyroid.

(Peter) 
So we'll call that doctor-induced hypothyroidism because you got treated for a high thyroid condition.  What else?

(Robert) 
Well, around the world iodine deficiency is -

(Peter) 
Iodine.

(Robert) 
in third-world countries is an incredibly important cause of both having a goiter and -

(Peter) 
A goiter meaning a thick neck caused by a big thyroid.

(Dr. Robert Heinig) 
Yeah, a big thyroid.

(Kathy)  
And where do you find iodine?  Isn't it in some foods and some -

(Robert) 
Yeah.  Well, in our country, it's ubiquitous.  We use almost exclusively iodized salt.  Iodine is added to bread and milk, but throughout the world there's huge endemic areas of iodine deficiency.

(Lisa)  
That old thing that we used to talk about, a Hashimoto's thyroiditis, where patients start out very acutely with a very overactive gland that burns itself out and becomes underactive.

(Dr. Peter Salgo) 
And that's a big inflammation of the thyroid gland.

(Robert) 
Yeah.

(Peter) 
Can we pause for a minute, because I think it's worth discussing, in a thyroid show, the reason there is iodine in salt and in some of these products, which we use to make food.  It's specifically because public health activists put it there to prevent goiter and prevent thyroid disease.

(Lawrence) 
Right.

(Peter)  
But every time -

(Lawrence) 
Starting with the Great Lakes area -

(Peter) 
Is that right?

(Dr. Lawrence Wood) 
in the '30's, we found there wasn't enough and people were getting a lot of goiter.

(Lisa) 
Mm-hmm.

(Lawrence) 
And so we started adding it, as you said.  It makes bread rise better.  They clean cows utters with iodine, so there was plenty in milk.  Now they're taking it out, ironically.

(Peter) 
Why is that?

(Lawrence) 
And so - well, people just - it's like when fluoride came.  They said, "If you want fluoride, drink it yourself.  I'm not going to have it in my salt or my water."  And I was staggered to find my wife had bought some sea salt and the iodine was listed as removed.  I mean, that's the worse thing they could've done.  So we now find that iodine isn't as common, and even in this country, now about a fifth of pregnant women don't have enough in their diet.  So that's a problem -

(Peter)  
And that's dangerous to the developing baby.

(Lawrence) 
 for the baby.  The baby can't make enough.

(Dr. Peter Salgo)  
But, I mean, as a thyroid group, doctors here with thyroid on your minds, you - your group and your colleagues, who came before you, were some of the first public health activists for additives in food.

(Lawrence) 
Yes.

(Peter) 
You were the original fluoridators, if you will.

(Lawrence) 
Yeah

(Peter) 
Now, what about pregnancy, is that associated postpartum with low thyroid, hypothyroidism?

(Dr. Lawrence Wood) 
It's a very high-risk time because the baby needs thyroid hormone, so we have to check -

(Peter)  
But I don't mean that.  I mean, yes, you're going to check during pregnancy and be sure that the thyroid hormone is okay, but postpartum-

(Lawrence) 
Antibody - antibodies flare right then.

(Peter) 
That's when your antibodies flare.

(Robert) 
And that's a time when you see some dramatic changes.  Once you deliver, the mother's body is kind of caught off guard, and then things can change very rapidly and you can have a transient hyperthyroid stage and people can be very depressed not knowing what is wrong.

(Peter) 
We've established Hannah has hypothyroidism.  We talked about what possibly causes it.  I'm going over Hannah's symptoms here again in the chart.  Are her symptoms common?

(Lawrence) 
Yeah, pretty much everybody has those symptoms.  By the time you're forty or fifty, you're saying, "Gee, I don't have the pep I used to have.  I feel cold all the time," and that's when a patient needs to talk to the doctor about how they're feeling.

(Dr. Peter Salgo) 
How many folks in this country have thyroid disease, either high or low?  I mean, this is a big group, small group?

(Lawrence) 
About twenty million -

(Peter) 
Big group.

(Lawrence) 
right now and fourteen million don't know they've got it.

(Peter) 
Hannah's feeling sluggish.  It's one of the reasons she went to see her doctor.  What was your mental state like when your thyroid began acting up?  What was it like?

(Ann)    
When I was hyper.

(Peter) 
Either way.  Did it affect the way you saw the world?  Were you depressed or excitable?

(Ann)    
No, I felt terrific.

(Peter) 
You felt terrific?

(Ann)    
Until it went - until it really went bananas.

(Lawrence) 
And that's very, very common.  Most people say they never felt better in their life ((and)) -

(Ann)    
Really.  I -

(Dr. Lawrence Wood) 
they start getting hyperthyroid.

(Ann)    
I felt wonderful, and then when I started to get sick I thought I'd lost words.
(Lawrence) So it affected your mental status?

(Ann)    
Absolutely.  Absolutely, because after I was diagnosed with the hyperthyroidism, I had to stay home because I could not - physically couldn't walk to across the room.

(Lawrence)  
Your muscles get weak.

(Ann)    
And I couldn't breathe, and then - but I couldn't - so I thought, great, a two-month vacation.  No, couldn't read, couldn't do a crossword puzzle, couldn't watch television, couldn't hold a thought long enough to connect to the next thing that was happening, so it was truly just - it was totally amazing to me.

(Peter) 
You started off high or low?

(Ann)    
Started off high.

(Dr. Peter Salgo) 
then what happened?
(Ann)    
Well, I was allergic to all the medications to correct that, so   I -

(Peter) 
Great.

(Ann)    
took the radioactive iodine pill.  So now I'm medically-induced hypothyroid.

(Kathy) 
About the radioactive iodine, I'm fixated on that.  When they say radioactive, is it really radioactive?  And, if so, what does that mean for the patient?

(Lawrence) 
That treatment was very important.

(Ann)    
Absolutely.

(Lawrence) 
And there's no evidence that that will give you cancer or anything else.  It just makes your thyroid low.

(Peter) 
What - before we pause for a moment and sum things up, I want to focus on this weight loss question and weight gain question.  I mean, people like thyroid because they're told, "Oh, you'll lose weight, if you're hyper," and Hannah's in because she apparently doesn't like the fact that she's gained weight or she's too heavy.  Is she hypothyroid because her weight is affecting her thyroid, or did she gain all this weight because her thyroid made her do it?

(Lawrence) 
Neither one.

(Peter) 
Oh, thanks.  That was really helpful.

(Dr. Lawrence Wood) 
Actually, you're right in - but not - it's not the whole answer.  Many people gain five or six pounds.  If you're hyperthyroid, you may lose twenty, and you had had a big weight loss.  But once you're hypothyroid, you don't gain that much weight.

(Peter) 
Let's pause for a minute.  Let me sum up some of the things we've been talking about.  The thyroid gland is a critical part of your body's regulatory system.  It affects your physical and can affect your mental health, as well.  Symptoms caused by too much or too little thyroid can greatly affect your daily life.  It is worth thinking about.  Hannah, in her own way, can we all agree, is right in the sense that somebody ought to have a look?  Is that fair?

(Lisa)
Yes.  That's fair.

(Peter) 
All right.  If hypothyroidism is so common, if these symptoms are so ubiquitous, it can cause real harm, and there are so many people with it, why not just screen everybody all the time?  We have the laboratories out there.  Just go ahead and get a blood test.  Good idea?

(Robert) 
Good idea and the American Thyroid Association, American Association of Clinical Endocrinologists endorse that idea beginning about age thirty-five or forty and doing it perhaps every five years, but again maybe more often in those individuals with family history.

(Dr. Peter Salgo) 
I can give you some more history on Hannah.  Her doctor takes a better history, goes back and asks some probing questions, and finds that she had postpartum thyroiditis.  Now, does this fit the pattern of low thyroid now?

(Robert) 
Oh, you bet.  What happens postpartum is that you may have a transient overactive stage because the stimulatory antibodies come back first, and then these blocking antibodies that produce hypothyroidism come at a later time, frequently four, five, six months, but if it's nine or ten months later, they kind of go back to where they were at baseline.

(Peter) 
What are you going to do for Hannah right now?  You going to treat her?

(Lawrence) 
Well, I'll start treating her slowly with a lot of education of her, telling her what it's going to be like, that it's not going to happen instantly, and that we can regulate it perfectly with blood tests.

(Peter) 
You going to put her on thyroid medication?

(Lisa)  
I'm going to check a T3, T4 and make sure that - and see where her hormone levels actually are.

(Peter) 
T3, T4 is?

(Lisa)  
The actual amount of hormone -

(Peter) 
In other words for - the distinction here is the T3, T4 is, what, made by the thyroid gland.

(Dr. Lisa Harris)  
Right.

(Peter) 
The TSH is what's telling the thyroid to make it.

(Lisa)  
Right.

(Dr. Peter Salgo) 
So you want more data.  I don't have that for you.

(Lisa)  
I would start her, but I would also - I'd do the blood work and then have her -

(Dr. Robert Heinig) 
Yeah, absolutely.  Very good point.

(Peter)
Okay.  You want to start her on something?

(Robert) 
I would start her on something.  I would probably make it a ((free)) T4, Lisa -

(Lisa)  
Yes.

(Robert) 
 not a total T4.

(Lisa)  
Correct.  Correct.

(Robert) 
I would definitely start her on -

(Peter) 
Well, her doctor did.  Put her on twenty-five ((mikes)) of Synthroid.  What's Synthroid?

(Lawrence) 
Synthroid's one of the company-made thyroid pills.  It's a good one.  It's been around a long time.  Its reliability has been shown, but there are also about four other major manufacturers who are making thyroid hormone.  And as long as you stay with a brand, that's fine.

(Peter) 
Ann?

(Ann)    
Yes?

(Peter) 
You were living this.  Did you get Synthroid, by the way?

(Ann)    
Yes, I did.

(Peter) 
What was it like as they started the Synthroid?  Did you get better immediately?

(Ann)    
No.  It took a long, long time.

(Dr. Peter Salgo) 
What was that process like?

(Ann)    
It just - it took a long time to gain the weight back - and I continued - and I still don't have all the words back.  Well, you know, of course, I'm not forty anymore either, but I still don't feel as well as I felt when I was hyperthyroid before it went extreme.

(Peter) 
Now, this is, of course, new age medicine era, and I'm sure that you're seeing patients, Lisa, when you say, "I'm going to give you a thyroid pill," they say, "Please don't.  Aren't there lifestyle changes, things that I can do?"  Does any of that work?

(Lisa)  
Lifestyle is always part of what you do in medicine, so it's not just give a pill and go away.  We have to talk about all the things and dietary changes and making sure they're getting iodine and -

(Peter) 
But you know what they want to hear.  I mean, they're goal-directed.  They're asking you, "If I eat better, if I lose weight, if I exercise, is my thyroid going to get better so I don't have to take that darn Synthroid?"

(Dr. Lisa Harris)  
No, she's going to have to take the darn Synthroid.

(Peter) 
So that's it, straightforward?

(Lisa)  
In conjunction.

(Peter) 
Well, I can tell you that after four months on Synthroid she's now back in her doctor's office and she's feeling a lot better.  Her thyroid hormone levels are normal.  And I - you know, it says thyroid hormone, so I'm going to take that at face value and say they looked at her T3, T4 and they're normal.  And so she's feeling better.  Ann, you were on all these meds.  You were on Synthroid.  I know that you told me that you're not completely back, but compared to where you were when your thyroid was too low, how do you feel?

(Ann)    It's getting there slowly.

(Peter) 
Now, six months, Hannah has her cholesterol checked and it's getting better, but she's not losing weight.  Hannah says, "Please increase my dose of Synthroid.  I am hypothyroid.  I'm on it anyway.  I would like to lose a few extra pounds.  Can I have some more medication, Doctor?"  Are you going to do that?

(Lawrence) 
No.  We had thought that they might be right, that we need to push the dose, but now we've had about five studies with thousands of patients to see if the weight did get better or if they felt better by giving too much, and the answer is no and the risk is too high.

(Dr. Peter Salgo) 
Do people who are older at the onset, for example, of thyroid disease, do they have a different time course, does their response to medication differ?

(Robert) 
Well, they - certainly it's more common.  Probably in women above the age of sixty, sixty-five, ten to fifteen percent are hypothyroid.

(Peter) 
So is it fair to say, then, age is a factor, but it's not a simple factor?  It can present in a lot of different ways.

(Lawrence) 
And it's complicated because there are other things going on.

(Peter) 
Let's pause for a minute.  Because, again, this has been a lot of information over here.  Hypothyroidism is treated by replacing the thyroid hormone that the body is not producing.  Untreated hypothyroidism and overtreated hypothyroidism can both be harmful.  I don't want to leave without touching on one of your - clearly your big topics here, which is iodine, iodine deficiency world-wide.  The thyroid gland needs iodine to work, and if you don't have iodine in your diet, then you can have a problem.  So how many people are affected by low iodine?

(Dr. Lawrence Wood) 
One person in five in the world, one-fifth of the world's population.

(Peter) 
That's huge.

(Lawrence) 
And that is huge and it's tragic, because there are babies born with no thyroid gland, no thyroid function because their mother never had it, and if a mother doesn't get iodine, if she's very deficient and doesn't get iodine before the end of the second trimester, that baby's going to be damaged.  It's tragic.

(Peter) 
And how much would it cost to fix this worldwide per person?

(Lawrence) 
We can prevent it with that fifteen-cent blood test of the mother during pregnancy.  We can solve it by simply adding iodine to the water that vegetables are grown in.  They've shown this in China.  We can just grow vegetables in water with iodine, and then the animals eat the iodine containing vegetables, milk in cows, if the cow has exposure that way.  It's just tragic that we're not paying more attention, so we're going to try to.

(Lisa)  
Death and global developmental delay.

(Lawrence) 
Yeah.

(Lisa)  
We're not talking about a few deficiencies.

(Peter) 
No, no, we're -

(Lawrence) 
We know how to do it and we - it's time we did.

(Dr. Peter Salgo) 
We can save babies.

(Lawrence) 
We can save babies from growing up with no brain.

(Lisa)  
Right.

(Peter) 
That's -

(Dr. Lawrence Wood) 
They - they're alive, but they can't go to school, they can't function.  It's tragic.

(Peter) 
I think we're going to have to stop.  I want to thank all of you for being here.  Thank you so much for sharing your story with us, Ann.

(Ann)    
You're welcome.  Thank you.  I learned a lot.

(Peter) 
It's an enormous problem and I think we can - if we listen to you, at least, we can make a real impact on world health.  Thanks for being here.

(Lawrence) 
I think we can.  I think it's going to be wonderful.

(Peter) 
Before we leave, let's sum up some of the things we talked about today.  The thyroid gland is a critical part of your body's regulatory system.  It affects your physical and mental health.  Symptoms caused by too little or too much thyroid can greatly affect your daily life.  Hypothyroidism is treated by replacing the thyroid hormone that the body is not producing on its own.  Untreated hypothyroidism and overtreated hypothyroidism can both be harmful.  You got to work with your doctor on this.  And that brings us to our final message.  Taking charge of your health means being informed and having quality communication with your doctor.  Remember, I'm Dr. Peter Salgo and I'll see you next time for another Second Opinion.

 

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Search for health information and learn more about doctor/patient communication on the Second Opinion Web site.  The address is pbs.org.

 

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