Is it my thyroid?
By Kelly Evans-Hullinger, M.D.
Hypothyroidism, the condition of the thyroid gland not making enough thyroid hormone, is a common hormonal disorder. Perhaps because hypothyroidism is common and its symptoms can be widespread and vague, misconceptions abound. Let’s cover the facts.
Symptoms of hypothyroidism can include fatigue, dry skin, weight gain, and hair loss. These symptoms can occur for many other reasons, so fortunately a very simple blood test can tell us whether an underactive thyroid is the culprit.
If hypothyroidism is suspected, the best thing to test first is TSH, or Thyroid Stimulating Hormone. TSH is made by the pituitary gland in the brain which physiologically responds to levels of thyroid hormone circulating in the patient’s body. Under normal conditions, the pituitary gland signals the thyroid gland to make more thyroid hormone. So, if thyroid hormone levels are low, TSH levels will be high. The pituitary gland is trying to tell the thyroid gland, “wake up and make some more hormone, pal!”
If the TSH level is normal, in short, the thyroid is not the problem and probably no other testing needs to be done along those lines. If the TSH is elevated, another blood test for free T4 should be done. Free T4 is one type of thyroid hormone. Other types of thyroid hormones do exist but testing for them is far less reliable. In hypothyroidism, the TSH will be elevated, and the free T4 will be low.
Okay, so when we find a patient has hypothyroidism, what next? In general, we do not need to dig for a cause. Unless the person has had removal or ablation of the thyroid gland, we can assume they have Hashimoto’s thyroiditis, the most common reason for hypothyroidism. Hashimoto’s is an autoimmune disease which eventually destroys thyroid producing cells. Antibody testing is possible for Hashimoto’s disease, but it generally is not necessary.
Treatment of Hashimoto’s thyroiditis and any cause of hypothyroidism is simple…replace the thyroid hormone. This is done with a synthetic version of T4 hormone, the most reliable and standardized form of which is levothyroxine. Other types of thyroid replacement exist, but levothyroxine is universally recommended in all but a small minority of cases. Pretty much all patients can expect to take medicine indefinitely, though repeat TSH testing should be done periodically to make sure the dose is proper.
In summary, hypothyroidism is an easily diagnosed and easily treated condition. If you are having symptoms of this hormonal deficiency, discuss a TSH blood test with your primary care provider to see if a simple intervention might help you feel better.
Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.
By Debra Johnston, M.D.
I don’t know how you feel, but in my opinion, parenting is hard! Someone must have forgotten to hand me the instruction manual when my children came home. I have yet to meet a parent who wouldn’t appreciate one.
New parents can count on getting lots of advice from well-meaning friends and relatives, and sometimes even perfect strangers. Some of that advice is welcome and useful. Some, not so much. And sometimes that advice is downright dangerous.
Many grandparents raised their own children at a time when doctors thought it was best to put babies on their stomachs to sleep. Research in the 1990s showed that this sleeping position significantly increased the risk of sudden infant death syndrome. And all those cute stuffed animals and fluffy blankets increase the risk of suffocation.
Many great grandparents started their newborns on solid food soon after birth. Now we understand more about infant nutrition and recommend waiting until six months for most babies. This helps ensure the baby is developmentally ready to swallow solids and reduces the risk of some health problems that can persist well into adulthood.
My own generation was told to avoid exposure to common allergens like nuts and fish in the hopes of reducing the risk of food allergies. More recent research indicates the opposite: early introduction to these foods reduces that risk. Of course, parents still need to be mindful of choking hazards. Try thinned smooth peanut butter, not whole peanuts. We still recommend avoiding honey, because of the risk of botulism, and liquid milk, because it is more difficult to digest. Besides, formula and breast milk provide more complete nutrition.
Parents today often swear by sleep nests or wedges. These are cushions meant to prop babies in a particular position. Although these devices are popular, they are dangerous and increase the risk of suffocation. Walkers are popular too, but they are associated with injuries, and have not been shown to help babies learn to walk. In fact, motor skills may be delayed if baby uses a walker.
So how can families sort out all this advice? Look for trustworthy sources of information, such as the American Academy of Pediatrics’ on-line resource, healthychildren.org, or the American Academy of Family Physicians’ educational website, familydoctor.org. Best of all, take advantage of regular well-child visits with your primary care provider. Your doctor desires a strong relationship and will work with you to help your child grow up safe and healthy.
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.
Mentioning the Unmentionables
By Jill Kruse, D.O.
Over the course of my career, I have performed countless pelvic exams on women of all ages from all walks of life. There are two common patient behaviors that I have observed. First, most women leave their socks on. This could be the fact that most stirrups are cold, but it also seems like one feels just a little less exposed when wearing at least one item of their own clothing. The other thing that almost every woman does in the exam room is hide her undergarments under her pile of clothes. It is interesting that almost everyone, me included, feels the need to cover and hide their “unmentionables” when they are about to bare the very areas normally covered by these garments.
Therefore, it is no surprise that it can be difficult for women to voice concerns when it comes to their “private areas.” These areas are just that, private! Women do not often visit with family or friends about incontinence, menstrual irregularities, or pelvic pain. It may be easy to discuss gallbladder issues or a migraine headache, but it is much more embarrassing to ask a friend if she leaks a bit of urine when she sneezes, jumps, or coughs after birthing a child. This condition is common, and it can be treated. But if we don’t talk about it, we may not realize when something is “normal” or if it is something to be concerned about.
It is perfectly fine for women to hide our underwear from our health care provider, but let’s not hide our concerns or be embarrassed about discussing the areas covered by these garments. If we choose not to talk about it, what may seem like a minor nuisance could lead to a bigger problem. For example, vaginal spotting or bleeding after menopause is never normal and should always be reported to your provider. It could be caused by harmless uterine fibroids, but it might also be a sign of uterine cancer. The sooner you discuss it with your doctor, the better.
Unfortunately, I have seen too many women who suffer in silence because they figure whatever is happening to them must be “normal” or just a sign of “getting older” or is the “price of having children”. Primary care providers and obstetrician-gynecologists are ready to help you talk about these sensitive topics. When you uncover and discuss your concerns, they will listen, diagnose, and treat with care.
So go ahead, keep your socks on and hide your “unmentionable” clothing, but please, never hide your health concerns.
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc®, a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.
Take a Moment to Breathe
By Andrew Ellsworth, M.D.
The act of breathing is essential to life and can be done with or without thinking about it. You can control your breath and vary it, but eventually air must come in, and air must go out.
The breath of life and breathing exercises are an important aspect of many religions. In the book of Genesis, when God created man, he formed man of the dust of the ground, and breathed into his nostrils the breath of life. Several Eastern religions use controlled breathing in meditation and prayer, helping in the processes of consciousness, mindfulness, and visualization.
In this time of increased stress and anxiety over money, wars, and numerous other matters, I encourage us all to take time to focus on our breathing.
One of the simplest ways to combat stress and anxiety is to breathe. It does not cost any money and does not have to take much time. However, deep breathing can decrease your stress, help you feel calmer, reduce pain, reduce your blood pressure, help you focus, and improve digestion. It can also increase your energy and improve your immunity.
How do you do it? Easy! Just do it. Make sure you are somewhere safe and close your eyes. Breathe in gently through your nose, take about four to five seconds, and fill your belly and chest. Perhaps hold it for another couple seconds. Then release it through your open mouth over five seconds or more, whatever is comfortable. Repeat this at least five times.
When I have patients that have anxiety or panic attacks, I often take a little time to practice this with them. Every time I feel calmer myself, and I hope they find it calming as well.
This week, our television program, On Call with the Prairie Doc®, is celebrating its 20th season of providing truthful, tested, and timely medical information. We are taking time to breathe in and reflect on our past, feeling grateful for our founders, the late Dr. Richard Holm and his wife Joanie, and celebrating the contributions of everyone on our team.
Thank you, our readers, for taking the time to read our columns through the years, and I hope there are many more to come. Now, please take a moment to do some deep breathing. First you breathe in, then breathe out.
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.