Thyroid Disorders: Are You at Risk? Health Radio April 18, 2007 Lawrence Wood, M.D. Lora Hammer. Introduction

Transcription

1 Thyroid Disorders: Are You at Risk? Health Radio April 18, 2007 Lawrence Wood, M.D. Lora Hammer Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you re your own doctor, that s how you ll get care that s most appropriate for you. Introduction Thanks for joining us once again on Patient Power live on Health Radio here every day for you, bringing you the most credible medical information to help you make smart choices. Now let s talk about another condition that I think is not talked about enough, and that is thyroid disease. Now I have in just my own experience two young women who work with me, both of them were treated for thyroid cancer and had part or all their thyroid gland removed. I think that s at the lower part of your neck there in the center, and then they had radiation, and hopefully they will go on with their lives Then I have met other women. There was another producer who worked with me, and after pregnancy she was just dead tired. It ended up that she had a low thyroid I believe and then needed some help there. So there are all sorts of people who find the thyroid is sort of a bad actor when usually we don t discuss it very much, and often doctors don t pick up on this problem. It s sort of an elusive problem. If you are tired, it could be one of 10,000 things or you just went through pregnancy, of course you re tired. Is it really sort of an imbalance of hormones in your body? So that s what we want to learn about. There is a physician in Boston who has really devoted his life to that, and we are going to meet him in a minute, Dr. Lawrence Wood. He has a foundation that he runs called the Thyroid Foundation of America, and their website is We are going to talk about that, and all the work they do. Lora's Story First I want you to meet someone who coincidentally works at the foundation and has for 21 years, but how come? That s because when she was pretty young, 27 years old, she was sick with problems that ultimately were diagnosed as being caused by her thyroid. So I want you to meet Lora Hammer. Lora joins us from Boston. Lora, welcome to the program. 1

2 Thank you very much. So back when you were 27 years old, and I know now you are 60, so we are talking about a history of 33 years coping and getting treatment for a thyroid condition, how were you sick? What showed up at age 27? Well actually my first symptoms were related to my eyes. I had really a very funny feeling like I had sand in my eyes all the time. They were very, very sore. They were dry and very red and irritated. So I started going to different eye doctors to try to find out what was going on, and this went on for quite a while where nobody really connected the fact that it might be related to my thyroid. I mean quite honestly at that point in my life I didn t even know what a thyroid was. So I just kept going to these different eye doctors. One, in fact, said, I think the problem is because your eyelashes are so long they are curled inward. So they cut my eyelashes off. I mean it was just ridiculous. Then I started having other symptoms, though, that were besides my eyes, such as losing a lot of weight, I was very high strung, very nervous and shaky; I was very sensitive to heat, and that s when I finally got diagnosed, and it was realized that there was a connection between my eye problems and my thyroid. Now when we talk about the thyroid, so we are going to learn more, but it is a gland in your body, and it produces a hormone, right? Right. It regulates lots of things and so if it gets damaged in any way or is putting out too much or too little or certainly if there is a cancer there, that all causes problems. So how long did it take you to get an accurate diagnosis, and what was that diagnosis? Ironically, let s see, I started having problems with my eyes probably in the late spring, and as I said I just went from eye doctor to eye doctor. By the end, maybe the middle of the summer or the end of the summer my sister and brother-in-law came to visit. They live in Ohio, and my brother-in-law happens to be a neurologist, and you know my sister walked in the door and looked at me and said, Oh wow, you lost a lot of weight. You look great. Then my brother-in-law walked through the door and went, Oh my god, you re a textbook case. You have Graves disease. So he s the one that really diagnosed me. 2

3 And you never heard that term before? No. I never even heard anything, I had no idea what that was. He had some friends here in Boston and was able to have me seen right away. Once I started having treatment I felt so much better, obviously. But it took a while; it really did, until they figured out what it was. Signs and Symptoms of Thyroid Disorders Okay, let s join someone you work with, and have for years now, Dr. Lawrence Wood, who is really the guiding light I guess of the Thyroid Foundation of America and a very smart internal medicine specialist who has devoted his life to this. Dr. Wood welcome to the program. Let s just start by understanding. So Lora who you have known for a long time was diagnosed with Graves disease. What is Graves disease, and how does it fit into the constellation of thyroid conditions? Sure, well first thanks for inviting Lora and me to be on your program. I really have a lot respect for what you do, and I think it s wonderful. Sometimes your body makes antibodies which attack parts of the body itself. In this sense, in this particular instance with Lora, her antibody system attacked her thyroid gland. There seemed to be other cells in the orbit of the eye that may be so closely related to the thyroid cell that the antibodies get confused and attack both. It doesn t happen all the time, and I don t think more than one or two percent of people who have Graves disease and that kind of hyperthyroidism have serious eye trouble too. Most of them have what looks like swelling, but it is really a retraction of the upper lid so your eye looks bigger, but Lora had a kind where there was inflammation in the orbit, and since that is restricting, if it swells in there, the eye is pushed forward. That s what she had. I ve seen that. I knew a friend s mother had that where it almost looked like her eyes bulged out. They do, and sometimes they don t respond. Lora s luckily got better when she got treated. Sometimes they don t, and they just keep getting bigger. Fortunately now we are able to operate in that instance and enlarge the orbit so there is more room for the eye, and the eye doesn t get hurt, but sometimes there is so much inflammation in there that the eyes get out of balance. The muscles get tightened so that you see double when you look a certain direction. That s very uncommon, but it can happen. 3

4 Dr. Wood let s look at the big picture for a minute. When we talk about any thyroid condition, and your website is how many people in the American population are we talking about who could be affected? It s about 25 percent; one in four have the ability to make antibodies against the thyroid, and not all of them do. Right now there are about 22-million Americans who have underactive thyroids, and about 14 million are hidden. We don t know that. It s about two to one women; that s 9.5 million women and 4.5 million men. What would the symptoms be? In the setting where the thyroid is damaged by antibodies you get sluggish and tired and slowed down and cold. Since it often happens in the 40s and 50s and 60s, one in ten women for instance by age 50 have a low thyroid. They feel tired, but they think they are getting old. Just like Lora felt, Gee I glad I m losing weight, that s the same thing Barbara Bush said when her thyroid went high, My diet is finally working. We are going to get into greater details about that Dr. Wood. We are going to take a break and continue our discussion with Lora Hammer who has been living with thyroid disease for what did we say, 33 years or so, and yourself Dr. Lawrence Wood both from Boston who are devoted to helping us understand more about thyroid conditions, getting the proper treatment you need and deserve so you can go on and have a better healthier life. We ll be back with more of Patient Power talking about the thyroid after this. Today we are talking about something that is probably not talked about enough, and that is diseases and conditions that affect your thyroid gland, which has hormones that are important to your body. We are going to find out a lot more because literally we have with us the doctor who wrote the book, and that is Dr. Lawrence Wood who is an internal medicine specialist. He has devoted his life to better understanding the thyroid and then communicating important information not just to patients but to other doctors who often overlook the signs and symptoms unfortunately of thyroid disease because they could be elusive, and it could be so many other things. Way back in the 1980s Dr. Wood and two colleagues wrote a book about it for patients, and here he is again back on the radio and over so many years of devoting himself to this. Lora I want to go back to you. You are somebody who has been living with thyroid disease, Graves disease is a type of thyroid condition, for so many years. When you were diagnosed you didn t even know what a thyroid was, and then you eventually got involved 4

5 with the Thyroid Foundation of America. How come? Was it just that you saw that there was no information for you, and there was so little information for everyone else? Yes, I think that was part of it. Also I was very, very appreciative of Dr. Wood, and I remember asking him if he knew any type of jobs or anything available at Mass General Hospital at the time. He actually called me very soon after that and said, You know I ve had this dream to start this foundation for thyroid disease patients, and I just jumped at it. He said, Would you be interested in working with me? It was just a perfect opportunity for me, and that s basically how I got started. Your dream job. Yes, it s been wonderful. What is the Thyroid and What Does It Do? Dr. Wood so I just want to fill in for people. Help us understand exactly what the thyroid gland is, what it s supposed to do when it is functioning properly? Sure. Well it s located in the front of your neck. If you put your hand there and swallow it s what moves. You can feel it moving up and down a little bit. Probably not much if you have got a normal thyroid; if you can feel a lot moving, see your doctor, but it is sitting right like a shield or like a butterfly wrapped around your windpipe. So it is sitting right there, it weighs about 20, 25 grams; not very big, and it feels soft normally. A lot of people have a lumpy thyroid, but most of it feels normal because the lumps are pretty much the same texture, about the same texture as breast tissue, that will give you an idea. It s not rock hard at all. It s small, but it does a lot of work. It makes a hormone that changes the metabolism or the function of every cell in your body. So if it produces too much thyroid you get jumpy, jittery, nervous, sweaty, tremulous, heat bothers you and you usually, although most people say they feel great for the first couple of months; weight loss, weight goes away, energy picks up, stay awake all night. In about three or four months, I would bet Lora would agree, you begin to feel something is really wrong because you are not sleeping right, you get irritable, you get jumpy and you get weak, your muscles get weak. When the thyroid fails and stops making enough thyroid you feel cold and sluggish and tiredness. I mentioned so many people do get slowed down at that time that they feel they are just run down or getting old or been doing too much work. 5

6 So if it is getting low it is often harder to pick up. That s why doctors are now saying that we ought to screen everybody at some age, and that seems to be at 50 or 60 most everybody s doctor will check them. Women are checked with a blood test at 50 and men at 60. What are the blood tests that are used? We actually can measure the hormones. There are two of them that the thyroid makes. The most common and the one we usually measure is a drug called thyroxine. That s a tiny hormone containing four iodine atoms, and it's got to have that iodine if it s going to work right. That is the main hormone. The way we know since there is a spectrum in the population on that hormone, some people we use the range of say 5 to 10 micrograms for every cc of your blood. So if you are between 5 and 10 you are probably okay, even maybe as low as 3 you are okay, but maybe you are somebody who ought to be 8 and you are only 4. Estrogen, like birth control pills, can make it be in the higher range, but we now finally in the last 15 years, have a way to tell whether your number is right for you. That s a very important test called the TSH test, or the thyroid stimulating hormone. So if you have a normal TSH level, that tells us that your thyroid level is right for you. So if you are pregnant or on estrogen and your level is 9 for the thyroid hormone, but your TSH is normal at 3 or 4, we say that s where God wants to you to be, and we are happy with that level. Now pregnancy is a tough time. That s what happened to the woman in my office where she went through pregnancy but then this condition persisted. Right. A lot of people will begin to get a little bit high in pregnancy or just before pregnancy and then it may calm down during pregnancy. Pregnancy kind of calms all the antibody systems. People with rheumatoid arthritis say their muscles and joints feel better, but in the week or month after pregnancy is when it often kicks in again. So just when a new mother who doesn t know what is like to take care of a baby full time starts to feel rundown and jittery and frazzled or cold and dry and you know mean, she says, Well maybe this is what it is like to have a baby and don t get their thyroid checked. So obstetricians and gynecologists and pediatricians are very good now at looking for evidence of thyroid trouble in those new mothers. There again fortunately you have a test you can use to take a look. 6

7 The blood test works. Right. So let me just understand this autoimmune part of it. So for instance I have done a lot of programs in multiple sclerosis and often that improves during pregnancy and you mentioned rheumatoid arthritis. It does too. So autoimmune means your body is kind of attacking itself, right? Right. There are autoimmune diseases and related diseases that aren t autoimmune. We don t know why hooked in, but we can get to that in a minute. The autoimmune ones are any time your body makes antibodies to your own cells. Now your antibodies should protect your cells from germ attacks and things like that, but if your body makes antibodies to your muscles and joints, you could get rheumatoid arthritis. If it is your nervous system you could get multiple sclerosis. If it s your pancreas, and Lora has had this in her family with her daughter, if the pancreas is damaged you could get juvenile diabetes requiring insulin from a very young age. There are just a number of them, colitis, a bowel inflammation or Crohn s disease can do that. Well let me ask a question then. So when we look at families then, could autoimmunity show up as a thyroid condition for one family member and one of those other conditions you mentioned for someone else, but the common thread is the antibodies are not operating properly? Exactly, and I ll give you an example. We have a family I take care of in which the dad had had thyroid trouble, and his daughter who by then was about eighth grade had been having diarrhea intermittently all her life, and finally began having bloody diarrhea. Well she didn t know what was normal so she never complained. She just learned to deal with it. It turned out once the family learned that they have to look for bowel problems in other family members that might be caused by antibodies, the daughter had colitis it turned out, and had to have an operation to remove that inflamed bowel to prevent cancer coming. So she did that. The girl is fine and has no symptoms at all, but a lot of times people just don t know what s normal. That s why we try to teach them. 7

8 Dr. Wood we are going to give them some guidance as we continue in our next section. We ll hear from Lora who is devoted to this too as somebody living with these conditions. We ll be back with more of Patient Power covering some very important ground to help you understand how the thyroid is supposed to operate normally and the signs when it isn t. More coming up right after this. So we are talking about that gland right down by your Adam s apple, you know lower in your neck, the thyroid, and when it is all working right everything is great, and for most people it is that way but for millions of people it isn t, and there are probably several million people where it is out of whack, and you need some help, and you don t know it. So Dr. Lawrence Wood from the Thyroid Foundation of America is with us joining us from Boston, as well as someone who works closely with him who is a thyroid patient. She has been working with him for so many years, Lora Hammer. We ll get back to Lora in a minute, but Dr. Wood you are a world expert in this. You ve devoted yourself to this. You are very kind. We talked about your body attacking yourself, making antibodies to things it shouldn t and the many conditions like that related to the thyroid then could have overactive thyroid or underactive and there are medications for that etc. But when it is not autoimmune what s going on? We re not quite sure all the time. It maybe has an autoimmune basis we just don t understand. I ll give you an example. We knew for a long time, and this is something I learned in the 1960s that people who tended to turn gray young tended to also have a tendency to the autoimmunity. So we kind of randomly suggested that any woman who is pregnant have their thyroid checked if they began to gray before age 30. This has proved helpful. Not every doctor knows it now, and doctors are kind of forgetting the prematurely gray part, because women dye their hair so beautifully and effectively the doctor doesn t now know how many people he s got with gray hair. Wait a minute. I want to make sure I understand this. So obviously the thyroid conditions are more often in women. So if you have a woman who is prematurely gray, dying her hair or not, that could have some correlation with thyroid illness? Sure, or if her brother or mother turned gray before 30, that could be it. 8

9 So I know you have been on another radio show I ve done, and so we talk about the fellow that won the big popular show American Idol last year, Taylor Hicks. I forget how old he is but not yet 30; beautiful like gray hair. Yes, and these guys are often very articulate, very verbal, so they make great actors. You watch among the actors you see, you won t know whose hair is gray, but you might see things like slight eye enlargement, or you might see somebody who looks like an ADD, a very verbal person, and these may be the boys in the thyroid family. Now it s their sisters we d be most worried about, but the boys too can get overactive thyroid just like George Bush, Senior. Both he and Barbara developed Graves disease during the White House time. Oh my. So, okay just to understand then for the them, for the Bush Seniors, now I ve got to go back because is there a chance that our current president or other blood relatives there could be conditions they should look for, and we can call the White House and we say, Hey, have they checked you for this or that? I guarantee because of the possibility of it running in the family, although the current president doesn t show any signs that I can see, they will have him checked and everybody in the family now is checked every single year for sure, and certainly women in pregnancy will be checked. Particularly that TSH blood test. Right. Often we see other signs, the gray hair in a sister or something like that or sometimes attention deficient disorder. We believe that that s related. It seems to run along with both left-handedness and prematurely gray hair. So we have started looking for that, and I started in my own practice telling mothers, How s your kid doing in school? The answer I sometimes got was, You know he s a great kid, but as soon as he got in the third grade he turned into a terror, and because these kids often don t read so well then sometimes they do start getting in trouble, and they need help and support. That s why I think Mrs. Bush is so interested in learning disabilities and helping kids with that trouble. Yes, I ve got one of those, you and I have to talk. 9

10 Well I ve got one too. It happens. Oh my. So let s carry on just a little further. What are the signs for listeners, particularly women, that they should look for where they then advocate for their doctor, like Lora went to doctor to doctor, to make sure that they get screened. You mentioned gynecologists are kind of up on it now, but a lot of other doctors are not. Right. I think a woman, and you could look on our website, there s an area called, Staying Well which talks about who should be checked. It s anybody with any family history of autoimmunity. Any of those autoimmune diseases or juvenile diabetes that we talked about, we would say anybody with prematurely gray hair. There is also a very common condition affecting about one in twenty people in the US called vitiligo where you get white spots on your skin. In that and the gray hair you are making antibodies to the skin cells or the hair color cells, so it s also autoimmune. That s probably the best place to look. If there is any in your family, look and see where the gray hair was; mom s or dad s side, and be sure, especially the older people or pregnant women on that side of the family, they get that TSH test. We sometime add a thyroid antibody test called the TPO test, and even if you don t have it now, if that test is positive, the antibody test, we d want you checked at least every year and certainly if you ever got pregnant. Okay, let me back up. Folks so you are hearing from Dr. Lawrence Wood. Dr. Wood did you teach at Harvard too? I know you were pretty famous guy back there. I practice at Mass General at Harvard, but I never taught in the medical school, no. Well actually I taught some students just getting introduced to medicine, yes. Okay, so what I want to tell the audience though is Dr. Wood is a true treasure when it comes to thyroid conditions so when he talks about these tests that you should advocate for, if you notice these things and it may seem off the wall, premature gray, you need to ask about it because he has been studying this now for decades. Dr. Wood we are going to take a break in a minute, but I just want to understand a little bit about thyroid cancer. I know my producer Jamie felt a lump, a younger woman in her 20s. I had another producer like that. They had surgery and radiation. Thyroid cancer is not than uncommon either. 10

11 Not at all and we are missing a lot, but there is also a very important thing to know. That is a lot of us have tiny little cancers. We see about, I think it's 20,000 people die every year, and about 270 thousand have cancer we thought. Then everybody started doing MRIs and so forth and finding all kinds of little nodules. It now turns out that 17 million of us have thyroid cancer, tiny ones. We think that 99 percent never change, never grow. So be very careful if somebody makes a diagnosis to get a thyroid specialist. Some people say, Oh gee, we d better take that out, and that s a risk for your vocal cord nerves and parathyroid gland so make sure you get good advice. We re going to come back to that. That s scary though. You know you get the diagnosis of cancer and certainly women you know with breast cancer or whatever, want to cut it out. So we are going to come back to that point because it seems sort of counterintuitive when you are talking about cancer. We ll come back. We re visiting with Dr. Lawrence Wood from Boston. He is the Medical Director of the Thyroid Foundation of America. The website is We ll also come back to his friend who has been his patient, Lora Hammer, who has been living many, many years with thyroid disease but getting treatment that has helped a lot. We ll be right back with Patient Power. Tomorrow we re going to switch gears and we are going to talk about living with kidney disease and particularly understanding how people can be on dialysis which is difficult, but people learn to cope and how you can do that and go on with your life. We ll have with us Cindy Barkley I think it is, who has thought a lot about that. The program is actually on chronic kidney disease and the effects of dialysis. So we will talk about that. Thyroid Cancer Diagnosis and Treatment Options Today we are talking about a much more common situation and that is thyroid disease, and Dr. Lawrence Wood has studied that and thought about that. So Dr. Wood we talked about what people should look at in their family and just before the break talking about cancer. So just one final point about that is, that seems scary that you might have a diagnosis of cancer in your thyroid, but it can simply be watched, and you can live with it, and it is a type that is not going to go anywhere, and you could avoid surgery I guess and radiation. How do you know? How do you know which is which? Here s a situation where you want to see a real expert, and find out in your community who is really good. Most thyroid diseases are taken care of by family physicians, about 85 percent and very well, but when you get the cancer I d worry because there is stuff changing all the time; new information found. 11

12 So if it is tiny, less than a centimeter, some doctors say leave them all alone and just take another ultrasound picture. Sound waves don t give you radiation. It s safe, and it is very accurate to tell how big something is and what it looks like. If an ultrasound shows us blood flowing into that nodule or little tiny flecks of calcium in it, they usually want that taken out because it may be a papillary tumor. As we said if it is just found by chance and it is a tiny, tiny five-millimeter nodule, that s when the doctor may say let s just take one more ultrasound, and see if this thing is getting bigger. Our producer, Jamie, she did have the papillary cancer and ended up having the surgery and radiation. That s probably just right for her. Let s go on. So Lora Hammer you ve been living with this a long time. Now it s a child you have had with type-1 diabetes which would be another autoimmune condition, one of your two kids? Yes. Okay, but I understand that you ve made a study of all this and found that there are other conditions, even urinary conditions that affect women that could be related. What s that? Well I ve had it my whole life but was finally diagnosed with interstitial cystitis, which is considered another autoimmune disease, and it is an inflammation of the lining of your bladder. I guess it runs also in families that have other autoimmune diseases. So Dr. Wood, is the thyroid the smoking gun or just another manifestation of your immune system not quite operating properly, and then it might show up in another way, interstitial cystitis or another family member might have rheumatoid arthritis or multiple sclerosis, Crohn s, colitis etc.? So is the thyroid the bad actor, or it s just another way this autoimmunity problem is showing up? We think it s the bad actor, and we are in the process of proving it now. The way that you prove it is you take the next 100 people that walk into a urologist s office and have proven cystitis of this kind and measure thyroid antibodies and the TSH test in every one of them. Now we know that about up to 25 percent of people, more likely 15 or 20 percent of those 12

13 young women that come in, will have thyroid antibodies and may not even have thyroid dysfunction, but if we find that 70 percent of them have thyroid antibodies, or develop them over the next few years, then we say this is another one of those autoimmune conditions. Then we say to thyroid patients, Are there women in your family that have bladder inflammation? Check with your doctor to be sure that it s not interstitial cystitis because that s the one that can be treated beautifully now. But the point is that then if we find out there is a thyroid imbalance, that s the smoking gun maybe. It doesn t have to be an imbalance though. All they have to have is the antibodies to know that there is a relationship, and the thyroid isn t causing it. It s just like prematurely gray hair. It s another antibody. So but as far as when there is an imbalance in the thyroid, and we just have a couple of minutes; we ll have t do another whole program on treatment, but you do have medications now. I know Lora you take one of the oldest ones, the old standby Synthroid and there are others now, daily medications that people can take to try to regulate to have the thyroid operate properly, or certainly people who have had their thyroid removed, cancer etc. they take medication. Well I had my thyroid surgically removed also. So I ve been on Synthroid for as long as I ve had my thyroid removed which is like 33 years. And you're doing okay? I'm doing fine. But Andrew you are making a very, very good point. When somebody is on a thyroid pill, watch out and don t let anybody change your brand unless you have another TSH test to make sure that works the same way. We are also thinking if you take it at bedtime you ll get a smoother and more reliable effect because it can be messed up by food, the absorption can. There is so much information that you have on your website. I want to give that out again. It s a very credible source; so Dr. Wood is the Medical Director of the Thyroid 13

14 Foundation of America, funded by some families that really care about that, had a family member affected, want to support the world if they can with accurate information. The website is Take a look. We ll be back with some final comments after this to help you make sure that you get this checked if this could be a situation in your family. I want you to be healthy and live well. More of Patient Power coming up right after this. So tomorrow we are talking about dialysis and you may know somebody who high blood pressure or diabetes and ended up with dialysis. Of course maybe a kidney transplant could be in the future and we ve done some programs with Northwestern Memorial Hospital. Take a look on the Patient Power site or Health Radio to learn more about that, even now increasingly living donors who donate their kidney and help people with kidney disease. We ll learn more about dialysis tomorrow. But let s get some final comments from Dr. Lawrence Wood who is an expert in thyroid conditions and any advice he d have if this could be something affecting you or someone you care about. Dr. Wood? I would say the most important thing that I hope we have conveyed to your wonderful audience is that if you don t know make sure your data source is good. We give links from our site to people that we think give evidence-based information, not hype, not what may be true, not what ought to be or what is out there, but you really need to know what you are hearing is right and goes along with current research. So I would say check our sites and our links. They re there. Right, and that site is and you have been listening to Dr. Lawrence Wood who is the Medical Director of the Thyroid Foundation of America, a nonprofit with nothing to gain other than the hope that you will be healthier because of this. And Lora Hammer, you ve been living with a thyroid condition for so many years. You ve devoted yourself to it too. Any just brief comment you want to make for people who are concerned about this out there? No, I just agree with Dr. Wood, and it s important to get the correct information and to definitely be checked if it runs in your family or other autoimmune diseases run in your family. I m living proof that I am absolutely fine. I had my thyroid removed, I ve been on medication for 33 years, and I m absolutely fine. Well we wish you all the best and you re family, and I know you are hoping to have grandchildren before long. 14

15 Yes So best with that. Folks thanks for being with us today. And thank you our listeners for being with us. Remember about all of this knowledge can be the best medicine of all. Accurate credible information if you are concerned about thyroid take a look at We ll be back tomorrow talking about kidney disease and coping with dialysis going on with your life. Tell your friends. Andrew Schorr signing off. Have a great day. Please remember the opinions expressed on Patient Power are not necessarily the views of Health Radio, our sponsors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. Please have this discussion you re your own doctor, that s how you ll get care that s most appropriate for you. 15