Recently, I interviewed Dr. Angela Mazza, and we talked about her book, Thyroid Talk: An Integrative Guide to Optimal Thyroid Health, what to include in comprehensive thyroid testing, the effects of thyroid disruptors, and more. If you would prefer to listen to the interview you can access it by Clicking Here [1].
Dr. Eric Osansky:
I have a return guest today who I am very excited to chat with, Dr. Angela Mazza. Very excited to talk about her new book Thyroid Talk. For those who didn’t listen to her first interview, which I highly recommend, I will give a brief bio here.
Dr. Angela Mazza is the founder of Metabolic Center for Wellness in Oviedo, Florida, where she spends a great majority of her time caring for persons with autoimmune thyroid disease, thyroid nodules, and thyroid cancer. Metabolic Center for Wellness is the only center in central Florida providing the thyroid-saving procedure radiofrequency ablation (RFA) for thyroid nodules. Highly regarded for her individualized approach for thyroid care, Dr. Mazza empowers each person to achieve their unique goals by providing education, lifestyle management, and support. Thanks for joining us again, Dr. Mazza.
Dr. Angela Mazza:
Thanks so much for having me, Dr. Eric.
Dr. Eric:
Really excited to talk about your book. Last time, you focused on a lot of things in your practice, including radiofrequency ablation, which is a very interesting procedure and something that can actually save people’s thyroid glands. We can chat about that here as well. What motivated you to write the book Thyroid Talk?
Dr. Angela:
There is probably a few things. We have been in practice for about nine years as well. As an integrative endocrinologist, I really feel like we are treating patients with thyroid issues the best they could possibly be treated. Traditional medicine falls short on a number of levels.
I got to a point a few years ago where I couldn’t take on any new patients. I was only taking on patients for procedures, like radiofrequency ablation and thyroid biopsies. We had people calling all the time, looking for new patient appointments. I felt so bad because I felt like these people were looking for help, and I’m not able to do that on a one-on-one basis.
Then I had people say, “You have to train other people.” We do some training. I lecture for A4M and societies like that. But I found there was a real need for solid information, like you give really good information to your listeners. It’s reliable, true information. There is a lot of false information out there. I’ll get questions all the time, like “Where did you even hear that from?”
That’s around the time we started the podcast to help give reliable, good information regarding thyroid health out there. Organically, I started writing a book. I would sit down and write one chapter at a time. Let’s start with the basics. How is thyroid hormone made? How is it controlled? What does it do? I went through, and the book came together by itself. I was addressing questions that patients were having concerns about, or even other practitioners had questions about. It was really a labor of trying to help more people that I couldn’t one-on-one help myself.
Dr. Eric:
What I love about the book is first of all, if someone has recently been diagnosed, it’s great because it does cover the basics. But if someone has been diagnosed for a number of years with Hashimoto’s or Graves’ or a non-autoimmune thyroid condition, they can still benefit from the book. There is some advanced stuff. You don’t have to go in order.
If someone was recently diagnosed, it might be a good idea for them to start at the beginning and go through the whole book. But they certainly don’t have to. If someone wants to skip around and just learn about the thyroid-gut connection or other things we will talk about, they can do that. Like I said, I think it fits anyone with any thyroid or autoimmune thyroid condition.
Dr. Angela:
I wrote it for patients who are motivated to put the work in, even providers who want to learn more. They don’t know everything because we don’t stop learning when we finish med school. We want to help our patients live their best lives.
Integrative endocrinology, especially when it comes to thyroid, there is really no magic pill. Wish there was. There are so many things we can use to achieve better thyroid health.
Dr. Eric:
Definitely agree. Most people listening to this probably know the basics, as far as hypo versus hyperthyroidism, thyroid glands. For those who don’t, check out Dr. Angela’s book.
We will hit a number of different topics. The first thing I want to talk about is testing. As far as blood testing, what do you recommend for those with hyperthyroidism or Hashimoto’s? I guess we should backtrack a little bit. When people come see me, they have already been diagnosed with hyperthyroidism, etc. I’m guessing with you, that might not be the case. You’re an endocrinologist, so going to you with an undiagnosed condition, and then they get diagnosed. What type of patients do you see? Then the testing you typically recommend.
Dr. Angela:
You’re right on. A lot of patients who have been referred to me already have a preceding diagnosis of hypo/Hashimoto’s. Some are hypo after surgery or a procedure. Some are hyper, not specifically diagnosed as Graves’. When patients get sent to me for hyper often, there is not a clear diagnosis. That’s where a little more digging in comes along.
I do take care of patients with diabetes where we uncover thyroid issues all the time that were not uncovered before. We do catch some new cases or find ones that were probably there all along or were undiagnosed.
As far as testing, I would have to say my go-to panel is TSH. I do want to say, and you and I are like-minded, TSH is not the be-all end-all. It’s an okay screening test, but it doesn’t tell us the full picture.
Free T4, free T3. I do only test free levels because thyroid hormones do circulate bound by protein. What’s bound by protein is really not usable. That’s why I tend to look at the free levels because the total levels can be misleading, especially in women when they are premenopausal.
I do check thyroid antibodies in pretty much everyone with any sort of thyroid issue. Thyroid globulin antibodies, thyroid peroxidase antibodies (TPO). I only check thyroid stimulating immunoglobulins (TSI) in someone I suspect is hypo.
But I will tell you anyone who has positive antibodies for Graves’, almost all of them are positive for TPO. I never used to check that if I knew someone had Graves’ already. But if we can adequately bring someone back into a euthyroid state from Graves’, having those antibodies, you can tell if they are going to develop hypo down the line.
Reverse T3, I do check quite a lot. It gives me a lot of information. Reverse T3 gets a bad rap, like it’s bad. But it tells us what’s going on in the body. It’s really a survival mechanism. If the body needs to conserve energy, mainly the mitochondria don’t have energy, we’re going to convert more T4 to T3. That gives me an idea of the mitochondrial reserve.
It also tells me if someone is on thyroid hormone replacement. If they are getting too much T4, we are going to use up our pathways to convert to T3 and start making too much reverse T3. That’s counterproductive.
The last part of my panel is I always check a random urine for iodine and creatinine. That way, I can extrapolate a 24-hour urine collection, which tells me if someone is getting too much or too little iodine. I am finding issues with iodine a lot. Not only not enough for some people, because we don’t eat as much iodized food, but having a lot of people who are taking thyroid hormone supplements, and they have a ton of iodine in them. That also can cause an issue.
Dr. Eric:
I want to talk more about iodine. With the panel, I agree. I test the free hormones. TPO, it’s interesting. Some of the research shows that anywhere from 60-80% of people with Graves’ have TPO antibodies. I didn’t when I dealt with Graves’; mine were negative. But I agree that the majority of people I see have elevated TPO antibodies. I’m sure you see some people with all three antibodies at times. Sometimes, TSI with TPO and thyroid globulins.
Reverse T3, I stopped testing it in my hyper patients because almost everybody has elevated reverse T3 if they have hyperthyroidism.
Dr. Angela:
It’s going to be high.
Dr. Eric:
It does make a lot of sense if someone has hypo. I agree that reverse T3 can be helpful.
A urinary test for iodine. Is that a 24-hour loading test? You said 24-hour iodine test?
Dr. Angela:
I’ll get a random because it’s a pain to do a 24-hour urine collection for everyone. It’s labor-intensive. I’ll get a random. It gives me a shout as to what the 24-hour urine collection is. You can extrapolate it out to a 24-hour, and it gives you a general idea.
Dr. Eric:
Like a spot test?
Dr. Angela:
Exactly. Super easy, inexpensive. It gives you a good idea of what’s going on with iodine stores.
Dr. Eric:
Do you see a lot of people with low levels of that urinary iodine?
Dr. Angela:
I do. A lot of people used to use iodized salt. Now everybody is using pink Himalayan salt and sea salt, which don’t have iodine in them. A lot of people used to eat iodized bread, but it’s not a regular staple in our diet as much as it used to be. A lot of places used to have iodinated water, but that’s not so much the case anymore.
Dr. Eric:
If you see someone who is low in urinary iodine, do you recommend supplementation? Do you encourage them to eat more foods that are rich in iodine?
Dr. Angela:
I do try to do the dietary route. Even if you do a quarter of a teaspoon twice a week of iodized salt, that’s going to be enough for the week. Our body is pretty efficient at using iodine. We only need 100-200mcg a day. It’s a very small amount.
Dr. Eric:
It sounds like you’re not advocating high dose iodine supplements. Just if someone is low, make sure you’re getting enough through food.
Dr. Angela:
I’ll once in a while do an iodine potassium supplement. It’s only going to be people who can’t have salt. Again, it’s only a couple times a week. It’s not a daily thing.
Dr. Eric:
When you see someone that is high in iodine on the test, is it typically because they’re supplementing? Or are they eating a lot of seafood or sea vegetables? I’m sure it varies. What do you typically see?
Dr. Angela:
It varies. It tends to be people who are doing extra supplementation mostly. I’ll get some really weird ones that are super high. It’s usually after they’ve had some sort of contrast study. I ask if they had that done.
Dr. Eric:
That’s a good point. If someone is doing an iodine test, that is a good question to ask, just to make sure they didn’t have any type of iodine contrast. Thanks for bringing that up.
I was going to ask you about serum iodine. What are your thoughts on testing for iodine in the blood compared to the urine?
Dr. Angela:
It’s just not as accurate. We have studies that support that. It’s not a really good plasma measurement.
Dr. Eric:
I agree. I figured that’s why you did urine because you’re not a fan of blood testing.
Next question that you are probably not expecting me to ask. I know you mentioned thyroid globulin antibodies, and you mentioned thyroid globulin when going over some of the basics. As far as testing for thyroid globulin, I’m bringing this up because I don’t know if you know this- But you do deal with cancer. When thyroid globulin is really high, it can be an indication of cancer, but it won’t confirm it. Some studies show that it can be related to an iodine deficiency. Some also show that it can be related to thyroid globulin antibodies.
I don’t test routinely thyroid globulin on my patients. I’m just curious if you test for it. What are your thoughts on that marker?
Dr. Angela:
Great question. Actually, I had that question come up today with a patient. Thyroid globulin is a substance of the thyroid itself. Thyroid globulin acts as a template for thyroid hormone assembly.
You’re right. In someone who has had total thyroidectomy followed by radioactive iodine for thyroid cancer, it will be a clue as to if there is a return to the thyroid cancer. If there is an elevation of thyroid globulin, it means that there are tissues.
The question my patient had for me was I was following up with her after an RFA. Her primary care doctor had ordered a thyroid globulin level for her, and it was elevated. She said, “He said I have cancer.” No. This just means you have a thyroid. It may be a little bit higher, maybe normal range. I find that patients who have larger thyroids tend to have higher thyroid globulin, whatever that means. There is no point in ordering a thyroid globulin if someone has a thyroid.
Dr. Eric:
Like I said, I typically don’t, but some endocrinologists or other doctors do. Sometimes, they might mistakenly order that instead of the antibodies. Maybe it’s a lab error. Either way, if it’s on the panel and it’s elevated-
Dr. Angela:
It’s scary.
Dr. Eric:
To the patient.
Dr. Angela:
It’s on a number of panels. If you go on Lab Corps and order a thyroid panel, it sneaks in there for a lot of these panels.
Dr. Eric:
I didn’t know that. I see it sometimes. Maybe it is paired up with thyroid globulin antibodies on one of the panels. It’s reassuring to hear that if it’s elevated, the person probably shouldn’t stress out.
Dr. Angela:
Exactly. Great question.
Dr. Eric:
Unless they had a history of surgery and radioactive iodine and then monitoring it. Then you don’t want it to be elevated. Especially if they had a complete thyroidectomy, it should be 0 then? Or less than one? Undetectable?
Dr. Angela:
It’s usually undetectable or less than .1. It depends on the lab itself. Some assays will be less than one. We shoot for undetectable.
One caveat with thyroid cancer patients is we are doing more conservative treatments for thyroid cancer now. Only half of the gland may be taken out. We leave the remaining gland in place. That would be a case of thyroid cancer where you don’t want to do a thyroid globulin check because it’s still going to be positive. That can be alarming to patients.
Dr. Eric:
Good to know. Just thinking on the topic for one other question. Last time we spoke, I think I asked you about RFA for thyroid cancer. At that time, it wasn’t approved. It hasn’t been that long since we chatted, so I’m guessing if someone has a cancerous thyroid nodule, is that something where you would not-
Dr. Angela:
It actually has been approved.
Dr. Eric:
Oh, it has?
Dr. Angela:
Yes. Pretty exciting. It’s very small, microcapillary, thyroid cancer. These are the cancers that our option before was either partial or total thyroidectomy, or observation. Just observation can be kind of alarming to a patient. They know they have cancer, even though it’s small. It’s 1.5cm or less usually.
RFA was approved for the treatment of capillary thyroid cancers that are less than 1.5cm. They can be adequately ablated. It’s pretty cool. I think that’s a big advancement for RFA.
Dr. Eric:
That’s awesome. I’m glad I asked that.
Dr. Angela:
I’m glad you did, too.
Dr. Eric:
In chapter six, you spoke about thyroid disruptors. I was very interested. Before we started recording, I mentioned cadmium. Most practitioners don’t talk about cadmium in general. I know you also mentioned fluoride and flame retardants. Let’s talk about some of the different ones.
Let’s start with heavy metals. Why did you focus on cadmium in that chapter?
Dr. Angela:
I don’t think we talk enough about cadmium. It’s present around us. I think cadmium doesn’t get enough credit in terms of bad things in smoking and cigarettes.
Cadmium is really important because it affects our selenium levels. That’s the key thing about it. Selenium is really our protector of our thyroid. It contributes to antioxidants that help protect the thyroid. Thyroid hormone production is an oxidative process. It’s inflammatory. Selenium helps protect our thyroid from that inflammatory state. If we don’t have selenium, our thyroid is left unprotected.
If we have a lot of cadmium, it will prevent selenium absorption, so we are not going to have our selenium that we need. It’s kind of a vicious cycle. If we have too much cadmium, we won’t have enough selenium. Selenium is needed to get rid of cadmium. It’s a self-perpetrating cycle. Nonetheless, cadmium has been linked to growths on the thyroid, like thyroid nodules and even thyroid cancer. It all comes back to selenium for me.
Dr. Eric:
It makes sense.
Dr. Angela:
Any of the disruptors of thyroid hormone production and thyroid activation, even thyroid receptor activation, at any step of the way. They are really destructive.
Dr. Eric:
You did mention other metals. Cadmium was the first one. You focused on it a little bit, but you did mention mercury, aluminum, lead. I forgot which other ones. You’re concerned with not just cadmium but the other ones, too.
Dr. Angela:
They’re all bad. It’s not to be scary. We’re exposed to things all the time. We can’t get away from them. We try to limit what we can. If you want to live in a bubble, you can’t get away from all the toxins we’re exposed to. If we can give our body what it needs to help detox and protect it as much as we can, then it gives us a fighting chance at offsetting the potential harm that these toxins can cause.
Dr. Eric:
How about fluoride? I had an interview about a year and a half ago with a medical doctor who briefly admitted that fluoride was a problem but didn’t want to talk about it. They were nervous about talking about it. You put it in your book, so I assume you won’t be nervous about chatting about it, how people should avoid it or minimize their exposure to it.
Dr. Angela:
I grew up in Delaware with fluorinated water. That was supposed to be good for us. It was good for teeth, bones. That’s what they said. Perhaps it does have some benefit there.
When it comes to thyroid, too much fluoride can actually decrease our thyroid hormone production. I mention in the book that if you put it in context to this, fluoride used to be used to treat hyperthyroidism. It used to be used to shut down thyroid hormone production. Too much fluoride does affect our thyroid hormone production, T4 as well as T3. That essentially leads to, whether it’s permanent or temporary, inadequate thyroid hormone production.
Dr. Eric:
Do you recommend not only avoiding drinking water with fluoride but using a fluoride-free toothpaste? Do you use toothpaste without fluoride?
Dr. Angela:
Yes, I do. If we are exposed to so many chemicals, how much do we want to try to work on detoxing? We can expose ourselves knowingly to these extra toxins. I would go the fluoride-free route.
Dr. Eric:
I agree. I use fluoride-free toothpaste. How do you filter your water? What type of water do you drink?
Dr. Angela:
We have a water filtration system. There will be times where you can’t get filtered water, or you have to drink out of plastic bottles. Again, you try to minimize what you can. There is controllables, and there is non-controllables. If you try to keep your health as optimal as you can, your body is able to handle some of these toxins. It can get overwhelming and scary, and I think you can fixate. The last thing I want to do is cause people to get too scared of things. Just provide knowledge like you’re doing, and you can be aware of it.
Dr. Eric:
I agree. I can’t say I never drink tap water. If I’m out and about, I don’t buy plastic water bottles by the case to keep in my home, but if I’m somewhere, like a plane, where you can’t bring your own stainless steel water bottle. I can bring it, but it can’t have water from outside.
Dr. Angela:
You have to find a place to get it.
Dr. Eric:
I think we’re on the same page with that. Any other thyroid disruptors/endocrine disrupting chemicals you want to chat about?
Dr. Angela:
Those are the biggies. These chemicals can really just disrupt thyroid on every level. Be aware. That’s all.
Dr. Eric:
Let’s talk a little bit about thyroid/gut connection. I like that you talked about concerns with PPIs, acid blockers. You also brought up the betaine HCL challenge, talking about supplementing with betaine HCL. Do you see a lot of people with lower stomach acid in your practice?
Dr. Angela:
Oh yes. The tough thing is you have every other patient already on a proton pump inhibitor. It’s tough to work backwards because there are over 110 million prescriptions for PPIs. They are available over the counter. Everyone who thinks they have a little bit of stomach upset or bloating thinks it’s GERD-related. GERD does exist.
But in our patients with Hashimoto’s especially, low hydrochloric acid tends to be the problem. If we put them on a PPI, it makes the problem worse. It’s better if I have someone who is not on a PPI to make the diagnosis.
That’s where the betaine challenge comes into play. Just to mention, it’s more of a progressive challenge, to see- It’s not only a challenge, but it’s a diagnostic test. If you try it out, if you take 1 betaine HCL and feel a burn right away, that’s probably not the problem. It’s a progressive increase with the betaine to figure out what is the dose that is needed. I’ll go a couple months and then retest things out. If we don’t have HCL, we can’t break down food, which leads to nutrient deficiencies like B12 and iron. Iron is important for our thyroid again. We need iron for thyroid peroxidase.
Dr. Eric:
Also, it has antimicrobial effects, so you need stomach acid to keep not just bacteria, but potentially pathogenic microbes in check.
Dr. Angela:
Exactly. The tough thing is when we have this HCL acid, people who are on hormone replacement don’t absorb thyroid hormone very well. That in turn leads to poor absorption, which leads to hypothyroidism, which decreases gut motility, which is another self-perpetuating cycle.
Dr. Eric:
In the same chapter, you also spoke about the gallbladder and how especially people with hypothyroidism are more susceptible to having gallbladder issues.
Dr. Angela:
Yes. I think you will probably agree. I’ve had a lot of patients who have gallbladder surgeries in the past. “You don’t even need a gallbladder, so just take it out.” It serves a purpose.
People with hypothyroidism have decreased cholesterol metabolism in the liver. That leads to super thick bile, which is stored in the gallbladder. The gallbladder can’t contract, which leads to gallbladder sludge. In worst cases, gallstones. That storage really serves a purpose. If we don’t have bile to go along with the enzymes for our pancreas, it’s tough to break down fats and proteins. It does serve a purpose. If we can catch that before the gallstones become a problem. Otherwise, it leads to unnecessary surgeries.
Dr. Eric:
Agreed. About half a million people get their gallbladder removed. I’m sure some of them are necessary, but who knows how many could have been saved if they addressed the cause of the problem.
Dr. Angela:
Sometimes, the threshold is very low for doing the surgery. If someone is uncomfortable, they take it out. I have seen more often recently patients who tend to have that same discomfort even when the gallbladder is out. It didn’t solve the problem.
Dr. Eric:
Again, that’s not addressing the underlying bile metabolism issue.
We’re just going through all these different topics. You covered a lot in the book. Obviously, we can’t cover everything, which is why people need to read your book. I want to touch upon some different topics, so we can take a different approach than in the first interview, when we just focused on RFA.
Brain fog. What are some potential causes and solutions for brain fog?
Dr. Angela:
Brain fog is a super frustrating thing. I’m sure your patients complain of brain fog sometimes. “Man, I can’t complete a task. I feel like I’m not getting things done or not remembering things. My brain is not as sharp as it used to be.”
Brain fog can be related to thyroid. It can be related to a lot of other things, so that’s the tricky thing about brain fog. You name it. Stress, dehydration, micronutrient deficiencies. We need all those neurons snapping, so they can work. They need the raw material to be fed. Anemia can cause brain fog. Infections. Medicines. Toxins. Biotoxins, like mold. Dementia. There are so many things that can cause brain fog, I don’t want to ignore them. But it is pretty common in folks with hypothyroidism.
Lots of times, if we get thyroid levels back on track, work on addressing root causes, decreasing inflammation. That’s what brain fog is, neuroinflammation, inflammation in the brain. That brain fog does improve. That’s when we’re healed with brain fog and even high antibodies. That’s where things like LDN are a good tool to use.
Dr. Eric:
Do you use it not only on your Hashimoto’s patients but also Graves’ patients?
Dr. Angela:
Yeah. I feel like it’s such a great immune modulator. It’s not an overnight fix, but it does really help bring down the inflammation from the immune standpoint.
Dr. Eric:
How long do you usually expect someone to be on LDN before they notice benefits? You said it’s not a quick fix. Is it something where they have to be on it for a few months to give it a chance to work?
Dr. Angela:
I usually say give it at least three months before you notice a big change. Just hang in there. As long as you’re not having any problems, keep with it. It’s almost like the clouds part, and the antibodies start coming down. Once it starts working, it starts working.
Dr. Eric:
Next topic is cortisol. Did you mention saliva testing as far as cortisol?
Dr. Angela:
Yeah.
Dr. Eric:
That’s your main way of testing for cortisol in your practice?
Dr. Angela:
Yeah, that’s the main way. Cortisol is a tough one. Cortisol in general, it’s like stress. There is good stress and bad stress. Good stress doesn’t last long. Bad stress hangs in. That is what pushes you over the edge when it comes to disease.
The cortisol/thyroid relationship is a complex one for sure. We have too much cortisol; it affects TSH production, conversion of T4 to T3, not to mention cortisol is catabolic to the gut lining. It impairs intestinal permeability.
I do cortisol testing pretty frequently and repeatedly in patients who I feel aren’t responding so well to thyroid hormone replacement as I think they should, or balancing thyroid hormone levels. Yes, I will do the four-point cortisol test to touch base and see where we’re at. If the cortisol curve is low, those symptoms can overlap with hypothyroidism: fatigue, not feeling well, lethargic. It’s tough to tell the two apart. If you bump up the medicine, you’re essentially making the cortisol lower because you’re metabolizing out the cortisol. You’re making that situation worse and not getting any better.
Dr. Eric:
When I dealt with Graves’, I did a salivary cortisol test, and it’s something I commonly recommend as well. Do you use any Dutch testing in your practice? Sometimes I will do Dutch testing, which also looks at cortisol. If I’m just focusing on adrenals, I will typically recommend saliva. If I am looking more comprehensively at the hormones, then I will do the Dutch test.
Dr. Angela:
I agree.
Dr. Eric:
Epstein-Barr (EBV). Also dedicated an entire chapter to EBV. Why did you do that? In my book, Natural Treatment Solutions to Hyperthyroidism and Graves’, I have a chapter focused on infections. But you go beyond that and have a chapter on EBV.
Dr. Angela:
I find EBV reactivation to be such a hidden thing. I almost think of EBV as a nuisance. It’s a real pain because just when you think you have everything taken care of, someone starts feeling like the cyclical fatigue. Oh my gosh, this is EBV reactivation.
I do screen for it a lot on patients who I feel like aren’t digging in deep enough, aren’t getting to the root cause, or aren’t getting the results we want. EBV is a tough thing because it has so many different phases. It will hang out in our system and reactivate when our bodies are less able to handle it, like in times of stress. If cortisol is up, that’s a time when EBV will reactivate.
Plus I feel like it’s something that we can treat well naturally. It follows the same principles as trying to keep stress low, sleep, taking care of our bodies as far as nutrition. We have great natural supplements that really do help. Whenever there is something that doesn’t seem right, it’s gotta be EBV.
Dr. Eric:
For both Graves’ and Hashimoto’s, it could be problematic. Other types of viruses, too. EBV is the most well-known. That might have changed over the last few years since 2020, but still, EBV is a pretty prominent virus.
I agree. You want to do things to manage your stress. Make sure you’re getting sufficient sleep. If necessary, there are some great natural approaches. You mentioned some of those in your book as well, like monolaurin and olive leaf and other antivirals.
The final thing I want to cover with you is radioactive iodine. When we had our first conversation, I don’t know if we spoke about radioactive iodine.
Dr. Angela:
I think we did.
Dr. Eric:
I know I asked you about the radioactive iodine uptake test, which you weren’t a big fan of. I was happy to hear that because I am not a big fan of that either.
Dr. Angela:
I really hate that test.
Dr. Eric:
It was good coming from an endocrinologist. Maybe our perspectives will differ on this, but I’m sure you prefer someone not to get radioactive iodine or surgery and save their thyroid. There is a time and place without question for conventional medical treatment.
If I was in this situation, if I had to choose between one or the other, I can’t picture myself getting radioactive iodine. I would probably go with the surgery because I know some people get radioactive iodine and have no regrets, but in our Facebook groups, I hear some nightmare stories. Same with surgery, too. There is no perfect method. There are risks with surgery as well.
What are your thoughts on that? If you had to recommend one or the other, do you have a preference?
Dr. Angela:
In my experience with radioactive iodine for Graves’, the thyroid cancer space is probably a different conversation. For Graves’-
Dr. Eric:
For Graves’, yeah.
Dr. Angela:
Specifically for Graves’. It’s almost a 50/50 shot. I find with radioactive iodine and Graves’, half the time, I will say it’s 40/40/20, or maybe 45/45/10. 10% of the time, maybe it’s in the sweet spot, and they end up normal. It’s like heaven. Perfect.
The other part, they become hypothyroid. They need to be on thyroid hormone replacement anyway.
Or that other part, it’s not enough, and they have to go through it again. You have to wait six months to a year to go through it again. You’re back on antithyroid medicine. That’s a problem. There is probably a reason why they couldn’t take antithyroid medicine, and they want the radioactive iodine.
At least with surgery, you know you fixed the problem, and you’re done. Then you have to be on thyroid hormone replacement. If you became hypo from radioactive iodine, you will need to be on thyroid hormone replacement, too.
It’s very patient-individualized. If we have to treat it, let’s just take it out and go from there if it’s that severe. It’s all patient-individualized. I wish there was a clear cut.
Dr. Eric:
What do you see less complications with? Is it about even?
Dr. Angela:
I think it’s about even. I think with a really good thyroid surgeon, you will have low complications. With radioactive iodine, I find the biggest complications can be more short-lived. Then again, you don’t know years down the line what problems may occur with radioactive iodine. It’s tough. Do you think the surgery would be better?
Dr. Eric:
Well, it comes with its own set of risks.
Dr. Angela:
Right.
Dr. Eric:
You could get damage to the parathyroid glands, the laryngeal nerve. Like you said, a lot of it comes down to choosing a surgeon who has a lot of experience. To me, the thought, like all the precautions to take with radioactive iodine, in some countries, they even quarantine. In the United States-
Dr. Angela:
That’s what they used to do here.
Dr. Eric:
I know they don’t quarantine. Still, you can’t share the same bathroom. I don’t know. It sounds very easy. Just swallow this pill, and that’s it, compared to going through surgery, which is more extensive.
I guess, hearing the stories from people who received radioactive iodine compared to people who received surgery, I don’t see a lot of those people personally. Usually, I see people who have the opposite; they are trying to save their thyroid and prevent those two.
In the Facebook group, we have thousands of members, people who received radioactive iodine or surgery and will share their stories there. It sounds like there is more negativity when it comes to radioactive iodine. I have also received emails over the years from people saying, “I got radioactive iodine and never felt the same. I wish I didn’t get it.” I know there are people who get it and feel fine afterwards. We could say the same thing with surgery.
In my personal experience, I hope I’m not faced with that decision. If I was, if I absolutely had to choose, I’m thinking I probably would try to find a surgeon who has a lot of experience and take my chances with the surgeon rather than receive radioactive iodine. Again, that’s just my opinion.
Dr. Angela:
It’s tough. You’re trying to foresee years into the future, too.
Dr. Eric:
Exactly.
Dr. Angela:
It’s not easy. If push comes to shove, and I have to present these options, I lay it out at the table and let the patient decide. Luckily, I don’t have to do that very often.
Dr. Eric:
At least you give them the option if someone needs to do it, where some endocrinologists will say one or the other and not even bring up the other option. That makes sense.
Dr. Angela:
I take care of patients not when they were under treatment for Graves’, but afterwards. I always hate to hear, “I wish I never did this. I wish someone would have told me.” Wow. I’m sorry. Let’s try to do the best we can now.
Dr. Eric:
That’s all we can do.
We covered a lot. There is a lot that we didn’t cover that is in your book. For those who are interested, definitely check out Dr. Angela’s book. Anything else that you really wanted to cover? Did we cover everything you wanted to? Any last words?
Dr. Angela:
I want to thank you for the opportunity to review my book. I really appreciate it. I so respect you.
I want to encourage people who have thyroid issues or think they might have thyroid issues to pursue your own health. My goal with the podcast and the book and even the master class is to empower patients to know that they’re not alone in this. There are things that are in their control that they can work toward their health now and years down the line. That’s really what it is. We want to feel good now, but we also want our health to be good 10, 20, 30 years down the line.
To encourage them to work with their doctor. If you feel like your doctor is not listening to you, it’s time to be proactive. I know it’s hard getting a second opinion, but go get one. This is information that you can use. I always love spreading good information. Just like you, Dr. Eric, it’s important to spread good information. There is a lot of scary things out there that aren’t quite right.
If people want to check out my podcast, Thyroid Talk with Dr. Angela Mazza. Also, the book. We have an upcoming online master class called Thrive Through Thyroid. We have different modules that dig into diagnosis, symptoms, treatment for both hypo and hyper. We really talk about gut health. You’ll be sick about gut health, but you’ll be an expert on gut health. Stress, putting it all together. We even have some bonus modules like hair loss, weight loss, specifically Hashimoto’s, Graves’, some recipes.
I think the cool thing we put together with this master class is once a month, a live coaching session. I meet with everyone, kind of like this. We answer questions, field concerns. It’s like a thyroid community, so people know they are not alone in some of their struggles, because you’re not.
Dr. Eric:
Wonderful. Where is it best to buy your book?
Dr. Angela:
It’s on Amazon, so that’s probably the best way.
Dr. Eric:
Definitely check out Dr. Angela’s book, Thyroid Talk. Her podcast is amazing, so check that out, too. Also called Thyroid Talk. That thyroid master class, too. Thank you so much. This has been great. Really enjoyed reading your book. I think I enjoyed even more chatting with you about it.
Dr. Angela:
Thank you so much. I appreciate it. I want to applaud you for all the good work that you do.
Dr. Eric:
Thank you. Same with you. You’re doing a great job, too. Keep up the good work.