Q&A: Interim endocrinology clinical chief debunks thyroid myths, shares care options

Dr. Stephanie Smooke Praw, the interim clinical chief of UCLA Health’s Division of Endocrinology, sat down with the Daily Bruin to dispel thyroid disease misconceptions, discuss risk factors and talk through treatment options during Thyroid Awareness Month in January.
Smooke Praw received her M.D. from the UCLA David Geffen School of Medicine and completed her internal medicine training at UCLA. She also completed her endocrine fellowship at UCLA before joining as faculty in 2009. Her research interests include thyroid disease and cancer.
This interview has been edited for length and clarity.
Daily Bruin: What are the key functions of the thyroid gland? How does it influence overall health?
Stephanie Smooke Praw: The thyroid gland is a butterfly-shaped organ that sits right on the front of the neck. It’s involved in a lot of different processes in the body, but interestingly, it’s not the sole controller of any of them. Things that the thyroid is involved in are our sense of temperature, some involvement in bowel function, some influence on heart rate and some influence over menstrual cycle and mood.
DB: What are the most common thyroid diseases and their associated symptoms?
SSP: There’s underactive thyroid. Underactive thyroid can either be caused by Hashimoto’s thyroiditis, which diminishes thyroid function over time by causing inflammation in the thyroid gland. It can also be the result of having had thyroid surgery or having received a treatment like radioactive iodine to decrease thyroid function. People with low thyroid function might have symptoms of feeling like they’re more cold, more constipated (or) more tired, and they might gain weight a little bit more easily.
The opposite is overactive thyroid or hyperthyroidism. The most common cause is Graves’ disease, a process where an antibody overactivates the thyroid. People with Graves’ disease or hyperthyroidism might feel like they’re overactivated. They might feel their heart race, their bowels (are) looser than usual, and they might lose weight without intention. Other causes of overactive thyroid are having a thyroid nodule that’s overproducing thyroid hormone, or you could have a temporary inflammation of the thyroid, which is called thyroiditis.
DB: Could you identify some misconceptions and risk factors for thyroid disease?
SSP: Risk factors for thyroid disease often involves your family history. If you have a family history of thyroid issues, you are more likely to have a thyroid problem than somebody who doesn’t have a family history of thyroid issues. When we think about thyroid cancer, the risk factors for thyroid cancer are family history (and) exposure to radiation. If you have an underlying thyroid disease and you have a big exposure to iodine, sometimes that can tip you over into more active thyroid disease.
Unfortunately, there are a lot of misconceptions about (the) thyroid and thyroid disease. If people are having symptoms that don’t feel right, then they go to their medical professional to get it checked out – (but) sometimes the advice you get from a medical professional is going to be different than the advice you’re getting from social media. I think that anybody who comes into the doctor feeling like they are tired, they’re lacking energy and gaining weight really easily – we want to be able to blame the thyroid. Sometimes it is. Sometimes it isn’t. But your physician can always do an appropriate set of lab tests to look into whether the thyroid is responsible.
DB: What lifestyle and environmental factors increase the risk of developing thyroid disease later in life?
SSP: There’s not a lot of lifestyle factors that are going to cause thyroid dysfunction, so I wouldn’t want people to worry that there’s a specific food that they’re eating or a specific habit that they have that’s going to disrupt their thyroid.
Environmental (risk) is a little bit more difficult. We know that there are some endocrine-disrupting chemicals out there that might impact the thyroid, and there’s still a lot of ongoing research to look into those factors.
DB: Has UCLA made any efforts toward dispelling misconceptions aabout thyroid disease and providing equitable care in surrounding communities? If not, what are some ways UCLA can help spread awareness and better its treatment process?
SSP: In the last two years, we have developed a UCLA Thyroid Center. It’s a virtual center that combines efforts in patient education, medical trainee education, research and direct patient care. We’ve identified providers all over our medical system who are interested and really adept at providing thyroid care. That way, we bring thyroid care closer to patients rather than the patients having to come into Westwood. We also have a series of videos available on our web pages as well as the UCLA (Health) YouTube Channel so that patients have a really good resource to look at.
We have two endocrinologists who are now working at T.H.E Clinic, which is “To Help Everyone.” It’s an FQHC (federally qualified health center) near downtown Los Angeles. We’re in the process of also expanding our presence at Venice Family Clinic. Those initiatives have really been driven by our new chair of medicine, Dale Abel, as part of his strategic plan to make sure that we are providing care not only to patients who can come to UCLA but also (those) in the community who might not be able to access us.
DB: How can individuals distinguish between normal fatigue and potential symptoms of thyroid dysfunction?
SSP: Fatigue is a tough symptom a lot of us deal with. Fortunately, when it comes to (the) thyroid, we have blood tests to distinguish whether the thyroid is functioning well or functioning abnormally. What I usually talk to patients about is that there are a lot of symptoms that we would like to be able to blame on the thyroid – but if the symptoms don’t match up with the blood test, then it’s not the thyroid that’s causing those symptoms, and we’ve got to investigate other causes.
DB: What are some preventative measures young adults can take to care for their thyroid health?
SSP: Nothing specific that I can recommend for thyroid health, but there is a lot that young adults can be doing to care for their health in general. A lot of that has to do with maintaining good nutrition, getting good quality sleep, making sure that they’re keeping their bodies active every day and putting down their phones and devices. We know that too much time spent on the phone is not good for our mental health. It’s not good for our sleep quality.
DB: What treatment options are available for those diagnosed with thyroid diseases, and how effective are they?
SSP: The treatments and management of overactive and underactive thyroid are very effective. For underactive thyroid, we are replacing the hormone that the thyroid is not able to produce with medication. For overactive thyroid, we have a couple of different options. We can either use medication to decrease the amount of thyroid hormone that’s being produced by the thyroid, (or) we can use a treatment called radioactive iodine, which helps to knock out the function of the thyroid, or we can always use surgery.
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