The Get Healthy Tampa Bay Podcast

E132: Dr. Chhaya Makhija on Thyroid Health, Hashimoto’s, and Common Hormone Myths Explained

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I’m joined by Dr. Chhaya Makhija, a triple board-certified endocrinologist and lifestyle medicine expert based in California. In this episode, we dive deep into thyroid health—what the thyroid does, why it matters, and how to know when it’s actually the cause of symptoms like fatigue or weight gain. Dr. Makhija breaks down how to interpret thyroid labs, the role of TPO antibodies in Hashimoto’s, and when supplements like selenium might be helpful.

We also explore common myths around thyroid nodules, broccoli, and over-the-counter “thyroid boosters”—plus the risks of taking thyroid medication without a true diagnosis. Whether you’ve been told your thyroid is “borderline” or just want a clearer understanding of this essential hormone system, this episode will give you clarity and direction.

00:28 – Meet Dr. Chhaya Makhija and her approach to endocrinology & lifestyle medicine
02:42 – What the thyroid does and why it’s essential for metabolism and wellness
08:35 – Top symptoms patients report when suspecting thyroid problems
12:33 – When to dig deeper: thyroid nodules, infertility, and irregular cycles
13:10 – Which thyroid labs matter and why TSH isn’t always enough
17:56 – Insurance coverage and the role (or not) of reverse T3 testing
22:20 – Understanding Hashimoto’s and when TPO antibodies mean action
26:30 – What to do with elevated antibodies but normal thyroid labs
30:08 – Myth busting: tired = thyroid? And other misconceptions
34:55 – The danger of “thyroid boosters” and using meds as weight loss hacks
37:53 – Lifestyle tips to support thyroid health and reduce autoimmune triggers

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Kerry:

All right. Hi everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller, and today we have Dr. Chhaya Makhija. Welcome to the podcast. How are you?

Chhaya:

Thank you. Thank you Dr. Reller. I am doing great. And very excited to listen to your questions and share some tidbits in the hormonal world.

Kerry:

Yeah. So why don't you tell our listeners a little bit about who you are and what you do.

Chhaya:

Sure. So I am Dr. Chhaya Makhija. I'm a triple board certified physician. So endocrinologist and lifestyle medicine are my big specialties that I provide care to for my patients in the state of California. And my practice is called Unified Endocrine Diabetes Care, which is a direct specialty care. And to simplify, it's like a boutique concierge care for our patients in California. My goal mission is prevention. So prevention of chronic diseases and simplifying complex questions and diseases. So it could be thyroid, it could be any form of the hormone in our body, as well as prevention because prevention of diabetes, prevention of obesity related conditions. As well as prevention of osteoporosis and low bone density. And we focus on like the time access, building that trust. And you know, the mission for patients, and I'm sure when they come get the door, is also that can I experience a transformation? So that's always you know, a big win for the patient and for me and my team when we're dealing with our patients as well as the community. The other part is my fun part or aspect of it, which is like lifestyle medicine, which is beyond exam room, beyond my practice which is engaging in the community. So we have these events where we practice laughter breath work as well as, you know, walking, moving workouts, using bands or how to incorporate physical activity no matter, no matter how busy we're so that's my fun profession that I can call which has been inspired a lot by, you know, about lifestyle and tying both and lifestyle medicine, but still connecting to the patient is what is what is you know, a part of the love that you in medicine and.

Kerry:

I, that's a beautiful combination of the endocrinology aspect, like the medical aspect and everything that you learn in lifestyle. And obviously you, like you mentioned like your upbringing and everything, so it's so nice that you're able to do all of these things and wear all of these hats. That's wonderful. I was gonna say. Where I know you're trying to put a lot of good information out there too, and I always ask people at the end, so I'll ask like, where can they find you? But you are, you know, doing the kinda something similar, like I think you mentioned you had a podcast and you're putting good information about hormone health out into the community as well,

Chhaya:

Mm-hmm. Yes. You know, in today's era, it's not just Google or chat GPT. And as we're rapidly progressing with ai you know, our patients are community and ourselves too, right? We're bombarded with information. And if someone can simplify and someone has to be an expert that I can trust, right, as a patient and that's been my that's been one of, decisions I made that instead of just having this exam room q&a with patients and trying to, you know, draw diagrams, give them a representation of you don't have this, versus let's work this up for a symptom or hormonal issue. I've had my medical students participate with me to create handouts to create guides which simplify, you know, the hormonal question, the metabolic questions. And then they are the ones who inspired me, that teacher, why don't you start a podcast, which is called Hormones and Hope. And the name was decided by them. They figured it out and they decided what it's gonna be. And then that's how I started interviewing a lot of physicians throughout the country. And now it's physicians who a re practicing internationally who are providing their expertise and their way of breaking science into simplification for our patients and community. So thank you for asking about

Kerry:

Yeah. And you should also mention that you are teaching Right. In the

Chhaya:

Correct? Yeah. Yes. That's the beauty of education. So it's not limited to patients, our community, but also to our future physicians

Kerry:

Nice. Well, I was going to ask you all about thyroid truths today. So where do you think we should begin and why does thyroid health matter for general wellness, energy, metabolism, weight, everything. So what, what's so important about the thyroid?

Chhaya:

sure. So thyroid is, you know, first where it's, it's in our neck and it's an endocrine gland, meaning it's producing hormones which it's one of the essential hormones for our sustainments. So we need insulin, we need cortisol and thyroid hormone without which we cannot sustain life. So that's why thyroid is one of those essential ones for our life in general. Right. Just to understand that. And it's saying it's acute structure. It's situated in the neck. The lower part, it has two wings, which is right and left lobe. And a connector called isthmus. The entire gland is producing, you know, hormones. And I'll specifically just relate to thyroid, which is T4 and t3. And you know, people should at least know that our thyroid hormone is different than animal thyroid. And this we may cover in, you know, supplements or our benefits by taking right supplements versus just incorrect supplements which might affect our health. So we produce around 80, 85% being the thyroid gland produces 80, 85% of the t4, which is also called as thyroxine hormone. And then the rest is T 3, which is less in terms of production by the thyroid gland Why is that? This is because your body or our body, every cell knows how much thyroid hormone I need for my machinery. So we have trillions of cells and each cell is an engine. And each cell needs glucose. It needs you know, one of the aspects is called hormone. So when the T four, that's the most available hormone, it circulates in the blood. It goes to say your heart cell, your brain cell, or your muscle cell. And the cell demands that, okay, I need some active thyroid hormone. T four enters into it, it gets converted into t3, which is your active hormone, or which is producing actions. And that's why the cell decides how much T3 I need. So we should, you know, that, that's a very common conversation that I have with patients just to understand what thyroid hormone is and how is it divided into the chemical structure, we need iodine. And that's why, you know, you start listening or hearing about iodine supplements or prenatal supplements, which more with more iodine and iodine deficiency. So that's also connected to the thyroid hormone. The other micronutrient is selenium, which is also in very, very minor portions, like literally very teeny tiny portions is needed. And it's a micronutrient that is micro amounts for the synthesis of the thyroid hormone. Now you asked about metabolism or how it's it's helping our body, right function. So it's not limited to just the engine part of it, but it helps our engine, cellular engine as well as our you know, the entire organ systems to run at a specific speed. But it's not the sole hormone to determine the metabolism. You know, glucose And also you know, various pathways that help each engine run effectively. So imagine if you're in harmony or your thyroid hormone is working in sync with what your body needs are. More into, called as a new thyroid phase or the labs will be called as new thyroid. And then we can dive into, you know, what's the what's the gray scale? So we have a large spectrum of thyroid conditions. It's not as simple as black and white. And that's why I feel like, you know gonna a physician rather than, you know, false claiming hormone expert. Very.

Kerry:

Wow, that was, that was a lot and great explanation of what it does like in the normal state. Right. So I guess since you're, you know, expert in this, what are some of the people are coming to you for when they think something is off and why might that be that they think the thyroid is off? And we'll talk about obviously, the common thyroid conditions, but

Chhaya:

Sure, yes. Yeah, that's a great question actually, because you know with one of the common symptoms, which I'm pretty sure you, as you know, your physician, you're seeing patients so frequently, and of course in the annual its fatigue.

Kerry:

Mm-hmm.

Chhaya:

And that could range from a kid to an elderly. The age spectrum is also wide. But most of the individuals in today's era will search for why am I tired? And your Google answers will be that, check your hormone. And the next thing is check your thyroid hormone pattern looks normal on the blood test, but it still may be a problem. Now that's the outside world. External world. And now I'll share, you know, what is evidence-based and also what's the clinical experience, right? Because everything is not medical textbook as, as we deal with real humans and real patients. So common symptoms would be, you know, fatigue palpitations, weight gain and sleep disturbances that patients will come to me with. And these are symptoms, you're not asking me to look at just a thyroid, but these symptoms, can they be connected because I have disease. The other ones very commonly are my antibodies are high. And they don't know which antibodies, but my antibodies are high or I have too much inflammation. Again, the inflammation is coming from the markers and the blood test. The third thing is you know, my thyroid level, they're just off, but my doctor says, or my, you know, mid-level provider says that we can watch and wait. So what do you think as a second opinion? The fourth aspect is our women, right? So when they are trying to conceive or they're not having regular cycles. And when I say not having regular cycles, it could be anything, no cycles, heavy fluid or lack of fluids. It's called oligomenorrhea or amenorrhea. Same thing is thyroid the problem. Right? And then comes palpitations, weight loss you know, or drive, like your system is on overdrive, which is palpitations, tremors. You know excess loose stool. So these are common scenarios where patients will seek out you know, care. It could be their physicians. It, it doesn't, it doesn't have to be an endocrinologist, but because I, you know, I don't have any requirement for referrals I end up seeing these patients as well before they've seen their primary care physicians. The other aspect, which is also an important aspect of thyroid, is my thyroids big. I feel a lump in my neck. And you know, usually the most common scenario is the patients will just point at the neck. It could be the right side of the neck, it could be left side of the neck, it could be the central part of the neck. But they think everything in the neck is vital, so they're concerned with a thyroid mass or lump. And then of course, referrals coming from physicians that there was a incidental thyroid nodule discovered on ultrasound. What did we do next? And very commonly is which, you know, which is important, is incidentally findings, just because we had a lab screening, annual screening especially in patients with perimenopause and menopause, they may have some drift in their thyroid hormone levels. And I'm being very specific for tsh, thyroid stimulating hormone. And that's where they're in this dilemma of, you know, should I treat it? Should I watch it or say, should I try hormone replacement therapy because I have symptoms? Are my cycles irregular because of perimenopause or is it thyroid? So now it gets into more complexities. Yeah. So that's I'm giving you just a commonly out of the common thyroid diseases. We're not, I don't think we need to go into thyroid cancer. Let's, yeah, I think this is more a hormonal issue.

Kerry:

Yeah. No, I agree. I think you gave a great outline of all the things that you know, I think that are important and that you would see rather than the thyroid cancer. And you've mentioned the, the thyroid nodules and stuff and why a doctor might have sent you there, but you're right, given your type of practice, like people are going to pursue, you know a second opinion or education on these symptoms that they're having. Yeah. So the, the thyroid is, you know, a super important gland, organ, endocrine system as you were saying. So when they come to you and you're, you know, trying to work them up, why well, what labs do you do, obviously, and sometimes, I guess why sometimes is just the TSH kind of not enough.

Chhaya:

Sure. Again, a very good question that that comes around. I'm pretty sure your patients ask you a lot too. Can you do, can you get me a tested, like a thyroid panel, a full thyroid panel rather than just one? Yes. So I feel like, you know we should be it's not necessarily thinking out of the box but if as a physician right, whatever labs we're ordering, if you're confident we know how to interpret it then it's very valuable for the patient. Right. So as per our guidelines most of them will suggest that if you're doing a screening annual test for a male or a female, they don't have any symptoms, just do a tsh, which is started stimulating hormone being synthesized or produced by a pet, which is right behind the behind the midsection of her eyebrows and underneath the brain. And it's a signaling hormone. It's not an actual thyroid hormone, which is active, right? So based on that they decide that, oh, if it's abnormal, then you'll do the rest, which is T4 and t3. When I'm screening patients I prefer getting all of them because I know how to interpret. I'll tell you some scenarios. So TSH, T3, T4. TSH is, you know, in sync, t4, t3 three vary a lot. So if a physician knows how to interpret it, it's based on also the half life. And what what are the patient's symptoms? What medications they're exposed to, if they're taking any form of supplements, like, you know, biotin is a very common culprit to mess with the TSH assay, like the machine itself. The t4, T3 also varies. So free levels in someone who is healthy, not pregnant on and not on any form of hormones like estrogen, progesterone, or any estrogen or no birth control pills, not in a postpartum period and they don't have any liver disease as such, then, you know, you can rely on the T4 and less reliable T three, but you know, over time you get to know that what T three ranges are and why it could be very, very valuable. This is, I'm talking about screening and not anyone with symptoms, but your decision will mostly be based on TSH and T3, T4, asymptomatic person. Now when they are symptomatic or you're not sure, you know, why this person has a specific symptom like weight gain or fatigue then I would, you know, get these three valuations done. But in many cases, if they have a larger gland or if it irregular. Or if they have a strong family history of autoimmune conditions, or especially if that patient is a female you know, it's worth getting the TPO antibodies not to scare the patient, but it just guides us that if that test is abnormal, especially when we have symptoms, you know, why waste another you know, another time for the patient to get a separate blood draw. Right? So you're getting the thyroid hormone levels and you know how to interpret the TPO antibodies. Because you're suspecting hypothyroidism or subclinical hypothyroidism, and that gets very valuable. Nowadays we also have thyroid globulin antibodies, but like I said, if that physician knows how to interpret it and alleviate the patient's anxiety and fear, then go ahead and do it. It will be valuable in terms of like helping supporting the the diagnosis of the subclinical or primary hypothyroidism and just guide them with that treatment. Now comes the other extreme, which is hyperthyroidism too much. In those scenarios, you have to, you know, if you have a diagnosis or if they're suspecting that the patient might have it, then you wanna get all three of them, TSH, T4, T3 And then the specific antibodies for that condition, which is called Graves Disease would be very, very essential to. We also see thyroid globulin antibody, but truly speaking, like no matter if you get it, if it's elevated if we have a functioning thyroid, you're supposed to have elevated thyroid globulin because its a protein. It's produced by a functioning thyroid gland., In a functioning for gland you don't need to get thyroid globulin. The only reason we get it is when patients have thyroid cancer diagnosis, they're gonna get a surgery. So that helps us to use that as a marker like literally like a cancer marker to follow up them in future post surgery. Similarly, thyroid globulin antibody goes along with with the thyroid globulin level. If you have a question, again, share some of the, you know, evidence or insights on reverse T3 because I get that as a very common question, but I.

Kerry:

Well, well, so you were mentioning previously something about evidence-based versus the clinical patient. So I was gonna ask you, so if you order all of these things, is this something that is covered by insurance or is it just the evidence-based things that are covered by insurance and, you know, otherwise what do you, what do you do and maybe where does that reverse T three come in?

Chhaya:

Yeah. So all the tests that I talked about, it's usually covered by the health insurance because you know, you have to a specific symptom not fatigue. a condition or disorder code that we have. So definitely then that's very valuable. I don't support getting free T3 for everyone if they're not having symptoms because it's just you know, it's not, it, it is a more expensive than TSH and free T4. But like I said, it depends on the physician's interpretation. They're confident. Then go ahead. But not to use it as a, a sole cast for diagnosis of of the condition called hypothyroidism or subclinical hypothyroidism. With evidence-based right clinical interpretation you know, one thing I'll point out, which is very essential that, our body knows how to maintain harmony and thyroid gland is one of them, which is very, I would say a very cool organ to adapt to situations. So say, you know a human or a patient is in the hospital or going through a major stress like fracture, major sepsis infection, urinary tract infection, there is a condition called sick euthyroid syndrome. Which basically in simple language or explanation that I can tell you is your pituitary is telling your thyroid, don't work too hard. Because I need to heal my fracture or I need to recover from this urinary tract infection. Or you know, I have an eating disorder, so I need to focus on saving my calories. So don't work hard. That's a protective mechanism. So in those scenarios, we might see a mild elevation in tsh, or many times we'll see a low free T3 three. And that is a more of an adaptive mechanism if we're getting into the clinical history when we're discussing with the patient. And I don't pamper the thyroids response, which is appropriate in those scenarios. You can wait for four to six weeks when you know that there is an obvious scenario which is appearing like thyroid syndrome. In those cases academically we can use reverse T three because that active T three is being converted into reverse T3 because it, you know, the body is telling the thyroid hormone that I don't need too much active thyroid hormone right now. I need to give my other cells a rest. It's not that they're not functioning, it's just slower because I need heal this, this eating disorder In terms of the intake, i need to make sure i match it. But this was only done in academia. Like, you know, when you're teaching students, residents we tell them that, okay, if you wanna order reverse three, go ahead. Because this just reemphasize the fact that whatever we're discussing clinically is actually making sense biochemically. But do you need to get that when you're an experienced physician? Not really, because you know what's gonna happen.

Kerry:

mm-hmm.

Chhaya:

And then and then focus on, you know, the patients recovery treatment. You know cases I see psychiatrist using T3 hormone in these patients with eating disorder, depression, anxiety and they have some literature on that, but I leave that up to psychiatrist because they're really trying to treat the patient overall in terms of their mental health. So that's a very complex situation if for the patient, I would say, because it's very difficult for them to understand the negative, positive feedback. What is thyroid and how is the complexity of this hormonal cycle to seek harmony or to seek homeostasis is being maintained. So those are the scenarios where, you know, where reverse T three actually came into play for biochemical orders or for lab orders, and then how do we use it clinically? It is an expensive test. But you know, do I need it as an endocrinologist? Not really. I haven't ordered three even once in my clinical practice now patient bring me their labs where they've ordered reverse T3 by some other, you know lab or physician or you know, the, the healthcare professional that they're following. But otherwise I help them interpret. I help them make sense outta it, but it really doesn't help me to help the patient.

Kerry:

How about well that's definitely more of a, I don't wanna say unique case, but maybe a little bit rare. What about with something a little more common, like Hashimoto's thyroiditis and how can you differentiate that from like other hypothyroidism.

Chhaya:

Yeah, that's again, a very, very great question for thyroid. Very highly searched terminology and condition. So Hashimoto's is the Japanese scientist who discovered TPO antibodies. Thyroid peroxidase antibodies. And you know, many of us now know that antibodies are basically proteins that don't let your thyroid hormone synthesize in a normal manner or you know, what your thyroid is supposed to do. And when it overtakes the thyroid hormone synthesis. The autoimmune condition, it can lead to underactive thyroid. And that's where the gray spectrum is. You know, someone could be just mildly hypothyroid based on, you know, their symptoms. And of course the TSH doesn't determine if it's mild, it's lot to do with symptoms and what their T four, the same but there's also something called a subclinical. TSH may appear to be high, that if the pituitary gland is really trying to push the thyroid that, Hey, I'm not getting enough thyroid hormone, can you just, I'll give you some boost. Can you just make adequate and a thyroid response? It makes adequate hormone, but the signal is working harder. That's a subclinical scenario. So when we have anti Q antibodies and now thyroglobulin antibodies to support that the thyroid is working harder than it's supposed to. You know, we term it as Hashimoto's disease, and Hashimoto is more specific to anti-TPO, TPO thyroperoxidase antibodies. Now, if anyone has Hashimotos that is presence of antibodies, does that mean that they have hypothyroidism? No. So hypothyroidism or subclinical, you still have to get those t tests, or at least tsh, T 4 to figure out where you're at for The spectrum for tsh, if someone has symptoms and the TSH is mildly elevated, but still not abnormal. Like, say not greater than 4.2 or so. You know, and if they're very symptomatic and all other causes have been ruled out, like especially in medicine, like you look at you know, fatigue or weight gain. Then supporting it with a trial of thyroid hormone clinically makes sense, but that is more of a physician decision making.

Kerry:

Sorry, do you mean that they have an elevated thyroid peroxidase antibodies, but normal TSH?

Chhaya:

High. So if the TSH is, you know, four, close to 4.2 or getting closer to five and they're symptomatic. Yeah. So, you low dose of 12.5 or 20 levothyroxine for 30 days. It helps, not messing with your thyroid hormone production, if it doesn't help, you know, it's very convincing for the patient that, okay, lemme look at what other things are causing their symptoms with their physician. But it would not cause harm per se if you ruled out every other scenario that can cause their symptoms. And especially in patients with, you know, again, perimenopause, menopause because there is this fluctuation happening. We have guidelines for patients with infertility. I'm getting more to talking about women infertility, preconception. And they have TPO antibodies and their TSH is greater than 3 You should be able to give them levothyroxine if their TSH is less than 2.5. And the main reason is once it's shown that i t can help with the success of IVF if they're going through that. And also, you know, just the physiology that the fetus, when it's growing the first 16 weeks, it needs the maternal hormone. So the maternal thyroid hormone is fluctuating. That's based on the TSH and TPO antibodies. Then you're actually helping the fetal thyroid hormone or the fetus to receive thyroid hormone during 16 weeks.

Kerry:

Mm-hmm. What, so what happens? Well, that's, I very good information for the, from the fertility perspective, but back to the TPO, but what if someone has elevated thyroid antibodies, but normal CSHT four, what kind of things should they be concerned about? What is the potential there?

Chhaya:

you say thyroid antibodies I suppose you because that's the most one. So the, so it's still autoimmune. So we have an autoimmune, there is likely a strong family history or, you know, scattered family history of autoimmune conditions, which are multiple, which are like, it could be rheumatoid arthritis, it could be type one diabetes. It could be, vit, like white patches. These are all autoimmune conditions and siblings and family. If they're dealing with any of these inflammatory bowel disease of colitis Crohn's, and then we inherit those that I'm blanking on the word, but we inherit the autoimmunity aspect of it so we can produce those antibodies. The most common ones for female is the TPO antibodies. So in general, you know thyroid disorders are more common in women than men. So we do see that, you know, there will be elevations in TPO antibodies despite having a normal TSH, free t4 and they probably may not have symptoms and they may have symptoms and suddenly they look at TPO antibodies, oh my gosh, it's elevated. What do I do? Is that causing that? Most of the times it's not causing the symptom if your TSH is excellent. So, you know, two, 2.53 and your four looks robust and you have this elevation in TPO antibody. It predicts that you have a risk of developing subclinical or clinical in the near future. The last time I looked at percentages, it's between three to 5% risk of developing it, and it doesn't stack up everywhere. Elevated TPO antibodies and very good mid normal range, t4. But if there could be some stressor, you know, specifically in female which we talked about, conception, preconception, postpartum period, they may have a higher incidence of thyroiditis and thyroiditis could be too much thyroid hormone, and then it gets to less thyroid hormone. Patients are quite symptomatic as much as, you know, it's not an emergent condition, but they do get symptomatic. The levels are fluctuating from high, low and then comes perimenopause, menopause age where they might have higher risk of developing hypothyroidism or thyroiditis. So when do you treat it? Is a very, it's like a million dollar question for physicians, right? And that's where when I, you know, discussed about that, if the TSH is three, 3.5 is it's it's getting higher. You see that patients have symptoms nothing else seems to be obvious, or you've corrected other disorders which could cause these symptoms, and they're still with fatigue or dealing with that weight issues then trying that 30 day trial and see what they, how they respond is a very good way of I would say the patient physician shared decision. And in some patients I see that they get an improvement with the low dose levothyroxine. And that is just because, you know, TPO antibodies are high. You cannot sit and check TSH every day. You cannot sit and check free T4 every day. So, you know, there could be fluctuations and variations that they may need that extra supplementation clinically. And that's where you know we decide. But again, you know, we wanna follow up those patients to see if they're actually benefiting rather than giving them an annual prescription.

Kerry:

And did, I'm sorry, did you say three to 5% end up?

Chhaya:

Mm-hmm. Like the risk if they have very good thyroid hormone level for TSH, free T4, mid normal range, and the TPO antibodies are elevated.

Kerry:

Okay. Yeah. are there any myths about, you know, thyroid care or misconceptions that are, you know, pretty common that you would like to dispel?

Chhaya:

Yes, a lot. all right, so on top of my head is, you know, I'm tired and it's always gonna be my thyroid. Because, you know, more common ones is, you know, how we how, especially in females, it's usually, you know, looking at our sleep. And of course what we eat and that dictates a lot onto what our metabolism, our energy levels are doing. So that's, you know that's why every fatigue is not thyroid. Every weight gain is not thyroid. But yes, you can rule it out, but most of the times you'll see that it's not necessarily always the case. So always look at multiple aspects especially for patients who are listening at the audience that don't just limit to thyroid. The other one is, every lump in my neck is thyroid cancer, or and then I'll tell you the third, which is also relevant, but what we need to remember, we have like hundreds and hundreds of lymphs in neck on. Then comes the thyroid gland. So most commonly, the lumps are usually related to lymph nodes. You know, we get dental infection, you can get eye infection, you can get your infection, and lymph nodes actually enlarged to protect us from from those infections. So it's basically immunity, which is working or it's an action at that time. The third one is. Every thyroid nodule is thyroid cancer. Again, the risk of thyroid cancer in every nodule is very, very, very low. I actually have a YouTube video with one of the you know, California's endocrine surgeon where we debunk a lot of thyroid nodule myths and actually share what is the the true incidents and how do you work them up, and how do you alleviate your anxiety and fear about the word cancer? So every thyroid nodule is not thyroid cancer. Most of them are benign. And you know, the best thing is to get the right information, knowledge about your thyroid in terms of ultrasound imaging and getting that evaluated. The fourth one is animal thyroid hormone. So there are these thyroid supplements available online.

Kerry:

Hmm.

Chhaya:

thyroid boost is very common. I have lots of pictures you know, thyroid power and then, you know, just thyroid supplement. So if anything's available over the counter people it's not gonna boost your thyroid. The reason being, you look at the micro ingredients, most of the times I'll find that it'll have animal thyroid hormone, animal extract. And it definitely has some amount of thyroid hormone. And as females as the mother that's the only time that they need more iodine than what their daily multivitamin is. The second Selenium supplement and the dose studied is around two microgram that can help with reducing the TSH level. And the TPO antibodies, and we don't have enough data for thyroglobulin antibodies but in these patients its can be used as a treatment, but it can support by adding you know, for me, I just take use of it 30 to six days not beyond that. And this is usually for abnormal TSH, that's high TSH. Mildly elevated, not in the, not in the hypothyroid numbers or range and elevations in TPO antibodies where it's supported in terms of what evidence we have for selenium. Brazil nut also contains a lot of selenium. Yes. And you know, the only thing is one brazil nut that may vary if may have have 200, 150, 175. So what I do personally for my patients is if there is a specific individual with autoimmune disease with Hashimotos either they're only with replacement for their hypothyroidism or they're not I may recommend to go on Selenium supplement 200 micrograms, no other ingredients. You know, for 30 to 60 days, or in some patients who are in that you know in the preconception phase, I may just tell them, stop. And they're not, or they're not planning to conceive they're postpartum, period. You know, they still, because that has iodine, some amount of selenium, probably 12 to 15 micrograms, but 200 is the dose. So take it for 30 to 60 days and then switch to brazil nut. So that you know, you're not sitting and worrying about Oh selenium toxicity, because that too,

Kerry:

Yeah, I mean, I was gonna bring up the Brazil nut and I think you'd only need like one of those a day, right. For your, your dose.

Chhaya:

Yeah. You're so right. Yeah.

Kerry:

Yeah. That's really always good information to have about the supplements. I think also with thyroid health, we sometimes hear some, I don't know, maybe. Previously people would give it for thyroid replacement, maybe even for like weight loss in a diagnosed hypothyroidism way. I don't know, can you, have you heard of this? Can you comment on that or anything?

Chhaya:

So, when you are not seeing a right board certified physician or you know anyone who physician, or of course the endocrinology, but you know, this, beyond this that's when I see these replacements happening. So there are adrenal extracts, there are thyroid extracts, and there are prescriptions for T three. And by the time I see the patients they're either you know dealing with anxiety or palpitations or just not feeling right. Or in the first common one is I'm just tired of taking supplements and I still don't feel good. Right. So patients are seeking out to feel good and when they know that, oh, it's not a prescription, but it's gonna be a supplement, or it's gonna be a low dose prescription, not knowing that it's an actual hormone which has effects on our cells and then eventually they get tired of it. So

Kerry:

Mm-hmm.

Chhaya:

that's very essential because you know, thyroid, be it in animals lytic extract or a prescription form, or you're taking a supplement, which has animal extracts of thyroid hormone is affecting metabolism. It's about some change. And the two most important organs are the heart. So the electrical activity is very sensitive to T3. T three is more or it's in terms of synthesis, like we talked about, T4 and t3. In humans, in animals, they produce more t3. So if you're taking animal extracts knowingly or unknowingly, that has more amounts of T3, and it will, you know, most of the times cause this side effect or an effect on the heart electrical activity. So arrhythmias, palpitations, feeling like there's a sense of anxiety, very common, extra beats and PVCs and they're taking supplements. And then you realize, oh, maybe this is the, and they've gone through this entire cardiac workup. The second is bone. So, you know, over time, more exposure to the thyroid hormone and not looking at the, the biochemical aspect of thyroid, which is your blood test. And if the TSH is kept low, because, like you said, because they're getting thyroid hormone for weight loss or they're getting thyroid hormone to treat their fatigue and their thyroid stimulating hormone is dipping down closer to zero, it'll impact the bone because bones are also sensitive. So we lose more bone cells than what we do normally. So these two organs are very sensitive to too much hormone. You know, you could get too much thyroid hormone even like if you're giving, getting a prescription for treatment versus too much of it versus an animal extracts supplements, which you, like I said, knowingly, unknowingly you've been taking it.

Kerry:

Well, I feel like I've taken so much of your time and there's so much more we could discuss, but I don't wanna not ask you about lifestyle you know, and thyroid health. So please give your recommendations on that. So

Chhaya:

Yes.

Kerry:

as

Chhaya:

you. Thank you for asking that. Yes. So, you know, if you had a patient or you know, if any your audience is listening, if they have an actual condition, which is undergoing treatment Like hypothyroidism or hyperthyroidism. So too much or too little, right? I would never advise that, oh yeah, go exercise or eat well to fix that problem. So pharmacologically as a physician, you keep treating those conditions just like you would, and simultaneously when their condition is getting stable or they've started feeling their normal cell the most common endocrine autoimmune disease is thyroid. It could be graves, it could be Hashimoto's. Hashimoto's is more common than Graves. So for the long term, right, that's where, you know, our foods and our activity. Anything that is anti-inflammatory, right? And it doesn't have to be going on again, on internet search and trying to look for anti-inflammatory diet. But anything that is mostly unprocessed or absolutely avoiding the ultra processed foods, which is anything in boxes and packages cans. Your plant foods are very, very helpful. Turmeric has an anti-inflammatory effect have been studied well for you know, for arthritis, for MSK or musculoskeletal issues. But it doesn't harm to use that as an anti-inflammatory supplement. If you're discussing with a physician that seems right. Now, do I say that, that will reduce your autoimmune thyroid disease. We don't have that in studies, but you know, when we have auto immunity, it's not just one aspect, right? We are producing a attack. There is inflammation in the body, so why not look at our foods and our physical activity towards it. I talked about two supplements, which is, you know the prenatal or if someone needs an iron supplement in females, and then the selenium. The rest. The other aspect is you know what I see in my patients with Graves disease. So when they are treated, this is hypothyroidism, when they're treated and they're more in that remission phase stressors. Okay? It could be physical stressor, it could be deice at home, or, you know, losing a loved one's stresses in life, and not just the usual work stress but, you know, lack of sleep or worrying about something. Shown to like trigger a relapse, right? So when they are getting better, stable because they're very symptomatic and they're hyperthyroid and they're getting stable, that's when we start talk about or teach them about how to cope with these challenges. Breath work is very, very helpful because it stimulates our parasympathetic nervous system. The vagus nerve, which is the longest coming from your brain all the way going into your gut. And it's passing right through the neck. So it's helping with the heart rate, it's helping with the heart rate variability, and this is all science. It's not just me sharing, you know, my experience. But that has helped them to cope with, you know, stressors. And then of course, you are dealing with one less medical condition. Worrying about a relapse because you're able to cope with that stress with more strength and with more power and just more wisdom. Then it's not affecting your physical body or condition, which is worse disease. You know, you'll also hear about avoiding Brussels broccoli, cauliflower when you have you know, hypothyroidism or Hashimoto's. That's only if there's like a lot of iodine deficiency and you're not treated for hashimotos or underactive thyroid. Avoiding a daily is is okay, but we can still incorporate that, you know, several times a week. But, you know, not taking it for breakfast, lunch and dinner. Only broccoli and cauliflower

Kerry:

I haven't heard this one. Why is that?

Chhaya:

What's that? They're called, they're called goitrogens.

Kerry:

Ah,

Chhaya:

yeah, but that's, you know, a lot coming from our ancient data and more in the East Asian countries where also there was deficiency and they, they call goiters a large thyroid

Kerry:

Okay.

Chhaya:

So that, you know, but it doesn't mean that you have to avoid these foods completely because they have great benefits and been studied so well with, with its effects for anti-cancer activity. So I would, you know, it's basically like a myth, so you don't have to avoid these completely. It's.

Kerry:

Mm-hmm. Well, hopefully I don't get that'cause I eat a lot of broccoli. Yeah. Okay. What, is there anything else you'd like to share with the listeners? Because I feel like we've done so much and I know there's so much more that I would ask and cover, but I just feel like we're kinda out time,

Chhaya:

Yeah, no, this was great. You actually covered you know, very important questions for the, and. You know, it's always getting the right expertise. You know, we have we have the internet world today and you know, me as a physician also, if I have a symptom or a pain and a joint, I may start looking for it, of course, the right resources and, you know, maybe have a back or, you know, the thought in the back of my mind that, okay, what if the business, what if, right? You think about the worst possibilities first. Coming back to reality, coming back to the visiting and knowledge it's best to get your expertise rather than coming out with your own differential diagnosis based on internet search and more worry and anxiety because it just leads to more sense of worsening of symptoms or just more sense of gene rather than just getting the right expertise. So, you know, following doctors like you who are giving that information out on this internet and looking for right resources and right expertise will save you so much in terms of your mental health and psychological wellbeing.

Kerry:

Yeah, very true. So speaking of that, where can people find you?

Chhaya:

Sure, yes, you can find me. On YouTube, I shared about the podcast, all the handles for Instagram, Facebook are atd. And my website is unified endocrine care com. And even if you search my name, I think those are the handles. And you know, very soon I'm releasing like a global consultant, like a second opinion. So anyone anywhere in the world can get a, a second opinion, you know, without any prescriptions. If they have these complex questions or complexities going on within their physical health that I would love to help them too.

Kerry:

Nice. Nice. We'll put all that stuff in the show notes as well. Yeah. Dr. Makhija, thank you so much for coming on the podcast today, and I hope everybody will follow you and listen to your, you know, YouTube and podcasts. And you know, thank you so much for joining

Chhaya:

Yeah. Thank you.

Kerry:

Likewise. Thank you. All right, everybody. Tune in next week.

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Dr. Kerry Reller

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