Recently, I interviewed Dr. Roy Steinbock, and we discussed how thyroid conditions present in children, the importance of early diagnosis and comprehensive testing, the challenges of diagnosing thyroid issues in children, the role of nutrition and lifestyle, why treatment approaches must differ for adults and children, the need for a holistic approach to pediatric thyroid health, and more. If you would prefer to listen to the interview you can access it by Clicking Here.
Dr. Eric Osansky:
I am super excited to chat with Dr. Roy Steinbock. We are going to be talking about thyroid conditions in children. Very interesting conversation. Even though I have a practice where I see mostly adults, I do see some children. It’s great to speak with someone who focuses on them. I know we’ll talk about you seeing some adults, too, so it’s not exclusively children, but you see more pediatric patients than I do. Great to have this conversation.
I should mention that Dr. Roy is a repeat guest. Recently, I had him and his wife Debbie on the podcast as we chatted about the Elemental Diet. You want to check that interview out.
Dr. Roy Steinbock is a board-certified pediatrician with an integrative and patient-centered approach. With over 20 years in primary care, he built a solid foundation assisting patients and families dealing with the diverse range of medical conditions. He believes that investigating the root cause rather than only addressing symptoms is the best route to achieving and maintaining optimal health and wellbeing.
In 2006, Dr. Roy founded Mindful Pediatrics, so he could combine evidence-based western medicine with a functional and mindful approach. It is his own nutritional, spiritual, and lifestyle choices that complement his pediatric practice and continue to influence his approach as a physician.
His degrees include a BA with honors from UC Berkeley and a doctorate in medicine with honors from the University of Tel Aviv, Sackler School of Medicine. Dr. Roy completed a pediatric residency at the Schneider Children’s Hospital in NY. Since residency, he has worked as a pediatric in-patient doctor in a newborn nursery and neo-natal ICU in several pediatric emergency rooms and for a large pediatrics private practice in Denver. He has completed advanced courses in functional and integrative medicine and maintains a lifelong passion for learning.
What an impressive bio. Welcome, Dr. Roy.
Dr. Roy Steinbock:
Thank you. It’s always funny hearing someone else talk about you like that.
Dr. Eric:
You have gone through a lot of training. Usually, I tell people if they could give their background, but we did. If you want to expand a little bit. Why did you decide to name your practice Mindful Pediatrics?
Dr. Roy:
It’s funny because now “mindful” is a household term. When I named my practice Mindful Pediatrics a little over 20 years ago, people didn’t have a clue what that was at the time. I have always been a bit of a spiritual seeker. I actually got turned onto eastern philosophy, Buddhism, in my college years. I meditated regularly, but it wasn’t until the year before I opened my practice that I got turned into vipassana meditation. I did a couple of these silent 10-day retreats, and that’s what inspired me to quit my job at a big pediatric practice in Denver and start my own thing and do it the way I wanted to do it.
Mindfulness is an approach to life, and it certainly has influenced my approach to medicine. It’s part of my meditation and mindful practice. It’s a lot of what informs the decisions I make day to day in my practice. It keeps me focused and present. It felt appropriate at the time and still does.
Dr. Eric:
Makes sense. One thing when it comes to your training, especially with pediatrics. In medical school, in your residency, did they get into any functional medicine or nutrition? Anything about actually improving children’s health? Obviously, some sort of wellness, but not really when it comes to diet and stress management.
Dr. Roy:
Not in medical school. I always joke that my nutrition course was nutrition pathology, so it’s things like scurvy and Rickett’s, which I have seen. That is the only serious nutritional deficiency I have seen in my career.
In residency, you learn a lot about children’s wellness when you are doing training. I did the primary care track, so I did a lot more work in primary care practices because I knew that’s what I wanted to go into initially.
It was really my own personal interest. I have always been an athlete and interested in my own personal health. I have experimented with different diets growing up in high school, college, and afterwards. When I finished residency, I realized I had this big gap in my knowledge base, so I started taking courses in nutrition. That led to meeting naturopaths and chiropractors. I had never heard of a naturopath until I finished my residency. I met all of these other people who were practicing more holistically.
It was right around the time Andrew Wyle came out with his first real big book, not to date myself. I read that, and I was like, “Oh, this is exactly what I want to do. Of course I want to look at everything. I want to look at the whole picture. Why wouldn’t every doctor want to do that?”
Dr. Eric:
Yeah.
Dr. Roy:
Nutrition was really the gateway for me. Then I learned about supplements, herbs, and functional medicine testing.
Dr. Eric:
In your practice, your wife Debbie handles nutrition. I’m sure you have some basic conversations. I don’t know so much about the child, but also the parents are there most of the time when dealing with children. Teenagers as well.
Dr. Roy:
Absolutely. Because I’m fortunate enough to have who I would argue is one of the best nutritionists on the planet in my actual practice, it’s a little different. I do talk about basic stuff with people.
Really what I do more is a diagnosis, come up with a bit of a plan, but I really rely on Debbie. She is the boots on the ground to get the people to make the changes. She is amazing at meeting people where they are and getting them to move forward with their lifestyle. I don’t have long conversations.
It’s also age appropriate. Little kids, oftentimes, you say one thing, and they don’t remember it the next minute. Teenagers depend on their receptiveness. Debbie frequently works with the parents, depending on age.
Dr. Eric:
When I do work with a thyroid patient, sometimes the child isn’t even on the call. It depends on the age. If it’s a teenager, maybe. 13/14, in that case, maybe they will make a brief appearance.
Dr. Roy:
Agreed. It’s the same thing with me. I always like to do a physical exam, so they will come for the first appointment unless it’s a distance educational kind of thing. Oftentimes, then I won’t see the child again for a while, 3-6 months, depending on what labs we do. The kids don’t want to hear all the lab results most of the time, unless it’s an older teen or someone who is precociously interested.
Dr. Eric:
I was going to ask. The example I was giving, I am pretty much working remotely with people, but you are seeing people in person. At least for the initial visit, you will have the child and parent, I’m sure. Do you do follow-up telemedicine visits as well, or do they always come in?
Dr. Roy:
I do both. 50% of my practice right now, and it really is growing because of COVID and people’s receptiveness to telemedicine, is telemedicine, even the initial visit. It really depends on the subject, what’s going on, the issues going on with the child. Some things absolutely need to be seen in person, and some things don’t.
I do a lot of distance consultations. They’re different because as a medical doctor, I have a license in Colorado, so I can only practice medicine in Colorado. But I do give second opinions and work with their doctor in other states; it’s a big part of my practice now. As you get more specialized and get expertise in specific things, people seem to find you for those specific things.
Dr. Eric:
Makes sense. This is getting into the thyroid side of things. Have you seen a greater number of children with thyroid conditions, especially autoimmune thyroid conditions, like Hashimoto’s and maybe some Graves’?
Dr. Roy:
Yes. For me in my practice, absolutely. It seems like the numbers are increasing. Interestingly, when I have talked about it with colleagues of mine who are endocrinologists, they say there isn’t an increase. I have scoured the internet to see: It’s not really clear whether it’s really increasing. It seems like autoimmunity in general seems like it’s increasing. I would argue it is.
Part of it might be selection bias. People come to me when they have a lot of problems/second opinions/people who are not getting diagnosed in their first round of seeing doctors. I have become much more aware of it in all fairness. Debbie and I both have Hashimoto’s, so that has made us more expert at understanding. We have done our own research, and both have very strong family histories of it.
In general, I see more sicker kids in general. A lot more autoimmunity that I saw early on. Maybe some of that is selection bias because that tends to become what people have gotten good results with in my practice, so they tell other people. Then they send people who are sicker to my practice. It seems like it’s on the rise to me certainly.
Dr. Eric:
I agree. You mentioned maybe not just children, but autoimmunity in general. Since you focus more on the pediatric side, it would make sense that you see more children. Maybe with the endocrinologist, if they are seeing a mixture of adults and maybe some children, they just don’t notice as big of a difference as far as focusing on the children. I would agree, with the toxic world and the stressors we have dealt with over the years and other factors, overall, in both adults and children, there has been an increase in not just Graves’/Hashimoto’s, but autoimmunity in general.
Dr. Roy:
Absolutely. It seems pretty obvious to me, but again, I only have my sample size.
Dr. Eric:
Is there a difference between diagnosing thyroid conditions in children compared to adults?
Dr. Roy:
Not really. What I was going to say is, this will tie into the diagnosis piece. Thank you for reminding me. Thyroid is tricky. What I mean by that is people can have symptoms before their labs show up as abnormal for a long time. People can have really abnormal labs because unlike adults, where it’s much more standard to do a screening annual lab test, people don’t do that with children in general. Even they don’t typically look at thyroid as a test. It’s not a screening test for kids.
If you look at the symptoms particularly for Hashimoto’s or even Graves’, it encompasses pretty much every system in our body, everything from your joints to your energy level. In kids, commonly growth and development, school performance, anxiety, mental health. Often, people are missing the diagnosis for many years. That is maybe part of the reason why endocrinologists don’t see this rise. It’s really just such a lag between symptom onset and diagnosis oftentimes for children and adults.
In terms of the testing, it’s not really different. Anyone who comes into my practice and is suffering pretty much from any condition that is either chronic or new onset, unusual, not something obvious like strep throat or a tummy bug. People who are coming in with long-standing or really acute new onset symptoms that don’t make sense, I will check thyroid. Depending on what it is. If it’s not very serious, I will start with just TSH or TSH and free hormones, free T3/free T4.
But if I am not really sure what’s going on, I will also check thyroid antibodies, both the Hashimoto’s antibodies, the TPO and antithyroid globulin, and also thyroid stimulating. What I have seen frequently in kids is if you catch it early on, they will both have TSI and Hashimoto’s antibodies. Usually, if you wait long enough or miss the diagnosis early on, they will generally just end up having Hashimoto’s.
That’s one of the reasons you won’t see an elevated TSH right away. They’re actually getting stimulated by the thyroid stimulating immunoglobulins, so their TSH actually looks normal, but they are not feeling well.
I don’t know about you, but I find that people, even if their thyroid numbers are normal, sometimes they are still not feeling great if they have antibodies. That might be particularly early on, the first signs. If you do early treatment, then you can get them to improve much more quickly oftentimes rather than waiting until their thyroid is really imbalanced with an elevated or low TSH.
That’s what I start with. I also look at things like why this person has an autoimmune condition. That is where I get more into stool testing, allergy testing, nutritional testing. I have what I call my dealbreakers. If these things aren’t balanced, you can’t expect the body to work well, particularly the immune system, both for kids who are getting sick a lot and kids who have allergies, eczema, asthma, hyperimmune type stuff, and autoimmunity.
I at a minimum look at things like Vitamin D deficiency, which is shockingly common. I just saw someone who had a Vitamin D of 10. I have had one lower than that, 9, before in my practice. That is a level where you can have Rickett’s, especially living in Colorado, which is so sunny.
I will look for, especially really important at altitude but at sea level, too. I will look for iron and storage, ferritin. We don’t see a lot of anemia here because people have a higher amount of EPO. That’s why people train at high altitude because we have higher hemoglobin levels. The average is 13 or 14 versus 10-12, which is at sea level. The definitions for anemia don’t really apply so well here at altitude.
I have to check things like ferritin level, iron storage. If you are not anemic but have low iron storage, that can affect the immune system, sleep, nervous system, development. I’ll aim to work for that to get those elevated.
Zinc also seems like one of those real dealbreakers. If zinc is really low, I find people’s immune system doesn’t work well. Zinc is really involved in cell turnover, growth and development for children.
Those are three basics I check for anyone coming in for basically any condition besides optimal health. Those are great places to start. Looking at things like stool testing. It depends on what’s going on. We can get into the weeds with mold testing and that stuff, too. That’s not where I start.
Dr. Eric:
Makes sense. Vitamin D, iron panel. You can’t just go based off a CBC. If someone doesn’t have anemia. That’s true in general. Not everybody with an iron deficiency has anemia, even if they are not living in higher altitude. I like to test pretty much with all my patients. I like to look at a full iron panel with everybody. If ferritin is elevated, that could be related to inflammation. You can’t just conclude someone has iron overload based on that.
Dr. Roy:
Exactly. That’s why I will look at CBC and ferritin at the same time. Especially with kids who get sick so frequently, because even if you just have a cold, your ferritin level can be elevated as an acute phase reactant.
Dr. Eric:
Do you just do a regular serum zinc, or is it an RBC zinc?
Dr. Roy:
I love RBC zinc. I dove into the research on this. I never got into the hair analysis. I see a lot of mental health stuff, so I am thinking about doing it, specifically to look at lithium levels because there are not great ways to look at lithium otherwise.
In any event, I do an RBC zinc. I think it reflects a longer time frame, whereas serum zinc can change pretty dramatically depending on what you have eaten. It’s more moment to moment. As an acute thing, maybe serum zinc is better, but I prefer red blood cell zinc. I know that’s a little bit debated what the best form is, but that’s the one that I’ve had the best luck with.
Dr. Eric:
I agree with you. Same thing with magnesium. I prefer RBC magnesium over serum magnesium. There is selenium. Do you ever test selenium levels?
Dr. Roy:
I don’t. Is there an RBC selenium level to test?
Dr. Eric:
There is. I can’t say I recommend RBC selenium to everybody, but that is an option. There is RBC selenium along with magnesium and zinc.
Dr. Roy:
I think the reason my logic for it is first of all, the red blood cells last for about 120 days, so it’s giving you a bigger time frame. Then we also know that the majority of zinc is found intracellularly anyway. It’s 10:1 amount of zinc in the cells versus what’s in the serum, so it reflects a larger volume of what’s in our body, functionally what’s being used, I think.
Dr. Eric:
Let’s talk a little bit about some of the other tests. It sounds like it varies depending on the person. Food sensitivity testing sometimes. Stool testing.
Dr. Roy:
First and foremost, anyone who’s got any autoimmune condition, I will check a Celiac test. There is a very strong association between autoimmune conditions and your propensity to have another autoimmune condition, especially thyroid and Celiac. I think there’s a 20% connection between Celiac and thyroid conditions. That’s #1.
Celiac is really one of those things because it’s the yield of treatment. If you catch someone who has Celiac, it’s such an easy fix. The cost of the test is not very high. I tend to do those a lot with anyone with chronic health issues. Especially someone with thyroid.
I’ll do a full Celiac panel. In that, I include both the tissue transglutaminase and the deamidated gliadin antibodies. Of course, a total IgA as well, to make sure they are not IgA deficient.
I’ll sometimes do more food allergy or sensitivity panels when those seem appropriate.
I’ll do a stool test on everybody who comes in for a thyroid condition because the gut is so important for immune regulation and inflammation. Oftentimes, that’s the first place to look.
The first functional medicine course I ever went to, do you know who Patrick Hanaway is?
Dr. Eric:
From IFM.
Dr. Roy:
Yes. I randomly sat with him at a lunch and started talking to him. I didn’t realize who he was at the time, the bigwig in functional medicine that he is. He saw I was fresh with it and basically said, “Do yourself a favor. Focus on the gut first. Learn everything you can about the gut first.” That’s what I did. That’s obviously paid huge dividends.
It’s still really the mainstay of my practice. Digestive disorders of course, but all the things that follow it, things like autoimmunity. I really focus on gut health. That’s with Debbie’s initial expertise as well. It’s expanded over the years. It’s a big part of our workup.
Dr. Eric:
When I interviewed you and Debbie, that was a big focus of our conversation, including the Elemental Diet.
Dr. Roy:
That is such an amazing thing for people who have flares of autoimmunity or even to calm things down.
Dr. Eric:
Gut tests. A comprehensive stool test on everybody. Food sensitivity testing, depending on the person. Maybe some other tests.
Speaking of the Elemental Diet, how about SIBO? I assume you don’t do it on every single person, but if you suspect it.
Dr. Roy:
Kids have a lower incidence of SIBO in general. But I do test it. It is a frequent test I do. If I diagnose someone with a thyroid condition, and they have any digestive symptoms, and they’re old enough, because I have had some kids with Hashimoto’s and Graves’ who are under two or three years old, as it is very difficult to do a SIBO test on those kids. Anyone who is old enough, I might do a SIBO test.
It’s not my first thing. I’ll do a stool test first. If the symptoms make sense, then I will do a SIBO test. If I am not getting results from a basic stool test, I’ll do a SIBO test as well.
Because of Debbie’s practice and her focus on SIBO, that’s been in my consciousness maybe more so than it would be had I not been married to her and learned everything she teaches me. I am more aware of it than maybe the average pediatrician. But I see it much less frequently. I get more negative tests than Debbie does. Part of that is patient selection.
Dr. Eric:
Circling back to the thyroid. When do you get uncomfortable with the TSH? Obviously, TSH alone, you can’t just rely on that. Like you said, there could be other variables like the TSIs. I would argue most doctors, including pediatricians and endocrinologists, don’t pay attention until the TSH is above the lab range, like 4.5 or 5.0, depending on the lab.
Dr. Roy:
Or even higher. If you look at some of the recommendations, some people say in pediatrics not to treat until the TSH is above 10. That seems crazy to me. I really focus on what I was taught in medical school to focus on patient symptoms. If the symptoms make sense.
A couple things with that, Eric. Kids tend to run higher TSH. It makes sense if you think about what the thyroid is doing. The thyroid is intimately involved with development and growth and energy in the body. Kids are using a lot more energy; they’re growing. Their thyroid is working harder. It would make sense if your thyroid would be higher to stimulate your thyroid gland to produce more thyroid hormone. So you have to be careful.
If you look at normal TSH, in the first few days of life, 15-20 can be normal. Really high amounts of TSH. Quickly, within the first few weeks, it does normalize close to adult levels. At least what the standard endocrinologist will say is 0.5-5.
What I do in my practice is when it’s adults, and we can talk about the type of adults I treat in a minute, I do try to stay between 0.5-2, maybe 1.5, depending on how someone is feeling. With children, you have to let it go a little bit higher because of their natural propensity to have higher TSH.
If someone has frank hypothyroid symptoms—constipation, cold intolerance, their hair is falling out, super dry skin, really extreme fatigue, anxiety—then I would treat at a lower number than if someone was what they would call subclinical. I don’t love that term. In any event, I will base it mostly on symptoms.
If they have thyroid antibodies, obviously, I might be quicker to treat than somebody who is not. Most of the patients I’m putting on thyroid either have frankly elevated TSH, above 5 or 6, even without thyroid antibodies. Or I have diagnosed them with thyroid antibodies, and I see their TSH creeping, so I’ll watch over a period of time and watch their symptoms.
If their TSH is 3, 3.5, I might just watch it if they are not having symptoms. If I see it creep up to 4, 4.5, 5, I will start treating sooner than later. I don’t necessarily want to wait for them to feel terrible before we start treating them, especially if they have antibodies and creeping TSH numbers. That’s how I do that.
The other interesting piece is though I myself take natural thyroid-
Dr. Eric:
I was about to ask you this.
Dr. Roy:
I knew you would ask this. We know that thyroid conditions are much more common in females than males. That’s true with children as well. It’s almost 10:1 in children as well. I definitely see that. The number of boys I have seen with thyroid conditions have been a handful, whereas I can’t count the number of girls I have seen in my practice, particularly peripubertal. I see a lot near hormonal changes. There is the rare kid who gets a thyroid condition at 2, 3, or 4. It’s often 11, 12, 13 for girls.
I found that during that time, it’s really challenging for me, at least from what I have been able to tell. It’s harder to control them with natural thyroid than just using synthetic T4 only. Though I did use that for years, I just found the ups and downs during puberty are really challenging to manage for girls with hypothyroidism. Once I switched to using synthetic only, it’s still hard, but it feels less difficult. I’ll do that. If they are doing amazing, I’ll leave them on that.
At some point, if we have additional symptoms, things we typically think of with low T3 like hair loss or insomnia, then I might add in the natural thyroid or switch them.
If someone is doing really well, I don’t like to make changes. I want to keep them happy and thriving.
Dr. Eric:
Makes sense. Adults like yourself, usually you will recommend the desiccated thyroid hormone. With children, you find on average they seem to do better with, say, levothyroxine.
Dr. Roy:
The adults I treat are really specific. I don’t have a general adult practice. I am a pediatrician. I do see a lot of young adults, so people who are college age, maybe into their mid-20s. That’s a pretty common thing, especially living in a college town, which is minutes from my practice.
Because a huge part of my practice is focused on mental health, and so many young adults have a lot of anxiety these days, that’s been a gateway into my practice for young adults. A lot of them have thyroid conditions, too.
Anxiety might be the #1 way I have diagnosed kids and adults with thyroid conditions. It’s really been insomnia, anxiety, panic attacks, new onset extreme symptom versions of that.
The #1 adult I see is moms in my practice. As they come in, I ask them how they’re doing. Of course, I care about how the moms are doing because they are people I care about, but also because they are taking care of the children, which is my #1 focus. I start asking them questions. I’ve had many moms tell me, “I can’t go out in public anymore. I’m having panic attacks.” Then I’ll do my workup. I’ll do those things I mentioned, like the nutrient deficiencies. I’ll start with a full thyroid antibody panel. I have probably diagnosed more moms in my practice with thyroid disorder than kids over the years. It’s probably double the number.
I’ll end up monitoring them and treating them if they want. Usually, they seem to want that. Oftentimes, it’s so bad that we need to treat the anxiety very intensely, maybe even use medications for anxiety to calm it down until we get the thyroid balanced. Then almost invariably, I find we can get them off an SSRI once their thyroid is calm within a few months. Their mental health improves dramatically.
Dr. Eric:
Would you say that most of the moms you work with with thyroid conditions have children with thyroid conditions or not necessarily? I am sure you see some with seeing their children with something else or a wellness visit, and you end up diagnosing the mom.
Dr. Roy:
1 in 5 women have Hashimoto’s or some thyroid condition. Maybe the number is higher than that. No, not 1 in 5 kids have it. I would say there is a higher propensity for, and we know there is a genetic component for autoimmunity in general. Hashimoto’s, we do see runs in families for sure. My mom has it. I have a very strong family history, as does Debbie’s family.
I’m more cautious. When I see someone who’s had thyroid cancer, Graves’ or Hashimoto’s, when their kids come in, I will do more regular screening, even if they’re totally well. The earlier you catch these things, the better it is, and the less likely they will have serious long-term problems. We will focus more on things like diet and lifestyle that decrease the risk of autoimmunity, maybe moreso than I would for the average healthy kid without a family history.
There is an increase, but a relatively small increase. We see thyroid conditions really develop around puberty for women, pregnancy, post-partum, menopause. Those are the big risk times. It can happen any time. That’s much later on. Kids typically come to me when they’re very young. Around that time, there is an increased risk. We will see more in families that have thyroid conditions.
Dr. Eric:
Graves’. I know you see a lot more children with Hashimoto’s, children and moms, because it’s much more common to have Hashimoto’s. When you do have someone that you end up diagnosing with Graves’, do you usually refer them out to an endocrinologist? Do you actually prescribe antithyroid medication for the few children that you have seen with Graves’?
Dr. Roy:
I usually refer to an endocrinologist for that. I will do the initial workup. I’m curious about your thoughts on this. I really do like to do thyroid ultrasounds for anyone who becomes positive with antibodies. Anyone who has a goiter, I’ll do an ultrasound on them.
I know it’s not the standard recommendation. I think that’s partially financial. Maybe it doesn’t make sense to screen everybody financially as a gigantic population from a public health perspective. But I think as an individual, it makes sense in my opinion.
You want to make sure there are no significant nodules to follow and things like that. I’ve had one patient only who had thyroid cancer at a very young age. That alone is worth it in my opinion. That could have easily been missed and would have been life-threatening for this little boy, who is doing amazing right now.
I find it’s so much harder to treat. That’s why I will often consult with you if I need to. It is so much easier to give thyroid replacement. If your thyroid is not working and work up the cause. When the thyroid Is overactive, I will try herbs. Sometimes, I’ve had some success.
Fortunately, if you wait long enough, most of the time, Graves’ will burn out. But I’ve had a few patients where it doesn’t, and they have needed a thyroidectomy or radioactive iodine unfortunately.
It’s a little out of my scope, I would say, to prescribe the thyroid depressing medications, just because they do have their own risks. It’s something I feel more comfortable when an endocrinologist follows. I will also follow them.
If someone has Hashimoto’s, they stop with an endocrinologist and continue with me, if it converts from Graves’ to Hashimoto’s, which is common.
Dr. Eric:
Yeah. Is that what you meant by what you said when most people “burn out?” They develop hypothyroidism?
Dr. Roy:
I have seen it in moms quite a bit as well. Particularly with post-partum thyroiditis-
Dr. Eric:
And Hashimoto’s.
Dr. Roy:
Fortunately, most of the time, eventually, if you can just wait it out and use some supplements or even thyroid-suppressing medication, you can wait it out and that swill switch over. There is a handful where it doesn’t. It’s not something I see a ton of. Because of that, I prefer to have an endocrinologist involved.
Dr. Eric:
Yeah, I get it. I do agree with you with the ultrasounds. Especially if someone has an existing thyroid condition, or you suspect they have one. They’re not that expensive when compared to other diagnostics. When I dealt with Graves’, the endocrinologist I saw recommended not to get an ultrasound, and I talked her into getting me one. I was paying out of pocket, so I think she was trying to save me money. It was $200 at the time.
Dr. Roy:
I think it’s still about $200. I do one every once in a while for myself. Debbie and I will do them. She just did one a year ago, and it was $200.
Dr. Eric:
It’s cost-effective to me, even if you have to pay out of pocket. I think the insurance companies would pay if there is justification. If someone has a thyroid condition, to me, that’s justification. Like you said, try to rule out if someone has thyroid nodules or if it looks good. if it looks good, maybe that will be the only ultrasound they need.
Anything else? I know we covered a lot. Is there anything I should have asked you that I didn’t ask you? Anything else you want to cover when it comes to thyroid health and pediatrics?
Dr. Roy:
I mentioned this before, but the take-home message, if I could tell anybody who is either a parent or a practitioner is that I think you have to look at thyroid very liberally to test it. Considering the list of symptoms, just spend a moment on the internet and google symptoms of Hashimoto’s or Graves’, and it can be almost anything. Everything from joint pain to the more obvious symptoms we know of. I just liberally look for it. If you look, you will find it more frequently than you think.
It could be patient selection for me. Selection bias on the type of people who find my practice. I would say anxiety is really the #1 way. The most common patient I find who has thyroid problems is a patient with relatively new onset anxiety or significantly worsening anxiety coupled with things like insomnia.
I have not studied the DSM-V. When I was in medical school and doing my psychiatry residency, I was interested in it because mental health is a huge area of interest for me. Ruling out thyroid disorder is mandatory for every mental health condition. It’s not done. A lot of psychiatrists don’t do blood tests on patients, but I think it needs to be ruled out.
If your child is struggling with any weird symptoms or chronic onset symptoms, thyroid testing is not super expensive, and it is one of those things where if you catch it early, you can prevent not just problems in the near future but problems really long term. Thyroid is that important.
I think that would be my take-home message. When in doubt, test it. The tests aren’t perfect, but they are decent. If you get positives, you want to address it, arguably relatively aggressively.
Dr. Eric:
Agreed. Thank you so much, Dr. Roy. Where can people find out more about you?
Dr. Roy:
You can go to our website, MindfulFamilyMedicine.com. Or you can go to MindfulPediatrics.com or evenDrRoy.com. That is the main place to find us. We don’t have a real presence on social media at this point. I don’t know if that will ever happen. We have a great newsletter and lots of free information on the website.
Dr. Eric:
Wonderful. This was a great conversation. Thank you so much for sharing. Continue doing the amazing work that you do.
Dr. Roy:
Thank you. Likewise.
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