Dr. Alan Farwell is an endocrinologist, Director of the Endocrine Clinics at Boston Medical Center, and Associate Professor of Medicine at Boston University School of Medicine, in Massachusetts.

In addition to his extensive academic and clinical activities, Dr. Farwell has been extremely active and served in multiple capacities in the ATA, including as Chair of the Education Committee and the Patient Education and Advocacy Committee, and as a member of the Program Committee and the Website Task Force Publications Committee. He has served two terms on the ATA Board of Directors, is the founding and current Chair of the ATA Alliance for Patient Education.

Dr. Farwell has been an Associate Editor and member of the Editorial Board of Thyroid, and since 2009 has been Editor-in-Chief of Clinical Thyroidology for the Public.

In this interview, we discuss the following topics:

• Thyroid surgery and RAI sometimes results in hypothyroidism
• Most common cause is Hashimoto's disease
• Explanation of overactive and underactive thyroid
• Weight gain, dry skin, constipation
• Very few symptoms unique to hypothyroidism
• Sleep apnea and being tired all of the time and weight gain.
• Brain fog and difficulty concentrating
• Blood tests diagnose hypothyroidism based on TSH levels, when elevated means it is not working too well.
• Explaining TSH in laymen's terms
• Normal TSH in the U.S. is .3 to 3.5
• Treating for feel rather than a number
• People with elevated TSH have many of the hypothyroid symptoms, but people with normal TSH levels may also have hypothyroid symptoms
• Sleep disturbances such as apnea and anemia can be disguised as hypothyroidism
• Historical explanation of hypothyroidism treatment
• About 10% of patients do not respond to Levothyroxin
• Explanation of desiccated thyroid, including pig and cow
• Dr. Jacqueline Jonklaas, PCORI Grant will look at a study, head to head, Levothyroxin versus desiccated
• Adding T3 to T4 treatment
• Discussing Dr. Bianco's research and deiodinases enzyme
• A discussion of celiac disease and gluten
• Explanation of auto-immune disorders, where the thyroid is attacked by the bodies own antibodies
• Physical symptoms of hypothyroidism are goiters, sluggishness, fatigue, dry skin, lateral eyebrows to disappear, the tongue can get thick, puffiness, swelling in legs, face, and around eyes. With proper treatment, these are reversible.

NOTES

Dr. Antonio Bianco

Dr. Jacqueline Jonklaas

American Thyroid Association