Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Goiter

Episode Date: January 26, 2018

This week on Sawbones, Dr. Sydnee and Justin rub two different kinds of poop on your throat because they don't know iodine exists. Join us for a history of the goiter. Music: "Medicines" by The Taxpayers

Saubones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, two, three, four. I'm the the the

the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the

the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the the

the the the the the the the the the the the the the the the the the the the the the for the mouth. Wow. Hello, everybody, and welcome to Saul Bones, a marital tour of Miss Guy to Medicine. I'm your

co-host Justin McAroy. And I'm Sydney McAroy. Well, Sid, we've had our finger on the pulse past couple weeks. That's true. Been replugged into the zeitgeist. And you said that this week you want to take it back, take it old

school. That's right. I wanted to step back. We've been doing some trendy topics, which I think are interesting because everybody's talking about them and everybody wants to know more about them. But there's a lot of stuff, there's so many things in medicine that are common and have a long history and a lot of stuff to talk about. And I get, I'm consistently amazed that we haven't done it yet on this show. But that's also a good thing

Because maybe our show can be infinite. Yeah. Oh, yeah, I love that Maybe that's what I'm learning and that and the topic we're gonna discuss this week is one of those I don't know how we haven't talked about it yet because it's also one of our most requested topics and That's thyroid disease. I know that doesn't sound as sexy and exciting as raw water and typods. I'm loving it. You sort of said, right before we started, it was funny. He said that you didn't include a section on what the thyroid is or how it works, because you sort of assumed that everybody just knew that, to which I kind of did, I took a bunch of water in my mouth so I could do a spit tape and shake my head violently to say no, Sydney.

I don't have any, I literally couldn't get a hemisphere of the body where the thyroid is. I do not know if it's in your brain or your butt. It's in your neck. Great. See how we've been wrong on both counts. Yeah, that's, see, that surprises me because it. Does it? Well we've been wrong on both counts. Yeah. That see that surprises me because it does it. Well, okay. Here's my rationale. This is very reasonable. It's a

common it's common to have problems with your thyroid. That's one of the more common disorders. And I get asked about it by patients a lot. I have like a lot of people who request that I test them for it. So I guess my impression is that it's out there in the popular medical knowledge. Right. Is my impression. I'm not saying that no one knows. I'm saying that like hoops doesn't.

And I'm here to speak for the trees. By which I mean, people like me. Well, a lot of people didn't know about it and requested it. And I'm going to speak for the trees by which I mean People like me. Well a lot of people didn't know about it and requested it and I'm gonna list them on now That's Kim Shannon Miranda Megan Brian Locke Karen Kate Emily Ryan Jill Sylvie Rebecca Jack Margaret and Caitlin Latisha and David Thank you all for recommending this topic. Like I said, I don't know how we haven't covered it yet So let me let me explain the thyroid gland, if you don't know, is a gland that consists, it's an endocrine gland, a consist of two lobes and an isthmus that connects them, a little piece of tissue that connects the two lobes, and it's right in the front of your throat,

of your neck, right there in the front. And the primary function, it does some other things, but the primary function of the thyroid gland is the secretion of thyroid hormones. Thyroid hormones are largely responsible for aspects of your metabolism. So this may be why I get the requests to test for it a lot, is because if you don't have enough thyroid hormone, one of the major symptoms, two of them, I guess, that I get asked about a lot, are weight gain and fatigue. And those are big concerns that I spend a lot of time with my patients discussing.

So maybe that's why I get that request a lot, is people thinking like, gosh, is there something else wrong? And they're looking it up, and they're finding thyroid disease as a common cause. So your thyroid glands accreate these hormones. It is stimulated by your brain to do so. And I think it's important just to take a second to explain that a lot of the, especially when the endocrine system, but a lot of glands in your body work on sort of a feedback loop. Okay. So your brain releases signals to your thyroid gland to say, hey, make thyroid hormone, the body needs it.

And your thyroid gland responds by making thyroid hormone. And then that thyroid hormone goes back to the brain to say, hey, don't where I'm here. The gland is working. Your job is done. Now, what can happen if the thyroid gland isn't doing what it's supposed to do? Is your brain just keeps sending more and more signals, which is part of how we test for and diagnose thyroid disease, is looking for increased numbers of these signals and decreased amount of this hormone and so on and so forth. I think that that kind of idea that a lot of systems in your body work on feedback loops is important to understanding this. Okay. Okay. So while there are different disorders of the thyroid gland, largely grouped as either not enough thyroid hormone

or too much thyroid hormone, the one that has the most history, I would say, is the goiter, which is an enlargement, a diffuse enlargement of the thyroid gland. Something is something about iodine. Yes, and it has something- Something about iodine. Yes, and it has something to do with iodine.

So we'll get into that. And the goiter, I think that there's the most history associated with it, simply because you can see it, right? It's a big swelling in your neck. And you can look at pictures of goiters and see some really impressive swellings. Sounds like a cool afternoon.

Well, I'm just- What are you doing? Hey, Dan, what are you doing? Looking for impressive swellings in my Google image search of Coiters, because Sydney said it was worth doing. I'm just saying there's some really impressive goiter throughout history So if you look to like ancient paintings and drawings and depictions, you'll see lots of people who have goiters. It's one of the most depicted probably medical conditions throughout history, again, because

it's really easy to see. And throughout history, it's been like a slightly swollen, rounded neck, has either been kind of sexy and associated with attractiveness or uh-oh something's wrong right but still sexy Maybe I mean something fine if that's your thing if you like sexy boy or if you like round next thing I got to see if sexy goiters.com is taken real quick Well, why you're doing that? Yeah I'm gonna say that again This is probably because it was really easy to see and fairly

common as well throughout history. The goiter is actually a pretty common medical condition because of iodine deficiency, which we will get into. You can find references to goiters in Chinese texts that date back to 2700 BCE. There are images of Cleopatra that appear to have a goiter. That's been disputed. Did she have a goiter or not? But there's some depictions of Cleopatra that would indicate have a goiter. That's been disputed. Did she have a goiter or not? But there's some depictions of Cleopatra

that would indicate she may have had a goiter. You can see paintings from the seventh century that show angels and saints and even depictions of Mary and Jesus as having goiters. Not that I'm saying they did. It was just a very common thing to pay people with goiters. Yeah.

Jesus may have. I don't know. Maybe I had a goiter. There are mentions of different swellings of the neck. If you read ancient Chinese medical texts, specifically from 85 AD, we get these descriptions from a physician, Shuichin Thee, who's talking about that some swellings of the neck are no big deal, and some swellings of the neck are very bad and can kill you.

And he's probably distinguishing between goiters versus benign thyroid nodules. Sometimes you can just have nodular, like a little bumpy areas of tissue that mean nothing. And then obviously, you can get cancer of the thyroid as well. And so he was probably distinguishing between these different conditions, although it would be hard to do that at the time. If you go back to 1400 BCE, Ayurvedic medicine from India, to find not only the goiter, but also broke it down into sometimes this thing in your neck tends to be over functioning, sometimes it's under functioning, which was really neat, because

we shouldn't have really been able to understand what any of that meant back then. But they were able to tie different symptoms and maladies to that thing in your neck, not working correctly, which was way ahead of their time. And if you look at the descriptions of under functioning and over functioning thyroid, they're pretty similar to what we would call hyper and hypothyroidism today. Speaking of those words, could they not have found

two prefixes that sounded a little more different? You really have to hit that R to make it clear which thyroid isn't you're talking about. And seeing as they're the exactts of each other, it seems very problematic to me. I will tell you that I recognize that because whenever I'm discussing it in my day job, I very clearly say high bow and high burr. And people think there's a problem.

The treatments though are fairly different from what we would do today. Even though we see these ancient depictions of, these are pretty good descriptions of what this disease is, the treatments are not the same. So for hypothyroidism, so I just did it. You could try to prevent it by eating a lot of rice and barley and sugar cane juice and cucumber and milk. I'll vary a lot of sugar, a lot of oats. Not necessarily something that would prevent hypothyroidism.

Yeah. More than likely. The treatments largely consisted of some herbal medicines that were thought to like give you energy them and vigor and boost your, because fatigue and weight gain can be associated with low functioning thyroid. And then there were some that made you pee, just give people diuretics, because you can also get some swelling,

especially in the legs associated with. Was that a low thyroid? Not probably not for the kind of swelling that you get from. I mean, maybe it might help a little, but it's not gonna solve the problem. You need thyroid hormone. So it's a different kind of swelling. It's called pre-tibial, meaning right in front of your tibia, so in front of your shin bones, you get swelling there or mix a dima. We'll call it a lot. And it's a very particular swelling that is associated with low thyroid function.

Yeah. So it may help the little, but that'd be it. When it came to goiter, they thought that it was probably a result of the same swelling that they were seeing in the legs. So they just thought, well, the next swollen too. So there was no thought that it was a different disorder. There was a different way to treat it.

It would probably have been treated the same way. Diarrhetics. Hippocrates thought that the thyroid was basically a big salivary gland. That's true. No. He thought, is that a panda? I would look smart. Did you really think that was where I was going with this? And it turns out he was right.

No, I mean, it's really rarely that, but what a cult shot that would have been, you know, he thought that it just made juices that lubricate your respiratory passages. And that was pretty much it. And that's wrong for right. That is not what it does. Well, I think I've already said what kind of what it does. Yeah, that's not. Yeah.

Uh, Galen disagreed arguing that it probably absorbed secretions as opposed to making them and he was right No, but and both of them both be wrong and opposite One of them's right. Well, they were both basing it on the fact that the thyroid seems spongy Okay, they agreed that it was spongy. They both agreed sponginess was a factor But was that for secretion? Like, you know, like if you squeeze a sponge, I guess, and so water comes out of it, or for absorption, they didn't know, but it's spongy either way.

Galen also thought that the goiter was a herniation of the larynx. So your voice box, he thought that the goiter was just kind of like it poking out there in your neck. And the term goiter actually probably originated from the word gooter, which means larynx or broncus and latin or gutter, probably gutter. And anyway, that's not correct. It has nothing to do with that. But that is where that word comes from. Plenty, of course, had his own ideas. Plenty of the elder.

He's got to get in the mix. He had a theory, and this was actually widely believed at the time that goiters were caused by drinking snow water. What? Specifically like alpine snow water. Oh, I see what you did. See what you did that you've been skiing? I can tell. How did you know? Amazing. Plenty, I can tell, how did you know? Amazing, plain, you're amazing. How did you know? Well, the goiter from the snow water you drink.

Did you drink, did you get thirsty? And yes, I drank snow water, you're amazing. This probably had to do with certain parts of the world, where, especially like in Bavaria, where the soil is not particularly rich in iodine. And so you see like a prominent, like there's a lot of goiters. And so they're connecting, but really snow covered mountains and people

are seeing it. Correlation, non-causation. Skin and yeah, and that kind of thing, like there's this weird connection between all this. And I mean, the two things did exist, but they had nothing to do with each other. Right. People probably did drink snow water.

Sure, it's delicious. Cold,. People probably did drink snow water. Sure. It's delicious. Cold. Who wouldn't want some snow water? This association was so, this was so strongly made that actually if you look at some traditional like bavarian clothing from especially like the Salisburg area from the 19th century, it includes a choker that especially women would wear, you know, the necklace, the choker. I don't know if you're, you looked confused.

No, I understand that. It includes a choker that was called the Croft Band or Struma Band, which was specifically to either hide a goiter or to hide whatever was left after you had surgery. So like, okay, I'm having trouble understanding something. A goiter, you can remove a goiter or like, do you always have a goiter or do you only have a goiter when you have a goiter? You know, not, okay, a goiter is an,

like the thyroid gland is too big. It's an overgrowth. Okay, but you can't just take that out, right? Because you need the gland. Well, you do need the gland, but now we can replace the hormone that you need. So if we have to, if we have to take your thyroid out, we can back in these days, they couldn't have. Well, they could have removed part of it and left part of the gland. They were discussing anyway, right? You know what the 35 was just in the not-roll-dice?

A partial thyroid act to me, only removing part of the thyroid is not, I mean, that happens even today. So that would not have been impossible. Okay. So removing a goiter would have been totally possible once we knew how to do surgery and such. Okay, got it.

So recommended treatments from the Greek and Roman era encompassed a lot of different substances, especially things like lizard and dog poop. I have no idea why that association was made. There are some things we're going to get into that made a lot of sense that didn't. I think anytime we use poop in treatment, we were probably just kind of guessing. Yeah. There's very little like logical lines of good job between like, well, I don't know, maybe just poop.

It's just poopy, maybe it's poop well, I don't know, maybe just poop. It's just poopy. Maybe it's poopy. I don't know. Oh, yeah. There was one Roman physician, a realius Celsius, who advised just cut it out. See, I see. Or maybe burn it out. I think that's a problem. Don't burn it.

Oh, man, Celsius. I mean, I'm not saying that we're not going to get there, but at the time, we probably couldn't have done that well. Da Vinci drew the thyroid gland, if you look at his anatomical diagram, he was aware of its existence, he drew it, and his theory as to what it did, because he had no idea. But I just think it's an interesting theory. He thought that it just basically filled the space between the neck muscles. Just kind of, well, you need something there to fill that empty space, And it keeps the trachea from bumping up against the sternum.

So he thought it was a shim, basically. Yeah. Like one of the bodies, many shims. It's a spacer to keep things apart. To make everything look nice. That's such an artistic way of like, well, you need something there to hold all those other structures in place. So we'll just, there it is. There's the thyroid. The first mention, and this becomes a very common treatment throughout history. There's a mention from China, 1600 BCE, of using birth sponges as in like sea sponges, or seaweed as a treatment for goiter. This was a good idea. It didn't know why. Nobodyiter. This was a good idea.

They didn't know why. Nobody knew why it was a good idea. They just... But it was one of those times where they tried something, it probably did help and people kept trying it. I wonder how they got that, just like intuitive or... That's why I just started to get it at the wall again.

It's why, I mean, how do people figure these things out before they understand the medicine underneath, but they did. And these substances do contain iodine, which is why they helped. And we're going to talk about why iodine helps with goiter soon. I don't know. But first, let's head to the Billy department. Let me hang in.

Let's go. The medicines, the medicines that ask you let my God for the mouth. Nesity, you promised me a lot of talk about iodine and then just left me hanging. And I'm hoping you can hold up your end of the bargain now. I'm going to go ahead and deliver on that now, even though there's a lot more history to get through. I do wanna make clear, because I think that it helps to understand the discoveries to follow.

So iodine is essential in producing thyroid hormones. Without iodine, your body can't make them. And iodine is considered an essential element, and meaning that we don't make it. We need to go get it from food. And it's easy to get nowadays, and we'll talk about why it's not something you probably think about, like, did I eat enough iodine today?

We've made that pretty simple, but back before we understood its importance, it really depended on where you lived. Some areas have a soil that is naturally very rich in iodine, and so one, you don't eat the dirt, but you eat like food from the dirt, water, and that kind of stuff. So iodine would have been easy to just get from your environment, but if you lived in areas where there was iodine poor soil, you may not have gotten enough naturally through your diet. Things like seaweed naturally contain a lot of iodine. So that's why you start to see these themes emerge of people eating things that have

iodine in them that will then give your body what it needs, which means your thyroid can start making thyroid hormone, which means your brain can stop stimulating your thyroid gland, which means it won't get so big. Does that make sense? Yes. All right. That's how you look like. For some reason, I always imagine it

in like, it looks like a bottle of ink. That's the image I always get in my head when I think about iodine, just like a big bottle of ink. But I don't think that it's like dark purple and black. I kind of think of iodine that way, but. Yeah, well, when it was first, no, but when it was first discovered, there is, and we'll talk about when it was first discovered,

they did associate it with like a purple poof of smoke or something. Okay, I don't, maybe that's where that comes from. Yeah, I know, so I don't know. I just want to think of when I think of iodine. No. Okay. It is dark, but like it's orangeish.

You know what? I might have seen somebody do an experiment that showed the iodine insult using purple something and I just got some wires crossed in my head. I think, no, I don't know. I'm not a chemist. I do think there are forms of iodine that have a purplish. I think you're right. I think it depends on what form of iodine you're using.

Can you just say that again? I've never heard you say it or are recording. Just repeat that out loud. I wanted to make an isolated text message alert a bull. I'm certain I am certain our chemist friends who listen can clarify that point. But I think the color of iodine. Hey, listen, y'all. I love you. I love you so much.

I love all of you. I'm a very busy man. Do not tweet at me about the color of iodine. Please, I beg of you. Please set me free. Don't do this. Well, the preps we use in surgical, iodine for surgical procedures and things like that are not purple. But I'm not saying, I mean, it's like a lot of things. It depends on, like, is it in a salt form or is it a liquid? Is it salt? Like it can change color depending on what form it sends. Yeah.

Okay. Anyway, so in the sixth through eighth centuries, surgeries continue to be attempted. As I already said, like people have already kind of started to think like, maybe we should do surgery for this. Just cut the goiter out. And they're mainly either using hot wires to try to kind of cut through the tissue or if you can't do that, they didn't have knives like, well, that was your backup. They would try to like stitch hot wires through it slowly or just use a scalpel if you

could do that. That was the backup plan. It wasn't until the 10th century that abacacis removed a whole gland while a patient was really high on opium. Nice. So it was like anesthesia, you know, I mean it was for a purpose. medicinal opium. medicinal opium. In the 12th century though, goiter was largely treated with things like calcium and copper and sulfur and ammonium salts, or they had like a specific concoction of barren walnut leaves, roots, wine and pepper. But underneath all these other random things people were trying, you still see recommendations for things like

burnt and dried marine sponges. So again, returning to iodine being present in substances, even though people didn't know. While a lot of different physicians were trying to study the thyroid gland, especially in terms of goiters, because they were so prominent and so many people complained about them probably, because a lot of people had them. There was a lot of disagreement as to, you know, what was going on, what was the disease, what was the cause. They were thought to be related to the trachea sometimes, some people thought they were related to the heart, to the spleen.

They argued over whether it was there just for shape or was it there to make things or was it there to absorb things. Some people followed the Hippocratic tradition tradition some people believed Galen was right They thought it was maybe just a buffer between the heart and the brain Okay provided some sort of conduit between the two sure Whatever Surgery was still popular as a treatment when you didn't know what else to do as as well as just like squishing the gland down, like wrap it with cloth, soaked in vinegar or ammonia. Gertel, like a little net girdle.

Gertel, Gertel. Gertel, exactly. Seaweed, marine shell sponges, they still persist, and you would have thought by now they would have taken over, but no, people are still doing other weird things. And finally, we figure out iodine in the 1800s. That's when we really, we really make a breakthrough. In 1811, there was a Frenchman Bernard Courtois who accidentally figured out iodine. He wasn't trying to.

He was not a doctor. iodine. He wasn't trying to. He was not a doctor. He was actually trying to find a way to help manufacture gum powder. Oh, fun. Okay. So not at all looking to cure people really. He was working with Napoleon's army and he had run out of the Willow ashes that he needed to make sodium carbonate, which is in compound. A part of salt powder? Yeah. They talk about that in 1776, I think. Oh, okay, so there you go. And so he began burning seaweed and was using those ashes instead.

And he added a little too much sulfuric acid at some point, and in all of this, a purple puff of smoke, like I said, a rose, and it hardened into some violet crystals. So, something, some form of iodine is purple. There you go. He basically said, I don't know what that was, and went back to trying to make gum powder. Anyway. But eventually, this substance that he isolated

would be studied again, figured out that it's iodine named and voila, we know what iodine is. So you just left the purple dust in a pile there? That's something else's problem. I guess he must have written about it though. Like clearly he wrote it up. He apparently wrote it up, because we put him in this episode of Solva. He wrote about it and like clearly he wrote it up. He apparently wrote it up because we put him in this episode of

He wrote about it and then said whatever We very rarely include people in history for leaving dirt around Leaving weird purple dirt on their desk. This seems interesting, but I'm very much into gunpowder I just remember I found out about this and did nothing with it. I need to put this in my journal So all of those substances that we've talked about before turns out they contain iodine and that's part of why it helped. Eugen, Boundmen, a scientist in the 19th century started while we were studying different things like, okay, so we know there's different things in the thyroid. So maybe we can help people by figuring out what they're lacking

or giving them those substances and that kind of thing. He boiled a thousand sheep thyroids. And so, if you're a gassid, collected the stuff that precipitated out of it. And he noticed that there were high levels of iodine present in it. So, reaffirming that there's iodine in there. Perfect. And he began to treat patients with goiter with this sheep thyroid extract. That sounds like out of context, that would say sheep thyroid extract would sound very

much like one of our fake treatments that is on the solvents. Nope, it is real. That's, I mean, the original treatments for thyroid were like animal thyroid extract. So, so there you go. There it is. So we'd figured out. And this was the same period of time. We're really starting at this point in history to figure out a lot of stuff about thyroid glands. This is the same time where we connect it to something because I know a lot of people have also written specifically asking about this, something that used to be called cretinism. That is a term that we no longer use in medicine.

It's considered a derogatory term. And so you would not, I purely mention it for, you know, historical, academic purposes. The term cretinism is someone who is born with congenital hypothyroidism. This usually means that whoever was carrying the child had hypothyroidism and was not treated. And therefore, the fetus

suffered some effects from that. And so it was born with hypothyroidism. I mention it because we finally figured out that all this was connected and that we could treat people born with this condition with thyroid hormone What is the name of it now? What do we call it out congenital hypothyroidism? But the name a lot of people talk about where did that name come from? Creotinism and it there are several theories the one that I learned in med school actually is not certain It is one theory, but I was taught that it was absolute. I remember being told this and thinking this is correct.

And from what I've read, this is just one possibility. It comes from the word for Christian. And it was thought that these people could not sin because there were usually some cognitive delays associated with it. And so it was thought these people were incapable of sinning because they didn't understand the difference between right and wrong. So they were connected with Christian with Christ's like behavior. And that was what I was taught that word came from. It may actually have been connected to Christian in terms of these are human beings and an attempt to try to humanize people who have some sort of

disability Through the the naming of it. Mm-hmm. If that makes sense But still we're not sure about this enough. So we're just we just decided as a community Just like we're not gonna say that new well It's it's a derogatory term. You should not use it. It is not something that we use in medicine We are taught it for historical purposes in med school, but we say congenital hypothyroidism. That is the term.

In the following decades, graves and Vaughan Bazdow were two doctors who began to define the opposite hyperthyroidism, meaning you make too much thyroid hormone. And that's why Graves' disease is one version of that to this day. There are many reasons why your thyroid might become dysfunctional. I'm not gonna go into all of them, but Graves' disease is one version of that to this day. There are many reasons why your thyroid might become dysfunctional. I'm not going to go into all of them, but Graves' disease is one.

And all the symptoms that come with that. So whereas people with not enough thyroid hormone can have fatigue and weight gain and dry skin and their hair can fall out and constipation and the swelling, people with too much thyroid hormone will have kind of the opposite symptoms. So like everything is great? No. They have full lush hair and they can lose weight really easily and...

Well, they do lose weight really easily, but it's a bad thing. They can be... They can lose too much weight. And you have diarrhea and your heart races and your anxious and your sweaty. It's not a good thing. Your heart can beat so fast that you have arrhythmia's abnormal heart. No sweaty, it's not a good thing. Your heart can beat so fast that you have a rhythmia's, abnormal heart rhythm. So no, so it's not a good thing.

It's not my face. Either way, it's not a good thing. And in addition, in this period of time, somebody actually proposed for the first time, maybe we should start adding iodine into something that everyone eats, like how about salt? And everybody kind of like was,

nah, oh, it sounds hard. Yeah. This wouldn't happen for like another hundred years. It was, like I said, it was initially mentioned, the guy who mentioned it was David Marine. He was a pathologist from Johns Hopkins, and he had this interest in goiters. And he had he found this idea from a French chemist who existed long before him whose last name is Boosing Galt. I'm trying my best here with the French pronunciation.

I'm fine. Sound good in my ears. And he had noticed all the way back in the 1830s that if you found places with crude sea salt Which has which has iodine in it people don't have goiters, but Places where they didn't have that people did have goiters and so he had recommended this idea of like put iodine in the salt Nobody paid attention to it until David marine did many many years later And he said like you know what everybody eats salt So why don't we just put iodine in the salt and kind of stole this idea from 100 years ago, which was a good one then and it's a good one now.

And it seemed like a good solution. So after he did some experiments where he took a bunch of, um, actually school girls who lived in an area that was prone to goiter development and he gave them iodized salt and none of them ever got goaters. Everybody went, yeah, you did it. And so it started out in Michigan and they started adding iodine to salt. And that has continued. And it's a huge public health triumph. Most of our salt is iodized.

Did you know that? Yeah, we did. Well, didn't we do. We did a salt episode where we talked about it. Yes. So I didn't know that because I remember all of it photographically.

So by adding it to our salt, we are all insured. We love salt. We are all insured that we get plenty of iodine in our diets and then we don't develop poider. By the mid-1900s, as I had already alluded to, we knew that using thyroid extract from animals to treat hypothyroidism and goiter and that kind of thing was successful. So we began to synthetically produce thyroid hormone, commonly called levytheroxin.

Nowadays, sinthoroid is the brand name. A lot of people connect it with. That's a brand name, but levytheroxin. So commonly, we use that to just replace the thyroid hormone that you don't have enough of. It's that simple. I like elegant solutions. It's that easy.

You don't have enough. We give you some. And we use, like I said, we use iodine to prevent goiter as well as if you have too much thyroid hormone, hyperthyroidism or gravestis, something like that. We can actually use radioactive iodine to destroy thyroid tissue because your thyroid gland is going to soak it up. So we use that to destroy excess thyroid tissue as well. So it is both a, I don't know, that seems like a, it is a treatment, although it's doing

something destructive, it's a treatment as well. It took us a while to figure out the right dose and we initially gave a lot of patients too much iodine in this process. And so there are symptoms of iodine poisoning that we figured out from that, but since then we were much better at it. And so now we know the right dose of iodine to give people, and we know how much thyroid medication to give people. Right.

We figured it all out. All right. we did it. Pretty much. Do you ever wish that you, do you ever feel like you missed like a lot of these good medical puzzles? Do you wish that you lived in a time period where like there was still a lot of this unsolved ever?

I think there still is. Oh, okay, well good. That's right, cancer and stuff, right? Yeah, I mean, I think, I think, you know, we talk a lot about, right? Just salt, maybe. I don't know. Some salt. Try a salt. Rub a seashell on it. That worked. I would say two things. I would say one. There's still a lot more puzzles because we didn't, we didn't talk a lot about, for instance, thyroid cancer. And when you talk about cancer in general, there's something we're still, we still have a lot of work to do to figure out how best to treat. But the other thing I'd say is,

there's a different puzzle here. We may have figured out that in this country, we add salt, we add iodine to salt. And so we see much, much less goiter. I mean, it's possible, but we don't see, I've never seen a case of goiter in my career. But there are many places in the world where they don't have access to any kind of iodized food. And so they're not getting a iodine and we're still seeing goiter as an endemic problem. So there's still that puzzle, which is, well, we may have solved it in some places, but how do we make sure that everyone has access

to that medical knowledge and that treatment and that same care that we're getting? So there's a whole other puzzle that maybe interests me just as much, maybe a little more sometimes. So folks, that's going to do it for us for this week. Thank you so much for listening. And thanks to Max Fun Network for having us as a part of their extended podcasting family and following. Find all their great shows at MaximumFun.org.

Also, thanks to the taxpayers for letting us use their song Medicines as the intro and outro of our program. And most of all, thanks to you for listening. We sure appreciate it and we hope you'll join us again next time. But until then, my name is Justin McRoy. I'm Sydney McRoy. And as always, don't juggle in your head. Maximumfund.org Comedy and Culture, Artistone Listener Supported