Posted on December 28th, 2020by RMANY

Ep 44: Thyroid Function with Dr. Taraneh Nazem

Fertility Forward Episode 44:

Today’s guest on the show is Dr. Taraneh Nazem, who is a reproductive endocrinologist, an infertility specialist, and a board certified obstetrician and gynecologist, who cares for patients at RMA of New York’s Manhattan West Side office. Dr. Nazem came to RMA after completing her residency in Obstetrics and Gynecology at the New York University School of Medicine and receiving her medical degree from The Icahn School of Medicine at Mount Sinai. She completed her undergraduate education at Yale University where she graduated with honors. Throughout her career, Dr. Nazem has distinguished herself as a clinician and researcher. She has presented numerous prize-winning abstracts at national conferences and has multiple publications in peer-reviewed journals regarding genetics, access to care, and embryonic development. In this episode, listeners hear from Dr. Nazem as she shares the basics of thyroid function, from the role it plays in our bodies to the types of tests and treatment available, should thyroid function be abnormal. She also explains the role that hypo- or hyperthyroidism plays in infertility, the difference between the two, and how their symptoms are sometimes misdiagnosed as mental health issues, as well as her advice for getting regular check ups and looking after your mind and your body. Tune in today to find out more!

Transcript of Episode 44

Rena: Hi everyone! We are Rena and Dara and welcome to Fertility Forward. We are part of the wellness team at RMA of New York, a fertility clinic affiliated with Mount Sinai Hospital in New York City. Our Fertility Forward podcast brings together advice from medical professionals, mental health specialists, wellness experts, and patients because knowledge is power and you are your own best advocate.
Dara: Dr. Taraneh Nazem is a reproductive endocrinologist and infertility specialist and board certified obstetrician and gynecologist who cares for patients at RMA of New York's Manhattan Westside office. Dr. Nazem came to RMA after completing her residency in obstetrics and gynecology at the New York University School of Medicine where she was elected administrative chief resident and graduated with Robert F Porges Honor Resident award for outstanding performance. She received her medical degree from the Icahn School of Medicine at Mount Sinai and completed her undergraduate education at Yale University where she graduated with honors throughout her career. Dr. Nazem has distinguished herself as a clinician and researcher. She has presented numerous prize winning abstracts at national conferences and has multiple publications in peer reviewed journals regarding genetics, access to care, and embryonic development. We are so happy to have you on today. Wow. That's a mouthful. You've accomplished quite a lot in such a short period of time.
Dr. Nazem: Well, thank you so much though. Such a nice intro and I'm so, feel so lucky to be a part of this podcast today.
Dara: We wanted you on for quite some time. She reached out to us and we were like, perfect. This is great. And she's also speaking about a topic that I feel like I could speak for myself that I'm somewhat confused about and so many of my patients have some form of thyroid issue. So we're today we're talking about everything, thyroid, your thyroid function. So let's talk about the basics. Why do we need a thyroid?
Dr. Nazem: Yeah, no, I mean, really we do have to start really from the beginning. Actually the thyroid is this tiny little butterfly shaped gland that's in our necks, but it controls so much in our body and it is an extremely important part of our metabolism, our development, and steroid production. And actually plays a pretty integral role in the menstrual cycle and fertility which is why we specifically want to talk about it today and why we care and check it so often. And I, I agree. I think a lot of patients are very confused about why we're tracking it so closely and what, how to interpret the results that they get. But, you know, the, the thyroid is interesting in that it in order for us actually make thyroid hormone in our body, we need iodine, which is something that is diet related and I'm sure you'll have a lot to talk about on that Dara. And it circulates in our bodies in a lot of different forms. There's bound thyroid, an unbound free thyroid, and it signals, the signals to create thyroid come from the brain down to the thyroid and then the thyroid signals back to the brain how to react. And that's why I think it's really confusing when you get test results and we're, we're trying to explain them and they're all kind of up and down and different directions. So I'll explain a little bit more what that means. So for example, if you are told you have a low thyroid or you’re hypothyroid, that means that you're not producing from your thyroid, what we call T3 and T4, which are the actual thyroid hormone products that act in our body. The signal to make T3 and T4 comes up from the brain. There's a part of the brain called the hypothalamus and the pituitary that make, the pituitary makes thyroid stimulating hormone or TSH and that's what signals to the thyroid to release the T3 and the T4 and act in all the different parts of our body. When we have a low T3 or T4, that low level is signaled back to the pituitary and makes TSH go up and says, make more thyroid. So your thyroid stimulating hormone goes up when your thyroid levels are down. So when you're hypothyroid and you have a low T4, you actually have a high TSH. So the tests that we do to diagnose people with thyroid abnormalities is TSH, but it's the inverse of what your syndrome is. And so I think that's where the big confusion comes from.
Rena: Yeah. And then, so does any, does every patient coming in for fertility treatment, do you automatically check their thyroid function or would this only be specific patients?
Dr. Nazem: So, it's generally it's recommended for anybody who has infertility to get their thyroid checked because the thyroid does play a significant role in infertility. But there are a lot of people who are not in the infertility world that should also get their thyroid checked and actually a lot of, a lot of our population meet the criteria anyway. So if you're over the age of 35, if you have any history of thyroid disease in your family, definitely over the age of 40, if you have any symptoms of thyroid disease, which I'm sure everybody at one point or another has felt something that's a symptom. So those are all reasons to be tested, but definitely infertility is another reason. And so I routinely check it on my patients, but I start with just a screening test which is the TSH before we dig deeper.
Dara: Because there are a lot of tests. And I think I heard that even like a, a GP often just checks like the basics, but sometimes certain things can get lost. And I think where it gets confusing, at least on my end is there's, you know, T3, T4, TSH, and then there's the free, the free ones, the free T3, free T4 which also can be signals for certain things. Is that correct?
Dr. Nazem: Correct. And you know, if you speak to a medical endocrinologist, you might get a few nuanced differences, but generally I think everybody starts with a TSH and then if the TSH is abnormal reflexively, meaning just automatically, we check the T3 and T4 levels. And what we're focusing on is the free levels because T3 and T4 can be bound in circulation to something called thyroid binding globulin or they can be free. And the free level is what is actually active in our body. And that's what we care about when we're talking about your thyroid levels. So we're focusing on the free levels and primarily the free T4 levels which is the most active level. There are some medical endocrinologist who also focus on the T3 and then prescribe medications based off of that. But that's a very nuanced and a specific approach for patients who are resistant to the traditional treatments
Rena: You come in and you have you do the test and it, and you find that the patient has a thyroid issue, what might be a common course of treatment?
Dr. Nazem: So we want to figure out what the cause is first for the thyroid issue. So in addition to doing these basic diagnostic tests we talked about which is T3, T4 and TSH, we also want to check their antibodies cause it's very common, especially in infertility patients, but also just generally in young women that they have an autoimmune process that is causing their thyroid levels to be low. We call that Hashimoto's Thyroiditis or it's an autoimmune thyroid problem. Regardless of the cause of it though, the, the initial treatment is usually thyroid replacement which is an oral medication. It's either Levithyroxine or Synthroid it’s the same exact thing. One's a brand and one's a generic version which is really just T4 replacement and your doctor's the one who is going to dose based on what your level of thyroid abnormality is and what your goals of treatment are. So are they for fertility treatment versus are they just for overall wellness and getting your thyroid in normal range?
Rena: Well, so then that medication is something you would stay on, you know, till for long-term?
Dr. Nazem: Yeah and it's very easy, which is the beauty of all this. It's such a fixable problem with just a one time a day oral medication. And patients, you take it early in the morning and before they eat or drink anything just because of the way that it's metabolized, it's, it's not as effective if your stomach is full before you eat it, you want great absorption. And that's it. And it's a teeny tiny little pill, like smaller than even an Advil. So generally it's an easy thing to take. It's, it's supposed to be a longterm treatment because if you're, if you have low thyroid levels now you probably will have them for the rest of your life that way. But for fertility purposes, if so, which we can dive into a little bit more, but if you're really just treating for fertility, it's not something you'll have to be on for your entire life.
Dara: So sometimes people can get an underactive thyroid during the treatment or, or when they're experiencing infertility That could be not a permanent issue per se?
Dr. Nazem: Yes, completely. Right. So, so some women don't know they have a thyroid problem until they come to get a fertility evaluation. And then we diagnose a real thyroid problem which means that they're gonna probably have to be on treatment for life. There are other women who we test and we find that their thyroid is within the technical normal range, but for fertility purposes, we recommend having a tighter control of your thyroid than is necessary for general wellness. So when we talk about values and cutoffs, TSH, a TSH value over four is an abnormal thyroid. But for fertility purposes, we want the TSH to be under 2.5 because it's been shown that pregnancy outcomes are improved when you have a much tighter control of the thyroid. So if you're somebody who came in for a fertility evaluation and you found out your thyroid was like, your TSH was level three or something like that, you may be on treatment for the duration of your fertility treatment, but you may not need it for forever for your lifetime. Whereas if you're somebody who had a clinical hypothyroidism over 4, then yes, you'll probably have to be on that for life.
Dara: And I'm assuming, you know, if someone doesn't have hypothyroidism, but their levels are not below the 2.5, the dosing would also be I'm sure somewhat smaller, or at least you said it may not be used as long?
Dr. Nazem: And that's sort of like a wise approach. I think that everybody kind of tries the lowest possible dose that would be effective from the beginning and then we generally recheck the thyroid levels every month to two months because that's how long it takes to really realize the difference. And if we need to sort of in a stepwise fashion increase in small increments, but, but you know, we don't want to go with a big dose from the beginning and it could be something very small that has a big effect.
Dara: But I want to let people know, at least on my end, I've been working at RMA for 10 years and, you know, seeing patients’ charts before I meet with them, it is so common. I see so many people on Synthroid. So it's, it's something we see quite a bit of.
Dr. Nazem: That's right. That's right. And actually the most common population of people who deal with hypothyroidism are women in their thirties. That's usually when it's first recognized and treated. And so it's not surprising. That is a good chunk of the population that we see in the fertility world. So there's such a thing called subclinical hypothyroidism too, which is sort of what we were talking where your TSH is abnormal, but all the T3 and T4 levels are completely normal and sometimes people in that situation will have positive antibodies as well. And those, that category of women are women that are probably prone to getting hypothyroidism in the future. So it's helpful to know early on so that you can track it over time and see when you convert to a full clinical state of hypothyroidism.
Dara: And this was the other thing that I, I wasn't familiar with until one of my friends had it. And then I did started doing research. So hyperthyroidism, which is overactive, correct.
Dr. Nazem: Right.
Dara: Often leads to hypo when it gets to the point where it's too hyperactive. Is that correct?
Dr. Nazem: That's correct. And also because some of the treatments for hyperthyroidism is removal of the thyroid. And so therefore you're officially completely hypothyroid and need Synthroid replacement or Levothyroxine for life. So that's one of the other causes if you will, of, of hypothyroidism.
Dara: Oh, wow. And of course the symptoms are often, you know, my friend was, was sweating profusely and, and, and hungry all the time. And so she went to her doctor and got it checked, whereas often, you know, unexplained weight gain, which I mean can happen to a lot of women in their thirties, can be one of the symptoms.
Nazem: Yeah. The symptoms I find are kind of tricky because the symptoms of hypothyroidism, masquerade as so many other things and they’re are things that we all experience on a regular basis. So, you know, like you said, gaining weight is a big part of it, feeling tired, having insomnia, constipation, you know, brittle nails, and losing your hair. These are all things that happen with hypothyroidism. But I, I would say that probably everybody, at some point, has experienced a handful of these things. And the question is, is whether it's a consistent thing or just a one-off, you know, that this month I was extremely stressed and so therefore I, you know, had some of these symptoms. So it sort of looks like a stress picture. It sort of looks like, you know, other syndromes and whatnot and so you have to really, um, carefully dissect it all to figure out whether or not it really is hypothyroidism.
Rena: What are the difference in symptoms between hyper and hypo?
Nazem: They're complete opposites. So with hypo, like I said, it's sort of a slowing down of the whole system, feeling tired, being intolerant to cold temperature, losing your hair, gaining weight, things like that, and menstrual irregularities. So, you know, having irregular cycles or not even ovulating at all, having no menstrual cycles which is a big part of the fertility piece that we deal with with women who have thyroid disorders. On the hyper side. So hyperthyroidism, it's usually palpitations, everything's running fast, your heart is beating fast, you're sweating, you're losing weight, you're maybe a little shaky, everything's amp’d up. And again, you can have menstrual irregularities from the hyperthyroid state as well. But it's much more common to have a low thyroid state than a hyperthyroid state.
Dara: And then in terms of like the, the hypo and then a Hashimoto's, which is auto-immune, do most hypothyroidism patients that you see have Hashimoto's? So is it more of an auto-immune issue that you typically see?
Nazem: It is quite common. And actually studies have shown that infertile patients have a higher tendency to have Hashimoto's than just some other cause of hypothyroidism. So we see it a lot, but it's a skewed population that I see. So I don't think it's fair for me to say whether or not that's, you know, the most common, but it is quite common, especially in young women. But, you know, the treatment's pretty much the same. There are some differences and implications for fertility. So if you have an autoimmune process, like Hashimoto's, that's causing your thyroid abnormality, there is an increased risk of having miscarriages or recurrent losses down the line, it can be like fourfold difference. But I, I think that a lot of that also stems from having your thyroid either under control or not. And so it's so important that you make sure to monitor your levels carefully with your doctor.
Rena: Well also too, for both thyroid conditions, you know, the mental health professional, we're always counseled as oh, we have a patient come in with those symptoms and also depression and anxiety, hypo or hyperthyroidism can often be misdiagnosed as depression or anxiety. So from the mental health side, we talk a lot about both conditions too so that we don't misdiagnose and that if we had, do have a patient come in, we say you should probably go, you know, to your medical doctor to get this checked out first, to rule out a thyroid condition instead of just saying, Oh, I think this is just sort of, you know, depression or anxiety because the mental health piece can be a significant part of this also.
Dr. Nazem: Absolutely. I think that's right on. And, you know, when we think about depression symptoms, these are all the same things. And when we get the other where I think that, you know, if you're struggling with a condition and you're having a lot of these side effects, it can make you more stressed and it can make you feel really down. I think a lot of, a lot of people struggle with body image and sort of all of the things that you're trying to do to fix that. And if you have a medical roadblock, I can only imagine how, how bad it is actually. I'll tell you my own personal story is, is that so I'm hypothyroid I'm Hashimoto's. And I only discovered this despite the fact that this is like my whole world. I only discovered this a few years ago when I was trying to get pregnant. And, um, I used to complain all the time about how I was always cold and my hair's falling out and I'm tired all the time. And everybody just said, well, you're a medical resident. Like you're tired all the time and you're gaining weight because you're in residency. And so I just sort of like pushed it off, pushed it off. And then finally, I, my gynecologist tested my thyroid and it was abnormal but it was in that subclinical range. And, but my antibodies were positive and ultimately I converted very quickly, like overnight into a real hypothyroid state. And I'll tell you one of the big moments, and this is, I'll tell you this specifically, because it involves you, Dara, is that I remember coming to you because before I was diagnosed, I was gaining so much weight and I was on this really strict diet. And I was exercising all the time and I was doing everything in my power. I was just like starving myself. And I said, Dara, I don't understand. I just keep gaining weight. And you had given me all these tricks and whatever. And then finally, when I found out that it was my thyroid, I was relieved. I sort of felt like, okay, I'm not going crazy here. Like, I don't need to, like, there was nothing I could have done except get on thyroid replacement. So that is my little anecdote, which is that I feel the pain for any woman who's struggling with the same thing.
Dara: And especially since you've gone through it. Yeah. I feel like you can for sure relate to, to your patients. But it's interesting. I do feel like the medical side of it, the mental health side of it and the nutritional side really is important. I feel like with hypothyroidism, the trifecta of the mental, physical and medical really can, can play a big role because even with what you were saying, you were coming in, you're exercising a lot, you're eating well or, or what you thought was eating well which actually was restricting, can actually create, I would think, more inflammation in your body if you're doing too much of things, you're being too restrictive. It's amazing how all the pieces of the puzzle are important.
Dr. Nazem: And it, and honestly it's a, it's a process. So just cause I got the diagnosis, I didn't shed all the weight. It took time and I had to eat healthily and I had to, you know, sort of slowly work at something that had been, I'd been sort of was working against me for so long. So, you know, it is a process and it doesn't change overnight. And I do think it's so important to have nutritional support, mental health support as you go through because just identifying the cause helps, but it doesn't solve the whole entire picture of the story.
Rena: So since you got diagnosed and you're on treatment, do you feel so much better or what is sort of the process been?
Dr. Nazem: Like, do I, I still, you know, I think just there's some things that were inherent to me that it didn't have to do with my thyroid. So I'm still cold all the time, but generally, yes, I feel so much better. Um, so many components that were off just started correcting, like my hair started growing back and my nails weren't as brittle and I slowly started to be able to go back to my normal weight and I just felt better altogether. And I, I felt relieved to be honest, that was a big thing. And I'm glad that I did it before I became pregnant and all that kind of stuff because that was important component of that, that process as well.
Dara: And now in terms of for yourself, this is also great to, for other patients to hear other people to hear. You know, I'm assuming that your thyroid levels can change throughout age and throughout, you know, wherever your life takes you. Is it important to get your, your levels checked annually?
Dr. Nazem: Absolutely. Actually sometimes more frequently. So when you first get diagnosed, like I was saying before, we have to titrate the dose to be exactly right - what's the optimal level for you? And sometimes it means tracking it every month to two months in the beginning. Then once you reach a steady state, once a year is usually sufficient because your dose really shouldn't change too much in the short term, you know, few years or so. You're right, as we get older and and more in postmenopausal women, their thyroid demands might change. And so as long as you're doing an annual checkup, it should be fine. In pregnancy, thyroid changes so much. So in pregnancy, we actually track it more closely, every trimester, because women who have a thyroid problem and then become pregnant tend to have a need for more replacement because they have lower free levels of circulating thyroid hormone in their body. And so that's something that your dose will go up in early pregnancy and then will sort of be maintained throughout the pregnancy and then has to be cut back again after pregnancy. So these are all things that would require more close monitoring. But if you've somebody, if you're you're somebody who has a normal thyroid and you become pregnant, you don't need any supplementation at all.
Rena: Hmm. I'm so glad you shared thank you so much. And I feel like it's inspiring me to go get my thyroid checked
Dara: Me too. I'm like, I definitely have a couple of those symptoms..
Dr. Nazem: I told you it's really hard to weed out what's real from thyroid versus what's just regular life, but I'm happy to share and happy to check your thyroid levels whenever you want.
Rena: I’m going to take you up on that. I think, and I'm sure people too are struggling now I can guess even harder. You know, I'm someone who got really sick in March, you know, it was likely COVID. And I, it was kind of like before the testing, and I've been dealing with a lot of remaining physical symptoms since then and trying to figure out like what's from that or what maybe it's, you know, coincidence and maybe I have something else all along, you know, plus, you know, what is just sort of the pandemic stress adding. And I'm sure, you know, a lot of people out there are trying to kind of unpack that too and figure out. It's harder now to differentiate, you know, what is sort of symptoms because of the fact we're under, you know, this constant stress versus what maybe we had before. And it's just coincidence that they're coming out now. So I think it's more important than ever to really take care of yourself. You know, if you've been, if you're someone like me who just puts off going to get tested because it's, you know, inconvenient, like do it, you know, there's really no time like the present because we all deserve to feel as good as possible. And especially now, if there is something that can be diagnosed and you can be, you know, treated for it to help us, you know, get better. So I really so appreciate you sharing that.
Dr. Nazem: Absolutely. I'm going to hold you accountable now, Rena. I'm going to ask you when you got your thyroid checked. But it's true. I think COVID has thrown us so many different curve balls because we really, we're still learning about it. And like you're saying, everybody has a different post COVID syndrome and different lingering effects. And a lot of these symptoms are very general and it's hard to know what's happening. I think a lot of people are scared to go to the doctor's office because they don't want the extra exposure, but if you're really not feeling well or something has been nagging at you, you, you should go in. And doctor's offices now have so many safety precautions to ensure that patients do feel comfortable coming in and making sure that they're their best self. So you're completely right. Stress is also confusing everyone's...
Rena: Right. We're all operating with such high cortisol levels, you know, adrenaline, you know, fight or flight on constant into that also causes, you know, the mind, body connection, physical symptoms as well.
Dr. Nazem: And a lot of our outlets have been taken away. You know, seeing friends and family, which is usually a very balancing thing for a lot of people. Gyms, yoga studios, Pilates, like all these things that we used to go out of our homes to do. We're stuck doing in our homes and the effects in the house is not the same as it is when you get out and see other people doing it with you.
Rena: Totally. It's hard, especially in New York city, we're all New York city, you know, in apartments, which is a really different kind of living than a big house. Yeah. So it's very difficult.
Dr. Nazem: My yoga studio, exercise studio, living room, dining room, it’s all the same room.
Dara: It's a one-stop shop for everything,
Rena: And I'm so neurotic that I can't like work and focus unless it's a very clean space. So now, because it's in here all the time, I vacuum probably twice a day or dust buss.
Dr. Nazem: Sounds like you need a Ruumba.
Dara: Oh it’s the best thing ever.
Rena: I need one. Someone get me that for the holidays.
Dr. Nazem: That will be, that will be the de-stressor for you.
Rena: Yes. Well, I call vacuuming my therapy.
Dr. Nazem: Yeah. Well, so whatever it is, do what makes you happy. I know. And I mean like same thing with diets and, you know, exercise all that. It's just very hard to maintain normalcy and balance when you don't have all of the other usual suppports you have. S
Dara: You know, one step at a time, one day at a time making, I think making goals, small goals can make it a little bit less overwhelming and not being so hard on yourself. I think that's the, probably one of the most challenging things as women, we typically want to do everything perfectly and everything at once and maybe taking a step back and, you know, kind of prioritizing your needs and, and building upon them.
Rena: Yeah. One thing I ask my patients, I don't know about you guys, but I always ask them in an initial intake, like, tell me about your routine. What is your life during, you know, how has it changed now? And, you know, I'm a very routine person. And so I've, I've been able to keep up. I get up very early and I always, you know, try and get dressed for the day and whatever, whatever, because that mentally helps me. But so many people tell me, you know, they get up, they get up at 10 o'clock, 11 o'clock. They don't leave their house all day. And I really work with them to try and get them into a routine, really need to establish this because it's very important, you know, we should all stay on this, you know, circadian sleep rhythm. Make sure you get out, get fresh air, have a routine. One of my patients who, I don't know if she's listening, but she's awesome. She's been not working for the duration of the pandemic. Her company kind of put everyone on hold and she's really gotten into the flow. She's made this amazing routine for herself. So, you know, she gets up, she has a whole routine every day that she's implemented. And I mean, it's awesome, she's hanging in, she's doing great and I really think it's because she's made this whole, you know, routine for herself and filled her time.
Dr. Nazem: We've lost the usual structure to our lives in our days and sort of days and weekends and weekdays, evening all just sort of converged into this one, amorphous bubble. So it absolutely is a great idea to make, like you said, small goals and achieve them every day, go out for a walk around the block every day. If you need to, you know, sit in a different room from where you're working to have a meal, you know, things like that that are small wins, they add up over time.
Dara: That's so true, especially for people who are working from home, at least what I've been hearing from people that, you know, they're taking less breaks. Whereas, you know, you work in an office and there's meetings and, you know, you walk outside to pick up lunch that people aren't really doing that as much now. So finding that time, and I actually just spoke to Rena before we recorded in terms of even the weather changes can be really hard for us mentally. And I just looked it up for Rena so I could share it with everyone. I bought a Phillips sad light, so sad, seasonal affective disorder. The Phillips light is ridiculous. It's not super cheap, but maybe for the holidays, you buy it for yourself. I think it’s like $80. I put it on every morning and it's a blue light. So it's not meant to be turned on in the afternoon or evening, cause it can actually impair your sleep habits. But if you use it in the morning, which I've used it for maybe two, three years now, it really for half an hour at a time when I'm waking up in the morning, preparing breakfast, starting my day, I turn it on after I meditate. It is a game changer.
Dr. Nazem: Wow. I'll look into it. Yes. It's worth it. A little splurge. You're there for all the things that you've cut out of your routine. I think it's worth it.
Dara: For sure. Wow. So much information you really made it that much more easy to understand for the lay person and even for myself that it has a little bit of knowledge. I feel like I've gained so much from, from this discussion.
Dr. Nazem: You sell yourself short, you have a lot of knowledge, but I'm glad it was helpful. And, you know, I, I, I do think that a lot of this is just about, you know, being open to coming in for an evaluation and taking it as it comes. And like you said, like small little goals, even with thyroid replacement, we're going to go step by step. And not overtreat or undertreat it. I think a lot of people are scared to take medication. They think that's gonna have negative side effects with them for life, or, you know, it's going to hurt their bodies, but this, this is something that you really do need. And it acts on every single organ in our body. So we, you know, we definitely encourage it. So hopefully this makes things a little easier. I’ll check both of your thyroid's now.
Rena: One more question - for someone that's listening that maybe they're not quite ready to go to a reproductive endocrinologist but they are listening and they think, okay, I want to get my thyroid checked. Whereas if they go? Should they just start with their GP? Should they go to their OB?
Dr. Nazem: Well first, any doctor, but generally a, your primary care physician is absolutely the best person to go to, or your gynecologist who you see for routine annual checkups. And it's something as simple as sometimes even just having a quick tele-health visit with them, telling them what's going on and they'll send you to a lab to do the testing. So absolutely explore it. And it doesn't have to be with a reproductive doctor at all.
Dara: And we should ask for a full, full thyroid panel? Is that the proper terminology?
Dr. Nazem: Usually, yeah, I guess, but I, you know, it doesn't have to be a full panel to start with, I'd say, start with the TSH and the reflex T3, T4 and see where that takes you before doing a battery of tests that might not be necessary. Once you have an abnormality, then, then we do a little more diligence.
Rena: Say you get abnormalities and you had gone to a lab. What are your, your GP or OB they would put you on meds or they would then send you to an endocrinologist?
Dr. Nazem: No, they could, they could put you on medications. This is something that's very common for a GP or a gynecologist to manage completely. It's, it's not a complex or sub-specialty thing that needs to absolutely happen. A medical endocrinologist can be extremely valuable if there's other, you know, other issues that are going on or if it is a really severe case of the abnormality or if you have the antibodies or something like that. So it’s always good to have a medical endocrinologist, but this is something a GP could do.
Rena: Okay. Awesome. Yeah. So no excuses.
Dr. Nazem: No excuses. Yeah, for sure. I mean, I think it's a, it's really easy. It's a simple blood draw. It's not a complicated test.
Dara: We're getting it. Rena. Maybe we'll go together post COVID we'll go together and we'll get it tested.
Rena: I'm so mad because I was at my OB last week. I was not, embarrassingly or not, like two years late for an annual.
Dr. Nazem: That’s a whole separate conversation. I think that a lot of people held off at the beginning of the pandemic. They were like, I just don't need to go anywhere, anything right now. And then once we realized that this was going on for so long, that there wasn't going to be an end. You can't just put off all doctor's appointments.
Rena: I'm going to throw it back in their court because I am not one of those people. They just didn't notify me. So I'm going to throw that. That was not me being irresponsible.
Dara: You need to take health into your own hands.
Rena: Clearly I need to put a calendar reminder every year. When you're there, they schedule you for six months from then.
Dr. Nazem: So this will be our PSA to everyone who's listening, which is please go for your health maintenance checkups and don't rely on them to tell you when it should be. Put a reminder in your calendar.
Rena: It’s important and I actually appreciate it now more than ever because there's no long wait times because everything is scheduled. Like, it's, it's amazing.
Dr. Nazem: I know our patients at RMA are thrilled now with our scheduling that they have so much more of a sense of when they're coming and going. There's a, there's a bunch of silver linings to COVID. It definitely brought up things that we would not have addressed without a global pandemic. I'm sorry we had to go through it, but there are a lot of positives that have come out of it.
Rena: The glass is half-full.
Dr. Nazem: It is. I mean, for example, we are not all three of us in the same room right now, and it's just as effective. A zoom is wonderful and we can, we can do a lot of what we used to do in person remotely. It gives people more access, it's less stressful.
Rena: I think it’s great.
Dara: The convenience of your own home.
Dr. Nazem: That's right.
Dara: So how we like to end our recordings is to talk about what we're grateful for today. Lots of gratitude. I feel like we've already shared a lot of things that we're grateful for getting, you know, going to the doctor, but what are you specifically grateful for at this very moment.
Dr. Nazem: This very moment? Well, I'm grateful for this podcast that you both created. It was your brainchild and you're helping to get more people engaged in what's going on and them to get information they might not have otherwise found. And I'm so grateful that I was able to be a part of it. I hope this isn't the last one. I hope it was the first of many. I'm grateful for my health, all of our health and our ability to keep doing what we're passionate about. I love, I love doing my job at RMA and I'm so glad that we're still seeing patients and able to help them through what is a very difficult time and start building new hope and new things to look forward to for 2021.
Dara: How nice. That's a lot.
Dr. Nazem: I mean after 2020, I have to, I really have to have some good things to look forward to.
Rena: A-woman to that.
Dara: A-woman to that.
Dara: What about you?
Dara: Lots to be grateful for. I was actually gonna initially talk about family, cause I haven't seen my parents in almost a year and I finally got to see them for the first time yesterday. And just that feeling of being able to give a hug to them meant a lot to me. You know, whether it's friends or family, just being able to get reconnected to people. And I dunno, it made me feel really good, but along the same, along the same vein, I'm grateful for learning. I'm grateful for this platform because I know I can speak for myself and I'm sure I could speak for Rena as well. We have learned so much more in the past year than ever before in, in the world of, of fertility. And of course often we sit in that bubble of nutrition and mental health and we don't always get the knowledge and background and input from other people and to be able to have this platform, to, to share to our, to, to these people, to patients and to listeners, but also to educate ourselves. I mean, I am so passionate about this topic and so nice to, to learn something new every day. What about you Rena?
Rena: I love that. I think it's a funny, you mentioned learning, I'll piggyback off that because as I've been feeling like I need an outlet, you know, at this time I've been thinking of, okay, I want to take a class and what is that, you know, do I just want to take a class, do I want to try and get another degree because why not? You know, whatever, I've been thinking a lot about doing health coaching and adding that to my sort of resume because that's such a passion of mine. So I've really been thinking about starting that and getting my health coach certification because I also love learning and I think it's such a great outlet. So, and I, you know, as I've been looking at just reflecting on our podcasts, looking at 2020 and review and all the guests we've had and looking to who we have lined up for 2021 and it's really incredible. So I really am so grateful for this platform too, to get this information out there for people like Dr. Nazem taking the time to come on. You know, I know your schedule is so busy and just that you, you know, take time to share with us is really wonderful. So it's great. And to have this, you know, constant during the pandemic has been really wonderful.
Dr. Nazem: Well, it's been a real pleasure. You two are so fun to talk to, and I think that's why this works. So let's keep doing it and come up with the next topic soon.
Rena: We’ll all reveal our thyroid test results.
Dr. Nazem: That’ll be part two of this podcast.
Rena: Stay tuned. I know everyone's on the edge of
Dr. Nazem: Dive into our medical records and we'll see how that blue Sonic light does for you, Rena.
Rena: Yes, I'm going to order it ASAP.
Dara: I’m telling you, holiday love. Give yourself some holiday love, treat yourself. Thanks again.
Dr. Nazem: Thank you so much. And hopefully I'll see you soon, but if not, I'll see you on zoom. Stay safe everybody.
Dara: Thank you so much for listening today. And always remember, practice gratitude. Give a little love to someone else and yourself. And remember, you are not alone. Find us on Instagram @fertility_forward. And if you're looking for more support, visit us at and tune in next week for more Fertility Forward.

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