The Almighty Thyroid Gland

The Thyroid is a gland that is butterfly shaped and lies in front of the windpipe at the base of the neck. The thyroid releases hormones that are literally involved in almost every single process in the body because thyroid hormone works to help with cellular metabolism. “There isn’t one cell that escapes the effects of thyroid hormone.”

Hypothyroidism is a disease where the thyroid stops doing it’s job. Hypo=not enough. Hypo-thyroidism = not enough thyroid hormone. The list of symptoms of hypothyroidism may be endless…because it affects every body system. I will mention some of the common symptoms: fatigue, thick or dry skin, slow reflexes, trouble focusing, small weight gain, constipation, heavy periods, easily cold or chilled, depressed mood, or dry brittle hair and nails.

So you may be asking… “Why do I care about the thyroid or hypothyroidism?” Well, healthcare providers check thyroid levels very often. If a patient has dry skin, fatigue, depression, heart disease, or even constipation…….a thyroid level may be drawn. It is even offered by our lab at a reduced price during our health fair because it is ordered so often by health care providers at our clinic. It also affects many people. Even if you personally don’t have thyroid problems, there is a good chance that you know someone who does. For instance, about 10% of women will develop hypothyroidism at some point in their lifetime. About 5% or less of men will develop hypothyroidism in their lifetime. Things that increase a person’s risk of developing hypothyroidism include but are not limited to: age >60, history of thyroid or neck surgery, history of neck irradiation, downs syndrome, personal or family history of autoimmune disorders, or certain medications (i.e. amiodorone and lithium).

When checking on the thyroid, health care providers don’t actually draw a thyroid level but we draw a lab called Thyroid Stimulating Hormone (TSH). The pituitary gland in our brain releases TSH which travels down to our thyroid gland and instructs the gland to release thyroid hormone or Free T4 (FT4). When we don’t have enough FT4 the brain gets a message to “release more TSH up there, we don’t have enough FT4 down here” and the brain listens. So that is why a HIGH TSH means that we don’t have enough FT4 or possibly hypothyroidism. If the TSH is high then a FT4 level is usually looked at as well to help diagnose the problem. It is best to check the TSH at the same time each day because it does peak in the afternoon and that way we can spot trending levels.

If you find that you are diagnosed with hypothyroidism you will be placed on medicine, usually this is a synthetic form of FT4. Medication should be taken on an empty stomach first thing in the morning. After taking the medicine a person should not eat anything for 30 minutes. The medication should aslo be taken separate from other medications including over-the-counter meds, minerals, and vitamins (separate by at least 2 hours). Don’t take with milk or soy milk because these may block absorption of the medicine. Always tell your health care provider about any new medications.

Once started on the synthetic FT4, your labs are repeated at about 6 weeks. This is how long it takes to reach a steady state in the body. If your health care provider feels like you need more and they change the dose, they will wait another 6 weeks to recheck your TSH. Once they feel you are at the correct dose, they will continue to check it regularly to make sure you stay at the correct level.

So if you don’t have any thyroid problems and you are reading this and possibly getting a little bored, well hang in there. There is a reason that endocrinologists (doctors who specialize in thyroid disorders) are some of the smartest people I know. They have a very complicated job and you have to be very smart and educated to do it. (One of the endocrinologists that I used to work with actually was planning to be on Jeopardy because he was so brainy!!) The complex endocrine system requires a lot of studying in order to understand…..even for the family practice providers…..believe me I know!

If you do have thyroid problems and you are reading this and saying “My health care provider never told me all of these details!”  well the reason might be that it is not easy to explain all of this. Usually about half way into the conversation about TSH and FT4 the patient’s eyes glaze over and they look like they are about to fall asleep! I know, I know…..”Not easy to explain” is not a good reason to NOT explain all the details, but I promise this….if you ask questions your healthcare provider will answer them. This is a good way to let them know you are interested in all the details. If you ask, soon you will know all that you EVER wanted to know about the thyroid and more! If you aren’t a patient of mine, I highly encourage you to have a primary provider that will take the time to sit down and answer all of your questions.

No matter whether or not you have thyroid disease, there are certain nutrients that will help your thyroid function to its full potential. Vitamin A, vitamin C, vitamin E, vitamin B complexes, selenium, iodine, zinc, L-tyrosine, copper, calcium, and magnesium. Some of these vitamins can be ingested in your diet  (remember we are what we eat!) but some can be purchased as supplements as well. Always ask your health care provider before adding new supplements in your diet in order to safely promote your health and wellness.

This is a lot of info for a person to take in in one sitting. So if you need to come back and read my blog again at any time feel free! If anyone wants to know what causes hypothyroidism you will have to ask me and I will respond. That way I know that you are interested 😉

Have a great weekend!

Erin Tobin APRN

   This would be a great meal for your thyroid!

Salmon has: Vit B12, Niacin, Selenium, Vit D, Vit B6, and Magnesium.

Sweet Potato has: Calcium, Phosphorus, Potassium, and Zinc.

Asparagus has: Vit A, Zinc, Magnesium, Vit E, Vit C, Copper, and multiple B Vitamins.


Brief Absence

So my goal is to get one good post out every month. If you haven’t noticed my last post was in August! I almost have my next post finished, but until then I apologize and will leave you with a few pictures.









Home-made ravioli! Even though they aren’t perfect looking…they tasted good!





Many different varieties of noodles: Spinach, Sun-dried tomato, and Garlic to name a few!




Used a few eggs…..




Hope this might inspire someone out there! Have a great weekend!


Dementia is a word we hear quite often but I believe the definition is a little confusing. The dictionary defines dementia as “severe impairment or loss of intellectual capacity and personality integration, due to the loss or damage to neurons in the brain”. Well what is severe impairment? I have been known to look around the house for hours and blame my husband for losing my keys, only to find them in my purse where I left them. Does this make me demented? No I don’t think so, because this impairment doesn’t interfere significantly with my life (but does make it a little harder sometimes 🙂 ) and it isn’t due to loss or damage of neurons in the brain (that I know of).

Sometimes people experience “reversible” neurologic problems due to dietary deficiencies, endocrine problems, etc. and there are many forms of dementia. Today I am going to discuss two specific types of dementia called Alzheimer’s Disease and Vascular Dementia.

Alzheimer’s Disease

Alois Alzheimer, a German psychiatrist, first described this disease in 1907, therefore, the disease was named after him. Alzheimer’s disease is a degenerative disease of the brain, commonly affecting the elderly, and is associated with plaques and tangled proteins in the brain. It is characterized by confusion, disorientation, memory failure, speech disturbances and eventually dementia (severe impairment). The exact cause is unknown, but there are links to genetics, environment, and lifestyle.

If Alzheimer’s disease begins before age 65 it is more likely to be a genetic form. There are three genes that scientist have found mutations in and a genetic lipoprotein that increases the risk. If a person has a first-degree relative with Alzheimer’s they should let their health care provider know this. If it occurs after age 65, it is probably a mixture of genetic, environmental, and lifestyle factors. 

Interestingly, the brain shrinks because brain cells die. Because of the issues mentioned above (plaque and tangled proteins) the brain cells do not get the oxygen they desperately need. This is a scary thought.

Alzheimer’s can only be diagnosed for certain during an autopsy when they take a biopsy of the brain. However, health care providers are armed with non-invasive tools that will allow them to diagnose Alzheimer’s disease without a biopsy. Those tools include….

#1 A complete personal/family history and physical

#2 A neurologic exam and lab work (to rule out other causes)

 #3 Imaging studies such as a CT (computerized tomography), MRI (magnetic resonance imaging), and/or PET (positron emission tomography) may be used as well.

Vascular Dementia

This type of dementia is more of a general type and it involves problems with reasoning, planning, judgement, memory and other problems with brain function. This dementia is caused by impaired blood flow to the brain as well, but for other reasons. You can develop vascular dementia after a stroke, but, high blood pressure, high cholesterol, and smoking can change the blood flow to your brain in a way that increases your chances of developing vascular dementia as well.

Vascular dementia may occur quite suddenly (over weeks or months) if it occurs after a stroke (any sudden change in mental status always requires emergent medical management in order to rule out a stroke or emergent health condition). Vascular dementia can also come on very slowly in some cases. Sometimes vascular dementia and Alzheimer’s disease can occur at the same time making it difficult to diagnosis the exact cause.

Diagnostic testing is a lot like the testing done for Alzheimer’s disease. The only difference is that a health care provider may want to do carotid Doppler studies as well to determine the chance of stroke or re-stroke with vascular dementia.

 What can be done to prevent it?

Keep moving

Staying active and exercising can help maintain blood flow to the brain and encourage new brain cells. Heart attack, stroke, and diabetes are risk factors for dementia and Alzheimer’s and exercise can prevent these risk factors.

Stimulate the Brain

People who are educated and/or continue to educate themselves have slower progression and possibly less of a chance of developing certain type of dementia such as Alzheimer’s. Keep reading, doing puzzles, learning, and playing card games. Try to avoid too much T.V. time.


There is research that social involvement benefits the brain. Have friends and stay involved with activities and social events.

Eat With a Purpose

We have to eat to fuel our bodies and provide necessary nutrients. Dark skinned fruits and vegetables can benefit our brain health. Halibut, mackerel, salmon, and tuna have omega’s that protect the brain. Nuts such as almonds, pecans, and walnuts will give our brains what they need to build new cells and remove free-radicals. Vitamins such as vitamin E, vitamin C, vitamin B12, and folate have also shown benefit in some studies.

What can we do to prevent it?

So in a nutshell 🙂 ……we need to do the same things for our brains that we do for our heart, lungs, gastrointestinal tract ect. These bodies of ours are capable of being healthy, but we just have to give them the right tools. Personally, the times that I begin to forget things or lose things are usually the times that I haven’t eaten well or slept well, or when I have too much stress in my life.

The topic of “dementia” is very complicated. I suggest talking with your health care provider about what your risks are and how you can prevent this problem. If you have a family history of dementia, especially Alzheimer’s disease,  you can discuss the warning signs with your health care provider and come up with a plan if the symptoms begin happening. Early treatment can slow progression of the disease. Dementia and brain health is not a scary topic if you are talking about it NOW and planning how you are going to prevent it from happening or how your health care provider can treat it quickly if it does happen.

Keep taking care of those brain cells!

Erin Tobin  APRN, MSN

All four of us finished the race on Saturday and we all finished under our goal time! Besides feeling a little sore  afterwards, the race really was an uneventful-event!

I believe know that the majority of people could train and finish a half-marathon if they put their mind to it. I understand that this accomplishment is not on the top of everyone’s list, however, I believe that setting fitness goals is important no matter what that goal may be. I am trying to think of what my next goal will be?????

What are some of your fitness goals for the next 6 months?

My Half Marathon


A marathon is 26.2 miles……wow!!!!! A half-marathon seems to be a much more reachable goal, but it still clocks in at a whopping 13.1 miles of one-foot-after-the-other, rhythmically breathing mindless movement. Thank goodness for I-pods!!

The name Marathon actually came from a Greek soldier who was sent from the battlefield of “Marathon” (in the year 490 B.C.) to Athens where he was supposed to deliver the news that the battle had been won. Supposedly he did not stop to walk on this mission and when he arrived to Athens he bursts out yelling “We have won!”…… but then he collapsed and died.

Back in the year 490 B.C. people were probably much more active then they are now, so maybe he had some form of training, especially if he was a soldier. However, one would assume that he was probably exhausted when he started the race if he had just finished a battle. This would have made for a very strenuous 26.2 miles…..if it isn’t strenuous enough already.

So tomorrow I am running 13.1 miles with three of my crazy friends. I have done one half-marathon previously (before child), but it is still an event in my life to complete this and it took us a little over 3 months to get ready for it.

This is how I personally keep myself excited about exercise. I enjoy setting goals and conquering them…..challenging goals. I enjoy completing these goals with other people. When I am finished, I am sure my mind will wander to what goal I want to conquer next. It sounds crazy to a person who has not ran much in their lifetime, but I really am starting to enjoy running! I think I know I will complete more of these races in my lifetime because its fun to get ready for the race and complete the race with the people you have worked hard with (and the hundreds of others running the same day too).

So wish me luck everyone! I am pretty sure I will not collapse and die at the end of the race, but I may need to be carried to the car 😉




And stay tuned for photos!!

Happy Friday,


“Back” to Basics

First a quick anatomy refresher….

There are 7 cervical vertebrae. The 1st holds up your skull and then they proceed downward with vertebrae #7 (C7) ending at the base of your neck. These vertebrae allow the head to rotate and if aligned correctly with a healthy disc in between each one, allow cushion and shock absorption for the active human. In between each cervical vertebrae nerve roots come out from the spine and feed the upper chest, arms, and fingers.

There are 12 thoracic vertebrae that begin after C7. These vertebrae have ribs extending from them and these ribs then attach to the sternum in the front (most of them) to provide a protective chest cavity. The nerves extending out from the thoracic vertebrae feed the trunk starting from the armpits down to the beginning of the pubic region.

There are 5 lumbar vertebrae beginning after T12. About 90 to 95% of compressive radiculopathies occur at the L1-S5 level. This is because 75% of the body’s flexion and extension occurs at the lumbosacral joint (L5-S1), 25% of flexion and extension occur at L4-L5, and the remaining 5% occurs at L1-L3. The nerves branching out of the lumbar spine feed the legs, feet, and toes. This is why many patients with low back pain have numbness, tingling, or weakness down the legs.

The sacrum (S1 through S5) consists of fused joints and the coccyx (tail bone) is the end of the bony spine.

Ok, maybe that was boring for some of you. But once you realize how the spine works it makes sooo much more sense as to why and how we suffer from back pain. I recommend pulling up an anatomy picture at some point in time and looking at the bones, nerves, and muscles  that support the back.

Herniated discs

The discs lie between the spinal vertebrae. They act as pillows or cushions between the skeletal bones of the spine. I like to think of them as jelly filled donuts, because pressure on one side of the disc will cause a bulge in the opposite side of the disc causing pressure to be placed on the nerves. As we age these disc can become more rigid and fragile. Simultaneously the bones are becoming more fragile as we age causing compression fractures (the bones collapsing on themselves) and often bone spurs will begin to grow taking more space away from the precious nerves to branch from the spinal column, thus, more nerve injury and back pain.

Herniated disc is the name we give to a disc that is bulging or broke open. There are risk factors for developing this type of injury……. some that we can change, but some that we cannot.


Sciatica is defined as a type of pain affecting the sciatic nerve that runs down each leg. Sciatica usually affects one side of the body. This type of back pain presents as….

1. Pain in the rear that is worse with sitting.

2. Burning or tingling down the leg.

3. Weakness, numbness, or difficulty moving the leg or foot.

4. A shooting pain that makes it difficult to stand up.

Risk factors for herniated discs/sciatica in which we cannot change

1. Age

2. Being male

3. History of back injury

Risk factors we CAN change

1. Jobs or activities that we do – such as sitting for long periods of time, pulling/pushing/lifting, bending/twisting of the back, repetitive motion, vibration (driving) etc.

2. Exercise – not exercising regularly, exercising too strenuously for too long a time, or beginning exercise too suddenly.

3. Smoking – this keeps discs from absorbing all the nutrients from the blood (making them less resilient) and increases our sensitivity to pain.

4. Being overweight – the extra weight in the abdominal area or elsewhere may put extra strain on the low back.

5. Core strength and posture – if we strengthen our core muscles and improve our posture we can help support the spine and keep pressure off the discs.

This is yet another reason to keep your weight where it should be for your height and another reason we should exercise. I recommend yoga to my back patients who want to take pressure off the nerves in the back. Yoga can stretch the muscles helping with tightness and strengthen the core muscles significantly.

If you are vested in a job that requires any of the above activities day in and day out, there are some things that you can do. Take regular breaks from sitting to get up and walk and stretch. Always use proper back mechanics to lift and pull.

(Left) My son’s puppy taking a moment to stop and smell the flowers!

Take care of yourself! Many of us expect to work until we are 65 and live until we are 100 so you have to protect your #1 asset. Would you expect to never change the oil in your car and drive it for 20 or 30 years??? Just like you should not expect your spine to be healthy and pain-free if you never invest in your core muscles, if you become (or remain) overweight, and if you use tobacco etc.

My Achy Back 😦

I am guilty of neglecting my core muscles as well. I lived quite actively when I was younger which included multiple 4-wheeler and horse miss-haps. Then when I went to graduate school and had a child, I let some (ok All!) of my muscles waste. I am a little worried because I already have had some back pain (I am not trying to get any sympathy…just sharing). I had some x rays done and realized my spine is showing some of the damages as well. I will try to include those xrays in a future post to help demonstrate.

Since I have been running and doing a little yoga I have not had any more back pain. My goal is to increase my yoga to 5 days/week when I am done with my half-marathon in two weeks. I would like to re-xray at some point and show that strengthening my core has the ability to help my alignment. A little experimentation here, so bear with me!!!

If any one else has some back stories to share or questions please feel free to post them. I would love to hear from you!

Happy Wednesday,


The length of the colon is about 1.5 meters! Wow! This organ is very important and we need to keep it healthy. Recently, intestinal bacteria and probiotics have been gaining popularity within medical facilities. In the past they were considered to be a “naturalistic approach” only. Because of research our methods are changing! In fact, today health care providers are even prescribing probiotics! I think there is a general lack of knowledge on the topic and therefore feel it is important to think about, discuss, and contemplate.

Intestinal Bacteria

First of all I want to talk about intestinal bacteria and the role of the intestine. Bacteria in the intestine plays a very functional role in our life processes. When we are born, our digestive tracts are “sterile” or “without bacteria”. Within a few hours after birth the colon begins to become colonized with E. coli, Clostridium welchiii, and Streptococcus. Who would have thought that our little babies would actually have these bacteria in their colons in a good way!

Intestinal bacteria do not have any major digestive functions, but they do play a role in many other colon functions. These functions include the metabolism of bile salts, estrogens, androgens, and lipids. They also play a role in drug metabolism and protection against infection.


Probiotics are defined as “microorganism that have beneficial properties for the host”. Most of the products that we have on the market are derived from food sources like cultured milk. Some types of bacteria that are included in these supplements include lactic acid bacilli, a non-pathogenic strain of E. Coli, Clostridium butyricum, streptococcus salivarius, and some types of non-pathogenic yeasts as well. Probiotics have also shown to have benefit in patients with inflammatory bowel disease, Crohn’s disease, antibiotic-related diarrhea, Clostridium difficile toxin-induced colitis, irritable bowel syndrome, and allergies.

Although their work in the intestine is not completely understood by researchers, it is believed that probiotics work by decreasing the amount of pathogenic bacteria (bad bacteria) in the colon, increasing the immune function of the colon, improveing the intestinal barrier within the colon, and even acting as a pain modulator! Currently their role in prevention of traveler’s diarrhea, constipation, lactose intolerance, and H. Pylori infection are being investigated.

The main point I want to make today is that probiotics have been accepted as safe and beneficial by medical experts. I also want to emphasize that you should purchase a trusted brand from a reputable source and always let your health care provider know what you are taking at each health visit so they can anticipate potential drug interactions.

We know that the FDA (Food and Drug Administration) does not regulate supplements and we have to be careful who we buy them from. So if you really want to be sure, take these supplements to your friendly nurse practitioner or physician to review. If you do this, they can answer any questions that you have and add it to your medication list at the same time.

Have a lovely day,

Erin Tobin FNP, APRN

Information obtained from:

Balfour Sartor, R., Thomas Lamont, J., & Grover, S. (2011). Probiotics for gastrointestinal diseases, http://www.uptodate.com.