EP 652: Adrenal Assassins: Is Hidden Endocrine Disease Hamstringing Your Hormones?
Sep 27, 2023
Dr. Sandeep Mistry and Donna Lee
In this episode, Dr. Mistry and Donna Lee are joined by Dr. Rhett Long, an endocrine surgeon with UT Health Austin’s Surgical Oncology Clinic. Dr. Long is one of the only Austin-area surgeons to specialize in the treatment of cancers and other diseases of the endocrine system, which regulates our bodies through hormones. This vital set of structures plays a major role in our overall health and wellbeing. While most surgical conditions of the endocrine system are non-cancerous and discovered by accident, they can still cause problems by compressing the vocal cords, esophagus, or other nearby structures. Compressive symptoms of thyroid disease may include a visible bulge in the neck, difficulty swallowing, and/or shortness of breath when lying down. Patients with such symptoms, or who struggle with unexplained fatigue, depression, or weight fluctuations should first consult an endocrinologist who can determine the cause and the course of treatment. Should you or someone you love need endocrine surgery, call Dr. Long at (512) 495-5717 or visit the Dell Medical School at UT Austin online today!
Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot
Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.
We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode.
In this episode, Dr. Mistry and Donna Lee are joined by Dr. Rhett Long, an endocrine surgeon with UT Health Austin’s Surgical Oncology Clinic. Dr. Long is one of the only Austin-area surgeons to specialize in the treatment of cancers and other diseases of the endocrine system, which regulates our bodies through hormones. This vital set of structures plays a major role in our overall health and wellbeing. While most surgical conditions of the endocrine system are non-cancerous and discovered by accident, they can still cause problems by compressing the vocal cords, esophagus, or other nearby structures. Compressive symptoms of thyroid disease may include a visible bulge in the neck, difficulty swallowing, and/or shortness of breath when lying down. Patients with such symptoms, or who struggle with unexplained fatigue, depression, or weight fluctuations should first consult an endocrinologist who can determine the cause and the course of treatment. Should you or someone you love need endocrine surgery, call Dr. Long at (512) 495-5717 or visit the Dell Medical School at UT Austin online today!
Voted top Men's Health Podcast, Sex Therapy Podcast, and Prostate Cancer Podcast by FeedSpot
Dr. Mistry is a board-certified urologist and has been treating patients in the Austin and Greater Williamson County area since he started his private practice in 2007.
We enjoy hearing from you! Email us at armormenshealth@gmail.com and we’ll answer your question in an upcoming episode.
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Speaker 1:
<silence>
Speaker 2:
Welcome to the Armor Men's Health Show with Dr. Mystery and Donna Lee.
Speaker 1:
Hello
Speaker 3:
And welcome to the Armor Men's Health Show. This is Dr. Mystery , your host, board certified urologist all around . Great guy. Hey. Hey . With my co-host an all around great girl, Donnel Lee . I love
Speaker 4:
It when you call yourself all around great guy. 'cause it makes me laugh out loud. <laugh> , but
Speaker 3:
Not . Yeah , well, I can say whatever I want. That's
Speaker 4:
Right. It's your show. This
Speaker 3:
Is our show. So , uh, uh, you are a comedian. That's right. You're also our business development guru in our practice. That's right. This practice is called N a u Urology Specialist. We are growing and blowing, showing and showing. That's right. That's , we're more growers than show, I think. And so we are an excellent urology practice. We are growing bigger and bigger every day . We are here and ready to see you as a patient, whether primarily to take care of your urologic needs or as a second opinion. We love second opinion. Mm-hmm . Dr .
Speaker 4:
Sunny , second opinion mystery <laugh> right
Speaker 3:
Here. How , how do people get ahold of us?
Speaker 4:
That's right. If you want that second opinion, or to learn more about our holistic urology group, call us at (512) 238-0762 or visit our website, armor men's health.com. We are in Round Rock, north Austin, south Austin , and Dripping Springs, Texas.
Speaker 3:
For those of you that are regular listeners, you'll clearly and easily understand what my favorite part of our guest is.
Speaker 4:
His penis,
Speaker 3:
His name. Oh , Dr . Long. Hey ,
Speaker 4:
Dr . I don't know why I missed that. I'm sorry. You
Speaker 3:
Know, there was a guy in town who used to practice medicine, Dr . Dick Chop, and I used to say, don't go to Dr . Dick Chop or Dr. Les Wing . Go to Dr. Moore Longfellow.
Speaker 4:
Hey. Oh, I'm glad Whitney's here today to <laugh> to bring that out . <laugh> ,
Speaker 3:
You don't want it shorter. She wants longer .
Speaker 4:
Wow. In
Speaker 3:
Dr . Dr . Rhett Long is an endocrine surgeon , uh, in the surgical oncology clinic at Dell Medical School. And is somebody that I met just hanging around in the surgeon's lounge one day. I was wondering
Speaker 4:
How y'all met. Okay.
Speaker 3:
Yeah. We were hanging around the surgeon . And you know what I love more than anything, you're pick
Speaker 4:
Up only another
Speaker 3:
Surgeon. I
Speaker 4:
Know . I think you have a pickup line though that says, Hey, I have a radio show .
Speaker 3:
Hey , I have a radio show. Would
Speaker 4:
You like to join me, <laugh> ?
Speaker 3:
And you know , uh, what's funny is that I thought he went to Stanford, but he didn't. He went to Sanford University. Yeah , Sanford University. Okay. Yeah .
Speaker 4:
We like to consider ourselves the Stanford of Alabama. So
Speaker 3:
Sits different . Yeah . But , uh, you know , um, something about him though he did his general surgery residency mm-hmm. <affirmative> at this little unknown place. Oh , you know what it's called?
Speaker 4:
Tell me.
Speaker 3:
Baylor College of Medicine, and he fight his institution on the face that planet. Okay . He went at a time when it was really good too. Really?
Speaker 4:
Not the time you went <laugh> .
Speaker 3:
Well , you know , <laugh> , I probably lowered their standards out a little bit. Maybe a little bit. So, Dr. Long , uh, welcome. Thank you for joining us today. Well ,
Speaker 5:
Thank you. Hey, it's good to be here. And, and , and I hate to disappoint you, but I was actually only a surgical intern at Baylor College of Medicine. I actually did the vast majority of my residency here at the University of Texas, so,
Speaker 3:
Well, that's okay. You
Speaker 5:
Got so , I , I at least have some Baylor ties, if that works for you. It , it ,
Speaker 3:
It , it does in fact work <laugh>. And so you're not the first surgical oncologist. We've had, we get Dr. Declan Fleming that has been on our show before. He's an a amazing mentor and an amazing surgeon. And , uh, he's a partner of yours. And , uh, so it really says something quite great about the burgeoning program that Dell Medical School is putting together. Why don't you tell us what is a surgical oncologist and how is that different from a regular surgeon?
Speaker 5:
Yeah. So , uh, Dr. Fleming, one of my partners , uh, he, he's also a general surgeon by training. So in order to become a surgical oncologist, you have to go through five years of , uh, general surgery residency, and then you'll pursue an additional, usually two to three year fellowship focusing on, you know, surgical oncology conditions. Now I am an endocrine surgeon, so I actually did a fellowship and endocrine surgery up at the University of Michigan. So
Speaker 3:
Endocrine , uh, it means glands Right. And hormones. And so tell us, what are all the, the components or what are the major components of the endocrine system that you specialize in? Sure.
Speaker 5:
So, you know , my practice primarily focuses on , uh, patients who have conditions of the thyroid, parathyroid and adrenal glands. So , uh, there are endocrine surgeons and major academic programs all across the country. And it's been exciting because , uh, you know, I'm the first one , uh, here in Austin who's really focusing exclusively on endocrine surgery within an academic environment. And so it's a new program, a relatively new at Dell Medical School. And, you know, I'm happy to be the one blazing the trail.
Speaker 3:
Nice. Now, when it comes to endocrine surgery, it , it's not all cancer, right? I mean, the vast majority of what you're taking care of is gonna be benign disease.
Speaker 5:
That's absolutely correct. You know, nationally , um, most major academic programs that have endocrine surgery , uh, a lot of us fall within the Department of Surgical Oncology because we do see conditions that are cancerous. So, for example, thyroid cancer, even the more rare types of adrenal cancer or metastases or that sort of thing. But you're right, the vast majority of the stuff that I see is actually benign disease. And so, you know, when it comes to patient referrals and, and , and if you get into a clinic that, that looks like surgical oncology, it can be a little bit , uh, daunting. It can be a little daunting. Of course, I'm not here for cancer,
Speaker 3:
This place some
Speaker 5:
Scary, but , but that's a , that's a good point. Yeah . The vast majority of my patients that I see do not have cancer.
Speaker 3:
So when it comes to thyroid disease, what are some of the more common conditions or presentations of thyroid disease that lead a patient to come see you?
Speaker 5:
So I would say that, you know, the vast majority of patients , uh, who have surgical conditions of the thyroid are typically found incidentally. So folks who have an imaging scan done for another purpose, an example would be, you know, a carotid ultrasound to, to look for vascular disease. They might have a CT scan or a PET scan that identifies a nodule incidentally. Um, and then I'll see 'em in , or if they're
Speaker 3:
Really lucky, they have a doctor that actually touches them. They do a physical exam
Speaker 5:
Quite , you know, that's, that's rare these days. Uh , usually if anyone, if any patients need to be touched, they're referred to a surgeon. Right. <laugh>. Um , but, but yes. You know , if if it's something that's that's picked up on exam, then, then certainly , uh, you know, an astute clinician would, would , uh, order an ultrasound or get some imaging, and then they'd ultimately end up in my clinic. What's
Speaker 3:
The purpose of the thyroid gland? Why do we even have one? Hmm .
Speaker 5:
Yeah. So the, the thyroid is actually the first embryologic gland to develop. So it's by about four weeks of , of age in , in utero , uh, the thyroid starts forming. Wow. And, and so it , it's extremely important , uh, early on for development of your nervous system. Basically every major organ system is, is impacted by thyroid hormone. And so, you know, as we age, it's, it's an important regulator of our metabolism just overall the way we feel. Um, so if your thyroid is off, either over-functioning or under-functioning, can have drastic impacts on just your overall wellbeing.
Speaker 3:
Wow . And so , uh, as we get older, there are people that have hyper functioning and hypofunctioning thyroids, and they will see an endocrinologist. But when they have a mass or a concern for cancer, they'll see an endocrine surgeon. And as luck has it, this organ is in a pretty important place. Right? Oh , is
Speaker 5:
It ? Yeah, absolutely. So the , the thyroid is located in the neck, and I always tell everybody who, who ask why, got into this, and, and no offense to Dr. Misery here, but , uh, the , the neck is the best anatomy in the body. It's, it's , it's so , oh , I hear a fight coming. Yeah. It's so clean. Mm-hmm . <affirmative> . It's pretty <laugh> . Um , it , it , it , it's just absolutely , uh, the , the best s stuff you can
Speaker 3:
See. I'm , I'm , I'm speechless. Yeah. I'm gonna invite you to my next robotic prostatectomy, and you're gonna see pretty Okay . Oh , geez . All right . And I'll come into one of your next surgeries. Okay. And we'll, and we'll see how pretty that
Speaker 5:
Is. C come on, by this week, we'll see you .
Speaker 3:
But for how pretty it is, there's a lot of really important structures right there. Right. I mean, people can, can have complications of thyroid surgery, which is why you don't want to go to any, you know, Tom, Dick and Harry.
Speaker 5:
Yeah. Hmm . Yeah, yeah. You know, Harry Dick, you certainly don't want to have your thyroid surgery surgery by somebody who, who does a lot of robotic prostatectomy, <laugh> <laugh> . Um ,
Speaker 4:
Good point. And welcome to the show.
Speaker 5:
Yeah. <laugh> . Yeah.
Speaker 3:
So , uh, what are some important complications that , uh, patients need to be aware of that can occur after a thyroid surgery?
Speaker 5:
Yeah. So, you know, and you mentioned that, you know, I, I do see a lot of folks who have thyroid nodules or masses that ultimately result in compressive symptoms of the adjacent structures in the neck. I also see folks with, you know, chronic hyperthyroidism, that, that is either refractory to medical management or is ultimately so chronic that, that the only kind of long-term management is to remove the thyroid. And so , uh, that's another common condition that I see. But once you're in the operating room, you know, if all you had to do was remove the thyroid, it , it wouldn't take more than about 20, 30 minutes. But the reason that, that the operation is so technical is 'cause you do have to protect those critical structures. For one, the parathyroid glands sit right next to , you know, right behind the thyroid gland, and they can be devascularized during a thyroidectomy. The, the nerves that control the vocal cords are within about a millimeter of the thyroid. So, you know, if those things are injured, it makes it really hard to host a radio show because you'll have a, you'll have a horse voice and, you know, problem swallowing. And, you know, last but not least, it's just such a vascular place that, that you want to be very vigilant about controlling all the blood vessels and stuff. 'cause it , it could be a very disastrous complication if you were to have something that bled after surgery. Head
Speaker 3:
And neck surgery is probably one of the most fascinating fields that was foreign to me when I was going through training at Baylor. Uh, we separated anatomy and head and neck anatomy was hiss own subtle segment and course. And we'd have to carry around a skull in a box just to keep track of all the different , uh, nooks and crannies. Wow . So , uh, the type of expertise that a head and neck surgeon , uh, and an endocrine surgeon needs to have is, is quite tremendous. So , uh, so our hat's off to you. Yeah. If somebody needs to come see you as a patient, what's, what's a good phone number to come and see you for your endocrine surgery?
Speaker 5:
Yeah, so my office is located at the Health Transformation Building, so that's, you know, adjacent to Dell Seton Medical Center. Uh, and our phone number there is (512) 495-5717 .
Speaker 3:
Dr. Long, thank you so much for joining us, and we'll be right back. Hello and welcome to the Armor Men's Health Show. I'm Dr . Mystery , your host joined by my co-host Donna Lee.
Speaker 4:
Hey, everybody. Happy day.
Speaker 3:
This show is brought to you by N A U Urology Specialist. We are a full service head to toe, well nipples to knees, nipples to knee urology practice. We would love to take care of you for your prostate and hormone needs. And Donna, how do people get ahold of us?
Speaker 4:
Call us at (512) 238-0762. You can visit our website at armor men's health.com. And don't forget to check out our podcast wherever you listen to free podcasts. We have like 140,000 downloads, you know,
Speaker 3:
That's nice. And I , and I , I'm only responsible for 120 of them . Yeah .
Speaker 4:
<laugh> . And your dad's got the other 20 .
Speaker 3:
My dad's got the other 20. <laugh> . Excellent. Hi, dad. Uh , today we are joined , uh, by an excellent surgeon , uh, a good friend of ours , uh, Dr . Rhet Long with the University of Texas Health, Dell Seton Medical School right here in Austin, Texas. Dr. Long thank you so much for joining us.
Speaker 5:
Happy to be here. Thanks for the invitation. You
Speaker 3:
Are an endocrine surgeon. An endocrine gland, as we explained in the last segment, is the system in our body that regulates our body through hormones. Correct. And so, you know, in, in my memory, the biggest endocrine glands that require a surgeon are going to be the thyroid gland, parathyroid gland that kind of helps contribute to calcium and bone and skeletal regulation. And then the adrenal gland , uh, am I missing anyone
Speaker 5:
As far as my PR practice is concerned, those are the predominant endocrine organs that I see now. You know, neurosurgeons are gonna treat conditions of the pituitary. Um , there's obviously endocrine systems in , in your field , uh, within the testicles, within the , uh, testicles of course. But those would be the predominant conditions that I would see.
Speaker 4:
How big are these glands? How big are the , in your field?
Speaker 5:
Yeah, so, you know, a a normal thyroid weighs about 20 grams. Mm-hmm . <affirmative> . And , and then when it gets enlarged or becomes abnormal and, and can grow down into your chest or grow out laterally or just start protruding from your neck, it can , it can get up to a hundred or 120 grams. And so the larger it gets , uh, the more potential there are for developing , uh, what we call compressive symptoms, where it , uh, starts pressing on either the trachea your esophagus and can result in problem swallowing, shortness of breath when you lie flat, or , or really just anything that that's located in that region. Now
Speaker 4:
I was watching TikTok , um, 'cause you know, I never do that. Yeah. And this lady was on TikTok and she said that her life was safe 'cause she was doing one of her usual toss. And one of the viewers sent her a message and said, you might wanna go get your thyroid checked out because it was, I guess, bulging in her neck. Is that what would happen? Yeah, I've, you can see it.
Speaker 5:
Yeah. I've certainly, it is not the first time I've heard that story of there's been people on air , uh, newscasters, various folks who you can start to notice a little protrusion in their neck, either in the front , uh, central portion or out laterally. And , and
Speaker 4:
They don't see it themselves because it's pretty gradual. But the person all , all of a sudden seeing them for the first time is like, Hey, what's that bulge in your
Speaker 5:
Neck? Exactly. And and
Speaker 4:
Unlike your pants <laugh> . Yeah.
Speaker 5:
Yeah.
Speaker 4:
Alright . Yeah.
Speaker 5:
Well, gotcha.
Speaker 4:
Yeah.
Speaker 5:
For perhaps some might be more noticeable than others, but , but yes,
Speaker 3:
Nobody's ever stopped me to tell me that. I may want to check that out.
Speaker 4:
You're bulging your pants, but you're bulging your neck. That's ,
Speaker 5:
Yeah. Yeah.
Speaker 3:
Now, when people are contemplating or thinking about who they should see, if they're concerned about a thyroid or a parathyroid problem, who's their first stop? Who should they see first?
Speaker 5:
Yeah. So we work really closely with endocrinologists and , uh, because hormones have such a important physiologic impact on our body, there's many endocrine , uh, issues that don't necessarily need a surgeon. They, they need an endocrinologist, but occasionally, you know, some patients have conditions that can only be managed with surgery. And so if the endocrinologist or primary care physician picks up a a condition that that is, needs to be managed by a surgeon, then uh, it's nice to have those relationships because you certainly wanna see somebody who does these, you know, high volume, a high volume thyroid parathyroid surgeon is somebody who does more than 30 of these a year. So if you do four or five, then that's where you might get into a higher risk. It's
Speaker 3:
Very delicate and intricate . So really having some experience is really
Speaker 5:
Important. Absolutely.
Speaker 3:
An area that we do overlap, you and I is gonna be adrenal surgery. Sure. What is the purpose of the adrenal glands? Because I think a lot of times, you know, our listeners don't really know what that gland is for.
Speaker 5:
Yeah. So the adrenals , uh, obviously sit right on top of your kidneys. And they also make hormones, hormones that, that control our blood pressure hormones that are involved in sort of the, you know , sex hormones system. And then of course, you know, cortisol, which is a very important hormone, and it , and it's involved with our stress response. So patients who have adrenal problems can either have nodules that are functional or nodules that are not functional. And so , so functional
Speaker 3:
Nodules will make hormones correct. And if you have too much of it, it may not be good. Correct. Well , one of those hormones is adrenaline, right? Yeah,
Speaker 5:
That's right. Yeah.
Speaker 3:
And that can really ramp you up and make your blood pressure go real high. And, and , uh, how are most adrenal nodules or adrenal things discovered
Speaker 5:
On accident? So , uh, wow. You know, one of the more common things that we see are folks that have an adrenal nodule that gets picked up on a CAT scan, say after a trauma, you might have these little growths on top of the adrenal gland. And because conditions like, you know, stress and high blood pressure are so common , uh, it's, it's very easy to overlook that these nodules actually might be contributing to the problem that, that your chronic medical issues. And so most of the time, you know, we find these on accident because very rarely do sym do people present with symptoms of, you know, an enlarged adrenal mass, because usually it's not something that people are gonna feel , uh, unless subjectively, because
Speaker 3:
The adrenal gland is really small. And indeed , if it gets big enough that you need to feel it, then you're gonna have a tough, tough goal of it . Yes. Yeah . And as luck has it, the adrenal gland is really in a really unique place, tucked right next to some other really important structures. Oh, yeah. Boy, describe that anatomy to us.
Speaker 5:
Sure. So the adrenal's, a retroperitoneal , uh, structure. So there, there are obviously a , a number of different organs and things within the abdomen. And , uh, you know, as a surgeon, we have to identify ones that, that are in specific planes . So either in the front part of the abdomen or in the back part of the abdomen. And the adrenal is one that is, is located in a more posterior portion.
Speaker 3:
So we have to move all the intestines and guts out of the way and go right next to the major blood vessels, the, the aorta and the vena cava. And these little glands are just tucked right next to these major blood vessels . Right .
Speaker 5:
Yeah. Yeah. It's sounds difficult.
Speaker 3:
Yeah.
Speaker 5:
It makes for a fun operation though, right?
Speaker 3:
Oh, yes . It's a lot of fun. Yeah. Y'all get off to the weirdest things. Yeah , we do get off to, yeah . Weirdest
Speaker 5:
Things <laugh> . I know. Yeah.
Speaker 3:
I mean, that's really , uh, you know , I say it all the time, surgeons are a different breed of doctor because we , um, you know, sometimes the messier it is the more intrigued and more excited that we are going to be to take care of it. So , uh, if somebody is found to have an adrenal nodule , uh, we don't operate on most of them, right?
Speaker 5:
The vast majority you don't. But really, everyone who has an adrenal nodule should undergo a biochemical evaluation. So essentially there's a standard algorithm for labs that, that your , uh, primary care doctor or endocrinologist can order. And basically the, the purpose of that is to assess for any hormonal excess. If all of the hormones are normal and most adrenal nodules are gonna be non-functional, then, then the vast majority can just be monitored to see if there's any growth. Now, some adrenal nodules might have a suspicion for cancer, and that's typically something that you see either on imaging , uh, that has some indeterminate characteristics or in nodules that, that, you know, have a more rapid growth over time. And that's thus why, you know, they need patients need to be followed for this.
Speaker 3:
And , uh, it's, it , it really leads to a common theme that I try to put on this is that when you're a patient, you really have to take control over your care. So if you've had a CT scan or you've had an M r I of the abdomen, you need to get that report and read it yourself because it happens all too commonly that something on a report gets brushed off by somebody who just didn't read it properly or doesn't understand it. You should, you should know what your imaging has had because so many renal tumors, adrenal tumors, abdominal tumors are found incidentally, and as Dr. Long said, if you have an adrenal nodule, you should have lab tests. I have had many patients with three and four drug high blood pressure with an adrenal nodule that nobody decided to check, and it was a functional adrenal nodule, and we were able to get them off medicines and really improve their life Wow . By just doing the proper functional assessment .
Speaker 5:
Yeah. And I think, you know, if you expand that e exact same concept to other conditions that we both see, so for example, you know, 90% of patients who have hypercalcemia or elevated calcium in an outpatient setting have a problem with their parathyroid glands.
Speaker 3:
That's right. And if you have chronic stones, you need to have the proper evaluation Correct. So that we can rule these things out.
Speaker 5:
Exactly.
Speaker 3:
Dr. Long, if somebody's going to have a surgery like this and be referred to , uh, a surgeon, are they still allowed to come see you as a second opinion? Well,
Speaker 5:
As you had stated so aptly in the last , uh, segment, you know, we love second opinions and, and I believe that that oftentimes , you know, we will see folks who either were offered surgery or were not offered surgery, who we might have differing opinions on. So if you're being told that you either have a condition that's , uh, related to the endocrine system that's either non-surgical or surgical it , it never hurts to get a second opinion.
Speaker 3:
And if somebody wants to do that, how do they call your office?
Speaker 5:
Yeah. So , uh, my office phone number is (512) 495-5717 and we're located on 1601 Trinity Street in building a
Speaker 3:
Well , I can't thank you enough for giving us this amazingly high level discussion about something that a lot of our listeners may encounter but not know too much about. Donna. How do people get ahold of us and send questions to us? That's
Speaker 4:
Right. You can reach us at 5 1 2 2 3 8 0 7 6 2 or our website, armor men's health.com.
Speaker 2:
The Armor Men's Health Show is brought to you by N A U Urology Specialist. For questions or to schedule an appointment, please call 5 1 2 2 3 8 0 7 6 2 or online at armor men's health.com.
