Q&A: the doctor's own answers

Some people think goiter is caused by iodine deficiency, so they buy iodine at the pharmacy and take it.

First, we need to explain to patients what goiter is. Goiter is really just the name we give to an enlarged thyroid gland: everyone has this organ, and if it has grown and can be seen from the outside, that is goiter. But most of our patients don't have what we call goiter. They have either a nodule, a structural change, or thyroiditis.

That is why iodine deficiency is not at the root of every goiter problem. Some people, on the contrary, have an excess of iodine. In others, the problem doesn't depend on iodine at all. For example, it is not right for a patient with Graves' disease, that is, toxic goiter, to take iodine. Just as it is wrong to tie a frog on a goiter, this is the same kind of thing. If that patient takes iodine, their condition will get even worse.

But there are some groups in which the population has been screened en masse with urine tests. For example, in one village, at the very least more than 100 people were tested and iodine deficiency was found. Such groups are allowed to take iodine. In all other cases, you cannot blame iodine deficiency for every thyroid disease — that is, everything you call “goiter.”

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Can I take the medication that “worked” for an acquaintance of mine too?

That's a very good question. Maybe if you hadn't asked it, I would have suggested adding a question like this myself. Today, one of the problems people suffer from most in society, one that affects all of us, is overweight and obesity. That's why I'd like to dwell on it. Today, both on social media and among patients who come in person, most ask about weight-loss injections — these injections are currently popular among people who are overweight or obese. Do they have an effect? Yes. Do we recommend them to everyone? No, we don't.

Let's say one patient has diabetes or is overweight, and there is another patient with the same status and the same disease. But their bodies weren't made the same. One of them may have a heart problem on top of diabetes — the medication I prescribe to that patient may both protect the heart and lower blood sugar. The other patient may have a kidney problem rather than a heart problem, and I can't prescribe that same medication to them. If that patient takes the medication on their own, the drug that protects the first patient's heart will harm this one's kidneys.

So two different patients suffering from the same disease can take the same medication only if a doctor has prescribed it to each of them separately. Taking it on your own is not right at all.

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There is a belief among patients that cheap medications from other countries can replace expensive ones, and that doctors prescribe expensive medications out of financial self-interest.

In general, no doctor prescribes today the medication they prescribed when they started practicing. For example, as an endocrinologist, I don't prescribe today the tablet I prescribed eight years ago. What's the reason? We work with patient feedback. If some of the patients we prescribed a medication to come back without having seen results, we change it — without looking at its price or country of origin — and switch to the medications we use today. The price of today's medication doesn't interest us; its quality does. If most of the patients we prescribed it to come and say, “Doctor, the result is good,” we keep prescribing that medication. As for some of those who saw no result, they probably didn't take the medication correctly, and so on.

As for the country of origin, there are countries that produce medications of good enough quality: England, Denmark, Türkiye — Turkish medications are the most common — Russia, even China. For example, I can prescribe a Chinese-made product for B vitamins, a Danish one for weight-related treatment, a Turkish one for a vitamin complex, and a Russian-made one for some groups of medications. So price is not what matters here. We are judged by patient feedback: we prescribe the medication with good feedback and an excellent effect. We don't tell the patient, “Never change this medication.” But if patients switch the medication we prescribed on their own, there will be many cases of no result.

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Sometimes patients turn to “folk remedies” more than to science-based treatment, because the doctor's recommendations require more discipline and patience.

Look, in medicine most drug preparations are derived from plants. That is, most of the substances we call “chemical” are obtained from plants. But let's also think about this: the dose we can obtain from plants naturally is very low.

We don't rule out folk medicine. But if a patient has come to a doctor, it means that before coming to the doctor they used a lot of outside remedies — folk medicine, Chinese medicine and so on — and came to the doctor because they saw no results, isn't that so? That is why the doctor's approach and prescription are very important. If a doctor has prescribed you something, there is a reason behind it, a pathological condition, a deficiency in your body, and the doctor wants to treat it.

So this one sentence is enough: other kinds of medicine can never replace what a doctor prescribes.

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Let me put it briefly: let anyone with any disease ask ChatGPT a question. For example, let a person with diabetes type in the medication they use: “An endocrinologist prescribed me this medication, and I take one tablet a day.” ChatGPT will write that if your endocrinologist prescribed it, it's correct. Then let them type: “I get pains when I take this medication; in your opinion, should I change it?” It will say to see an endocrinologist, who may change the medication. You see, it's slippery. For now, ChatGPT is a platform that is prone to “slipping up,” and the people who made it are people like us. There have been times when I myself deliberately asked questions, got incorrect information and said, “This is wrong, it should be like this” — and it answered, “Yes, that's wrong, you're right.”

So people should not trust ChatGPT blindly. It gives direction. For example, if you ask, “I have a choking feeling and shortness of breath — could it be related to goiter?”, it will say, “It could be; see an endocrinologist.” But that doesn't necessarily mean it will turn out to be an endocrine problem. If you ask about a medication, “Should I take this medication?”, it will often automatically say “yes” — perhaps so as not to take responsibility. But that may not be right.

ChatGPT will also give correct information, but for now patients should treat most of the information it gives as “50/50.” Such platforms are still at a development stage and rely mostly on basic data. If you ask ChatGPT for a PubMed article about an endocrine disease, it will show you one. But if you tell it, “Ali is 1.75 m tall, weighs 56 kg and uses these medications,” it knows nothing about the condition of Ali's heart, kidneys or liver.

The blood tests a doctor looks at, and ultrasound data too, are subjective to a certain extent. What the doctor writes on the ultrasound sheet and what the patient says can differ, because we don't write everything on it — if we did, the ultrasound report would run to six or seven pages; the sheet contains only basic data. ChatGPT may also look at it and say, “There is no serious problem here, there is no need to see either a urologist or an endocrinologist.” For its accuracy to be one hundred percent, data from hundreds, even thousands of patients of the same kind would have to be fed into it.

The doctor’s answer on video:Instagram

In general, the problems we encounter most often when examining patients in the Ganja region are infertility, short stature in children, and also goiter and diabetes problems. Patients can notice these quite easily:

• Infertility. If a couple is planning a pregnancy but pregnancy does not occur despite at least one year of marital life without contraception, that means infertility. Unlike other diseases, the patient can determine this easily on their own.
• Diabetes. It has specific signs, and we all know them: dry mouth, thirst, frequent urination.
• Goiter. Goiter is a “popular” disease. In Azerbaijan, regionally, some areas have specific types of goiter. In the Ganja region too — I'm speaking based on the number of patients — we saw a lot of goiter. It has many signs: a feeling of tightness, choking, being stifled, a goiter or nodules becoming visible in the throat. Patients can recognize these easily.
• Short stature in children. This is also a factor visible to the eye. Parents themselves say: “Doctor, my son's or daughter's height is among the shortest in the class” or “the child is falling behind other children.” Parents can notice this easily.

The doctor’s answer on video:Instagram

Here is how it works:

• If the annual height gain is 6 centimeters or more, there is no serious problem, and it is not considered a height deficiency.
• The minimum limit we take is 4 centimeters.
• We usually monitor the patient at three-month intervals. If there is 1.5–2 cm of growth in three months, don't worry.

So after the age of 4–6, if the annual height gain is less than 6 centimeters, you need to be careful. If it is less than 4 centimeters, you must see an endocrinologist. If it is more than 6 centimeters, there is no serious problem.

Especially in the regions, people see a doctor very late — after their condition has gotten worse.

You know, nowadays there are many ways for a patient to reach a doctor: social media, the doctor's website, a phone number. If you have any complaint at an early stage, first contact the doctor through these channels. If the doctor sees that your complaint falls within their specialty, they will invite you to a consultation.

For example, you write to the endocrinologist: “Doctor, I have a choking feeling.” From two or three signs we will know whether this is an endocrine problem — whether it's a goiter or not. If the symptom isn't related to this, we point you in the right direction anyway. That's why today, thanks to social media and WhatsApp, it is very easy for a patient to get in touch with a doctor. You can make the first approach this way.

The doctor’s answer on video:Instagram