Kathryn Knowles  00:00

Matt, hi everybody. We are on season nine, episode 10, and I have Matt RAM back with me. It’s been a little while since we’ve had you on the podcast. How are you doing? Matt, hi, very well.

 

Matt Rann  00:13

Thank you. Yeah. It seems to be a long time I’ve missed our chat. To say the least, I have

 

Kathryn Knowles  00:20

as well. It’s been strange because I’ve been doing quite a lot of like, sort of like product features in some ways, and then also been quite reactive to people chatting to me about stuff on social media and stuff as well. And they’ve been more sort of like factual or opinion pieces in some to some level, in some ways, and but it’s lovely to have you back and get us back to what we’re good at, which is really helping advisors to understand different different underwriting risks and what insurers are going to want to know. So today, everybody, we are starting off a chat about thyroid disorders and what that can mean when you’re applying for protection insurance. So this is the practical protection podcast

 

Kathryn Knowles  01:05

so to start off with thyroid disorder, little bit of information before we get in that obviously providing lots and lots of insight for us. So we have about one in 20 people have a thyroid condition, and I imagine that most advisors do speak with more than 20 people. And so at some point, you’re probably likely going to be coming across this. It is six times more likely for women to have a thyroid condition than for a man. Just to share my own experiences that I have an underactive thyroid, but I actually had postpartum thyroiditis, which is a lovely set of words. And basically, after I had my third child, I felt horrific, absolutely horrific. And at this point, obviously, I had three children. There was sort of six. Was it six? Yes, six on, hang on. No, five, two, and then newborn. I was breastfeeding. Obviously, had all the the other children to look around, you know, just, just generally, obviously, really, really, not feeling very well. And I felt much, much worse than I had done when I’d had my other children. And I just I was so shattered all the time, but I felt like I had so much energy. And then I also started noticing that I had, like, a huge amount of hair loss. I had, like, a quarter, not a quarter, sorry, not one description. I had a triangle at the front of my hairline, and quite significant was couple of inches backwards where I suddenly lost hair. And at first I hadn’t noticed, because I quite shot hair at the time, and it would usually kind of flick over to one side and and I hadn’t noticed, and I’ve suddenly looked in the mirror, and I thought, that’s that patch of hair. And then I spoke to Alan. He said, he goes, Well, I didn’t want to say anything, but actually I followed you. Followed you into the bathroom after you would follow me into the bathroom and follow me after I’d been in the bathroom, and he’d noticed a significant amount of hair in the bath, and he took a picture, and he’d spoken to my mom, and I was like, why didn’t you just speak to me? But you know, and he hadn’t wanted to worry me, because I’ve just had a baby and everything like that. He wanted to know, is this what women do after having babies, even though, obviously we’d already had two children together, and it hadn’t happened before, but you know, and, and I was guessing, I was went to the doctors, and they were like, well, we’re not really sure what’s going on, but let’s check your blood levels. And they did, and I had, at the time, an overactive thyroid, and they’re like, this is why it feels so horrific. And I was like, okay, and like, but you need to have a certain amount of blood tests after with certain time intervals between them, with a thyroid condition before they will actually, like, officially diagnose it and give you medication. So it was, I think it was like, at least, I think it’s about six weeks or so. So I was already six weeks into feeling horrific, six weeks later, had a blood test which showed an underactive thyroid. And at this point, the doctors went, we have literally no idea what’s going on. And which was really comforting, obviously, and obviously, naturally who I am. I googled, and I came across this thing called postpartum thyroiditis. And the next time I spoke to the doctor, I was like, Is it this? And basically postpartum thyroiditis. For whatever reason, is your body goes into overactive thyroid after having a child, and for whatever reason, just switches to underactive thyroid. And again. Then it was a case of, right? Well, now it’s an underactive thyroid. You’re going to need to wait another six weeks. And I was like, Oh, no. And so I had the other blood test, and it was like, yeah, you’ve still got an underactive thyroid. Now we can start giving you new medicine, which was brilliant, obviously, because then I again, still very, very tired, but then I started to be able to treat it. The hair loss stopped. And it was really, really strange, because obviously, as anybody who listens to the podcast knows, I have a range of health conditions. And I’m not somebody who’s particularly vain. You’ll have seen me do social media videos, I’ve done podcasts. I’ve been at conferences without makeup on. You know, I’m I’ll, sometimes when I’m doing meetings and things, I’ll be there with a dressing gown wrapped around me. I am properly dressed. It’ll just be that I’m cold or something and but, you know, I’m not someone who’s. Particularly bothered about how I look, but it really tipped me over that edge when I had this clump of hair missing, and I got really upset. I was on the phone to the doctor crying my eyes out, saying, I’m not vain, but I’ve lost my hair, and I want to know what’s going on. And, you know, I was obviously all the emotion still, you know, at this point, I think I was still only four months into having a new baby, so I had all the emotions of new baby and everything like that as well. So it’s so that’s my experience anyway, with a thyroid condition, and it’s certainly not pleasant, but I can certainly say it can whammy you. It really, really hits you. And we do have, we’re not going to be focusing on thyroid cancer today, because it does have its own episode in its own right, but we do have about 11 people are diagnosed with thyroid cancer every day in the UK, and that’s come from Cancer Research UK. So, you know, it is something that’s happening quite a bit, I would say, in that kind of regard, and in terms of the under active thyroid, which is what’s known as the hypothyroidism, is 10 times more likely in women. It’s roughly two people in every 100 people, and that is from thyroid UK. There’s lots of other ones as well, lots of different names for thyroid conditions, but I’m going to hand over to Matt to take us through what the thyroid is, what these different conditions are doing to the body and how it’s going to be affecting a person’s health. So fire away. Matt. Well, thank

 

Matt Rann  06:27

you very much. I think you’ve taken most of my, my the next 10 minutes with your with your own case study there.

 

Kathryn Knowles  06:35

Oh, hopefully, hopefully not with you. I haven’t gone into TSH levels or anything. There you go. Well, I

 

Matt Rann  06:42

wasn’t going to talk too much about TSH, but

 

matt  06:47

yes, what can I say? It sounds absolutely horrendous, and certainly I can back that out from the from the many, many hundreds of notes I’ve seen on thyroid cases over the years as well. Not at all nice. However, there is light at the end of the tunnel putting thyroid cancer to one side

 

Matt Rann  07:09

in that the absolute key to any form of thyroid disorder is to get an early diagnosis and get that treatment started as soon as possible, untreated thyroid conditions can end up with some very nasty complications. So if you do get some of those symptoms, I know Kathryn and I have spoken before about, well, we all feel a bit tired, and we all feel, you know, going to do a bit of weight gain, might have a little bit of weight loss. The heart might thump a little bit more than normal. Surely, these are things that we just have to cope with in everyday life. But I think Kathryn is absolutely highlighted there, the fact that if we all feel run down a little bit on occasions, however, if there is a prolonged period of not feeling at all well, all those symptoms are much worse than you normally have. Then get to see your doctor for many reasons, but thyroid disease disorders are one of those common things that can be sorted out very, very quickly. Okay, in terms of the biology the condition going back to our O levels, those people who can remember O levels, the thyroid is a gland, and it’s a small Butterfly, butterfly shaped gland in the neck, which sits just in front of the wind pipe. Or if you want to go technical, the trachea. I’m glad you mentioned

 

Kathryn Knowles  08:40

it being butterfly there, Matt, the reason being, it just popped us. Just popped into my mind. So one of the things, especially with my kids, because obviously they could tell, like, when I was, when we had the baby, that I was really, really not okay. And what I did is I used to say to them, along the lines of rights, you know, I was like, I know this could sound weird, boys, but there’s something inside you. I was like, it’s a bit like a butterfly just inside your throat. I was like, it’s an organ. And obviously, because I’m always really thinking, I was like, I thinking, I was like, and I was like, and it’s just, I was like, it’s just making me very, very tired. And just, you know, I’m finding it quite tricky so, but as they’ve grown up, they still can, you know, if I’m really, really tired, and say to me, mum is the butterfly. And it’s so, so sweet. It’s so lovely to do that. But it’s, I just think it’s a lovely way as well for children to be able to, like, help them visualize. Well, actually, it’s not actually able to find someone’s thought that’s making the milk, because that could obviously cause phobias, but to just sort of, like, give them a little bit of a visualization of, you know, this is actually what’s it’s there and it’s just doing its thing.

 

Matt Rann  09:37

No, absolutely. That’s, that’s very, very cute indeed. That’s lovely. Okay, so we have, we have this gland just in front of the wind pipe, and its main function is to produce hormones that regulate the body’s metabolism. Metabolism, we’ve got talked a lot about metabolic health these days, and really what that is in play. English, is the process that turns food into energy. Okay, it’s part of our endocrine system which controls many of the body parts, functions by producing and releasing and secreting certain hormones and other members of the endocrine Well, other examples of the endocrine system which regulates the hormone production are the Pituitary and the pancreas. So those are those other body parts, if you want that are that form part of that endocrine set. As I say, the main, the main function, is to control the speed of your metabolism, and that’s and that’s how, as I’ve said, You the Body transforms, transforms food and into energy. And therefore every, nearly every organ in the body is impacted in one way or the other, and it can also, and that also includes your heart, and the way that your heart actually beats, as I’ve said, Without enough thyroid hormones, many the body’s function functions slow down. And just to comment on the hormones that we often see mentioned by doctors, the medical profession. And I certainly I see enough hidden reports. And some people will will, some of your clients will also potentially mention t3 and also t4 probably more often, t4 which is the abbreviation for thyroxine, and t3 which is one of these wonderful names which I will try and pronounce. I must admit, it’s not one that I come across very often, but it seems to be thrio di throne Leanne. So there we go. That’s the full name of t3 if I was recommend to anybody listening, I would just remember it as t3 the fact that there are two, t3, t4, thyroxine is the one that some of your clients may know, but certainly doctors will be looking at that and forms part of a the standard thyroid function tests. I’ll just also throw in a little bit of as an aside, but it what I’m back to say. I’ve not seen as an issue in the UK already, of the developed countries, for a long time. However, it’s worth mentioning it that the thyroid does use iodine to make those thyroid hormones, so the t3 and the t4 and without enough iodine, the thyroid gland has to work a lot harder, and it swells up or becomes enlarged, which is commonly known as goiter, and it is the most common form worldwide, and would underline worldwide of thyroid disease. Goiter, in itself, as I say, is literally, I kind of think about it, rather than like if you work a muscle, and certainly when the thyroid gland is not a muscle by any stretch. But if you work as, let’s say, your bicep hard or your quadriceps hard, then they will grow because they have to work harder to so, you know, you to the normal part of muscle development, but so so does your thyroid gland. If it can’t find enough iodine, it becomes swollen and large to try, and that’s its natural reaction, to try and find more iodine in the blood and to absorb it as to to effectively meet its meet its function in the body, which is to provide those thyroid hormones. Okay? So most common problems we’ve seen, all we see, is too much hormone, the thyroid hormone, and that is known as Kathryn has already said, hypo, hyper, thyroidism, hyper, very common if you probably hear with hypertension and a few other examples of hyper, means too much and too little. Hormone, thyroxine, of course we’re talking about here in particular, then it’s hypo. Of course, you get that with high poem tension. In this case, two little thyroxine is hypo thyroidism. And like a lot of the disorders, medical disorders that Kathryn and I have spoken about over the last couple of years now, if not longer, the cause of it is not really fully understood, but definitely a cause can be that the immune system, again, is attacking the thyroid gland and damaging it. So I’ve got another immune system mal response going on here, and it also can so this is thyroid disease in its. Its entirety can be caused by the treatments for thyroid cancer, or indeed, the treatment for overactive thyroid. So that’s something in terms of the overactive overactive thyroid causing disorders in his own right. Then that is post most likely down to too much replacement hormone being given, and it actually causes so that’s hyperthyroidism. Too much replacement hormone is given and it actually causes overactive Okay, and that’s one of the things that when an under item sees somebody who’s just been diagnosed with thyroidism of some kind authority thyroid disorder, can’t get my words out today that they will see and they will want a period of postponement, I suppose you would call it just for make sure that The thyroid disease is controlled adequately. So that’s maybe why you’ll sometimes get a short postponement period. Was that that treatment settles down and the doctors are convinced that they’ve got the right hormone treatment levels in order to gain maximum control. Is

 

Kathryn Knowles  16:17

that? Matt? So it was that a specific thyroid condition, where you’d maybe expect, well,

 

Matt Rann  16:23

it reminds me a little bit like you, but it was different kind of scenario, cause with your postpartum. But

 

Kathryn Knowles  16:33

because things that you have to wait for the diagnosis, well, you have to have the initial blood test to show that they think it’s there, wait to then have the few weeks also for them to confirm it, and then obviously, if it’s showing it’s there, it’s probably quite likely that what’s known as the TSH levels and in the normal ranges. So they would probably want to you to wait get again until you the medication has shown that your thyroid is back in male control. Probably that’s

 

Matt Rann  17:02

absolutely right. Yeah, yeah. So it is, so it is a bit of a lengthy it can be a lengthy process, as you kind of highlighted, in a way, to ensure that the replacement hormone drugs that they’re giving you are achieving the right level. Sometimes they can give you too much, which causes hyperthyroidism. They thyroidism, they’ll bring that down to get you to a normal level. Does that make sense? Does that what you say Kathryn is absolutely and I think it’s time to settle to get those, those those hormone replacements Correct, yeah, well,

 

Kathryn Knowles  17:35

when you, when you do an application as an advisor, you know, it’s usually, you know, when you come across things like that, you know, especially if it’s something like underactive thyroid, underactive thyroid, that tends to be the more common one that I come across. You know, you’ll probably go on to your show’s application, and there’ll be your standard question sets, and then usually the answer is, is it now? Have you now been told that it’s now within normal ranges and well controlled? And if you can answer yes to that, that’s usually the end of it that I find, but, but just quickly, sort of, like some of people so underactive thyroid is hypo thyroidism, yeah, overactive thyroid is hyperthyroidism, yeah. But then we also do come across the names of, you know, I hear Hashimotos disease and Graves disease as well. I’m just wondering if you’re able to just give, like, a very quick rundown of what they’re doing in terms of that naming. Because, you know, I think sometimes I’ll see things like, because Hashimoto disease acts like the hypothyroidism, but it is different as well, isn’t it from from having an underactive thyroid, in some ways, I believe.

 

Matt Rann  18:40

Yeah, absolutely. I mean Hashimotos. I must admit, I did try and find out who Mr. Or Mrs. Flat matter Hashimoto is or was, just to, just to try and sound clever, but I’ve failed on that, I’m afraid. So. Just have to bear with me, but, but certainly, if I can just maybe provide a little bit of background to Hashimotos and to graves? Would that be okay to hopefully that will develop? Yeah,

 

Kathryn Knowles  19:05

absolutely. I think they’re the ones. I know there’s loads of different types of fires. I’ve got a list of all the different ones, but it tends to be, as I would say, the majority of the ones I see under active thyroid. I don’t tend to come across over active thyroid much, but then I think I’m probably in terms of most seeing of them, I probably got underactive Hashimotos graves and then overactive, but that’s obviously just my client bank, as to what I tend to see?

 

Matt Rann  19:30

Yeah, absolutely. And I think I think probably hearing there is that people do remember the name Hashimotos and and, to an extent, graves, because those are kind of standout names that you tend to remember, as opposed to under active hyperthyroidism, which is a bit of a mouthful, or vice versa, or hypothyroidism. So I think those certainly are very important names to to remember, and certainly our clients seem to as well. But Hashimoto is. The most common, and I think this fits into what you were saying. Kathryn Hashimotos is certainly the most common type of auto immune reaction that causes under active thyroidism. It’s unclear what causes Hashimotos, but it does seem to run in families, and it’s common with people with other immune system disorders such as type one diabetes and vitiligo, which really is a skin condition. So again, you’re absolutely right. That is a it’s an auto immune disease specifically named Hashimoto disease, and it is called the under active thyroid and symptoms. Just to reiterate, some of these symptoms, here you will get tiredness, weight gain, and you can feel depressed as well, with with Hashimotos. Again, this is where, where I think you were talking about t3 and t4 maybe it was myself, really. But diagnosis are based on the low levels of hormones, such as your t3 and your t4 and these can change the way that your body processes fat, hence the weight gain. But it can also maybe loose link with fat here, but it also can cause high cholesterol, and that is something obviously we all need to be very, very careful about, and also needs medical treatment, if indeed that is one of the complications, high cholesterol and heart disease, cerebral vascular disease, disease that can cause stroke, can be complications here. So it kind of goes back to my point initially, that if you don’t feel well and you and it’s and not feeling well is either is unusual to you, or the the length of the period that you feel unwell is unusual, then go and get go, go and get your GP to To test your thyroid levels very, very common, as Kathryn has said, but it’s also very important that you try and get this thing, this sorted out as soon as possible and adequately treated. Okay, so I just wanted to we talked about t3 and t4 here. I will go on to graves in a minute. Kathryn, honestly, but I think something that is, I see an awful lot of in Kathryn. I hope you will have seen that as well. Is the reference to a thyroid function test and and clients having had one. And basically this test is, is looking for the thyroid stimulating hormone, TSH, and also thyroxine, which I’ve already mentioned, is t4 and it’s a simple blood test now, TSH, I certainly see an awful lot of times that it’s actually referred to as free t4 or anything abbreviated to ft four, actually, but, but free TFT for I usually just say it’s seized as free throw, free thyroxine. That’s the way that I see it in medical records, at least. And a high level of TSH and a low level of t4 can indicate that there is a risk, not that you’ve got it, but a risk of developing an interactive thyroid in the future. Interestingly, t3 which I’ve mentioned, the one with the the long name, which is difficult to pronounce, is not routinely offered within a simple thyroid function test. Yeah, in terms of that’s the thyroid function testing its own right, and you’ll get the TSH, the and the T for looked at what you’ll also get sometimes is, in fact, to be honesty, that I see it more often than not these days. I don’t know about you, Kathryn, but is the thyroid antibody test. And basically that is the test that helps the doctors rule out also immune thyroid conditions such as Hashimotos. So if we go back to the very beginning this, it tends, tends to be an also immune disease that will be the test for it.

 

Kathryn Knowles  24:20

Yeah, I’ve not come across that. It’s interesting. I literally had my thyroid checked earlier this week, and I don’t know why, but for some reason, it’s I ended up with quite a lump on my arm. It’s been very, very sore. I was having the blood test, but I was looking on my results. I know you’re saying about all the different aspects of it. And what’s interesting is, obviously, because I could access my online app and everything, yeah, and all it mentioned was the TSH. It told me my level. It told me that obviously I was well within the the fine ranges for thyroid. But all the extras that you were saying about the t fall and everything like that, it’s, it’s something that you know you don’t as as somebody who has a thyroid condition when you do get your blood test. Was. Thoughts, in general, you don’t get all of that information. You just literally get told some normal ranges, and that’s, that’s pretty much it. So sometimes it can, I think, be a bit tricky when you are going for certain insurances, because, you know, it can be that you have to suddenly trying to start going delving into more but it might not actually be there on your records at times.

 

Matt Rann  25:19

No, absolutely. I think that if you have a you have a diagnosis, or have had a diagnosis, and you’re I would imagine that your t4 has been done at some stage. Would I be right? Or maybe your records that are on your phone don’t go back? No, I don’t

 

Kathryn Knowles  25:38

think they go that far back. I will have had it in some point. And I have obviously very nature of what we do. I have got an entire copy of my medical records. I will have it somewhere. I mean,

 

Matt Rann  25:49

imagine it would have been done at some stage, and as long as you your TSH has remained normal since then, they probably don’t bother with doing a t4 and I think you will find, I hope you would find, rather than, I think you will find that your end of underwriters will not be concerned that they don’t have an up to date t4 they will look, or absolutely guarantee that we as an underwriter will look at the diagnosis and and the when, because that’s important, because you need to get all your everything settled, and then that you have adequate control. That’s the key. Is the control element. Once you’re I would also say what’s key is that you do have follow ups. So somebody that had their last th done, you know, more than, say, a couple of years ago, an underwriter may think, Well, hold on, really. Are they following best medical advice, which is required for this, because you can have complications. However, if you it’s been like hypertension check, in other words, or a cholesterol check,

 

Kathryn Knowles  27:02

or your diabetes check, anything. Those are usually annual. Another,

 

Matt Rann  27:07

another hugely important example, Kathryn, really important with diabetes. If the doctors say you need to be seen on a on a regular basis, maybe that’s six months, whether it’s 12 months, then an underwriter will want to it’s a positive, very positive point for an underwriter as well, that you’re actually following medical advice, because if you don’t, then sometimes goes as far as all bets are off,

 

Speaker 1  27:33

yeah. I was gonna say, I mean, yeah. And I think you can have complications, yeah. I was

 

Kathryn Knowles  27:39

gonna say, you know, I think in some ways, obviously, when we had lockdown, that was very tricky, obviously, for people to get their regular checks. And I think sometimes it’s possibly affected some people going forward, you know, there may be some of that feel of like, well, I didn’t get checked for three years then, and I was fine. And being I think it’s, it’s fair to say, you know, if medical advice says that you should be checked every year, and I do appreciate that sometimes that will go a time frame just from sheer resource, a strain on the NHS. But if somebody, you know, if somebody’s not getting those tests done, then I think it’s, it’d be fair to say that, you know, we would, you know, I’d hope most people to understand that the underwriters are then going to think, well, hang on a minute, if, if you’re not getting these tests done, to double check that everything’s okay, then what does that mean in terms of long term health, you know, if you’re not, in sense, if people aren’t being on top of this, which is, you know, a blood test once a year, I do appreciate that. I have to say that people will have, you know, fear of blood tests, and it may not be easy for them at all. So, you know, there are going to be sometimes exceptions as to what we as to what the perception will be. But if somebody isn’t having these regular checks on a condition that they know they have, then you’ve kind of sat. I imagine sometimes, is that thing of all, what if something else comes along and it’s maybe more serious? Are they going to pay attention to it? Are they going to get the medical support? What does that mean in terms of, you know, attitudes, long term health and things like that?

 

Matt Rann  28:59

Yeah, I think, I think the main focus, I do take the point, particularly the latter point. I think the main focus will be, though, if somebody’s got an established condition that they are not following up on medical advice, then that would be the major concern. You mentioned two important points for me there, Kathryn. One was COVID, and one was the fear of needles. And I do see, and I’m still seeing quite a few medical reports with where people have been lost in the system due to COVID, and if somebody has missed a series of tests, it’s worth finding out the why. So you mentioned COVID, you mentioned people having a fear of needles, which is very, very common. I have it myself, by the way, and that’s despite being poked God knows how many times when I was having chemotherapy. And I’ve had a fear of needles since I was 12. By the way, there’s nothing to do with chemotherapy, but say so i. Yes, fear of needles or being being lost in COVID is very, very different to somebody just not looking after their health. Absolutely. That’s a different mindset in its entirety. So if say, you know, underwriters, we work to guidelines, not absolute rules, in my opinion, unless we will get on to my favorite subject of automated underwriting systems.

 

Speaker 1  30:26

But, and just, just, why? Sorry, no, and

 

Kathryn Knowles  30:30

just just expanding a little bit on that fear of needles thing, I think it’s important to say as well that there are times, obviously, that, you know, underwriters and shows will try and do their best, but there will be times where they will have to say, Oh, they will say, you know, well, you know, they are sorry. Obviously that fear of need on is something that affecting somebody, but they just cannot assess without the blood results. And it could be from any number of reasons. You know, I’ve certainly come across that before. But what I have had before, I had somebody who needed to have a medical for their insurance, just because of the amount of insurance, but they did have a needle and fear and and they just kept saying, I just, I can’t. I cannot get this. You know, if they’re not going to give me this insurance without this, I just cannot do it. And then what we did establish is that actually they had had a blood test that a regular annual blood test, I think, maybe about two months prior. And what we were able to do was use that instead of having the blood test from the medical, just because, you know, it was the case, if everybody was just trying to look at it in as best the way possible for the client, the blood tests that have been done covered what we needed to have covered in the medical. And so that was a potential option. So it’s always as an advisor as well. Just think outside the box at times with things like this. If you know, somebody’s going to have a condition where there is those kind of regular checks, and that kind there is going to need to be some kind of blood test done for the insurer. Well, if you if you’ve got an official test there, or maybe even they’ve had a medical through work, you know, some people get there, or it might be that they’ve had a medical through another insurance at some point, and it’s maybe within the timeframes that the new insurer that you’re applying to can consider it’s always worth having having a look and exploring that, rather than just going well, well, if we can’t get a if we can’t get a blood test, then we just need to say this isn’t going anywhere.

 

Matt Rann  32:17

I would totally agree with you, and certainly I mean, if you don’t want me being a little bit skeptical, the person would say the client, particular client, was saying they couldn’t get insurance because they didn’t want a blood test, but had because their fear of needles, but it actually had had one two months before. Yes, by the way, I’ll just draw a line under that full stop. However, the point that you’re really, the fundamental point I think you were making, is around thinking outside the box and asking whether blood tests that the client, whether they had any recent blood tests or employer employee medicals. And absolutely that is something that I use, and other high net worth underwriters will use, we’ve got, you know, with their client, particularly on the on the employer medical side, and if they’ve had a medical exam, which included blood tests and goodness knows what else as well. These days, these can be used instead of some of the routine medical evidence that is acquired by the underwriters. And that’s that kind of it’s all encompassing, almost. And not only that, let’s be honest, it having a whole set of tests just after having had an employer medical doesn’t really, isn’t really a great experience for the potential client. But also, and one could argue rather cynically, it also can save the insurer money.

 

Kathryn Knowles  33:48

Oh, absolutely,

 

Matt Rann  33:52

there is a win win there as well. It helps the client just have to waste, not waste, exactly, but use so much time up going for a medical exam, and also helps the insurers budget as well. So that’s an absolute Win. Win, absolutely worth exploring with with your client. The one thing I would say is that as a couple of maybe potential downsides that I’ve I’ve seen over the last two or three years is that there has been a a huge rise in in what I would call low budget private medical examinations or health checkups, okay, yeah, and these, the the actual reports, the tests themselves, are generally have quite a low standard, and they aren’t the great they are not great for substituting an insurance medical for so it’s a little bit hit and miss on whether the insurers will be able to waive but it’s absolutely certainly worth a try. What I would also say is that. These things, I tend to see that any slight deviation in a blood test result or an ECG result, the health insurer or the or the people that did the medical examination will to cover themselves from a liability perspective, they will say you need to see your doctor. Yeah, everything is you need to see your doctor. You need to see your doctor. And that can cause an awful lot of delay with the the client that you’re trying to get insured by having to go and see. Go back to the GP. Have you had this test? Have you had that test? If not, why not? And the GP turns around half Tom and says, Well, I don’t think you should have another test. It’s completely irrelevant. Yeah, you know, but it which is absolutely fine, because under us do listen to doctors, but obviously, but it just creates a big delay in a quite a messy client experience. So these are, these are good, generally, very good things just, but just be wary that they can bite you, come back and bite you in a way that you wouldn’t necessarily expect. Sorry, I’ve got a little bit of a Tom, I think just something that I thought I’d share. But you know, if you ask me on an 8020 basis, I would say that they it is well worth getting or alerting the underwriters to recent medical test results. Let me put it that way. I

 

Kathryn Knowles  36:27

think as well, insurers are much, much more open as well. You know, if we can do that, the whole thing about getting specialist letters as well to confirm diagnoses and things that have happened, rather than going for the GPU parts that there, there’s a lot more openness now to accept that kind of information, to sort of to save everybody time as well. And, you know, to get people insured. You know, I think the key thing is, is that as advisors, as insurers, we’re wanting to get people insured. We want to get them insured as quickly as possible and as as easily as possible. And, and, you know, there’s certainly different, different steps we can take. So, um, refocusing us on a thyroid, and I took us on a tangent there again.

 

Speaker 2  37:10

Um, Hashimotos. Kathryn, yeah, yes, sorry, yeah, right, yeah, absolutely go for it. Okay,

 

Matt Rann  37:15

so Hashimoto is just a very summarize, we’re talking here of hypo thyroidism. Okay, in terms of grave disease. And you’re absolutely right. Kathryn, I don’t see that many cases of graves or histories of Graves disease which fits in with your experience as well. But again, it’s it’s an auto immune condition which affects the thyroid, and this is where the gland actually produces too much thyroid. And by definition, it’s called, again, we’ve mentioned it a few times, but I don’t think we should apologize. Hyper thyroidism. Now, in itself, it is not fatal, but it can cause serious heart complications. Okay? And again, you’re looking at often how this impacts the the heartbeat itself, so the electrical conduction systems. It’s not curable, but it can be managed. And the most common drugs that certainly I see, Kathryn maybe want to throw through your view in as well. Is called COVID. So is the one that I see the most. There is a, okay, there’s another one, apparently. But again, it’s one of these, one of these wonderful names, and it’s called a profile thyrourous, ill, apparently, often used as well, and because of the potential heart complications. You often find people are on B Block beta blockers as well to manage heart and your heart symptoms. Okay, maybe the next natural thing I feel is just to go into goiter. That’s one of the potentially common names that you’ll hear from your clients, and just to we did touch on it earlier, but really, just to reconfirm, goitra is no is no more than, and I say that from a an underwriting perspective, a lump or a swelling that’s at the front of the neck and caused by the swollen thyroid, which is where, effectively, that thyroid gland is working too hard and it swells up due to the iodine deficiency, which is usually dietary, it has to be said. But if you hear Goethe mentioned, it’s usually down to iodine deficiency, and as long as the underlying condition has been treated, always being treated, and everything is returning to normal, then it will be no problem from an underwriting perspective. But also add that iodine deficiency is rarely seen in Western Europe or North America and Eastern Europe, that might. To these days. So it’s probably something that you’ll see from a good many, many years ago, potentially. And we’ve already talked briefly about thyroid cancer. That’s a discussion for a different day. The last thing I wanted to just very quickly talk about was thyroid nodules, which I do see mentioned not that often, but I certainly do see them mentioned. And just to say that 95% are benign and red, but you’ve got this again, this adherence to medical advice, which is important here. They do need to be monitored, usually by ultrasound, but they’re generally benign. They’re often found as an incidental finding. In the words the doctors looking for something else completely and suddenly they found either clinically, in other words, when they’re examining the area under your chin your throat, they notice some thyroid nodules there, so the person themselves might be completely oblivious to it, and generally they’re just an overgrowth of normal thyroid tissue. And you might hear the term thyroid adenoma, and that is literally the posh name for overgrowth of normal thyroid tissue, okay, but I say 95% are benign, and if somebody is being has a diagnosis of nodules, but they are being regularly followed up by ultrasound, then it will be no problem. From an underwriting perspective, I think that wraps me up in terms of the different kind of thyroid disorders that are around and that I see from an underwriting perspective. Does that does that help? Kathryn, yeah, absolutely.

 

Kathryn Knowles  41:38

I think that’s really, really helpful. Thank you. So so as an underwriter, Matt, what are you looking for? I’ve got a client with a thyroid condition. I appreciate it could be different depending upon the conditions, but what are the key things that you’re going to be wanting to know?

 

Matt Rann  41:51

I think the absolute key thing, really is, if they have a thyroid conditions, in other words, they know about it, then what is the diagnosis? When were they diagnosed? And has the is the condition well controlled. Those are really it is relatively simple. And what we do need to know is, obviously, I say obviously, got a welcome and control condition. But in fact, have there are there rather, I should say any complications of that disease. And I want to say any. We obviously talked about heart disease today, but you can get disease of any organ of the body, as we explained early in terms of the Congress conversation, yeah. Does that help on that? So it’s relatively simple. An underwriter won’t be that concerned, as long as there is good control and there are no complications. Absolutely,

 

Kathryn Knowles  42:51

I think what I tend to ask people, as my standard thing is always, what is it? You know, what have you been diagnosed with? When was it diagnosed? As you say, is it in normal range? And I would often with people with thyroid, just as an extra on my part, before I start doing my research, I would check with them, have they had surgery, or surgery planned? Obviously planned surgery will be likely a postponement if they’ve had surgery, and if so, that’s sort of like a bit of a bit of a sort of like a catch all for me in some ways, because what I’m doing is, yeah, you know, if somebody is telling me they’ve had an underactive thyroid, there’s been no issues that is completely well controlled, but then they’ve had surgery that would make me feel there’s something here that I’m missing. And so I’ll probably just try and deep dive a bit more. If you’re not familiar with how to deep dive a bit more, what I would say is get the information you can and then speak with an underwriter and then say with them, right? What would you expect potentially the surgery to have been, or what would you need to know about it? Is there anything I should be asking more for? And then just go back to the clients and clarify a bit more, because with underactive thyroid, I mean, you might swoop him up, but an under directive thyroid for me, I just as a an underactive thyroid, I wouldn’t expect surgery for that. I would just be expecting medication. And I would also be saying to the person, what is your medication? And you know, if they could also tell me the dosage as well, and that would be, generally, my my rule of things, does that sound like quite a good fair things to ask? I

 

Matt Rann  44:20

think in terms of the deep dive, absolutely, I think you’ll find, and maybe you could help me on this one, because, you know, you deal with cases far more often than I do. But what the the old electronic underwriting system would, would, I don’t think they would necessarily ask for treatment,

 

Kathryn Knowles  44:40

not necessarily. It’s, it’s, yeah, most of the time, but

 

Matt Rann  44:44

yeah, I think there are good questions to ask. I think your point about the surgery, yeah, is, is, is certainly worth doing. But I it

 

Kathryn Knowles  44:53

probably, you’re right. It probably won’t come off an underactive thyroid. It’s unlikely. I think the surgery is going to come up in the question. Set. But i As for me to be as preemptive as possible, and obviously trying to make sure we don’t get non disclosures, because people do get quite confused. You know, not everybody, but some people can get quite confused about things. And obviously, if there has been surgery, it will come up, if it was in the last five years, a lot of the time in the application set. So we want to make sure that we are just capturing that if we are going to be seeing I have to ask it about surgery, and, like any investigations about a lot of medical conditions, just because, again, you know, the last thing you want to do is get through all the way through your app, you’ve done your research, then you get to that question, in the last five years, have you had surgery, or had to, you know, do some appointments with a specialist, and obviously, oh, yeah, well, I had this and that, and you’re like, oh, this changes things potentially. And, you know, it can really, really change things. Sometimes it doesn’t matter in the slightest. But, yeah, I think for me, I wouldn’t, obviously, if there has been a greater things like that than we assume, might be expecting surgery. And so again, you know, if you, if you did have that, you know, that would be quite an important question to have there, I believe. Sorry. So when did it happen? Any kind of ongoing complications from that, things like that. So, and obviously, you know, I get come across quite a few people who have had a full thyroid removal, yeah, as well. So again, just finding out when that happens, it might be that, you know, it might be outside a time frame to notify in terms of, you know, the insurers generally tend to ask about the last five years, but you can find, with some things, that questions will react and and ask about stuff. And obviously, if you have said thyroid remove, although probably will be some specific questions in relation to that and the time frames, because of the very nature of it does mean that there has been surgery in terms of that disclosure, but I think a lot of the times that I would typically find that with most people, when I come across thyroid conditions, it is usually under active thyroid. They’re usually taking something known as leather thyroxine, that would be the common medication, and as say, as long as that is, you know, if they stay within the normal ranges, then I would just expect that to go through, straight through an application with Most insurers, assuming there’s no complications or no other risk factors. So Matt, from your experience, I’ve got a couple of case studies to share, but from your experience, what do you think in terms of life insurance, critical illness, income protection, what we’re going to be looking at, and I know that we’re going to be talking in kind of broad terms as well, because we’re having this open to, in many ways, all thyroid disorders. But we know we have already said that in this episode, we’re not going to be commenting on things like thyroid cancer just because it’s it just needs to be its own episode. So if we’re talking things like underactive, overactive, what would you be expecting

 

Matt Rann  47:38

for life insurance, no complications, and the condition is stable. Standard Rates in terms of critical illness, again, I think the underwriter will be keen to understand or satisfy themselves that there are no complications, but I would probably be looking at standard rates there maybe plus 50. And in terms of income protection, control is absolutely vital there, as well as the complications. So again, I think I’ll be looking, depending on the case, income protection is not that easy to underwrite. But I would be looking at, say, plus 50 for that as well, depending on the third period. By the way, if it was four weeks, I think I will be writing if it was 26 weeks, then I think I’d be letting it go. Yeah, your your case studies?

 

Kathryn Knowles  48:31

Yeah, absolutely. I have a mixture of cases, because I wanted to show you know, in terms of under active thyroids, the hypothyroidism, you know, no complications, no other risk factors, I would probably be expecting standard terms across the board on the different products. You know, as you say, there can be other factors in there that the case studies that I’ve brought do have additional complications. Because I wanted to show that, you know that there can be options. Because I think sometimes when we do get a mixture of what we’d consider to be risk factors, and people can become quite wary. And so I think, well, can we actually ensure this person, what can we do? And you know, I have an option where I have to say I’ve got it, and the premium isn’t cheap. So we will, we’ll chat through that, and hopefully I’ll be able to explain why. And then the other one where actually there was, there’s a few things happening, and the premium was pretty, pretty okay. So I’ll, I’ll go through them now. So the first client I have, this is the one with the premium, is it’s a premium, let’s just say, but there are certain factors to why it is higher as well. So we had somebody in their late 50s, and they’re a non smokers. So straight away, obviously non smoker, really positive. But we are talking somebody in their late 50s. So you know that the pricing does go up the older you are when you’re trying to arrange these insurances. Now with this person, they did have hypothyroidism. So sorry, hypothyroidism, make sure I pronounce that right with my northern accent. So an underactive thyroid is well controlled, and it had been diagnosed about nine years prior to the application. And BMI, absolutely fine. I think sometimes i. There can be an assumption sometimes that, like with an underactive thyroid, that the BMI might be a bit higher. But this one, the BMI was 20. So, you know, in the lower areas on this as well as the under active thyroid, the person had epilepsy and was well controlled. So, so that was something that the insurer was was okay about. There hadn’t been any of the potential risk factors with epilepsy that can sometimes cause underwriters to promote the application. They’d also had a heart attack six years prior to the application. So we have an underactive thyroid, we have epilepsy, and we do have a heart attack as well. Now for this person, I’d say they’re in their late 50s. They have been arranged mortgage cover, sorry, a mortgage, and they come to us because there hadn’t been the life insurance arranged for them to cover that mortgage. And especially, my opinion, I have to say so, just very conscious for anybody who’s doing this, my opinion, especially if you are arranging, if you’re arranging a mortgage for anybody, then really we should be considering it at least income protection, and really probably life insurance as well, because of the fact that there’s often family that would need to or who would inherit the debt. And when we are starting to get people towards their late 50s, early 60s, and we’re seeing more and more of these mortgages, I’m seeing mortgages being arranged until people in their 70s. We are naturally at a time of age where the chances of passing away are higher than when they’re younger. So, you know, I do really strongly suggest, if mortgages are being arranged, that’s, you know, we are looking at the protection side as well. So this person is decreasing life insurance of 320,000 over 15 years now, for this person, that meant that meant that the premium was 235, pounds per month. So it’s, you know, it’s certainly not a cheap premium. I’m not saying that everybody in a similar situation would be seeing that kind of a premium. It just so happened with this person’s situation, the different aspects of their different health factors, and the fact that, as I say this, you know, this mortgage, sorry, this cover is taking them into their late 60s, 30s, 70s. And it’s not a small amount either. 320,000 is, is a is a good amount of insurance, you know, for the majority of people. So, you know it’s, it’s, certainly the premium was higher on this one. We then have the second case study. So that was something that early 40s, non smoker, again. BMI, absolutely fine? Again, I did an interactive thyroid because I think that’s the one that most people are going to come across, well controlled and diagnosed seven years prior to app. Now also for this person, because I wanted to again, show something where there is another risk factor, but where say the premiums aren’t going super high. So as well as the interactive thyroid, this person had nod your sclerosis, Hodgkin’s lymphoma, and had been diagnosed 14 years prior to app and it had been diagnosed as a stage two Hodgkin’s lymphoma. So when we were able to do the insurance, obviously, with 14 years since diagnosis of the Hodgkin’s lymphoma, we had seven years since the under active thyroid had been diagnosed, well controlled. So for level life insurance of 300,000 over 30 years, we were looking at 41 pounds per month. So I think it was just really important to show the distinction. And that difference between where the premium is depending upon different risk factors, depending upon the age of the person as well. Hopefully, Matt, they seem like a good case studies to have brought. And

 

Matt Rann  53:25

absolutely, I mean, I think it demonstrates that, you know, the hypothyroidism in itself, with no complications, it can certainly be covered and on very, very good terms. I think, I think, you know, if I step back out of the absolute specifics of the cases, it really does show that to get, if you can, and the need arises, say that insurance is always required however that that get it, get insurance in place when you are young. Oh yes, the as you quite rightly say, if you look at the chances of a person dying of, let’s say, natural causes in their day, 50s, and if you look at a mortality curve, in other words, that’s the rate of increase. Then difference between a 45 year old and a 65 year old is huge as a very steep increase, where, apart from a lump in your late teens early 20s, then the difference between a 16 year old and a 35 year old isn’t that much, yeah, yeah, absolutely, once you get into your over 45 that that that those premiums are going to increase quite dramatically. And to me, that’s, that’s what you’ve shown there. Yeah, I think if you took the thyroid issue out of both of those cases, then potentially there wouldn’t. Been a rating? Maybe, yes. But you know, what are the great risks? It’s age and second second is smoking. Those, those big risks in life insurance, that’s the new person. So, yeah, the other thing they could study is they’re, they’re, it really does highlight try and get cover when you’re young. Even though the reason might not necessarily be very obvious, get it get cover when you’re

 

Kathryn Knowles  55:27

young. I was gonna say

 

Matt Rann  55:29

over 40. It starts to get that mortality curve, the chances of you dying to start to increase rapid, quite rapidly. So there you go. That would be the most gonna say, yeah, kind of story for me? Well,

 

Kathryn Knowles  55:43

I was gonna say, as an advisor and as a mom, I have to say, I’ve already said, I’m being very, very clear to Alan about this, my husband, for anybody who doesn’t know, who’s also my co director, my broker, fan, I’ve already said to him, once the kids are 18, that’s it. They’re getting, you know, critical illness cover. We’re getting it. We lock it in place. We’ll pay for it for them, you know, because I just want to know that they’re going to have it and you know that it’s going to be locked in before any of life events start affecting and things like that. Just, you know, get it in while it’s so cheap, while, while they are young, you know, in a sense, and and then it’s, it’s there, you know, obviously, I, you know, even though I work in this industry, I probably didn’t, until I worked in this industry, really take this kind of thing, as many people don’t, you know, and and I was, obviously, it was when I came out of university, so I was kind of mid 20s, and at that point, and you start to think, and even when you start starting it, you kind of like, Yeah, I’m going to need it when I’ve got my mortgage and that. And then I think, the more and more your industry, the more you see the claims, the more you see people the health conditions. And obviously, as a firm, we see a significant amount of people with health conditions. And you know, ages, age doesn’t factor into many of it as well. You know, we see everybody from every age group with things that are very, very difficult to potentially ensure. And obviously, regardless of being, you know, the insurance side, which is very, very difficult for the person to to live with at times, right through to the other side of things, where people don’t have anything at all that’s going to cause them any concerns. But if you can just lock it in place while, you know, people are young, and as I say, before things start really going then that’s that is got to be the the right kind of call, assuming, assuming that your compliance allows you, I will always caveat assuming I’m my own compliance person so I can my

 

Matt Rann  57:33

view. And I hope you would agree with it, there’s some, some pretty substantial amounts of insurance can be purchased without a compliance person worrying?

 

Kathryn Knowles  57:41

Oh yeah. Well, I was going to say, you say that it does depend upon the compliance as to where you are. There’s, there’s certainly people I would, I would know, would be not thrilled about certain things in certain ways. But ultimately, you know, you go by what your compliance says. You go by what they’re saying that you’re allowed to do, you know, if you’ve got so as an example, with my children, I’ll be arranging them life and critical illness cover, you know, from a very young age, and locking it in place the prior. They won’t need the life cover, but they’ll need the kick. Yeah, I may as well put, I may as well put the life on, because then we avoid the survivability clause with the standalone kick. So that will be my argument. So there’s always ways that you can discuss it with your compliance people, the ways that you can discuss the reasons for it, the difference, there’s certain, there’s certain statements you can make as an advisor, in a sense, to make it all work and everything, but, but, yeah, always, I’m completely with you there, Matt, let’s, let’s lock it in while we can, while we’re young and and unfortunately, you know, we are at a stage where there are, you know, I’ve done this in quite a few months. It’s more than one or two people. Have we diagnosed with cancer? Now, I think it’s every five minutes in the UK, somebody is diagnosed with a heart attack or goes to hospital with a heart attack. In the UK, we mentioned earlier, about was 11 people a day diagnosed with thyroid cancer in the UK, you know, and and unfortunately, very unfortunately, these numbers keep increasing. So, you know, every steps we can do to protect ourselves, protect our clients, we may as well do it. No,

 

Matt Rann  59:14

absolutely, I would maybe just add, I’m sorry to to expand on this topic, but I do know clients or clients of the I phase that I tend to work with, who said, Well, okay, I’m relatively young, I’m fit, healthy, nothing’s ever been wrong with me. And I always think that I Yes. I remember when I was 47 I was nothing wrong with me, fit, healthy as a as they come, jogging, running weights. 24 hours later, I had stage I was diagnosed with stage three colon cancer. My wife completely fits a fiddle, trains three or four days a week, swims, one day a week. Nothing wrong with us. Since, well, ever walks into a routine breast mammogram and five days later, is diagnosed with Stage Two breast cancer? Yeah, these things do happen, and just because you’re fit, you feel you’re fit and healthy, doesn’t necessarily mean you actually are Yeah, so I’m just, yeah, I would throw that in as well. Thank

 

Kathryn Knowles  1:00:24

you for sharing, Matt, because I know that obviously it’s no problem having those real experiences just really, really do make it stand out. So, so thank you for that. Okay, everybody, thank you so much for listening. And as always, thank you, Matt for joining me next time. Pleasure, to have you. Next time I’m going to be doing a bit of an overview on Group Life Insurance, just a short snippet one, again, just a bit of a bit of a hopefully none too jargony overview of that type of protection insurance. As always, you can visit the website practical hyphen protection.co.uk, to access other episodes and access your CPD certificate. Thank you to our sponsors, the Okta members, for that. Thank you so much, Matt and I’ll speak to you soon. Yes,

 

Matt Rann  1:01:10

you Take care. Goodbye. Bye. You