Is Your Thyroid the Hidden Root Cause of Your Health Issues?
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Coming up on this episode of The Doctor's Pharmacy. But your thyroid gland is important to understand and take care of, to love and figure out. Often can be fixed. I had thyroid issues when I was really sick with chronic fatigue, but then it all corrected.

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Hi, I'm Dr. Mark Hyman, a practicing physician and proponent of systems medicine, a framework to help you understand the why or the root cause of your symptoms. Welcome to The Doctors' Pharmacy. Every week, I bring on interesting guests to discuss the latest topics in the field of functional medicine and do a deep dive on how these topics pertain to your health. In today's episode, I have some interesting discussions with other experts in the field. So let's just trump right in. What is a thyroid function? What is your thyroid gland? It's this little gland in your throat.

And think of it as your overall metabolic regulator. It really controls everything. It's like your motor. In terms of the RPM on your engine, so you know some things like a golf cart or something will have a governor and you can only go so fast. It's a little like that. So if it's slow, your whole system slows down. If it's fast, your whole system speeds up. That's hyperthyroid. Not that common, but it can be a problem for some people. But low thyroid or hypothyroid function is really common.

And your thyroid gland produces hormones T4, which is the inactive thyroid hormone. And your brain produces something called TSH, which tells your thyroid to make more thyroid hormone if it's low, or if you have too much thyroid hormone, your TSH goes down. So it's a way we sort of track things.

Now, the inactive hormone is T4. That has to get converted in your body to the active hormone, which is T3. Now, T3 is only about 7% of your thyroid hormone, but it's really important.

because it does all the work. It actually binds to the nuclear receptors that then translates into gene expression, into all these downstream metabolic effects. And it sends these messages to your DNA to turn up your metabolism, to turn up fat burning in your mitochondria, to basically get all systems go. And if you have

a good T3 level, your cholesterol is in check, your memory is good, your metabolism is good, you stay thin, it helps your hair grow, it helps your muscles, prevents muscle aches, constipation, and even improves fertility. So if you have your T3 working, it's really great. But in the inactive form,

often doesn't get converted. And there's a lot of reasons for that into T3. And it can be environmental toxins, it can be stress, it can be lack of certain nutrients. So we'll talk about that like selenium, it can be overgrowth of yeast. So there's a lot of things that affect this conversion. And often we'll see people with inadequate levels of T3. So the main role of thyroid is to stimulate metabolism, and it really affects almost every single function of the body. And it can cause

so many weird, vague symptoms that people don't even often identify it because it's like, oh, I'm a little this, a little that, and you don't really get it. And the main reason it's not diagnosed is that the symptoms aren't specific. You're a little achy, you're a little tired, you gain a little weight, your skin's a little dry, you're losing a little bit of hair, you're maybe sluggish, you have trouble concentrating, you're a little depressed, you know, you're

You're maybe a little cold when everybody else is warm. You get whole hands and feet. You get low libido. You might get a little flu retention. Your cholesterol is a little high. These are really nonspecific symptoms that can be caused by many, many things. But when you add it all together and you look at this list, it's like, oh, I have all that. That's really a clue that you might have thyroid issues. So when we're taking a thyroid quiz, which is really important, we can link to it in the show notes.

gives you a pretty good sense of if you're having a likelihood of having low thyroid. And then you need to do the right testing. Now, the problem is that it's often what we call subclinical. So it might not be full-blown thyroid disease, but in functional medicine, we like to think about how do we get to optimal function, not just...

what's normal. If you look at the normal lab tests, they're often misleading because they're based on a population that may not be healthy. So, you know, the range of, for example, TSH, which is what most doctors look at to check your thyroid, is 0.5 to 5. That's a tenfold range of what's considered normal.

The American College of Endocrinology has lowered the top number to 3.5 or three, but what's optimal might be one or two or, you know, 0.5 to one. So what's really optimal is very different than what's quote normal. And that's why it's often missed. And doctors will often miss it because they just check the TSH and not the whole panel of tests. It gives you a really comprehensive view. If you check TSH, uh,

It could be normal, but you could still be, for example, having an autoimmune thyroid condition, or you could still have a low T3. And doctors will not check that. They'll only check your other numbers if your TSH is abnormal, which is really a bad way to go about it. So I think it's really important to do a comprehensive thyroid panel, which includes TSH, free T3, free T4, and thyroid antibodies, thyroid peroxidase and antithyroglobulin antibodies.

Now, a lot of doctors will check thyroid panel on a lab rec and the old lab recs have very old thyroid panels that use all kinds of antiquated tests, which I still see, unfortunately, like T3 uptake and all these weird things that are not really accurate, given how sensitive these current new tests are for free T3, free T4 and ultra sensitive THH. And also,

If you're really stuck and there's other things going on, there's more advanced tests like thyroid releasing hormone that we can use by using a stimulation test. So we won't get into that, but the key is the basic test should be TSH, free T3, free T4, thyroid antibodies, TPO, and antithyroglam, antithyroglam antibodies.

If you get that whole panel and you can see, for example, cases where there's high antibodies but normal fibroid testing, those people still need to be treated or you'll see a low T3 but normal TSH. So it's really, really important to do a whole panel.

Now let's talk about what causes thyroid problems because why are we seeing so many people with thyroid issues? Is this a genetic defect in human beings? I don't think so. It's really because we are living in a toxic world in many ways. One, environmental toxins are really impactful on the thyroid function. Think of your thyroid as the yellow canary in your body.

The yellow canaries were put in coal mines, and when the canaries died, the coal miners knew the air was bad. They had to get out of the coal mine. So the thyroid is like the yellow canary of the body. Very sensitive to pesticides, heavy metals, environmental toxins of all sorts, which are super abundant. And it's 80,000 of these compounds in the environment. Only 1% have been tested for safety.

They're ubiquitous. The average person is basically a walking toxic waste dump. Dioxin, PCBs, phthalates, DDT, all this stuff is still in us, even though it's been banned. Some of this stuff has been banned. And most of us can handle it, but it's really important to focus on identifying these toxins. Heavy metals are a huge factor, particularly mercury, and a big factor. Also stress. You know, there's a deep connection between your adrenals and your thyroid glands. So people who are overstressed, you know,

by psychological stress, physical stresses, lack of sleep. Those stresses register in the body directly in terms of adrenal function. And when your adrenal function is low,

you often will see a kind of this thyroid function go low. So you're, for example, if you put young soldiers on a forced march, you'll see their thyroid function decrease just because of the stress of an overnight march with carrying a 50 pound pack. And they'll look like they're hypothyroid, even though they're really not. So stresses are a big factor. The other one is gluten.

gluten is a huge factor in about probably 20, 30% of, in my experience, seeing thousands of patients and testing them. Everybody who's got low thyroid or antibodies to thyroid, I check their gluten antibodies too. About 20% to 30% of people who have

low thyroid function can be a result of gluten sensitivity, either celiac disease or non-celiac gluten sensitivity. And it's really important to track because if you keep eating gluten or you keep having mercury, your thyroid is just not going to work.

And this can affect about 10 to 20% of the population. So it's really common in terms of the inflammation in the thyroid. Also, nutrient deficiencies. Thyroid function needs iodine to make the thyroid hormone. You need selenium to convert T3 to 4. You need vitamin D and vitamin A to have it bind on the nucleus to work and do its thing. You need the right omega-3 fats and many other nutrients to help

to optimize thyroid function. So what do you do if you think you might have low thyroid? What steps should you take? Well, first, do the symptoms check. Look at the questionnaire, the link, the things that I just mentioned. You can kind of do a mental checklist or you can fill out the thyroid questionnaire we're going to link to in the show notes. That's the first thing. And if there's some suspicion, you need to get the right tests. And there's a lot of ways to do that.

Right now, you have to ask your doctor. There are labs that are coming online like Function Health where you'll be able to do your own ordering of tests, which is important. But you want the full spectrum, like I said, TSH, free T3, free T4, thyroid antibodies, TPO, and anti-thyroid antibodies. You also want to check for celiac or gluten sensitivity with deaminated anti-glycan antibodies, tissue transglutaminase antibodies. I've

We'll write all this up in the show notes so you can keep track of it. We might also want to do a heavy metal test, look for heavy metals with a

DMSA challenge test to look for urine toxic metals after a six hour collection. There are tests to look at pesticides and chemicals in your body through urine testing. Sometimes I'll do that, but we can all, we're all pretty exposed. You just want to reduce our exposures and you can do that by going to ewg.org and learning about how to reduce your exposures across skincare products, household products, food products.

Vitamin D plays a huge role. If you're vitamin D deficient, you want to see that for sure because by correcting that, it'll help your thyroid work better. You can check for selenium levels. Often there's selenium deficiencies, iodine deficiencies. We can measure that as well. So we do a really close inventory of nutritional status. That's how I kind of evaluate it.

So what do I do to help fix thyroid function? Well, first you deal with all the causes, gluten, stress. I've been microbiome. We didn't really talk much about that, but that can play a role in generating inflammation that causes problems and obviously environmental toxins. And then what do you do to optimize your thyroid function? Well, first thing is eat the right foods that support your thyroid function. My favorite is seaweed. Seaweed is full of iodine, minerals,

It's great for your thyroid. Fish, also great. Sardines, wild salmon, mackerel, herring. Also, fish contains a lot of iodine. Omega-3 fats, which you also get from the same foods. Make sure you get vitamin D. Probably need to supplement. Herring, mackerel are a great source of vitamin D. Mushrooms, like porcini mushrooms, but it's hard to get enough. So sunlight and obviously checking your vitamin D and taking vitamin D.

Also, you can get your vitamin A, which is important for thyroid function from dandelion greens, mustard greens, dark green leafy vegetables, liver, organ meats. Also, if you like that, I do. Also, selenium is super important and that can come from herring, scallops, smelt, which are tiny little fish. Brazil nuts probably are the best source. You get 50 micrograms of per Brazil nut.

So I would make sure you have plenty of those foods. And the things you want to avoid if you're having thyroid function issues, well, I would get off of gluten, dairy, which are inflammatory for most people, and processed soy. If people are eating a lot of processed soy, it can affect thyroid potentially. Also, kale and some of the cruciferous vegetables. If you juice a lot of kale, for example, it can cause a problem. I once read a report of someone who...

I thought of the broccoli family vegetables was good for them. And they ate two pounds of bok choy raw every day. Now, if it's raw, it's worse. So don't eat raw cruciferous vegetables that much. And she went into a hypothyroid coma. So that's an extreme case. But...

If you're juicing raw kale every day, you can get into trouble. And then what should you do in terms of supplements? A good multivitamin that contains selenium, iodine, zinc, vitamin A, and then you might want to add in vitamin D and omega-3 fats. If your adrenals are stressed out from chronic long-term stress, you want to deal with that through regular circadian rhythm, lifestyle management, getting sunlight exposure in the morning for 20 minutes, waking and sleeping at the same time every day.

having meditation practice, yoga, deep breathing, all the lifestyle practices for resetting your adrenals. And then you can use herbs like rhodiola, Siberian ginseng,

various adaptogenic mushrooms. This is really a way to kind of boost your adrenal function. And then if you're stuck, you know, you kind of might need to work with a doctor to optimize what you need in terms of thyroid treatment and adrenal treatment. So if you, let's say you need thyroid replacement, and a lot of people do, sometimes you can get away without it. But if you've done all the things that I just said and your thyroid is still not optimized,

then you need to know what should you take. Now, the traditional approach is everybody should take Synthroid, which is Libothyroxine or T4. And that works for some people, but many people it doesn't. And they'll be partially treated. And if you check the T3, their T4 will be good because you're getting it, but their T3 will be low. And I think it's better to use a bioidentical form of thyroid, which is actually how all the hormones were first developed.

and it might sound kind of weird or gross, but it comes from pig thyroid, porcine thyroid, and it's very similar or almost identical to ours. And it contains T4, T3, something called T2, which is really unusual that people might not know about, which actually helps metabolism and is very important. And so most doctors just assume that the Synthroid will get converted, but it really doesn't because all the pesticides in the environment, the heavy metals, the stress, the food sensitivities,

gluten, you know, deficiencies of nutrients, you know, 100% of us have toxins in our body. So it's better to just take a combination

bioidentical thyroid replacement. Now usually it's armored thyroid. In the old days it wasn't well manufactured and so the dose was variable but now it's really well controlled and a lot of doctors don't like it but I encourage you to think about trying it because it really can help. You need to check your thyroid if you change your thyroid or put yourself on thyroid or take thyroid you need to check it probably about six weeks after you take your your whatever dose you're on and then you can see how it's working and then adjust it.

If you take too much, you want to be careful because you can take too much and that can cause bone loss. It can make you hyper, insomnia, palpitations. So you have to track it. But your thyroid gland is important to understand and take care of, to love and figure out. And it often can be fixed. I had thyroid issues when I was really sick with chronic fatigue, but then it all corrected.

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What are the problems with the traditional way we treat thyroid in America or around the world? Well, I think the first thing that as functional medicine docs we recognize is that we're not asking that question why, right? So we're not looking for that underlying root cause which so often helps us when we're treating our patient because it helps us figure out for them, for that individual person, what do we need to do to help their thyroid work better.

So is it because of a nutritional deficiency? Yeah. We know that we need iodine and selenium and iron and all sorts of good amino acids. Vitamin D. Just to get the thyroid to work on your cell, you need vitamin D to help it actually send the message to your DNA to do what it's supposed to do. Right. And 80% of us are deficient in vitamin D. Yes.

Yes, yes. And so if people aren't eating enough of certain foods, we might see nutritional deficiencies, or maybe if their digestive system is a mess, they're not absorbing their nutrients well. So we have to ask that question, why? Because sometimes that will just help the thyroid work better when we help support it nutritionally. Or maybe it's an autoimmune condition, like you mentioned, Hashimoto's.

And then it gets us thinking of a lot of different things, right? It gets us thinking about, well, why does this person have autoimmunity? Isn't it the most common autoimmune disease? Yeah, it really is. What causes it? Well, you know, the body, when in an autoimmune condition, the body starts to fight itself off, right? So it starts to, it looks at the thyroid gland and says, okay, I'm going to fight you off. I'm going to attack you. And when it attacks the thyroid gland, the thyroid gland doesn't work as well. And so then you get low immunity.

Well, in many cases, you get a low thyroid. So what causes the autoimmune disease is the big question we always ask in functional medicine. That's it. Why? Right. And everybody's different, right? For one person, it may be gluten. We know gluten is associated with a lot of Hashimoto's thyroiditis. Not all, but some. My experience is you look at thyroid antibodies and you compare it with the gluten antibodies in that patient. And my thinking is about 30% of the time, it could be related to gluten. What do you think?

Yeah, I think it could be. It could be. It might even be a little higher. It depends because the patients we're seeing. So we might be seeing more patients who have a lot of different digestive issues going on and so I might see it even a little more frequently. We call that selection bias. People who are sick select to come see us so they have more stuff for sure. But we always think about the digestive system, right? You've got autoimmunity, you've got to think about what's going on in the digestive system.

But then you think about, could there be an overgrowth of bacteria? Certain bacteria in either the digestive system or other parts of the body have been shown to trigger autoimmunity in some people. We know that. We're going to talk about that on another podcast. So stay tuned. We're going to talk about the gut and leaky gut. Okay, we'll do that.

We know that imbalances in iodine, actually excessive amounts of iodine. Can shut down the thyroid. Yeah. Hashimoto's, because it was found first in Japan, where they have lots of iodine. So we know iodine is important for the thyroid, but too little is not good, but too much is also not good. So we pay attention to that.

And toxins, of course, right? Toxins can be triggers for autoimmune disease in some people. Yeah, so they all say that the thyroid is a yellow canary of our body, that the yellow canary was the coal miners to bring the yellow canary into the mine. And if it dropped dead, they knew the air was bad. They had to get out.

Right, so it's an early warning sign and the thyroid is like that and it seems to be extremely sensitive to disruption from heavy metals from pesticides the plastics and everything fluoride Yeah, so yeah, Florida water all these things can disrupt our thyroid function and often your doctor never even looks for them Absolutely, right they say okay, you know, we're just gonna look at the TSH and if it's if it's in the normal range

you're fine or we're going to give you medication to get it in the normal range but not really look a lot deeper. Yeah, so what is the difference in the testing that... Oh, there's one other thing I wanted to bring up which I remember reading about in the New England Journal of Medicine was a lady who thought that bok choy was healthy

And she ate like two pounds of raw bok choy a day and she went into a hypothyroid coma. And people are having kale juice. Talking about goitrogens. Yeah, there's a whole kale craze. It's a great point. And people are juicing it and it's raw. And, you know, raw...

cruciferous vegetables can be a problem. Right. If you're eating a lot of raw broccoli and cabbage and if you're having raw Brussels sprouts or raw, you know, bok choy, kale. And eating it in a level that's beyond just like a normal food portion. Yeah. Right? But as you mentioned, if you cook it, if you cook it, you get rid of a lot of that goitrogenic potential, the part that's going to interfere with thyroid function. Yeah. So you don't have to be concerned when you have cruciferous

cooked cruciferous vegetables but it's that like you said should I worry about having a kale juice every day it's a good question depends how much kale you put in it right well I'd like to drink green juices and most of them have kale a little bit of kale is fine I'm careful about it and it depends on the person of course right yeah right what about soy

So, you know, that's a good question too. You know, I think that if... Because a lot of people are like soy is really bad. It interrupts your thyroid. It's dangerous. You shouldn't eat it. I think if we're going with, you know, non-GMO organic soy as a whole food, like edamame and tofu, then I'm not concerned. Tempeh, right. Yeah, tempeh. I'm not concerned. Yeah, traditional...

soy foods that have been used for centuries, right? Miso, tempeh, tofu, natto, you know, soy sauce. I mean, those are fine. It's, it's, uh, you know, when we're drinking a quart of soy milk a day, that's a problem or,

when you're having all these fake soy foods that are processed or soy burgers and you're eating stuff that's sort of weird, frankenfood. Or like the texturized soy protein that they put in cereals and bars just to get that protein content up. We don't. Yeah, a little wonky. That's stuff I tell people to stay away from. Okay, so you're someone who comes in, you feel tired, you're constantly depressed, your skin's dry, your hair's falling out, you don't have a sex drive anymore, you can't concentrate. Yeah.

You know, and you go to a traditional doctor, they'll just test one thing. What do they test? - Right, so they typically test your TSH. - Okay, so what is that? - Your TSH is your thyroid stimulating hormone, and there's a feedback loop in the body. So if your thyroid level is low, then the body will get triggered to make more TSH. - And that comes from your brain, from your pituitary gland. - Yeah, and then that TSH will say, okay, make more thyroid. So if the TSH is high,

then the doctor says, okay, your thyroid is underactive and we need to treat it. So that's typical. That's the only thing they test.

- Often, often. - And I think you have your functional medicine doctor, a very different approach. - Yeah. - So what kind of thing would you look at? - We always start with a full thyroid panel where you look at TSH, but you look at free T3 and free T4. So free T4 is one thyroid hormone that's floating around in your body, but then the T3 is the active form that your body needs for all the thyroid functions to occur.

So we look at both. We look at all three of those at least. And then we often look at thyroid antibodies. Yeah. And sometimes we'll even do things like reverse T3 and the reverse T3 total T3 ratio. So there's... What does reverse T3 tell you? So the reverse T3 is a thyroid hormone that the body... When the body is...

I always think of it almost as the brake that the body puts on itself. So when the body is saying, okay, I've got to slow myself down, it takes some of its T3, which is your active thyroid hormone, and it converts it to reverse T3, almost in a way to slow down our metabolism. It's a protective

mechanism I think of, right? And it makes sense that we have that in times of stress. A lot of things will actually trigger that that are not actually good, right? That's very true. So like if there was a major stress going on, you'd want to have that mechanism in place so you didn't starve to death. But with a lot of chronic stress, which we see a lot these days, we can sometimes see high reverse T3. And the other thing we see a lot that causes that high reverse T3 is sometimes toxins. So it can be a sign that we've got to look

deeper and say, okay, is this person under a lot of chronic stress? How is their adrenal gland functioning? How are they, are they working to activate that parasympathetic nervous system, that calming nervous system, which helps the body heal. And then we look for toxins. Yeah. Yeah. In the gluten issues, we look

We look for everything that is imbalancing the thyroid. So we look for nutritional deficiency, do you have selenium deficiency, iodine deficiency, are you low in zinc, do you have low omega-3 fats, do you have yeast in your gut, do you have heavy metals, do you have pesticide exposure, toxin exposures? So we take a very detailed history that your traditional doctor would not do to really look at the broad spectrum of what's causing it. Because we can just treat the symptoms of the thyroid, but

Maybe we may not need to do that. And I've seen many patients where you fix these other things and their thyroid gets better. Absolutely. And it's so powerful when you see that. It's like, oh, I don't need to do thyroid. I can actually fix the upstream cause. Yeah. It's pretty impressive when that happens. And the last thing you were talking about was antibodies. So tell us about what antibodies are and why we should look at them and why traditional doctors don't look at them. Yeah.

I'm not sure why they don't look at them enough, but the antibodies are giving us a signal that the body is attacking its own thyroid, and it's a sign that there's autoimmune disease going on in the body. And we've got to figure out that question, you know, why is that? Why is that going on? And, you know, so I had a woman who came in to see me, and she...

She was 40 and she had been struggling with all those symptoms we talked about with low thyroid. You know, she was cold all the time. You know, her hands were cold. She was gaining weight. She was tired. She was constipated. She was losing hair. Her eyebrows were thinning. Sound familiar to anybody? I know, right? So I'm like, okay. But then her primary doctor did her TSH and it was normal.

So we then went deeper. - Can I stop you for a sec? So when I was trained, and I'm sure you were trained the same way, was you only check TSH. If that's normal, then you don't do anything else. And what's normal,

is a range of like 0.5 to 5. Often, yeah. Which is a massive range that actually doesn't reflect even our current understanding on most reference ranges on the lab tests that even the American College of Endocrinologists says if it's over 3.5, we should be worried. Right, and many, many studies are saying people between 1 and 2 feel the best, right? Yeah, right. And I remember, you know,

because I always do all the tests. I don't do reverse T3, but I do TSH, T3, T4, and the thyroid antibodies. Because what I've learned is that even if all those are normal, TSH, T3, T4, you can have elevated antibodies.

Yes. And people who have those feel better when they get on thyroid. Very true. And I went to a conference years ago at Harvard, and it was a traditional medicine conference, and the endocrinologist was talking about thyroid. And he said, look, if your antibodies are elevated, they should be treated because they're probably symptomatic, and you treat the patient, not the lab test. But in traditional medicine now, we're more treating the lab test, not the patient. And I think that's really important. And the physician sometimes thinks, well, I'll just wait until these antibodies damage the thyroid enough, and then I'll treat the patient.

- Right. - Right? That's not the way they, you know. - It's like once the TSA starts to go up. - I'm gonna wait until, but we say, okay, no, there's so much we can do. - 100%. - There's so much we can do right away. - Yeah, I remember this patient came in once with blood sugar like 115 and 126 is diabetes, 100 is prediabetes.

And I'm like, "God, did your doctor say anything about your high blood sugars?" "Oh yeah, he checked it out." "What did he say?" He said, "Well, when it gets to like 126, we'll treat it with medication." And I'm like... - No, this is the perfect time to treat you. - We look at the gut microbiome and the function of the gut almost first and foremost when it comes to autoimmune diseases, because that's where you're gonna find the majority of the triggers.

So the gut is always a key thing to think about because 70% of your immune system is in your gut and if you have an autoimmune disease you have to treat your gut. Yeah, I don't think that there's one person with an autoimmune disease I've treated that hasn't had some gut issue that had to be dealt with that was part of reducing their autoimmune process and getting them into remission. Okay then, wow. And what's really fascinating is that

It just recalls this patient of mine who was about a 40 year old woman who had Graves disease and was struggling and did not want to be on medication long term. Was willing to do whatever it took and she turned out she had real gluten issues, she had terrible gut issues and we did a really, and she had parasites. I mean we did a really aggressive gut repair program and we optimized her health and her vitamin D and we improved her diet and what was amazing was that

Her antibodies for Graves went to zero, her thyroid normalized, and she's completely fine now and off medication, which is just really striking to me because that's something I never learned was possible in medical school. Yeah. And, you know, I've had a case where, again, you get to the root cause and, yeah, was gut a major issue? Sure. Sure.

But in my particular case, it was a woman who's 55 years old. She came with a diagnosis of Graves, like I said, many do. And she just didn't want to do the traditional therapies. So when she came in, she was also menopausal within the last two years. And that was the other main issue with her. And although she had gut issues, she had bloating and distention and constipation, some loose stools.

So with her, one of the things that works, when you want to treat somebody, it's perfectly appropriate to try to understand the mechanism, the pathway of the way the organ works. In this case, thyroid, TPO, thyroid peroxidase is an enzyme that's blocked with a pharmaceutical agent that is very harmful.

Botanical agents can oftentimes, because we get many of our medicines from botanicals, so botanical agents can oftentimes be very effective.

In this particular case, L-carnitine can act as a thyroid peroxidase inhibitor. And so using L-carnitine was one of the first things I did with this particular woman. And before our next follow-up, she was already beginning to have some relief from her symptoms just using L-carnitine. And then because she was menopausal,

estrogen can have an impact on your autoimmune state. So balancing hormones is really important. When you think about hormone replacement, there's always been a concern, particularly with women, about the possible impact on the breast and breast cancer. What I will say is that there are now studies that are showing that early in menopause, using hormone replacement for a short period of time

can have a very beneficial impact on brain aging, there's reduction in Alzheimer, development of Alzheimer's for women who have estrogen early in their menopausal state. -Interesting. -It also reduces

the autoimmune state, because estrogen does play a role in balancing the inflammatory and anti-inflammatory sides of the immune response. So I actually put on a hormone replacement. - I wonder if that's why you see most of the case of autoimmune disease in women. - Yeah, in 40 to 50, 40 to 60 range. So I balanced her hormones, and then of course we worked on her gut microbiome, which is always a critical piece.

Yeah. And, you know, the other thing you did was you got off gluten and you put on an anti-inflammatory diet. Yep. Right. Yep. And you gave her the raw materials for helping her. Yeah. And I, you know, I, yeah. And I think it's really important when we say we work on the gut. You know, we have to remember that when we work on the gut, we have a very...

programmatic approach that can be adopted and adapted to the various conditions people have but it's that 5-R approach you know it's basically let's find out what may be a trigger so there are triggers to you know there are some you know bacterial and parasitic triggers to thyroid autoimmunity one of them happens to be blastocystis hominis which is a parasite

that has been implicated in triggering antibodies that will go after the thyroid. - That's interesting, 'cause that patient that I mentioned, that's what she had, she had this parasite. - Yeah, yeah. - Which we're gonna talk about on another podcast. - Yeah, we are. So when we look at the gut, we're gonna look, and so we're gonna need to, we know we need to look at the gut carefully. - So talk about what is really driving this parasite.

problem and what what is Graves what is hyperthyroidism and what does it do to people how do they feel and how do people know they have it right so hyperthyroidism is when the thyroid gland is producing way too much thyroid hormone that's t3 and t4 level uh and so uh when they're being overproduced

then you're going to have symptoms that are going to cause you to lose weight, feel sweaty, have palpitations, be anxious, have thinning hair, lose your hair, have thinning nails.

Graves disease happens to be the most common, it's about 60-70% of people with hyperthyroidism are Graves. It happens to about 1 in 200 people, women more than men, 10 to 1. And it usually peaks around in the ages of 40 to 60 years old, but it can happen younger. So that's like the overview of Graves disease. -Now, the most, as you said... -What are the symptoms? The symptoms?

are some of the ones I just mentioned, which are going to be weight loss, sweating, thinning nails, hair loss, thinning skin, palpitations. When it gets really bad. Diarrhea, atrial fib. Yep. And when it gets really bad, you can have heart failure, you can have hormone imbalance, and you can have anemia.

-And insomnia, people can't sleep. I had a friend call me who was like, "I can't sleep, I don't know what's wrong." And we get through our history, he's like, "I lost 20 pounds and I wasn't trying." I'm like, "Oh, okay." And she had graves. -Yeah, so most people, as you said, have hypothyroidism. It's less common, I think 1% of thyroid disease or 2% is hyperthyroidism and graves is the most common.

But when you have it, it can be really debilitating and it can be really hard to treat. And as you said earlier, in conventional medicine, the treatments haven't changed in 50 years and they're quite harsh. And functional medicine really gives us a great opportunity to get to the root causes of what triggers graves and allows us to then

treat our patients in ways that make sense for the biology and their life environment. - Yeah, so it's really, you know, the symptoms can be quite dramatic for people, right? - Absolutely. - That we went through. And like as you mentioned, some of the complications are serious. It's not just about having a racing heart or insomnia or diarrhea.

You can get eye damage, so your eyes can bug out of your head. Right. You can get heart failure, right? Yeah, that can happen. And the reason why that happens, and I think we're going to have to just jump right into this part of it, is the autoimmune process. Graves is an autoimmune disorder, just like Hashimoto's, which causes hypothyroidism.

And so you can't get away from talking about thyroid disease without talking about our immune system, autoimmunity, why we have it, why it's getting worse, and what some of the major triggers are.

So the eye disease is actually antibodies that are being made against your thyroid. They're called thyroid stimulating hormone receptor antibodies or T-RABS. And they're made specifically against the receptors on the thyroid. So when those antibodies hit those receptors, it doesn't destroy those receptors. It actually triggers them to make more thyroid hormone.

But we have, it's a very nonspecific interaction. And those antibodies can also trigger like antigens in other parts of the body. They happen to be in the eye where there are thyroid stimulating receptors and also in the lower extremities. So you can get the deposition of all these antibodies in the eye that cause the Graves-Opthalmogenesis.

Graves Eye Disease, and also Pretibial Myxedema. -And that's because... -That's like fluid retention in your legs. In your legs where you get a destruction of the tissue underneath the skin of the tibia or your shin. And you can see it gets thickened and fluid filled, and it's not nice looking, and it's not nice feeling. So those are the things that are the hallmarks of Graves.

And they're all related to that autoimmune antibody response. What's interesting also is that autoimmune diseases often come in clusters. And with Graves, you see people often with other autoimmune diseases, right? You do. Like what? So some of the other autoimmune diseases can be...

You can actually get Hashimoto's. Hashimoto's is one of the other autoimmune diseases. -You can have low and high at the same time? -You can. You can definitely have that. You can have diabetes, which is an autoimmune disease. -Type 1 diabetes. -Type 1 diabetes. -Vitiligo, right? -Vitiligo is a common one. -It's where you lose all the pigment in your skin. -Yep. -Anemia and autoimmune things like arthritis, rheumatoid arthritis, lupus, right? -Yep. -And then what's interesting is also celiac disease.

Well, there's a link between celiac disease because gluten is a huge trigger for autoimmunity, particularly creating antibodies against the thyroid. Okay, so that's kind of a good overview of the prevalence of it, what the symptoms are, what the complications are. It's often not that hard to diagnose. When people are that sick, you can kind of tell. But it's subtle sometimes.

What tests do doctors do to find out traditionally whether you have it? Yeah, so... And we're going to get to what are the tests you do in functional medicine that are quite different. So yeah, so the traditional test, how you find it is looking first at your thyroid function. So you're going to be looking at somebody...

The key thing is the clinical symptoms, right? It's not always tests. People come in and they have symptoms. Then you have to start to use your medical cognition and everything you know about medicine to figure out, "Okay, what do I think is going on?" Well, once you realize what the symptoms are, then you start to understand, "This is the thyroid." So you're going to look at the thyroid and you're looking at what we call the TSH, which is a thyroid stimulating hormone.

And if that's really, really low, that means that the thyroid is producing way too much thyroid hormone and your pituitary gland is being suppressed so it doesn't make enough of this thyroid stimulating hormone. Let me just back up for a second. Your pituitary gland drives your thyroid. Yeah. And it sends a signal to the thyroid. It's called the thyroid stimulating hormone.

So your thyroid- TSH. Yeah, TSH. And so your thyroid is sort of lazy. And so it has to be reminded to work. So the pituitary's responsibility is to send out this signal all the time. So you're going to have this certain normal level of TSH reminding the thyroid to work. And as long as it's doing its job and nothing's impairing it from doing its job, then it's going to function great and it's going to make thyroid hormone.

T4 and T3. T4 and T3 go to the cells. Now, T3 is the active form of thyroid hormone. And inside the cell, T4 gets converted to T3. Then it goes into the nucleus where it causes the DNA to start to transcribe and make enzymes and proteins that upregulate metabolism. And that's exactly what it's supposed to do.

Now, if you don't make enough thyroid hormone, then you're going to experience hypothyroidism and a slowdown of your metabolism. And if you make too much, you're going to have an uptick in your metabolism and everything that goes along with that, and that's called hyperthyroidism. So, what happens is... - And what are the tests? - So, the tests. So, when we go for the test,

the TSH is going to be suppressed if the thyroid is making too much. The pituitary is going to stop sending the signal. - So the feedback system tells your TSH shut off and then the other hormones go up. - It's a negative feedback loop. - But there's also antibodies we check, right? - Right, so now we're going to, so once you realize they have hyperthyroidism, then you want to check for antibodies. And the main one you check for is thyroid stimulating hormone receptor antibodies.

And if those are positive, it's 99% sensitivity and specificity for Graves' disease. That's the main test. There's also a radioactive iodine test, right? Yeah. So after you do that, you can do a radioactive uptake to see if the person has maybe some other reason for having that hyperthyroidism, which can be an adenoma or multi-nodular toxicoid.

And so what do doctors, once people are diagnosed with this, what are the treatments? Because it seems like they haven't really changed much since 40 years since I graduated medical school. Yeah, they haven't changed much and they're pretty harsh. And, you know, one, you know, so there's methimazole, which is basically a thyroid peroxidase drug.

enzyme inhibitor, thyroid peroxidase is the enzyme that the thyroid uses to bind iodine together to make thyroid hormone. And so it blocks that. And so you just reduce the production. Methimazole can have some significant... And polythiourasol, PTU, particularly can have some very impactful side effects, like hepatic toxicity.

So, and you're going to be on them for 18 months, up to 18 months to get into remission. And so they're not, they're not really, they can be harsh and they can have lots of adverse reactions. And a lot of, most of the people that I see in the ultra wellness center, they come to me with graves. I don't have to make the diagnosis. They come. And the reason why they come is they don't want to be on methamazole.

and they don't want to have iodine. The next therapy is radioactive iodine destruction of the thyroid. - Basically nukes your thyroid gland. - Yeah, basically nukes it. So you're gonna get I-131, which is iodine tagged with, you know,

a radioactive molecule and when that is iodine so now this radioactive material gets absorbed into the thyroid that's going to wants to use that iodine but then that radioactive material breaks down to xenon and xenon destroys the thyroid or parts of it and reduces the production of thyroid hormone again

Pretty harsh. You're radioactive. And you can't breastfeed. You can't be around kids. You can't touch people. Not your whole life. It can be up to two weeks of the treatment. And then finally, there's just take the thyroid out. So basically like nuke it, take it out, or poison it.

- Yeah, poison it, nuke it, or rip it out. - Okay, well, I mean, sometimes that's necessary just to deal with symptoms, or people can use beta blockers if their heart's racing and so on. - Which is perfectly fine. - Which is okay, but the question is how do we deal with this in functional medicine that's different? And at the Ultralisks, how do we think about this condition? - This gets into the testing we do in functional medicine. So one of the first tests I do is a stool analysis.

And that stool analysis is not only going to tell me about the balance of good bacteria, which are your commensals, and your bad bacteria. I always say that those are the bacteria that realize that poop's a great party, great place to live, and they come and hang out, but they may not do anything for you.

unless you have a really bad diet, you're under too much stress, you're not taking care of your gut microbiome, you're eating processed foods and sugars, you're eating lots of GMO foods that have lots of glyphosate on them, and your microbiome is disordered, now all of a sudden, those hanger-on-ers are now gonna just, they're just gonna multiply, and they're gonna push your good bacteria out. And when that happens,

then the good bacteria can't modulate your immune system, can't help you, doesn't make the compounds that you need. As we know, 70 to 90% of your serotonin is actually made by bacteria in your gut.

You need to rebalance that. So we're really careful about doing that. We want to know not only that balance, but how's your digestive system working? One of the things that allows the gut microbiome to go into this disorder is you're not making enough gastric acids. You're under too much stress.

When you're under stress, then your flight response takes over and suddenly you don't want to have an appetite when you're running away from the bear. So your appetite goes down, you start making less gastric acid. And when you're under chronic stress, this chronic loss of gastric acid allows bacteria and parasites and viruses to get into your intestinal tract where they can wreak havoc.

That's another reason to worry about stress is more parasites, right? More parasites. Stress brings it all on. So we really work on the gut. Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at DrMarkHyman. And we'll see you next time on The Doctor's Pharmacy.

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