Is Your Thyroid the Hidden Root Cause of Your Health Issues?

Mark Hyman, MD

Full Transcript

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Dr. Mark Hyman 
Coming up on this episode of The Doctor's Farmacy. But at your thyroid gland, it's important to understand and take care of, to love, and figure out. Often, it can be fixed. I had thyroid issues when I was really sick with chronic fatigue, but then it all corrected. Before we jump into today's episode, I'd like to note that while I wish I could help everyone via my personal practice, there's simply not enough time for me to do this at this scale.

And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out function health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, Hyman Hive. And if you're looking for curated and trusted supplements and health products for your routine, visit my website, supplement store, for a summary of my favorite and tested products. Hi.

I'm doctor 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 Doctor's 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 jump right in.

What is a thyroid function? What is your thyroid gland? It's a subtle gland in your throat. And it's the think of it as your overall metabolic regulator. It really controls everything.

It's like your motor. It's like, know, in terms of the RPM on your engine. So you know some some, things like a golf cart or something have a governor and you can only go so fast. It's 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 it 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 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 t 4. That has to get converted in your body to the active hormone, which is t 3. Now t 3 is only about 7% of your hormone, 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 message you needed, your to your DNA to turn up your metabolism. There's not fat burning in your mitochondria to basically get all systems go. And if if you have, a good t three level, your your cholesterol's in check, your memory's good, your metabolism's good, you stay thin, it helps your hair grow, it helps your muscles, prevents muscle aches, constipation, and even, you know, improves fertility. So if you have your t three working, it's really great.

But the inactive form often doesn't get converted, and there's a lot of reasons for that into t three. 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 and often we'll see people with inadequate levels of t 3. 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, little that, and and you don't really really get it.

So and the main reason it's not diagnosed is that is that they're the symptoms aren't specific. Oh, you're a little achy, you're a little tired, you gained a little weight, your skin's a little dry, Lose 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, you know, everybody else is warm. You get whole hands and feet. You get, you know, low libido. You might get a little flu retention, your cholesterol's 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 feel like, oh, I have all that. You know? Like, 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 now the problem is that it's often what we'll call subclinical.

So it may not be full blown thyroid disease, but, you know, 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, with a 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 3.

But what's optimal might be 1 or 2 or, you know, 0.5 to 1. 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 to give you a really comprehensive view. If you just check TSH, it could be normal, but you could still be, for example, having an autoimmune thyroid condition, or you could still have a low t three, and doctors will not check that. They'll only check your other numbers if your TSH is abnormal, which is really a a bad way to go about it.

So I think it's really important to a comprehensive thyroid panel, which includes TSH, free t 3, free t 4, and thyroid antibodies, thyroid peroxidase and antithyroglago antibodies. Now a lot of doctors will check thyroid panel on an lab rec, and the old lab recs have a very old thyroid panels that use all kinds of antiquated tests, which I still see, unfortunately, like t 3 uptake and all these weird things that are not really accurate, given how sensitive these current new tests are for free t 3, free t 4, and ultra sensitive THH. And also, you know, 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 t three, free t four, thyroid antibodies, TPO, and anti thyroid gland anti thyroid gland antibodies. If you get that whole panel, and I and you can see for example cases where there's high antibodies but normal thyroid testing, those people still need to be treated or you'll see a low t three but normal TSH.

So it's really really important to do a whole panel. Now let's talk about what causes thyroid problems because, now 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 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 your thyroid as a 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 there's 80,000 yeast 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 and a big factor. Also stress, you know, there's a deep connection between your adrenals and your thyroid gland. 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 you're you 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 £50 pack. And they look like they're hypothyroid even though they're really not. So stress is a big factor. The other one is gluten.

Gluten is a huge factor in in, about probably 20, 30 percent in my experience. I don't I've seen, you know, thousands of patients and testing them. Everybody'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, their celiac disease or non celiac gluten sensitivity.

And it's really important to track because if you keep eating gluten, like you or you keep having mercury, your thyroid's just not gonna work. And this can affect, about 10 to 20% of the population. So it's really common, in terms of of the inflammation in the thyroid. Also nutrient deficiencies. You know, thyroid function needs, you know, iodine to make the thyroid hormone.

You need selenium to convert t 3 to 4. You need vitamin d and vitamin a to have it bind in the nucleus to work and do its thing. You need the right omega 3 fats, and and many other nutrients to help optimize thyroid function. So, what 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 gonna 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 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 t three, free t four, thyroid antibodies, TPO, and anti thioclonal antibodies.

You also wanna check for celiac with with or gluten sensitivity with deaminated gly antiglyden antibodies, tissue transglutaminase antibodies. We'll write all this up in the show notes to 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 6 hour collection. There are tests to look at pesticides and chemicals in your body through urine testing.

Sometimes they'll do that, but we can all we're all pretty exposed. We just wanna reduce our exposures, And you can do that by going to ewg.org and learning about how to reduce your exposures across skin care products, household products, food products. Vitamin d plays a huge role. If you're vitamin d deficient, you wanna see, that for sure because by correcting that, it'll help your thyroid work better. You can check for selenium levels.

Often when there's selenium deficiencies, iodine deficiencies, we can measure that as well. So we do a really close inventory of nutritional status. So 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, other microbiome.

We didn't really talk much about that, but that can play a role in generating inflammation that causes problems, and and obviously environmental toxins. And then what what do you do to optimize your thyroid function? Well, first thing is get eat 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. You You know, 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 is a tiny little fish. Brazil nuts probably are the best source. You get 50 micrograms of per Brazil nut. So I would I would I would make sure you have plenty of those foods. And the things you wanna 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 if you juice a lot of kale, for example, it can cause a problem. I I once read a report of someone who who thought of the broccoli family vegetables was good for them, and they ate 2 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 and she went into a hypothyroid coma. So that's an extreme case, but if you're juicing Rock Hill every day, you can get into trouble. Then what should you do in terms of supplements? A good multivitamin that contains selenium, iodine, zinc, vitamin a, and then you might wanna add in vitamin d and omega 3 fats.

If your adrenals are stressed out from chronic lung from stress, you wanna 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 kinda boost your your adrenal function. And then if you're stuck, you know, you kinda might need to work with a 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 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 Levothyroxine 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 t 3, their t 4 will be good because they're getting it, but their t 3 will be low.

And I think it's better to use a bio identical form of of thyroid which is, actually how all the hormones were first developed. And and it may sound kinda weird or gross, but it comes from pig thyroid, porcine thyroid. And it's very similar or almost identical to ours. And it contains t 4, t 3, something called t 2, which is really unusual if you might not know about, which actually helps metabolism and is very important. And and so most doctors just just assume that the 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, a 100% of us have toxins in our body. So it's better to just take a combination bio identical thyroid replacement. And that usually is Armour 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 6 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 wanna be careful because you can take too much and that can cause bone loss. It can make you, you know, hyperinsomnia, 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's and it and it's It often can be fixed. I had thyroid issues when I was really sick with chronic fatigue, but then it all corrected. What are the problems with the traditional way we treat thyroid in in America Well, I think

Dr. Elizabeth Boham
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.

Dr. Mark Hyman
Vitamin d. Just to get 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. So And and 80% of us are deficient in vitamin d.

Dr. Elizabeth Boham
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 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?

Dr. Mark Hyman
Isn't it the most common autoimmune disease? Yeah.

Dr. Elizabeth Boham
It really is.

Dr. Mark Hyman
What causes it?

Dr. Elizabeth Boham
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 gonna fight you off. I'm gonna attack you.

And when it attacks the thyroid gland, the thyroid gland doesn't work as well.

Dr. Mark Hyman
Yeah.

Dr. Elizabeth Boham
And so then you get low well, in many cases, you get a low thyroid. So what causes the autoimmune disease is the big question. Yeah. We always ask in functional medicine.

Dr. Mark Hyman
That's it. Why?

Dr. Elizabeth Boham
Right. And and everybody's different. Right? For one person, it may be gluten. We know gluten, is associated with a lot of Hashimoto's thyroiditis.

Yeah. Not all, but some.

Dr. Mark Hyman
Right? My experience, like, you look at thyroid antibodies and you compare it with the gluten antibodies in that patient, and it's about my thing is about 30% of the time, it could be related to gluten. What do you think?

Dr. Elizabeth Boham
Yeah. I think it could be. It could be. It might even be a little higher. Yeah.

For but it depends because of 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

Dr. Mark Hyman
You call that selection bias.

Dr. Elizabeth Boham
Yeah.

Dr. Mark Hyman
We're seeing select to come see us so they have more stuff for sure.

Dr. Elizabeth Boham
But 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 a 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. Yeah. We know that We're

Dr. Mark Hyman
gonna talk about that on another podcast. So stay tuned. We're talking about the gut and leaky gut.

Dr. Elizabeth Boham
Okay. We'll do that. We know that imbalances in in in iodine actually, excessive amounts of iodine

Dr. Mark Hyman
Can shut down the thyroid.

Dr. Elizabeth Boham
Yeah. Yeah. So, you know, some Hashimoto's because it's it's you know, it was found first in Japan where they have lots of iodine. So, you know, we we we know iodine's 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. Yeah. Right? Toxins can be triggers for autoimmune disease in some people.

Dr. Mark Hyman
Yeah. So I will say that, you know, the thyroid is a yellow canary of our body. Mhmm. That that the yellow canary was the coal miner who was bringing the yellow canary into the mine. And if it dropped dead, they knew the air was bad.

They had to get out. Yes. Right? So it was 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.

Dr. Elizabeth Boham
Yep. Fluoride. Fluoride.

Dr. Mark Hyman
Yeah. So, yeah, fluoride, the water. All these things can disrupt our thyroid function, and often your doctor never even looks for them.

Dr. Elizabeth Boham
Absolutely. Right? They say, okay. You know, we we're just gonna look at the TSH.

Dr. Mark Hyman
And if it's if

Dr. Elizabeth Boham
it's in the normal range, you're fine. Or we're gonna give you medication to get it in the normal range, but not really look a lot deeper. Yeah. So what, what is the difference in in

Dr. Mark Hyman
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, £2 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. That's a

Dr. Elizabeth Boham
great point.

Dr. Mark Hyman
And, people are juicing it, and it's raw and Yep. You know, raw cruciferous vegetables can be a problem.

Dr. Elizabeth Boham
If you're

Dr. Mark Hyman
eating a lot of raw broccoli and cabbage and if you're having raw brussels sprouts or raw, you know, ponchos, kale

Dr. Elizabeth Boham
Eating it in a level that's beyond just, like, a normal food portion. Yeah. Right? But but as you mentioned, if you cook it if you cook it, you get rid of a lot of that goitrogenic potential, that the part that's gonna dam or interfere with thyroid function.

Dr. Mark Hyman
Yeah.

Dr. Elizabeth Boham
So you don't have to be concerned when you have cooked cruciferous vegetables. But it's that, like you said, juice

Dr. Mark Hyman
having a kale juice every day?

Dr. Elizabeth Boham
It's a good question. Depends how much kale you put in it.

Dr. Mark Hyman
Right? Well, I'd I'd like to drink green juices, and most of them have kale. But A

Dr. Elizabeth Boham
little bit of kale is

Dr. Mark Hyman
fine. Careful about it.

Dr. Elizabeth Boham
So And and it depends on the person, of course. Right?

Dr. Mark Hyman
Yeah. Right?

Dr. Elizabeth Boham
You're an infant.

Dr. Mark Hyman
What about soy?

Dr. Elizabeth Boham
So, you know, that's a good question too. You know? I I think that if if

Dr. Mark Hyman
because a lot of people are like, soy is really bad. It interrupts your thyroid. It's dangerous. You shouldn't eat it.

Dr. Elizabeth Boham
I think if we're going with, you know, non GMO organic soy as a whole food, like edamame and tofu, then I'm and I'm not concerned. Yeah. Tempeh. I'm not concerned.

Dr. Mark Hyman
Yeah. Traditional soy foods that have been used for centuries. Right? Miso, tempeh, tofu

Dr. Elizabeth Boham
The fermented soy too. Right? Yep.

Dr. Mark Hyman
You know, soy sauce. I mean, those are fine. Mhmm. It's it's, you know, when we're, you know, drinking a, you know, 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

Dr. Elizabeth Boham
Yep.

Dr. Mark Hyman
Stuff that's sort of weird Frankenfoods?

Dr. Elizabeth Boham
Or like the the texturized soy protein that they put in cereals and bars just to get that protein content up. We, you know, we don't

Dr. Mark Hyman
Yeah.

Dr. Elizabeth Boham
A little long. That's stuff I yeah. I tell people to stay away from.

Dr. Mark Hyman
Okay. So you're you're someone who comes in, you feel tired, you're constipated, a little depressed, your skin's dry, your hair's falling out, you don't have any sex drive anymore, you can't concentrate, You know? And you go to a traditional doctor. They'll just test one thing. What do they test?

Dr. Elizabeth Boham
Right. So they typically test your TSH.

Dr. Mark Hyman
Okay. So what is that?

Dr. Elizabeth Boham
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.

Dr. Mark Hyman
And that comes from your brain, from your pituitary gland.

Dr. Elizabeth Boham
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 just taking us Often.

Dr. Mark Hyman
And and I think you have your functional medicine doctor. It's a very different approach. Yeah. So what what kind of things

Dr. Elizabeth Boham
do you look at? We we always we always start with a full thyroid panel where you look at TSH, but you look at free t 3 and free t 4. So so free t 4 is 1 thyroid that, hormone that's floating around in your body, but then the the t three is the active form that you wanna that your body needs for all the thyroid functions to occur. So we look at both we look at all 3 of those at least, And we often look at thyroid antibodies Yeah. And sometimes we'll even do things like reverse t 3 and the the reverse t three, total t three ratio.

So there's

Dr. Mark Hyman
What does reverse t three tell you?

Dr. Elizabeth Boham
So the reverse t three is a thyroid hormone that the body when the body is it's it's I always think of it almost as the break that the break yeah. That the the body puts on itself. So when the body is saying, okay. I've gotta slow myself down. It takes some of its t 3, which is your active thyroid hormone, and it converts it to reverse t 3, almost in a way to slow down our metabolism.

It's a protective mechanism, I think of. Right? Yeah. And and it makes sense that we have that in times of stress.

Dr. Mark Hyman
Trigger that that are not actually good. Right?

Dr. Elizabeth Boham
That's very true. So, like, if there's a you know, if there was a major stress going on, you'd wanna 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 Mhmm. We can sometimes see high reverse t 3. And the other thing we see a lot that causes that high reverse t 3 is sometimes toxins.

Yeah. Toxins. Be a sign that we've gotta look deeper and say, okay. Is this person under a lot of chronic stress? How is their adrenal gland functioning?

Dr. Mark Hyman
How

Dr. Elizabeth Boham
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.

Dr. Mark Hyman
Yeah. Yeah. In the gluten issues. We look we look for everything that is is in balancing the thyroid. So 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 Right. To really look at the broad spectrum of what's causing it because we could 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.

Dr. Elizabeth Boham
Absolutely.

Dr. Mark Hyman
And 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.

Dr. Elizabeth Boham
Yeah. That's pretty impressive when that happens.

Dr. Mark Hyman
And the last thing you were talking about was antibodies. So Mhmm. Tell us about what antibodies are and why we should look at them and why the traditional doctors don't look at them.

Dr. Elizabeth Boham
I'm not sure why they don't look at them at an at them enough, but the the antibodies are were 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?

Yeah. And 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.

Dr. Mark Hyman
Sounds familiar to anybody?

Dr. Elizabeth Boham
I know. Right? So I'm like, okay. But then her her primary doctor did her TSH, and it was normal. So we then went deeper.

And we

Dr. Mark Hyman
said Can I stop you for a sec? Yeah. 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

Dr. Elizabeth Boham
Often. Yeah.

Dr. Mark Hyman
Which is a massive range Mhmm. 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 3a half, we should be worried.

Dr. Elizabeth Boham
Right. And many many studies are saying people between 12 feel the best. Right?

Dr. Mark Hyman
Right. And and I remember, you know, because I always do all the tests. I don't do reverse t 3, but I do TSH, t 3, t 4, and the thyroid antibodies. Yep. Because what I've learned is that even if all those are normal, TSH, t 3, t 4, you can have elevated antibodies.

Dr. Elizabeth Boham
Yes.

Dr. Mark Hyman
And people who have those feel better when they get on thyroid.

Dr. Elizabeth Boham
Very true.

Dr. Mark Hyman
And I went to a conference years ago at Harvard and I, you know, 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 Yeah. Traditional medicine now we're more treating the lab test, not the patient. And I think that's really important.

Dr. Elizabeth Boham
And and and the and the physician sometimes thinks, well, I'll just wait until these antibodies damage the thyroid enough, and then I'll treat. Right. Right? That's not the way they you know?

Dr. Mark Hyman
It's like once the TSL starts to go up

Dr. Elizabeth Boham
I'm gonna wait until but we say, okay. No. There's so much we can do.

Dr. Mark Hyman
A 100%.

Dr. Elizabeth Boham
There's so much we can do right away. Yeah.

Dr. Mark Hyman
I remember this patient came in once with blood sugar, like, 115 and 126 is diabetes, 100 is prediabetes. And I'm like, god. You know your did your doctor say anything about your high blood sugars? Oh, yeah. He checked it out.

I well, what did he say? He said, well, when it gets to, like, 126, we'll treat it with medication.

Dr. Elizabeth Boham
Yeah. That's what I'm like. No. This is the perfect time to treat you.

Dr. George Papanicolaou
We look at the gut microbiome and and and the function of the the gut, almost 1st and foremost when it comes to autoimmune diseases because that's where you're gonna find the majority of the triggers.

Dr. Mark Hyman
So the gut is always a cute thing to think about because 70% of your immune system's in your gut. And if you have an autoimmune disease, you have to treat

Dr. George Papanicolaou
your gut. Yeah. I don't think that there's one person with an autoimmune disease I've treated that hasn't had hasn't had some gut issue, that had to be dealt with that that was part of reducing their autoimmune process and getting them into remission.

Dr. Mark Hyman
Okay then. Wow. And 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 wanna be on medication long term, and was willing to do whatever it took. And she 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.

Dr. George Papanicolaou
Yeah.

Dr. Mark Hyman
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 0. 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.

Dr. George Papanicolaou
Yeah. And, you know, you know, I've had a case where, again, you get to the root cause. And yeah, was gut a major issue? 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 wanna, you know, do the traditional therapies. So when she came in, she was also menopausal within the last 2 years, and she, that was the main the other main issue with her. So, in all, oh, she had gut issues. She had bloating and distension and constipation and loose stools.

So with her, you know, one of the things that works, and I you know, when you wanna treat somebody, you're it's perfectly appropriate to try to understand that the the mechanism, the pathway of the way the organ works. In this case, thyroid, TPO, thyroid peroxidase antibody 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.

Wow. And so using L Carnitine was one of the first things I did with this particular woman. Mhmm. And she, you know, 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. You know, 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.

Dr. Mark Hyman
It

Dr. George Papanicolaou
also reduces, the the autoimmune state and because estrogen does play a role in balancing the inflammatory and anti inflammatory sides of the immune response.

Dr. Mark Hyman
Yeah.

Dr. George Papanicolaou
So I actually put her

Dr. Mark Hyman
on the replacement you see most of the case of autoimmune disease in women.

Dr. George Papanicolaou
Yeah. And and 40 to 50, you know, 40 to 60 range. So I balanced her hormones. And then, of course, you know, we worked on her gut microbiome, which is always a critical piece.

Dr. Mark Hyman
Yeah. And and, you know, the other thing you did was you got her off gluten and you put her on an anti inflammatory diet. Yep. Right?

Dr. George Papanicolaou
Yep.

Dr. Mark Hyman
And you gave her the raw materials for helping her thyroid.

Dr. George Papanicolaou
And I, you know, I that's right. Yeah. And I think it's really important when we say we work on the gut. Now 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, you know, has been implicated in triggering antibodies that will go after the thyroid.

Dr. Mark Hyman
So That's interesting because that patient that I mentioned, that's what she had. She had this parasite.

Dr. George Papanicolaou
Yeah. Yeah.

Dr. Mark Hyman
Which we're gonna talk about on another podcast.

Dr. George Papanicolaou
Yeah. We are. So, so when we look at the gut, we're gonna look at it. So we're gonna need to we know we need to look at the gut carefully.

Dr. Mark Hyman
So talk about, you know, what is really driving this this this this problem. And what what is Graves? What is hyperthyroidism? And what does it do to How do they feel? And how do people know they have it?

Dr. George Papanicolaou
Right. So hyperthyroidism is when the thyroid gland is producing way too much thyroid hormone. That's T3 and T4. And so 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 to 70 percent of people with hyperthyroidism are Graves'. It happens to about 1 in 200 people, men more than 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.

Dr. Mark Hyman
So

Dr. George Papanicolaou
that's like the the overview of Graves' disease. Now there the most likely as you say

Dr. Mark Hyman
What are the symptoms?

Dr. George Papanicolaou
The symptoms are some of the ones I just mentioned, which are gonna be weight loss, sweating, thinning, thinning nails, hair loss, thin skin, palpitations. When it gets really bad. Dietria,

Dr. Mark Hyman
atrial fib.

Dr. George Papanicolaou
Yep. And when it gets really bad, you can have heart failure. You can have hormone imbalance, and you can have anemia.

Dr. Mark Hyman
Yeah. Those

Dr. George Papanicolaou
are some those are the

Dr. Mark Hyman
things that And insomnia, people can't I had a friend I had a friend call me who was like, I can't sleep. I know what's wrong. Yeah. And, we get through our history. It's like, and I lost £20 and I wasn't trying.

I'm oh, okay.

Dr. George Papanicolaou
Yeah. You know, and and it could be yeah. So most people, as you said, have hypothyroidism. It's less common. I think 1% of thyroid disease or 2% is is hyperthyroidism in 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. The symptoms

Dr. Mark Hyman
can be quite dramatic for people, right, 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. Your eyes can bug out of your head.

Dr. George Papanicolaou
Right. So the You

Dr. Mark Hyman
get heart failure. Right?

Dr. George Papanicolaou
Yeah. Yeah. That that can happen. And, you know, the reason why that happens, and and I think this we're gonna get 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 the autoimmune you know, 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 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 trigger 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 could also trigger like anti 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 that, the Graves' eye disease, and also pre pre tibial myxedema. And that's because That's

Dr. Mark Hyman
like fluid retention.

Dr. George Papanicolaou
Fluid retention in your legs where you get a destruction of the tissue underneath the, the of the tissue underneath the, the the the skin of the the tibia or your your shin. And you can see it gets thickened and fluid filled. And it's it's not nice looking and it's not nice feeling. So those are the things that are the hallmarks of Graves. Yeah.

And they're all related to that autoimmune antibody response.

Dr. Mark Hyman
Mhmm. What's interesting also is that, you know, autoimmune diseases often come in clusters. And with Graves, you see people often with other autoimmune diseases. Right? Like You do.

Like what? So some

Dr. George Papanicolaou
of the other autoimmune diseases, can be, you can actually get Hashimoto's. Hashimoto's is one of the other autoimmune diseases.

Dr. Mark Hyman
You can have low and high at the same time?

Dr. George Papanicolaou
You can. You can definitely have that. You can have diabetes, which is an autoimmune disease.

Dr. Mark Hyman
Type 1 diabetes.

Dr. George Papanicolaou
Type 1 diabetes.

Dr. Mark Hyman
Vitiligo, right? That's where you're looking at.

Dr. George Papanicolaou
Vitiligo is a common one.

Dr. Mark Hyman
In your skin. Yep. Anemia and and autoimmune things like arthritis, rheumatoid arthritis, lupus. Right?

Dr. George Papanicolaou
Yep.

Dr. Mark Hyman
And then and then and then what's interesting is also celiac disease. So

Dr. George Papanicolaou
There's a well, there's a link between celiac disease because gluten is a is a huge trigger for autoimmunity, particularly creating antibodies against the thyroid.

Dr. Mark Hyman
Okay. So so so that's a kind of a good overview of the prevalence of it, what the symptoms are Mhmm. Complications are. And you sort of it's not it's often not that hard to diagnose when people are that sick, you can kinda tell. No.

But it's subtle sometimes. What tests do doctors do to find out traditionally whether you have it?

Dr. George Papanicolaou
Yeah. So we did the

Dr. Mark Hyman
And we're gonna get to what are the tests we do in functional medicine that are quite different to us.

Dr. George Papanicolaou
So yeah. So the traditional test that you how you find it is looking first at your thyroid function. So you're gonna be looking at somebody. The key thing is is the clinical symptoms. Right?

It's not always tests. It's people come in and they have symptoms. Then you have to start to use your your medical, you know, 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, you know, this is the thyroid. So you're gonna look at the thyroid, and you're looking at what we call the TSH, which is the thyroid stimulating hormone.

And if that's really, really low, that means that your the the thyroid is is producing way too much thyroid hormone, and it's and your your pituitary gland is being suppressed, so it doesn't make enough of this thyroid stimulating hormone. Just 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 it has to be reminded to work.

So the pituitary's responsibility is to send out this signal all the time. So you're gonna have a

Dr. Mark Hyman
certain

Dr. George Papanicolaou
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 gonna function great, and it's gonna make thyroid hormone, t 4 and t 3. T 4 and t 3 go to the cells. Now t 3 is the active form of thyroid hormone. And inside the cell, t 4 gets converted to t 3, 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 gonna experience hypothyroidism and a slowdown of your metabolism. And if you make too much, you're gonna have a uptick in your metabolism and everything that goes along with that, and that's called hyperthyroidism. So what happens is

Dr. Mark Hyman
And what are the tests? Oh, we're gonna go through that.

Dr. George Papanicolaou
So the test. So when we go for the test, the TSH is gonna be suppressed if the thyroid is making too much. The pituitary is gonna

Dr. Mark Hyman
stop that. System tells your GSA shut off and then the other It's a negative stimulant. Hormones go up. Yep. But there's also antibodies which Right.

Dr. George Papanicolaou
So now we're gonna so once you've realized they have hyperthyroidism, then you wanna check for antibodies. And the 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.

Dr. Mark Hyman
There's also a radioactive iodine test. Right?

Dr. George Papanicolaou
Yeah. So after 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 multi, nodular toxicoider.

Dr. Mark Hyman
And so what are what are doctors, once people are diagnosed with this, what are the treatments? Because it seems like they haven't really changed much since No. 40 years since I graduated medical school.

Dr. George Papanicolaou
Yeah. They haven't changed much, and they're pretty harsh. And, you know, one, you know, so there's there's Methimazole which is basically a thyroid peroxidase enzyme inhibitor. Thyroid peroxidase is the enzyme that the thyroid uses to to bind iodine together to make thyroid hormone. And so it blocks that.

And so you just reduce the production. Methimazole, can have some, you know, significant, in poly polythiourasol, PTU, particularly can have some, you know, very impactful side effects.

Dr. Mark Hyman
Side effects.

Dr. George Papanicolaou
Like, you know, hepatic toxicity. So and you're gonna 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 the the most of the people that I see in your 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 Methimazole, and they don't wanna have, you know, iodine. The the next therapy is

Dr. Mark Hyman
Yeah. What else is it?

Dr. George Papanicolaou
Radioactive iodine destruction of the thyroid.

Dr. Mark Hyman
Basically nukes your thyroid gland.

Dr. George Papanicolaou
Yeah. Basically nukes it. So you're gonna get you're gonna get, you know, I I 131, which is iodine tagged with, you know, a radioactive molecule. And when that it's iodine, so now there's radioactive material gets absorbed into the thyroid that's gonna 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 you're you're radioactive, and you're, you know, you're you're you're not, you know, when you can't breastfeed, you can't you can't be around kids, you can't you can't touch people. Yeah. You know?

Dr. Mark Hyman
Not your whole life.

Dr. George Papanicolaou
It can be up to 2 weeks, you know, of the treatment. And then finally, there's just take the thyroid out.

Dr. Mark Hyman
So basically, like, nuke it, take it out, or poison it. Yeah. Yeah. Yeah. Poison it.

Dr. George Papanicolaou
Nuke it or rip it out.

Dr. Mark Hyman
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.

Dr. George Papanicolaou
Which is perfect. Which

Dr. Mark Hyman
is okay. But But the question is how do we deal with this in functional medicine that's different and intellectual wellness? Or how do we think about this condition?

Dr. George Papanicolaou
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 all gonna tell me about the balance of good bacteria, which are your commensals, and your bad bacteria. I always say that those are the 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 oners 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 in your gut. So you need to rebalance that. So we're really careful about doing that. We wanna know not only that balance, but how's your your digestive system working?

One of the things that allows the 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 fight flight response takes over. And suddenly you don't wanna 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.

Dr. Mark Hyman
Oh, yeah. But that's another reason to worry about stress is more parasites. Right?

Dr. George Papanicolaou
More parasites. Another another

Dr. Mark Hyman
So Yeah. We just

Dr. George Papanicolaou
brings it all on. So we really we really work on the gut.

Dr. Mark Hyman
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