From Fatigue to Freedom: Healing the Thyroid Beyond Lab Tests

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a fifteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Dr. Hyman Show with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

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Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. George Papanicolaou
About sixty to seventy percent of people with hyperthyroidism are Graves'. It happens to about one in two hundred people, women more than men, 10 to one, and it usually peaks around in the ages of 40 to 60 years old, but it can happen younger.

Dr. Mark Hyman
Before we jump into today's episode, I want to share a few ways you can go deeper on your health journey. While I wish I could work with everyone one on one, there just isn't enough time in the day. So I built several tools to help you take control of your health. If you're looking for guidance, education, and community, check out my private membership, the HymanHive, for live q and a's exclusive content and direct connection. For real time lab testing and personalized insights into your biology, visit Function Health.

You can also explore my curated doctor trusted supplements and health products at doctorhymen.com. And if you prefer to listen without any breaks, don't forget you can enjoy every episode of this podcast ad free with Hyman Plus. Just open Apple Podcasts and tap try free to start your seven day free trial. What is a thyroid function? What is your thyroid gland?

It's this little gland in your throat, and it's think of it as your overall metabolic regulator. It really controls everything. It's like your motor. It's like, you 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 in 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 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 messages your need to your DNA to turn up your metabolism. Or fat burning in your mitochondria to basically get all systems go.

And if if you have a good T3 level, your your cholesterol is in check, your memory is good, your metabolism is good, you stay thin, it helps your hair grow, and it helps your muscles, prevents muscle aches, constipation, and even, you know, improves fertility. So if you have your T3 working, it's really great. But 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 because it's like, oh, I'm a little this, little that, and you don't really, really get it. So and the main reason it's not diagnosed is it is that the symptoms aren't specific. You you're little achy, a little tired, you gain a little weight, your skin's a little dry, you lose a little bit of hair.

You may be sluggish. You have trouble concentrating, 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 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 going, 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, the problem is that it's often we call subclinical, so it may not be full blown thyroid disease. But, you know, with 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 five. 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, point five 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 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 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 anti thyroglobulin 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 ultrasensitive 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 T3, free T4, thyroid antibodies, TPO, and anti thyroglobulin antibodies. If you get that whole panel 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 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 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 it's 80,000 of these compounds in the environment. Only one percent 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 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 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 pound pack. And they'll 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 about probably 30%. In my experience, I've seen, you know, thousands of patients and testing them. Everybody who's got low thyroid or antibodies to thyroid, I check their gluten antibodies too. About twenty percent to thirty percent 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, like you or you keep having mercury, your thyroid's just not going to work. And this can affect about ten to twenty percent of the population. So it's really common in terms 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 T3 to four. 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-three fats 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 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 Functional 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 antihydroglobulin antibodies. You also want to check for celiac or gluten sensitivity with deaminated glyde, anti gliadin 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 six 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 want to 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 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, the 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 get 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-three fats, which you also get from the same foods, make sure you get vitamin D.

Probably need a supplement. 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 will tell you a little fish. Brazil nuts probably are the best source. You get fifty 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, 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. Once read a report of someone who 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 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. 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-three 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 twenty 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 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 T3, their T4 will be good because they're getting it, but their T3 will be low. And I think it's better to use a bio identical form of thyroid, which is actually how all the hormones were first developed. And it may 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 if you might not know about, which actually helps metabolism and is very important. And so most doctors just assume that Synthroid will get converted, but it really doesn't because all the pesticides in the environment, heavy metals, the stress, the food sensitivities, gluten, you know, deficiencies of nutrients.

You know, one hundred percent of us have toxins in our body. So it's better to just take a combination bioidentical thyroid replacement. And that usually is 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, you know, 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. So tell us about this case here.

Dr. Elizabeth Boham
So she came in and she wasn't feeling good at all, but her TSH was normal. So we did the full panel and we saw that her thyroid antibodies were elevated. So then we

Dr. Mark Hyman
had But was her TSH and the rest abnormal or not really?

Dr. Elizabeth Boham
No, her TSH was pretty normal. I can't remember exactly. It might've been a little on the high side, I don't even know if it was. I think everything

Dr. Mark Hyman
looks Yeah, looks really pretty good, right?

Dr. Elizabeth Boham
But she had those thyroid antibodies. And so I had to ask that question why, right? Why do you have these thyroid antibodies? And then it brought us down this whole pathway of what's going on with her digestive system, what's going on with food sensitivities? Was there any signs of increased intestinal permeability?

And so we pulled her off of gluten and we measured things like her iodine level and her selenium level just to get the right balance. And we gave her some thyroid hormone. We gave her some glandular thyroid hormone. I used Armour Thyroid on her, which is a combination of T4 and T3. And she really responded well.

She felt better. She noticed her hair starting to come back in, know her skin starting to be less dry, her bowel movements improving. And so you know I think it's important that we take that step and go a little deeper.

Dr. Mark Hyman
People don't often realize how bad they're feeling until they start feeling better on this stuff, right? And I think just to back up a little bit, you know you did something which was kind of unusual, controversial, most traditional endocrinologists would scoff at which is you used a combination of t three and t four in a hormone that comes from pig. Yep. That is the entire thyroid combination of hormones including T two which we don't even talk That is actually really important to replace your own because you make a complex array of hormones and often the T 4 can't get converted to the T3 in your body which is the active hormone. So even if you're taking T4 which is what most doctors recommend like Synthroid or Levoxyl or any of these, and they're not terrible but they're just challenging because you actually may not be giving the person the T3 that they really need because their body's not able to make it as well.

Dr. Elizabeth Boham
Right. So then we ask that. So some people, as you mentioned earlier, feel fine on T4 thyroid hormone. That's like Synthroid or, you know, so they do okay with it. But a large percentage of people don't.

And that might be because they have deficiencies in nutrients that help the body go from T4 to T3, right? So they might be deficient in iodine or selenium, as we mentioned, in vitamin A, or iron and zinc. We talked about that earlier that they can't make that conversion as easily, and so the medicine doesn't work as well for them. Or it may be because they have a variation in a gene. We know there's this gene.

It's kind of a really interesting low impact type of gene. So what that means is that it can Not

Dr. Mark Hyman
gonna kill you.

Dr. Elizabeth Boham
Right, thank It's not gonna kill you, but it can make you not feel so good. And, it helps us know how to treat people. So the gene is the DIO2 gene that encodes for this enzyme, the DI2 enzyme, which helps the body convert T4 to T3, especially in the brain, but also in all throughout the body and make that active T3 thyroid hormone. And what we're learning is that some people have this gene variation. And so when you give them just T4, a thyroid hormone, they don't get the benefit.

And studies have shown even when lab work looks normal. So even if their T3 looks normal, even if their TSH looks normal, that they do better when you give them some T3, which could be like a glandular thyroid hormone like ARMOR, which is a combination of T4 and synthetic T3. We sometimes use like Cytomel and we'll add that to Synthroid, for example, or a T4. And so sometimes we see those people who start to feel better in terms of, especially mentally.

Dr. Mark Hyman
Mentally,

Dr. Elizabeth Boham
yeah. Energy wise, mood wise, they really start to feel better finally.

Dr. Mark Hyman
I don't realize that depression's really linked to thyroid and that often psychiatrists in treatment resistant depression when drugs don't work, they'll give them T3 as a treatment for depression.

Dr. Elizabeth Boham
They've been doing that for a long time. It's not anything new.

Dr. Mark Hyman
Right, right. But it's like weird for the rest of And also, know, T4 thyroid replacements, there are challenges with that because there's often fillers, things like and gluten even.

Dr. Elizabeth Boham
Right, could be other reasons why people don't feel well on those.

Dr. Mark Hyman
Yeah. So those are important to recognize. A lot of the traditional doctors really scoff at the use of glandulars, Westeroid, Nature Thyroid, Why Armor and is that and should we be worried?

Dr. Elizabeth Boham
I don't think so. I think maybe during their training or many years ago, was a question of regulation of those or the dosage, but I don't find that to be a problem at all, that we can definitely regulate dose with our patients. It's very reproducible in terms of the medication. I mean, a good portion of our patients, I think we've talked about this before, right? We'll say like, maybe was it eighty percent of our patients or a good portion of our patients do really well when we use a glandular.

Mean, there are some that don't. There are some where that might actually cause more autoimmunity maybe for some, where they just don't feel good on them. And we use synthetic, but for a good portion, works really well.

Dr. Mark Hyman
And you can combine T3 and T4, we'll talk about the next case, that are separate, not as a glandular but just as a prescription drug. And I think the other problem with the glandulars and the things like Armour and Westright is that doctors can misinterpret the lab tests because the thyroid, the TSH goes really low because the T3 suppresses the feedback loop. But you have to look at the T4 and T3 separately and also the symptoms of a patient. Absolutely. So tell us about

Dr. Elizabeth Boham
Well, sometimes like when you give T3, right, then you might see a low T4 on and like you said, TSH, but definitely a low T4 on the lab test because you're giving some of your thyroid in T3 and with the food feedback loop, it causes that your body doesn't make as much T4.

Dr. Mark Hyman
And the TSH goes down, which worries doctors that you're taking too much or

Dr. Elizabeth Boham
being And

Dr. Mark Hyman
actually it's not true, Zai.

Dr. Elizabeth Boham
It's really important to pay attention to the patient's symptoms. And I find that everybody's different. You know, I have patients who are so sensitive to thyroid that, you know, if their TSH gets a little too low, they feel awful. They get palpitations, they get anxious, they have trouble with sleep. But then other people, if you don't get their TSH low enough or if you don't give them enough thyroid, then they're feeling all those signs of low thyroid.

So I think the takeaway is paying attention to your patient and their symptoms and getting that feedback and listening to them

Dr. Mark Hyman
and So like what William Olser said, treat the person who has the disease, not the disease that the person has, right?

Dr. Elizabeth Boham
Absolutely, That's what we're working to get It

Dr. Mark Hyman
reminded me of a case I had years ago where this woman was so symptomatic on hypothyroid and her TSH, her T4, T3 were totally normal and her thyroid antibodies were off the chart. And I treated her and it was like a miracle. She lost like 21 pounds in six weeks. She had all her symptoms get better. She had fibromyalgia.

She had all these quote things that were symptoms of low thyroid So that weren't being it's really powerful. So tell us about the second case of your patient who actually been on thyroid for fifteen years and really Right.

Dr. Elizabeth Boham
So she was a 35 year old woman who came to see us, who had been hypothyroid for, since her late teens, 20s. And she had been on thyroid medication. She had been on Synthroid.

Dr. Mark Hyman
And antidepressants.

Dr. Elizabeth Boham
Well, they wanted her to be on antidepressants. So she was on the thyroid medication for a long time, but always sort of dealt with this low level depression, you know, not a major depressive episode, but enough where sometimes she would stay in bed all day, you know, she would sleep too many hours, she would sleep fourteen hours sometimes. She just had loss of interest in things. And so when she went to her primary doctor about that, you know, they were saying, okay, maybe we should try an antidepressant, right? Maybe this is interfering so much with your life at this point now that you're 35 that we should try this, try an antidepressant.

And she came to see me because she wanted to look at it a different way. And so we did a bunch of different tests and we included in that is we did that DIO2 gene test. And what was interesting is her thyroid levels, you know, looked fine, right? Her TSH, her T4, T3, it looked fine, but she did have a homozygous variation in that DIO2 gene, which is associated with depression and that people who need thyroid hormone and get T3 in addition to T4 feel so much better in terms of mood and energy when they have that gene variation. So we actually, with her, she was feeling fine on her Synthroid.

She'd been on it for many years. So we added the Cytomel to it. And it really helped. It helped a lot with her energy and her mood.

Dr. George Papanicolaou
So hyperthyroidism is when the thyroid gland is producing way too much thyroid hormone. That's T3 and T4. 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 sixty to seventy percent of people with hyperthyroidism are Graves'.

It happens to about one in two hundred people, men more than women more than men, ten to one. 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, as you

Dr. Mark Hyman
say- What are the symptoms?

Dr. George Papanicolaou
The symptoms are some of the ones I just mentioned, which are going to be weight loss, sweating, thinning nails, hair loss,

Dr. Mark Hyman
palpitations,

Dr. George Papanicolaou
skin, palpitations. When it gets really bad,

Dr. Mark Hyman
the 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 things.

Dr. Mark Hyman
Insomnia people can't say. 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 her history.

She's like, and

Speaker 4
I lost 20 pounds and I wasn't trying. I'm like,

Dr. Mark Hyman
Oh, okay. Yeah. You know, should be.

Dr. George Papanicolaou
Yeah. So most people as you said have hypothyroidism. It's less common. Think one percent of thyroid disease or two percent 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 fifty 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.

Dr. Mark Hyman
Yeah. So so it's really, you know, the symptoms can be quite dramatic for people. Right? We went through and like

Speaker 4
as you mentioned, some of the complications are serious. It's not just

Dr. Mark Hyman
about having a racing heart or insomnia or diarrhea. You can get eye damage. Your eyes can bug out of your head. Right. So heart failure, right?

Dr. George Papanicolaou
Yeah. That can happen. And, you know, 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 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 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 that the Graves' eye disease and also pre tibial myxedema. And that's because

Dr. Mark Hyman
That's like food retention

Dr. George Papanicolaou
in Food retention in your 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. Those are the things that are the hallmarks of Graves' and they're all related to that autoimmune antibody response.

Dr. Mark Hyman
What's interesting also is that autoimmune diseases often come in clusters. With Graves' you see people often with other autoimmune diseases. You do.

Dr. George Papanicolaou
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.

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

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

Dr. Mark Hyman
Type one diabetes. Vitiligo, right? Vitiligo is a common one. Your skin. Anemia and autoimmune things like arthritis, rheumatoid arthritis, lupus, right?

Dr. George Papanicolaou
Yep.

Dr. Mark Hyman
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 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,

Speaker 4
what the complications are.

Dr. Mark Hyman
And sort of it's not 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?

Dr. George Papanicolaou
Yeah. So we did the

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

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 going to 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 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 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 your 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. 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. 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 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 gonna function great and it's gonna 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 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?

Dr. George Papanicolaou
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

Dr. Mark Hyman
to So the stop feedback the system tells your TSH shut off and then the other hormones go up. There's also antibodies we check.

Dr. George Papanicolaou
Right. Once you've realized 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.

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

Dr. George Papanicolaou
Yes. After you do that, can do a radioactive uptake to see if the person has maybe some other reason for having that hyperthyroidism, can be an adenoma or multi nodular toxic goiter.

Dr. Mark Hyman
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 forty 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 methimazole which is basically a thyroid peroxidase 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 polythiouracil particularly can have some very impactful side effects.

Dr. Mark Hyman
Side

Dr. George Papanicolaou
effects. Hepatic toxicity. And you're gonna be on them for eighteen months, up to eighteen months to get into remission. And so they're not really they can be harsh and they can have lots of adverse reactions. 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. And the reason why they come is they don't want to be on methimazole and they don't want to have iodine. The next therapy is radioactive iodine destruction of the thyroid.

Dr. Mark Hyman
So basically nukes your thyroid.

Dr. George Papanicolaou
Basically nukes it. So you're gonna get you're gonna get, you know, I 131, which is iodine tagged with, you know, a radioactive molecule. And when that it's iodine so now this radioactive material gets absorbed into the thyroid that's good 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, can't touch people.

Dr. Mark Hyman
Not your whole life.

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

Dr. Mark Hyman
So basically, nuke it, take it out or poison it. Yeah, yeah, Poison it. So nuke it or rip it out. Okay. Well, I mean, sometimes it'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 the question is how do we deal with this in functional medicine that's different and in adult wellness center? 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 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 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 honors are now gonna just they're just gonna multiply and they're gonna push your good bacteria out. 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 So 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 fight 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, start making less gastric acid. And when you're under chronic stress, this chronic loss

Dr. Mark Hyman
of gastric acid

Dr. George Papanicolaou
allows bacteria and parasites and viruses to get into your intestinal tract where they can wreak havoc.

Dr. Mark Hyman
Oh, That's another reason to worry about stress is more parasites.

Dr. George Papanicolaou
More parasites. Another another. So really brings it all on. So we really we really work on the gut.

Dr. Mark Hyman
Work on the gut. You get rid of the food sensitivities. And, you know, I've been we'll see a disease that I've never really treated or that is not that common. And I'm like, well, gee, I don't really know all the time. You know, I don't know if this is going to work.

Right. But then I go back to first principles and functional medicine and look at what are the root causes of disease, what are the causes of whatever it is, inflammation or metabolic disease. And then I can usually zero in on what their story is and listen from their story. I'm like, Yeah, yeah. You know, I I've been eating tuna every day for thirty years or, you know, like I I basically have this terrible stomach issue that blah blah blah blah.

And I go, Oh, you start to kind of find the clues in the paper story and you follow the threads and you start to do the diagnostic tests that help you. And then you start to peel the onion and treat all these problems.

Dr. George Papanicolaou
And so,

Dr. Mark Hyman
you know, your treatment isn't just take this PTU drug or get your thyroid nuked or take it out. It's like, Oh, we have to change our diet. Oh, we have to deal with stress. Oh, we have to take the right nutrients to optimize the levels. Oh, you have heavy metals.

Have to take care of that. Oh, we have pesticides. We have to figure out how to get rid of that. So we basically go through a process, a therapeutic process that's based very strategically on that patient's story and their specific labs. And it's no there's no two people that are the same who have any particular disease like No.

Or Graves or anything else.

Dr. George Papanicolaou
Yeah. I'm just gonna echo everything you just said, Mark, because we have this conversation. This is the work that we do. We get to the root cause and then we use treatments that make sense for each person's specific biology and their life environment. And there's not a patient that comes to me or it's a rare patient that comes to me that we don't find multiple reasons why their health is either currently compromised or is a setup for being compromised in the future because of all of those particular areas you just talked about.

It's not a matter if people have toxins, it's how much. And then the genetics determine how well they're going to detox these toxins. And so we also know that you have genetics that drive your immune system. But we have places to look. We do a lot of antibody testing to help us identify do you have an autoimmune process and where is the trigger.

And so and we could go through every, you know, every biologic system that we look at with all the testing that we do and explain in detail how we're using those tests in those biologic areas toxins, the HPA access, energy production of mitochondria. We do specific tests that will look at mitochondrial function. All of those things have to be addressed. It's never one thing. Multiple layers.

Dr. Mark Hyman
That's the whole problem with traditional medicine. It's like reductionist, it's Grave's disease, you get this drug, you'll see you later, that's it, nothing else. And we're like, no, no, no. 10 people with Grave's might have 10 different issues and we need to treat them in 10 different ways and we need to find out what their cause is and how to optimize their system. If you love this podcast, please share it with someone else you think would also enjoy it.

You can find me on all social media channels at Doctor Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the doctor Hyman show wherever you get your podcasts. And don't forget to check out my YouTube channel at Doctor Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in. We'll see you next time on the Doctor Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am chief medical officer.

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