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Episode 65
The Doctor's Farmacy: House Call

A Root Cause Approach to Hyperthyroidism and Graves’ Disease

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The thyroid gland is a small gland located in your neck that is part of your endocrine or hormonal system. It produces two major thyroid hormones, and the overproduction of these hormones is termed hyperthyroidism. Sixty to seventy percent of individuals with hyperthyroidism suffer from an autoimmune condition called Graves’ disease. So, what is driving these issues and how can that information be used to treat the root causes of hyperthyroidism and Graves’ disease?

In this episode, Dr. Hyman sits down with Dr. George Papanicolaou to discuss how they work with patients to treat the root causes of hyperthyroidism and Graves’ disease. They discuss topics including environmental toxin exposure, the role of gut health in driving autoimmune disease, using thyroid hormone replacement therapy, and much more.

George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital. He is also an Institute for Functional Medicine Practitioner. Upon graduation from his residency he joined the Indian Health Service. He worked on the Navajo reservation for 4 years at the Chinle Comprehensive Medical Facility where he served as the Outpatient Department Coordinator. In 2000, he founded Cornerstone Family Practice in Rowley, MA. He practiced with a philosophy centered on personal relationships and treating the whole person, not just not the disease. He called that philosophy “Whole Life Wellness”. Over time as the healthcare system made it harder for patients to receive this kind of personal care Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health – a practice dedicated entirely to Functional Medicine. Dr. Papanicolaou joined The UltraWellness Center in 2017.

This episode is sponsored by Rupa Health and Paleovalley.

Rupa Health is a place for Functional Medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, Great Plains, and more. You can check out a free live demo with a Q&A or create an account at RupaHealth.com.

Paleovalley is offering 15% off your entire first order. Just go to paleovalley.com/hyman to check out all their clean Paleo products and take advantage of this deal.

In this conversation, Dr. Hyman and Dr. Papanicolaou discuss:

  • Characteristics and symptoms of hyperthyroidism and Graves’ disease
  • Common autoimmune issues that cluster with hyperthyroidism and Graves’ disease
  • Thyroid supporting nutrients
  • The link between autoimmune disease, gut health, gluten sensitivity, and Celiac’s disease
  • Traditional vs Functional Medicine approaches to testing, diagnosing, and treating hyperthyroidism and Graves’ disease
  • Hormone replacement therapy
  • Patient cases they have treated with hyperthyroidism and Graves’ disease

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. George Papanicolaou

Dr. Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital, Abington, Pennsylvania. He is also an Institute for Functional Medicine Certified Practitioner. Dr. Papnicolaou established his own practice: Cornerstone Personal Health dedicated to the Functional Medicine Model. Dr. Hyman invited him to bring his expertise and twenty years of experience to the UltraWellness team. He specializes in treating the root causes of many conditions including Neurodegenerative disorders, ADHD, PANDAS/PANS, gut and hormone health.

Show Notes

  1. The Functional Medicine Approach To Hypothyroidism And Hashimoto’s Disease
  2. Is An Underactive Thyroid To Blame For Your Mysterious Symptoms? with Dr. Elizabeth Boham
  3. Is Your Environment Harming Your Thyroid
  4. House Call Highlight: Wired and Tired: Fixing Adrenal Burnout

Transcript

Announcer: :
Coming up on this episode of The Doctor’s Farmacy.

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

Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman, and that’s farmacy with an F, a place for conversations that matter. Today, we’re talking about … On our special episode of House Call with Dr. George Papanicolaou, one of our extraordinary docs at the UltraWellness Center here in Lenox, Massachusetts, we’re going to talk about thyroid. Most people struggle in this country with low thyroid. It affects one in five women, one in 10 men. But there’s another condition called hyperthyroid, as opposed to low thyroid, high thyroid, that is a real problem for some people. It affects less people, but it’s really a problem, and traditional medicine approach really hasn’t changed in 50 years. I discovered with functional medicine that there’s really a whole new way of thinking about it that can get to the root cause and often reverse it or even cure it. I’ve had a few patients that have been really effective in using this model.

Dr. Mark Hyman:
So welcome back to the podcast, George. It’s great to have you. Today, we’re going to dig into a couple of really interesting stories about how autoimmune diseases are so prevalent, and hyperthyroid is even one of them, and how we treat it with traditional medicine but also how we think about it differently with functional medicine. So talk about what is really driving this problem. What is Graves’, what is hyperthyroidism, and what does it do to people? How do they feel, and how do people know they have it?

Dr. George Papanicolaou:
Right. 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 60 to 70% of people with hyperthyroidism are Graves’. It happens to about one in 200 people, women more than men, 10 to one, and it usually peaks in the ages of 40 to 60 years old, but it can happen younger. So that’s the overview of Graves’ disease. Now, they’re mostly, as you said-

Dr. Mark Hyman:
And 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, thinning skin-

Dr. Mark Hyman:
Palpitations.

Dr. George Papanicolaou:
… palpitations. When it gets really bad-

Dr. Mark Hyman:
Diarrhea, 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. Those are-

Dr. Mark Hyman:
And insomnia, people can’t … I had a friend call me who was like, “I can’t sleep. I don’t know what’s wrong.” We get through a history. It’s like, “And I lost 20 pounds and I wasn’t trying.” I’m like, “Oh, okay.”

Dr. George Papanicolaou:
Yeah, and it could be-

Dr. Mark Hyman:
And she had Graves’.

Dr. George Papanicolaou:
Yeah. So most people, as you said, have hypothyroidism. It’s less common. I think 1% of thyroid disease or 2% is hyperthyroidism, and Graves’ is the most common. But when you have it, it can be really debilitating, and it can be really hard to treat. As you said earlier, in conventional medicine, the treatments haven’t changed in 50 years, and they’re quite harsh. 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 makes sense for the biology and their life environment.

Dr. Mark Hyman:
Yeah. The symptoms can be quite dramatic for people, right, that we went through.

Dr. George Papanicolaou:
Absolutely.

Dr. Mark Hyman:
And 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, right. Yeah, so that-

Dr. Mark Hyman:
You can get heart failure, right?

Dr. George Papanicolaou:
Yeah, that can happen. 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 auto-immune disorder, just like Hashimoto’s, which causes hypothyroidism, and so you can’t get away from talking about thyroid disease without talking about our immune system, autoimmunity, why we have it, why it’s getting worse, and what some of the major triggers are. So the eye disease is actually antibodies that are being made against your thyroid. They’re called thyroid-

Dr. Mark Hyman:
Stimulating.

Dr. George Papanicolaou:
… stimulating hormone receptor antibodies or TRAbs, 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. It’s a very non-specific 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 caused the Graves’ eye disease and also pretibial myxedema, and that’s because-

Dr. Mark Hyman:
That’s fluid retention in your legs.

Dr. George Papanicolaou:
Fluid retention in your legs, where you get a destruction of the tissue underneath the skin of the tibia or your shin. It gets thickened and fluid-filled, and it’s not nice-looking and it’s not nice-feeling. So those are the things that are the hallmarks of Graves’, and they’re all related to that autoimmune antibody response.

Dr. Mark Hyman:
What’s interesting also is that autoimmune diseases often come in clusters, and with Graves’, you see people often with other autoimmune diseases, right?

Dr. George Papanicolaou:
You do.

Dr. Mark Hyman:
Like what?

Dr. George Papanicolaou:
So some of the other autoimmune diseases can be … You can actually get Hashimoto’s. Hashimoto’s is one of the other autoimmune diseases that you-

Dr. Mark Hyman:
So you can have low and high at the same time.

Dr. George Papanicolaou:
You can. You can definitely have that.

Dr. Mark Hyman:
Yeah, I’ve seen that.

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

Dr. Mark Hyman:
Type one diabetes.

Dr. George Papanicolaou:
Type one diabetes.

Dr. Mark Hyman:
Vitiligo, right? That’s where you lose all the pigment in your skin.

Dr. George Papanicolaou:
Vitiligo is a common one. Yep.

Dr. Mark Hyman:
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, so-

Dr. George Papanicolaou:
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 that’s kind of a good overview of the prevalence of it, what the symptoms are, what the complications are. It’s often not that hard to diagnose. When people are that sick, you can kind of tell.

Dr. George Papanicolaou:
No.

Dr. Mark Hyman:
But it’s subtle sometimes. What tests do doctors do to find out traditionally whether you have it?

Dr. George Papanicolaou:
Yeah. So the-

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

Dr. George Papanicolaou:
Yeah. So, yeah, the traditional tests, 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 a test. It’s people come in and they have symptoms. Then you have to start to use your medical cognition and everything you know about medicine to figure out, “Okay, what do I think is going on?” Well, once you realize what the symptoms are, then you start to understand, “This is the thyroid.” So you’re going to look at the thyroid, and you’re looking at what we call the TSH, which is the thyroid stimulating hormone. If that’s really, really low, that means that the thyroid is producing way too much thyroid hormone and your pituitary gland is being suppressed so it doesn’t make enough of this thyroid stimulating hormone. Let me just back up for a second. Your pituitary gland drives your thyroid, and it sends a signal to the thyroid. It’s called the thyroid stimulating hormone. So your thyroid-

Dr. Mark Hyman:
TSH.

Dr. George Papanicolaou:
Yeah, TSH. Your thyroid is sort of lazy, and so it has to be reminded to work. The pituitary’s responsibility is to send out this signal all the time, so you’re going to have this certain normal level of TSH reminding the thyroid to work, and as long as it’s doing its job and nothing’s impairing it from doing its job, then it’s going to function great and it’s going to make thyroid hormone, T4 and T3. T4 and T3 go to the cells. Now, T3 is the active form of thyroid hormone. And inside the cell, T4 gets converted to T3. Then it goes into the nucleus, where it causes the DNA to start to transcribe and make enzymes and proteins and up-regulate metabolism. 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? We were going to-

Dr. George Papanicolaou:
So when we go for the test, the TSH is going to be suppressed if the thyroid is making too much. The pituitary is going to stop sending a signal.

Dr. Mark Hyman:
So the feedback system tells your TSH to shut off-

Dr. George Papanicolaou:
The feedback loop, yeah. It’s a negative feedback loop.

Dr. Mark Hyman:
… and then the other hormones go up.

Dr. George Papanicolaou:
Yep.

Dr. Mark Hyman:
But there’s also antibodies we check, right?

Dr. George Papanicolaou:
Right. So once you’ve realized they have hyperthyroidism, then you want to check for antibodies. 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 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 multinodular toxic goiter.

Dr. Mark Hyman:
Once people are diagnosed with this, what are the treatments? Because it seems like they haven’t really changed much since 40 years since I graduated medical school.

Dr. George Papanicolaou:
Yeah, they haven’t changed much, and they’re pretty harsh. 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 … And propylthiouracil, PTU, particularly can have some very impactful side effects-

Dr. Mark Hyman:
Side effects?

Dr. George Papanicolaou:
… like hepatic toxicity. And you’re going to be on them for 18 months, up to 18 months, to get into remission. So they can be harsh, and they can have lots of adverse reactions. Most of the people that I see in the UltraWellness 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 want to have iodine. The next therapy is-

Dr. Mark Hyman:
Yeah. What else is there?

Dr. George Papanicolaou:
… you have radioactive iodine, destruction of the thyroid, so you-

Dr. Mark Hyman:
It basically nukes your thyroid, right?

Dr. George Papanicolaou:
Yeah, it basically nukes it. So you’re going to get I-131, which is iodine tagged with a radioactive molecule. It’s iodine, so now this radioactive material gets absorbed into the thyroid that 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 the thyroid hormone. Again, pretty harsh. You’re radioactive. You can’t breastfeed, you can’t be around kids, you can’t touch people.

Dr. Mark Hyman:
For a while, for a while, not your whole life.

Dr. George Papanicolaou:
Yeah. It can be up to two weeks of the treatment. Then, finally there’s just take the thyroid out.

Dr. Mark Hyman:
So, basically, nuke it, take it out, or poison it.

Dr. George Papanicolaou:
Yeah. Yeah. Yeah. Well, yeah, poison it, nuke it, or rip it out.

Dr. Mark Hyman:
Okay. Well, 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 perfectly fine.

Dr. Mark Hyman:
… which is okay. But the question is, how do we deal with this in functional medicine that’s different and at the UltraWellness Center? How do we think about this condition?

Dr. George Papanicolaou:
Well, it’s always getting to that root cause. We always look for the root cause in functional medicine here at the UltraWellness Center. Everything’s designed, all the tests that we do, all the work that we do, and the way we think about things is to get to the root cause. We know that it’s an autoimmune process that drives thyroid disease, particularly Graves’, in this case that we’re talking about, and that 75 to 80% of your immune system is in your gut. It’s called GALT, gut-associated lymph tissue. And so why? Because everything that you eat has organisms on it, has compounds in it that can potentially threaten your health. So your immune system has to be on high alert all the time, making sure that there’s no disruption, nothing gets into your system that could cause you to be ill. We look at the gut microbiome and the function of the gut almost first and foremost when it comes to autoimmune diseases because that’s where you’re going to find the majority of the triggers.

Dr. Mark Hyman:
So the gut is always an acute thing to think about-

Dr. George Papanicolaou:
Yeah, that’s acute.

Dr. Mark Hyman:
… because 70% of your immune system’s in your gut and if you have an autoimmune disease, you have to treat your gut.

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

Dr. Mark Hyman:
Okay, then. Wow. And what’s really fascinating is that it just recalls this patient of mine who was about a 40-year-old woman who had Graves’ disease and was struggling and did not want to be on medication long-term who was willing to do whatever it took. She had real gluten issues, she had terrible gut issues, and she had parasites. I mean, we did a really aggressive gut repair program, and we optimized her health and her vitamin D, and we improved her diet. What was amazing was that her antibodies for Graves’ went to zero, her thyroid normalized, and she’s completely fine now and off medication, which is just really striking to me because that’s something I never learned was possible in medical school.

Dr. George Papanicolaou:
Yeah. 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 want to do the traditional therapies. So when she came in, she was also menopausal within the last two years, and that was the other main issue with her. And although she had gut issues, she had bloating and distension and constipation, some loose stools … So, with her, one of the things that works … And when you want to treat somebody, it’s perfectly appropriate to try to understand the mechanism and the pathway of the way the organ works, in this case, the thyroid, TPO. Thyroid peroxidase is an enzyme that’s blocked with a pharmaceutical agent that is very harmful. Botanical agents can oftentimes, because we get many of our medicines from botanicals … So botanical agents can oftentimes be very effective.

Dr. George Papanicolaou:
In this particular case, L-carnitine can act as a thyroid peroxidase inhibitor, and so using L-carnitine was one of the first things I did with this particular woman. Before our next follow-up, she was already beginning to have some relief from her symptoms just using L-carnitine. Then, because she was menopausal, estrogen can have an impact on your autoimmune state. So balancing hormones is really important. When you think about hormone replacement, there’s always been a concern, particularly with women, about the possible impact on the breast and breast cancer. What I will say is that there are now studies that are showing that, early in menopause, using hormone replacement for a short period of time can have a very beneficial impact on brain aging. There’s reduction in development of Alzheimer’s for women who have estrogen early in their menopausal state.

Dr. Mark Hyman:
Interesting.

Dr. George Papanicolaou:
It also reduces the autoimmune state-

Dr. Mark Hyman:
Autoimmune disease.

Dr. George Papanicolaou:
… because estrogen does play a role in balancing the inflammatory and anti-inflammatory sides of the immune response. So I actually put her on hormone replacement.

Dr. Mark Hyman:
I wonder if that’s why you see most of the cases of autoimmune disease in women.

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

Dr. Mark Hyman:
Yeah. The other thing you did was you got her off gluten and you put on an anti-inflammatory diet, right?

Dr. George Papanicolaou:
Yep. Yep.

Dr. Mark Hyman:
And you gave her the raw materials for helping her thyroid [crosstalk 00:17:34]-

Dr. George Papanicolaou:
Yeah. 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. It’s basically let’s find out what might be a trigger. There are some bacterial and parasitic triggers to thyroid autoimmunity. One of them happens to be Blastocystis hominis, which is a parasite that has been implicated in triggering antibodies that will go after the thyroid. So-

Dr. Mark Hyman:
That’s interesting because that patient that I mentioned, that’s what she had. She had this parasite, which we’re going to talk about it on another podcast.

Dr. George Papanicolaou:
Yeah, we are. So when we look at the gut, we’re going to look, and so we’re going to need to … We know we need to look at the gut carefully, and we do … This gets into the testing we do in functional medicine. So one of the first tests I do is a stool analysis, and that stool analysis is not only going to tell me about the balance of good bacteria, which are your commensals, and your bad bacteria. I always say that those are the bacteria that realize that poop’s a great party, a 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.

Dr. George Papanicolaou:
Now, all of a sudden, those hanger-oners are now going to just … They’re just going to multiply, and they’re going to 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 gut. So you need to rebalance that. 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, you start making less gastric acid. When you’re under chronic stress, this chronic loss of gastric acid-

Dr. Mark Hyman:
Your stomach [crosstalk 00:20:13]-

Dr. George Papanicolaou:
… allows bacteria and parasites and viruses to get into your intestinal tract, where they can wreak havoc. So we fix that.

Dr. Mark Hyman:
That’s another reason to worry about stress, is more parasites, right?

Dr. George Papanicolaou:
More parasites. Another-

Dr. Mark Hyman:
So, really, this-

Dr. George Papanicolaou:
Well, stress brings it all on. So we really work on the gut.

Dr. Mark Hyman:
We work on the gut, you get rid of the food sensitivities. But the traditional approach to autoimmune disease is you just use suppressive medications or, in this case, you take out the thyroid or you nuke it. But in functional medicine, we really look at the root causes, and there are many that are environmental toxins, and they play a huge role in thyroid disease, whether it’s heavy metals or pesticides or chemicals. We look at the gut, as you mentioned. We look at food sensitivities like gluten.

Dr. George Papanicolaou:
Yeah. And I said earlier, hormones.

Dr. Mark Hyman:
Hormones and stress.

Dr. George Papanicolaou:
We look at the HPA axis, which is the-

Dr. Mark Hyman:
Which is the stress hormones.

Dr. George Papanicolaou:
… the stress hormones. And so we know that cortisol is going to have an impact on your immune system and autoimmunity, and if you’re under chronic stress, like most people are … And, certainly, over the last year and a half, with COVID, people were under an enormous amount of stress. That’s why we started to see a lot more death from other causes as well, particularly heart disease, during this phase, because stress has a big impact on heart disease. Chronic infections, as you said, environmental toxins, nutrient imbalances.

Dr. Mark Hyman:
Yeah. What kind of nutrients are playing a role in thyroid disease?

Dr. George Papanicolaou:
Yeah, we can talk about that because that moves into treatment. We want to support a really healthy thyroid, so you’re thinking about things like iodine. You’re thinking about selenium. You’re thinking about zinc. You’re thinking about vitamin C, vitamin E. These are easy to come-

Dr. Mark Hyman:
Vitamin B and A.

Dr. George Papanicolaou:
B and A all support-

Dr. Mark Hyman:
D and-

Dr. George Papanicolaou:
… a good healthy thyroid. If you’re low in any of those, that will impact the health of your thyroid and your immune system. So you’re going to be way more susceptible to any type of autoimmune process in the thyroid.

Dr. Mark Hyman:
There’s really a 360 approach, it looks like-

Dr. George Papanicolaou:
Absolutely.

Dr. Mark Hyman:
… all the root causes, very similar to what we do in general with people, but we specify for the thyroid. I think that we do testing like stool testing, organic acid testing, hormone testing, adrenal testing, toxin testing, heavy metal testing, checking for iodine, vitamin D levels. These are things that you don’t typically get at a traditional doctor’s office.

Dr. George Papanicolaou:
No, no.

Dr. Mark Hyman:
At the UltraWellness Center here in Lenox, We’ve been doing this for decades, and we really see amazing results. 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.”

Dr. George Papanicolaou:
All the time.

Dr. Mark Hyman:
“I don’t know if this is going to work.”

Dr. George Papanicolaou:
Right.

Dr. Mark Hyman:
But then I go back to first principles in functional medicine and look at what are the root causes of disease, what are the root causes of whatever, if it’s inflammation or metabolic disease? Then I can usually zero in on what their story is and listen from their story. They’re like, “Yeah, yeah. I’ve been eating tuna every day for 30 years or I basically have this terrible stomach issue that … Blah, blah, blah, blah, blah.” And I go, “Oh.” So you start to find the clues in the patient’s story-

Dr. George Papanicolaou:
Oh, you do.

Dr. Mark Hyman:
… and you follow the threads and you start to do the diagnostic tests that help you. Then you start to peel the onion and treat all these problems.

Dr. George Papanicolaou:
Absolutely.

Dr. Mark Hyman:
So 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. We have to take care of that. Oh, we have pesticides. We have to figure 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. There’s no two people that are the same who have any particular or Graves’ or anything else.

Dr. George Papanicolaou:
Hell, no. Yeah. I’m just going to 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. 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 set up for being compromised in the future because of all of those particular areas you just talked about. It’s not a matter of people have toxins, it’s how much. Then their genetics determine how well they’re going to detox those toxins.

Dr. George Papanicolaou:
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?” We could go through every biologic system that we look at, with all the testing that we do and, and explain in detail how we’re using those tests in those biologic areas, toxins, the HPA access, energy production in the mitochondria. We do specific tests that will look at mitochondrial function. All of those things have to be addressed. It’s never one thing. It’s multiple layers and-

Dr. Mark Hyman:
That’s the whole problem with traditional medicine. It’s reductionist. “It’s Graves’ disease. You get this drug. I’ll see you later.” That’s it, nothing else. And we’re like, “No, no, no.” 10 people with Graves’ 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, and it’s different.

Dr. George Papanicolaou:
You know what? 20 years ago, or maybe it’s longer, maybe 21, 22 years ago, you were at Canyon Ranch, and you had the opportunity to hear Jeff bland speak.

Dr. Mark Hyman:
I did.

Dr. George Papanicolaou:
You got the fever early on, right?

Dr. Mark Hyman:
I did, I did.

Dr. George Papanicolaou:
20 years ago, I had just started my own conventional family practice, and I was a conventional doc for … It took me about 15 years, but even in my conventional practice, I always had that holistic approach. I was writing nutrition programs. I was putting together exercise programs for my patients and my diabetics. I had a weight loss program specifically for my diabetics. However, the pressures of the insurance industry, the pressures of my discipline in family medicine were such-

Dr. Mark Hyman:
Yeah, [crosstalk 00:26:21]-

Dr. George Papanicolaou:
… that it was see as many pages as you can, make the diagnosis, use a pharmaceutical agent. Probably 13, 14 years in, I started to say, “You know what?”

Dr. Mark Hyman:
“This is not right.”

Dr. George Papanicolaou:
“There’s something wrong because my patients aren’t getting better. I’m maintaining disease.” Then I found functional medicine, and that changed everything.

Dr. Mark Hyman:
It changes everything, right?

Dr. George Papanicolaou:
It changed everything. So where you would have come to me with Graves’ disease 10 years ago, I would have sent you to the endocrinologist, I would have put you on methimazole and a beta blocker and then talked about having you go to an ENT doc who’s going to take out your thyroid. I would have been right on board. You know what? I saw the light, and I can tell you, in my time as a functional medicine doc, I’m now board certified in functional medicine, the IFM, I think I have helped more people leave their disease behind, actually be better than I did in 20 years of private practice in conventional medicine.

Dr. Mark Hyman:
Wow. So that’s a big statement. You literally have helped more people in last few years of functional medicine than your entire-

Dr. George Papanicolaou:
Yeah, absolutely.

Dr. Mark Hyman:
It’s kind of a miracle. To me, it’s both inspiring and it’s also incredibly frustrating because so many people out there are not getting answers to their problems with solutions that exist. It just breaks my heart, and people suffer terribly. Autoimmune diseases are so bad. I was recently out west, and I was sitting in Montana in the cabin I was staying in, and I went out in the morning to just hang out and have my coffee and maybe journal a little bit. There’s this old guy sitting there. He looked old, anyway. He turned out to be a lot younger than I was. But he was pretty overweight, a big belly, started chit-chatting. “Where are you from?” “Oh, Texas.” “Oh, yeah. Oh, great. What do you do?” He was like, “Well, I was an oil construction guy,” and I’m like, “Oh, wow, that’s kind of cool.”

Dr. Mark Hyman:
He said, “Well, I had to quit,” and I’m like, “Why, what happened?” He was like, “Well, I collapsed on the job. I had MS, and I’ve been on these drugs, and I’m just terrible. I can’t do anything. I can barely get up. I can barely tie my shoes. I used to wear boots. I can only wear sneakers now because I can’t do anything. I just feel terrible.” I thought, “Wow, this guy’s just not getting access to information that’s going to really help him.” I told him about Terry Wahls’ work on MS and I recommended her book. She’d been on the podcast, she’s going to be back on the podcast. He’s like, “Why are you helping me?” I’m like, “Well, I don’t know. I’m a doctor. I can’t help myself because I’m like, “Here you have a problem. You’re going to get dramatically better.”

Dr. George Papanicolaou:
No, you do. You come across it all the time. You have doctor’s eyes and you have a doctor’s heart. I have doctor’s eyes. I have a doctor’s heart. I see things that other people don’t see, and I cry over things other people wouldn’t cry over because I know the implication of what I’ve just seen and I know the suffering that people experience when they have chronic disease that they can’t get an answer to. We see those patients here at the UltraWellness Center all the time. The good news is, is here at the UltraWellness Center, we have a team that’s highly compassionate, empathetic, and really works with patients to get them through the process and give them hope.

Dr. Mark Hyman:
Yeah. It’s so powerful. That’s great. So if you’ve been listening and you’ve had a thyroid issue or Graves’ disease, I encourage you to think about trying a different approach.

Dr. George Papanicolaou:
Absolutely.

Dr. Mark Hyman:
We can certainly help you at the UltraWellness Center. You can find other people who do functional medicine. Don’t just stop at the traditional approaches. Sometimes, you do need medications or you need an ablation or you need surgery, but most of the time we can get you through without it. If you love this podcast, share it with your friends and family on social media. We’d love to hear from you. If you have a comment about what’s going on, leave a comment and how you maybe solved your Graves’ disease. Maybe you have, and we’d have something to learn. Subscribe wherever you get your podcasts, and we’ll see you next week on The Doctor’s Farmacy.
Announcer:
Hi, everyone. I hope you enjoyed this week’s episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you’re looking for help in your journey, seek out a qualified medical practitioner. If you’re looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It’s important that you have someone in your corner who’s trained, who’s a licensed healthcare practitioner and can help you make changes, especially when it comes to your health.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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