How To Treat The Root Cause Of Thyroid Problems

Mark Hyman, MD

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Narrator: Coming up on this episode of the Doctor's Farmacy. Dr. Mark Hyman: The things you want to avoid if you're having thyroid function issues, well, I would get off of gluten, dairy, which are inflammatory for most people and processed soy. If people are eating a lot of processed soy, it can affect thyroid potentially, also kale and some of the cruciferous vegetables. Hey, everybody. It's Dr. Mark Hyman. Welcome to the Doctor's Farmacy, a place for conversations that matter. And today, I'm bringing you a new feature of the Doctor's Farmacy called Health Bites. We show you how to take small steps to upgrade your health. Today we're talking about thyroid disease, which is super common, and why if your thyroid's out of whack, it can really screw up your health and create so many downstream problems. And it's common. Thyroid disease affects one in five women, and one in 10 men have low functioning thyroid. And half of those are not diagnosed, and the ones who are diagnosed are not actually treated properly for the most part. And they've become often partially treated with drugs like Synthroid, but it really doesn't get to the whole root of the problem. So when we have this undiagnosed epidemic of thyroid disease, it worsens our health in many, many ways, increases heart attack, strokes, weight gain, and just makes you feel crappy. And there's really a very comprehensive approach that we've developed in functional medicine to look at all the causes of thyroid dysfunction. How do we optimize thyroid function and how do we diagnose it properly? Because often when the diagnosis is really missed, so let's get right into it. What is the thyroid function? What is your thyroid gland? It's this little gland in your throat. And think of it as your overall metabolic regulator. It really controls everything. It's like your motor. It's like in terms of the RPM on your engine, so you know how some things like a golf cart or something have a governor and you can only go so fast. It's a little like that. So if it's slow, your whole system slows down. If it's fast, your whole system speeds up. That's hyperthyroid. Not that common, but it can be a problem for some people, but low thyroid or hypothyroid function is really common. And your thyroid gland produces hormones, T4, which is the inactive thyroid hormone. And your brain produces something called TSH, which tells your thyroid to make more thyroid hormone if it's low or if you have too much thyroid hormone, your TSH goes down. So it's a way we sort of track things. Now the inactive hormone is T4. That has to get converted in your body to the active hormone, which is T3. Now T3 is only about 7% of your 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 you need to your DNA to turn up your metabolism. There's not fat burning in your mitochondria to basically get all systems go. And if you have a good T3 level, 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 improves fertility. So if you have your T3 working, it's really great. But in the inactive form, often doesn't get converted. And there's a lot of reasons for that into T3. And it can be environmental toxins. It can be stress. It can be lack of certain nutrients. So we'll talk about that. 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 in the body. And it can cause so many weird, vague symptoms that people don't even often identify it, because it's like, oh, I'm a little this, a little that, and you don't really get it. And the main reason it's not diagnosed is that the symptoms aren't specific. You're a little achy. You're a little tired. You gain a little weight. Your skin's a little dry. Losing a little bit of hair. You're maybe sluggish. You have trouble concentrating. You're a little depressed. You're maybe a little cold when everybody else is warm. You get cold hands and feet. You get low libido. You make get a little fluid 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 like, oh, I have all that. That's really a clue that you might have thyroid issues. So 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 a low thyroid. And then you need to do the right testing. Now the problem is that it's often we'll call subclinical. So it may not be full blown thyroid disease. But in functional medicine, we like to think about how do we get to optimal function? Not just what's normal. If you look at the normal lab tests, they're often misleading because they're based on a population that may not be healthy. So the range of, for example, TSH, which is what most doctors look at to check your thyroid is 0.525. 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 0.5 to one. So what's really optimal is very different than what's quote "normal." And that's why it's often missed. And doctors will often miss it because they just check the TSH and not the whole panel of tests that gives you a really comprehensive view. If you just say 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 do a comprehensive thyroid panel, which includes TSH, free T3, free T4, and thyroid antibodies, thyroid peroxidase, and antithyroglobulin antibodies. Now a lot of doctors will check thyroid panel on a lab req. And the old lab reqs have a very old thyroid panels that use all kinds of antiquated tests, which still say, unfortunately, my 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 TSH. And also if you're really stuck and there's other things going on, there's more advanced tests like thyroid releasing hormone that we can use by using a stimulation test. So we won't get into that. But the key is the basic test should be TSH, free T3, free T4, thyroid antibodies, TPO, and antithyroglobulin 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 it's a genetic defect in human beings? I don't think so. It's really because we are living in a toxic world in many ways. One, environmental toxins are really impactful on the thyroid function. Think of your thyroid as the yellow canary in your body. The yellow canary 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 of these compounds in the environment. Only 1% have been tested for safety. The 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. There's a deep connection between your adrenals and your thyroid gland. So people who are overstressed 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's low, you often will see kind of this thyroid function go low. So for example, if you put young soldiers on a forced march, you'll see their thyroid function decrease just because 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 stressors are a big factor. Another one is gluten. Gluten is a huge factor. And about probably 20, 30% in my experiences, of seeing 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, either celiac disease or non celiac, gluten sensitivity. And it's really important to track because if you keep eating gluten or you keep having mercury, your thyroid's just not going to work. And this can affect about 10 to 20% of the population. So it's really common in terms of the inflammation of the thyroid. Also nutrient deficiencies, thyroid function needs iodine to make the thyroid hormone. You need selenium to convert T three to four, you need vitamin D and vitamin A to have it bind on the nucleus to work and do its thing. You need the right omega fats and many other nutrients to help optimize thyroid function. So what do you do if you think you might have low thyroid? What steps should you take? Well, first do the symptoms check. Look at the questionnaire, the link, the things that I just mentioned. You can kind of do a mental checklist or you can fill out the thyroid questionnaire that we're going to link to in the show notes. That's the first thing. And if there's some suspicion, you need to get the right tests. And there's a lot of ways to do that right now. You have to ask your doctor. There are labs that are coming online, like Function Health, where you'll be able to do your own ordering of tests, which is important, but you want the full spectrum like I said, TSH, free T3, free T4, thyroid antibodies, TPO and antithyroglobulin antibodies. You also want to check for celiac or gluten sensitivity with the deamidated antigliadin antibodies, tissue transglutaminase antibodies. We'll write all this up in the show notes so you can keep a track of it. We might also want to do a heavy metal test. Look for heavy metals with a DMSA challenge test, to look for urine toxic metals after a six hour collection. There are tests to look at pesticides and chemicals in your body through urine testing. Sometimes I'll do that. But we'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 skincare products, household products, food products. Vitamin D plays a huge role. If you're vitamin D deficient, you want to see that for sure, because by correcting that, it'll help your thyroid work better. You can check for selenium levels. Often there's selenium deficiencies, iodine deficiencies. We can measure that as well. So we do a really close inventory of nutritional status. 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, 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 eat the right foods that support your thyroid function. My favorite is seaweed. Seaweed is full of iodine and minerals. It's great for your thyroid. Fish, also great, sardines, wild salmon, mackerel, herring. Also, fish contains a lot of iodine. Omega 3 fats, which you also get from the same foods. Make sure you get vitamin D, probably need to supplement. Herring, mackerel are a great source of vitamin D, mushrooms like Porcini mushrooms, but it's hard to get enough. So sunlight and obviously checking your vitamin D and taking vitamin D. Also you can get your vitamin A which is important for thyroid function from dandelion greens, mustard greens, dark green, leafy vegetables, liver. Organ meats, also, if you like that, I do. Also, selenium is super important, and that can come from herring, scallops, smelt, which is a tiny little fish, Brazil nuts probably are the best source. You get 15 micrograms per Brazil nut. So I would make sure you have plenty of those foods. And the things you want to avoid if you're having thyroid function issues, well, I would get off of gluten, dairy, which are inflammatory for most people and processed soy. If people are eating a lot of processed soy, it can affect thyroid potentially. Also kale, and some of the cruciferous vegetables. If you juice a lot of kale, for example, it can cause a problem. I once read a report of someone who thought the broccoli family vegetables was good for them, and they ate two pounds of bok choy raw every day. Now if it's raw, it's worse. So don't eat raw cruciferous vegetables that much. And she went into a hypothyroid coma. So that's an extreme case, but if you're juicing raw kale every day, you can get into trouble. Then what should you do in terms of supplements, a good multivitamin that contains selenium, iodine, zinc, vitamin A and then you might want to add in vitamin D and omega 3 fats. If your adrenals are stressed out from chronic long term stress, you want to deal with that through regular circadian rhythm, lifestyle management, getting sunlight exposure in the morning for 20 minutes, waking and sleeping at the same time every day, having meditation practice, yoga, deep breathing, all the lifestyle practices for resetting your adrenals. And then you can use herbs like Rhodiola, Siberian ginseng, various adaptogenic mushrooms. This is really a way to kind of boost your adrenal function. And then if you're stuck, you kind of might need to work with a doctor to optimize what you need in terms of thyroid treatment and adrenal treatment. So let's say you need thyroid replacement, and a lot of people do. Sometimes you can get away without it, but if you've done all the things that I just said, and your thyroid's 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 bioidentical 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 that people might not know about, which actually helps metabolism and is very important. And so most doctors just assume that the Synthroid will get converted, but it really doesn't because all of the pesticides in the environment, the heavy metals, the stress, the food sensitivities, gluten, deficiencies of nutrients, a hundred percent of us have toxins in our body. So it's better to just take a combination bioidentical thyroid placement and that's 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 six weeks after you take 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 a little hyper, insomnia, and palpitations. So you have to track it. But your thyroid gland is important to understand and take care of, to love, and figure out. And it often can be fixed. I had thyroid issues when I was really sick with chronic fatigue, but then it all corrected. So really important to focus on this, get your thyroid straight, make sure you identify if you have thyroid problems, get the right tests, eat the right foods, take the right supplements, use the right thyroid hormone replacement if necessary. And I think you'll be much happier. And that's it for this week's health bite. If you loved it, please share it with your friends and family on social media or leave a comment how you handle your thyroid dysfunction. And we'd love to hear from you. And subscribe wherever you get your podcast. And we'll see you next week on the Doctor's Farmacy. Narrator: 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.