Is An Underactive Thyroid To Blame For Your Mysterious Symptoms? with Dr. Elizabeth Boham - Transcript

Dr. Mark Hyman: All these things can disrupt our thyroid function and often your doctor never even looks for them. Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: Hey everyone. It's Dr. Mark Hyman and welcome to a special episode of The Doctor's Farmacy and that's Farmacy with an F, F-A-R-M-A-C-Y, place for conversations that matter in this special episode and is called House Call, because we're going to take medicine to you and help you understand how functional medicine can help your issues in ways that you might not actually have realized. And they'd give you answers when conventional medicine doesn't. Dr. Mark Hyman: And I'm here with my friend, my colleague, my partner at the UltraWellness Center and the medical director of the UltraWellness Center, Dr. Elizabeth Boham, who I've known for gosh, 20 years now, and has been by my side, learning and growing and teaching functional medicine. She's pretty extraordinary. She's what every physician should be. She's a registered dietician and exercise physiologist and an MD. Good luck finding that, she's a unicorn, but we're going to talk about specific conditions that we see every day at the UltraWellness Center and how we approach them and how we often get people better when traditional medicine can't. And today we're going to talk about one of the most prevalent conditions that exist today in America, and it's an autoimmune disease called Hashimoto's or Hypothyroidism. So we're going to talk about Hypothyroidism and Liz and I see this a lot and we see it mistreated a lot, and we see people suffering a lot when they don't need to. So welcome Liz. Dr. Elizabeth Boham: Thank you, Mark. It's so great to be with you. Dr. Mark Hyman: Okay. So tell us how prevalent is this problem of low thyroid function? Dr. Elizabeth Boham: You know, it's so prevalent. We see it all the time with our patients. We see people who are really obviously low thyroid, and then we see people who are kind of that their thyroid numbers might be normal, but they have symptoms of low thyroid. So that would include things like hair loss, they feel cold all the time, they're constipated, they feel low energy. Maybe they've lost hair at the outer part of their eyebrow and they have dry skin. And they just feel crummy. Dr. Mark Hyman: Depression. Dr. Elizabeth Boham: Depressed. Yes. Dr. Mark Hyman: Trouble concentrating, focusing, muscle aches, fatigue, getting tired in the morning. All these weird things that people suffer from, they think are quite normal, but they're not in their clues. Dr. Elizabeth Boham: Right. They're clues to say, "Okay, we've got to look deeper. We've got to figure out why are they not feeling well? And then we've got to figure out is it their thyroid?" Dr. Mark Hyman: Yeah. And it affects one in five women. Dr. Elizabeth Boham: It's so common. Dr. Mark Hyman: And one in 10 men and 50% of the time it's not diagnosed. I would say probably 80 to 90% of the time it's not treated properly. Dr. Elizabeth Boham: That's true. Dr. Mark Hyman: So you might be one of the 10% that's got it nailed. But most of you, even if you have thyroid issues, you still may have symptoms. And the doctor's like, "Well, you're fine. You're on thyroid. Don't worry about it." Dr. Elizabeth Boham: Right. "Your TSH looks normal. I think we're doing everything we need to do." Dr. Mark Hyman: Yeah. So what are the problems with the traditional way we treat thyroid in America or around the world? Dr. Elizabeth Boham: Well, I think the first thing that as functional medicine docs we recognize is that we're not asking that question, why? We're not looking for that underlying root cause, which so often helps us when we're treating our patient, because it helps us figure out for them, for that individual person, what do we need to do to help their thyroid work better? So is it because of a nutritional deficiency? We know that we need iodine and selenium and iron and all sorts of good- Dr. Mark Hyman: zinc- Dr. Elizabeth Boham: ...amino acids- Dr. Mark Hyman: Vitamin D, just to get the thyroid to work on yourself, you need vitamin D to help it actually send the message to your DNA, to do what it's supposed to do, and that 80% of us are deficient in vitamin D. Dr. Elizabeth Boham: Yes. And so if people aren't eating enough of certain foods, we might see nutritional deficiencies, or maybe if their digestive system is a mess, they're not absorbing their nutrients well. So we have to ask that question, "Why?" Because sometimes that will just help the thyroid work better when we help support it nutritionally, or maybe it's an autoimmune condition, like you mentioned Hashimoto's and then it gets us thinking of a lot of different things. It gets us thinking about, well, "Why does this person have autoimmunity?" Dr. Mark Hyman: Isn't it the most common autoimmune disease? Dr. Elizabeth Boham: Yeah. It really is. Dr. Mark Hyman: And what causes it? Dr. Elizabeth Boham: When in an autoimmune condition, the body starts to fight itself off. It looks at the thyroid gland and says, "Okay, I'm going to fight you off. I'm going to attack you." And when it attacks the thyroid gland, the thyroid gland doesn't work as well. And so in many cases you get a low thyroid. So what causes the autoimmune disease is the big question we always ask in functional medicine. Dr. Mark Hyman: Why? Dr. Elizabeth Boham: And everybody's different, right? For one person, it may be gluten. We know gluten is associated with a lot of Hashimoto's thyroiditis, not all, but some. Dr. Mark Hyman: My experience about it, when you look at thyroid antibodies and you compare it with the gluten antibodies in that patient, and it's about 30% of the time it could be related to gluten. What do you think? Dr. Elizabeth Boham: Yeah, I think it could be. It might even be a little higher. It depends because of the patients we're seeing. So we might be seeing more patients who have a lot of different digestive issues going on, and so I might see it even a little more frequently. Dr. Mark Hyman: We call it Selection bias. People who are selected to come see us, they have more stuff for sure. Dr. Elizabeth Boham: But we always think about the digestive system. You've got auto-immunity you've got to think about what's going on in the digestive system. But then you think about, could there be an overgrowth of bacteria, certain bacteria in either the digestive system or other parts of the body have been shown to trigger autoimmunity in some people. We know that- Dr. Mark Hyman: We're going to talk about that in another podcast so stay tuned. We'll talk about the gut and leaky gut. Dr. Elizabeth Boham: Okay. We'll do that. We know that imbalances in iodine actually, excessive of iodine- Dr. Mark Hyman: Can shut down the thyroid. Dr. Elizabeth Boham: Yeah. So, some Hashimoto's because it was found first in Japan where they have a lot of iodine. So, we know iodine's is important for the thyroid, but too little is not good, but too much is also not good. So we pay attention to that and toxins of course, right? Toxins can be triggers for autoimmune disease in some people. Dr. Mark Hyman: Yes. I will say that the thyroid is a yellow Canary. In the coal mine, they used to bring the yellow Canary into the mine and if it dropped dead, they knew the air was bad they had to get out. So it was an early warning sign and the thyroid is like that. It seems to be extremely sensitive to disruption from heavy metals, from pesticides, plastics and everything. Dr. Elizabeth Boham: Fluoride. Dr. Mark Hyman: With fluoride. Oh yeah. Fluoride in the water, all these things can disrupt our thyroid function and often your doctor never even looks for them. Dr. Elizabeth Boham: Absolutely. They say, "Okay. We're just going to look at the TSH and if it's in the normal range, you're fine." Or, "We're going to give you medication to get it in the normal range, but not really look a lot deeper." Dr. Mark Hyman: So what is the difference in the testing that... Oh, there's one other thing I wanted to bring up which I remember reading about in the new England journal of medicine was a lady who thought that Bok Choy was healthy and she ate like two pounds of raw Bok Choy a day and she went into a hyperthyroid coma. And people are having kale juice- Dr. Elizabeth Boham: Chema goitrogens? Dr. Mark Hyman: There's a whole kale craze and people are juicing it and it's raw. And raw cruciferous vegetables can be a problem eating a lot of raw broccoli and cabbage. And if you're having raw Brussels sprouts or Bok Choy, kale. Dr. Elizabeth Boham: Eating it in a level that's beyond just like a normal food portion. But as you mentioned, if you cook it, you get rid of a lot of that goitrogenic potential the part that's going to interfere with thyroid function. Yeah. So you don't have to be concerned when you have cooked cruciferous vegetables, but it's that, like you said, juicing- Dr. Mark Hyman: So should I worry about having a kale juice every day? Dr. Elizabeth Boham: It's a good question. It depends how much kale you put it in. Dr. Mark Hyman: I'd like to drink green juices, and most of them have kale when you buy them. Dr. Elizabeth Boham: A little bit of kale is fine. Dr. Mark Hyman: I'm careful about it. Dr. Elizabeth Boham: And it depends on the person of course, right? Dr. Mark Hyman: What about soy? Dr. Elizabeth Boham: That's a good question too. I think that if- Dr. Mark Hyman: Because a lot of people are like, "Soy is really bad. If you interrupt your thyroid, it's dangerous, you shouldn't eat it. Dr. Elizabeth Boham: I think if we're going with non GMO or organic soy as a whole food, like edamame and tofu and I'm not concerned- Dr. Mark Hyman: Tempeh. Dr. Elizabeth Boham: Yeah tempeh. I'm not concerned. Dr. Mark Hyman: Traditional soy foods that have been used for centuries, right? Miso, tempeh, tofu, natto, soy sauce, those are fine. It's when we're drinking a cod of soy milk a day, that's a problem. Or when you're having all these fake soy foods that are processed or soy burgers and you're eating stuff, that's sort of weird. Frankenfood ... Dr. Elizabeth Boham: Or like the texturized soy protein that they put in cereals and bars, just to get that protein content up. That's stuff I tell people to stay away from. Dr. Mark Hyman: Okay. So you're someone who comes in, and you feel tired or constipated or depressed, or skin's dry, your hair's falling out. You don't have a sex drive anymore. You can't concentrate, and you go to a traditional doctor, they'll just test one thing. What do they test? Dr. Elizabeth Boham: So they typically test your TSH. Dr. Mark Hyman: Okay. So what is that? Dr. Elizabeth Boham: Your TSH is your Thyroid Stimulating Hormone and there's a feedback loop in the body. So if your thyroid level is low, then the body will get triggered to make more TSH- Dr. Mark Hyman: And that comes from your brain from the pituitary gland. Dr. Elizabeth Boham: Yeah. And then the TSH will say, "Okay, make more thyroid." So if the TSH is high, then the doctor says, "Okay, your thyroid is underactive and we need to treat it." So that's typical. Dr. Mark Hyman: That's the only thing they test? Dr. Elizabeth Boham: Often. Dr. Mark Hyman: And I think you have your functional medicine doctor. It's a very different approach, so what kind did you look at? Dr. Elizabeth Boham: We always start with a full thyroid panel where you look at TSH, but you look at free T3 and free T4. So free T4 is one thyroid hormone that's floating around in your body, but then the T3 is the active form that your body needs for all the thyroid functions to occur. So we look at all three of those at least. And then we often look at thyroid antibodies, and sometimes we'll even do things like reverse T3 and the reverse T3 total T3 ratio. So there's this- Dr. Mark Hyman: What does reverse T3 tell you? Dr. Elizabeth Boham: So the reverse T3 is a thyroid hormone when the body is... I always think of it almost as the break that the body puts on itself. So when the body is saying, "Okay, I've got to slow myself down." It takes some of it's T3, which is your active thyroid hormone and it converts it to reverse T3 almost in a way to slow down our metabolism. It's a protective mechanism. I think of. And it makes sense that we have that in times of stress- Dr. Mark Hyman: [crosstalk 00:11:09] trigger that are not actually good, right? Dr. Elizabeth Boham: That's very true. So, if there was a major stress going on, you'd want to have that mechanism in place so you didn't starve to death, but with a lot of chronic stress, which we see a lot these days, we can sometimes see high reverse T3. And the other thing we see a lot that causes that high reverse T3 is sometimes toxins. So it can be a sign that we've got to look deeper and say, "Okay, is this person under a lot of chronic stress? How is their adrenal gland functioning? Are they working to activate that parasympathetic nervous system that calming nervous system, which helps the body heal?" And then we look for toxins. Dr. Mark Hyman: And the gluten issues. We look for everything that is imbalancing the thyroid. We look for nutritional deficiency of selenium deficiency, iodine deficiency. Are you low in zinc? Do you have low Omega three fats? Do you have any acid in your gut? Do you have heavy metals? You have pesticide exposure, toxin exposure? So we take a very detailed history that your traditional doctor would not do. So we really look at the broad spectrum of what's causing it. Because we can just treat the symptoms of a thyroid, but maybe we may not need to do that. And we've seen many patients where you fix these other things and their thyroid gets better. Dr. Elizabeth Boham: Absolutely. Dr. Mark Hyman: And it's so powerful and you see that and it's like, "Oh, I don't need to do thyroid. I can actually fix the upstream cause." Dr. Elizabeth Boham: Yeah. It's pretty impressive when that happens. Dr. Mark Hyman: It is. And the last thing you were talking about was antibodies. So, tell us about what antibodies are and why we should look at them and why the traditional doctors don't look at them. Dr. Elizabeth Boham: I'm not sure why they don't look at them enough, but the antibodies are giving us a signal that the body is attacking its own thyroid. And it's a sign that there's autoimmune disease going on in the body. And we've got to figure out that question, "Why is that going on?" So I had a woman who came in to see me, she was 40 and she had been struggling with all those symptoms we talked about with low thyroid. She was cold all the time, her hands were cold, she was gaining weight. She was tired. She was constipated. She was losing hair. Her eyebrows were thinning- Dr. Mark Hyman: Sound familiar anybody? Dr. Elizabeth Boham: I know right? So I'm like, "Okay." But then her primary doctor did her TSH and it was normal. So we then went deeper. Dr. Mark Hyman: Can I stop you for a second? So what I was trained and I'm sure you were trained the same way, it was, you only check TSH. If that's normal you don't do anything else. And what's normal is a range of like 0.5 to five. Dr. Elizabeth Boham: Often. Yeah. Dr. Mark Hyman: Which is a massive range that actually doesn't reflect even our current understanding on most reference ranges on the lab tests that even the American college of endocrinologist says, if it's over three and a half, we should be worried. Dr. Elizabeth Boham: Right. And many, many studies are saying people between one and two feel the best. Dr. Mark Hyman: And I remember, because I always do all the tests. I don't do a reverse T3, but I do TSH T3, T4 and the thyroid antibodies. Because what I've learned is that even if all those are normal TSH, T3 T4, you can have elevated antibodies. Dr. Elizabeth Boham: Yes. Dr. Mark Hyman: And people who have those feel better when they get on thyroid. Dr. Elizabeth Boham: Very true. Dr. Mark Hyman: I went to a conference years ago at Harvard, it was a traditional medicine conference and the endocrinologist was talking about thyroid. And he said, "Look, if your antibodies are elevated, they should be treated because they're probably symptomatic and you treat the patient, not the lab test." But in traditional medicine, now we're more treating the lab test, not the patient. And I think that's really important. Dr. Elizabeth Boham: And the physician, sometimes thinks, "Well, I'll just wait until these antibodies damage the thyroid enough and then I'll treat." That's like the way they... Dr. Mark Hyman: It's like, "Once the THS stars to go up,"... Dr. Elizabeth Boham: I'm going to wait until, but we say, "Okay, no, there's so much we can do right away." Dr. Mark Hyman: Yeah. I remember this patient came in once with a blood sugar, like 115 and 126 is diabetes and 100 is prediabetes. And I'm like, "God, did your doctor say anything about your high blood sugars?" "Oh yeah. He checked it out." "Well, what did he say?" "He said, well, when it gets to like one 26, we'll treat with medication." Dr. Elizabeth Boham: No, this is the perfect time to treat you. Dr. Mark Hyman: So tell us about this case you have. 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. And so then we had to- Dr. Mark Hyman: Well 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, but I don't even know if it was, I think everything looks really normal, 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 actually gave her some thyroid hormone. We gave her some glandular thyroid hormone. Dr. Elizabeth Boham: 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, her skin starting to be less dry, her bowel movements improving. 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 I start feeling better on this stuff, right? And I think just to back up a little bit, you did something which was kind of unusual, controversial, and most traditional endocrinologists would scoff at, which is you used a combination of T3 and T4 in a hormone that comes from pig, that is the entire thyroid combination of hormones, including T2, which we don't even talk about. That is actually really important to replace your own because you make a complex array of hormones and often the T4 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 Luvox all 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: So some people, as you mentioned earlier, feel fine on T4 thyroid hormone. That's like Synthroid, 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 and or iron and zinc. We talked about that earlier that they can't make that conversion as easily. And so that 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- Dr. Mark Hyman: Not going to kill you. Dr. Elizabeth Boham: Thank you. It's not going to kill you, but it can make you not feel so good. And it helps us know how to treat people. So the gene is this a DIO2 gene that encodes for this enzyme, the DI2 enzyme, which helps the body convert T4 to T3 especially in the brain, but also 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 thyroid hormone, they don't get the benefit. And studies have shown even when lab work looks normal, So even if they're, even if their T3 looks normal, even if their TSH looks normal, that they do better when you give them to some T3, which could be like a glandular thyroid hormone, like armor, which is a combination of T4 and T3 or it could be a synthetic T3. We sometimes use like Cytomel and we'll add that to Synthroid for example, or T4. Dr. Elizabeth Boham: And so sometimes we see those people who just start to feel better in terms of especially mentally, energy wise, mood wise, they, they really start to feel better finally. Dr. Mark Hyman: People don't realize that depression is leading to thyroid and often psychiatrists and 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: And it's like weird for the rest of it. And also the T4 thyroid replacements, there are challenged with that because there's often fillers things like lactose and gluten. Dr. Elizabeth Boham: Could be other reasons why people don't feel well on those. Dr. Mark Hyman: Yeah. So those are important recognize. And a lot of the traditional doctors really scoff at the use of glandulars. Like, Westhroid, Nature-Throid, Armour Throid, why is that and should we be worried? Dr. Elizabeth Boham: I don't think so. I think maybe it's during their training or many years ago, there was a question of regulation of those are the dosage, but I don't find that to be a problem at all. We can definitely regulate dose with our patients. It's very reproducible in terms of the medication and a good portion of our patients. I think we've talked about this before, right? We'll say it was at 80% of our patients or a good portion of our patients do really well when we use a glandular. I mean, there are some that don't, there are some that might actually cause a more auto-immunity maybe for some, or they just don't feel good on them and we use synthetic, but for a good portion, it 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, West throid, 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. So tell us about that. Dr. Elizabeth Boham: Well, sometimes like when you give T3, then you might see a low T for on, and like you said, TSH, but definitely a low T4 on the lab test because, because you're giving some of your thyroid and T3 and with the food feedback loop, it causes that your body doesn't make as much T4. Dr. Mark Hyman: And the CSH goes down, which worries doctors, "Are you taking too much? Are you treated?" And actually it's not [inaudible 00:21:49]. Dr. Elizabeth Boham: It's really important to pay attention to the patient's symptoms. And I find that everybody's different. I have patients who are so sensitive to thyroid that if their TSH gets a little too low, they feel awful. They get heart 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 what I think the takeaway is, is paying attention to your patient and their symptoms and getting that feedback and listening to them. Dr. Mark Hyman: So like what William Osler said, treat the person who has the disease, not the disease that the person has. Dr. Elizabeth Boham: Absolutely. That's what we're working to get to. Dr. Mark Hyman: Reminds me of a case I had years ago where this woman was so symptomatic on hypothyroid and her TSH 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 things that were symptoms of low thyroid that weren't being treated. So it's really powerful. So tell us about the second case of your patient who had actually been on thyroid for 15 years and really struggled. Dr. Elizabeth Boham: So she was a 35 year old woman who came to see us who had been hypothyroid since her late teens twenties. 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 at antidepressants. So she was on the thyroid medication for a long time, but always sort of dealt with this low level depression. Not a major depressive episode, but enough where sometimes she would stay in bed all day, she would sleep too many hours. She would sleep 14 hours sometimes, she just had loss of interest in things. And so when she went to her primary doctor about that, they were saying, "Okay, maybe we should try an antidepressant. Maybe this is interfering so much with your life at this point, now that you're 35, that we should try an antidepressant." Dr. Elizabeth Boham: 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 looked fine. Her TSH or T4, T33, it looked fine, but she did have a homozygous variation in that DIO2 gene, which is associated with depression 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 with her she was feeling fine under 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. Mark Hyman: Yeah, that's amazing. So these cases are not atypical. We see this all the time at the UltraWellness Center and we help people when no one else can help them because we look at things differently through the lens of functional medicine, which is about root causes about treating the whole system. When you're coming with thyroid to your regular doctor, and I'll ask you, if you have been eating tuna fish every day for 30 years, or if you worked in a pesticide factory, or if your stomach's upset. They don't care if you have, maybe you're constipated, that's a symptom, but they don't care if you have bacterial overgrowth or yeast overgrowth or leaky gut or any of this stuff. And so at the UltraWellness Center, we tend to look at all of that. And we really dive deep into each person's story because everybody's different. Dr. Mark Hyman: If you've seen one person with thyroid, you've seen one person with thyroid and everybody has to be treated a little bit differently and personalized care. And it's really what the future of medicine is. It's personalized precision medicine and also precision health in folks. Medicine is more about how do we create health. And so, just to recap what Dr. Boham and I have talked about, I think it's important to recognize if you have any symptoms. If you're tired in the morning, if you have dry skin, food retention, muscle aches, cramps, constipation, depression, low sex drive, low concentration, flaky skin, whatever that it might be worth checking with a functional medicine doctor. And at the UltraWellness Center we take care of patients from all over the world. And then when we do that, we look at different kinds of testing. Dr. Mark Hyman: So yes, we'll look at your TSH. We'll look at T3 T4, the thyroid, we might have to get reverse T3, we might look at the genes involved with thyroid function, but we'll also look at things like your gut. And we'll look at heavy metals and look at your experiences, your diet we'll look at nutritional deficiencies, I'm on to check selenium or zinc or iodine things that are really important. Vitamin D and Omega three. All these things are playing a huge role in our thyroid function, and then we'll talk about what foods you can eat. So what do you eat? I mean, so selenium is in Brazil, nuts. Iodine's in fish, zinc is in pumpkin seeds. You can get Omega threes and sardines, so you can actually use food to help optimize your thyroid function. Maybe you're having kale juice every day, you don't want to do that. So we'll sort of adjust things. Dr. Mark Hyman: And then by doing that, we really get a holistic view of what's going on and we can really optimize people's health. So I just thank you so much for sharing today about your cases and helping people understand that if you suffer from any of these symptoms, if you have challenges with your health, that nobody else can figure out that functional medicine lens really is different. And we are probably more experienced than anybody. At the UltraWellness Center there's four doctors there, and collectively, we probably have more experience than any center in the world, probably over 65 years of functional medicine experience. And we're getting old. Liz was like 30 when I met her and now she's like 50, but she looks 20. So I still don't know how all that works. Dr. Elizabeth Boham: We're aging backwards. Dr. Mark Hyman: We're aging backwards. So thank you for listening to Doctor's Farmacy. This is a case study of a thyroid case or two, and I hope you understood a little bit more about what's ailing you and hope you enjoyed this Farmacy episode. If you'd like to share with your friends and family on social media, leave a comment we'd love to hear from you and subscribe every year podcast. For those who are listening in the show notes, we're going to put the tests, the dietary instructions, the supplements you need lifestyle things to look at for every condition we're going to talk about on the mini episodes of The Doctor's Farmacy to learn more and get your little cheat sheet handout so you actually know what we're talking about. You don't have to write everything down because you're probably driving while you're listening or working out or something. So anyway, it's great being with you and thank you, Dr. Boham for being on Doctor's, Farmacy podcast. Dr. Elizabeth Boham: Thank you so much, Mark. Dr. Mark Hyman: All right, we'll see you next time.