Full Thyroid Panel Explained: How to Optimize Your Thyroid and Get Your Energy Back

All right, and we're live. Thank everyone for being patient here. Uh worth the wait. This is going to be an exciting episode. Before we get into it, let's do some introductions. My name is Kolsi here from one of the co-founders of MedMatrix, and I'm joined here with the brilliant Dr. Rose. Dr. Rose, thanks for making time. Yeah, happy to be here. Yeah. Why don't you give for those who don't know who you are, why don't you give a little background on, you know, your expertise and actually, you know, how you know so much about thyroid health. Sure. So my name is Dr. Sasha Rose. I'm a naturopathic doctor, licensed acupuncturist. I've been practicing functional medicine for over 20 years, and um a big part of our training, a big part of my practice for that time, um has been thyroid health and really diving deeper into thyroid health and um kind of moving beyond the standard testing, maybe the standard treatments, which is what we're going to get into today. So um yeah, I mean, I probably have a conversation a couple times a day with patients about about various aspects of thyroid health. So um I'm super excited to talk about it, and um yeah, it's just it's just an important part of everybody's health, and something that I think people are often have a level of frustration with. So glad we got to to dive in. Yeah, definitely. So let's kind of like what we like to do with these episodes is set a little bit of like groundwork and then kind of like go deeper. So first off, like what is when you say thyroid, and like like what is thyroid, where does it live in your body, what is it responsible for, why is it so closely tied to your energy? Yeah. Um one thing that that I should probably say, we should probably say at the beginning is that everything that we talk about today is um you know, not medical it's advice, it's just kind of informational. Right. right. That's job. Today is just for education. If you want medical advice, you're welcome to go to your doctor or you know, reach out to a patient coordinator here and see if we can help you out. Um, but Yeah. We catch. Yeah. Um, so the thyroid gland, I mean, the simplistic terms, I guess, would be to say that it's really kind of in charge of metabolism and energy, you know, helps with kind of energy production. Um, there are thyroid receptors, meaning receptors to the thyroid hormones throughout the whole body, including the gut. Um, and so when a thyroid is not functioning optimally, people can feel that throughout, you know, throughout the body. It's not just going to be felt kind of with one sign or one symptom. Um, and it it can really can affect people differently, but um, you know, the the most prominent symptom I would say if the thyroid and again, usually it's a sluggish thyroid. We can get into this if we want. Kind of there's there's hyperactive type of thyroid disease and then there's a hypo, meaning like a sluggish Yeah. form, which is the more common and that's when people are going to feel fatigued. So, common knowledge, I think, is that fatigue, you know, if someone's fatigued, it may be your thyroid and that's that is accurate, actually. Yeah, okay. So, thyroid issues kind of go on a scale, right? Because you have like you're like you're diagnosed Hashimoto's or hypothyroidism or hyperthyroidism, but like can you kind of explain the kind of way that functional medicine looks at thyroid health health differently? Like cuz you can still be in the conventional range, but your thyroid may not be optimal. Can you explain that? Yeah, exactly. So, usually if you go to the doctor and if they or you are wondering about your thyroid health, there's usually one test that they're going to do and that's called a thyroid stimulating hormone or a TSH. Mhm. And um we talk about this a lot in functional medicine, and I think it's especially relevant in regards to these tests, which is that normal versus optimal. And so, for example, on a standard lab, a TSH range for what's normal is everywhere from 0.5 to 5. Mhm. So, if you come back and your TSH is at 4.98, it's not going to be flagged by the lab, and it's possible that your provider is going to say you're fine. Your fatigue, your weight gain, your dry skin, your constipation has nothing to do with your thyroid. In functional medicine, we're always looking at optimal, not just normal. And so, we have a much more narrow range when we're looking at a TSH level. So, every provider's maybe a little bit different within functional medicine, but as a general rule, we're looking at 0.75 to 2. So, it's just it it's narrow on both sides. Um it doesn't mean that anytime somebody comes in and their TSH is 2.75, that I'm going to be, you know, diagnosing them or giving them thyroid replacement necessarily, because we're looking at a lot of things. We're looking at a more comprehensive thyroid panel. We're looking at the actual thyroid hormones. We're going to get into this a little bit later, but the there's, you know, there's an active form, there's an inactive form, there's thyroid antibodies. You mentioned Hashimoto's, which is the autoimmune form of hypo or a sluggish thyroid. Um so, we need all of that information to really get a full picture of the thyroid, not just a TSH, in my opinion. And I would think I I think I can speak for for most functional medicine providers. Yeah. Yeah. Can you explain I guess can you just for more context for the viewers like can you explain TSH and the way it relates to like your actual active thyroid because TSH is actually just a a piece of the puzzle and that's kind of interesting why you know most conventional doctors don't even look at the other markers. The whole picture yeah. So TSH is thyroid stimulating hormone and the way that it it's role within the whole path the whole system whole pathway is that the pituitary secretes TSH and it's basically a a messenger sent to the thyroid gland to produce T4 which is the inactive form of the thyroid hormone. Now if somebody is taking levothyroxine or Synthroid or some other similar medications that person is taking T4. So TSH is basically a signaling messenger telling the thyroid to produce the hormone. If there's something going on where the thyroid is having a hard time producing T4 or an adequate amount of that hormone the pituitary can sense it right everything's kind of you know in the blood here. Pituitary says oh there must not be enough I'm not yelling loudly enough. I have to yell louder to the thyroid. I better I have to put out more TSH and so it's counterintuitive that you have a sluggish thyroid yet your TSH is going up because the pituitary thinks that it's not again it's not loud enough it's not being clear enough it has to make more and more and more. So that's kind of that connection between the TSH and the what's actually happening. Gotcha. So what's the scope of this like how many patients are coming in that like already have like like they are diagnosed by conventional standards like hypo or I mean, majority of cases are hypo. Literally hypothyroidism, yeah. And and then what percent are like, okay, they're they're not hype they don't have like a diagnosed um like by like conventional standards, they're not like, you know, they don't qualify for a diagnosis, but they still have a less than optimal thyroid. Like what percent of patients have thyroid that can still be improved and therefore feel better? I mean, your first question was how many people come in with an actual hypothyroid diagnosis and I would say um It's a relatively high percentage. I don't have obviously I don't have an exact figure for you, but I'm going to say um maybe 40% of the people that I see. Now Now, that might be a little bit high. However, you have to realize that a a majority of my patient population is women over the age of 40. Okay. Right. And hypothyroidism is much more prevalent in that demographic. Much more Much more likely to happen with women and higher likelihood of it being diagnosed postpartum. So that that's partly why it's such a high percentage. Um I do have men who come in as well who have been diagnosed with hypothyroidism. Your second question was how many people don't have that don't come in with that diagnosis, but I would diagnose them as if not hypo that having hypothyroidism is it borderline, right? Is it kind of normal, but not optimal? Right. Is that Is that the question? So Yeah. Yeah. Um I don't know. Um Obviously not as many, but um um you know, out of say the number of people that I'm out of let's say out of um maybe 25 patients, I would probably say like two to three of those, probably. I would say, you know, so something Here's a common scenario. Your TSH looks looks pretty good, but I I can tell that you may develop hypothyroidism down the road because as part of our initial panel, we're looking at the antibodies, and I can get into what that means in a second, but basically, there's some autoimmune activity going on at the level of the thyroid, and um there's some inflammation there. Your levels are your thyroid is still stable, but if that continues, it's probably going to start to impair the function of your thyroid. And that's I would diagnose that as kind of again, like a mild or a borderline or a let's keep an eye on this situation. Got you. Yeah, why don't we explain antibodies right now and T3 as well? Let's dive into T3 and antibodies. Yeah, so um the other tests So, this again, this is just kind of the the panel that we have that we run on people. It's just kind of the complete thyroid panel. We have TSH as we described. We have T4, which is the inactive thyroid hormone. That T4 circulates throughout the body and in the gut, at the in the liver, and in tissues throughout the body, it's converted to T3, which is the bioactive form of thyroid hormone. T3 has a much shorter half-life, so it's just a very efficient system in that the hormone that's doing most of the circulating is T4, which has a longer half-life. There's an enzyme that lobs off an iodine molecule, and that makes the T4 become T3. We're measuring all of that, right? We're measuring the T4, we're measuring the T3. Um and oftentimes in hypothyroidism, it's an issue with that enzyme. It's a conversion issue. So, that T4 is not Somebody's taking T4, they're taking levothyroxine, but their T3 just isn't optimal. And so, we know it's an issue again of conversion, not necessarily a problem with the dose of the medication. Mhm. Um so, we're measuring all of that, and then we're looking at thyroglobulin antibodies and thyroid peroxidase antibodies. And these, if they're below a certain level, that tells us that um if somebody has, you know, a sluggish thyroid, hypothyroidism, there's not an autoimmune cause. Autoimmune, by definition, means that part of your immune system is attacking a specific tissue in the body. In this case, the thyroid. Right. If those levels are are below a certain level, then that's it's not an autoimmune cause. Mhm. If those antibodies are elevated, then we are potentially looking at Hashimoto's disease, also known as um autoimmune thyroiditis. Mhm. And again, it's just part of what we do, right? It's just kind of completing the picture. It's more information. It's helping us get to the root cause um of, you know, why is there a sluggish thyroid? Right. the I think it's maybe something like 80 to 90% of people with hypothyroidism have Hashimoto's as the cause. Mhm. Yeah, okay. Um here, I actually have a really interesting question go off of that what you just said, but um guys, if this is one of your first webinars uh live webinars joining us, feel free to uh post some comments. We love interacting with you, and we're going to do some Q&A at the end. So, the more active you guys are, the more fun this is for us, and uh I think it's better for everyone, cuz probably if you have a question in your mind, I bet the audience is thinking it as well. So, uh keep up the questions. So, this was really interesting. We got a comment from Instagram that says, "I just had my blood work done for a yearly checkup. What you just mentioned is not on the list of items tested." So, can you kind of dive into like that a little bit cuz that's something we hear all the time. So the question is what in that list of tests that's in our in our thyroid panel, what did what is included in ours that is probably not included in that person's yearly checkup? Is that the question? Yeah, that you were talking about like TSH and antibodies. Yeah. So in my experience, and again, every practice is a little bit different, but usually when I have people come in and they've been getting that yearly checkup, um and I don't know if this listener if this viewer has a thyroid condition. I don't know if anybody's if they're doing extra work for the thyroid, but usually there's not even any not even a TSH is included in a general screening panel. Now, if you have a known thyroid imbalance, if you come in to your physician and you say, "I have unexplained fatigue. I can't lose weight." They might run probably just a TSH. And if that's again normal, then it's going to end there. In my experience. Yeah. And why is that? Yeah, so the So the other so to to to repeat, what's probably not included is the T4, the T3, the thyroid antibodies, and there's even another one called reverse T3, um which just kind of gives us a more complete picture of um how well that the actual T3 is actually able to lock into receptors. Yeah. Yeah, and the testing's important, right? I mean, here's another comment here, which is actually interesting. Um this patient here is like cuz you want to explain why you need to test the whole picture of thyroid, not just the TSH. Like why like go out kind of going off of this, you know? Yeah, so this person's comment is um what was eye-opening is that I have Hashimoto Hashimoto's disease. Um this person has been on Synthroid, which is the brand name of levothyroxine. It's T4 for 10 years and never knew. So, basically, I think what this patient is saying is that they never knew that it was Hashimoto's. They obviously knew they had hypothyroidism. They had been put on Synthroid for 10 years. The reason why they never knew that it was autoimmune was because those antibodies had never been included in the testing. That's really the way that you find out. Right. Yeah, yeah. Okay, so here's here's my next question here. It's like many people are diagnosed with hypothyroidism, like this patient right here, and placed on a medication, right? Uh but they still struggle with fatigue, you know, can't lose weight, brain fog. Um why does this happen so often where patients are put on like synthetic thyroid medication, but it really doesn't like fix much? Or maybe they don't know about it. Yeah, so so why are people being diagnosed with hypothyroidism? They're put again on like Synthroid or levothyroxine, yet they don't necessarily feel any better. So, they're going to have those some of those classic symptoms of fatigue, brain fog, weight gain, as we've kind of discussed. And why is like yeah, that it is quite common, unfortunately. Um and I think that it's comes back to again something we talk about a fair amount on this podcast, which is that those medications do work. They work in that they normalize labs. If your TSH was a six and we want to get it again under five it's going to happen. It's going to work. It can take, you know, as short a time as like 4 to 6 weeks. So, according to kind of the conventional medical model, job's done. Mhm. But it's not necessarily within optimal. And we don't again have that full picture of what, you know, is it an autoimmune? Is there systemic levels of inflammation? Is there kind of other hormonal imbalances? Is there an adrenal component? Like all of that is really going to be feeding in to the health of the thyroid, not to mention nutrient deficiencies. Like I I mentioned the conversion of T4 to T3. There's very specific minerals and vitamins that are required for that conversion to happen. If somebody is not getting that through their food or their gut health is imbalanced or they're not absorbing those nutrients, you can give them all the levothyroxine in the world and their labs will look great and they're not going to feel any better. Right. Can you explain like the um like what's like what's actually going on with the conversion of T4 to T3 in the whole pathway from TSH all the way to the end? I don't think we explained that. Okay, I'll I'll say that again. So, um the pituitary is um basically putting out thyroid stimulating hormone, telling the thyroid gland to make T4. So, um TSH is is what they normally test. So, pituitary gland puts out TSH which signals to make T4 because it knows that T it's sensing the pituitary gland is sensing, okay, we're we're low on thyroid. We're low on thyroid, I got to make I got to I got to stim I got to I got to push the thyroid gland. So, so thyroid gland says, "Okay." and puts out T4 which is kind of I always describe it as kind of the inactive version of the hormone. It could also be called like a storage hormone. That circulates throughout the body and then kind of at the receptor level is when that that that enzyme comes in and lobs off an iodine molecule converting T4 to T3 which is the active hormone at the receptor level, at the cellular level. This conversion happens everywhere including the liver and the gut. So, you can have normal TSH, you can have normal T4, but if that conversion is inadequate, your teeth and your T3 is low, sometimes that's when you will still have these chronic symptoms, the fatigue, the weight gain, the brain fog. Um it's not the whole picture, but it's a big part of it's a big part of the picture that's missed, I think. And so, if that act T3 is really kind of the magic ticket, and if that's insufficient, you're not going to get the energy that you need. Yeah, so let's talk more about like T3 and what it actually does in the body. So, okay, what like what happens when you have adequate T3 in the body? Like, how do you feel? Like, what is it what is that actually doing and leading to? Yeah, I mean, it's basically it's like fuel. It's basically charging cells, right? It's basically kind of like helping cells um work optimally, produce energy optimally. So, it's directly related to cellular energy production. And so, if the cells are not getting that charge, everything's going to be kind of depressed and lowered. So, um you're you really you really need that T3 as kind of the driver, I think, somewhat systemically. Mhm. Okay, got you. Um what I I guess like what uh what are some of your favorite strategies to like actually improve T3? Like, patient comes in, okay, they they have Hashimoto's, they're you're testing their TSH is high, you know they have a sluggish thyroid. Like, what is what what's going through your head? What are the tests that you want to run, the data that you want to get? What are some of the things you're going to like the nutrients you're going to look at? Can you talk more about actually like problem-solving this? Yeah, so looking at the whole picture. So, we're always looking at the whole picture. We're always looking at, you know, potentially if I'm suspecting that it's a conversion issue, for example, I have to look at new I have to look at nutrient level, what it how does this person eat? I have to look at gut health and gut dysfunction as I mentioned. Um is are the nutrients not getting absorbed? They might be eating the best food in the world, but if they can't their body can't process it then it's not getting it's not getting in and the thyroid can't use it. That That enzyme can't use it. Um if there's chronic inflammation and so we, you know, part of our testing includes inflammatory um markers. Mhm. So, I'm looking at the whole picture. I'm looking at even chronic stress, physio physical stress, um mental emotional stress. I'm looking at the health of the liver. Is are things processing right? As I mentioned, there's T3 receptors in the liver. Um specific nutrients that I want to make sure that they're getting to help with that conversion um are viewers may have heard of, you know, the importance of these before. Selenium is a big one, zinc is a big one, iron is a big one, the fat-soluble vitamins, vitamins D, A, and K. Those are all really important. Um so a deficiency in any of those is going to make it so much harder for the enzyme to do its work, for T4 to become T3. So, thyroid is like such a great example of looking at the whole person and um so I'm looking at all of that, trying to optimize that, and um I think with the gift of these of this these lab values. Um yeah. You mentioned stress. How does like stress play a role in your thyroid function? Cuz people have like heard about the mind-body connection, but I think if you can actually explain it that that would be pretty cool for people. Yeah, I mean I think of it as um everything in the body, maybe especially the thyroid, has to work harder and when we are under any kind of stress. And when I say stress again, yes, it's like the mental emotional stress that we often think of with that word, but chronic pain is a is a chronic stress as well. And so, it takes like on a cellular level, it takes so much more energy to function under those under that um that duress. And so, the thyroid's just going to be working harder. And we also have And so, that's going to take a toll after a while. And there's a very strong connection um between the adrenal glands, so the glands that produce cortisol, and the thyroid. And so, sometimes the way that what happens is is we're not routinely testing for cortisol. We're not testing our adrenal glands, but that's the that's the gland that's really kind of or those are the glands that are kind of really struggling, and yet it the thyroid is trying to compensate, right? So, there's this fundamental level of fatigue, and the thyroid is trying to kind of pick up slack for the adrenal glands and working overtime. And so, then you start to see the thyroid start to find And this is chronic stress, right? This is not like you had a stressful week at work. This is like Right. past This is like history of trauma, PTSD, chronic stress that's finally kind of impacting you physiologically. Got you. Yeah, great great example. And I I think like that kind of really explains well like why just taking a medication for something like thyroid issues isn't enough. Like it's just so multifaceted, there's so many things going on. And when you go in and like they just put you on a synthetic thyroid medication, and then like okay, you're you're fixed now, it's really actually not the case. Do you want to Do you want to explain more like kind of cuz you like like when do you use a synthetic thyroid medication versus a bioidentical thyroid medication like armor thyroid or can you kind of explain the different types of medications that are are out there for thyroid and kind of like when you use different ones? Absolutely. It's a great question. So, when am I using a synthetic like a levothyroxine versus a combination more natural one like NP thyroid or armor thyroid? Um So, it's really personalized. Um I really am a big fan of giving people options and giving people like like educating and so giving people an explanation of okay, you you're coming into my office and you're you're currently on levothyroxine. This is T4. This is it requires the body to to this conversion. It looks like your body's not doing it as well as it could. Um So, we have the option of staying on it. We have the option of adding in synthetic T3 and I and I I do that somewhat fairly fairly often if somebody for the most part has been feeling okay on levothyroxine. I will just add in a very very low dose of T3 and just see what happens on the blood work and how they feel. Sometimes people are not doing great on their levothyroxine and whether it's on the blood work or symptom clinically how they feel. And they need to know that there are other options out there and that what you refer to is the natural version which is also called a combination therapy and that is um they're usually desiccated porcine thyroid glandulars. And what it is is it's basically both T4 and T3 and it's in the physiological ratio that matches the human the normal human ratio, which is um 3.5 units of T4 to one unit of T3. So, it's kind of conveniently packaged in a tablet and it takes the burden off the body to have to do that conversion as much, right? Cuz you're getting a little bit of both. Now, some people, this is just clinical experience, some people feel better on that than they do on the synthetic. Other people don't. It's not a one-size-fits-all at all. And sometimes it takes tweaking and and so, you know, we we try somebody on something for a little while, we repeat labs, we listen to how they're feeling, we adjust. Um but it the beautiful thing about functional medicine is that we, you've heard me say this a million times, we have a large toolbox and we are not here to to tell you that, you know, we've got one way of doing things and if and that's how it is and I, you know, it's really a back and forth and um the other op- the other thing with the synthetics is that, especially when we're talking about the generic, which is levothyroxine, there's many different pharmaceutical companies that manufacture it. They don't all have the same inactive ingredients. And you don't I don't think that the pharmacies know or are required to disclose all of those inactive ingredients. And sometimes people may be having a reaction to that. For example, sometimes levothyroxine includes gluten and it's not like spelled it's not on your little Yeah. And it doesn't We're going to talk about that more, but gluten's actually Gluten, if you have Hashimoto's disease, you do not want to be consuming gluten. And so, um there's no way to know. And so, I do have people the other again, when I I'm giving people like a menu of these are some options that we can try. Synthroid is a brand name and some people they know that they feel good on Synthroid. They do not feel good on levothyroxine. There's another one that's even more expensive, but I have one I'll I'll talk about her in a second. I have one case where this is a perfect example. It's called Tirosint. Um t i r o s i n t I think and it's a synthetic T4. And it's got I think fewer inactive ingredients and um this person that I'm thinking of this is a 48-year-old woman who has historically really struggled with finding balance with her thyroid. She's been to multiple endocrinologists. She felt terrible on Synthroid. She felt terrible on levothyroxine. I tried her on NP Thyroid. Felt terrible. Um when I get her levels within normal, she feels worse. Um Really well. The last time I saw her, we decided to start on a very very low dose of Tirosint. I just got a message from her this week that she's actually feeling really good and she wants to to go up on that on the dose on that. So all we're we're all different. Our biochemistry is different and so part of the process is like sometimes a little bit of trial and error. Yeah, it's interesting. So like what is your scares like I'm sure patients I'm sure viewers are curious about this. Like what is your personal philosophy on like medications when cuz like I know just I think what's the practice consensus with all the doctors here it's like the ideal like the last resort is to put a patient on a medication for the rest of their life. But sometimes it's necessary if they want to feel feel better. But then it's like you're talking about levothyroxine and synthetic thyroid medications versus organic bioidentical thyroid medications. Is like one better than the other? Like would you rather have a patient on a organic thyroid medication or does it actually not really matter? What's kind of your thought process there? Yeah, so just in terms of terminology around the medications, I don't think they're organic. They are natural. They are natural because they're sourced it's you know, I can't and it's porcine which means pork. So just for some you know, if you're vegan or vegetarian, you don't want to be taking an NP thyroid or an armor thyroid. Um but they are more natural and they really don't have a a lot of extra inactive ingredients. You know, honestly, 20 years ago when I was first when I was you know, newly practicing, I would have said all natural all the time. Based on clinical experience as I kind of mentioned, it's not always the right fit for every person. So yes, I want I think what I want is that people to know that they have options. And whether or not they feel like levothyroxine for example has been working for them, they should just know that there are other options. That's not usually provided to that initially. You know what I mean? And so it's really like I tell people I don't have a set agenda. I'm not coming here to prove to you that you have to do something more natural, but I want you to know that it's there if you want to try it. So it's just a little bit more of like yes, of course always like the fewer ingredients, the more natural when possible, but I think we have to be sometimes a little less dogmatic and just realize that um I yeah, just to be repetitive that everyone has different different metabolism, different biochemistry. Right. What are some of like the longer term, you know, maybe side effects of like the synthetic or being on a thyroid medication? Like are there Are there health later if you're on a thyroid medication? know that there are. I think part of I think maybe the bigger question in terms of long-term negative side effects is the big the broader deeper question is that we're not getting to the root cause necessarily. And so, people are just put on thyroid replacement and it's just left at that. And they still feel like crap, right? And they their inflammation hasn't been addressed. Their gut health hasn't been addressed. Their nutrient deficiencies haven't been addressed. Nobody's even talking about stress or adrenal functions. So, it's just that kind of band-aid medicine. You just kind of slap on a medication and your TSH is within normal and so, I'll see you in 6 months. And so, that to me is more I think the issue than that we see what I don't I'm not aware of any from the research necessarily any significant long-term effects except that these other kind of persistent things can kind of go on and on because they've their TSH is technically within normal. Okay. Yeah, so something that's really interesting we touched on it like just for a second there was gluten and thyroid. What's up with that? Like why is why are gluten and thyroid so closely linked? I'm actually curious too from your experience like when people go to their conventional doctors and they have thyroid issues, are they even being told about hey, you probably shouldn't eat gluten? Um I can't say. I think it's not necessarily common knowledge. I have had people come back and I I don't know if it's primary care or endocrinology who has recommended that they minimize gluten. So, it's not impossible. Um the connection is primarily when you have the autoimmune form or you have Hashimoto's disease. And the reason, in my understanding this is the reason, is that um part of the thyroid gland, there's a specific um part of it called the thyroglobulin. That specific part of the actual gland is molecularly similar to gliadin, which is the protein in gluten. If you are having a sensitivity, not an allergy, not necessarily celiac, but a sensitivity, your immune system is having some kind of reaction to gluten, it's going to also react to the thyroglobulin part of the thyroid. Mhm. And so, one way to lower that reaction, that reactivity, is to minimize gluten, and that's going to calm down the inflammation at the level of the thyroid. It's not going to fix your hypothy- your your Hashimoto's. It's not going to make it go away, but it is part of the root cause of like supporting the body, um and maybe needing less thyroid replacement, or just kind of that global like let's reduce inflammation systemically, and let's support the thyroid, not just replace the hormone. Yeah, totally. And that's kind of part of the whole holistic approach, right? Um Quite a lot of stuff. Yeah. I'll throw in a few other kind of nutrition things while we're just on the topic of that, um that people often aren't aware of. So, a couple things, um we mentioned selenium. Um Brazil nuts are ridiculously high in selenium. If you were to Google at this moment foods high in selenium, Brazil nuts are like super super high, and I don't even know what the next one is, but um you can buy a bag of Brazil nuts, and you can eat like three a day, and that's going to support your thyroid. Only three? Uh iodine. So, seaweed. So, putting a little bit of kelp in your if you're making a stew or a soup, little bit of like dulse powder, that's a type of seaweed, you can sprinkle that on your salads or on your rice. That's natural iodine. Okay. Let's talk more about iodine. I actually see a comment here from uh Dr. Julia. First, she mentioned iodine. So, why what's the link between cuz you actually mentioned iodine molecule in the conversion of T4 to T3, right, earlier? Did you say that? Uh yes. Yeah. Okay. So, can you talk more about like how iodine and like supplementing iodine and kind of other forms of iodine are like from your experience helpful or Yeah. Yeah. Hi Dr. Julia, I know her. She's great. Um so, you if you have a if you know that you have a hypo if you have hypothyroidism um and or you suspect that somebody does, it's not it's probably not going to hurt to start taking, you know, iodine or iodide um iodized salt. Obviously, we are big fans of testing and kind of knowing rather than just guessing and just kind of throwing anything at somebody. But, um I guess if for some reason you can't test, you don't I don't know yeah, if if if if that's not kind of in the cards, then sure, you could supplement with with extra iodized salt. Right. Okay, got you. Are do you how often are you doing iodine testing? I don't. I feel like it's usually the reason that I don't is because we do have such a great thyroid panel and I'm repeating that panel often when I'm managing somebody um with hypothyroidism and oftentimes some of the sub nutraceutical supplements that I'm doing for that person will include iodine. Um and obviously, overall like, you know, looking at their nutrition and what they're eating, I want to make sure that that's adequate. Yeah, got you. Okay. So, what like how long does it take to start like patient comes in, they're sluggish. Let's say it is a thyroid issue. Let's say they have a sluggish thyroid. Um how long does it start to take to move the needle and kind of notice from your clinical experience, notice like positive outcomes? So, somebody comes in and we know or we suspect that they have a sluggish thyroid, they have hypothyroidism, we start we initiate a treatment plan that might include some thyroid replacement, it might re include kind of looking at their overall nutrition intake, their gut health, maybe doing some additional sup you know, nutraceutical supplementation. Um I will often repeat, if not the full thyroid panel, which I would do maybe you know, 3 months later, say 12 weeks later, at the 6-week mark, I'm probably going to at least repeat the TSH and do a quick check-in with that person to see if they're feeling better. So, I would say within And this is who knows what other things we might be doing in terms of hormone balancing, lifestyle modifications, etc. Um sleep optimization, but you know, theoretically, we're just working on the thyroid. Um So, you know, I want to see I want to see some shift within 6 weeks. 6 weeks, okay. So, it's Would you say it's pretty quick or in your like it's pretty quick. I mean, again, it it's everybody's different, right? Has this person never been on thyroid replacement? Um and now they are, were they on but it wasn't the right dose or the right form? Um but usually yeah, we're going to we're going to know if we're going in the right direction at least. Got you. Okay, so how does thyroid affect other parts of the body? Because you met you I went to one of your in-person seminars, you talked about the uh what do you call it, the triangle? Yeah. Yeah. What what something the something triangle. Can Can kind of explain that as far as like the how everything else is connected? Yeah, so there's this triangular relationship among the thyroid gland, the adrenal glands, and um the ovaries or the testes. And so it's basically it's not a linear, it's not that, you know, one you know, thyroid then goes to adrenal then goes to the ovaries. It's really that they're it's they all interact. And so when you So often times, here's an example is kind of perimenopause, um your progesterone levels start to drop, your estradiol or estrogen levels start to drop. Sometimes the that's going to impact the thyroid. That's often when, again, a woman is diagnosed with hypothyroidism. Is it just the thyroid? No, it's the impact of this drop in sex hormones that's kind of played a role in her with her thyroid health. Um we talked about chronic stress, that's the adrenal glands. And so it's it's a little nuanced, it's like I said, it's not a linear thing, but if we're trying to look holistically at somebody's hormonal health, we're looking at the we're looking at all of it. And so that's that's the questioning and the thorough, you know, visit of asking about ev- you know, everything having to do with hormones and not just focusing on on the thyroid. Yeah, so what happens like So like let's say someone does have hypothyroidism and they have a slow thyroid. Like So is that now going to throw off their adrenals, their sex hormones? Potentially it potentially it's it's almost like um why are they is it's almost like is there is the drop in these other hormones or the dis you know, the dysregulated cortisol has that kind of has that played a role in the thyroid having a hard time. Um, and yes, if your thyroid is, you know, not functioning optimally, that's that probably is indirectly going to make things like, well, it's going to make the symptoms of perimenopause that much worse cuz you're you've got, you know, you've got this kind of cellular reason for not for already being fatigued, and then you add kind of the hormonal fluctuations and drop um of perimenopause, and again, you just don't you don't feel good at all. Yeah. Totally. All right. How often are you like for your patients over 45 when they're probably experiencing some type of hormonal decline, how often are you using other therapies in tangent with, you know, fixing their thyroid, whether that's outside of the lifestyle stuff and solving for nutrient deficiencies, but things like um, you know, we use a lot of peptides, do hormone replacement therapy. How often are you using like other strategies in kind of tandem with thyroid probably 90-something percent of the time. Okay. And this is I mean, these are women who are like 35, not 45. Really? Oh, yeah. I mean, I'm looking at perimenopause is like a 15-to-20-year process for a lot of women, and so I think for a lot of women, if we if we don't even look for it until they're 45 or 50, we're not missing the boat, but things could be balanced a lot earlier. Yeah, and there's actually a lot that you can do to be preventative, right? As far as like just helping them Like if you start getting on perimenopause like at the beginning, they're going to be so much better off. It's pretty exciting. Yeah, and it's just not I mean, again, we've talked about this a lot in other episodes, but it's just not recognized, and people think that unless you're having hot flashes or night sweats, then it's it's not perimenopause, but it's you know, it's a lot of the same symptoms that we see with hypothyroidism, unfortunately. And sometimes both things are going on, but sometimes it's the fatigue and it's the weight gain and irritability and all that and it's um you have to kind of look at the whole picture and it it often is you know, a decade or so younger than anybody's even thinking to look for it. Yeah, totally. Um cool. All right, so let's we got about 15 minutes left here. So, for those joining us live, we love to do Q&A. Looks like we have an awesome active audience today. We appreciate you guys. So, why don't you start throwing some questions? We already have some really good ones there and we're going to jump into a case study and then we're going to try to answer as many questions as we can. So, Dr. Axe, why don't you kind of we always like to do a case study here. So, why don't you walk us through um a case study for a thyroid case? Yeah, well I think I'll just repeat I'll kind of go over that one that I mentioned earlier, the woman with that with that I ended up she's we've ended up putting her on Thyrotain. So, just and I'm just going to use her just cuz it's I mean it's sort of an unusual case, but I think it does really make the point of individual chemistry. And so, this is somebody who's like she's 47, I think and um had was diagnosed with hypothyroidism, I'm going to say 15 years ago and treated kind of which is pretty normal, which is they would put her on Synthroid. I think she was put on levothyroxine um and her her TSH normalized and so, they said you're good to go and she said, I still feel like crap and lived with that for 15 years just not feeling good and um shortly before she came in to see me, she was just kind of fed up, went off of her medication altogether. When she first when she first came in to see us, her TSH was through the roof um like 14 or something and we, you know, per conventional model, we want to see it under five. And so, you know, I look I we always review the blood work and the case before we see the person and I'm looking at this thinking something is not right. This is This is, you know, and then I got the full picture that she was just so tired of not feeling good on the medication. So, we looked at obviously we looked at everything. We looked at how she was eating. We optimized her vitamin D levels. We kind of um I think I made some dietary adjustments with her. We looked at chronic stress and all the lifestyle pieces. Um and then I you know, I tried her on the NP thyroid. She didn't feel good on that. We tried tried her on the Synthroid. She still didn't feel good on that and I couldn't for like a while I couldn't find that balance of she was only feeling good when she wasn't on a thyroid replacement. Like that's when she felt her best. Her brain fog was better. Her energy was better. And Then why didn't she just stay off? Like she felt her best she felt her best but her level her her TSH would start going up to 12 again. Okay. And we know that just metabolically that's her body's going to struggle without that thyroid support, right? Right, right. Okay, got it. And so, even though all the other things are really important, the nutrition and the lifestyle and the stress management, like if your if for whatever reason your thyroid cannot produce the hormone, I feel like it's negligent to ignore that. Um and so, it was just kind of continually So, my at my last visit with her, I it was a little bit like what do you want to do? Do you want to have this take the risk of not having this support because you feel so poor on everything we've tried or do you want to try one more? And I'm and I described the Tirosint, which again is a synthetic T4, um which has is kind of cleaner in terms of the synthetics. And And remember, I had tried the natural. I had tried the NP and she did not feel good on that. And um so we tried her on a very, very low dose of the Thyrocsin, and her message to me this week was that she's actually feeling pretty good. Um, not In In other words, not feeling worse. Yeah. And wants to bump up the dose, cuz I put her on a ridiculously low dose just to start. And so, to me it's just a really good example of patience on the part of the patient and the provider. Um, and that we're all so different and that you can't You just can't treat each person with the exact same plan. It just doesn't work. Yeah, totally. Um, what about the I was thinking of patients, um, this one's on our website. She's given us permission to share her story, Carla. Did you work with her? Carla? Yeah, that's a really good story. She had a crazy And that was like quick, too. Can you explain kind of what happened there? Yeah, if I can remember. So, Carla is in her, I think, early 60s, and, um, you know, you're putting me on the spot a little bit here. I know that I I think she was on Was she on the synthetic? I think she was on Leva. I think she was on levothyroxine for a while, and not feeling great for, again, years. Had trouble losing weight, was like chronically fatigued. And so, she is one that I switched to NP Thyroid. Mhm. And I think pretty quickly she started to feel better. Primarily like energy and just overall metabolism. Yeah. Has been having an easier time losing weight. So, she was kind of a pretty classic example of somebody who just does better on the combination natural, right? Like, here we go. Two people, two different options for whatever reason, one works well with one, one works well with the other. Yeah, I think the thing with the I mean probably both patients is like they never like for Carla at least I know like it was like decade Decades, yeah. Like it was a long time and like no one could figure this out. I mean it was like pretty quickly we figured that out. Just like why like why does why does it happen to so many patients where it's like Like cuz you mentioned like personalizing and giving them options, walking through like why like why is that not happening in kind of conventional medicine and why do patients have to come to us to get like that level of care? Right, why do they have to come to us to even know that there's alternatives, right? Right, yeah. Um I mean broken healthcare system, um 5-minute visits, um training, like I think can be you know conventionally it's often like there's a standard of care. Here's a lab value, here's the medication. Mhm. End of story. And it's kind of baked into our medicine, I think, um to that we have options and that we we do treat each person as an individual. And so I mean I that's what my whole day is like. My whole day is basically offering people safe options, things that are backed by science and that I've actually seen work in my own practice and not coming to them with a set agenda, plan. Um I'm not trying to sell them anything. I just want them to feel educated and kind of empowered. Yeah, that's awesome. Yeah, that's great. That's very exciting. Cool. All right guys, well let's um What's I What's that? It's very rewarding. Oh yeah, I mean when I mean there I don't know if there could be anything else that's more rewarding than like seeing patients. But like for example Carla, like if you're you know you should go on our patient testimonials and stories and watch her story. It's like so cool. Um all right, so let's start doing some questions here. So um Guys, let's see some more questions rolling in. We've had fun answering these. So I already answered that one about iodine salt. Um What would induce hypo thyroidism? What would indicate hypothyroidism? I'm guessing that I'm I'm not sure if the person's asking about symptoms or lab values, but if we're talking about symptoms, um the most common complaint is fatigue. Mhm. And obviously we need to look at kind of sleep and other factors that can go into fatigue, but um a thyroid as if you've been listening you'll realize that we really encourage a full thyroid panel, but you know, testing is usually indicated if there's kind of unexplained fatigue. Um other things times people are you know, kind of doing all the right things lifestyle wise to lose weight, but they they feel like they can't lose weight. Those are the most common signs or symptoms. Okay. Well said. Um there you go. What is the level of antibodies to classify as Hashimoto's? Well, I have to look that up really quickly. I think it's cuz I don't I'm not sure exactly what the units are. Um What do you see on labs that you're like, oh this is high? Yeah, um hold on 1 second. Um it's going to look like I can tell you right now. Um so on the thyroid panel we are looking at thyroglobulin antibodies and according to our lab, the reference range of normal is 0 to 4.11 and it's IUs or international units, I think, per ml. So that's for thyroglobulin and then thyroid peroxidase is a different kind of antibody and that reference range is 0 to 5.61 IUs per ml. So we're looking for you know, if you're if you're below those numbers, then we're pretty certain that there's there's not enough antibodies to be considered um Hashimoto's. Now, it's very common for me to see one elevated but not the other or to see like a range of there it's somewhat elevated versus it's really high. And what we will see is um once we start again treating the thyroid, supporting the thyroid, reducing inflammation, maybe cutting out gluten, etc., we see the those numbers still on repeat blood work, the the antibodies are still there, but they go down. Mhm. Okay, got you. Um ch- This one's interesting. Dairy inflammation, thyroid does can dairy really trigger thyroid? So, everybody has a can dairy um cause inflammation? Yes, not for everybody. Um some people do find that that it definitely can, you know, contribute to inflammatory um symptoms. We're all different, but yes, it can, you know, if I'm trying to like kind of ru- figure out what's inflammatory for somebody and I put them on what's called like an elimination diet or an anti-inflammatory diet, dairy is is you know, not you're not eating dairy during that time. Okay, got you. Um I guess let me rephrase this question. Would autoimmune be the only reason for increased antibodies? Uh the thyroid antibodies specifically? Mhm. Yeah. Yeah. Yes. Okay, so there's no nothing else that leads to There's nothing else that's going to be increasing thyroid peroxidase or thyroglobulin. Um Okay. Awesome. Cool. All right, well, that's it. We finished on time, so that's that's a first. Oh, well, awesome. Well, everyone, thank you so much for joining. Um yes, if you want to watch the replay, um it will be available on Spotify, Apple, YouTube. Um and then if you're interested in becoming a patient working with us, um, you can go to medmatrixusa.com and get started and uh, book a call with a patient coordinator. If you're If you register for the webinar, I do believe you will get a $100 credit. Um, below the screen you can actually book your kind of initial free evaluation right there. Um, all right everyone, thank you for joining. We will see you in the next one. Dr. Rose, anything you want to take us home with? I just hope that, you know, I hope that some of this information was helpful and um, I think it's just a super important topic and good luck to everybody who was who was watching or listening. Well said. All right. Bye everybody. Thank you.