The Dr. Hyman Show - From Fatigue to Freedom: Healing the Thyroid Beyond Lab Tests

Episode Date: September 29, 2025

Thyroid trouble often starts as a whisper—tiredness, stubborn weight, dry skin—until a closer look shows the tiny neck gland that sets the body’s “speed” is out of tune. Basic tests can miss the real issue, so checking active hormones and thyroid antibodies—and hunting for triggers like stress, gluten sensitivity, toxins, nutrient gaps, and gut imbalances—can reveal what’s really going on. When understood this way, thyroid health is no longer just about numbers on a lab report—it’s about restoring balance in the whole system. With the right testing, nutrition, and support, energy, mood, and metabolism can all return to their natural rhythm. In this episode, I discuss, along with Dr. Elizabeth Boham and Dr. George Papanicolaou, thyroid conditions such as hypothyroidism, hyperthyroidism, thyroid autoimmunity and how Functional Medicine practitioners take a different approach to find the root cause of the imbalance. Dr. Elizabeth Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women’s Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine. Dr. George Papanicolaou is a graduate of the Philadelphia College of Osteopathic Medicine and is Board Certified in Family Medicine from Abington Memorial Hospital. Over time as the healthcare system made it harder for patients to receive personal care, Dr. Papanicolaou decided a change was needed. He began training in Functional Medicine through the Institute of Functional Medicine. In 2015, he established Cornerstone Personal Health—a practice dedicated entirely to Functional Medicine. In August 2017, I invited Dr. Papanicolaou to join The UltraWellness Center and we’ve been successfully helping people together ever since. This episode is brought to you by BIOptimizers. Head to bioptimizers.com/hyman and use code HYMAN to save 15%. Full-length episodes can be found here:How To Treat The Root Cause Of Thyroid Problems Is An Underactive Thyroid To Blame For Your Mysterious Symptoms? A Root Cause Approach to Hyperthyroidism and Graves’ Disease

Coming up on this episode of the Dr. Hyman Show. About 60 to 70% of people with hyperthyroidism are graves. It happens to about 1 and 200 people, women more than men, 10 to 1. And it usually peaks around in the ages of 40 to 60 years old, but it can happen younger. Magnesium is like the body's natural chill switch. It helps regulate stress, sleep, mood, and more. But most people are deficient. And most supplements don't give you the full spectrum.

That's why I recommend magnesium breakthrough. the only formula with all seven forms of magnesium. Feel calmer, sleep better, and give your body what it's missing. Bioptimizers has increased their discount for my audience. Go to bioptimizers.com slash hymen and use code Hyman to get 15% off your order today. Before we jump into today's episode, I want to share a few ways you can go deeper on your health journey. While I wish I could work with everyone one-on-one, there just isn't enough time in the day, so I've built several tools to help you take control of your health.

If you're looking for guidance, education, and community, check out my private membership, the Hyman Hive for live Q&A's exclusive content and direct connection. For real-time lab testing and personalized insights into your biology, visit Function Health. You can also explore my curated doctor-trusted supplements and health products at Dr.hyman.com. And if you prefer to listen without any breaks, don't forget, you can enjoy every episode of this podcast, add free with Hyman Plus. Just open Apple podcasts and tap try free to start your seven-day free trial. What is a thyroid function?

What is your thyroid gland? It's a subtle gland in your throat. And it's as think of it as your overall metabolic regulator. It really controls everything. It's like your motor. It's like the, you know, in terms of the RPM on your engine, so you know some things like a golf cart or something, have a governor and you can only go so fast.

It's little like that. So if it's slow, your whole system slows down. If it's fast, your whole system speeds up. That's hyperthyroid. Not that common, but it can be a problem for some people. But low thyroid or hypothyroid function is really common. And 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 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 is good. good, your metabolism is good, you stay thin, it helps your hair grow, and it helps your muscles, prevents muscle aches, constipation, and even, you know, improves fertility. So if you have your T3 working, it's really great. But 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. I will talk about that like selenium. It can be overgrowth of yeast. So there's a lot of things that affect this conversion and often we'll see people with inadequate

levels of T3. So the main role of thyroid is to stimulate metabolism and it really affects almost every single function of the body and it can cause so many weird, vague symptoms that people don't even often identify it because it's like, oh, I'm a little this, little that and you don't really get it. So the main reason it's not diagnosed is that the symptoms aren't. specific. You know, 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 know, you're maybe a little cold when, you know, everybody else is warm, you get whole hands and feet, you get, you know, low libido,

you make a little flu retention, your cholesterol is a little high. These are really non-specific 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, you know, like, that's, really a clue that you might have thyroid issues. So we're taking a thyroid quiz, which is really important, we can link to it in the show notes, gives you a pretty good sense of if you're having a likelihood of having low thyroid. And then you need to do the right testing. Now, the problem is that it's often we'll call subclinical. So it might not be full-blown thyroid disease. But, you know, 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, you know, the range of, for example, TSA, which is what most doctors look at to check your thyroid is 0.5 to 5.5. That's a 10fold range of what's considered normal. The American College of Endocrinology has lowered the top number to 3.5 or 3. but what's optimal might be one or two or, you know, point five to one.

So what's really optimal is very different than what's, quote, normal. And that's why it's often missed. And doctors will often miss it because they just check the TSA and not the whole panel of test. It gives you a really comprehensive view. If you just like TSA, 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 TSA is abnormal, which is really a bad way to go about it. So I think it's really important to a comprehensive

thyroid panel, which includes TSA, free T3, free T4, and thyroid antibodies, thyroid peroxidase, and antithyroglobulin antibodies. Now, a lot of doctors will check thyroid panel on a lab rec. And the old lab wrecks have a very old thyroid panels that use all kinds of antiquated tests, which I still say, unfortunately, like T3 uptake and all these weird things that are not really accurate given how sensitive these current new tests are for free T3, free T4, and ultrensitive THSH. And also, you know, if you're really stuck and there's other things going on, there's more advanced tests like thyroid releasing hormone that we can use by using a stimulation, test. So we won't get into that, but the key is the basic test should be TSA, free T3, free T4, thyroid

antibodies, TPO, and antithythoglagin 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 TSAH. So it's really, really important to do a whole panel. Now let's talk about what causes thyroid problems. Because Now, why are we seeing so many people with thyroid issues? Is this a genetic defect in human beings? I don't think so. It's really because we are living in a toxic world in many ways.

One, environmental toxins are really impactful on the thyroid function. Think of your thyroid as the yellow canary in your body. The yellow canaries were put in coal mines, and when the canaries died, the coal miners knew the air was bad, they had to get out of the coal mine. So the thyroid is like the yellow canary. of the body. Very sensitive to pesticides, heavy metals, environmental toxins of all sorts, which are super abundant. And it's 80,000 these compounds in the environment. Only 1% have been tested for safety. They're ubiquitous. The average person is basically a walking toxic waste dump

dioxin, PCBs, ddt, all this stuff is still in us, even though it's been banned. Some of this stuff has been banned. And most of us can handle it, but it's really important to focus on identifying these toxins. Heavy metals are a huge factor, particularly mercury, and a big factor. Also, stress, you know, there's a deep connection between your adrenals and your thyroid glands. So people who are overstressed, you know, by psychological stress, physical stresses, lack of sleep, those stresses register in the body directly in terms of adrenal function. And when your adrenal function is low, you often will see kind of this thyroid function go low. So you're, for example, if you put young soldiers on a forced march, you'll see their thyroid

function decreased just because of the stress of an overnight march with carrying a 50-pound pack. And they'll look like they're hypothyroid, even though they're really not. So stresses are a big factor. The other one is gluten. Gluten is a huge factor in about probably 20, 30% in my experiences, I don't, seeing thousands of patients and testing them, everybody who's got low thyroid or anybody's the thyroid, I check their gluten antibodies too. About 20% to 30% of people who have a low thyroid function can be a result of gluten sensitivity, either celiac

disease or non-celiac gluten sensitivity. And it's a really important to track because if you keep eating gluten, like you or you keep having mercury, your thyroid is 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 in the thyroid. Also, nutrient deficiencies. You know, thyroid function needs, you know, iodine to make the thyroid hormone. You need selenium to convert T3 to four. You need vitamin D and vitamin A to have it bind on the nucleus to work and do its thing. You need the right omega-3 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 does you take? Well, first, do the symptoms check. Look at the questionnaire,

the link, the things that I just mentioned, you can kind of do a mental checklist or you can fill out the thyroid questionnaire we're going to link to in the show notes. That's the first thing. And if there's some suspicion, you need to get the right tests. And there's a lot of ways to do that right now. You have to ask your doctor. There are labs that are coming online like Function Health where you'll be able to do your own ordering of tests, which is important. But want the full spectrum, like I said, TSA, free T3, free T4, thyroid antibodies, TPO, and antithylogin antibodies. You also want to check for a celiac with or gluten sensitivity with deaminated anti-glyden antibodies, tissue transgutamines antibodies. We'll write all this up in the show notes

and keep track of it. We might also want to do a heavy metal test. Look for heavy metals with a DMSA challenge test to look for urine toxic metals after a six-hour collection. There are test 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 skin care products, household products, food products. Vitamin D plays a huge role. If you're vitamin D deficient, you want to see that for sure, because by correcting that, it'll help your thyroid work better. You can check for selenium levels. Often there's selenium deficiencies, iodine deficiencies. We can measure

that as well. So we do a really close inventory of nutritional status. That's how I kind of evaluate it. So what do I do to help fix thyroid function? Well, first you deal with all the causes, gluten, stress, I've been 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. Seweed is full iodine, 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. You know, herring mackerel are a great source of vitamin D, mushrooms, like porcini mushrooms, but it's hard to get enough. So sunlight and obviously checking your vitamin D and taking vitamin D. Also, you can get your vitamin A, which is important for thyroid fungus, 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 50 micrograms of 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 issue,

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 of 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, reciferous vegetables that much.

And she went into a hypothyroid coma. So that's an extreme case, but if you're juicing raw calories, you can get into trouble. And 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-from 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 rodeola, Siberian ginseng, whereas adaptogenic mushrooms. This is really a way to kind of boost your adrenal function. And then if you're stuck, you know, you kind of might need to work with a doctor to optimize what you need in terms of thyroid treatment and adrenal treatment. So, If you, let's say you need thyroid replacement, and a lot of people do, sometimes you can get away without it. But if you, if you've done all the things that I just said and your thyroid is still not optimized, then you need to know what should you take. Now, the traditional approach is

everybody should take synthroid, which is libithoroxin or T4. And that works for some people, but many people that doesn't. And they'll be partially treated. And if you check the T3, their T4 will be good because they're getting it, but their T3 will be low. And I think it's better to use a bio-identical form of thyroid, which is actually how all the hormones were first developed. And it may sound kind of weird or gross, but it comes from pig thyroid, porcine thyroid. And it's very similar or almost identical to ours. And it contains T4, T3, something called T2, which is really unusual that people might not know about, which actually helps metabolism and is very important.

And so most doctors just assume that the synthoid will get converted, but it really doesn't, because all the pesticides and environment, the heavy metals, the stress, the food sensitivities, gluten, you know, deficiencies of nutrients. You know, 100% of us have toxins in our body. So it's better to just take a combination, bioidentical thyroid replacement. And that usually it's armor thyroid. In the old days, it wasn't well manufactured. And so the dose was variable. But now it's really well controlled. And a lot of doctors don't like it. But I encourage you to think about trying it because it really can help. You need to check. your thyroid, if you change your thyroid or put yourself on thyroid or take thyroid,

you need to check it probably about six weeks after you take your 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, palpitations. So you have to track it. But your thyroid gland is important to understand and take care of, to love, and figure out. If you're feeling stressed, anxious, or having trouble sleeping, it's not always about willpower or mindset. It could be a mineral deficiency. Magnesium is essential for your nervous system. It helps calm your body, supports better sleep, eases muscle tension, and even helps stabilize mood. The

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So tell us about this case. So, right. So she came in and she. She wasn't feeling good at all, but her TSAH was normal. So we did the full panel and we saw that her thyroid antibodies were elevated. And so then we had to- But was her TSA and the rest abnormal or not really? No, her TSA was pretty normal.

You know, I can't remember exactly, might have been a little on the high side, but I don't even know if it was. I think everything looked 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 it brought us down this whole pathway of what's going on with, you know, 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, you know, we measured things like her iodine level and her selenium level just to get the right balance. And we actually, we gave her some thyroid hormone. We gave her some glandular thyroid hormone. I used armor thyroid on her, which is a combination of. T4 and T3, and she started, she really responded well. She felt better. She noticed her hair starting to come back in, you know, her skin's starting to be less dry. Her bowel movement's improving. And so, you know, that, you know, I think it's important that we take that step and go a

little deeper. People don't often realize how bad they feeling until they start feeling better on this stuff, right? And I think, I think just to back up a little bit, you know, you did something which was kind of unusual, controversial, most traditional endocrinologists would scoff at, which is you used a combination of T3 and T4 in a hormone that comes from pig. Yep. That is the entire thyroid combination of hormones, including T2, which we only 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.

Right. So even if you're taking T4, which is what most doctors recommend, like Synthroid or LaVoxal or any of these, 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. Right. So then we ask that. So some people, as you mentioned earlier, feel fine on T4 thyroid hormone. That's like synthroid or, you know, so they do well, they do okay with it.

But a large percentage of people don't. And that might be because they have deficiencies in nutrients that help the body go from T4 to T3, right? So they might be deficient in iodine or selenium, as we mentioned, in vitamin A or iron. And zinc, we talked about that earlier, that they can't make that conversion as easily. And so the medicine doesn't work as well for them. Or it may be because they have a variation in a gene. We know there's this gene. It's kind of a really, I mean, you know, really interesting, low impact type of gene.

And so what that means is that it, you know, it can- Not going to kill you. Right. 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 DIO2 gene that encodes for this enzyme, the DI2 enzyme, which helps the body convert T4 to T3, you know, especially in the brain, but also in all throughout the body, and make that active T3 thyroid hormone.

And what we're learning is that some people have this gene variation. And so when you give them just T4, thyroid hormone, they don't get the benefit. And studies have shown even when lab work looks normal. So even if their T3 looks normal, even if their TSA looks normal, that they do better when you give them to some T3, which could be like a glandular thyroid hormone like Armour, which is a combination. of T4 and T3, or it could be a synthetic T3. We sometimes use like Cytamel and we'll add that to Synthroid, for example, or a T4. And so sometimes we see those people who, you know, just start to feel better in terms of especially mentally, energy-wise, mood-wise, they really start to feel better finally.

I don't realize that depression is really into thyroid and that, you know, often psychiatrists in treatment-resistant depression when drugs don't work, they'll give them T3 as a treatment for depression. They've been doing that for a long time. That's not anything new. Right, right. But it's like weird for the rest of it. And also, you know, the T4 thyroid replacements, there are challenges with that because

there's often fillers, things like lactose and gluten even. Right. Could be other reasons why people don't feel well on those. Yeah. Yeah. So those are important to recognize. And a lot of the traditional doctors really scoff at the use of glandulars, like west thyroid, nature, thoroid, arm, retired. Why is that, and should we be worried?

You know, I don't think so. I think maybe it's maybe during their training or many years ago, there was a question of regulation of those or the dosage. But I don't find that to be a problem at all, that we can definitely regulate dose with our patients. It's very reproducible in terms of the medication. And, I mean, a good portion of our patients, I think we've talked about this before, right? We'll say, like, maybe is it 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 where that might actually cause more autoimmunity, 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. And you can combine T3 and T4. we'll talk about the next case, you know, that are separate, not as a glandular, but it just has a prescription drug. Right. And I think, you know, the other problem with the glandulars and the things like Armour, Westwright, is that doctors can misinterpret the lab tests because the thyroid, the TSAH goes really low

because the T3 suppresses the feedback loop. But you have to look at the T4 and T3 separately and also the symptoms of a patient. Absolutely. So tell us about that. Well, sometimes like when you give T3, right, then you might see a low T4 on, and like you said, TSA, but definitely a low T4 on the lab test because you're giving some of your thyroid in T3. And with the feedback loop, it causes that your body doesn't make as much T4. And the TSAH goes down, which worries doctors that you're taking too much or treated.

And actually it's not true. It's really important to pay attention to the patient's symptoms. And I find that everybody's different. You know, I have patients who are so sensitive to thyroid that, you know, if their TSA gets a little too low, they feel awful. They get palpitations. They get anxious. They have trouble with sleep.

But then other people, you know, if you don't get their TSA 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. So like what William Moller said, treat the person who has the disease, not the disease that the person has, right? Absolutely, right? That's what we're working to get to.

I did remind me of a case I had years ago where this woman was so symptomatic on hypothyroid. And her TSA, her T4, or T3 were totally normal, and her thyroid antibodies were off the chart. And I treated her and it was like a miracle. She lost like 21 pounds in six weeks. She had all her symptoms get better. She had fibromyalgia. She had all these, quote, things that were, you know, 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'd actually been on thyroid for 15 years and really struggled. Right. So she was a 35-year-old woman who came to see us who had been hypothyroid for, you know, since her late teens, 20s. And she had been on thyroid medication. She had been on synthroid. And antidepressants. Well, they wanted her to be out of antidepressants. So she was on the thyroid medication for, you know, a long time, but always sort of dealt

with this low-level depression, you know, not a major depressive episode, but enough where where sometimes she would stay in bed all day, you know, 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, you know, they were saying okay maybe we should try an antidepressant right maybe you're this is interfering so much with your life at this point now that you're 35 that we should try this try an antidepressant and she came to see me because she wanted to look at it a different way and so we did a bunch of different tests and and we included in that is we did that di o two gene test and what was

interesting is her thyroid levels you know looked fine right her her tsh her t4 t3 it looked fine but But she did have a homozygous variation in that DIO2 gene, which is associated, which is associated with depression and that people who need thyroid hormone and get T3 in addition to T4 feel so much better in terms of mood and energy when they have that gene variation. So we actually, with her, she wanted, she was feeling fine. on her synthroid she'd been on it for many years so we added the citamil to it and and it really helped it helped a lot with her energy and her mood so hyperthyroidism is when the thyroid gland is producing way too much thyroid hormone that's t3 and t4 level uh and so uh when they're being overproduced then you're going to have symptoms that are going to cause you to lose weight feel sweaty have have palpitations, be anxious, have thinning hair, lose your hair, have thinning nails.

Graves disease happens to be the most common. It's about 60 to 70% of people with hyperthyroidism are graves. It happens to about 1 and 200 people, men more than women more than men, 10 to 1. And it usually peaks around in the ages of 40 to 60 years old, but it can't happen younger. So that's like the overview of Graves disease. Now, the most, as you said, what are the symptoms? The symptoms are some of the ones I just mentioned, which are going to be weight loss, sweating, thinning nails, hair loss, thinning skin, palpitations, when it gets really bad. Diarrhea, atrophib. Yep.

And when it gets really bad, you can have heart failure, you can have hormone imbalance, and you can have anemia. Yeah. And insomnia, people can't say. I had a friend, I'd a friend call me who was like, I can't sleep, I don't know what's wrong. And we get to her history. It's like, and I lost 20 pounds and I wasn't trying. I'm like, oh, okay. Yeah, you know, and she had grapes.

Yeah, so most people, as you said, have hypothyroidism. It's less common. I think 1% of thyroid disease or 2% is hyperthyroidism in graves is the most common. But when you have it, it can be really debilitating and it can be really hard to treat. And as you said earlier, in conventional. medicine, the treatments haven't changed in 50 years, and they're quite harsh. And functional medicine really gives us a great opportunity to get the root causes of what triggers graves and allows us to then treat our patients in ways that makes sense for the biology and their life

environment. Yeah. So it's really, you know, the symptoms can be quite dramatic for people, right? Absolutely. And as you mentioned, some of the complications, they're serious. It's not just about having a racing heart or insomnia or diarrhea. You can get eye damage so your eyes can bug out of your head. Right. Yeah. So you get heart failure, right? Yeah. That can happen. And, you know, the reason why that happens, and I think we're going to have to just jump right into this part of it is the autoimmune process. Graves is an autoimmune disorder, just like Hashimoto's, which causes hypothyroidism. And so you can't get away from talking about thyroid disease without talking about the autoimmune

immune, you know, our immune system, autoimmunity, why we have it, why it's getting worse, and what some of the major triggers are. So the eye disease is actually antibodies that are being made against your thyroid. They're called thyroid stimulating hormone receptor antibodies or T-Rabs. And they're made specifically against the receptors on the thyroid. So when those antibodies hit those receptors, it doesn't destroy those receptors, it actually triggers them to make more thyroid hormone. But we have, it's a very nonspecific interaction, and those antibodies can also trigger like antigens in other parts of the body. They happen to be in the eye, where there are thyroid stimulating receptors, and also in the lower extremities. So you can get the deposition of all

these antibodies in the eye that caused that the grave's uptho up the uh grave's eye disease um and also pre-tibial mix edema and that's because that's like food retention in your legs where you get a destruction of the tissue underneath the um the the skin of the the tibia or your your shin and you can see it's thickened and fluid filled and it's not nice looking and it's not nice feeling so Those are the things that are the hallmarks of graves, and they're all related to that autoimmune antibody response. What's interesting also is that autoimmune diseases often come in clusters. And with graves, you see people off with other autoimmune diseases, right?

You do. Like what? So some of the other autoimmune diseases can be, you can actually get Hashimoto's. Hashimoto's is one of the other autoimmune diseases. You can have low and high at the same time. You can. You can definitely have that. you can have diabetes which is an autoimmune disease type one diabetes type one diabetes

um vitiligo right that's where you lose all the pigment in your skin yep anemia and and autoimmune things like arthritis from your arthritis lupus right yep and then and then and then what's interesting is also celiac disease so there's a well there's a link between celiac disease because gluten is a is a huge trigger for autoimmunity particularly creating antibodies against the thyroid okay so So that's kind of a good overview of the prevalence of it, what the symptoms are, what the complications are. And it's often not that hard to diagnose. When people are that sick, you can kind of tell. But it's subtle sometimes.

What tests do doctors do to find out traditionally whether you have it? Yeah. And we're going to get to what are the tests we do in functional medicine that are quite different. So yeah. So the traditional tests that you, how you find it, is looking first at your. thyroid functions. So you're going to be looking at somebody. The key thing is is the clinical symptoms, right? It's not always tests. People come in and they have symptoms. Then you have to start to use your medical cognition and everything you know about medicine to figure out, okay,

what do I think is going on? Well, once you realize what the symptoms are, then you start to understand, you know, this is the thyroid. So you're going to look at the thyroid and you're looking at what we call the TSA, which is a thyroid stimulating hormone. And if that's really, really low, That means that the thyroid is producing way too much thyroid hormone. And your pituitary gland is being suppressed so it doesn't make enough of this thyroid-stimulating hormone. Let me just back up for a second. Your pituitary gland drives your thyroid. Yeah.

And it sends a signal to the thyroid. It's called it thyroid-stimulating hormone. So your thyroid-TS-H. T.S.H. And so your thyroid is sort of lazy. And so it has to be reminded to work. So the pituitary responsibility is to send out this signal all the time. So you're going to have a certain normal level of TSH reminding the thyroid to work. And as long as it's doing its job and nothing's impairing it from doing its job, then it's going to function great and it's going to make thyroid hormone. T4 and T3. T4 and T3 go to the cells. Now T3 is the active

form of thyroid hormone. And inside the cell, T4 gets converted to T3, then it goes into the nucleus where it causes the DNA to start to transcribe and make enzymes and proteins that upregulate metabolism. And that's exactly what it's supposed to do. Now, if you don't make enough thyroid hormone, then you're going to experience hypothyroidism and a slowdown of your metabolism. And if you make too much, you're going to have a uptick in your metabolism and everything that goes along with that. And that's called hyperthyroidism. So what happens is...

And what are the tests? So the test. So when we go for the test, the TSA is going to be suppressed if the thyroid is making too much. The pituitary is going to stop setting the signal. The feedback system tells your TSA shut off and then the other... It's a negative feedback. The other hormones go up.

Yep. But there's also antibodies we check. Right. So now we're going to... So once you realize they have... hyperthyroidism, then you want to check for antibodies. And the main one you check for is thyroid stimulating hormone receptor antibodies. And if those are positive, it's 99% sensitivity and specificity for grave disease. That's the main test. There's also a radioactive iodine test,

right? Yeah. So after you do that, you can do a radioactive uptake to see if the person has maybe some other reason for having that hyperthyroidism, which can be an adenoma or multi-tile multi-nodular toxicoider. And so what are doctors, once people are diagnosed with this, what are the treatments? Because it seems like they haven't really changed much since, 40 years since I graduated medical school. Yeah, they haven't changed much and they're pretty harsh. And, you know, one, you know, so there's methamazole, which is basically a thyroid

proxidase enzyme inhibitor. Thyroid proxidase is the enzyme that the thyroid uses to, to, to, you know, to, you know, bind iodine together to make thyroid hormone and so it blocks that and so you just reduce to production but thimazol uh can have some you know significant uh in poly polythyroidurisol pt um particularly can have some you know very impactful side effects like like you know hepatic toxicity so and you're going to be on them for 18 months up to 18 months to get into remission and so they're not they're not really uh they can be harsh uh and they can have lots of adverse reactions. And a lot of, most of the people that I see in your ultra wellness center,

they come to me with graves. I don't have to make the diagnosis. They come. And the reason why they come is they don't want to be on methamazole. And they don't want to have, you know, iodine. The next therapy is, you know, radioactive iodine destruction of the thyroid. So basically nukes your thyroid. Yeah, basically nukes. So you're going to get, you're going to get, you know, I-131, which is iodine, tagged with, you know, a radioactive molecule. And when that it's iodine so now this radioactive material gets absorbed into the thyroid that's wants to use it iodine but then that radioactive material breaks down to xenon and xenon destroys the thyroid or parts of it and reduces the production of thyroid hormone again pretty harsh

you're you're you're you're not you know when you can't breastfeed you can't you can't be around kids you can't touch people yeah you know not your whole life it can be up to two weeks of the treatment. And then finally there's just take the thyroid out. So basically like nuke it, take it out or poison it. Yeah. Yeah. Poison it or rip it out. Okay. Well, I mean, sometimes that's necessary just to deal with symptoms or people can use beta blockers if their heart's racing and so on. Which is perfectly fine. But the question is how do we deal with this in functional medicine that's different? And it's an cultural wellness. Or how do we think about this condition? This gets into the testing we do in functional medicine. So one of the first tests I do is a stool analysis. And

And that stool analysis is not all going to tell me about the balance of good bacteria, which are your commensals and your bad bacteria. I always say that those are the bacteria that realize that poop's a great party, great place to live, and they come and hang out, but they may not do anything for you. Unless you have a really bad diet, you're under too much stress, you're not taking care of your gut break or biome, you're eating processed foods and sugars, you're eating lots of GMO foods that have lots of glyphosate on them and your microbiome is disordered, now all of a sudden, those hangar-onters are now going to just, they're just going to multiply, and they're going to push your good bacteria out.

And when that happens, then the good bacteria can't modulate your immune system, can't help you, doesn't make the compounds that you need. As we know, 70 to 90% of your serotonin is actually made by bacteria in your gut. So you need to rebalance that. So we're really careful about doing that. We want to know not only that balance, but how's your digestive system working? One of the things that allows the gut microbiome to go into this disorder

is you're not making enough gastric acids. You're under too much stress. When you're under stress, then your flight response takes over, and suddenly you don't want to have an appetite when you're running away from the bear. so your appetite goes down, you start making less gastric acid, and when you're under chronic stress, this chronic loss of gastric acid allows bacteria and parasites and viruses to get into your intestinal tract where they can wreak havoc.

That's another reason to worry about stress is more parasites, right? More parasites. It's another, another, it brings it all on. So we really work on the gut. We work on the gut, you get rid of the food sensitivities. And, you know, I often will see a disease that I've never really treated or that is not that common. And I'm like, well, gee, I don't really know.

All the time. You know, I don't know if this is going to work. Right. But then I go back to first principles in functional medicine and look at what are the root causes of disease, what are the causes of whatever is inflammation or metabolic disease. And then I can usually zero in on what their story is and listen from their story. I'm like, yeah, yeah, you know, I've been eating tuna every day for 30 years. or, you know, like, I basically have this terrible stomach issue that blah, blah, blah, blah.

And I go, oh, you know, so you start to kind of find the clues in the page of the story and you follow the threads. And you start to do the diagnostic test that help you. And then you start to peel the onion and treat all these problems. And so, you know, your treatment isn't just take this PTO drug or get your thyroid nuked or take it out. It's like, oh, we have to change her diet. Oh, we have to deal with stress. Oh, we have to take the right nutrients to optimize the levels. Oh, you have heavy metals.

We have to take care of that. Oh, we have pesticides. We have to figure out to get rid of that. So it basically go through a process, a therapeutic process that's based very strategically on that patient's story and their specific labs. And it's no, there's no two people that are the same who have any particular disease or graves or anything else. Yeah, I'm just going to echo everything you just said, Mark, because we have this conversation. This is the work that we do. We get to the root cause and then we use treatments that make sense for each person's specific biology and their

life environment. And there's not a patient that comes to me, or it's a rare patient that comes to me, that we don't find multiple reasons why their health is either currently compromised or is a set up for being compromised in the future because of all of those particular areas you just talked about. It's not a matter of people have toxins, is how much. And then the genetics determine how well they're going to detox. toxins. And so we also know that you have genetics that drive your immune system. But we have places to look. We do a lot of antibody testing to help us identify. Do you have an autoimmune process? And where is the trigger? And so, and we can go through every, you know, every biologic

system that we look at with all the testing that we do and explain in detail how we're using those in those biologic areas, toxins, the HPA access, you know, energy production in mitochondria. We do specific tests that will look at mitochondrial function. All of those things have to be addressed. It's never one thing. It's multiple layers. That's the whole problem with traditional medicine. It's like reduction is it's grave disease, you get this drug, let's see you later, that's it,

nothing else. And we're like, no, no, no, 10 people with graves might have 10 different issues. And we need to treat them in 10 different ways. and we need to find out what their cause is and how to optimize their system. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels

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We'll see you next time on the Dr. Hyman show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic and Function Health, where I am chief medical officer. This podcast represents my opinions and my guest's opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help

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