A Root Cause Approach to Hyperthyroidism and Graves' Disease

Coming up on this episode of the Doctor's Pharmacy.

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

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Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman and that's Pharmacy with an F, a place for conversations that matter. and today we're talking about on our special episode of House Call with Dr. George Papam: Nicola, one of our extraordinary docs at the Ultra Wellness Center here in Lenox, Massachusetts. We're going to talk about thyroid. And most people struggle in this country with low thyroid. It affects one out of five women, one out of 10 men. But there's another condition called hyperthyroid, as opposed to low thyroid, high thyroid, that is a real problem for some people. It affects less people, but It's really a problem and traditional medicine approach really hasn't changed in 50 years. And I discovered with functional medicine that there's really a whole new way of thinking about it that can get to the root cause, it can often reverse it or even cure it. And I've had a few patients that have been really effective in using this model. So welcome back to the podcast, George. It's great to have you. And today we're going to dig into a couple of really interesting stories about how our autoimmune diseases are so prevalent and Graves is, and hyperthyroid is even one of them. And how we treat it with traditional medicine, but also how we think about it differently with functional medicine. So talk about what is really driving this problem and what is Graves, what is hyperthyroidism and what does it do to people? How do they feel and how do people know they have it? Right.

So hyperthyroidism is when the thyroid gland is producing way too much thyroid hormone. that's T3 and T4. And so when they're being overproduced, then you're going to have symptoms that are going to cause you to lose weight, feel sweaty, have palpitations, be anxious, have thinning hair, lose your hair, have thinning nails. Graves' disease happens to be the most common, it's about 60 to 70% of people with hyperthyroidism are graves. It happens to about one in 200 people. 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 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, skin palpitations, when it gets really bad.

Diarrhea, atrial fib.

Yep. and when it gets really bad, you can have heart failure, you can have a hormone imbalance, and you can have anemia.

Yeah. Those are some, those are some of the things. And insomnia people can't sleep. I had a friend, I had a friend call me who was like, I can't sleep. I don't know what's wrong. Yeah. And we get to her history, she's.

Like, and I lost 20 pounds and I wasn't trying. I'm like, oh, okay.

Yeah.

You know, and she had Graves. Yeah. So most people, as you said, have hypothyroidism. It's less common. I think 1% of thyroid disease or 2% is hyperthyroidism and Graves is the most common. But when you have it, it can be really debilitating and 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 to the root causes of what triggers graves and allows us to then treat our patients in ways that make sense for the biology and their life environment.

Yeah.

So it's really, you know, the symptoms can be quite dramatic for people, right, that we went through. And like as you mentioned, some of the complications are serious. It's not just about having a racing heart or insomnia or diarrhea. You can get eye damage so your.

Eyes can bug out of your head.

Right. So, yes, 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. thyroidism. And so you can't get away from talking about thyroid disease without talking about the autoimmune, 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, thyroid stimulating hormone receptor antibodies or TRABs, and they're made specifically against the receptors on the thyroid. so when those antibodies hit those receptors, it trigger, 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 anti, 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 cause that, the, graves optho up the graves eye disease and also pre-tibial myxedema.

And that's because that's like fluid retention.

In your legs where you get a destruction of the tissue underneath the skin of the tibia or 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 often other autoimmune diseases, right?

Like 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 1 diabetes. Type 1 diabetes. Bitoligo, right? That's where you're going. Bitoligo is a common one. skin, anemia, and autoimmune things like arthritis, rheumatoid arthritis, lupus, right?

Yep.

And then what's interesting is also celiac disease.

Well, there's a link between celiac disease because gluten is a huge trigger for autoimmunity, particularly creating antibodies against the thyroid.

Okay, so that's a kind of a good overview of the prevalence of it, what the symptoms are, what the complications.

Are.

And you sort of, 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 did doctors do to find out traditionally whether you have it?

Yeah, so we, and we're gonna get.

To one of the tests we do in functional medicine that are quite different.

So yeah, so the traditional test that you, how you find it is looking first at your thyroid functions. So you're gonna be looking at somebody, the key thing 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 gonna look at the thyroid and you're looking at what we call the TSH, 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. And it sends a signal to the thyroid, it's called the thyroid-stimulating hormone. so your thyroid- TSH. Yeah, TSH. And so your thyroid is sort of lazy and so it has to be reminded to work. So the pituitary's responsibility is to send out this signal all the time so you're going to have this certain normal level of TSH reminding the thyroid to work. And as long as it's doing its job and nothing's impairing it from doing its job, then it's going to function great and it's going to make thyroid hormone, T4 and T3. T4 and T3 go to the cells. Now T3 is the active form of thyroid hormone and inside the cell, T4 gets converted to T3, then it goes into the nucleus where it causes the DNA to start to transcribe and make enzymes and proteins 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 then when we go for the test, the TSH is going to be suppressed if the thyroid is making too much. The pituitary is going to shut off.

So the feedback system tells your TSA shut off, and then the other.

It's a negative.

The other hormones go up. But there's also antibodies which check for thyroid.

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 Graves' disease.

That's the main test. And 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-nodular toxic goiter.

And so what do 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 methimazole, which is basically a Thyroid peroxidase enzyme inhibitor. Thyroid peroxidase is the enzyme that the thyroid uses to bind iodine together to make thyroid hormone. And so it blocks that. And so you just reduce the production. Methimazole can have some significant, and polythiouracil, PTU, particularly can have some very impactful side effects. Side effects. Hepatic toxicity. And you're gonna be on them for 18 months up to 18 months to get into remission. And so they're not really, they can be harsh 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 methimazole and they don't want to have, you know, iodine. The next therapy is radioactive iodine destruction of the thyroid.

So basically nukes your thyroid.

Yeah, basically nukes it. So you're gonna get, you're gonna get, you know, I I 131, which is iodine tagged with a radioactive molecule. And when that it's iodine, so now this radioactive material gets absorbed into the thyroid that wants to use that iodine, but then that radioactive material breaks down to xenon and xenon destroys the thyroid or parts of it and reduces the production of thyroid hormone. Again, pretty harsh. You're radioactive. and you're not, you can't breastfeed, 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.

Yeah, poison it, nuke 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 perfect. Which is okay, but the question is how do we deal with this in.

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

So the gut is always a key thing to think about because 70% of your immune system is in your gut. And if you have an autoimmune disease, you have to treat your gut.

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

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

Yeah. And, you know, you know, I've had a case where, again, you get to the root cause and, yeah, was gut a major issue? Sure. But in my particular case, it was a woman who's 55 years old. She came with a diagnosis of Graves, like I said, many do, and she just didn't want to. do the traditional therapies. So when she came in, she was also menopausal within the last two years. And she, that was the main, the other main issue with her. So, and also she had gut issues. She had bloating and distension and constipation and some loose stools. So with her, you know, one of the things that works and I, you know, when you want to treat somebody, you're, it it is perfectly appropriate to try to understand the mechanism, the pathway of the way the organ works. In this case, thyroid TPO, thyroid peroxidase antibody, thyroid peroxidase is an enzyme that's blocked with a pharmaceutical agent that is very harmful. Botanical agents can oftentimes, because we get many of our medicines from botanicals, so botanical agents can oftentimes be very effective. in this particular case, L-carnitine can act as a thyroid peroxidase inhibitor. And so using L-carnitine was one of the first things I did with this particular woman. And before our next follow-up, she was already beginning to have some relief from her symptoms just using L-carnitine. And then because she was menopausal, estrogen can have an impact on your autoimmune state. So balancing hormones is really important. You know, when you think about hormone replacement, you know, there's always been a concern, particularly with women, about the possible impact on the breast and breast cancer. What I will say is that there are now studies that are showing that early in menopause, using hormone replacement for a short period of time, can have a very beneficial impact on brain aging. There's reduction in Alzheimer development of Alzheimer's for women who have estrogen early in their menopausal state. It also reduces the autoimmune state because estrogen does play a role in balancing the inflammatory and anti-inflammatory sides of the immune response. So I actually put on one of my patients.

That's why you see most of the case of autoimmune disease in women.

Yeah. And, and 40 to 50, you know, 40 to 60 range. So I balanced her hormones, and then, of course, you know, we worked on her gut microbiome, which is always a critical piece.

Yeah. And, and, you know, the other thing you did was you got her off gluten and you put on an anti-inflammatory diet. Yep.

Right.

Yep.

And you gave her the raw materials for helping her thyroid.

Yeah.

And I, you know, yeah. And I think it's really important when we say we work on the gut, you know, we have to remember that when we work on the gut, we have a very programmatic approach that can be adopted and adapted to the various conditions people have, but it's that 5R approach. It's basically let's find out what may be a trigger. So there are triggers to, there are some bacterial and parasitic triggers to thyroid autoimmunity. One of them happens to be Blastocystis hominis, which is a parasite that has been implicated in triggering antibodies that will go after the thyroid.

That's interesting because that patient that I mentioned, that's what she had. She had this parasite.

Yeah.

Which we're gonna talk about on another podcast.

Yeah, we are. So when we look at the gut, we're gonna look and so we're gonna need to, we know we need to look at the gut carefully and we do kind of, we do, this gets into the testing we do in functional medicine. So one of the first tests I do is a stool analysis. and that stool analysis is not 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 is 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 microbiome, you're eating processed foods and sugars, you're eating lots of GMO foods that have lots of glyphosate on them, and your microbiome biome is disordered. Now, all of a sudden, those hanger oners are now gonna just, they're just gonna multiply and they're gonna 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, 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 fight-flight response takes over and suddenly you don't want to have an appetite. when you're running away from the bear. So, your appetite goes down, you start making less gastric acid. 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, another, another, so it really brings it all on. So, we really work on the gut.

Work on the gut, you get rid of the food sensitivities, you know, but, you know, the traditional approach to autoimmune disease is you use suppressive medications or in this case, you take out the thyroid or you nuke it. But in functional medicine, we really look at the root causes, and there are many of their environmental toxins, and they play a huge role in thyroid disease, whether it's heavy metals or pesticides or chemicals. Yeah. We look at the gut, as you.

Mentioned, we look at foods Institutes like gluten. Yeah. I think I said earlier, hormones.

Hormones.

We look at the HPA axis, which.

Is the stress hormones.

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

What kind of nutrients are playing a role in thyroid disease?

So, moving, yeah, we can talk about that because that moves sort of into treatment. We want to support a really healthy thyroid. So you're thinking about things like iodine, you're thinking about selenium, you're thinking about zinc, you're thinking about vitamin C, vitamin E, these are B and A, all support good healthy thyroid. And if you're low in any of those, that will impact the health of your thyroid and your immune system. So you're going to be way more susceptible to any type of autoimmune process in the thyroid.

It's really a 360 approach that looks at all the root causes, very similar to what we do in general with people. we specify for the thyroid. And I think that, you know, we do testing like stool testing, organic acid testing, hormone testing, adrenal testing, toxin testing, heavy metal testing, checking for iodine, vitamin D levels. These are things that you don't typically get at a traditional doctor's office. And the Ultra Wellness Center here in Lenox, we've been doing this for decades, and we really see amazing results. And, you know, often we'll see a disease that I've never really treated or that is not that common. And I'm like, well, gee. I don't really know. All the time. I don't know if this is going to work. 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, I've been eating tuna every day for 30 years. Or, I basically have this terrible stomach issue that blah, blah, blah, blah, blah. And I go, oh, you know, so you start to kind of find the clues in the patient's story and you follow the threads. and you start to do the diagnostic tests that help you, and then you start to peel the onion and treat all these problems. And so, you know, your, your treatment isn't just take this PTU drug or get your thyroid nuked or take it out. It's like, oh, we have to change our diet. Oh, we have to deal with stress. Oh, we have to take the right nutrients to optimize the levels. Oh, you have heavy metals. You have to take care of that. Oh, we have pesticides. You have to figure out how to get rid of that. So we basically go through a process, a therapeutic process that's based very strategically on that patient's story and their specific Labs, 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 gonna 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 setup for being compromised in the future because of all of those particular areas you just talked about. It's not a matter of people have toxins, it's how much. And then the genetics determine how well they're going to detox those 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 could go through every, you know, every biologic system that we look at with all the testing that we do and, and explain in detail how we're using those tests in those biologic areas, toxins, the HPA access. 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 reductionist, it's Graves disease, you get this drug, a CO2 later, that's it, nothing else. And we're like, no, no, no. 10 people with Graves might have 10 different issues and we need to treat them in 10 different ways and we need to find out what their cause.

Is and how to optimize their system and it's different. You know what, 20 years ago, right, or maybe it's longer than that, maybe 21, 22 years ago, two years ago, you were at Canyon Ranch, and you had the opportunity to, you know, hear Jeff Bland speak, and you, you got the fever early on, right?

I did. I did.

20 years ago, I, I just started my own conventional family practice, and I was a conventional doc for, you know, it was, it took me about 15 years, but even in my conventional practice, I always had that, that holistic approach. I was writing nutrition programs. I was putting together exercise programs for my patients and my diabetics. I had a weight loss program specifically specifically for my diabetics. However, the pressures of the insurance industry, the pressures of my discipline and family medicine were such that it was, see as many pages as you can, make the diagnosis, use a pharmaceutical agent. And about six, you know, probably 13, 14 years in, I started to say, you know what?

This is not right.

This. There's something wrong because my patients aren't getting better. No, I'm maintaining disease. and then I found functional medicine. And that changed everything. It changed everything. So where you would have come to me with grave disease 10 years ago, and I would have sent you to the endocrinologist, who would have put you on methimazole, a beta blocker, and then talked about having you go to an ENT doc who's gonna take out your thyroid. I would have been right on board. You know what? I saw the light. And I can tell you, in my time as a family, as a functional medicine doc, now board certified in functional medicine, the IFM, I think I have helped more people leave their disease behind, actually be better than I did in 20 years of private practice in conventional medicine.

Wow. So that's a big statement. You literally have helped more people in the last few years of functional medicine than you're tight. It is. It's kind of a miracle and to me, it's both inspiring and it's also incredibly frustrating because so many people out there are not getting answers to their problems with solutions that exist. And it just breaks my heart and people suffer terribly. Autoimmune diseases are so bad. I was recently out west and I was sitting in Montana in the cabin I was staying in and I went out in the morning to just hang out and have my coffee and maybe journal a little bit. And there's this old guy sitting there, looked old anyway, he was turned out to be a lot younger than I was, but he was, you know, kind of pretty overweight, big belly, started chit chatting. Where are you from? Oh, Texas. Oh, yeah. Okay. What do you do? I was like, well, I was an oil construction guy. And I'm like, oh, wow, it's kind of cool. Well, I had to quit. And I'm like, what happened? He's like, well, I collapsed on the job. I had, I had MS, and I've been on these drugs, and I'm just terrible. I can't do anything. I can barely get up. I can probably tie my shoes. I used to wear boots. I can only wear sneakers now because I can't do anything. And I just feel terrible. And I thought, you know, wow, this guy's just not getting access to information that's going to really help him. And I told him about Terry Walls work on MS, and I recommend her book. And, you know, she's been on the podcast. Gonna be back on the podcast. And he's like, why are you helping me? I'm like, well, I don't know. I'm a doctor, and I just can't. I can't help myself because I. I'm like, here, you have a problem. you're gonna get dramatically better.

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

Yeah, it's so powerful.

And that's great.

So if you've been listening and you've had a thyroid issue or Graves disease, encourage you to, you know, think about trying a different approach. We can certainly help you at the UlTera Wellness Center. You can find other people who do functional medicine. Don't just stop at the traditional approaches. And sometimes you do need medications or you need an ablation or you need surgery. but most of the time we can get you through without it. And if you love this podcast, share with your friends and family on social media. We'd love to hear from you. If you have a comment about what's going on, leave a comment and how you maybe solved your Graves disease. Maybe you have, and we'd have something to learn. And subscribe wherever you get your podcasts, and we'll see you next week on the Doctor's Pharmacy.

Hey, everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. nothing else I promise. And all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

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