Exclusive Dr. Hyman+ Functional Medicine Deep Dive: Thyroid + Hashimotos

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Hello and welcome. My name is Dr. Natasha Falahi and I will be your guide and host for this month's deep dive. We are going to be covering the thyroid and in particular my favorite topic, Hashimoto's. As always with these calls, this content is for informational and educational purposes only. It's not intended to provide medical advice or take the place of medical advice or treatment. So if you have any questions or concerns, be sure to talk to your personal physician. A little bit about me and why I'm talking to you about this. I am the sensitive doctor. I have a doctorate in chiropractic and I also have extensive postgraduate training in functional medicine, functional neurology, functional immunology, psychoneuroimmunology, energy psychology, and autoimmune coaching. I have a clinical and virtual practice. I'm based in Northern California, and I focus primarily on helping sensitive women with natural and mind-body approaches for holistic thyroid health, in particular Hashimoto's and other autoimmune conditions. Most of my tools involve functional medicine, but also some more esoteric and mind-body tools, which I'll touch on near the end of this presentation. Some of you may also recognize me with much shorter hair from Broken Brain 2, the mind-body connection with Dr. Mark Hyman from a couple of years ago, where I actually shared my personal Hashimoto's healing story, as well as a lot of the mind-body connection in that holistic realm of healing. so let's get right into it because there's so much to cover and I really want to share as much information as I can with you today. So we're going to start kind of with the basics in the background of what the thyroid is, and then we're going to cover a lot of that functional medicine perspective of thyroid care and health, in particular Hashimoto's. And after that, I'm going to get a little bit into some of the mind-body practices that also are related and can help thyroid conditions, in particular autoimmune and Hashimoto's conditions. So a little bit background on the thyroid. A lot of people actually have thyroid conditions, but they don't know it. It's estimated that at 20 million people have a thyroid condition, but 60% of them don't know they have it. And to be honest, I didn't actually know I had a thyroid condition until I was getting my doctorate and I was studying functional medicine and I was running labs on myself just to see what a quote unquote normal or healthy patient population would look like. Lo and behold, in running those labs, I came across a lot of dysfunction in my thyroid. Approximately 90% of hypothyroid cases are estimated to actually be undiagnosed Hashimoto's. So a lot of people may be aware that they have hypothyroidism, or they're taking medications for it, but they haven't quite explored if it is or isn't Hashimoto's. Because Hashimoto's is so prevalent and it is most likely cause of the most likely condition of hypothyroidism, we're going to be talking about Hashimoto's the most on this call. Women are also five to eight times more likely to develop a thyroid condition. One in eight women will develop a thyroid condition in her lifetime, and hypothyroidism itself is about eight to 10 times less common in men. That's because again, that 90% of hypothyroid cases are most likely autoimmune, Hashimoto's cases and women are much more likely to have autoimmune conditions. It's much more common among women. About 1.2% of people in the United States have hyperthyroidism. That's a little bit more than hyperthyroidism, sorry if I misstated that. That's a little bit more than one percent out of every 100 compared to 4.6% of people who have hypothyroidism, which is about every five in 100 people. A lot of people, again, don't know they have a thyroid condition or they're not as familiar with it. I really wanted to give you a big picture sense of why you should really care about your thyroid. It comes down to this. If you take a look at this image, it's just an idea of the interconnected web of the way that thyroid interacts with so many systems in our body. There are actually thyroid hormone receptor sites on every single cell of our body. So if there's even a slight imbalance in our thyroid hormone production or metabolism, it's going to impact globally. So you're, you know, going to affect every organ and every system in the body when you start having thyroid imbalances, because the thyroid regulates processes that have to do with metabolism and our basal metabolic rate. So things that also impact heart rate, blood pressure, menstruation, our body temperature, our metabolism, energy levels, sleep, memory, digestion, and blood sugar. So again, any imbalance in the thyroid, you're going to start to feel it globally. You might have brain symptoms, you might have bone symptoms, cardiovascular, liver function, hormones kind of across the board. So we always want to make sure that the thyroid is optimized. Whether or not somebody is really aware of it, it's always great to do a screen. So the anatomy of the thyroid is here, located at the base of your neck. this picture is actually quite enlarged. It's an exaggerated illustration, but that's where it's located at the base of your throat over your trachea, and it has a butterfly shape. The normal size of a thyroid is two thumbs held together in the shape of a V. So if you were to kind of look at your own thumbs, that's the normal size, not the amount, the size of this illustration. But there can be enlargements in the thyroid itself, and usually when it's ineffective at making thyroid hormone or it becomes inflamed or occupied by tumors. So we'll talk about some of those disorders or imbalances that start to happen in the thyroid. The other thing I really want to emphasize and help people understand, because this is one of the biggest teaching points that I teach my clients and kind of big aha moment for me was understanding the full spectrum of full body thyroid metabolism. So a lot of times, you know, people focus just on the thyroid and say, oh, it's the organ or that the endocrine gland that is having an issue, but really everything is again so interconnected and the actual metabolism of our thyroid hormone and the production of it and the conversion of it happens throughout our whole body. It starts up here in our brain where our hypothalamus and our pituitary gland are communicating from our brain down to our thyroid. The TSH, which a lot of people are familiar with, is the thyroid stimulating hormone. This is our brain telling our thyroid to produce more thyroid hormone. And so there's that first signal there. And again, that signal is actually coming more from a feedback mechanism of our brain kind of sensing what's going on in the rest of our body. So then in our thyroid, using a lot of different nutrients and co-factors, our thyroid is then producing thyroid hormone. So the, you know, the terms that people may or may not be familiar with are T3 and T4. Now, if you think about the thyroid hormone being the fuel for all our cells, that basal metabolic rate, metabolism, we can think of an analogy of gasoline or lighter fluid. So our thyroid will produce T3 and T4. T3 is the active form of thyroid hormone and it gets used up right away. As soon as it touches the cell, it's like lighter fluid. It will just light up, provide that energy and then be done with. So when our thyroid actually releases the thyroid hormone, it's only releasing about 7% of T3, that active form. 93% of that hormone that's coming out of our thyroid is T4. And this is kind of the inactive form. You can think of this as gasoline and those red canisters. So those red canisters are going to be delivered to tissue all around our body. And at that point, we need to be able to take the cap off the canister, and pour the gasoline into the tank to use the fuel. So that's where we're going to talk about where some of the dysfunction starts to take place. So again, that T4 that comes out the 93% starts to travel around our body. And first of all, we need to be making optimal levels of that T3 and T4. But the T4 should be circulating and throughout the body getting converted to T3. So one of the places where that happens is in the liver. So the T4 travels to the liver and with different enzymatic activity, about 60% of it should get converted to T3 right there and then be dispersed and used throughout the body. And then some of it's converted to reverse T3, which are kind of like the brakes. It's another inactive form of T3. And we'll talk about what that means a little bit later when we talk about the labs. And then some of it is actually converted to T3 sulfate or T3, and T3 AC. Now, these forms, 20% of that T4, should travel to our gut and then from our gut get converted from T3S and T3AC to active T3. So you can see now that not just from the thyroid itself, but the brain signaling, the thyroid production, the nutrients, the co-factors, the enzymes, the liver, the guts, all of these are involved in that thyroid metabolism. so if any of these are sluggish, like if our guts are not ideal, if our liver is not working that well, then that may be part of the issue in which at the end of the day, we're not receiving enough thyroid hormone or we're receiving too much and the feedback mechanisms not working properly. So anyways, this is a lot of physiology, but I think it's so important for all of us to understand that this is happening in our body. And when we start to have a thyroid imbalance, it's not always just from the thyroid, it could be in other places. And that's why it's really important to do comprehensive testing. So when we start looking at the Diagnostics and testing of thyroid and thyroid health, it really starts with history, too. So you want to look at the history of your symptoms. And, you know, we'll talk about the symptoms of hypothyroidism and hyperthyroidism as we move forward here. But you, you know, your practitioner and yourself, when you're looking at this, you want to start to explore your history, but also your family history. Again, there's a genetic component to a lot of this, particularly autoimmune conditions with higher susceptibility. And a lot of people say, oh yeah, my mom, my aunts, they all had thyroid issues. They took thyroid hormone replacement. But if we think about that statistic of how the majority of people who are hypothyroid are actually Hashimoto's autoimmune thyroid, there may have been a lot of missed autoimmunity in the family or in the history. Next, it's important to do physical exam of the thyroid. This can be palpation, visualization, seeing if it's enlarged, auscultation, listening to it. And then there's the lab testing, which is normally done through the blood. It can be a venous draw. And there's actually some great at-home tests now which allow you to do blood spot testing and send it in to get some of these numbers. And then more advanced testing and diagnostics of the thyroid include ultrasound, radioactive uptake, fine needle aspiration, if there's a nodule or something that they want to kind of look at more specifically. And then it's super important to also incorporate functional medicine advanced testing into the idea of holistic thyroid care. Like we talked about, you saw already that the brain and the liver and the guts are involved. So we need to look at gut health. We need to look at adrenal health because there's hormonal connections, pathogens, infections, toxins in the body. So all of that great functional medicine stuff that you learn about every month here, it applies to thyroid health as well. So now let's talk about the specifics of actual thyroid markers and thyroid lab testing. So a lot of times when I work with clients, they say, oh yeah, I had my thyroid tested, everything was normal, everything was fine. Well, first of all, not always is the full thyroid panel run. So when I actually review and look at their labs, we see that, you know, maybe TSH was run, maybe TSH and T4 or maybe even T4, T3, that's a little bit more comprehensive than we often see. But you know, it's you saw that diagram, if doctors are only measuring TSH before they'll go on and measure anything else, they're not getting the whole picture of what's going on. They're just getting that image of the brain's communication to the thyroid. But if anything else is breaking down after that, you're missing it on the labs. So a full and comprehensive thyroid panel includes all of these markers. so TSH, again, is that brain communicating with a thyroid to produce hormone. And it's a feedback loop. So if the body, all of a sudden, has lots of hormone, the brain says, oh, we have plenty. Let's slow down. And so at that point, it, you know, if the TSH is high, it's usually that there's a hypothyroid condition going on. If the TSH is low, there's usually a hyper. Next is total T4. So this is the bound and unbound T4. This can be altered by prescriptions. and this is combined with some other numbers to calculate free T4. So free T4 is the active T4 in the blood. Again, if this is high, it can indicate hyper, and if it's low, it can indicate hypo. Then if we go a little further in the testing, some doctors will run total T3. This is the T3 concentration in the blood. So this can be high from like hyperthyroidism or thyrotoxicosis. So these are kind of really dangerous conditions that need to be monitored as well. but it'll be low if there's down regulation of that five prime deiodinase, which is the enzyme in the liver. It can be low from stress, elevated cortisol, free radical damage. And then there's free T3. So some doctors will run this too, and this is really the best marker to evaluate active thyroid hormone. This is rarely tested, but it's really helpful if you have hyper symptoms. and your free T4 is within normal limits. And then I mentioned this number or this factor to look at of the reverse T3. This is the inactive form of T4. And sometimes the liver, we saw the T3, T4 goes down and gets converted to reverse T3. This is a metabolic break on the body. And this number can be impacted by inflammation, chronic stress, high cortisol, major trauma, surgery, chronic illness, nutritional deficiencies. And actually it's really interesting because fasting and yo-yo dieting, lack of exercise, all these factors, increased alcohol intake can actually impact the reverse T3. If it's high, it's an indication of stress or cortisol and low, an indication of injury. So reverse T3 is actually a really great marker to run to track chronic stress and inflammation in the body as well. T3 uptake measures the amount of sites for active T3 to bind, and this can be impacted by things like estrogen, pregnancy, birth control, and it will make the binding sites low. And they will become high if there's testosterone, hyperthyroidism, and it decreases the binding sites. and then the bottom here are all the thyroid antibodies. So to really look for autoimmune thyroid, we need to be running these antibodies. So the most common one is TPO antibody, and some doctors will run this, but it's really essential to run both TPO and anti-TG, antithyroglobulin antibody, to kind of rule out a Hashimoto's condition. And then you look for antibodies to the TSH receptors, which would then indicate an autoimmune graves condition. So again, this is a full thyroid panel. This should be run at least once if you're really wanting to get a comprehensive look on your thyroid, if not run once a year because so many different factors can impact your thyroid health that it could trigger changes in some of these. So the other thing about running labs like this is that the lab range that you will get results from and the doctor will say, oh, things are normal, is really considered a pathological range, meaning if something's outside of that lab range, it's considered it's already to a point of pathology. Now, as you know in functional medicine, we don't want to wait till a pathology develops. We want to look at all systems, look for root causes and see if anything is imbalanced along the way. So a functional range of these markers or numbers is going to be much tighter than the actual pathological range. So TSH, for example, the full lab range of it might be, you know, depending on your lab, they all vary because they're based on the population of sick and healthy people, but it might vary from like 0.4 to 4.5. I've seen some lab ranges up to even 10 for TSH, but really the optimal range of wanting, you know, ideal thyroid communication from the brain to the thyroid for TSH should be anywhere from 1.3, 1.5 to three maximum. And really for women who are having any infertility concerns or pregnancy, it, you know, a lot of doctors don't want to see TSH over two because it will impact the pregnancy and the developing fetus as well. And same goes for all the other markers, you know, they're going to have much wider lab ranges. So unless you're working with a functional medicine practitioner who's looking at the functional ranges, you're not necessarily getting the most comprehensive look on optimizing your thyroid.

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Hi, everyone. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their Find a Practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner, and can help you make changes, especially when it comes to your health.