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

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

All these things can disrupt our thyroid.

Function and often your doctor never even looks for them.

Absolutely. Hey everyone, it's Dr. Mark Hyman and welcome to a special episode of the Doctor's Pharmacy and that's Pharmacy with an F-A-R-M-A-C-Y, Place for Conversations that Matter. And this special episode is called House Call because we're gonna take medicine to you. and help you understand how functional medicine can help your issues in ways that you might not actually have realized and that give you answers when conventional medicine doesn't. And I'm here with my friend, my colleague, my partner at the Ultra Wellness Center and the medical director of the Ultra Wellness Center, Dr. Elizabeth Boham, who I've known for gosh 20 years now and has been by my side learning and growing and teaching functional medicine. She's pretty extraordinary. She's what every physician should be. She's a registered dietitian, an exercise physiologist, and an MD, good luck finding that, she's a unicorn. But we're gonna talk about specific conditions that we see every day at the Ultra Wellness Center and how we approach them and how we often get people better when traditional medicine can't. And today we're gonna talk about one of the most prevalent conditions that exists today in America and it's an autoimmune disease called Hashimoto's or hypothyroidism. So we're gonna talk about hypothyroidism and Liz and I see this a lot. and we see it mistreated a lot and we see people suffering a lot when they don't need to. So welcome, Liz.

Thank you, Mark. It's so great to be with you.

Okay, so tell us how prevalent is this problem of low thyroid function?

You know, it's so prevalent. We see it all the time with our patients. You know, we see people who are really obviously low thyroid and then we see people who are kind of that, their thyroid numbers might be normal but they have symptoms of low thyroid. So that would include things like, Hair loss, they feel cold all the time, they're constipated, they feel low energy, maybe they've lost hair at the outer part of their eyebrow. Yeah. And they've dry skin and they just feel crummy.

Depression.

Depressed, yes.

Trouble concentrating, focusing, muscle aches, fatigue, getting tired in the morning.

Yeah.

All these weird things that people suffer from they think are quite normal, but they're not. and they're clues.

Right, they're clues to say, okay, we've got to look deeper. We've got to figure out why are they not feeling well?

And then we've got to figure out, is it their thyroid?

Yeah, and it affects one in five women.

It's so common. One in 10 men, and 50% of the time, it's not diagnosed. And I would say probably 80 to.

90% of the time, it's not treated properly.

That's true.

That's true. So, you might be one of the 10% that's got it nailed, Most of you, even if you have thyroid issues, you still may have symptoms. And the doctor's like, well, you're fine. You're on thyroid, don't worry about it.

Right, your TSH looks normal. I think we're doing everything we need to do.

Yeah, so what are the problems with the traditional way we treat thyroid in America around the world?

I think the first thing that as functional medicine docs we recognize is that we're not asking that question why. Right? So we're not looking for that underlying root cause, which so often helps us when we're treating our patient because it helps us figure out for them, for that individual person, what do we need to do to help their thyroid work better? So is it because of a nutritional deficiency? We know that we need iodine and selenium and iron and all sorts of good amino acids.

Vitamin D. Just to get the thyroid to work, on your cell, you need vitamin D to help it actually send the message to your DNA to do.

What it's supposed to do.

Right. And 80% of us are deficient in.

Vitamin D. Yes, yes. And so if people aren't eating enough of certain foods, we might see nutritional deficiencies or maybe if their digestive system is a mess, they're not absorbing their nutrients well. So we have to ask that question why? Because sometimes that will just help the thyroid work better when we help support it nutritionally. Or maybe it's an autoimmune condition, like you mentioned, Hashimoto's. And then it gets us thinking of a lot of different things, right? It gets us thinking about, well, why does this person have autoimmunity?

Isn't it the most common autoimmune disease?

Yeah, it really is. What causes it? Well, you know, the body, in an autoimmune condition, the body starts to fight itself off, right? So it starts to, it looks at the thyroid gland and says, okay, I'm gonna fight you off. I'm gonna attack you. And when it attacks the thyroid gland, the thyroid gland doesn't work as well. And so then you get low, well, in many cases, you get a low thyroid. So what causes the autoimmune disease is the big question. We always ask in functional medicine. That's it, why? Right, and everybody's different, right? For one person it may be gluten. We know gluten is associated with a lot of Hashimoto's thyroiditis, not all, but some.

My experience, like you look at thyroid antibodies and you compare it with the gluten antibodies in that patient, and it's about 30% of the time, it could be related to gluten. What do you think?

Yeah, I think it could be, it could be. It might even be a little higher. It depends, 'cause of the patients we're seeing. So we might be seeing more patients who you have a lot of different digestive issues going on, and so I might see it even a little more clearly.

We call that selection bias. People who are sick select to come see us, so they have more stuff for sure.

But we always think about the digestive system, right? You've got autoimmunity, you've got to think about what's going on in the digestive system. But then you think about could there be an overgrowth of bacteria? Certain bacteria in either the digestive system or other parts of the body have been shown to trigger autoimmunity in some people. We know that.

We're gonna talk about that in another podcast. so stay tuned, we're gonna talk about.

The gut and leaky gut. okay, we'll do that. We know that imbalances in iodine, actually excessive amounts of iodine. Can shut down the thyroid. yeah, so Hashimoto's, 'cause it was found first in Japan, where they have lots of iodine. So we know iodine's important for the thyroid, but too little's not good, but too much is also not good. So we pay attention to that. And toxins, of course, right? yeah. Toxins can be triggers for autoimmune disease in some people.

Yeah, some people say that, the thyroid is a yellow canary of our body. That the yellow canary was the coal miners used to bring the yellow canary into the mine, and if it dropped dead, they knew the air was bad, they had to get out. So it was an early warning sign. And the thyroid is like that, and it seems to be extremely sensitive to disruption from heavy metals, from pesticides, the plastics and everything.

Yeah, fluoride.

So, yeah, fluoride in the water, all these things can disrupt our thyroid function, and often your doctor never even looks for them.

Absolutely, right? They say, okay, we're just gonna look at the TSH and if it's in the normal range, you're fine, or we're gonna give you medication to get it in the normal range, but not really look a lot deeper.

Yeah, so what is the difference in the testing that... oh, there's one other thing I wanted to bring up, which I remember reading about in the New England Journal of Medicine, was a lady who thought that Bok Choy was healthy and she ate like two pounds of raw bok choy a day and she went into a hypothyroid coma. And people are having kale juice.

Talking about goitrogens.

Yeah, there's a whole kale craze. It's a great point. And people are juicing it and it's raw and you know, raw cruciferous vegetables.

Can be a problem.

If you're eating a lot of raw broccoli and cabbage and if you're having.

Raw Brussels sprouts or raw bok choy. Eating it in a level that's beyond just like a normal food portion. Yeah. Right? But as you mentioned, As I mentioned, if you cook it, if you cook it, you get rid of a lot of that goitrogenic potential, that the part that's gonna dam or interfere with thyroid function. So you don't have to be concerned when you have cooked cruciferous vegetables, but it's that, like you said, Should I worry about having a kale juice every day? It's a good question.

Depends how much kale you put in it, right?

Well, I like to drink green juices and most of them have kale. I mean, you take a little bit of kale is fine. I'm careful about it, so. And it depends on the person, of course, right?

Right?

You're an expert.

What about soy?

So, you know, that's a good question too. You know, I think that if, because.

A lot of people are like, soy is really bad, it interrupts your thyroid, it's dangerous, you shouldn't eat it.

I think if we're going with, you know, non-GMO organic soy as a whole food, like edamame and tofu, then I'm not concerned. Tempeh, I'm not concerned.

Traditional soy foods that have been used for centuries, right?

Yes.

Miso, tempeh, tofu, the fermented soy too, right? Yep. You know, soy sauce. I mean, those are fine. It's, it's, you know, when we're, you know, drinking a, you know, quart of soy milk a day, that's a problem. Or when you're having all these fake soy foods that are processed or soy.

Burgers and you're eating stuff that's sort of weird Frankenfoods. Or like the, the texturized soy protein that they put in cereals and bars just to get that protein content up. We, you know, we don't Yeah, that's the stuff I tell people to stay away from. Okay, so you're someone who comes in.

You feel tired, you're constipated, depressed, your skin's dry, your hair's falling out, you don't have a sex drive anymore, you can't concentrate, and you go to a traditional doctor, they'll just test one thing.

What do they test? Right, so they typically test your TSH. Okay, so what is that? Your TSH is your thyroid stimulating hormone, and there's a feedback loop in the body. So if your thyroid level is low, then the body will get triggered to make more TSH.

And that comes from your brain, from your pituitary gland.

Yes, and then that TSH will say, okay, make more thyroid. So if the TSH is high, then the doctor says, okay, your thyroid is underactive and we need to treat it.

That's the only thing they test.

Often, often.

And I think if you're a functional medicine doctor, it's a very different approach.

So what kind of where are you looking at? Well, we always start with a full thyroid panel where you look at, TSH, but you look at free T3 and free T4. So free T4 is one thyroid hormone that's floating around in your body, but then the T3 is the active form that your body needs for all the thyroid functions to occur. So we look at both, we look at all three of those at least. And we often look at thyroid antibodies. And sometimes we'll even do things like reverse T3 and the reverse T3 to total T3 ratio.

So what does reverse T3 tell you?

So the reverse T3 is a thyroid hormone that the body, when the body is, I always think of it almost as the brake that the body puts on itself. So when the body is saying, okay, I've got to slow myself down, it takes some of its T3, which is your active thyroid hormone, and it converts it to reverse T3, almost in a way to slow down our metabolism. It's a protective mechanism, I think of, right? And it makes sense that we have that in times of stress.

A lot of times we trigger that that are not actually good. Right?

That's very true. So like if there's a, you know, if there was a major stress going on, you'd want to have that mechanism in place so you didn't starve to death. But with a lot of chronic stress, which we see a lot these days, we can sometimes see high reverse T3. And the other thing we see a lot that causes that high reverse T3 is sometimes toxins. So it can be a sign that we've got to look deeper and say, okay, is this person under a lot of chronic stress? How is there adrenal gland functioning, how are they, are they working to activate that parasympathetic nervous system, that calming nervous system, which helps the body heal? And then we look for toxins. Yeah, yeah.

In the gluten issues, we look for everything that is imbalancing the thyroid. So look for nutritional deficiency, do you have selenium deficiency, iodine deficiency? Are you low in zinc? Do you have low omega-3 fats? Do you have yeast in your gut? Do you have heavy metals? Do you have pesticide exposure, toxin exposures? So we take a very detailed history that your traditional doctor would not do. Right. To really look at the broad spectrum what's causing it, because we can just treat the symptoms of the thyroid, but maybe we may not need to do that. And I've seen many patients where you fix these other things and their thyroid gets better. Absolutely. And it's so powerful when you see that, it's like, oh, I don't need to do thyroid. I can actually fix the upstream cause. Yeah. It's pretty impressive when you see that. And the last thing you were talking about was antibodies.

So tell us about what antibodies are and why we should look at them and why traditional doctors don't look at them. I'm not sure why they don't look at them enough, but the antibodies are giving us a signal that the the body is attacking its own thyroid, and it's a sign that there's autoimmune disease going on in the body. And we've got to figure out that question, why is that? Why is that going on? And so I had a woman who came in to see me, and she was 40, and she had been struggling with all those symptoms we talked about with low thyroid. She was cold all the time. Her hands were cold. She was gaining weight. She was tired. She was constipated. she was losing hair, her eyebrows were thinning.

Sound familiar to anybody?

I know, right? So I'm like, okay, but then her primary doctor did her TSH and it was normal. So we then went deeper.

Can I stop you for a second? So when I was trained, and I'm sure you were trained the same way, was you only check TSH? If that's normal, then you don't do anything else. And what's normal is a range of like 0.5 to 5.

Often, yeah.

Which is a massive range that actually doesn't reflect even our current understanding on most reference ranges on the lab tests that even the American College of Endocrinology says if it's over three and a.

Half, we should be worried. Right, and many, many studies are saying people between one and two feel the best, right?

Right, and I remember, you know, because.

I always do all the tests.

I don't do reverse T3, but I do TSH, T3, T4, and the thyroid antibodies. Because what I've learned is that even if all those are normal, TSH, T3, T4, You can have elevated antibodies.

Yes.

And people who have those feel better when they get on thyroid.

Very true.

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I went to a conference years ago at Harvard and I, you know, it was a traditional medicine conference and the endocrinologist was talking about thyroid and he said, look, if your antibodies are elevated, they should be treated because they're probably symptomatic and you treat the patient, not the lab test.

But in traditional medicine now we're more treating the lab test, not the patient. And I think that's really important. And, and, and the, and the physician sometimes thinks, well, I'll just wait until these antibodies damage the thyroid enough and then I'll treat Right, that's the way they, you know. It's like once the TSH starts to go up. I'm gonna wait until, but we say, okay, no, there's so much we can do.

100%.

There's so much we can do right away.

Yeah, I remember this patient came in once with blood sugar like 115 and 126 is diabetes, 100 is pre-diabetes. And I'm like, God, did your doctor say anything about your high blood sugars? Oh yeah, he checked it out. What did he say? He said, well, when it gets to.

Like 126, we'll treat it with medication. Yeah, right.

But I'm like, no, this is the.

Perfect time to treat you. So tell us about this case. So right, so she So she came in and she wasn't feeling good at all, but her TSH was normal. So we did the full panel and we saw that her thyroid antibodies were elevated. And so then we had-: Was her.

TSH and the rest abnormal or not really?

No, her TSH was pretty normal. 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 then it brought us down this whole pathway of what's going on with her digestive system, what's going on with food sensitivities, was there any signs of increased intestinal permeability? And so we pulled her off of gluten and we measured things like her iodine level and her selenium level just to get the right balance. And we actually, we gave her some thyroid hormone. We gave her some Glandular thyroid hormone. I used Armour 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, her skin starting to be less dry, her bowel movements improving. And so, you know, I think it's important that we take that step and go a little deeper.

And people don't often realize how bad they're feeling until they start feeling better on this stuff, right? And I think just to back up a little bit, you did something which was kind of unusual, controversial, and most traditional endocrinologists would scoff at, which is you used a combination of T3 and T4 in a hormone that comes from pig that is the entire thyroid combination of hormones, including T2, which we don't even talk about, that is actually really important to replace your own because you make a complex array of hormones and often the T4 can't get converted to the T3 in your body, which is the active hormone. So even if you're taking T4, which is what most doctors recommend like Synthroid or Levothyroxine or any of these, and they're not terrible, but they're just challenging because you actually may not be giving the person the T3 that they really need because their body's not able to.

Make it as well. 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 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, really interesting low impact type of gene. So what that means is that it can-- It's not gonna kill you. Right, thank you. It's not gonna kill you, but it can make you not feel so good. And it helps us know how to treat people. So the gene, this DIO2 gene that encodes for this enzyme, the DIO2 enzyme, which helps the body convert T4 to T3, especially in the brain, but also all throughout the body, and make that active T3 thyroid hormone. And what we're learning is that some people have this gene variation, and so when you give them just T4, thyroid hormone, they don't get the benefit. And studies have shown even when lab work looks normal. So even if their T3 looks normal, even if their TSH looks normal, that they do better when you give them 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 Cytomel and we'll add that to Synthroid, for example, or a T4. But, and so sometimes we see those people who, you know, just get, start to feel better in terms of, especially mentally.

Mentally, yeah.

Energy-wise, mood-wise, they really start to feel better finally.

You don't realize that depression is really linked to thyroid and that, you know, often psychiatrists in treatment resistant depression, when drugs don't work, they'll give them T3.

Yes.

As a treatment for depression.

They've been doing that for a long time. It's not anything new.

Right, right, right. It's like weird for the rest. 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 Westroid, Nature-Throid, Armour-Throid.

Why is that? And should we be worried? I don't think so. I think 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. We can definitely regulate dose with our patients. It's very reproducible in terms of the medication. A good portion of our patients, I think we've talked about this before, we'll say, Maybe was 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 that are separate, not as a glandular, but just as a prescription drug.

And I think.

The other problem with the glandulars and the things like Armour, Westhroid, is that doctors can misinterpret the lab tests because the thyroid, the TSH, goes really low because the T3 suppresses the feedback loop. But you have to look at the T4 and T3 separately and also the symptoms of a patient.

Absolutely.

So tell us about that.

Well, sometimes when you give T3, right, then you might see a low T4, and like you said, TSH, 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 TSH goes down, which worries doctors that you're taking too much or you're treated. It actually is not true, side.

It's really important to pay attention to the patient's symptoms. and I find that everybody's different. I have patients who are so sensitive to thyroid that if their TSH gets a little too low, they feel awful. They get palpitations, they get anxious, they have trouble with sleep, but then other people, if you don't get their TSH low enough or if you don't give them enough thyroid, then they're feeling all those signs of low thyroid. So, what I think the takeaway is, paying attention to your patient and their symptoms and getting that feedback and listening to them. And so, like what Billy Moulser said.

Treat the person who has the disease, not the disease that the person has. Right?

Absolutely. Right. That's what we, that's what we're working to get.

It reminded me of a case I had years ago where this woman was so symptomatic on hypothyroid and her TSH or 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 things that were symptoms of low thyroid that weren't being treated. So it's really powerful. So tell us about the second case of your patient who'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 on 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 this is interfering so much with your life at this point now that you're 35 that we should try an antidepressant. And she came to see me 'cause she wanted to look at it a different way. And so we did a bunch of different tests and included in that is we did that DIO2 gene test. And what was interesting is her thyroid levels looked fine, right? Her TSH, her T4, T3, it looked fine, but she did have a homozygous variation in that DIO2 gene, 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 was feeling fine on her synthroid. She'd been on it for many years, so we added the cytomel to it. And it really helped. It helped a lot with her energy and her mood.

Yeah, that's amazing. so these cases are, you know, not atypical. We see this all the time at the Ultra Wellness Center. And we help people when no one else could help them because we look at things differently through the lens of functional medicine, which is about root causes, about treating the whole system. Like when you come in with thyroid to your regular doctor, they don't ask you if you have been eating tuna fish every day for 30 years or if you worked in a pesticide Factory or if your, you know, stomach's upset. They don't care if you have. Maybe you're constipated. That's a symptom, but they don't care if you have bacterial overgrowth or yeast overgrowth or leaky gut or any of this stuff. And so at the Ultra Wellness Center, we tend to look at all of that. And we really dive deep into each person's story because everybody's different. If you've seen one person with thyroid, you've seen one person with thyroid and everybody has to be treated a little bit differently in personalized care. And it's really what the future of medicine is, it's personalized precision medicine and also precision health. And functional medicine is more about how do we create health. And so just to recap, what Dr. Bub and I have talked about, I think it's important to recognize if you have any symptoms, if you're tired in the morning, if you have dry skin, food retention, muscle aches, cramps, constipation, depression, low sex drive, low concentration, flaky skin, whatever, that it might be worth checking with a functional medicine doctor. And at the UltraWellness Center, we take care of patients from all over the world. And then when we do that, we look at different kinds of testing. So yes, we'll look at your TSH, we'll look at T3, T4, the thyroid antibodies, we might look at reverse T3, we might look at genes that are involved with thyroid function. But we'll also look at things like your gut and we'll look at heavy metals and we'll look at your experience. Your other hormones. Your diet, we'll look at nutritional deficiencies. We want to check selenium or zinc or iodine, things that are really important, vitamin D and omega-3s all these things are play a huge role in our thyroid function and then we'll talk about what foods you can eat, right? So what do you eat? I mean, so selenium is in Brazil nuts, iodine is in fish. Zinc is in pumpkin seeds. You can get Omega-3s in sardines. So you can actually use food to help optimize your thyroid function. Maybe you're having kale juice every day. You don't want to do that. So we'll sort of adjust things. And then by doing that, we really get a holistic view of what's going on and we can really optimize people's health. So I just thank you so much for sharing today about your cases and helping people understand that if you suffer from any of these symptoms, if you have challenges, with your health that nobody else can figure out that, you know, functional medicine lens really is different. And we are probably more experienced than anybody at the Ultra Wellness Center. There's. There's four doctors there, and collectively, we probably have more experience than any Center in the world, probably over 65 years of functional medicine experience. And we're getting old. Liz was like 30 when I met her, and now she's like 50, but she looks 20, so it's. I don't know how that We're aging backwards. We're aging backwards, right? So thank you for listening to Dr. Pharmacy. This is a case study of a thyroid case or two, and I hope you understood a little bit more about what's ailing you, and I hope you enjoyed this Pharmacy episode. If you'd like to share with your friends and family on social media, leave a comment. We'd love to hear from you and subscribe every year podcast. For those who are listening in the show notes, we're going to put the tests, the dietary instructions, the supplements you need, the lifestyle things to look at for every condition we're going to talk about in the, on the mini episodes of the doctor's Pharmacy to learn more and get your little cheat sheet handout so you actually know what we're talking about and can't, don't have to write everything down because you're probably driving while you're listening or working out or something.

So anyway, it's great being with you.

And thank you, Dr. Baum, for being.

On doctors Pharmacy podcast. Thank you so much, Mark. All right, we'll see you next time.

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