WHY CAN’T I GET BETTER? Chronic Illness, Post-COVID, and More: **THYROID CHANGES

Medicine Health with Dr. Paul Anderson. And in our series on Why Can't I Get Better? This session we're going to talk about the effect of one of your hormonal components in your body that's fairly important, which is your thyroid. And there's of course a lot of hormonal components, but in chronic illness, one of the places that kind of can go off of the rails, so to speak, and not work as well as it used to or not work as well as it should is actually the thyroid, and so it's worth bringing that up. Now, in this series of Why Can't I Get Better, what we're talking about are people who have usually had an acute infection or an acute trauma or some combination thereof, and then some point in the future after, they never really fully recover. They don't get better, or they have one of the very difficult to treat and assess chronic illnesses such as Long COVID or post-COVID syndrome, things such as chronic fatigue syndrome, CFS/ME, or fibromyalgia, or any other number of chronic illnesses that go on. And so they'll legitimately wonder why they can't get better. Well, in this session, we're going to talk about your thyroid. And in other sessions, we talked about toxins and other infections and immune inhibitors and all this other stuff. Well, With your thyroid, the thing to keep in mind is it is what operates the metabolic rate inside your body. So in other sections, we talked about the mitochondria and how they make your energy. Well, they get their marching orders from the thyroid hormone, which tells them at what rate to put out energy. Now, Go back to the cell and mitochondria section that we did, you also know that there's other things that can mess with the mitochondrial function, such as not enough of, you know, oxygen and other nutrients going in, or too much toxicity and junk that's not moving out of the cells fast enough. So obviously it's not just the thyroid, but the thyroid does play a role. So your metabolic rate is operated by your thyroid gland. Your thyroid gland puts out thyroid hormone, And one version, the T3 version of your thyroid hormone, has receptors on both the outside of the cell and on the mitochondria on the inside of the cell. And so the receptor on the outside of the cell turns on the, the feeding system for the cell, half of which goes to the mitochondria, and then the internal receptor actually up or down regulates your metabolic rate, how fast the mitochondria are going to do their thing. So back in the mitochondria and cell section, what we said is if anything slows down the mitochondria, your energy production slows down and you slow down. You don't feel right. Well, there's a number of reasons that that can go on and not enough or abnormally functioning Thyroid hormone can be a piece of that puzzle. So when we think about that, we think, well, how, you know, the thyroid, like, you're not dead, it didn't stop working. How did it get injured with your, you know, whatever triggered your chronic illness? Well, there's a couple of things to think about. The first thing is your thyroid could have been totally normal and serving you very well for your whole life. And then you get enough stressors into your system and your hormonal system tries to respond, tries to bounce back and respond against those stressors because your body is ill. And so the thyroid has feedback mechanisms that will say, we're creating too much metabolism in this person who's sick. And so sometimes with patients, I would, you know, make the analogy that If your motor is really not operating well and you just have to go a few blocks to get down to, you know, the auto repair shop, if you don't put too much, you know, of the gas on and you don't run your motor too fast, you're going to get a little bit more distance out of it while it's not running well. Whereas if you, you know, floor it, put a lot of gas into a motor that's very dysfunctional, the motor may break sooner. It may have other problems. And your body literally has a version of this that it largely regulates through your hormonal system. So thyroid is one of those big regulatory areas. Now you think, well, how could that go on? It's not usually a quick process. It's usually, let's, let's say for the sake of argument, your thyroid was no problem and then you get knocked down with an illness, and that could be you've got pneumonia, you've got Lyme disease, you've got a chronic other problem, you've got a bunch of other infections, you got COVID, you got whatever else that happens, or you got a trauma. You had a car accident or a big surgery, or maybe, you know, the trifecta of you get, you know, an accident, a trauma, surgery, then you've got recovery going on. So your body, you know, is sensing this. So sometimes with a sick body, what the hormonal system will do is, is it'll say, let's slow down things. And it's using that sort of, uh, logic, if you will. It's sort of chemical logic. It's not sitting there really thinking about it, we don't believe, but it's chemically feeding back and giving this idea that the, the motor, you know, the body is not running well. Uh, we don't want to put too much energy, too much gas into it and make it run fast but ill, right? So you can actually— and you see this with people if they're real sick and you upregulate their thyroid by giving them thyroid hormone— though sometimes they'll feel sicker. And I tell them, well, it's, it's like having a sick motor and then making it run faster. It's going to run fast but not appropriately. So your body has these ways of turning down hormonally your, your energy production system. Now, one way to do that is through the production of antibodies, and these are actual autoantibodies, meaning against us, and they can turn on during these acute illnesses and chronic illnesses, and they can be against our thyroid function. Now, the thyroid function is heavily dependent on taking basic things like iodine, and the amino acid tyrosine and putting them together into either a triiodothyronine, the T3 molecule, or a tetraiodothyronine, the T4 molecule. And so our body does this through a bunch of little processes in our thyroid gland, which is right in the lower part of your throat. And so there are places when you inflame the thyroid or the system is backed up, et cetera, where the immune system can go start attacking attacking that production system. So it can start attacking in 2 major places to slow down production. And so a lot of times what happens is that people will get, you know, they have normal thyroid before and they're sick afterwards. And sometimes those antibodies don't get checked and you'll see that they went up because of the illness. So that has to be worked on to get the antibodies to come down, which is a long, slow process. But the longer the antibodies are elevated, the worse your thyroid function's going to be. Well, the other thing that your thyroid will do is it will actually, um, start to trigger a mirror image molecule of the active T3 hormone, and it's called reverse T3. And so they both can go sit on the receptor sites to turn things on, right? So your metabolism, if you put T3 in your system, gets turned on, works faster by the T3 binding to the receptor. Well, if you have reverse T3, it will bind to the receptors, but it won't turn them on. It's sort of a blocking hormone. Now, a lot of folks in medicine will say, well, reverse T3 is probably meaningless, it probably doesn't really help your clinical guidance, etc. And I would say for the average human who's healthy, that's probably true. Reverse T3 is probably not a great measurement for healthy people. But because my world is chronically ill people or people with cancer, which is a chronically ill patient also. What we see in the chronically ill patients, especially when they've had these inciting traumas and stuff, is that the reverse T3 will go up, and that's your body's way of blocking the thyroid from turning on your energy. And so what'll happen then is your energy production doesn't shut off or you'd be dead, it slows way down. Now, those symptoms then can be things such as fatigue, usually severe tiredness, sleeping too much. You can also have disturbed sleep sometimes. You can gain weight really easy. Your water retention can be very bad. A whole number of things happen when your metabolism slows down. But another thing that's super important there is that the metabolism slowing down will also make that mitochondrial problem that we talked about in the other segment, uh, more magnified. So let's say the mitochondria are already kind of sick and they're recovering from your illness. They're feeling slow, you're feeling slow. If now you're blocking your thyroid either through autoimmune issues or reverse T3 or whatever, or you just— your levels of T3 and T4 go down, um, your mitochondria are going to be double slow, and so you're going to be double slow. So the things that you have to do first is realize that Even if your thyroid was normal prior, even if you didn't have any antibodies to your thyroid or reverse T3 prior, now your body is in a new situation. And so every chronically ill patient on the screening side, when we're trying to sort out how many problems they have creating their chronic illness, all of those patients really need to have the thyroid looked at in a multidimensional way. And so that would be the normal screening. of the TSH test. And then usually they do a T4, that's the primary output hormone. And sometimes now they'll do a T3 as well. So those are the hormonal and the feedback parts. But then we also add on 3 other things. So that would be the 2 main thyroid antibodies that are blocking. There's others that do other things, but the 2 main blocking antibodies, which would be the antithyroglobulin and the thyroid peroxidase antibodies, and then we do a reverse T3 just to get a 360 look at the thyroid function. Now maybe it's doing great, no problems anywhere there, then you kind of focus on other things. You focus on the mitochondria more, you focus on, you know, many of these other things we talk about. But a lot of times in chronically ill people, that's one of the factors that comes up. Now the thing you have to keep in mind is if that's all you fix and you've got all this other junk in your system and your mitochondria can't work because there's a lot of metabolic toxicity and all that stuff, you're going to turn your thyroid on and you're going to feel actually worse because your thyroid's working hard in a system that's sick. So a lot of times in chronic illness, we have to play a little bit of a balancing game of getting the thyroid back online slowly so that your body starts to work faster and better, and then kind of start to fix the other things that are contributing. That's all these other sections that we're doing on Why Can't I Get Better? And you fix all of those kind of at the same time, or at least in a rotation, and then your thyroid can get back to being normal. So there's a whole number of other things, but that's why the thyroid is so critical, and that's why it gets feedback to it that slow it down. Now, one thing I'd like to say is wherever you're seeing or hearing this, we're on all the pod burners, we're on CTR Radio, Facebook Live, and then on YouTube on DRA Online, Dr. A Online. Please like, share, and subscribe. Do the notifications. It really helps. We need subscribers on all the platforms, especially over on YouTube, where there's a really growing community for this sort of information. Also, I will put in the show notes some links. There'll be some links to some information around this and also some links to, you know, some provider referral services, et cetera, that may be of help to you. But that's about all the time that we have for thyroid. One of the things that we usually say is with thyroid, it's because it's a hormonal problem and there's all these things to test, you really need to work with a healthcare provider who's used to looking at chronically ill people's thyroid so you can do all the testing, but also then they can treat you appropriately. And that might mean hormonal treatment, it might mean non-hormonal treatment, but that's really dependent upon How you're doing in that respect with your thyroid, how your labs are, and how you physically are doing in your body. Well, we're going to move on right now to our next segment, and I want to thank you for listening to this one on Why I Can't Get Better, Thyroid Edition. Welcome to Medicine Health with Dr. Paul. And we're in our Why Can't I Get Better series, and we're talking about all kinds of different reasons why we, you know, whether we're chronically ill or we have a subacute illness or something lingering and we just can't quite get better, back to ourselves, or maybe we have a long-term chronic illness, we can't get there. This particular segment, I want to talk about neurological injury. And while this has always been part and parcel of chronic illness, neurological inflammation and injury, the world of COVID and post-COVID has really brought this out into the public, out to light, so to speak. And so what we want to think about is And a good analogy for this is the other segment that we did about your mitochondria and them not working as well in a chronic illness, etc. When we think about this, your brain not only has a lot of mitochondria, but the dynamics are very similar. There are things that occur when you have an inciting event or events that lead you to chronic illness, and you could even be so long chronically ill you don't remember what happened. But there's usually inciting events that collude together to become problematic, and they will start to then create changes in the normal physiologic manner in which you operate. And so one of the things that happens, and this is really— there's a lot of research around this with respect to COVID, but it goes on in most other you know, subacute and chronic illnesses, and that is the changes in the chemistry, the cytokines and the other chemicals that our immune system uses to talk to our system, and many of them are pro-inflammatory. Some are anti-inflammatory, some are pro-inflammatory. And so the problem with that is that A lot of times, because that is sort of a silent injury, like you don't realize that's going on when you have the initial infection or even a trauma or something, it is happening. You don't see it, and often you don't notice the problems it creates until later. Now, when we're acutely ill, let's say you have influenza or pneumonia, or you have some other problem like COVID. COVID, or, or maybe you've just been in an accident or had surgery. We all know it's normal during those times for us not to feel very well. Our energy will be low. We may have brain fog. Our system might be running slowly. We might sleep a lot more. But a lot of times we think, well, that's kind of normal because that's just part of the healing process. And that's true. So what's going on there is that as a way to protect your body and help you rest enough to recover and of that, your body, your system, whether the trigger is infectious or toxic or traumatic or whatever the trigger is, your system will release these immune chemicals. And then those will go to your whole body. But a lot of them are very brain-specific. And they'll go in there as a way to try and slow your brain function down, slow your motor output and other stuff so that you can rest more. recover. The problem is, is that most of those chemicals that your immune system is using to— for all of this discussion in your body are pro-inflammatory. And so, as is evidenced in things like acute and chronic COVID problems, the infection may not be doing anything anymore, but the inflammatory aspect may be giving you neurological problems. You have chronic headaches, you could have loss of taste or smell, you could have fuzzy vision, you have all sorts of other things. Now, with any of these things, if they're going on long term, you do need to see your healthcare provider to make sure there's not some other bad reason for them going on, but they're very common in the post-infectious patient. So what happens then is you get this, this rush of inflammatory chemistry, and then there's some anti-inflammatory chemistry, but it can have some bystander problems where the inflammation will lead to the supportive membranes that keep your brain chemistry kind of nice and tidy, as tidy as it can be. Those supportive membranes can become inflamed as well. Then they become leaky, and then they're not balanced very well. They don't work very well. And what that will lead to a lot of times then is chronic dysfunction that goes on. And like I say, that could be chronic fatigue, it could be sleep disturbances, it could be anxiety or depression, it could be any number of neurological, neuro-emotional sort of things. Also, as I said, pain syndromes like headaches or central pain where your whole body just doesn't feel well, sometimes hormonal feedback problems, etc. Just many, many things that can be triggered through this inflammation. And so then when you develop this inflammation in your brain, it leads to physical problems downstream somewhere. And what I would always tell students is wherever the problem is in your brain will show up in your body with whatever that part of your brain is in charge of or responsible for. So if you have a problem in the motor function area, you're going to have a physical, you know, motor movement issue. If you have a problem in the sensory apparatus, you might have a change in or a loss of a sense. So this is like with post-COVID, with loss of smell or taste or, you know, things of that nature. But it can also be things like numbness and tingling and other, you know, unusual symptoms that go on. If it's more of a global area or more of one of the master control areas that gets kind of inflamed, You can, like I say, have centrally mediated either hypersomnia where you're sleeping a lot or insomnia where you're not sleeping much or at all. Or like we said, anxiety, depression, et cetera, et cetera. Or even a centralized pain syndrome where your body just hurts or you just don't feel well. And it's coming not really from your body, but from your brain's processing of what your body is doing. Now, when it comes to the world of what do we do about this, because none of this sounds very good, like nothing we've talked about in the Why Can't I Get Better series sounds like any positive or any fun at all, and it's really not. The first thing with neurological inflammation and injury is realizing that it's pretty much most of the people. who have a chronic ongoing illness will have some or a large degree of this. That's a big deal. The next thing to keep in mind is that it's getting a little easier to test for this, but it's still pretty hard to test for it. And so a lot of the determination that you're having these sort of problems is going to be more of a clinical determination. By a healthcare provider who works with chronically ill patients, works with people with complex problems. As I said, there are some tests that are getting better at identifying these things, and that's great. But if you've had, you know, whether you remember what the inciting event was or not, you've had a big enough problem where now you're chronically ill, there is a component that is neurological inflammation that you have going on. So the first thing really is recognizing it. The next thing is recognizing that in medicine, we're really good in the brain at finding things like strokes and tumors and abnormal anatomy and other things like that that go on. And, uh, and we can look at some inflammatory signs, etc., when it comes to the, the imaging and things. But with these sort of microscopic problems, we really don't see those things very well. They don't come up. So you might even have to a specialist and they saw a neurologist and they said, well, you know, neurologically your body is intact. Yes, you may have some sensory damage or something we can pick up on the exam, but your images of your brain look totally normal. And that's good. You don't want your brain to not look normal, but you need to remember that a normal-looking brain on a scan doesn't tell you a whole lot or anything really about about the cellular activity that's going on in most cases. So things to do would be, number one, you want to get screened by either your primary care or they might refer you to a neurologist or a specialist just to make sure that you didn't have something, you know, that's organic in nature that went wrong. So there's not an anatomical problem or a vascular problem or, you know, a mini stroke or any clotting that shouldn't be there or, you know, tumors, et cetera, et cetera. So that's why they're looking for those things. And really, if you have chronic, you know, neurological symptoms, you really do need to get screened for those things because you don't want to be going treating it as sort of this nebulous chronic illness and then turns out you have some other problem. The next thing though is after you rule in or rule out that it's, you know, a different problem, Then you want to think about, well, what would help with my brain and my inflammatory system working? And so there's a number of things. And again, I'm just going to say what we do with patients a lot of times, and it's very clinically determined. So none of this is medical advice. Again, don't take medical advice from people on the radio or TV or podcasts. That's not real smart. You want to use the information to round out your information and talk to your healthcare providers or find healthcare providers who work with chronic illness and talk to them about it. But things that we have done and seem to be helpful— one is, uh, something I bring up with a lot of these areas, and that's hyperbaric oxygen therapy. It's used a lot for brain injuries and other neurological problems, and the mechanisms by which it works are numerous and complex. complex, et cetera. But that is a possibility. And a lot of times, especially early on in a case, it's really useful to add hyperbaric oxygen therapy in. Now, not everyone can do that. Not everyone has it available, but I like to talk about it and say it. The next thing is the things that I mentioned in the mitochondrial section are actually very good for your brain as well. And so those are things like coenzyme Q10, alpha- lipoic acid, basic vitamins and minerals for repair, amino acids that you should be getting from protein you're eating, but sometimes we give those separately. Then there's a lot of plants that are very good for helping the brain inflammation. There's an Ayurvedic herb called Boswellia from the Boswellia serrata plant. and boswellic acid is in boswellia, very helpful for brain inflammation. Curcumin, one we hear about a lot. Then there's other fats that can be helpful for some people, like omega-3 fats or phospholipids, et cetera. And all of those are things that really you should work with somebody on. There's an over-the-counter supplement that we use with most of our neurological cases. And like I said, it's not a prescription, it's over-the-counter. Again, run it by your healthcare provider. provider if you want to use it, but it's called Cover-3, and it's all in one little gel packet that you take, usually 1 or 2 packets a day for a little bit, and then you taper that off or taper it down. We'll put a link in for that. I don't have any connection to any of these things I'm talking about financially. I'm just sharing what we do with people, but they're all worth looking into. And the next thing is, if you're working with healthcare provider who doesn't do chronic or long-term illness. Sometimes, just like if you had a heart problem, you get a cardiologist, you might want to work and find a specialist who works with chronic illness, chronic problems.