02: Is Your Thyroid Really the Problem? Understanding Misdiagnosis in Thyroid Disorders

And when it comes to making decisions about adjusting patients medications based on tsh, I describe it like throwing darts at a dartboard blindfolded, hoping to hit a bullseye. Today is an exciting day because we start truly digging into the information. I am so excited to share with you all on this podcast and this platform. I figured to start our conversation, we would talk about why in the world your doctor is telling you that your problem is not your thyroid when all of your symptoms are thyroid. I want to dissect this and I want to dig in deep today. We'll continue to unravel this topic, but I want this to be a big umbrella that we can establish good, solid information on from the start. So. So if you're not familiar with who I am, I'm a pa, I'm a physician assistant, and I'm the founder of Modern Thyroid Clinic in Austin, Texas. My day job is to give people back their lives with complex thyroid disorders after they've been repeatedly told, A, their thyroid is not their problem or B, their numbers, their medication, everything's just fine, your symptoms are from something else. So let's talk about why this is happening. We're going to start this conversation looking at the conventional approach to thyroid conditions. Why is medicine failing men and women, but so largely women in the thyroid sector. And it really boils down to a few key things that must evolve. Number one, in medicine, we are trained to to simply check a patient's tsh, to diagnose them with a thyroid condition, or to know if their medication needs to be adjusted. That is not enough. You have to in fact, check a full thyroid panel. Why? For several reasons. Number one, your TSH is a hormone that comes from your brain. It tells us how hard your brain is asking your thyroid to work. It doesn't directly tell us about your thyroid output hormones. I am going to share my screen with you guys so that if you happen to be tuning in on YouTube, you can understand what I'm talking about. So your TSH is simply a mechanism that tells me that I utilize to gauge how much energy is going in to produce this patient's thyroid hormones. What is the energy in versus the energy out? We can't gauge someone's output of energy simply by how much they are using to produce it. Right? Your TSH stimulates your thyroid and then your thyroid actually secretes your first thyroid hormone, which is free T4. If you're lucky, maybe your doctor will also check free T4. So your thyroid secretes this hormone called free T4. This is actually an inactive hormone. And this is important, and we're going to circle back to this because this is largely what our thyroid medications are made from that we offer patients today. T4 is what I give an analogy of crude oil for. So we don't put crude oil in our car to make it run, but we do actually need it to make gasoline to put in our car to make it run. If we cannot convert that crude oil to gasoline, we're not really going anywhere in our car. Right. So your thyroid produces T4. It's inactive. We are dependent on that hormone being activated elsewhere and converting into free T3. Your whole entire thyroid function and symptoms rely on your ability to produce enough T3 and to absorb it. Okay. Something later can come into play where you're not actually even able to absorb your T3. It's called reverse T3. This is an inhibitory hormone. So your body is supposed to be on what's called a feedback loop. You are supposed to send a message back to your brain. Adjust your TSH based on your output hormones. And that is the reason why regular medicine continues to use TSH as a marker for your thyroid function. But the reality is this a even when people are not on medication, research shows about 35ish percent of the time there is a disconnect between someone's output hormones and their TSH when medication is introduced specifically. Even more so in cases of Synthroid, levothyroxine, tyrosine, unithroid, levoxal, T4 based medications. This feedback mechanism is no longer intact and is completely unreliable. And we'll dig into why that is over time. But in a world where we are only checking tsh, it's almost useless to diagnose thyroid conditions. And when it comes to making decisions about adjusting patients medications based on tsh, I describe it like throwing darts at a dartboard blindfolded, hoping to hit a bullseye. If you do, you might want to go ahead and buy a lottery ticket because, hey, you happen to be pretty lucky. But the chances that you are, as a consumer of your healthcare, as a patient, that you are going to get your life back with your doctor, adjusting your levothyroxine based on your TSH is, you know, 1%, in my opinion. So go buy a lottery ticket if that's you. But I assume if you're listening to this, it probably isn't you. So first barrier to getting real care in the thyroid world is getting a full thyroid panel. I put together a thyroid lab guide. I'll put it in the show notes you can always find it at gift.modernthyroidclinic.com but it tells you what labs you need and what they mean. So it talks about ranges, it talks about labs, the whole gamut. So find it there. But again, you need a full thyroid panel. So. So step number one is that if your doctor won't order it, guess what? You can order your own thyroid lab panel in a lot of states. I've got links to this all over my social. I freely share it. The second barrier in traditional medicine to getting adequate thyroid care and getting your life back with hypothyroidism is lab ranges. Okay? And this is a hugely important topic, y'. All. Like, I can't state it enough. There is no set range to determine if you are hypo or hyper or you thyroid or hyper. There's no set standardized range to diagnose or treat thyroid conditions. Doctors literally base their decisions on whatever the lab says is normal. So they hold up your lab sheet, they look at it, and they see if anything's in bold or off to the side. That is determined by what the lab that you went to says is normal. What does that mean? It means there is variances between labs, for example, Quest and LabCorp, and even between locations of each lab. For example, Quest by my office's normal ranges are different than Quest. That's close to my house. What does that look like as a patient? That looks like patient A can walk into a doctor's office, hand them their thyroid labs, and be told that their TSH, for example, of 4.8 is normal and that they do not need thyroid treatment. They leave, they go on with their life, and they think, gosh, all my symptoms of thyroid conditions like fatigue and brain fog and weight gain and low libido and etc. They must not be due to my thyroid. Gosh. And then they go and they suffer for years needlessly. Patient B, also with the same exact lab number, also with the TSH of 4.8, but they went to a different lab, and that lab happens to flag that TSH as abnormal, goes in, sits down with the same doctor, and the doctor says, well, gosh, I guess we know why you have all these symptoms of fatigue and brain fog and weight gain at all. It's because you have hypothyroidism. Let's start treatment. Meanwhile, they actually have the same exact lab reading. We are relying on elementary, quick protocol scanning labs to make these enormous medical decisions that impact patients lives in an enormous way. Patients, lives, families, marriages, generations, right? And we are not putting a lot of thought and consideration into this. So there is no standardized range. That's a big issue with lab ranges. Right. We are looking at normal and not optimal. These lab ranges are not based on healthy people that feel good. These lab ranges are largely based on people going to the lab. And it's an average of those people who is going to LabCorp to have their labs drawn. Well, it's not people who are like, wow, I woke up today and I just, I feel so great. I wonder what my thyroid labs look like. I think I'm gonna go get them checked. No, these people are looking for answers as to why they don't feel well. The majority of people going to labs are not going feeling great. They're going because of an issue. So now we are basing lab ranges on people who aren't well. We're basing these lab ranges on people who have the condition we are trying to rule out. Meaning when LabCorp establishes these baselines, they are not excluding people with hypothyroidism in them. Sure, they're taking out the extremes on either side. But because of that, again, we are ending up with ranges that are incredibly wide to establish where people should be. And within those ranges, people can continue to have massive symptoms and be honestly debilitated with them. I am the perfect example of that. Like I shared in my last episode, I was 27, very much within normal lab ranges. Was repeatedly told my symptoms were not due to a thyroid condition. I was literally going to bed at 3:30 in the afternoon, and the rest of my entire life looks very dark and dismal. If this is what it would be. I've shared so many times with my patients, if I had not been able to find someone to actually help me, I truly believe I'd be on disability right now. So those ranges that you can be in are wide enough, your life can be ruined and still be, quote, normal. Okay, we need to start dealing with optimal. And I will dig in deep about what that looks like at modern thyroid clinic at some point. But y', all, it is very, very specific. But truly, if you can get people into those very narrow margins, they get their lives back, their symptoms go away, and it's profoundly life changing. I want to tell you too what's happened in the landscape of medicine over the last few years that is moving the needle forward farther from where people need to be to get help to get support for their thyroid condition. And it's really, in my opinion, put us back decades as far as access to appropriate thyroid Care. And that was a study that came out a few years ago that determined people were not getting better with thyroid treatment unless their TSH was above 10. What does that mean? A TSH above 10 is, you know, someone who is a non functioning human who for 10, 15, 20 years has been barely able to function in life and work. If they have even been. I mean, I would say if my TSH was 10, I would absolutely be on disability. I would be in bed all day, every day. So. But the study determined, hey, if you treat people with a TSH less than 10 with thyroid medication, they don't get well. So we need to stop treating people with a TSH of 10. And a lot of clinicians have bought into this study. And do you know what the problem is with it? The problem is not that in fact, these people didn't need thyroid medication because they're not getting well because their thyroid problem wasn't so severe that they needed it. The problem is that the medication that they used to conduct the study does not work an enormous portion of the time. And you know what's the saddest part about that? It is the number one prescribed medication in the country. It is the mainstay and essentially the only real option given to people for their thyroid condition. And so instead of looking at that study and analyzing it from an actual forward thinking approach and saying, you know what, these people aren't getting well on this medication. Do we need to look at other options? Maybe everyone in the world doesn't respond to one type of thyroid medication. Of course. Right? No, they didn't do that. They said, we just are going to assume that this medication, this option we're offering people works great. They just don't need it unless their TSH is over 10, which is absolutely mind blowing. And so many clinicians have bought into this and now this is their standard of care for their practice of medicine, which is going to put millions of people into diabetes, high cholesterol, heart disease, depression, divorce, loss of employment. You just can't function at a TSH at that level. And it is such a shame because I think for a few years we were headed in the direction where things maybe were getting a little better. We were looking at other medication options. The margins were getting a little more narrow. And the study came out, y', all, and it shifted everything and it pushed us back so much. So it is so incredibly important that you are an informed and empowered consumer of your healthcare in general, but especially in the realm of thyroid, because hypothyroidism is an extremely common issue, especially among women. And it is exceedingly difficult to get proper care and diagnostic measures and treatment for it. So, you know, it's my goal in my lifetime that I can cut down the amount of time that people need to suffer before they realize there's a better and other way that they're not doomed for a lifetime of feeling the way that they feel. So big, big piece of this you guys, is labs, types of labs, getting a full lab panel and optimal ranges. I share all of this information with you all freely so that you can drive your care. You cannot put your thyroid care in the hands of your doctor. So again, if you want my thyroid lab guide gift modern thyroid clinic.com, it is free. It is. I share everything that I use treat people at Modern Thyroid Clinic so that you can have access to that information. The last big piece of this is medication. Okay, we're not going to do a super, super deep dive in this today, but I want you to have some basic knowledge about types of medication and why you might still have symptoms even though you're on medication. And again, this was me, this was my journey and this is so many of my patients journey. In medicine, we are trained as clinicians to use one class of thyroid medication. Our training is literally verbatim. Do not use medications with T3 in them or active thyroid medications. Only use medications with T4 in them. These are drugs like levothyroxine, Synthroid, loboxyl, tyrosin, Unithride. If you use T3 based medication with your patients, you are going to give them a heart attack or a stroke. So there's a couple dynamics at play here. Number one, we are trained to be very afraid of these medications. We are trained that if we use them, they will hurt people. And two, we are not trained how to use them. So the barriers to entry of getting access to any, any type of thyroid medication, with the exception of the one size fits all approach, it's impossible. Right? And the issue with that is the following is again, if you remember back to the diagram that I showed you before and I will, I'll show you again. For those of you who are tuned in visually, T4 is your inactive hormone. We are giving people only inactive thyroid hormone. That is people's only option. If. And this is your crude oil hormone, right? If you cannot convert crude oil to gasoline, you are out of luck. You've got a lot of crude oil in your garage, but your gas tank is on empty and you're not going anywhere in your car and your body Needs gasoline hormone to function. You need to get to T3. And the incidence of having issues with this one is not even ever talked about. And formal medical training not even addressed, not even spoken about as an option or a barrier to people feeling better. It is simply a one size fits all. Everyone gets levothyroxine based medication. So if you are what I call a poor converter, you can't take that levothyroxine and activate it, convert it, make it usable, make it into T3, you will never get your life back. I can give someone all the crude oil in the world, but if they cannot convert it to gasoline, they are not going anywhere in their car. And that is what we are doing to millions of women in our country and the world. We are only giving these people crude oil and it is not usable for their physiology. They will never ever feel good again. Doesn't matter their dose of levothyroxine or if they get put on Synthroid instead because it's brand name. No, it will never work. Okay, so. And it's such a problem, I can tell you that 100% of my patients at modern thyroid clinic are on some form of active thyroid hormone. I have zero patients out of thousands and thousands of people who are on only T4. So it is an enormous issue and burden on our healthcare because without enough T3, you end up with diabetes, you end up with high cholesterol, you end up with heart disease, you end up with fatigue, you end up with chronic fatigue syndrome and fibromyalgia. And you know, all of these things that plague people's lives where they can't function. And medicine is completely not accounting for these people. They are repeatedly looking at them in the face and telling them that their issue is not their thyroid. They are telling them that based on their tsh, that based on that horrible lab range, that based on their TSH and their T4 because their T4 is the medicine they're taking and not using, that their thyroid labs look fine and that their symptoms are completely unrelated and that they need to go home and diet and exercise and you will never diet and exercise your way out of a true thyroid disorder. So what does all of this mean? It means that our medical system has not evolved to a place where patients can put their trust for their care into the hands of their provider. Even functional medicine providers are wildly, inadequately trained in the world of thyroid. Are they more progressive? Yes. Are they more open minded? Yes. But do they understand the nuances and how complicated it is to adequately and safely and effectively treat someone with a thyroid condition. They do not. They do not. So you, my friend, you are in the driver's seat of your health, wellness, thyroid, especially even all of my patients. I tell them, look, I, I want you to be an expert, an informed consumer for your health so that you can make decisions with me together now, but also long into the future because you cannot entrust those decisions blindly to someone else because you will end up in your sweatpants, exhausted, not able to enjoy your family, your kids, and just miserable in your life. And I don't want that for you because there is so much hope for healing. It takes such a short period of time if you can actually get things properly addressed. It takes such a short period of time for you to get your life back. In fact, most people at Modern Thyroid Clinic get improvement in their first round of treatment. Meanwhile, you guys are out there in the world waiting decades to feel better, just hoping the next round of treatment will get you there when it's days, weeks before people feel better. So my goal together in this journey, in this podcast is I want you to a, reduce the amount of time that you need to needlessly suffer before you get your life back and B, to give you all the tools, all the knowledge, all the strategies that you need so that you can drive your care yourself. So to start today, you can download my thyroid lab guide. I'll also put in the show notes where you can go to get your own labs. If your doctor will not order a full thyroid panel, order your own thyroid labs. You can in almost every state. So do it. You can analyze those labs and compare to my optimal ranges that I use all day, every day at Modern Thyroid Clinic. So you can see what does it take to get my life back. Am I in those ranges or am I outside of them? Do I need to find someone to help me? And I try to put all of that power back into your hands. So thanks for being here today. I hope you tune in to the next episode. We are just getting started and I can't wait to see where we go together.