04: Graves and Hyperthyroidism Uncovered!

Welcome to Modern Thyroid and Wellness, the podcast that explores the intricate dance between health, wellness and thyroid, unraveling the threads that weave our vitality together. I'm your host, McCall McPherson, and I'm so thrilled to guide you on this journey to optimal wellness. We are digging in deep today on the topics of Graves and hyperthyroidism and I am so excited to talk about about these topics because you all are honestly kind of left in the dark. There is not a lot of content about hyperthyroidism, about Graves disease. The Internet is flooded with information about Hashimoto's and hypothyroidism, and of course that is the more common of these entities. But Graves is extremely confusing to navigate and so I'm excited to shed light on it. If you struggle with Graves, I'm so glad you're here. If you know someone, if you have a friend, a colleague, etc, who might struggle with Graves, please share this with them. Honestly, it could change lives. Let's start with the basics, right? Let's start by discussing what is Graves disease? What is hyperthyroidism? And I really want you to think about these two things separately. Hyperthyroidism is extra potent, extra intense thyroid function, meaning people are walking around with excess thyroid hormones in the form of free T4, free T3, and even often reverse T3. This creates symptoms that are the opposite of hypothyroidism in a lot of cases. So a lot of times people will feel anxious, agitated, sweating, heart palpitations, heart racing, hot, cannot control body temperature, have a really difficult time exercising because their heart rate skyrockets, hair loss, weight loss, diarrhea, and you know, when people get to a certain degree of hyperthyroidism, symptoms can begin to mimic hypo because their body starts working in overtime to help them excrete and get rid of these excess hormones. So sometimes they end up looking very similarly to a hypothyroid patient when in fact they're hyper. How do we know if you're hyperthyroid? We check your labs. So it is so incredibly important, and you guys hear me say this to people with hypothyroidism, but it is incredibly important that you are checking a full thyroid panel. You are not simply diagnosing someone or getting diagnosed with Graves disease by way of a TSH or hyperthyroidism by way of a tsh, because that is wildly invalid. People's TSH can be zero and they can have normal thyroid function even in the absence of even with hypothyroidism. People's TSH can be zero. We have to know what your output hormones are. I personally begin to get concerned about hyperthyroid when I see a T4 above 2.0. My optimal range is.09 to 1.2. That is quite a wide range. But once people get above 2, I'm like, H, something's going on here. A TSH, you know, really above 6. But anything over, you know, 4.9 should be screened for graves if they're not medicated with a thyroid problem, if they're walking around in their T3 or free. T3 is close to 5 without medication on board. Again, I'd be checking people for hyperthyroidism. Graves, on the other hand, is an autoimmune disease where your body attacks your thyroid gland. It gets confused and it looks looks at your thyroid gland as a foreign invader. And instead of triggering an autoimmune condition that leaves you with hypothyroidism like Hashimoto's, Graves disease leaves you with hyperthyroidism or overabundance of thyroid hormones. There are some unique things about GRAVES that we are going to dive into on this podcast that you literally will not hear anywhere else. Our approach to Graves disease also at Modern Thyroid Clinic is honestly, I know no one in the country that does it in the same manner as we do. I know one other person in the country that remotely treats like us. So this is not information you're going to find in a lot of other places, but it is very valuable and it is potentially life changing for someone with graves. We measure GRAVES antibodies by way of two antibodies. One is called thyroid stimulating immunoglobulins and the other is called thyrotropin receptor antibodies or tab. TSI is thyroid stimulating immunoglobulin. So you can see it abbreviated that way as well. If these are positive, you have Graves disease. Some people have hyperthy thyroidism in the absence of graves and a lot of times that is rooted in a nodule that is overproducing thyroid hormones. We're not going to dig into that today. I want to keep it focused, but I did at least want to put that in there. Now, I want to describe something pretty unique about Graves disease that is very different than Hashimoto's. So with GRAVES and hyperthyroidism, the severity of someone's hyperthyroidism or overproduction of thyroid hormones can be directly correlated to the severity of their GRAVES antibodies. Okay. Meaning if someone's GRAVES antibodies are through the roof, they are strapped into what I describe as a GRAVES roller. Coaster. And what that looks like is when someone's GRAVES antibodies are so high, when their thyroid function is swinging wildly, really, really high, low, those swings are very frequent, very, very severe. Right. What's interesting and the opportunity that this creates is we can then begin to influence directly people's thyroid function of overproduction of thyroid hormones, again yielding all those anxious, stimulated, hair loss, sweating, all of those symptoms, heart racing by lowering their antibodies. And medicine will not tell you this, the lower you can get someone's GRAVES antibodies, the less frequent and the less severe the swings of their thyroid function actually are, which is incredibly powerful. So truthfully, if we compare kind of conventional treatment with functional medicine or, I mean, this is not available at most functional medicine people's offices. Let me clarify, like, you're not. Don't just find a functional medicine practitioner and expect to go there and get this kind of treatment, because even in that realm, I don't know another clinician that does what, what we do. It's very nuanced. But if we want to compare conventional to, you know, modern thyroid methods approach to GRAVES disease, conventional treatment is the following. You go in with graves, they check your thyroid function. Sometimes I even have people say, they tell me I'm hyperthyroid, but they're not sure if I have graves. I'm like, well, why would they not be sure if you don't have graves, why don't they just check your antibodies to definitively find out not? Doesn't always happen, sadly, but it should. And their options are start on a thyroid blocker like methimazole or ptu, and try to reduce someone's thyroid function to the degree that they're left feeling hypothyroid. I assume a lot of hypothyroid people aren't listening right now, but hypothyroidism is miserable too. Like, neither are fun, but medicine is perfectly fine as long as they can get someone out of a grave state, shoving them into being hypothyroid and allowing them to be fatigued, overweight, foggy, depressed, no libido, hair loss for the rest of their life. They don't care. They just don't want you to be hypocrisy. Bur thyroid, okay? They don't want your too much thyroid hormones happening in your body. So that's usually the start. And then pretty quickly the conversation then goes to, well, we should probably just take out your thyroid, right? Let's remove it. You won't have to deal with this anymore. So often they dangle a carrot of oh, my gosh. You're just going to feel so much better if we just take out your thyroid. Which is quite possibly the biggest lie I hear in the thyroid community, because life without a thyroid is miserable. And so are there cases of Graves disease that require a thyroidectomy for treatment? Yes. I've had one patient need to do that out of a lot of Graves patients that did not need to do that. So does it happen? Yes. Is it common? No. Should it be the first kind of trial after failing a little bit of methomazole? In my opinion, absolutely not. There are many ways to get people into safe and functioning levels with Graves disease that do not involve removing their thyroid gland. Okay, so that is conventional treatment. Right. They basically want to kill off your thyroid gland to leave you hypothyroid, and then they'll shove you on some Levothyroxine or Synthroid and say, bye, you know, see you in a year. If the surgeon ever sees you again. It depends on who. Who does your thyroidectomy, and that leads to lifelong misery and suffering. So let's talk about options that we can do before we look at surgically removing your thyroid. And there is so much hope for these people. There is so much hope for you. If you have graves, if you have hyperthyroidism, there are better and more progressive ways to allow you to not be hyper, but also have a life that you can enjoy and thrive in. Functional medicines approach, and I shouldn't say that I should really say modern thyroid clinics approach. Our approach is a bit multifaceted. Number one is we actively try to reduce your Graves antibodies. That does not happen in conventional medicine. They view Graves and Hashimoto's as the reverse lottery. You have this thing, it's totally random. There's nothing you can do about it. So we just need to treat you over here with this medication or remove your thyroid. And those are your only options. Not the case. You can absolutely reduce GRAVES antibodies and put people into remission. I have put someone with Graves into remission in six months, and they have never gone back into a grave state. And. And that was back in 2015. So that was nine years ago. It is extremely possible. Even if we do not get you into remission, the lower we get your antibodies for Graves disease, the less severe your hyperthyroidism will be. So one of the very first things we do at Modern Thyroid Clinic is we establish what can we do to reverse GRAVES antibodies. A common one we'll do pretty quickly is food inflammatory testing. If they seem to have some Reactions to foods, in part to get that information, hey, what foods could be contributing to this autoimmune disease burden? Because our viewpoint and the reality is this medicine's viewpoint is going to have to update at some degree. Autoimmune diseases are driven by inflammation. If we can reduce inflammation, we can reduce the severity of autoimmune diseases and even get them into remission. I personally am in remission from my autoimmune thyroid condition. Hashimoto's. I have been for over a decade and this is the story for so many of our patients. Additionally, something that I use in every single Graves patient that I see is low dose naltrexone or ldn. Okay. LDN is an extremely powerful way to reduce antibodies in people with Graves disease extremely quickly. And I'll go into, hey, what is LDN like? How does it work? I don't want to spend too much time on this, but I do want to give you guys an idea. So LDN is what's called low dose naltrexone. Naltrexone, conventionally used in medicine at higher doses, not quote, low dose, is an opioid antagonist or an opioid blocker. It blocks pain medicine in cases of addiction or overdose, that kind of thing. That starts at about 50 milligrams and it goes up very quickly to much higher doses. Low dose naltrexone is slowly increased up and the final dose is usually 4.5 milligrams. When it is used in this small, conservative dose, it does something completely differently than the higher doses do. It blocks a little bit of our natural endogenous opioids that we produce ourselves. We have opioids in our body. That's what pain medicine activates, our opioids receptors, our opioid receptors. Rather, we block a little bit of those receptors with L, D, N and that actually communicates to our body, oh gosh, we are in a deficit of opioids and we need to increase our production. And it ends up leaving us in a state of excess opioids as opposed to depleted levels of opioids. What's really cool about that is when you're walking around with extra opioids, it lowers inflammation of any kind, which in turn lowers the burden for autoimmunity. LDN also has a ton of other health benefits. I don't have an autoimmune disease anymore. I'm on ldn. I will be on LDN until the day that I die. It can help to prune off weak cancer cells. It improves immune Function, which is a very important differentiating factor. Historically in medicine, to reduce inflammation, we have used immunosuppressants like steroids, things that reduce your immunity levels. LDN works by improving your immune system while simultaneously reducing inflammation, which makes it very unique. It is extremely well tolerated. It is, in my opinion, extremely price efficient. It's about 100 to $120 every three months. And considering all the benefits people get from this medication, that's powerful very, very quickly. Even more pronounced in GRAVES than I see in Hashimoto's. Does this medication reduce antibodies? That is why I use it literally with a hundred percent of my GRAVES patients. And what that translates to, that I really, really want to convey during this process, is if your antibodies drop 40%, 50%, that is a 50% reduction in the severity of your actual hyperthyroidism. It's not just a number on a paper. The frequency and severity of your flares, your high hormones, your heart rate, all of it will drop 50%, which is huge. That that equals. Also, you get to reduce your methomazole. If you're on methomazole for treating your hyperthyroidism, definitely you get to reduce that because you are no longer as hyperthyroid, which is so incredibly empowering and powerful. LDN can also lower antibodies that can promote and contribute to thyroid eye disease, or ted, which is really a debilitating symptom with this because it changes the physical appearance of people, which can be devastating. You know, I mean, it really, truly can. And slowing that process, slowing that attack on that orbital rim of autoimmunity can be a really, really big deal. So that is kind of, you know, some other things that you can do. Red light therapy is a very powerful way. Studies have shown, specifically, even in graves, not just in Hashimoto's, that red light therapy can reduce GRAVES antibodies over time. I recommend my pat do 10 minutes once or twice a day with red light therapy. And I'll absolutely drop some red lights in the show notes for you. That is one that I go to very, very commonly. And then the other kind of big topic that I wanted to dig into is something called block and replace therapy. Okay, before, before I do that, let me back up one moment and just say a couple other things. Okay? In some people with graves, they also show positive for Hashimoto's antibodies. Okay, so GRAVES is hyperthyroidism antibodies. Hashimoto's is antibodies that usually lead to hypothyroidism. But I find in about 30% of my graves patients, they have both. And what is really fascinating about this is a lot of these people were with both antibodies. If they do not have their thyroid removed over time, I find that their Graves disease antibodies drop and their Hashimoto antibodies are the only thing remaining, and they end up in a Hashimoto hypothyroid state. They're grave spades, and they're left with plain old hypothyroidism and Hashimoto. And I know that sounds like a bummer, but let me tell you guys, anyone with Graves would happily take hypothyroidism and Hashimoto because we can simply replace thyroid hormones at that point. And I know that that's not always the case. Like, a lot of people with hypothyroidism are miserable because they don't have clinicians to adequately treat their hypothyroidism. But if they found the right clinician, they could really, truly get their lives back. And it wouldn't be a question, right? Graves people do not really have that opportunity. There's not stability, ability to build off of. The problem with GRAVES are the swings, what I describe as the Graves roller coaster. Sometimes you're really high, sometimes you're really low. It can change any day, any week, any month, any year. So the fact that these people have both antibodies and anyone with Graves disease should also be checked for Hashimoto's antibodies. And those are both TPO thyroid peroxidase antibodies and thyroglobulin antibodies. If. If you have both sets of GRAVES and Hashi antibodies, gosh, for me, personally, that's a really good reason not to get my thyroid removed. Because I am very hopeful that my Graves is going to fade over time and settle into simple Hashimoto. And there is no way I want anyone to take my thyroid gland out if I'm going to be left with plain old Hashimoto. Let's talk about the second. You know, we touched on the idea of a thyroidectomy in conventional medicine, right? Like that is they rush to that conclusion. So. So very quickly. And I would not be planning my own thyroidectomy if I had Hashimoto's or if I could fix my Graves disease, reduce antibodies with things like ldn, et cetera, and tertiarily to that. If I could get control of my thyroid gland using something called block and replace therapy, I would not be letting anyone take my thyroid out. So the problem, the problem in the trouble with Graves is you're hyper, you have too much thyroid hormones. It's not good for your heart. It's not good for your physiology. So again, they take you and they shove you into being hypothyroid by putting you on a ton of methomazole because all the doctor or clinician cares about is getting you out of graves because it's dangerous, right? They don't care if you suffer your whole life with hypothyroid symptoms. There is a middle ground here that no one really talks about. And step one is certainly reducing antibodies to reduce the swings of the GRAVES rollercoaster. But step two is to build on that. And it is what we do at modern Thyroid clinic, which is to put people on just enough GRAVES medication, PTU or methimazole, make them slightly hypothyroid. And the power in that is we have you just below the optimal range. But what we've done done is we've created stability. We have removed you from the GRAVES roller coaster, and we leave you in just kind of this barely hypothyroid state, which isn't fun, it's not comfortable. But then the good stuff comes. So when we have stability and control over your thyroid gland, we do not leave you in a hypothyroid state. At that point, we take thyroid medication that we use with hypothyroid people, and we put you on just enough to make you you thyroid, which means perfect thyroid function. You're not hyper, you're not hypo. You are just smack dab in the middle. And that allows people with Graves to not live a life filled with anxiety and heart racing and inability to exercise. But it also allows them to live a life where they are not suffering with debilitating fatigue and brain fog and waking their whole lives. Right? It creates an answer and a solution where people with Graves disease can actually have a high quality of life, which is powerful. Again, that is called block and replace therapy. Okay, There. I only know of one other person in the country that does it, so it's hard to find, but. But it is possible. Obviously. Modern Thyroid clinic is expanding nationwide. So, you know, we'll eventually be in every state. We're already In, I think 16, 18, 20 states somewhere around there. And we're adding new ones every week or two. But the biggest message with this is I want you guys to know that there is hope, there is an opportunity for healing, and there is an opportunity for you to live a life of vitality and not suffering. And I also want you to know that your only solution is not a thyroidectomy. Okay? If you are listening to this and you are post thyroidectomy from Graves disease. If someone has already taken your thyroid gland and made you think that that was the option, dangled the carrot, that life is going to be so much easier, everything's going to be so much better if we just take this out. I'm sorry, first of all, because I am pretty darn sure you are suffering tremendously. But I did want to create a little part of this episode for you. Okay, so couple tips and tricks. For those of you post thyroidectomy, you still need to be checking your antibodies for both Graves and Hashimoto's. 30 to 35% of my patients who do not have a thyroid gland still have antibodies. And you need to know that because when you have antibodies, it puts you at an increased risk for developing other autoimmune diseases. You can also use it as an indication of your level of inflammation. Okay? So if your antibodies are dropping, things are going well, your risk for other autoimmune diseases is reducing. Additionally, I think it's very, very important for those of you who are post thyroidectomy to have the same tools and skill set that I preach to people who are hypothyroid. Because now, by definition, you are hypothyroid. You are no longer hyperthyroid. You don't have a thyroid gland to produce or overprotect produce these hormones. So it is imperative that you get full thyroid panels. Okay. You can find links to our full panel and what lab ranges we even use at modern Thyroid clinic to treat our patients in the show notes. So I, I provide you guys with all of that information. Truly, I give so much of our proprietary information out so that you guys can successfully navigate your care to the degree that you can have your life back. In addition to getting a full thyroid panel and looking at optimal ranges, not normal ranges, that the lab says is okay, because we all know you can be debilitated and be in normal lab ranges. I certainly was. You also need to know that if you are having persistent symptoms on medications like levothyroxine, Synthroid, T resent, et cetera, you need to have a conversation with your clinician about potentially layering in some active thyroid hormone, for example, adding cytomel or leothyrene to levothyroxine or Synthroid, that is usually the best bet for people post thyroidectomy because most people are on T4 based medications already. Inactive hormone like levosynthroid, et cetera. So the easiest way for you to get access to T3 when you're on a T4 is to just add T3 medication to your current regimen. Changing someone post thyroidectomy from levothyroxine Synthroid to a medication like Armor and NP at the that is extremely difficult and I don't think 99.9999% of providers are equipped to do that in a way that is not going to create massive dysfunction and misery in your life. So in our practice we simply add Cytomel to T4. If you're starting from scratch, you could certainly consider starting with an ARMOR sort of desiccated thyroid medication. But again, you are putting a lot of faith in your clinician to adequately prescribe that in a way that is going to support your physiology. And most clinicians are not trained how to appropriately do that and they undermedicate people because they're afraid of those medications and they don't know how to use them. And that is not what I want for you. So you can maintain all of that stability with Levothyroxine or Synthroid and Simply adjunctively add T3. The last piece of advice I want to give people post thyroidectomy is I need you to understand something that I've discovered along the way in my path in thyroid specific medicine and that is the longer it takes someone to get adequate care post thyroidectomy, the harder it is for me to give them back their life. And that is not the case in any other situation. It doesn't matter if someone with hypothyroidism sees me in year one or year 50 after they have a thyroid problem, I can just as easily give them back their lives. Something changes in people post thyroidectomy that cannot be accounted for in lab data. And the longer it takes for them to get adequate thyroid hormones into their body, the harder it is for them to get their lives back. So the clock is ticking and you need to quickly find someone who can help you truly with these issues and not just unendingly increase and decrease your levothyroxine or synthrate dose. Okay? It is vitally important. I hope that this conversation was offered a lot of clarity, a lot of insight. I want you guys to have a bit of a deeper understanding for this because I do think there is not a lot of opportunities to gain that knowledge elsewhere. So if you want more information or if you have more questions on this, please tune into my social I often do ask me anythings on Instagram. You can find me there at McCall McPhersonpa and I'm happy to answer more questions but I am sending you all the thyroid love and remember there is no reason to still have thyroid symptoms.