(Audio Transcript Below)
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Hello, I’m Dr. Biddle and we’re going to talk about the thyroid gland today and problems with the thyroid that are often missed by conventional medical doctors. And to help me out, I have Robyn Paulete, who is our educational outreach coordinator.
And we’re of course talking on the phone because this is done during the COVID-19 stay at home and stay safe orders. So I hope this technically works out okay for y’all listening at home. The first thing I want to do is just introduce the thyroid gland. So the thyroid gland sits right above your chest right at the bottom of your neck, in the front. It moves up and down when you swallow. If it’s enlarged it’s called a goiter, and you may have at some point seen somebody with a goiter there. The thyroid makes a hormone called “thyroid hormone”….. actually, it makes a couple of hormones.
A thyroid hormone is more complicated than just one hormone, which is the the root of our conversation today. Thyroid makes the thyroid hormone called T4 or thyroxin. And what does thyroid hormone do? It keeps you alive! It helps your to create energy at the cellular level. So if you don’t have enough thyroid hormone, or if you don’t make the right types of thyroid hormone, then you’re going to feel a lack of energy. And that shows up throughout the body.
It shows up as fatigue, weight gain, mental dullness, sluggishness, especially in your bowels. A lot of times constipation…if it shows up as swelling and bloating it’s called myxedema. It’s fluid between your tissues and it can even show up as psychosis. When I was in my residency doing my psychiatric rotation on an inpatient, I got to see a young man who had an acute hypothyroidism that was undiagnosed, and he had what’s called myxedema madness, which is a psychosis from a lack of thyroid hormone.
I had one other kind of alternative practitioner take one of my patients off of thyroid hormone and six months later she was in the cardiac intensive care unit with pericardial tamponade, which means she had fluid between the sack around her heart and it was filling up with fluid so her heart couldn’t beat. So you can’t just stop your thyroid hormone treatment if you need it. Everybody needs thyroid hormone. You can’t live without it.
>> I’m curious about how come there are so many undiagnosed thyroid disorders. If this hormone is so important, and it seems like we’re deficient in it, wouldn’t the symptoms be pretty obvious? Tell me more about how there are so many undiagnosed thyroid disorders?
Well, that kind of goes upon what are your diagnostic criteria? I have a medical license in North Carolina and I am very interested in keeping my medical license in North Carolina. I don’t want to lose it. And so everything I do in my practice, I run through a filter in my brain that says, can I defend this in court? Can I defend this scientifically? And if I can’t, then I don’t do it in my practice. And so when I do diagnoses of actual hypothyroidism, I use the conventional criteria, which means you have an elevated TSH. And TSH is the pituitary hormone that we make called Thyroid Stimulating Hormone. And it’s the hormone that goes from your brain and your pituitary to your thyroid gland through the bloodstream and tells your thyroid gland to make thyroid hormone. And if your thyroid gland is sucking wind and not doing well, then your TSH goes up pushing on the gas, telling your thyroid gland to make more thyroid hormone.
Now, if you’re hyper thyroid, then your TSH will be suppressed because it’s a negative feedback loop. It’ll be trying to put on the brakes and say, hey, don’t make so much. So the diagnostic criteria is you’d have a TSH over the lab reference range, which varies from lab to lab. It’s somewhere around 4.5 to 6.2. So that’s the conventional criteria for hypothyroidism. But many, many people have what is often called subclinical hypothyroidism, which means you have symptoms and your symptoms are consistent with thyroid dysfunction. And from our criteria, it looks like your thyroid glands not working. But we can’t really diagnose you hypothyroid because your lab tests aren’t out of range yet.
>> That makes sense. And that seems to happen often. Is that true?
It does happen often. I get people all the time. They say everything I read says that I had the symptoms of hypothyroidism, but my doctor tells me my labs are normal. So how can that happen?
>> Yes. How can that happen?
Well, the first way that can happen is the lab tests aren’t sensitive enough, so they don’t diagnose hypothyroidism until you have a TSH over about five. We want a TSH less than three. So anytime the TSH is greater than three, I’m suspicious that your thyroid gland is sluggish. If you have a goiter or nodules on your thyroid gland, then those are signs that your thyroid gland is missing something that it needs or is poisoned in some way and it’s slipping.
The analogy I would use would be when your transmission in your car starts to go out and you push on the gas. Your engine revs, but nothing happens. The power doesn’t get to the wheels and your transmission slips. And that’s what it feels like with your metabolism when your thyroid gland isn’t working quite right.
So the next way you can have a problem is that you make enough thyroid hormone but it’s not the right type. And this is one of the things I’m most excited about over the last 25 years in studying thyroid health….and that is most missed by conventional doctors, especially endocrinologists. Endocrinologists really for some reason don’t like this concept. But I’m gonna explain it to you. The psychiatrists and the OB-GYN’s get it because it’s all through their literature. And that is this: The conversion of T4 to T3. So T4 is the main hormone that the thyroid is producing, right? And then it needs to convert it to another hormone.
But that conversion doesn’t actually happen in the thyroid gland. So your thyroid gland mostly makes T4 or thyroxin, but that’s not an active hormone in the body. It’s a precursor hormone. And then in your liver and in your bloodstream or in your cells actually throughout your body, your cells convert the T4 into T3, also called triiodothyronine.
And that is what actually turns on your metabolism. So basically a molecule of thyroid hormone has four amino acids called tyrosine, four of them in a ring. And then off of each one of those is an iodine. So there’s four iodines. And if you knock off the proper iodine, then you get this active hormone called T3. But if you knock off the wrong iodine, you get an inactive hormone called reverse T3.
And the knocking off, that’s the process of the conversion from one to the other.
And that conversion doesn’t just kind of happen randomly. It has a specific enzyme that does that called five prime deiodinase. I know it’s a mouthful. If you knock off the wrong one, you get this inactive hormone called reverse T3, which actually clogs up your receptors. The thyroid homone works by going through the cell membrane into the nucleus of the cell and actually has nuclear receptors.
But the reverse T3 clog up the receptors and then it can’t even receive the signal of T3. So then people will get stuck in this pattern of having a reverse T3 rather than T3. And they’ll have all the symptoms of hypothyroidism that I already described. But especially, what I didn’t say yet, is low body temperatures. And we check temperatures generally with an old fashioned glass oral thermometer under the tongue for seven to 10 minutes. It takes more than five minutes.
You got to learn how to shake it down or you put it in a sock and spin it to get it down and you do it in the middle of the day because we want to know how hot you get at your hottest.
We don’t care how cold you are when you first wake up. That’s fine if you’re trying to get pregnant or not get pregnant, if you’re trying to track when you’re ovulating. But if you want to know whether your thyroid’s working, you want to know, do you get up to your 98.2 to 98.6 that you’re like you’re supposed to in the middle of the day or 37.0 Celsius!?
And this is indicative of how well the conversion from T4 to T3 is. If we have a normal TSH we know you’re making enough thyroid hormone. The next question is, can you use it? Are you actually able to use it?
>> Okay, so I was going to ask you that. It seems like there’s two parts to this. There’s the TSH and the creation of T4 that could be one potential problem, or lead into hypothyroidism, or it could be a conversion of the T4 to T3. Am I understanding that correct?
Exactly. In the first part, you know when it gets bad enough will eventually be recognized by your physicians. And then what they’re going to give you is T4 replacement, called Synthroid.
>> Okay. So they’re not even going to consider that maybe the issue is in the conversion?
Never. They’ll never consider that. The only time they consider that is in the intensive care unit. There’s a process that’s also associated with ICU psychosis and other things. But when you’re ill, your body shuts down your thyroid conversion. And that’s called euthyroid sick syndrome. But that comes back to the question of, why do we have this alternative pathway? Why would we ever make reverse T3?
Well, in our evolution, it’s a way to survive. So let’s say you break your leg and you can’t get any food or you’re starving to death. What you do, your body shuts down your metabolism to burn less calories and live till spring or live until your leg heals and you can go find some food. So it’s a way of surviving, but we get stuck there and the reasons we get stuck there in our modern culture is what fascinates me and what I’ve really been looking at for the last 25 years with our thyroid.
It comes down to three basic categories. Well maybe four, maybe five! But the first is a lack of the proper nutrients. We don’t get the proper nutrients. And for this, this includes of course iodine, tyrosine, and also zinc, selenium, iron, and certain other vitamins like B6. So half of Americans, for example, are low in zinc. I don’t know how many are low in selenium, but quite a few. Iodine for sure. We used to give iodine in the salt to get rid of goiters at one point in the middle of the United States, in the Northern part of the Midwest. You know, up to three fourths of people had goiters because of lack of iodine. And that’s why we put iodine into the salt. But now people are eating all this fancy sea salt without iodine. And so we’re seeing this resurgence of goiters over the last 10, 15 years.
So the first thing is nutrient deficiencies. And in integrative medicine we measure these. We can measure all these and figure out what you need and give it to you. The second category is toxicities, especially heavy metals like mercury, lead, cadmium, arsenic. All of these, but especially mercury poisons the thyroid gland. And these are more prevalent than people realize, especially if you like your sushi, and even more especially if you eat tuna.
There’s a series of patient studies right out of conventional medicine from, for example, San Francisco who would go out and eat sushi two or three times a week. And by conventional blood testing, they showed really toxic in mercury from the tuna. Other things show that, for example, dental assistants who had exposure to amalgam fillings. Back in the day, there’s not as much amalgam and there’s not as much mercury in fillings anymore. But when I started the practice over 20 years ago, more than half of the fillings put in in the United States were still mercury fillings and the dental assistants have the highest rate of thyroid disorders and infertility and miscarriage. It’s really, really sad.
So we can measure all these toxicities and we can help get rid of them. The other category of toxicities besides the heavy metals is all the pesticides and plastics and petrochemicals. So for example, glyphosate, which is commonly marketed as Roundup and other pesticides can inhibit these enzymes too. So we can measure those actually in your urine and see if you’re getting excessive exposure. And of course your lifestyle for that is to eat organically and avoid those things, right? And then it’s your other hormone balance. You know, if your other hormones are out of whack, then your thyroid can’t convert.
So, you have the adrenals making cortisol and DHEA, your gonads making either to testosterone for men or estrogen and progesterone for women, and then your thyroid….they’re all playing together as a concert. And if you go to a concert and the violin’s dropout or the the bass drum is four times louder than it should be, then the concert is not going to sound good. It’s not going to all go together. So if your other hormones are not in balance, then this will all go awry, which is why in my observation, the vast majority of postmenopausal women who are not on bio-identical female hormone replacement therapy have some degree of this conversion disorder, which by the way has a name, it’s called Wilson’s Syndrome, named after Dr. Dennis Wilson. And he has a website you can go to. It’s a wilsonsyndrome.com.
>> Okay. So just to recap, it’s the conversion from T4 to T3 that is often sabotaged by really three primary things, and that’s nutrient deficiencies, heavy metal toxicities and petrochemicals, and then the other hormone balance in the body!?
Yes, and the fourth big category would be chronic infections, and we talk more about that when we get into the autoimmune conditions like Hashimoto’s, but the chronic infections…and the most commonly known one is Reactivated Mono or Epstein BARR virus, but there’s a lot of different chronic infections and autoimmune diseases that can throw off the thyroid if you’re generally sick in any way. If you’re chronically ill, you’re going to have this problem converting your thyroid because there’s going to be something wrong. And a large percentage of Americans are chronically ill.
>> And is there hope for these people who are suffering with this? The conversion issues and the sabotages that are leading to it?
There is hope! And the hope falls in two broad camps. One is if you need thyroid hormone, if you are hypothyroid, then the type of thyroid hormone we give you can be changed. And the second is if you don’t need thyroid hormone, then fixing all these other things and temporarily supporting you with the right type of thyroid hormone can help. So if you’re hypothyroid, then most likely you’re taking Synthroid or levothyroxine….it’s that T4. And the reason is because the makers of Synthroid had the greatest marketing coup ever in modern history.
For 60 years they have brainwashed all doctors and especially endocrinologists that you’ve got to give T4 because other types of thyroid hormone don’t work right and are unstable. Now, we CAN give T3, it comes over the counter from a prescription pharmacy, but mass made by big pharma as a Cytomel. And that works really well. And you have to take it usually twice a day, which is the big downside because it is a very short live molecule. So you’ve got to take it in the morning, and take it again in the afternoon, generally, if you’re on higher doses. You can also get it from a compounding pharmacy called sustained release T3 or SRT3, and that sometimes you can take just once in the morning.
>> Okay. So it seems like typically conventional medicine likes to go the route of just giving the body more T4. Right? But the Integrative Medicine approach is really looking at the problem may not be needing more T4 but converting it….so giving the body T3 instead?
Right. And what happens, how you feel when what you need is T3, but instead of they give you more T4 trying to make you feel better, is you’ll feel better for a few weeks and then you’ll be back to where you started having all those symptoms of hypothyroidism…the weight gain and sluggishness and fluid retention and things like that. But now you’re also going to feel wired. You’ll be wired and tired. It’s not good at all. It’s kind of like drinking too much caffeine…but you’re still sleep deprived, right? You’re just getting too much T4 and not enough. T3.
>> So hypothyroid seems like a really great example of the value of investigative integrative medicine and the focus on root cause, because as you named those four primary sabotages to T4 T3 conversion, it seems like addressing those as the root cause of the thyroid issue… when you get in there and address those, people tend to see a turnaround?
Absolutely. It’s going to be a little bit different for everybody and it takes some time to turn those things around. Now, by giving you some T3, you can feel better right away, and if you need to be on thyroid hormone the rest of your life anyway, if you’re already in that situation, then we can just give you T3 for the rest of your life and that’ll be good. But you know what? If you have these problems, if you have nutrient deficiencies, heavy metal toxicities, and other types of toxicities, hormonal imbalances or chronic infections, they’re going to start to show up as other problems in your health too. So we like to go after those anyway because then your overall health is going to get better and it’s going to be good for your risk of, for example, vascular disease or cancer or dementia or physical frailty, which are the main ways that we age, and do “not well” at the end of the line.
>> Right. So important. That really helped me understand more about what’s happening in my thyroid and where things get clogged in the process of having my body function optimally, that conversion piece, especially.
Yeah. We’ve got to get the right type of hormone if you need it. And that’s shown by a very simple test, just taking your temperatures. You know, why? Why can’t we do blood tests for this? So I see people and I have done it measuring the blood levels of T3 and reverse T3and T4 and sometimes that will show, but often it doesn’t. And that’s because this conversion happens at the cellular level.
That’s why we do the temperatures test and go from there. That way we’re going to give the right type of thyroid hormone that really works for you. And that will drive some doctors really loony when they see us do that. And then we’re going to work on balancing your other hormones, your gender hormones, your adrenal hormones….work on suppressing chronic infections if you have them, we can identify those and measure your nutrients and replace those and then measure your heavy metal toxicities and other types of disease and help you detoxify them.
>> Amazing. You make it sound so simple. So that’s very refreshing.
Well, the devil’s in the details all the time, isn’t it?
>> Indeed it is.
All right. Well I hope this helps you understand thyroid better.
>> Yes! Was there anything, for our listeners, that I didn’t think to ask that you feel like might help wrap this up….understanding why we have thyroid issues in the first place, and that it’s not necessarily what conventional medicine is telling us and treating us with…but that it’s something else that is the root cause?
Well, I’m always go back to nature’s balance, right? In a perfectly healthy person, their thyroid is gonna keep working right. If your thyroid is not working right there is some reason…but we may not have figured it out yet. Doctors may not have figured out why that is and unfortunately in the conventional medical model, they’re not very curious about why that is. For example, one in four women after menopause go hypothyroid. Well that pretty much tells you there’s a relationship with thyroid functioning to female hormones, right? Cause that doesn’t happen for guys at age 50. So you know, in Integrative Medicine we have that curiosity, that Sherlock Holmes mentality of like, “what went wrong, why, why aren’t you perfectly healthy and how can we restore that!?”
>> Right. That makes sense…that that’s the direction to look…that hose are the questions to ask.