Graves’ Disease and Hyperthyroid | Podcast #219

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There are a lot of ugly things that could be in one’s health bucket. If one has Hyperthyroid, finger pointing is not enough. There is a need to turn over every rock and take a big shotgun approach through functional medicine.

In today’s podcast, Dr. J and Evan Brand discuss some of the essential points in Graves' Disease and Hyperthyroid. Learn why Hashimoto's can sometimes feel like Graves' when one has hyperthyroid or Graves', or high cortisol and high catecholamine. Also, learn how functional medicine can help address major side effects of different drugs while at the same time not going to something excessively drastic that will result in thyroid removal or ablation. Continue for more and don’t forget to share. Sharing is caring!

Dr. Justin Marchegiani

Dr. Justin Marchegiani

In this episode, we cover:

00:38    Drugs that Affect Thyroid

04:29    Acid Blockers

08:41    Fluoride-Containing Medications

14:03    Addressing at the Root Cause

20:04    Other Drugs That Affect Thyroid

24:48    Effects of Depleted Thyroid

25:39    Lithium Mechanism for Graves'

29:54    Multivitamins and Borderline Hashimoto's


Dr. Justin Marchegiani: Hey guys, it's Dr. Justin Marchegiani here, I'm with Evan Brand. Today's podcast is gonna be on Hyperthyroid and Graves' disease. So, we're just finishing up the thyroid s- reset summit. So make sure you head over the, make sure you subscribe. We're gonna give a little love our high or Hyperthyroid uh, people. Again, a very small percent, 90, 95% are gonna be Hashimoto's, low thyroid. A lot of Graves' people will eventually develop potential low thyroid, but we're gonna go into that path to physiology and we're gonna break down what it is, causes and what you can do about it to get better.

Evan Brand: Yeah.

Dr. Justin Marchegiani: Evan, how we doing today man?

Evan Brand: Hey, doing pretty well! We were just looking into some research, there's a lot of drugs unfortunately that affect the thyroid. So, maybe we should start there because your average person who has symptoms, they may already be on some of these drugs. So, let's go through this together and talk about what are the things you're doing that maybe messing up your thyroid, and that can be one of your big root causes. Acid blockers is one that I think is gonna be most commonly used and abused. We know that when you reduce stomach acid, you're therefore reducing your ability to digest. So-

Dr. Justin Marchegiani: Mm-hmm.

Evan Brand: -therefore, you're gonna develop food intolerances 'cause now your food isn't digesting, and then that causes leaky gut, and leaky gut is the doorway to create thyroid antibodies in the case of Hashimoto's or Graves'. So, to me I would say PPI is like, even just people at home doing tums and pepto bismol and all that stuff is just garbage.

Dr. Justin Marchegiani: Yeah, one of the big things that you're gonna be with these medications is, you're gonna lose the ability to digest protein optimally and ionize minerals optimally. We know how important selenium is with autoimmune thyroid as well. More on the Hashimoto's-hypothyroid side but, typically, anytime you have, even like Hashimoto's can feel like hyperthyroid in the beginning, 'cause we're tackling that thyroid gland, hormone spilling out. So, you can still have Hashimoto's which will eventually develop and lead to low thyroid function, and it will feel like Graves' in the beginning. Graves', we have antibodies that are affecting the- the- the thyroid, uh, receptor site antibodies, they're gonna be stimulating thyroid hormone production, uh, thyroid stimulating immunoglobulin and- and thyroid stimulating hormone receptor site antibodies are all increased. So, we're stimulating more hormone production, we're on the other side of the defense, with like a lower thyroid function, Hashimoto's, or uhm, which is causing TPO, Thyroid Peroxidase antibodies, and thyroid- thyroglobulin antibodies, you're attacking the gland, and then the gland ss- spilling out thyroid hormone. Where on the Graves' side, we're- we're stimulating either the thyroids stimulating immunoglobulin which is causing more thyroid to be made, or the thyroid, uhm, receptor site antibodies, the TSH receptor site antibodies which stimulate. So, one were attacking and spilling on the Hashi- side, can still feel like hyper the one were stimulating to make more. That's kinda the- the diverting line there.

Evan Brand: Yeah, well, couple things I need to point out, the lab test that you just referred to like the TSH receptor antibodies-

Dr. Justin Marchegiani: Yup.

Evan Brand: -your average doctor and even endocrinologist, they don't always run these, correct?

Dr. Justin Marchegiani: Corretc. Most of the time they're gonna just look at symptoms and they're gonna see if your TSH is very low. And a lot of times, if you're taking actual thyroid hormone, you maybe overdosed, you may be taking a little too much, or uhm you may need to spread it out throughout the day and that can also give a lot of false readings with lower TSH, 'cause TSH is an inverse brain hormone. It goes low and thyroid goes high, so a lot of times, they won't look at T4 and T3, they'll just look at TSH, right? So, we have TSH is the brain hormone, that talks to the thyroid to make T4. T4's are- our more inactive thyroid hormone, that gets converted to T3, so they won't typically look at T4 and T3 to see if they're high. They typically just make the assumption, if TSH is low, then these have to be high. So, good doctor will actually look at TSH, T4, T3, and they'll look at all of the antibodies, 'cause I seen many times, patients will have thyroid receptor sites antibodies but they may also have Hashimoto's antibodies too. And then once the Graves' hyper like symptoms are addressed, now they're left with other symptoms that may lead them down to hypothyroid path.

Evan Brand: Yup, well said. So you gotta get the proper labs done, that's important. If you're just trying to have a doctor-

Dr. Justin Marchegiani: Exactly.

Evan Brand: -just medication on TSH-

Dr. Justin Marchegiani: Mm-hmm.

Evan Brand: -you're not gonna feel good.

Dr. Justin Marchegiani: 100%. So you have to know what the pattern is. But if you can figure that out, it's gonna give you a ton of information to how to move forward. And again , the- the underlying issue is autoimmunity, right? If you go to your conventional doc, they're typically- if they're very conventional minded, they're gonna typically just recommend uh, a radioactive thyroid, and they're gonna ablate your thyroid, that's gonna be the big thing. And again, they're concern of a thyroid storm, which is essentially elevated amounts of thyroid hormone causing a stroke. That's really what they're looking at. So, we understand that, we're trying to do our best to decrease that and curtail it, and we may wanna look at that, we wanna stabilize you with methimazole or- or-propylthiouracil, PT used to medication which basically block iodine uptake. That may be okay acutely, uhm, by your conventional medical doctor, typically, we're gonna monitor, we're gonna check your levels, TSH, T4, T3 and we'll look at all of the antibodies, and we're gonna try to get things down naturally. Obviously cutting out gluten's gonna be important, uh, obviously, uh, adding in certain nutrients. Lithium, super helpful, uhm, L-carnitine at very high levels is very modulating, uh, blue flag is very good, lemon balm or melissa is very good. So, you really wanna work with your natural medical doctor to kinda help this under control. And of course, like, there can be other underlying issues, the same issues that are causing Graves' could be causing, Hashimoto's as well. So, just because we're talking a lot about Hashimoto's, we still have to look at the leaky gut. We still have to look at infections, the gut issues, we still have to look at a lot of the medications that you mentioned. Let's go over on those medications to make sure we can at least connect those dots.

Evan Brand: Yeah, I was looking at some statistics, the acid blocking drugs, there are over 170 million prescriptions in the U.S. alone for acid blockers, so, when you take a U.S. population of 3 to 400 million people, that's basically half of the population that's on acid blocking medication. So, those are all bad, you know, prilosec, prevacids, nexiums, dexilants, protonix, there's tons here, and then of course this is over the counter stuff, a lot of those are over the counter. Uh, oral contraceptives, those are in here too, because those increasing your thyroxine binding globulin, your TBG, and that's gonna lower your free thyroid hormone. So, we've seen that birth control pills cause waking. I would say-

Dr. Justin Marchegiani: Mm-hmm.

Evan Brand: -that's probably the mechanism right there-

Dr. Justin Marchegiani: Yeah.

Evan Brand: -is if… affecting thyroid.

Dr. Justin Marchegiani: Yeah, birth control is also gonna have a major effect on your immune system because estrogen levels can skew out that CD8, CD4, uhm immune balance. Your CD8 cell are your natural killer cells, your CD4′ cells are your helper cells. Estrogen levels can skew that, that's why women are 5 times more likely to develop an autoimmune condition compared to men. So, the birth control pill aspects' a big one, is gonna obviously create more estrogen dominance. Progesterone's really important for making thyroid hormones. So, that can kinda skew more of a- a hypo thyroid uh, you know, setting, but just- of course, it's having the immune system more imbalance can be a- a big issue. Now, the big issues here on the Graves' side is, they may wanna ablate your thyroid with radioactive iodine or thyroidectomy faster than you're comfortable with. So, my whole thing is, you know, let's not get on the thyroid meds or the radioactive iodine or the thyroidectomy first unless your doctor is very concerned of a thyroid storm, then maybe we- we go on the medications first. But, at least get ruled by your conventional doc to make sure you're good. And, work on the diet dialed in, a good paleo template cutting out all the inflammatory foods is gonna be big. Managing the stress, the sleep, managing the blood sugar with good healthy proteins and fats, and, you know, not going longer than 4 or 5 hours without eating. So, if you're doing a lot of intermittent fasting that maybe too stressful on your bloodsugar and on your immune system. Gotta get your adrenals also looked at, and then uhm, gotta cut out all the pesticides, in the- in the GMOS and the gluten, and then the big thing after that is calm down the inflammation. So, we may use things like re- resveratrol or curcumin, or glutathione and Vitamin-D to modulate the immune system. We're also gonna work- work on uhm, getting the gut addressed and looked at, we'll also work on getting the adrenals looked at as well.

Evan Brand: Yup. So, uh, back in medications, a few more to go over here. So things that contain fluoride, there's a ton of them. I didn't realize honestly how many of these drugs have fluoride in them. Your acid blockers, your anxiety, depression, OCD drugs like prozac, lexapro, celexa, paxil, diflucan which is antifungal drug, uh, cipro, levaquin, avelox, these are the uh, fluoroquinolone family of antibiotics, they often use 'em for UTI's which are just terrible. Justin and I can fix these using herbs and it works just fine, celebrex used for pain, lipitor used to lower cholesterol, these all contain fluoride, and these can affect your uptake of iodine into the thyroid and therefore you're gonna be in bad shape if you have fluoride containing drug in your body, and you have fluoride toothpaste, and you have fluoride in your tap water, then, I mean, you know, fluoride was even used to treat hyperthyroidism. That-  I mean, we know in the literature, tre- a treatment for o- over- overactive thyroid or hyperthyroid, fluoride was used to- to suppress the thyroid. I mean, even just 1 milligram a day was enough to shutdown the- the thyroid. And, so, in terms of fluoridated communities like here in Kentucky, they do f- they do fluoridate the water. I'm looking at just a piece of literature here, the average adult who is drinking fluoridated is injusting between 1.6 and 6.6 milligrams of fluoride per day. Remember, it only took 1 milligram in the research to- to- to lower the hyperthyroidism. So, I would say part of our hyperthyroid epidemic is the tap water so that's why I filter fluoride, I know you do too.

Dr. Justin Marchegiani: 100%. It's a big immune stressor, it could also pinch it and affect the- the halides and wore the thyroid hormone binds in a synthesize, right? We know iodine is a haladie, very important for making and synthesizing thyroid hormones. So, we don't wanna be clogging up those receptor sites either, that's important. We also know high amounts of iodine can stimulate autoimmunity, right? Population for iodine has been added to salts or into the food supply, you see more autoimmunity. Now, there are some people that will actually use high dose iodine, to shutdown the thyroid. So if there's a Graves' issue going on, we can do super high doses of iodine, you know, upwards of 5, 10, 15 milligrams of iodine, I typically don't recommend that. Uhm, there are doctors that do, Dr. Jonathan Write talked about it many times, but basically, you've these various effects where like, the Wolff–Chaikoff of the Jod-Basedow effect, or effects where high amounts of iodine can cause a low or high thyroid function. Like the Wolff–Chaikoff effect is where you give so much and it can shutdown iodine getting into the thyroid, and that lack of iodine go into that sodium uhm, iodine symporter can decrease thyroid function. But then there is the opposite where if you don't get enough, you can have this Jod-Basedow phenomenon where you can have hyperthyroid. So, in general, that's one thing, it's out there. I'm just putting it out there 'cause people have talked about it, but I typically won't stay more with the dietary strategies, the anti inflammatory nutrients of the blood sugar support and really cut out all of the inflammatory foods, and use some of the nutrients to modulate thyroid function, right? The herbs, the blue fla- the blue flag, the melissa, the lemon balm which is essentially the same thing, the carnitine, the litium, and some other things.

Evan Brand: Motherwort. I would have motherwort [crosstalk] too.

Dr. Justin Marchegiani: Mm-hmm.

Evan Brand: Uh, we've seen- I mean, there are some thyroid support blends out there that have motherwort in it. I just happen to come across motherwort on my own when I was having heart palpitations, when I had those cavitations, those infections on my jaw bone, the motherwort calmed it down. So if you look up like motherwort thyroid, you'll see a lot of cool stuff. Now, uh, let's go back to the labs real quick, just so people understands. So if they're going to their doctor, their endocrinologists and they're just not running the labs they want, we'll wanting them to add a few things, right? We want them to have the TSI on there, the Thyroid Stimulating Immunoglobulin, and then I've seen another one called TSII, but is that the same thing, is just referenced differently between Quest and LabCorp maybe?

Dr. Justin Marchegiani: So TSI is probably Thyroid Stimulating Immunoglobulin?

Evan Brand: Yeah.

Dr. Justin Marchegiani: Right?

Evan Brand: And then I've seen one called TSII, and I don't know if it- maybe that's just the way they wrote it down but was- it's the same thing.

Dr. Justin Marchegiani: Yeah, it probably just the same thing, right? For instance, you have thyroid peroxidase, TPO?

Evan Brand: Yup.

Dr. Justin Marchegiani: TPO antibodies, but then there's also a- another one called uh, microsomal antibodies. Microsomal antibodies are the same thing as TPO, right? So you may not know that. So, a lot of times medicine is ways of saying the same thing, so I wouldn't be surprised if it's the same thing as just TSI.

Evan Brand: Yeah, it looks like it is. Okay-

Dr. Justin Marchegiani: Mm-hmm.

Evan Brand: -so we wanna do our TSI, we wanna do our TPO antibody, our [crosstalk]

Dr. Justin Marchegiani: Yup. Yeah, TPO antibody, we'll wanna run a thyroglobulin antibody, TG antibody, and we also wanna run our thyroid stimulating hormone receptor site antibody, run all 4 of those. Uhm, that way you get a total window of what's going on, and then don't guess, don't just run TSH and say, “Oh, my TSH is low”, right, “I must have Graves'”. Look at TSH, look at T4, 3 and total, look at T3 free and total, and that way you have a full kind of complement of what's going on, you know exactly what's up, and then also get a window into how your adrenals are doing.

Evan Brand: You you have to, I mean-

Dr. Justin Marchegiani: Mm-hmm.

Evan Brand: You did a great talk on your thyroid summit with Dan Kalish about mitochondrial function, and how people look at thyroid and mitochondria as separate. But really, mitochondria and thyroid are one and the same, and so, by fixing and supporting mitochondrial health, by removing toxins, getting rid of infections, increasing detoxification, getting out heavy metals, getting out mold, all the things you need to do to fix mitochondria, that improves thyroid function as well. And you all kinda made the distinction that look, people are trying to fix these as two separate things. You go to a thyroid specialist, and they don't look at the mitochondria when really they have to, to fix the thyroid, you gotta fix the mitochondria. So, that's part of the puzzle too, and, you and I measured that, looking in the urine organic acid test. There's a whole section dedicated to mitochondria that we can look at, and the good news is, you can track this, and you can see, wow! Look here, this is where you were 6 months ago and now we detox you, fix your gut infections, now look at your mitochondria, and then of course your thyroid numbers are gonna improve too. Maybe you can speak on that for a minute. How many times we've just fixed everything else, and then the thyroid magically gets better just as a byproduct of doing the other functional medicine pieces.

Dr. Justin Marchegiani: Yeah. So, in general when you have hyperthyroid or Graves', a lot of times Hashimoto's can feel like Graves'. So can high cortisol and high catecholamine. So, a lot of people, they may never really know that they have a hyperthyroid or Graves' issue, they may just feel symptoms and assume that. So, in functional medicine world, we know there are a lot of uhm body systems that may be out of balance that may give hyper symptoms, hyperthyroid symptoms, right? Uh, the excessive sweating, the irritability, uhm the anxiety, the heart palpitations, uh, insomnia, difficulty sleeping, these are all hyperthyroid symptoms. But when you have Hashimoto flares, they can also feel very similar. So, we're looking at the diet, we're looking at the leaky gut, we know how the leaky gut, and the gastrointestinal permeability can have a major effect on stimulating immune system. So, of course, we're looking at- we're checking off the gut, we're going to the 6 R's, removing the bad foods, replacing the enzymes and acids, repairing the gut lining and the hormones, right? Adrenals-thyroid-female, or adrenals-thyroid-male, ATM or ATF. Removing the infections. We know things like blasto, lymes,such as borrelia burgdorferi, uh, yersinia enterocolitica, uh, H-Pylori, these all can have negative effects on the immune system. We're repopulating, re-inoculating good bacteria and then we're retesting. So, we're- we're checking off the adrenals, we're checking off the thyroid, the thyroid nutrients, we understand the medications that can be contrary, indicating, we're making sure digestion is good, and we're making sure the gut permeability is good, we're making sure the anti-inflammatory supports on track that calm things down. So, we're looking at not system wise, but system wise, not symptom, but system. We hear the sym- we- we look at the symptoms, and we trace them upstream. Our brain isn't “Oh, symptom, what drug or supplement can I give to fix that, hey, let's trace it upstream and what nutrients and lifestyle changes, and what support can we give to help modulate and support those systems back to healing”.

Evan Brand: Well said. And I don't wanna, skip over what you said because it was very important. I'm gonna say it in a different way, the H-Pylori infection, you mentioned blasto, you mentioned lyme and co-infections, these could be your root cause. So, if you keep going down this thyroid rabbit hole, you're taking thyroid supplements, you're going to the endocrinologists, etc., Justin and I have seen it literally hundred, if not, thousands of times now. Well, we have someone with an H-Pylori infection and parasites, we'll take care of that infection, get it gone, and then we can retest the blood and we'll see antibody numbers drop hundreds of points, just by working on the gut. We didn't even touched thyroid, right? Yup, “I hear you, I hear you, I hear you, I know it's a thyroid symptom, let's fix the gut, boom!”, look at the bloodwork and the thyroid is fixed. I mean, it's a miracle.

Dr. Justin Marchegiani: A hundred percent. That's why you wanna understand the mechanism, and just know, “Okay, great, you got a thyroidectomy, you get your thyroid taken out” but that underlying mechanism is still in motion, will other organs be affected? Is the gut- was the gut the root cause and is that still in motion? Was there an adrenal issue there, was there a blood sugar issue there. So a lot of people, they may get their thyroid ripped out, they may get their thyroid ablated and think that the underlying issues been addressed but a lot of times it's still ignored. So, first things first is don't do uhm- irreparable damage to your thyroid first. If you have to get on a medication short term because you're seeing your doctor and they're concerned of a thyroid storm, fine, but do your best to get everything else going right there after, do your best to not cause any irreparable damage to start. And then, find a good functional medicine doc where you can start getting to the root issue with all these other issues, right? With the anti-inflammatory nutrients and everything else.

Evan Brand: Yeah, we've seen people where they get the thyroid removed, or they get it ablated, or they get it, you know, they- they get tons of radiation on it to basically they- they- they call it killing or shutting down the thyroid, and then guess what, then they pop up with Sjogren's, or they pop up with rheumatoid arthritis, or also-

Dr. Justin Marchegiani: Yes.

Evan Brand: -colitis, or Crohn's, or some other autoimmune disease, and you- you made the point, okay, yeah, you know, you took out, I'll try to make a car analogy 'cause you're good at those. So, yeah, you- you just took the light bulb out that said the check- the light was on, you just pulled out the light bulb but you still didn't fix why the light bulb came on in the first place. So, like thyroid's gone, there's still a leaky gut, there's still H-Pylori, there's still parasites, boom, now you got rheumatoid arthritis and you don't know why then what do you do? I mean, you go get on, like immune drugs or pain drugs for the pain in your knees, but really, it could still just be the gut. So, it's just sad, it's truly frustrating how many people end up getting multiple autoimmune diseases, and that's just a drug for that thyroid, a drug for the knee pain, a drug for the back, a drug for the gut, you have- irritable bile disease, or you have IBS, here's the antispasmodic drug, you're depressed-

Dr. Justin Marchegiani: Right.

Evan Brand: -here's the antidepressant, you still didn't get the root cause addressed.

Dr. Justin Marchegiani: Exactly. And I really wanted through today's video because a lot of people on thyroid reset summit, we're like, “Hey but, you didn't really focus enough on the Graves', the hyperthyroid aspect”. We talked about it and mentioned it in with Jack Wilson in a couple other people, but the- the major mechanisms are still the same, there maybe more nutrients that we wanna talk about acutely like I mentioned with the carnitine, and the- the lithium orotate, and some of these nutrients like the Melissa, and the motherwort, and the blue flag, uh and the Omega-3's which can be used palliatively to get things under control. But, the same mechanism with the gut, with the adrenals, with the infections, with the blood sugar. And then, looking at those medications, right? We have the acid blockers are most common. What are some other ones outside acid blockers? I wanna make sure we have that list for everyone.

Evan Brand: Yeah, it was the acid blockers, the blood pressure drugs, uh, I think, no, was blood pressure on the list? I don't think it was, but blood pressure drugs are bad in their own right. So, we'll talk about it in another day. Uh, fluoride containing drugs, so that was all of the, uh, acid reflux drugs, anxiety, depression, like prozac, lexapro, celexa paxil, diflucans for yeast infection, cipro, levaquin, celebrex, lipitor, those are cholesterol drugs I had in my brain. Birth control, hormone replacement using oral estrogens, you talked about those, the PPI's we talked about those, I think that was it. Oh, there was another one on here, accutane. Accutane which is often used for the acne problems. Those also have been in the uh- in the research showing to affect thyroid. I don't know the exact mechanism, all we know is that there has been significant changes in TSH levels.

Dr. Justin Marchegiani: Oh, I- I would say-

Evan Brand: Yeah?

Dr. Justin Marchegiani: -it's probably affecting Vitamin-A 'cause it's a Vitamin-A analogue, and Vitamin-A is really important for the thyroid hormone and the thyroid receptor sites. So, it's probably affecting Vitamin-A.

Evan Brand: Okay, okay.

Dr. Justin Marchegiani: Yeah, and the other medication that's similar to blood pressure is the amiodarone which is a- antiarrhythmic medication for the heart. And that's known to have some side effects on the hyper side. You mentioned the fluoride, uhm, which is really important. Uhm, the birth control pills are another big one, the proton pump inhibitors are another big one, and uhm, interferon which is commonly given for- for pain issues, and for a lot of other, you know, immune suppression type of issues can easily drive that as well. You mentioned the accutane already, uhm, iodine as well, right? Iodine can cause the Jo- Jod-Basedow phenomenon which is- it cause hyperthyroid, but there's also the Wolff–Chaikoff effect we you give tons of iodine where it can suppress that sodium iodine symporters so it decreases iodination. So, it's a double-edged sword, so be careful on it. Some docs use high iodine to treat, some say iodine can actually cause of this well. Jod-Basedow on the hyper, Wolff–Chaikoff On the hypo.

Evan Brand: Yeah, that was it. I think we could wrap it up. We did have uhm, one question on here.

Dr. Justin Marchegiani: Oh, the other last medication we wanted to hit was uh, botox.

Evan Brand: Oh, yeah.

Dr. Justin Marchegiani: That's the big one. Yeah. That's the- the Botulinum toxin which could, you know, typically used for wrinkles or for headaches that gets the allergy in medication, and that's known to have some connections with hyperthyroid and autoimmune stuff.

Evan Brand: Not good, not good. So, long story short, drugs are bad, and yes they have a place, yes they have a role, yes there may be a time where you need drugs, but in general, those are not things you wanna be on long term, because you can't just stay on antidepressant if it's gonna affect your thyroid, 'cause- and you're gonna get depressed, 'cause your thyroid shuts down-

Dr. Justin Marchegiani: Yeah.

Evan Brand: -your thyroid is overactive, you know? It's crazy.

Dr. Justin Marchegiani: First thing is if you know or you think you have Graves', at least get your conventional MD to look at it and to watch over you, while you work with someone else. We're just wanna make sure there are no thyroid storm that can happen, there's no stroke. We wanna take away those major side effects, while at the same time, we don't go to something excessively drastic and get your thyroid removed or ablated, uh, early on when there's time to save it and be on top. And, but just keep your MD or endocrinologist in the loop, so they're monitoring you and watching what's going on.

Evan Brand: Yup, well said.

Dr. Justin Marchegiani: Anything else you wanna add Evan?

Evan Brand: No, that was it, get the testing done. We talked about the blood, uh, get the stool looked at, look at your infections, look at the urine, get the mitochondria evaluated, look for candida, look for bacteria, look for mold, look for lyme, look for co-infections, these are all things that could be in your- in your bucket so to speak. So we need to turn over every rock. You and I are never gonna say, “All thyroid problems are caused by…” and point the finger. It's gonna be a- a big shotgun approach. You can't just have like uh, of- one bullet approach, I'm gonna shoot this one bad guy and that's the thyroid problem, and that goes away, no, it doesn't work that way unfortunately.

Dr. Justin Marchegiani: Exactly. And then, just to kinda highlight some questions here. Barbara writes in, “Will hyperthyroid eventually deplete the thyroid and become hypo?”. It's possible, I mean, the hyper symptoms you feel from Hashimoto's like I mentioned is more of the gland actually spilling out hormone, where in hyper Graves', whether TSI and thyroid stimulating hormone receptor antibodies, it's- think about it as the tired horse getting whipped. Little bit different but I would imagine it's possible for sure, that could eventually lead to hyp- uh- hypothyroid as well. Uhm, my big concern is they start to develop Hashimoto's antibodies, and that starts to happen.

Evan Brand: Well, you seen both, right? Haven't you seen like TPO, TG antibodies and TSI or TSH antibdies all at the same time where it tend to-

Dr. Justin Marchegiani: I have. I've seen them all at the same time.

Evan Brand: So you could say you have Hashimoto's and Graves'?

Dr. Justin Marchegiani: Yup, exactly.

Evan Brand: [crosstalk]… place to be?

Dr. Justin Marchegiani: Yup, exactly. And then, someone writes in, “A lithium mechanism for Graves'”, uh, well, lithium orotate, remember that's the supplement, has a modulation effect on thyroid hormone. So it can modulate it. So if it's high, we can kinda bring it down. It almost has like an adaptogenic effect, so does carnitine. Now, we also have the medication lithium, which is actually known to cau- as lithium carbonate, that's actually known to cause hypothyroid that can decrease thyroid hormone production production. So, a little bit different there, lithium orotate, it's a modulator, uh, it's gonna be less strong as the medication. Lithium carbonate is typically given for bipolar, F.Y.I. And then, Amhet writes in, “Is an iodine anti…” uhm, “…infective so it could help the thyroid? I thought it as anti-bacterial”. Yeah, I mean, you can give iodine at correct doses at- at lower doses, and you don't have this Jod-Basedow or Wolff–Chaikoff effect. Jod's causing the high, uh, Wolff's causing the low, but also it can stimulate autoimmunity. Lots of studies and populations where iodine's been added whether it's to the salt or to the food supply, and you see lot higher, you know, level of incidence for Hashimoto's.

Evan Brand: Uh, Paul says, “You're looking fresh today, Dr. J.”, I agree.

Dr. Justin Marchegiani: Oh, I appreciate it. I got this new skincare line that I am- I am doing. I had a Perioral dermatitis the last year. It really sucked. Uhm, I got it because I was just mixing too many essential oils and mixing too much crap and rubbing 'em on my face, and it screwed up my immune system, my skin. And, any woman that has Perioral, women get it a lot of times from birth control pills, and they can get it from like pregnancy hormone fluctuations. It's a little bit different of a mechanism. Uhm, I was able to find a skincare line, that's catered to it, 'cause Perioral is a type of rosacea, and I found a skincare line that was great and I just have to use zinc oxide and titanium oxide on my skin every- every day to prevent any sun from hitting it because once you have a little Perioral, 3 to 5 minutes of sun can flare it up. It's the most [crosstalk]

Evan Brand: Whoah.

Dr. Justin Marchegiani: -thing ever. So annoying. So, the thing is, you go around, you used to getting a little bit of sun, and it's fine, right? No problem. It's ni- it's nice getting a little bit of sun, but then when you have this Perioral thing that comes in, you're like, “Where did this come from? Where is this flare coming from?”. So, I found a great skin care line, and I'm just using a little bit more higher quality zinc based SPF to protect it so- I'll do a podcast with the owners in these company in the next month or so. I wanna give it a little bit more time, but really happy with the results so far.

Evan Brand: Yeah, I was gonna say, I wanna hear how the experiment plays out longer, and then yeah, let's hear about it, yeah. Another question-

Dr. Justin Marchegiani: I got a protocol- I got a protocol lined up, so, any guys or gals that have that Perioral dermatitis issue, we're gonna be talking about it and doing some podcast on this topic later on.

Evan Brand: That's exciting man, great job, great job. I'm glad to hear progress. Uh, another question was on phytotherapy for thyroid? I don't know if that's the same thing but, that did stem the thought of doing the [crosstalk]… the laser for-

Dr. Justin Marchegiani: Oh, oh, yeah. Yeah Isabella Wentz is talking about this a lot using lasers to help kinda modulate thyroid function. I think it can be great to decrease inflammation. Uhm, uh- uh- uh, I wouldn't- I'm not sure if it would stimulate the thyroid, I wanna be careful with that-

Evan Brand: Yeah.

Dr. Justin Marchegiani: With inflammation, I think it can help modulate it for sure.

Evan Brand: Okay. Yeah, that's- that's- that's something I haven't looked into much. I've known Isabella talked about it and she's done a good job of documenting it, there's been some other people out there telling about the- I think they call it like an LLDT like a- like a- Low Level, maybe it's LLLT, Low-Level Laser therapy, something like that?

Dr. Justin Marchegiani: Yeah, a lot of people that talk about Pulse Electromagnetic Frequency Therapy which can help increase stem cells which can help obviously repair the gland too. So there's that uhm, like the PEMF. There's various uh, devices at home like the ___[29:18], these various devices that can help uh, with that Pulsed Electromagnetic Frequency.

Evan Brand: Here's my thought on it though. Somebody can go buy this PEMF machine and then they disregard focusing on their gut, and then they don't get better.

Dr. Justin Marchegiani: Yeah, like- that's all palliative stuff, right?

Evan Brand: Yeah.

Dr. Justin Marchegiani: So, we kinda have our foundational things and then we kinda have our more palliative things that are in the branches, uh they're not necessarily in the limbs or the roots or the- the trunk of the tree. So-

Evan Brand: Yeah.

Dr. Justin Marchegiani: -we focus on the trunk, the limbs, the branches, first and then the leaves all at the end. So, we wanna make sure these are more like in the leaves type of palliative options.

Evan Brand: Yeah, well said. Uh, I'll read Paul's question here, “For someone in their 20's with borderline Hashimoto's, how fast can that deteriorate over time if not correctly addressed?”. I don't know what you would define as borderline Hashimoto's, would you just say that TPO antibodies maybe a little bit up or?

Dr. Justin Marchegiani: Yeah, I'd say TPO's are maybe, you know, in the- like- typically like LabCorps like anything greater than 33 for TPO, or greater than 1 for thyroglobulin, is gonna be po- high, right? So. maybe thyroglobulin between 2 and 5, maybe a TPO between you know, 35 and 50 or a hundred, you know, that's gonna be a mild Hashimoto's, that's kinda where I sit personally, so, just keep it under control with, you know, maximizing selenium, maximizing zinc, good quality, you know, multi that will get you some extra nutrients on top of a great diet, right? This has never replaces good diet, and then that's gonna give you a good foundational nutrients to keep everything in check.

Evan Brand: Look at that. You just ripped out of multivitamins pack out of nowhere, and here is your multi. [Laughs].

Dr. Justin Marchegiani: I know. Hey man, I got- you gotta practice what you preach, you know?

Evan Brand: You do.

Dr. Justin Marchegiani: Absolutely.

Evan Brand: Here's another question, uh, unrelated, alright, if it's unrelated we'll cover it just 'cause we're having fun but we gotta wrap up here. Uhm, “what do you think of water fasting for long periods of time? 24 to 72 hours every so often?”. I don't know why water fasting become like so cool.

Dr. Justin Marchegiani: Yeah, I mean.

Evan Brand: Everybody at about this?

Dr. Justin Marchegiani: I mean, here is the deal, like, so I kinda draw a line, right? There are people that like have- they're- they're not healthy, right? And they wanna get healthier. Now there is no magic in not eating anything. But, what not eating something could do for someone, if they're eating a lot of food allergens, or they have a lot of gut inflammation caused by their food, it can help obviously decrease the inflammation that help the gut. But the problem is, you gotta actually eat something because now your body is missing those nutrients. So for a short term effect it can be helpful, but you gotta get the right foods in, and the nutrition that's not gonna irritate your gut. Now if you're just a regular person that's already really healthy and doing well, fine that's great, that can give your gut a good chance to- to heal or rest or just kinda, err- up-regulate cellular autophagy, help improve mTOR, right? Uhm, all these different uhm- uh- what are they called, these different anti aging, uh, pathways. I have 3 on my phone that I typed out last night when I was looking at couple of articles. There's 3, there's 2 major fat- uh- pathways that improve as they uhm, fast. There is the AMPK, the AMPK pathway that should lower insulin levels that gets upregulated, good anti-aging pathway. The other one is uhm, mTOR, ‘kay? mTOR, that's the one that you're gonna- when you modify protein to fast that also improves. And then you have the uhm, sirtuins. And sirtuins improve with resveratrol and NADH, and basically mitochondrial nutrients. So, sirtuin, up-regulation in the mitochondria, and then you have the mTOR and you have the AMP, you have a uh, AMPK. So, those are gonna be the big pathways that we're gonna benefit through fasting.

Evan Brand: My only fear is that if someone is already so nutrient-deprived, I mean, you and I looked at trace minerals in micronutrients and B Vitamins and C Vitamins, and zinc and all that, if someone's already so deficient, you know, this- this guy who ask a question is the same guy who say he's got borderline Hashimoto's, so therefore he's probably got some gut issues going on, I mean, just right there, it already sounds-

Dr. Justin Marchegiani: Your gotta work with your doctor. Gotta work with your doctor and figure out, make sure it works. Make- make sure it's the right next step. A lot of people may not be the right next step.

Evan Brand: Yeah, if you- if you ha- if you don't have the foundations in order and there's an infection going on, you probably don't wanna do that.

Dr. Justin Marchegiani: Totally. Uh, moongoddess writes in, “Hi doctors, I'm slowly going off my methimazole…”, so that's the- iodine blocking medication we talked about for Graves', “…have a small pituitary tumor, and also a growth in my adrenal glands, feel like I get surges. TSH is low , T4 and t3 are good”. So, you gotta be really careful because if you have a pituitary signaling issue, you're maybe over stimulating the thyroid through TSH or maybe overstimulating the adrenals through ACTH. So, you really gotta be careful with that, make sure that your, uh, endocrinologist is monitoring you and watching and giving you the “okay” to come off that. ‘Cause when we have tumors, that's a different ball game because you have uhm, basically the tumor, uh, is, up-regulating those signals to make more hormone that may be necessary. So make sure your endocrinologist is watching it and monitoring it and giving you the thumbs up.

Evan Brand: Ahmet here, “What do you think about nutritional yeast? It has selenium and lots of nutritional benefits for thyroid”.

Dr. Justin Marchegiani: I think it can be helpful, Dr. Berg's a big fan of nutritional yeast. Again if you're on a good quality multi or good quality B Vitamin that'll have high quality yeast derived B-Vitamins, that's fine too.

Evan Brand: Yup, uhm, Paul, “How's your mold issue Evan?”. Feeling better, yes. As long as I live in the bubble, I'm feeling pretty good. Uh, I went to uh, sporting good store last night with my wife and, I felt weird as soon as we walked in, I was like, “There's no way I feel weird this quickly”, and we looked up at the ceiling, and the ceiling was covered, that- all the ceiling tiles was covered in water damage, it was white and brown, and yellow, and green, it was disgusting, so, I held my breath and I literally ran out of the store. So, if I go in places like that, it could set me back for multiple days. So, yeah, you just kinda have to- I- I kind of say that I'm- I'm on a tightrope, and I'm- I'm working on my own protocol too, just like Justin's working on skin, I'm working on mold, developing things, because here's the deal with the tightrope of detox, if you don't detox enough, because you re-circulate 95% of your bile, mycotoxins are in there, you're only making 5% new bile 'cause it's energy intensive. So, when you're trying to use binders, if you use too little binders, you feel bad. If you use too many binders, you feel bad. So, it- it's totally the tight rope that you're on. But we'll do- we'll do more shows on that soon once I have some update to test results to see how I'm doing.

Dr. Justin Marchegiani: Excellent. Well, thyroid summit's coming to a close here y'all, so, there'll be a replay coming up, so make sure you get uhm, subscribed on there,, get access to it. You're also gonna get my first, uh, quarter or so of my uh, new book coming out, for 77 pages, the book will be out on Amazon very soon. I'll do an audio version very soon as well, so you can hear my voice read it to ya, as well. So, I'm excited [crosstalk]… access.

Evan Brand: It's a great book. So, yes, definitely go register for the event, and support Justin. You can buy the talks, you can get the transcriptions, uh, it's something you should definitely have in your- in your library. You can educate yourself and educate others. And we've got a lot of thyroid problems in the world, so hopefully we can help to prevent a few issues a few people from getting their thyroid cut out, etc.

Dr. Justin Marchegiani: Well, this is great, I'll add this interview as a compendium to the Thyroid Reset Summit on Grave. So, we'll talk to the people uh, health talks and we'll have this kinda add it for people that want that extra Graves', hyperthyroid support, so this is wonderful.

Evan Brand: Great. Well, cool, uh, if you wanna reach out to Justin, you can, his website is justinhealth-, you can schedule a consult anywhere around the world. We send lab tests across the globe, so if we need to get you in the U.S., great, if you're out of the U.S., we can help you there too, if you wanna reach out to me, you can do that at, and make sure you stay tuned 'cause we'll be back next week for more.

Dr. Justin Marchegiani: Excellent Evan. Great chat with you, have an awesome day man. Talk to you soon.

Evan Brand: Take care, same to you. Bye-bye.

Dr. Justin Marchegiani: Alright, bye.


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