Hashimoto’s and Hypothyroidism – Foundational Info to Heal Your Thyroid – Podcast #54

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Dr. Justin Marchegiani and Evan Brand talk all about thyroid issues in this podcast.  Listen as they share their recommendations on the first steps that patients with thyroid issues need to take in order to be successful along with helping them to push their thyroid to heal in the right direction. 

Find out what the potential signs and symptoms of a thyroid issue are and distinguish between adrenal and thyroid issues as well as the difference in dealing with thyroid issues from a conventional medicine approach versus from a functional medicine perspective. They also differentiate adrenal failure versus adrenal fatigue. Have you ever wondered what role does progesterone have that affects the thyroid function? Discover more about it and the other hormones affecting thyroid issues in this interview.

In this episode, topics include:

1:18   Thyroid 101

2:35   Thyroid physiology

6:20   Adrenal physiology

11:29   Conventional medicine approach versus functional medicine perspective

21.30   Adrenal failure versus adrenal fatigue








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Dr. Justin Marchegiani:  Hey, it’s Dr. J here with Evan Brand and today we’re gonna be talking about thyroid issues.  We got lots of patients coming in to our offices and they’re like, “Hey, doc, I got a thyroid issues, what do I do?”  And we haven’t even talked about what we’re gonna say yet, but we’re just gonna have a dynamic conversation about what we recommend any of our patients that are coming in that think they have a thyroid issue, what the first steps they need to take are to be successful and to start helping to push their thyroid to heal in the right direction?  Evan, what’s up today, man?

Evan Brand:  Hey!  Not much.  I’m fired up.  Let’s do this thing.

Dr. Justin Marchegiani:  Dude, I’m–I’m ready to go, man.  My thyroid’s feeling great today, so let’s do this.

Evan Brand:  Sounds good.

Dr. Justin Marchegiani:  Before you go in, what did you have for breakfast?

Evan Brand:  What did I have?  I can’t even remember.  I woke up.  Did I eat anything yet?  I may even be fasted honestly, what did I eat?  I have no clue.  If I re–if I remember, I’ll let you know.

Dr. Justin Marchegiani:  Nice.  So you didn’t eat any leprechauns or gnomes today?

Evan Brand:  No.

Dr. Justin Marchegiani:  Nothing like that?

Evan Brand:  No.

Dr. Justin Marchegiani:  Gotta love those grass-fed leprechauns, man.  They’re awesome.

Evan Brand:  Yup, yup.

Dr. Justin Marchegiani:  Especially if you get some Kerrygold butter, you know, it’s like perfect.

Evan Brand:  A little pinch of Himalayan salt.

Dr. Justin Marchegiani:  That’s it, that’s it.  Alright, so thyroid issues.  Thyroid 101.  So first off, anyone’s that potentially having hair loss, energy issues, fatigue, the outer third of those eyebrows that are thinning, potential constipation, vertical ridging on those fingers, low temperature, you know, tingling, numbness in the fingers and toes, these are all potential signs and symptoms of a thyroid issue.  But the problem with the thyroid is that a lot of the symptoms–it’s like a Venn diagram where there’s a massive overlap between thyroid issues and adrenal issues.  So all of my patients no matter if they have a diagnosed thyroid issue or not, we wanna look at the thyroid and the adrenals side by side.

Evan Brand:  Yeah, I remember what I had for breakfast.  It was organic pork sausage that my wife made for me.  That’s why I didn’t remember because I didn’t prepare it.

Dr. Justin Marchegiani:  Nice, awesome.

Evan Brand:  Yes, so you’ve already alluded to–to–we were gonna talk about, you know, what is the first step to do when it comes to thyroid issues, and for me, my answer which I didn’t know your answer–my answer was gonna be to look at the adrenals because if the adrenals are taxed, then it’s gonna be pretty hard to us to keep the thyroid in a good, healthy, functioning manner if the adrenals are taxed.

Dr. Justin Marchegiani:  Yeah, so let’s just break down thyroid physiology for the listeners.  So your thyroid gland is this little bow–bowtie type of gland that sits just below the Adam’s apple.  So if you just kinda run your hand or down your chin here where your chin and your platysma, that skin underneath your chin hits your throat, that your little bump there that’s your Adam’s apple, if you go about a couple–about a centimeter down and a centimeter out, that’s your thyroid gland and that gland secretes a hormone called T4 that is–that gets converted into an active thyroid hormone, T3.  So that gland right there, bowtie-shaped, that thyroid hormone is needed for all cells of the body to be metabolically active, right?  To control metabolism and that T4 about 20% of it happens at the thyroid gland.  So the conversion of T4 to T3, right?  T4 inactive, T3 active, 20% of that conversion happens at the thyroid gland.  The other 80% happens peripherally.  So now out of that 80% that happens peripherally, 60% is the liver, 20% is in the healthy gut bacteria and the other 20% is via healthy adrenal function and stress regulation.  So there’s a lot of like percentages in there, I go back to the anchorman quote, 60% of the time, it works every time, a 100% of the time.  So it’s a little confusing, so just quick little recap on it.  20% of the thyroid conversion at the thyroid, T4, T3 done, right here.  The other 80% happens peripherally, 60 liver, 20 gut–healthy gut bacteria and gut function, 20% by healthy stress and adrenal management.

Evan Brand:  That’s cool, yeah, and so you mentioned the liver, that is a place where I actually would have not started with the–with the thyroid but I didn’t realize the–the huge percentage there.  I always look at the adrenal stress pictures so maybe I’m looking at the smaller piece of the pie when I should be looking at the bigger one.

Dr. Justin Marchegiani:  Yeah, I mean, the enzyme. 5-deiodinase enzyme–so deiodinase what it means is it’s de-i–it’s deiodinating meaning it’s pulling off an iodine molecule.  So when you see like T4, with the T4, the T stands for tyrosine which is an amino acid and the 4 stands for 4 molecules of iodine.  So when you’re deiodinating something you’re pulling off 1 iodine molecule.   So you’re pulling off 1 molecule off the T4, which then makes it the T3, and the enzyme that does that, that 5-deiodinase enzyme is selenium-based.  And a lot of that conversion happens in the liver.  That’s where that enzyme is most metabolically active.

Evan Brand:  And a lot of people are deficient in selenium.

Dr. Justin Marchegiani:  Absolutely, I mean, 2 to 400 mcg a day is gonna be a pretty good amount, and if you’re sitting there thinking well, I just gotta have 3 Brazil nuts, *beep*, the selenium content in Brazil nuts can range between ten-fold.  So you could have 3 Brazil nuts hoping to get 200 micrograms of selenium or maybe you’re getting 20 micrograms of selenium depending upon the soil it’s grown in.  So there’s quite a lot of variations, so really important that you’re on a good multivitamin that’s got 200 mcg of selenium in it just off the gecko.  And all of my patients are on a high quality, highly absorbable multi with 200 mcg of selenomethionine as our thyroid insurance policy.

Evan Brand:  That’s great, yeah.  I should probably switch mine.  I’ve been using just a standalone, because I’m not using a multi right now personally.  I’ve just been using a 200 mcg of selenium by itself.

Dr. Justin Marchegiani:  Nothing wrong with that, too.  So we talked about the thyroid, right?  Let’s talk about adrenal physiology, just so everyone kinda can wrap their head around it.  I wanna take these complicated concepts, break it down, and have people walk away with an action point.  So the adrenals, they sit right on top of our kidneys and they help manage stress.  And again, stress isn’t just emotional stress, it’s physical stress.  It’s also chemical which could be blood sugar, it could be infections, it could be inflammation.  And our adrenal physiology is we’re pumping out cortisol and that cortisol fluctuates throughout the day in a diurnal rhythm, meaning higher in the morning, lower at night, and that cortisol is there to help give us energy.  It’s there to help put out the fire of inflammation but our adrenals also put out significant amount of sex hormone, too, called DHEA sulfate.  And that sulfate is really important for healing, it’s really important for sex hormone output for female so a lot of PMS symptoms are gonna be caused by adrenal fatigue and we need healthy levels of cortisol to be able to help assist in thyroid conversion.  So that cortisol, if it’s too high, that cortisol will actually block thyroid conversion and increase TSH which is this brain hormone called thyroid-stimulating hormone.  So too much cortisol, we block that T4 to T3 conversion, and we have TSH go up.  And if we don’t have enough cortisol, then we’re tired already because cortisol gives us energy and it regulates blood sugar, if we don’t have enough cortisol for thyroid conversion.  And then typically in those patients, TSH will even look normal on a lab test but T3 will be low.  And you’ll go to your doctor every time, you go to your endo, and then they’ll tell you your thyroid’s fine when it’s not.

Evan Brand:  Yeah, actually, I just got a lab result back from a female patient yesterday.  She’s in her mid-30s.  She loves high intensity interval training.  She’s got everything pointing at adrenal issues, so we finally get the–the salivary results back.  Her cortisol is so low, man.  She’s in the 0-5 range in the morning and she’s just like 2-3 units per day.  The only thing that was in range was her nighttime level because she–just completely tanked at that point.

Dr. Justin Marchegiani:  Yeah, absolutely, I see that all the time.  So things that we’re trying to get across to anyone listening is so you get some thyroid symptoms.  Take a step back.  We gotta look at the thyroid, right?  Individually.  We gotta look at the adrenals individually.  So the test you want for the adrenals is gonna be a #201 by BioHealth, that’s a cortisol rhythm test.  And if people are having a hard time getting access to this test, they can reach out to you, they can reach out to me, and we can get access to these tests for them and evaluate it.  That’s step one.  The next test is a full thyroid panel.  That’s gonna be your TSH.  That’s gonna be your T4 free, your T4 total, your T3 free, your T3 total.   Ideally, a T3 uptake and reverse T3.  And thyroid antibodies because a significant percent of these patients, they’re autoimmune.

Evan Brand:  I think that’s awesome that you mentioned that and you’re never gonna get told to run that by your conventional doctor.  So once again we’re looking at this from a functional perspective, not the “Oh, your TSH is low or whatever, here’s some Synthroid.”

Dr. Justin Marchegiani:  That’s it.  That’s it and most patients because they’re autoimmune–what autoimmune is it means self attacking self, that your immune system is ramped up to the degree where it’s attacking the thyroid tissue and breaking it down and the problem with that is is people that have this autoimmune type of sequelae of symptoms, they’re in the middle of hyper to hypo because as the glands being attacked or stabbed if you will, the–the thyroid hormone is dripping out, creating hypersecretion because there’s a lot more dripping out if you will.  It’s kinda like to use the gruesome of like let’s say you–you stab someone, right?  A whole bunch of blood comes out in the beginning, but in the end the person’s empty and there’s no more blood left.  Think of thyroid as like that.  I know it’s kind of a gruesome analogy, but honestly you will never forget it and you’ll be able to wrap your head around, “Oh, I’m having a hyper-like symptom, oh, wait, now I’m hypo,” and you kinda go back and forth, you’re gonna think of those thyroid as like you’re basically your immune system is putting little knives into it and it’s dripping the hormone out, and you only got about 3-4 months of thyroid hormone stored in those follicles.  So once those follicles has been bursted for a long enough time, they’re eventually gonna run dry and you’re gonna start having more hypo-like symptoms.

Evan Brand:  Yeah, and if people had access to the video feed here, they would be laughing out loud at your–your–your hand demonstrations, it’s just an–a great–great analogy.

Dr. Justin Marchegiani:  I know, I’m like pretending I have a knife in my hand and like trying to s–and like motioning like I’m stabbing my thyroid gland, oh man, and just so everyone knows I do have Hashimoto’s so I can speak from experience.  I’ve had to make myself an expert on thyroid health because of necessity because conventional medicine typically offers nothing for it.  So–

Evan Brand:  Yup, you’re a wounded warrior, man.  Those are the best ones to see.

Dr. Justin Marchegiani:  Absolutely and I can tell–I can say with confidence that anyone watching this or listening to the show is gonna walk out of it knowing more than their conventional trained endocrinologist on–on thyroid issues from a functional perspective.  They’re gonna know more of the disease stuff of course, like you know, thyroid nodules and–and Graves’ and things like that, but the thing is, conventional medicine’s approach is pretty much 3 options, okay?  If it’s Hashimoto’s or hypo, it’s Synthroid.  Most people that are given Synthroid, that’s synthetic T4, they don’t convert it to T3, so they still have tons of thyroid symptoms.  Number two, if they’re Graves’, they’re typically gonna just want a thyroidectomy, pull the darn thyroid out, done, right?  Number 3, radioactive iodine, shut the thyroid gland down.  I mean, those are the 3 major options, or they’ll give like methimazole or propylthiouracil to help knock down the thyroid hormone levels, you know,  they’ll–they’ll get PT or something like that.  So those are like the 3-4 options that are in the cookbook of your conventional endocrinologist for thyroid.  There may be a rare thing left out there, you know, thyroid cancer, thyroidectomy as well, but that’s your general kind of gist, and the majority of people, 90% of people are gonna be in the hypo-Hashimoto camp and there’s gonna be underlying issues that are affecting the thyroid conversion outside of their control.  It’s not gonna be pathological, it’s gonna be functional and that’s where we come in to really get to the bottom of it.

Evan Brand:  Yup, so we alluded to the adrenal distress picture but I mean, what’s the other important picture, I mean would you look at something like adding in some liver support, I mean some milk thistle, if you’re gonna be helping take some of the load off of the toxin filtration process that the liver’s doing, is that gonna free up more energy so to speak, more fuel for the liver to do its job in thyroid conversion?  Am I–Am I thinking right there?

Dr. Justin Marchegiani:  Absolutely.  So a lot of times we’ll start out and we’ll run an organic acid test and we’ll be able to run various organic acid markers that will look at liver function like hippurate, glucarate, there’s about 6 or 7 of them, sulfate for instance, pyroglutamate for B12. so we’ll be able to run these different markers that look at methylation, that look at an–acetylation, that look at our detoxification pathways from a phase 1 to phase 2 perspective, so we can really get a window on how it’s functioning.  But typically off the bat because I don’t wanna get into supplement overload with patients, the first thing we’re doing is just clearing out all the liver stress from a diet and lifestyle perspective, alright, aspartame, all the junkie food additive, gluten, all of the crap that’s just in your diet, that has to go first, right?  Because our liver is always detoxifying, you know, giving detoxification support, you’re not, you know, turning on detoxification systems, you–your buffering it, you’re taking the stress off which can be helpful, but we always wanna make sure we’re stopping the stress from going in first, and then–then it’s probably better supplementing later.  So for me, I have a 3 body system approach where it’s hormones first and then part of that foundational layer, below that is diet, lifestyle and nutrition.  So that’s the first step that we’re looking at before we go deeper and there’s exceptions to every rule but that’s in general, the first step.

Evan Brand:  Yeah, I always like to geek out and go beyond because sometimes I assume that people have the diet and lifestyle picture figured out but a lot of people are still struggling with that.

Dr. Justin Marchegiani:  Yeah, I mean, I see so many of my thyroid patients, they’re just–their adrenals are shot and they are just so myopically focused on the thyroid gland that the forget about the adrenals and they forget about their female hormones, right?  We can’t forget progesterone, a female hormone is responsible or highly involved in TPO production, okay?  So TPO is thyroid peroxidase.  That’s an enzyme that actually helps build or make thyroid hormone.  It binds the iodine and the–and the tyrosine together and if we have super low progesterone, that’s gonna lower thyroid peroxidase activity.  So we’re gonna be making less thyroid hormone just by having lower progesterone.  And again, why do we have lower progesterone?  Well, because progesterone goes downstream to make cortisol if we’re under a lot of progesterone and that low progesterone in the second half of the cycle, right before during that week before you bleed, that’s your PMS time, well, that’s where PMS happens typically due to that progesterone falling out early.

Evan Brand:  And the reason that happens you’re saying is because you have elevated cortisol from excess stress, is that what you’re saying?

Dr. Justin Marchegiani:  Yeah, elevated cortisol in the acute phase and then chronically low in the–you know, lower in the chronic phase.

Evan Brand:  Uh-hmm.  So–

Dr. Justin Marchegiani:  Meaning the longer that stress has been going on, that cortisol bottoms out.

Evan Brand:  So when that cortisol bottoms out, what happens to progesterone then compared to when cortisol’s high.

Dr. Justin Marchegiani:  Well, progesterone’s a building block for cortisol.  So if we look at the adrenal hormone cascade, we see cholesterol as the first domino, like all hormones are made from cholesterol.  So don’t go on a low fat diet, vegan diet.  You will destroy your hormones.  I’ve seen it hundreds of times.  Again, some people do better on it than others and a lot of people feel better on a vegan diet because they’re coming from it–with a crappy standard American diet, so they see improvement and they think well, it’s the vegan diet, but no, it’s all the other crap they cut out.  That’s another podcast for another time.  But cholesterol first, conversion to pregnenolone.  Pregnenolone then gets converted to progesterone on the other side of the cascade and then progesterone gets converted to cortisol.  So you can see what happens is if we’re under more stress, this progesterone escape, this cortisol escape where that progesterone leaks down because it’s needing to deal with the cortisol stress.  The cortisol needs to be there to manage the stress and inflammation.  So I always tell patients, your body is hardwired to deal with the stress of today versus the healing of tomorrow, right?  Progesterone’s there for healing, it’s there for healthy brain and–and brain function and relaxation.  It’s also there for pregnancy, right?   Progestation, progesterone.  So all those are really important but if our bod–body is so stuck in the stress in the moment, tomorrow never happens because you’re always in this stressed out state.

Evan Brand:  And that’s a miserable place to be by the way.

Dr. Justin Marchegiani:  Oh, my gosh, absolutely.  So almost all my female patients, they come in with some degree of thyroid issue, some degree of adrenal fatigue, and then because all of these are connected, right?  These hormones function and dysfunction together, there’s a level of PMS and/or female hormone dysfunction along with it.

Evan Brand:  Uh-hmm.  Yeah, and then you were kinda alluding to the pregnenolone steal, if people wanna geek out and read about that, it’s an amazing–just to look at the chart of the hormones getting stolen and sex hormones are messed up and now your libido’s gone, and I mean, it’s just–everything goes haywire.

Dr. Justin Marchegiani:  Oh, my gosh, absolutely.  Did you wanna comment on that a little more?

Evan Brand:  Well, I was just a–I just think you’re doing a really good job of taking a pretty complex topic and breaking it down.  I mean, this is intimidating for some people to try to take this knowledge into their lives and apply it and you know, if they try to go back to their doctor with this information, you know, they’ll probably be just laughed at or maybe even, they’ll get their eyes rolled at.  “Oh, I heard this functional medicine doctor and this functional nutrition guy talking about this and just silly.”

Dr. Justin Marchegiani:  Exactly and just remember, right?  If you’re going to your doctor and you’re trying to get functional medicine help in the conventional medical model, you’re like banging your head against the wall.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  Alright?  It’s–it’s gonna be very, very difficult, right?  It’s trying to get your surgeon to not operate.  I mean, your surgeons are typically there to operate.  That’s what they’re there for.  That’s what they’re trained for.  And same thing with conventional physicians.  Conventional physicians are there to–most of the time just prescribe drugs unless they’ve been taking training outside the conventional medical paradigm.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So if you go there, you’re gonna find yourself having to educate your doctor more about this and again, why do you wanna sit there and educate your doctor about this when you can find people that are already educated?

Evan Brand:  I agree.

Dr. Justin Marchegiani:  I have patients all the time and they’re like, “Well, can you call my conventional doctor and–and talk to them about that?”  I’m like, “That is an act of futility.”  I mean, they can listen to this podcast but you’re much better off just finding people that are already in sync because then you don’t have to waste time.  So with that, the typical downfalls I see–most patients go to their doctor, they about adrenal issues.  Let’s say the topic of adrenal issues are brought out, right?  Conventional doctor, the first thing they go to is Addison’s or Cushing’s disease.  So Addison’s is an adrenal failure state, cortisol is almost non-existent.  And then Cushing’s is a hyper, hyper cortisol state, right?  Where you typically have elevations of blood sugar, you have the moon shape face, you have the buffalo hump in the back, you know lots of adiposity and that’s it.  So we have the two extremes, right?  So basically, you go to your doctor, it’s the one extreme on the high and the one extreme on the low, and the idea that everything in between is normal, that’s the idea.  That’s what it is and in the functional realm we realize that there are two extremes and there’s a functional spectrum in between there.  And the farther away you reach the high or low end, the more symptoms you have.  But the problem with that philosophy is that you may never each, you know, the high or the low end.  And what that means is that you’re stuck.  You’re never gonna get help.  You’re gonna be told it’s all in your head and there’s gonna be no solutions for you.

Evan Brand:  Right.

Dr. Justin Marchegiani:  That’s the problem.

Evan Brand:  Yeah, or here’s an anti-depressant, it’s just–that’s–that’s what we’re gonna do.  Yeah, so–

Dr. Justin Marchegiani:  And they’re just gonna just say, it doesn’t exist, so we wanna just differentiate adrenal failure versus adrenal fatigue, right?  Adrenal fatigue is more of the functional imbalance that may or may not progress into a disease state.  90% of people that have adrenal fatigue are never gonna progress into an Addison’s or Cushing’s state, it’s just not gonna happen.

Evan Brand:  I was gonna say–

Dr. Justin Marchegiani:  Those conditions are rare.

Evan Brand:  I was gonna say, I–I’ve personally never seen adrenal failure.  I’ve only dealt with the fatigue side of things luckily.  I mean, I don’t even know if–I don’t know.  I’m sure there’s people out there that are–that are in that, but I haven’t–I haven’t dealt with any.

Dr. Justin Marchegiani:  Yeah, so if you’re going to your conventional doctor and you’re having this conversation, just know that there’s gonna be a massive amount of backlash and there’s why, right?  Because of the–the differences in fatigue versus failure, right?  Adrenal fatigue is more of an HPA, right?  Brain talking to adrenal issue and also a stress feedback loop issue, right?  That’s number one and then on the thyroid side, well, most doctors are gonna run a TSH, which is a thyroid-stimulating hormone test which is nothing more than a brain test.  It’s looking at your pituitary.  So for instance, if we wanted to test something, it makes sense to actually test the hormone that the gland produces.  So for instance, if we wanna test your hormone function for your, let’s say your testosterone, right?  We would test testosterone, right?  We wouldn’t test LH per se, we would test testosterone.  That makes the most sense because testosterone is the actual hormone we’re looking at.  But LH, that’s the pituitary hormone that tells the gonads to make testosterone.  So why would we just look at LH when we can go look at the actual hormones being made.  Same thing, take that analogy now and throw it into the thyroid.  Why are we using brain hormones to look–to look at and assess the thyroid when we can actually test the T4 and T3 hormones individually?  Well, it’s just because it’s an antiquated way.  It’s what we were able to test first and it’s kind of the whole model of drug-prescribing is based off of that.  So it’s a very end-stage approach.  We’re look at the disease pathology, the high and low versus the functional imbalances that happen in between.  So we wanna live on the in between side, you know, all of the functional imbalances in between not on the high and low side.  Most patients that come to see us, they’ve–if they’re on the high or low, they already know it and they’ve been prescribed and typically many of them still don’t feel better and they still need answers.

Evan Brand:  Yup, and we do.  We do get them back into that functional range and it’s amazing how much you can feel better.  Even something like optimizing vitamin D levels has been huge for–

Dr. Justin Marchegiani:  Yeah.

Evan Brand:  Like my grandpa.  He was having a lot of chronic low back pain issues.  I found a couple of studies linking the two and we upped his vitamin D, re-tested and now, you know, he’s better.  He’s got some other inflammatory issues going on, but I mean, just getting back in the functional range of everything one at a time is just–it’s the way to health and healthy people do exist and it is possible for you to get better out there.

Dr. Justin Marchegiani:  Yeah, and a lot of people for instance aren’t getting the help they need from a functional perspective in the thyroid community, in the conventional community, because most thyroid issues are autoimmune in nature.

Evan Brand:  Uh-hmm.

Dr. Justin Marchegiani:  So because they’re autoimmune, giving a thyroid hormone does not fix the immune system destroying the thyroid tissue and then the inflammation that’s then created by that then affects conversion of T4 to T3, it then affects receptor site uptake, so it affects the hormone from binding into the receptor site so a hormone has to go into this receptor site to have a metabolic effect, kinda like your key is useless it goes into the lock and turns.  It’s kinda the same thing and autoimmunity is affected by things like gluten and potentially dairy and infections and selenium levels and nutrient levels and leaky gut, and all of these things that are functional medicine issues and they will never ever be touched upon in the conventional medicine community.

Evan Brand:  Yup.  So just a quick question, I know we gotta wrap things up here–people that are listening, they may just feel like, “Wow!  This Synthroid is killing me.”  Going cold turkey on Synthroid, what are the–what are the complications or issues there?

Dr. Justin Marchegiani:  Well, again, if you’re prescribed a thyroid hormone by your conventional medical doctor, most of the time, 99% of the time you need it because they’re using TSH as a established range to dose thyroid hormone.  The problem with that is is that TSH takes about 5-10 years to go high.  So most of the time, your thyroid issues have been going on for almost a decade.  So you don’t ever wanna come off thyroid hormone if you were prescribed it but you wanna find in someone like us.  Now typically what I do off the bat is I don’t ever take them off their thyroid hormone but we may change and put them on a full spectrum thyroid hormone, where they’re getting T4.  The same T4 levels, not that touching that at all, but also adding in some T3 as well, and then also looking at the adrenal side of the fence.  And most people that are dose thyroid hormone based on TSH, they aren’t given enough thyroid hormone.  So if the gland has been destroyed for a couple decades or a decade or so, they may need thyroid hormone because the B cells, alright, the immune cells have infiltrated that thyroid, they’ve destroyed, they–now the tissue has gone fibrotic, it’s now scar tissue, and it’s no longer functional.  Again, we may be able to get recovery back, but if we don’t have recovery, we gotta make sure we’re getting enough thyroid hormone for healthy function.  So we always wanna make sure we’re getting enough thyroid hormone but we don’t wanna base it off a TSH per se, we actually wanna use our T3 free and T3 total to look at how much active hormone we’re actually making.  That’s gonna be the best way to do it.  Don’t look at TSH.  Your brain is much more sensitive to thyroid hormone than the peripheral tissue.  So what happens is, the thyroid hormone, the TSH will actually go lower in response to the thyroid hormone.  So your thyroid hormone may not be quite where it needs to be for optimal function in that T3 reference range, but your TSH may go low because your TSH and your thyroid or inverse, right?  TSH goes high when thyroid’s low.  TSH goes low when thyroid’s high.  So if we see the TSH drop, most doctors go, “Oh no!  We’re giving you too much thyroid hormone.  You’re overdosing.  You have Graves’.”  But just look at the T3.  Most of the time we’ll see the T3 in the top half to the top 25% of the range.  It’s not even high but most docs will just jump to that conclusion, you’re given too much without actually looking at the hormones individually, which drives me nuts because it’s like they’ve–if we can look at the direct temperatu–if we can look at the direct measurement of the hormone, let’s do it.  And the analogy I give my patients is, using a TSH as a gauge for thyroid hormone levels is like going outside and feeling the sidewalk to detect what the temperature is, right?  So the sidewalk’s always gonna be way hotter than what it is, right?  So we have this extra sensitivity thing going on.  And why the hell touch the sidewalk when you–when you can just look at the thermometer or pull up your weather app on your phone, right?  We have much more sensitive ways.  So don’t go outside touching the sidewalk, go and look at your app for the temperature.  Same thing with your thyroid.

Evan Brand:  That’s awesome.  I was waiting for the analogy, man, and I’m pumped.  That’s a great way to wrap this thing up.

Dr. Justin Marchegiani:  That analogy like hit me 2 weeks ago and I was like, “Eureka!”

Evan Brand:  That was incredible.  I was thinking the whole time we were going through this I was listening but I was trying to visualize an analogy and I was drawing a blank.  So you really killed it with that one.

Dr. Justin Marchegiani:  Yeah, ex–yeah, thank you.  And I just want everyone that’s in the conventional model and trying to get help, I know how it feels.  It’s ridiculously frustrating.  I have so much empathy.  Don’t bang your head against the wall.  I want you to have compassion for your medical doctor and to understand where they’re coming from.  They’re just coming from a different place, okay?  So if you need the functional medicine support to heal which the majority of people do, then we need a different and your MD may not be the best person to get that approach.  Get all the pathology stuff ruled out first.  We wanna make sure nothing’s being missed from a global pathological standpoint, like a cancer or something, maybe an over, you know, hypothyroid issue like TSH through the roof or something.  But once that’s been addressed, they gotta reach out to people like you and people like me to get this stuff under wraps.

Evan Brand:  Definitely.

Dr. Justin Marchegiani:  So I know, I–you know, went into like professor mode today.  We’re gonna have this stuff all transcribed, so go back, take a look at it.  Read it a few times.  We’ll do more podcasts on it.  People who have more questions, let us know.  We’re gonna be happy to break this down.  I want everyone to walk away with an action item.  So action item is get a full thyroid test, get a full adrenal test if you’re on the fence.  That’s your first two things to do and then from there, we can talk about options about what the next steps are.  But those are your first 2 options and if they need it, they can get it from me or from you.

Evan Brand:  Yup, sounds great.

Dr. Justin Marchegiani:  Evan, do you want to add some stuff?  I feel like I was just an absolutely ball hog today.  I’m so sorry.

Evan Brand:  Oh, no.  No, perfectly fine.  I’m sitting here loving it, man.  It’s been great.  No, I just want to say that, you know, the main thing is that you’re–you’re taking baby steps in the right direction.  So maybe you’re on the fence about this, you’re looking into the testing, that doesn’t mean that you should wait until you get testing and you actually get a piece of paper that says you need help.  It’s okay to go ahead and start helping yourself right now.  Removing the gluten if you’re still eating that.  Removing the excess stimulants if you’re doing that.  If you’re speeding 30 miles over the speed limit today on the highway, reducing that, you know, all of these lifestyle things that we’re going to recommend you anyway, go ahead and get started on some of those now.  If you’re speedometer or your RPM in your car is red lining right now, you have the power to turn that down and get yourself out of the red line.  Take a hot Epsom salt bath or something this evening, you know.  Get that red line down, start calming yourself down and getting yourself ready for the therapy that we’re gonna put you on anyway and you’re really gonna help accelerate your results.  You’re gonna get better faster and at the end of the day, that’s what we want.  We wanna help you get well as fast as possible, but in an ethical and you know, an intelligent way.  We don’t just wanna come in with huge jackhammer.  So just slowly work yourself there and–and start–start swimming now and we’ll meet you at the other side.

Dr. Justin Marchegiani:  Absolutely.  And you forgot to mention how important consuming the grass-fed leprechauns are.

Evan Brand:  Grass-fed leprechauns, yup.

Dr. Justin Marchegiani:  Alright, everyone, hope you enjoyed the show.  Check out the transcription, beyondwellnessradio.com, notjustpaleo.com.  Thanks everyone and have a great day!




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