Thyroid Testing and the Importance of TSH | Podcast #214

There are different symptoms of thyroid issues that need to be considered in thyroid testing. These are symptoms that are subclinical, the less talked about and the typical. A bit overrated? Find out more and learn from Dr. J’s interactive and live podcast!

Today’s podcast talks about thyroid tests and the importance of TSH. Learn about the symptoms of thyroid issues, the physical assessment of thyroid gland or palpation, addressing different TSH issues and all other factors that may affect thyroid functions. Stay tuned for more!

Dr. Justin Marchegiani

In this episode, we cover:

00:42    Thyroid-Stimulating Hormone

02:38    The Less Talked About Symptoms of Thyroid Issues

03:57    Physical Assessment of the Thyroid Gland

04:36    Poly Autoimmune Conditions

05:40    Indicators used by Endocrinologists to Assess Thyroid Hormones

07:42    Optimal Thyroxine Conversion

08:47    Addressing High TSH Volume

12:32    Other Factors that Affect Thyroid Functions


Dr. Justin Marchegiani: Hey there it’s Dr. Justin Marchegiani. Today, we are doing a live podcast. We’re gonna be talking about thyroid labs and TSH. Why is it important? Why is it- maybe a little bit overrated. We’re gonna go into this. And again, make sure you hit the thumbs up, give me a uhm- subscribe, hit the bell as well so you get notifications. I’m one of the only health professionals that sees patients and does lot of these live, interactive podcast, slash Q&A hybrids. I really wanna get lots of uh- interactive involvement, and I wanna get your feedback, I wanna get your thoughts and I wanna interact in the podcast live information so we can make it even better. Alright, so, let’s dig in.

So, when we’re sessing thyroid function, you know, one of the big obvious things that we’re gonna do is- is blood testing, to look at your thyroid. Now, even before that, you may have thyroid symptoms, you may have cold hands or cold feet, you may have hair loss, outer third of the eye eyebrow issue, you may have mood issues like brain fog, mood issues, depression, constipation, those are more of a subclinical, meaning, let’s say- a typical, like they aren’t typically- they are what comes to mind if you go see your medical doctor when it comes to thyroid. The typical ones are gonna be cold hands, cold feet, hair loss, for sure. The depression, the anxiety, the mood issues, uhm- the constipation, low or slow bowel motility are typically gonna be less talked about, just FYI.

So, we’re gonna- maybe do a palpation. They’re gonna look for thyroid swelling. They’re gonna look for thyroid inflammation. Why would that thyroid be swollen? It could be because TSH is elevated. TSH is the whipping thyroid hormone. Its the- it’s the person that sits on the horse-carriage that whips the horse to make the horse go faster. Think of the conductor whipping that- the harder, and the more he whips that, that’s like TSH going up, tryin’ and get that thyroid to make some thyroid hormone, typically T-4 – tetraiodothyronine. T-4, tetra means 4, ‘kay? And then iodothyronine, so that’s 4 molecules of iodine bound to typically uh- thyroxine molecule that makes your T-4, your active thyroid hormone. That gets converted and activated down the road with the 5-deiodinase enzyme that’s selenium-based, so we need selenium. And we need other nutrients like vitamin-A, copper, zinc, magnesium, uhm- ye- yeah, Vi- Vitamin-C, uh- typically some glutathione, maybe some superoxide dismutase, a lot of good compounds there that are really designed to help with that conversion. Also, cortisol imbalances, too high or too low, same with insulin, too high or too low can also thwart that thyroid conversion.

So your conventional docs’ gonna- number 1, kinda do an audit of your symptoms. Number 2, they’re gonna do some palpation to look at the swelling, could be high TSH, could be an elevation in thyroid antibodies, TPO, thyroid peroxidase , or thyroglobulin antibody. And that could be whipping the thyroid- not quite the same as the TSH but more like someone putting daggers or stabbing your thyroid, your antibodies actually attacking. So TSH is different ’cause that’s your pituitary talking to your thyroid but raising the volume, and that can cause swelling if the TSH goes too high, then we have the thyroid antibodies which are your immune system coming in for the attack. And that’s really trying to attack the thyroid, that’s a little bit different ’cause that can actually cause a lot of long-term damage as well, and a lot of that functional thyroid tissue that makes thyroid hormone can really be impacted and produce less hormone overall, and you may need to actually be on thyroid hormone for a longer period time, if not, your whole life, depending on how long an autoimmune attack’s been going on. For most people that I see, there’s been an autoimmune attack to some degree for at least a decade, typically, before I see them. So, tends to be happening at a very subclinical level for many years, before people even notice any symptoms. That’s kind of a scary thing about it that can be going on for such a long period of time.

Alright, so we talked about kind of the physical assessment, right? They may have you swallow some water, they may palpate just above and below the Adam’s apple while you swallow. So here’s your Adam’s apple, they’ll go and just- maybe just a centimeter or so outside. And they’re feeling, if there’s any nodules, right? Typically, you’ll just feel like a little bump, it’s a nodule, they’ll feel if it’s swollen, where- it’s just- it’s a little puffy, it’s sticking out more the normal. Of course, you need a- a baseline to know what normal feels like. But when it feels a little bit more puffy and kinda sticks out a little bit, once you feel a couple of normal, once you can get an-  a sense of what that feels like, and looks like.

Now it’s a poly autoimmune, TPO thyroglobulin. It could also be potentially Grave’s, but that’s usually a- a minority percent of the cases, usually 1 or 2%, 90, 95%+ are gonna be hashimotos in origin. Now, hashimoto’s is an autoimmune attack that involves TPO and thyroglobulin, and it tends to fatigue the thyroid out overtime, but you can’t hyper off the bat, and then, the Grave’s tends to affect the receptor sites or the stimulating imm- immunoglobulin that causing the thyroid to make more thyroid hormone. Hashimotos can feel like Grave’s in the beginning, so it’s really tough to know the difference. Typically you’re gonna be looking at TSI and thyroid receptor site antibodies to differentiate the two. Again, hyperthyroid symptom with hashimoto’s isn’t that big of a deal. With Grave’s it could be a bigger deal because it can cause potential stroke, because you can really ratchet up those uh- thyroid numbers very-very high, much higher than you could with let’s just say hashimoto’s type of an attack, but, always good to get both of that asses.

Now, most people that are going to see their doctor, they- they’re kinda in this “no man’s land” where the first thing that’s really being looked at, to assess what’s going on is TSH. Now, I mentioned earlier, TSH is like the whipping hormone, right? That’s the con-  that’s the person in the- in the carriage whipping the horse, right? So, they’re looking for that- that whipping to start going up a little bit above. Now, according to the American Clinical Association Endocrinologists, AACE for short. AACE, anything above two and a half, may be a problem. So, we start looking at things a little bit more closely, once the TSH goes above two and a half… me, about 3. Once it’s going above 3, I’m a little bit perked up and I’m paying very close attention. Now, conventional endocrinologists typically won’t care until it goes above 4 and a half, to 5 and half. I always tell patients, “The easy way to cure your hypothyroidism, if you’re diagnosed ‘conventionally’, is if you have a high TSH on the west coast”. Remember, the TSH on the west coast is a 4 and a half. You go to the east coast, its 5 and half. You have a 4.75 on the west coast, think of ship from L.A. to Boston and now you’re cured overnight. I wish it was that simple though, that, seriously, you’ll see in the lab-reference range that changes that easily. So, 4 and a half to 5 and a half I think is a little bit late when it comes to assessing thyroid hormones. Some don’t even care ’till it goes even 10 or even above. So, we like to use that TSH of an indication of 3- 3 or so. But we also wanna look downstream, you wanna look at T-4, 3 and T-4 total. We wanna look at how much hormone that the thyroid actually making. ‘Cause sometimes we see TSH high, right? And then we see T-4 is adequate. Meaning, okay, the thyroid is compensating by making enough thyroid hormone, but it’s having the whipped at horse a lot. Meaning, “Hey, that horse is going that normal speed, but having a whip it a little bit more than we should”, meaning, we’re eventually gonna fatigue that horse out, over time if we have to maintain that level of whipping. So that goes, okay, good- so the horse is able to do its thing, but, over time it’s not a good thing if we whip it that much.

And then we have some areas where we see T-4 starting to drop. And that’s a concern ’cause that tells me that, alright, we’re overstimulating, we’re over-whipping, and the thyroid is still not motivated enough even with that stimulation to make more thyroid hormone, that’s a concern. We also have to look at the conversion downstream ’cause some people, we see, okay, that T-4, that horse is going a good speed, but the conversion to T-3, the active thyroid hormone, doesn’t really fit into the horse analogy, but that active T-3, T-4 is relatively inactive, 300% more inactive than T-3. That T-3 has to convert, and has to- you go from typically like uhm- a T-4-free, and like, let’s say around 1 to 1.5, that has to convert downstream to T-3 and about 3 to 3.5 . And if it starts dropping below that where we have a good level of T-4 around 1 to 1.5, and that T-3 drops into the low 2’s, we got a problem, ’cause that’s a relatively active thyroid hormone being that T-3. So we have to make sure it’s converting optimally, that’s number 1.

Number 2, we have to also address the TSH. We hope- we won’t want the volume of that TSH to be so high. We wanna get that under control as well, and we also wanna make sure the T-4 is good and the thyroid conversions’ good. So, we’re looking at TSH, we’re looking at T-4, number 2, we’re looking at T-4 to T-3, number 3, and then number 4, we’re looking at thyroid antibodies, is that TSH being attacked, or is that TSH compensating because that thyroid that’s being attacked in the hormone is not quite optimum. And then number 5, the 5th variable is gonna be reversed T-3. Are we converting some of that T-4 to reverse T-3? So, we have TSH is the first domino, T-4 is the second domino, T-3 is the third… this is where the T-4 to T-3 co- conversion happens. Zinc, selenium, magnesium, healthy CoQ10, uhm, of course glutathione’s gonna be involved, superoxide dismutase, uh- co- uh- cortisol and insulin. This conversion happens here, we have the sub-conversion which is reversed T-3, and this is the blanks in the metabolic gun. So when we see T-4 going to reverse T-3, that reversed T-3 congest and blocks up that thyroid receptor site and prevents active T-3 from going in there. This is vitally important if we have thyroid issues.

So, most conventional medical docs are looking at TSH, that’s it. Maybe they look at T-4, but, they’re not really looking at it in depth, they’re not running T-4, 3 or total, they’re not looking at the conversion downstream and give very rarely have thyroid antibodies looked at because, well, thyroid autoimmunity doesn’t matter, we’re not gonna do anything from a conventional standpoint, we’re not gonna give immunosuppressant drugs, we’re not gonna give corticosteroids typically ’cause the side-effects are worse than the actual disease. So they’ve kinda made- let’s just say an analysis that we’re gonna save those from more serious autoimmune conditions like crohn’s or also the colitis, those kind of things, ’cause the medications aren’t warranted for the symptoms. But, the problem is, if we see autoimmunity which we know about 50 to 90% have an autoimmune mechanism involved, that means a lot to us functional medicine docs. Why? ‘Cause we’re gonna look at leaky gut, A.K.A. gastrointestinal permeability. We’re gonna look at infections, we’re gonna look at gluten sensitivity, we’re gonna look at certain nut- certain nutrient-deficiencies that are really important for autoimmunity such as low zinc, low selenium, low CoQ10, really important nutrients to run our thyroids. And also CoQ10 is gonna get blocked if we’re taking a statin. So of course if you’re taking any statin medications, you’re gonna have some problems with your thyroid as well, ’cause you’re not gonna make your own internal CoQ10.

So, kinda recapping, right? Conventional analysis, alright: analyze symptoms, palpation. Palpation’s only gonna be good if there’s an extreme autoimmune attack, and then of course, uhm- they’re gonna assess, maybe run TSH, T-4, if you have a better doctor whose assessing the autoimmune stuff, they may run a thyroid ultrasound. Okay, great. So now, we get in assessment of inflammation, typically, not too much will be done with that because the drugs typically are worse than the actual symptoms of the autoimmune thyroid. Next step is how does that hormone cascade look? TSH, T-4, 3, and total. T-3 for you and total, reversed T-3, thyroid antibodies only can even look at T-3 uptake as well. We wanna look at the whole kit and kaboodle. Now, if you wanna dive deeper I’d refer you to other podcast where we can look at adrenal halve ’cause cortisol plays a huge impact. We also know as a female, right? Estrogen-dominance, alright, A.K.A. higher estrogen, lower progesterone relatively speaking.

Progesterone has a big impact on thyroid function as well. And then we add in the elements of insulin-resistance, excess carbohydrate, insulin resistance or reactive hypoglycemia, can exacerbate autoimmunity, affect thyroid conversion as well, and obviously deplete a lot of nutrients just through having a run more glycolysis for our fuel. We tend to burn up a lot more B-Vitamins and magnesium and really important minerals. And then if we add in the extra vector of hypochlorhydria, those stomach acid from gut infections, then it makes it even more apparent, that we don’t have enough acidity to ionize our minerals, get ’em into the blood and be able to breakdown, absorb and digest our fatty acids, cholesterol and amino acids, so it’s quite the cascade. So, most people need to get the full thyroid workup, ge- go to your conventional doc, fine, get at least the big things ruled out. But then once your- once your to- hey, it’s all in your head, you really wanna go see, or they don’t give you much of an option, or maybe they just say, here’s some centroid, the other option with that is a lot of people, when we talk about that T-4 to T-3 conversion, my clinical experience is about 80% don’t make that conversion optimally because of all the other important nutrients that are involved in that conversion. So that’s why you gotta look at the full, complete picture. And most people, centroid won’t get the job done and may make your TSH look pretty, meaning get it back below- get it back to about a 1, but it may not help the rest of that hormone cascade because the conversion is not there, it’s just T-4, and many people don’t have all the other nutrients to make that conversion downstream.

Alright, so I’m live here, I’m gonna open it up to some questions in the topic of thyroid, thyroid health and anything that we can tangentially connect back to thyroid and thyroid lab testing. So, let’s go dig in to what the listeners have to say here, will be got y’all.

Neem writes in, “Low TSH, insulin, bile and cholesterol due to chronic infection, any recommendations?”, yeah. So if TSH is low, that means your hypothyroid, your- your- I mean your pituitary is going basically low, right? You- almost the hypopituitary issue, and if you’re not taking too much thyroid hormone, it’s probably just because of stress and cortisol and inflammation so you have to get the diet right, get the adrenals right, and get the gut right. So, 6 hours on the gut, remove the bad foods, replace the enzymes and acids, repair the gut lining and the hormones, all of it, thyroid, female hormones and adrenals, and then eventually deal with body system too and getting rid of the gut infections.

Hey Ahmet, hope you’re enjoying today’s show. Uhm, Soupper writes in, “Hashimoto’s, high cortisol, please the Vitamin-C”. So, yeah, Vitamin-C’s helpful, I have no problem with that, it’s gonna help with inflammation, no problem there.

Justin G writes in, “Hi Dr J. I am 64 Male, low to normal T-4 and T-3, 6.4 TSH. No swelling, no symptoms other than anxiety. No meds taken. Some evidence of autoimmune antibody. Doc says monitor without meds”. So if you’re having some thyroid symptoms, personally, with low normal T-4 and T-3, I’d wanna know is there any antibodies at all? You mentioned some evidence of autoimmune antibodies, so I wanna know what those levels look like, and I would definitely add in a little bit of bioidentical thyroid hormones to knock that TSH down. I didn’t go into this but I think it’s important. A lot of doctors get freaked out over TSH going too low. I had a patient just before I jumped on today’s uh- live podcast, whose doctor was concerned about TSH that was too low. And this is the problem when were you- actually using thyroid supports, sometimes that TSH can go too low because we’re supporting the thyroid, that the brain saying, “Hey, we can lower our volume because the thyroid’s getting extra support, so let’s lower the volume”. Now, when that TSH go so low, let’s say below .3, a lot of doctors get concerned of grave disease. Remember, we talked earlier, grave’s is uh- autoimmune attack where it affects TSI, thyroid stimulating immunoglobulins, or TSH receptor antibodies where it stimulates the thyroid to make more thyroid hormone. So when they see TSH low, they’re thinking that maybe a grave’s attack that’s hyper stimulating the thyroid. But, really, it’s just we’re giving a little bit of thyroid hormone and we’re- we’re focusing on the thyroid hormone being in the therapeutic range and not necessarily worried about the TSH being in the right range. The problem is, TSH, when we give exogenous thyroid support or hormones, the TSH tends to be more receptive to these exogenous hormone than the actual tissue is. So, what does that mean? My analogy, my famous analogy is, go outside and try to figure out on the hot- in the hot day, what the temperature is by touching the sidewalk. Well, the sidewalk conducts heat, more or better than the air temperature does. So, a hundred degree outside in Austin, is gonna be like a hundred and seventy degrees or- like a hundred and fifty degrees sidewalk. So, your pituitary is like the sidewalk in this analogy, it’s more sensitive and picks it up so, you tend to see a lower TSH when we give thyroid support. Now, problem is, if we base everything off a TSH, we tend to be under supporting the thyroid hormone levels. Meaning, if we’re shooting 50% to 25% of the reference range, right? So if we have a range of let’s say T-3, T-3 is like between 3 and 4 and a half. Let’s say we’re shooting for 3 and a half to 3.75, we may undershoot it if we’re trying to just hit the TSH. So, essentially, you wanna look at the thyroid hormone, you wanna look at the TSH too. Ideally if we can have the TSH not go below .3, maybe ideally have it settle around 1, that’s great. But sometimes, my patients that, their TSH is at 1, but they still have low thyroid symptoms, we go up another grain with their thyroid support and it’s like boom, the symptoms are gone. So, what should we do? Should we make the TSH in the lab look pretty? Or should we focus on the patient’s clinical outcome, their symptoms, and their actual thyroid hormone levels. Meaning, let’s say they’re in the top 25% of the range, that’s where their symptoms go away, but at the top 25% of the range for T-3, 3, that may cause your TSH to go a little bit low. But if we go let’s say, 50% of the range for T-3, their TSH looks perfect but some symptoms creep up. So you got to gotta weigh out all the options. A lot of doctors, even some natural ones, prioritize TSH over the patient’s symptoms and thyroid values. I weigh both of them up. Sometimes we can do both, sometimes we can’t. So we have to look at all of the issues. Are we addressing the adrenal issues, check. Are we addressing the thyroid issues, check. Are we addressing any female or male hormone issues, check. Are we fixing the gut, check, are we supporting the nutrients that help the thyroid get better? Are we supporting blood sugar and insulin resistance. If we have to look at the whole, entire picture, if you just look at the thyroid and your whole treatment plan off a TSH and these numbers and that’s it, maybe missing the forest for the trees, so to speak. So, we gotta have a complete perspective we have to take, the TSH and the T-4 and the T-3, all in context ’cause most people on the conventional side, they prioritize the TSH, partly because that is the main thing they are looking at to analyze grave’s, and I think because conventional medical doctors are conce- overly concerned about grave’s ’cause it can mean stroke or heart attack, so they are v- you know, are thyroid storm essentially, so they are hyper focused on the TSH where in- in functional medicine land, we look at the the full thyroid hormones typically, so if there is grave’s we’re gonna see it down the road with T-3 being excessively high, and our T-4 being excessively high, and then we’re rule it out by ordering additional thyroid stimulating immunoglobulin and TSH receptor antibodies as well. We won’t just ever take it for granted.

Okay, let me keep on rolling guys. I went into a pretty in depth on that one, but hopefully it was helpful. Uh, “T-4 to T-3 conversion issues?”, yeah, that’s gonna be nutrients. Uhm, the 5-deiodinase enzyme is gonna be an important enzyme, it’s selenium-based. It comes from the liver. So liver stress, liver issues, toxic livers, low selenium, low glutathione, uhm- magnesium, zinc, important digestive nutrients and minerals, Vitamin-A, cortisol higher or low, insulin too high or too low. And this is probably why lower carb can sometimes cause low thyroid symptoms, we had a little bit of starching, boom, low thyroid goes away, or the other way around. We see high blood sugar, we get the blood sugar under control, we go on a keto-paleo template, and then boom, magically, insulin gets better and thyroid gets better too. So we gotta look at everything is connected, alright?

Uhm- pa-pa-pa, Ahmet writes in,”Hypoglycemia, autoimmune relation…”, yeah, so when you have reactive hypoglycemic, blood sugar swings, this is when you make- consume too much carbohydrate, alright? Not enough proteins or fat, or you’re just going too long between meals and then you’re eating a bunch of carbs, blood sugar goes up, and then your body over secretes insulin and it crashes. And the crash is the reactive part, meaning, you’re going, you’re reacting into low blood sugar because the pancreas made extra insulin. And that drop creates lots of cortisol, lots of uhm- adrenaline to bring that blood sugar back up. So, what you’re seeing is lots of cortisol and blood sugar, cortisol and adrenaline surges to bring back up that blood sugar if you will.

“Would very high TSH and normal T-3 and T-4 in postmenopausal women mean adrenal issue due to estrogen dominance?”, “Would very high TSH and normal T-3 and T-4…”, potentially, I mean, it’s one thing that would be on our checklist that we’d wanna cross often. Make sure it’s not a vector. So, yeah, it’s potential but it could be autoimmune, it could be other things with the adrenals too.

Uh, “Best grave’s treatments?”. So, I mean, we treat grave’s the same way as we treat hashimoto’s in general. Of course, if thyroid hormone’s really high, we may recommend PTU or methimazole which is a- the conventional drugs that actually block iodine uptake, or we may use more natural things like carnitine, or lithium lithium orotate, uhm, or blue flag, various herbal compounds. Again, it just depends on how severe, how bad the symptoms are, and we wanna look at the numbers. Make sure they’re not too high. Typically, refer out to an MD just to get stabilized while we work on all the other underlying things, gluten as well is a big one. But you wanna have a good conventional MD as well as a functional MD. The problem is, a lot of conventional MD’s can over-freak out, and sometimes I had some patients get recommended to get their thyroid removed right away, which is a terrible move, right? You kinda- you gotta understand what’s going on here and try to give the body a chance to get back in the balance as long as the levels, let’s just say aren’t excessive, and we’re having cardiovascular issues, worst case, we use a medication to stabilize while we go deeper.

Uhm, Sherry write in, “Do I still have grave’s disease if my thyroid has been completely removed; it’s been 2 yrs and my levels are all over the place”. So, number 1, you never actually get your thyroid all the way removed. Getting your thyroid removed is like ripping up gum on your shoe. And it’s probably always gonna be some, and some of it can grow back, not all the way but you may have some grow back. And then number 2, the underlying autoimmune stress is still there. So you have to get the autoimmune mechanism whether it’s leaky gut, or other nutrient issues or gut permeability or infections or foods, you have to slow, get the underlying mechanism removed, right? Why there’s grave’s or hashimoto’s, or an autoimmune thyroid, a- happen. Well, what happens, ’cause the conditions are just right. If I remove my thyroid, does that change the conditions being just right? No, it doesn’t.

Lisa writes in, “What are appropriate levels for reverse T-3?”. Ideally between 10 and 20. 12 and 20-ish.

Yoli writes in, “Dr. J., my lymph node on my neck is swollen and it’s uncomfortable and painful what can i do if anything, uhm, to help… and can I continue doing my sinus rinse?”. Yeah, continue doing your sinus rinse. Obviously there’s swollen lymph nodes in this area, so there’s obviously bacteria or your lymph system and your macrophage are trying to gobble up stress in the throat area. So, adding ginger, add natural things are gonna help with flushing out the lymph. You could do lymphatic massage right here by the back angular of your jaw, and you can just do kind of clo- kinda clockwise turning and massaging, like this, and then you can just drain one side right into the- thoracic cavity, and just drain it all down, that’s helpful. You could also add in some burdock tea which is great for the lymph, and or ginger tea, and you can even throw in some red roots or red clover is great for the lymph. But something is going on with your immune system it’s attacking stuff, and it could just be bacteria and junk that’s making you sick so continue with the sinus rinse because any mucus here can go down the Eustachian tube and then- and then go to your ear and create an ear rakes, so you wanna keep your sinuses flushed out with Xlear and Neomed, that’s fine. And also make sure you’re doing the ginger and/or some immune support or you can even do some Reishi mushroom to make sure you are fully supported.

Emmah writes in,”Graves’, pins and needles on my feet. and extreme discomfort. Hair loss and eyebrows. On neurontin, not as effective anymore”. So, yeah, you gotta go see a conventional MD. More than likely Emmah, all the issues that we talked about in today’s podcast are happening to you, and you need to get a full workout to see which one’s are the top priorities.

Roshan writes in,”Outside of hashimoto’s, what are the hardest to cure thyroid issues? Are most thyroid issues completely curable?”. Uhm, it just depends. The more severe the autoimmune attack is, obviously the harder, especially if- it’s because of infections and leaky gut, and there’s lot of other autoimmune conditions like let’s say you have, uhm hashimoto’s but you also have rheumatoid arthritis, or crohn’s, right? It’s something called PGAS, polyglandular autoimmune syndrome. If you have one autoimmune condition, there’s a- a 76% chance that you have a second autoimmune condition. And if you’re a female, it’s even higher. Uhm, females have issues because of the fact that they have more estrogen than guys, right? Part of the reason why they’re fertile and the women, in general, that higher amounts of estrogen can throw off the CDH, CD4 cell balance and make them more prone to autoimmunity. So, that estrogen can really have an effect in the- and the more the estrogen dominance goes into effect, the higher risk of autoimmunity, ’cause that CDH, CD4 ratio. CDH being the natural killer cells, the T- uh- the CD4 being the natural- or the helper cells. When that balance goes out of whack, increased autoimmunity, that’s why estrogen dominance is such a big deal and needs to be addressed. And again, that also includes environmental estrogens, right? Pesticides, round-up, uh herb- herbicides, rodenticides, uh- fluoride in the water and junk in the water, birth control pills in the water, hormones in the meat, all of that stuff, hormones in the milk, all of it.

Rhonda writes in, “Is it bad to have any TPO antibodies? My levels are 9”. No, that’s okay. It’s natural to have some antibodies because there’s a natural recycling process that happens, we just don’t want it to be excessive. So, like LabCorp uses a range of I think 34 or higher as positive. I think Quest uses 9, so I typically say keep it below 15-ish, and that’s pretty good.

Roshan writes in, ” How do fungal or bacterial infections drive hypothyroid?”. Well, I mean, bacterial and fungal issues can increase leaky gut, of course, bacteria contains lipopolysaccharides, fungus consain- contains acid aldehyde and mycotoxins that are put stress in the liver, uh, more leaky gut, and of course they can eat and uhm, that cause malabsorption of nutrients as well.

Paul writes in, “Could Hashimoto’s cause Crohn’s? Or other way around?”. Well, no, basically, hashimoto’s and crohn’s are the effect. None of that’s the cause, right? These are the effect, crohn’s, hashimoto’s, rheumatoid arthritis. The underlying cause can be a combination of genetic predisposition, which is then triggered by gluten sensitivity, by cortisol fluctuations, by insulin resistance, by inflammation in your diet, by high amount of Omega-6 to Omega-3, nutritional deficiencies, gut infections, poor sleep, right? So, of course, genetic predisposition, is what loads the gun, what pulls the trigger is gonna be the stressors that I just mentioned and then the effects are hashimoto’s, crohn’s, RA. Now, the difference is, you may just have that gun ready to go and that hammer already backed, right? So, you’re more predisposed. Or others, let’s say that can actually put the bullet in, cock the hammer back and pull the trigger, meaning, a lot more things going on for a lot longer for that effect to happen. But either way, we have control if we pull the trigger or not, whether your guns are already loaded, we still have control over- over you pulling the trigger.

Yoli you are totally welcome there. Uh, Paul writes in, “How does low thyroid give cold hands and cold feet?”. Well, because thyroid hormone controls metabolism, and that’s basically the sum of all chemical reactions in the body. So, of course, uh- the more chemical reactions you have which is controlled by your thyroid hormone, which increases metabolism, the byproduct of your meta- having a healthy metabolism is heat. It’s kinda like, you know, do you get enough heat to keep you warm from a small fire or a large fire? Well, a large fire, why? Because there’s more reaction with the oxygen and the fire and the wood, right? And that gives off heat as the byproduct, of course. So, of course, you need more fuel, you need more metabolic reaction happening, more metabolic reaction with the air, and the combustion of the- of the wood gives you more heat. It’s the same thing with what’s happening in your body. And then of course we need thyroid hormone to be able to break down cholesterol and breakdown our hormone metabolites and hormone building blocks so we can make more female, or male, or adrenal hormones too. So, when you have low thyroid it can affect a lot of your other hormonal systems as well.

Rhonda writes in, “Are all thyroid hormone tests reliable (ZRT, Everlywell)?”. Well, great question. I mean, when it comes to some of the ones like ZRT or- they have some good spot tests. I- I’ve use ZRT, I use their spot test only if someone does not have a conventional lab to get an actual draw on. My concern is, I used to run some of the Theranos test like couple of years ago before they went out of- out of business, uhm and I found, I would compare ’em to like LabCorp, Quest and they were very inaccurate. So, the spot technology, meaning like it’s a little finger spot, hmmm- it- it’s getting better but it may still be off a little bit so I only use ZRT or the spot ones if someone does not have a lab test within 3 hours. If not, we run a- a Quest or LabCorp, which is pretty standardized. You need more blood to run those so it’s hard to do it with the spot. Meaning, just a little finger print one like you went on a blood sugar meter. Uhm, but the technology is getting better but if I can run a Quest or LabCorp and actual, you know, vial or 2 is run, and that is always better.

Let me jump on to Facebook here and give here and give you some Facebook love. Sorry you guys, I did not given you the attention here. Alright, Annie writes in, “So, a whole bunch of…”, let’s see here, “…I was 17 years old. Ever since recent illness resulting in gall bladder removal, my body has been out of whack – gut issues, anxiety, never had that before”. Yeah, I mean, here’s the deal. If you don’t have a gallbladder, it probably means you have hypochlorhydria, it definitely means you don’t have enough bile salts to break down fat. You’re gonna have a hard time probably breaking down protein and fat because of the- the low stomach acid and the low bile. And that puts you in the position to have a lot of nutrient i- issues, so you really have to work with a good functional medicine doc to get the diet better, to get the digestion better, and to get your hormones better. Lot of issues going on there.

And Lara writes in, yeah, gluten is huge, I totally agree, it’s a big issue. It’s a one of the major drivers of leaky gut. So here… “Without giving synthroid can we cure better hypothyroid situations?”. Well, I mean, yeah, if there’s an autoimmune attack, as long as we’re getting the autoimmune attack under control, synthroid will help bring that TSH down which helps prevent whipping of that thyroid, right? Remember, TSH, the whipping of TSH is not the same as an autoimmune thyroid attack. Not the same but still, it’s still stimulating the thyroid. So, by giving a little bit hormone that does bring that TSH which is good. Lots people were concerned about, you know, excessive bone loss, or thyroid nodules with TSH going too low. Uhm, but again, err- from my s- situation here, as long as it’s not excessively too low from grave’s, you’re more than likely okay. Just make sure your doctor’s monitoring your thyroid levels.

Megan writes in, “Can excessive sweating in warm weather be your thyroid?”. Hard to say, I mean, it’s pretty normal to sweat in the warm weather. Uhm, I would just run a basal body temperature test and- and make sure you’re utilizing your, you know, regular indoor room temperature. That way you’re not using any extreme high, low, to assess your metabolism. So, we wanna be between 97-8 and 98-2 for an axillary temp, armpit, and 98 to- to 98-6 for your oral temp. Do it first thing in the morning before you move around and eat.

Paul writes in, ” When is last time your hashimoto’s gave you issues Dr. J?”. I- I’ve been able to keep it under control. I mean, my levels, my TSH stays below beneath 2, my T-3 stays above 3, my T-4 stays between 1 to 1.5, my antibodies stay right in the border, been able to keep in control.

Donna writes in, “Is intermittent fasting ok with hashimoto’s?”. Only if it’s in control. Only if it’s stabilized and in control. If it’s not, do not do it. Make sure you’re having your hormones stable first.

“What nutrient support the pancreas?”. Well, I mean, of course, for you to give enzymes- for you to give more enzymes to prevent the pancreas to have to make extra enzymes, we’d give a stomach acid to help. Those are gonna be the big things is, you know, the exocrine function of the pancreas which are gonna be enzymes and lipase, enzymes, pancreatic, proteolytic, or cer- essentially these are- they’re pancreatic enzymes and they have proteolytic function, meaning, protein, and then lipolytic functions, meaning, fat digestion. So we’d to give a lot of those things to take stress off the adre- uhm, the pancreas, and we give more acidity as well to the stomach which is an important trigger of pancreatic enzyme sec- secretion.

Ahmet writes in, “Hypothyroid situations. Some doctor recommends low fat, low calorie diet. Is it true?”. I mean, would some doctors recommend it? Yeah, it’s terrible. Go into PubMed, type in “hypocaloric diet”, and “hypothyroidism”, low calorie causes low thyroid. It make sense because if the sum of all your chemical reactions, essentially your metabolism, right, is controlled by your thyroid and you stop giving fuel into your thyroid, or meaning, you sta- you start giving low calorie I- A.K.A., low nutrition, low fuel, you are not gonna have enough nutrients to run your thyroid, and that’s gonna cause low thyroid hormone functioning. The same thing, if I put less gasoline in the tank of your car, eventually you run empty. It’s the exact same thing.

Rhonda writes in, ” If my basal temperature is in the lower 97 degrees, is that thyroid problem?”. May- maybe not, it really depends on your symptoms, and it depends on what your thyroid test says as well. I don’t ever go all one- all in on the- the basal temp, because that can be other issues, and sometimes that can just be a broken thermometer too, so we wanna look at your symptoms, and we want to look at your hormone levels.

Alright, jumpin’ over to Facebook, “Hypothyroidism and diabe…” uhm- “Hypothyroid and diabetic, have beginning of gastroparesis and concerned of the meds prescribed… Armour, might not be metabolized if it sits in my stomach too long”. So, yeah, so- if we have digestive issues Kathi, I definitely recommend absorbing your thyroid hormone in your mouth sublingually to bypass a lot of that, then swallow after 1 to 2 minutes. But you wanna work with the good functional medicine doc as well.

Uhm, Rejjiie writes in, “Been suffering from autoimmune thyroid condition for the past few years. My throat was enlarged, but after taking some herbs mixed with garlic, pau de arco, oregano leaf, zinc and Vitamin-C, it has gone back down”. Yeah, a lot of those herbs are also anti-microbial, so I wouldn’t be surprised if there’s some gut issues, bacteria, yeast or fungal that could be part of what’s stressing out the body, it’s very possible.

Alright guys, I think we answered a lot good questions here. Just make sure you guys sign up for the thyroid reset summit. We’re gonna go into all these things. I have 30 experts that I’ve heard, interviewed, amazing interviews where we go into depth in all these different topics. So, totally free to sign up,, you’ll be able to see my own personal interview, Evan’s interview, and a bunch of other amazing expert’s interview. You guys are gonna love it, and it helps support the channel, and it helps support more content coming to you. So, appreciate you guys signing up, and I will be back tomorrow for a live Q&A. I’m trying to get better at giving you guys heads up, so sometimes I’m like, “Oh, a patient”, like, you know, is “mister console”, I jump in, or at the end of the day, and I put my sun down for bed, I have a half hour free, let me jump on. So, I’m gonna try to get better like giving you guys, what, maybe 24-hour heads up. Let me know how much time you want, put your questions down below, I’ll answer it later. And uhm, let me know future topics, future live podcast topics you guys would love to hear about. I love being on the fly and dynamic so we can make the show interactive ang get your questions answered. So, I appreciate it, you guys have a phenomenal day, and I will be back tomorrow. Take care, bye. 


Xlear Sinus Rinse Kit

Testing and tracking your thyroid health – Podcast #111

Dr. Justin Marchegiani welcomes Dave Korsunsky of Heads Up Health back to the show to talk about assessing the thyroid. Listen to this podcast to learn more about the complete thyroid panel and how you can organize your lab test data. 

thyroid testingFind out exactly what you can do about all the information that you get from your thyroid tests in terms of keeping track and charting your own data to look at patterns. Learn how these can be very useful when compared to other variables such as sleep, blood sugar or even the steps you’ve done in a day. Discover why you should get a full thyroid panel and how or where you can get it.

In this episode, topics include:

02:29   The role of the thyroid and hormones

05:26   Components of a full thyroid panel

09:48   Supplementing the thyroid

21:22   Thyroid antibodies

26:10   How or where to get full thyroid panel









Dr. Justin Marchegiani:  Hey, there, it’s Dr. J. I’ve got my good friend here, Dave Korsunsky. We’re gonna be chatting about how to measure—how to assess your thyroid. Dave’s got some great technology called Heads Up Health, We use this software a lot for—to help patients kind of chart their lab data so they can follow it, create graphs, compare it to other variables like sleep or blood sugar or how many steps you’ve done in a day. So we’re gonna really dig into how to look at and how to assess your thyroid and what numbers and lab values we look at. Dave, how are we doing, man?

Dave Korsunsky: Doin’ great, doc. Thanks for having me. I can see on Skype here that you’re sitting in your home office and I remembered that just a few months ago I was over at your place and we did a—we did a show on testing ketones which went great and happy to be back and actually talking about something that I see coming up all the time. Heads Up Health is pretty active online in a lot of the different Facebook groups and different communities on Ketogenic Diets and Paleo Diets and this—this question of the full thyroid panel comes up all the time. So I’m glad we can dive into it. It’s also something that was personally relevant for me and you may recall when I was your patient, that was one of the things you helped me fix. So I can throw in some of my own personal experience here as well.

Dr. Justin Marchegiani:  Absolutely, that’s great. I was going to do a nice live on-screen recording here of a—with my ketones but my battery is dead. Damn it. I hate wasting these strips. They’re so expensive.

Dave Korsunsky:  Where do you get yours from? It’s 4 bucks a strip here in the US. I know there’s cheaper sources out there.

Dr. Justin Marchegiani:  Well, I got it from the person that you told me to get it from over in New Zealand.

Dave Korsunsky:  That’s right.

Dr. Justin Marchegiani:  On eBay.

Dave Korsunsky:  Actually, it was Australia.

Dr. Justin Marchegiani: Australia.

Dave Korsunsky:  Yeah, it was Australia.

Dr. Justin Marchegiani:  Australia. Yeah, that’s it–.

Dave Korsunsky:  But they’re clamping down on that now. They—I think it’s illegal for them to ship to the United States now. So they’re getting harder to find on eBay.

Dr. Justin Marchegiani:  Yeah, I hear you. There’s still there a little bit though, but today for lunch I had—I had a collagen bar. I had tuna with a little bit of like Mark’s Primal Mayo so like egg yo—like you know, egg, olive oil or egg avocado oil.

Dave Korsunsky:  Yup, I’ve seen that product. Yup, it’s great stuff.

Dr. Justin Marchegiani:  And then like some shreds of carrot in there and like a little bit of cut up spinach, so it’s pretty high fat, very little carbohydrate. So my ketones will probably be around 0.6 mmol right now.

Dave Korsunsky:  Yeah.

Dr. Justin Marchegiani:  Now–

Dave Korsunsky:  Well, as I mentioned to you I don’t have my meter with me, otherwise we could nerd out and do some ketone testing like we did last time.

Dr. Justin Marchegiani:  Absolutely.

Dave Korsunsky:  Another time.

Dr. Justin Marchegiani:  Another time. Absolutely. Well, today we were gonna talk about thyroid and just really put the focus on thyroid and thyroid’s important, right? Thyroid’s that gland that sits kinda right where that bow tie in the neck would, just below and outside of the Adam’s apple and it produces a metabolic hormone called thyroid hormone and that hormone gets produced and it gets converted and activated in the body and there’s a lot of things that are responsible for making thyroid hormone and activating thyroid hormone. Like we’ve talked a lot in the past about ketosis and insulin resistance and having too much or too little insulin can really have an effect on how thyroid hormone gets activated which is really interesting. So with the software that you created over at, anyone listening can go head over there and get a free account, but you can plug in your thyroid lab values and–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Let’s kinda just start—well, let’s just start with an anecdote kind of your personal story of us working together with your thyroid and then we’ll dig in to the meat of the matter here.

Dave Korsunsky:  Yeah, so this was back in I think in 2011-2012 when you were still working out of the Cupertino office.

Dr. Justin Marchegiani:  Uh-hmm, yeah.

Dave Korsunsky:  And you may recall you and I met at Asprey’s 1st ever conference.

Dr. Justin Marchegiani:  Yup.

Dave Korsunsky:  In San Francisco and you were hustling there. You had your—your adjustment table out–

Dr. Justin Marchegiani:   Yeah.

Dave Korsunsky:  And you were just—I’m like this guy is awesome.

Dr. Justin Marchegiani:  Mmm.

Dave Korsunsky:  So the first time I started working with you, I—I just brought in all my labs from my conventional doctor and—and I had them in a—a horrendous spreadsheet at the time.

Dr. Justin Marchegiani:  Right, right.

Dave Korsunsky:  I’m sure there’s a lot of people listening who have those horrendous spreadsheets, but as we started going through my numbers and you started looking at stuff, you noticed that the only test I’d ever had one was TSH, and I maybe had 2 or 3 of those done over the course of a lifetime. Maybe this was standard physical, etc., and so that was one of the first things you ordered for me, was—was a full thyroid panel and I guess maybe I think it’s important to talk about the components about the full thyroid panel, also important to address why maybe a lot of conventional doctors only ordered TSH but in any event that was my situation. So as soon we ran the full panel, there were a few things that—that you noticed and that you immediately picked up on. The first is you noticed that TSH actually looked good. It was great actually in range, perfect. But when we looked under the covers a little bit, we noticed, first of all T4, also excellent and—and you were educating me on all these numbers.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  I had no idea what any of this stuff meant as a patient and—and you sat down with me and took me through this whole panel.

Dr. Justin Marchegiani:  Right.

Dave Korsunsky:  And you said, “Hey, T4 is the start of the whole cascade.”

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  That never looks good but then you noticed my T4—my T3 was incredibly low, out of range low.

Dr. Justin Marchegiani:  Right.

Dave Korsunsky:  And my reverse T3 was out of range high.

Dr. Justin Marchegiani:  Yes.

Dave Korsunsky:  And everything else was fine. So that was my situation and then we started working on it and—and we can talk about the treatment protocol later but maybe you can just get into a little bit more about—first of all what are components of the full thyroid panel?

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  Why it’s more important to get that, besides just TSH, and even how people can get that if—if their doctor won’t do it for them.

Dr. Justin Marchegiani:  Right, exactly. So you can use Heads Up Health and just kinda plug your data in there to help keep track of it. Anyone that’s really doing their thyroid testing, they can use that as a technology to help track it and then compare it to sleep or maybe their carbohydrate levels, right? You could plug it up to MyFitnessPal, one of these apps, and then see how your carbohydrates and/or your insulin chart with your thyroid hormone.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  But starting off here, we kinda have the domino rally of our thyroid hormone cascade, meaning the first block that falls over is TSH. Now TSH is a brain hormone so a lot of people really get wrapped up in TSH being too high or too low, but it’s a brain hormone. It’s—it’s not quite like measuring your thyroid hormone. It’s very indirect. So TSH is looking at how the brain is yelling or talking to the thyroid. The whole analogy is if the thyroid’s not producing enough thyroid hormone, it’s like someone across the room that can’t hear you, you instinctively raise the volume of your voice, which is because the thyroid is on the lower side, right? Lower thyroid function, if someone can’t hear you, you raise the volume, the thyroid raises the volume of TSH and just like if you were in a library and—and it’s really quiet and they’re really close to you whisper and you lower the volume because it can—it’s where the thyroid or the person is very receptive to your voice. So think of your thyroid, kinda in those analogies. So TSH too high or too low can mean issues. The problem is if you’re waiting for the thyroid to be assessed and you’re looking at the TSH, it can take a very long time. Some even say 8-10 years to assess the thyroid properly by looking at the TSH because it’s a late stage indicator. It’s not the thyroid, it’s the brain. So if you’re looking and waiting for the thyroid to get assessed, it may take a while, and not to mention it’s—it—either the cut-offs for the reference range are pretty high. I mean, typically in the East Coast it’s gonna be about 5-1/2 on the TSH. In the West Coast, it’s gonna be a 4-1/2 on the TSH, where once it gets to that height, we call that hypothyroidism because the brain’s having to yell so loud that the thyroid is—we’re assuming is not responding well. I’ll just kinda take a breath there.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Any comments on that, Dave?

Dave Korsunsky:  No, I think it makes sense. I mean especially if—if you’re waiting on changes that have to happen in the brain. So help me understand that. That—that’s presumably stuff that takes a lot longer to settle in, and—and it may mean eliminating stress in your life.

Dr. Justin Marchegiani:  Yeah, sleep.

Dave Korsunsky:  It may mean dietary change. It may mean–

Dr. Justin Marchegiani:  Uh-hmm.

Dave Korsunsky:  Also the things–

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  That—that first have to show up at a—at a brain level, like at a neurotransmitter level or at some level in the brain. So that has to happen first before you see change in thyroid. Is that right?

Dr. Justin Marchegiani: Yeah, so when we look at TSH, it can be a really good indicator if something’s really high of diagnosing or picking up hypothyroidism.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani:  Now, the conventional range 4-1/2 on the West Coast, 5-1/2 East Coast, I like it to be around 1,

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  Definitely 2-1/2, 1 to 2-1/2 is a pretty good, what I call functional range for the thyroid. That’s a good starting. Again the—where it gets fuzzy is when you start supporting someone’s thyroid because they need thyroid with thyroid glandular or hormone, most docs are basing the treatment off of the TSH.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Not a good way to do it because the brain is very sensitive. It’s more sensitive to thyroid hormone than the actual peripheral receptor sites. So my analogy for the patients is, go outside on a hot day and figure out the temperature by touching the sidewalk. Well, the sidewalk conducts heat much higher than the air, so it’s gonna be a lot hotter.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  I.e., the TSH may respond more sensitively because of the receptor sites, just like the sidewalk would be hotter or be more sensitive to heat than the air. So that’s step 1. Step 2 is then looking at the T4 hormone which is what’s made by the thyroid. So TSH comes down, talks to the thyroid, the thyroid goes through this process called deiode— deiodination where it’s adding and building thyroid and tyrosine and thyroglobulin molecule to build this thyroid hormone, alright? Vitamin A, copper, zinc, magnesium, selenium are also involved in those processes. Vitamin A as well. And–

Dave Korsunsky:  So that’s why you got me on a selenium. Part—part of your treatment then was—was adding some of these supplements in at some point.

Dr. Justin Marchegiani:  Uh-hmm.

Dave Korsunsky:  is that right?

Dr. Justin Marchegiani:  Yeah, exactly. Iodine can be really important, too. You just gotta be very careful with iodine because a lot of people that have thyroid issues, it’s autoimmune in nature. It’s the immune system attacking the thyroid gland. So you gotta be careful because more iodine can be like throwing gasoline on the fire.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  So you gotta be careful in the beginning. I always favor giving selenium in the beginning over giving—over giving iodine as well just because of that inflammatory mechanism. So–

Dave Korsunsky:  Yeah, that’s where you started me off. You started me with selenium and then we added the iodine then later.

Dr. Justin Marchegiani:  Yeah, exactly. So we have our T4, right? We make that through this whole iodination process. Then we convert it or we activate T4 to T3. So when we look at T4, we like our T4 Total being around 6-10, that’s a pretty good range for T4 Total, and T4 Free about 1-1.5 is a pretty good range. Again, go over Heads Up Health to get all these ranges more in depth.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  We then cleave off, right? This is part of the deiode—the—this is the 5-prime deiodinase enzyme, that’s selenium-based, that now cleaves off the iodine process. So it’s iodination is what makes the thyroid hormone then de iodinate, we pull an iodine, we—we grab an iodine off. So instead of being T4, now it’s T3. There’s 3 iodines now and we activate T3 which is the active thyroid hormone. So that’s what’s really having the whole metabolic reaction in the body, increasing our temperature, increasing metabolism, energy, heat, temperature and the selenium enzyme’s really important into that. And when you go on Heads Up, you’ll see T3 Free, we like above 3, you know, above 3-3.8, 3.4, you know, 3.8, 3.4 is fine, pretty good, right in that top 25%, top third of the reference range is great. 3.0 to about 4 is fine and that’s for T3 Free. And T3 Total, we like above 100, 100-130 is fine, and again we fine tune that with objective temperature testing, making sure the temperature is looking well. So typically 97.8 to 98.2 if we’re looking at the armpit or 98.2 to 98.6 if we’re looking at the mouth is a pretty good way to assess that.

Dave Korsunsky: Uh-hmm.

Dr. Justin Marchegiani:  And we’ll do that in the morning before we get up and we’ll do it in the afternoon before lunch, because if we increase metabolism, we’re thinking that that’s gonna spill over into objective symptoms like energy but we’ll also see it as heat in the temperature.

Dave Korsunsky:  Yup. So I remember when we’re working on Heads Up, you said, “Dave, you need to have a place to track basal temperature as well.”

Dr. Justin Marchegiani:  Yes. Yes.

Dave Korsunsky:  And that’s part of what you’re doing. Do you use that to diagnose or to zero in on—on thyroid health?

Dr. Justin Marchegiani:  it’s a good indicator to look at side by side. The problem is a lot of people have broken thermometers, and I’m just—I see people coming back with 95 on their temperature and it’s just like they have no—you know, they’re feeling better. Their temperature’s up and then when you tell them to get a new thermometer, and it’s better. So you know, I don’t put too much stock in it, but it’s nice to see it–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  When it starts to change and move in the right direction and it correlates with symptoms and it does that a lot.

Dave Korsunsky:  I know that when you were helping me along those lines, it was specifically recommended to use a mercury-based thermometer, and in that one time you had those on your website and they are—they’re getting increasingly harder to get, so is that still something you sell on your site?

Dr. Justin Marchegiani:  Yeah, I have a couple right here. I’m gonna throw them up on screen. I actually have 4 right here.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  I used to recommend more of the mercury. The problem was I actually dropped a couple and I was just like, “Damn, it’s too dangerous.”

Dave Korsunsky:  I did, too.

Dr. Justin Marchegiani:  And so it’s just—I just said, “You know what, even though it’s —it’s accurate, nice. It’s just not worth the potential of dropping it and having the toxicity of having to clean it up.” So I went away from it just because I’ve met some accidents.

Dave Korsunsky:  Sure.

Dr. Justin Marchegiani:  So what I typically use now is just the highest ranked fertility digital thermometer on Amazon. That’s measured to a 100.

Dave Korsunsky: Cool, yeah, it’d be good—yeah, it’d be good to get that model if you have it. I know, I’m going to get another one.

Dr. Justin Marchegiani:  Yeah, I—I have it in my store over at It just links to Amazon and–

Dave Korsunsky:  Got it. Yup.

Dr. Justin Marchegiani:  And in JustInHealth approved products and then my thermometer’s there. But it’s just the highest ranked fertility digital. Not just the digital but a fertility one because fertility has to be more accurate than—than not because of the nature of hormone testing in temperature.

Dave Korsunsky:  Yup, good.

Dr. Justin Marchegiani:  So that’s where I’m at now. So I do like temperature. It’s nice for patients to see it, to feel it. Also with the temperature testing that’s pretty cool is you can get a window into how the adrenals are functioning, too, because if your temperatures are varying greater than 0.3°F per day can be a really big sign that the adrenals are overtaxed.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  So one of the things we see as people’s thyroid and adrenals get healthier and better, their temperatures get warmer and they’re more consistent. Warmer and more consistent means healthier thyroid and healthier adrenals.

Dave Korsunsky:   Yup, okay, that’s all good. So what’s on the rest the panel? I know there’s a bunch of other stuff that’s included in—in the full thyroid panel where—we’re slowly working our way through it here.

Dr. Justin Marchegiani:  So TSH, we already mentioned.

Dave Korsunsky: Yup.

Dr. Justin Marchegiani:  The T4 Free and Total. Again, the Free represents about 2-5% of the hormone level.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  The Total represents the balance.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  T3 Free and Total.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  T3 uptake. What’s being absorbed and taken up by the receptor sites.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  We like above, you know, upper 20s, 28 to lower 30s, 32, 33, 34 is fine.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  We also like to look at reverse T3. Now this is important because this was something that came up on your test.

Dave Korsunsky:  Right.

Dr. Justin Marchegiani:  You had good levels of T4 but then you weren’t converting downstream to T3, right? We had this high level–

Dave Korsunsky:  Exactly.

Dr. Justin Marchegiani:  Of reverse T3 and just, you know, a sub-clinical low level of T3 but it was me—really going downstream to RT3 or reverse T3.

Dave Korsunsky:  Exactly. Yup.

Dr. Justin Marchegiani:  And reverse T3, it’s like putting—it’s like putting blanks in your gun. You fire the gun off, you hear the noise but no bullet comes out. You got this blank that’s sitting in that thyroid receptor site. It’s supposed be like T3 but it doesn’t quite have that metabolic property so to speak.

Dave Korsunsky:  So do you—do you see that a lot, Doc? Where there’s—where that conversion is just not happening, right? And—and what are the first things you think of when you see that the T4 to T3 conversion is just not uprating right?

Dr. Justin Marchegiani: Great question. So the first scenario, if T4 to T3 is not converting well but we see reverse T3 going high–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  You know, we always think selenium and we always think stress.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  So then when we look at stress, we’re making sure the diet’s good, sleep’s good. We’re looking more at the adrenal to make sure the adrenal function is good as well, and you know, making sure practices of meditation, the right amount of exercise are good, not overexercising or underexercising, keeping all the bad foods out, and then we’ll even use things like selenium to help lower reverse T3 and even things like milk thistle to lower it as well to help clear it out because a lot of that reverse T3 is made by the liver so we can clear it out but we gotta fix the underlying reason why it was getting converted there to begin with. That’s the key.

Dave Korsunsky:  Yup, makes sense. And I think in my case, it was just a combination of things exactly like you described. It was really a stressful time for me personally. You introduced the selenium supplement. I also at that time started moving over to a much cleaner diet, more of a Paleo based diet, coming off of just a standard diet. So I think all of those things helped and then what we were doing was we were—were running the thyroid panel. You’d—you’d give me my treatment protocol in my Word document. I’d—I’d get the intervention. We’d run the thyroid panel 3 months later and we’d—we’d track the numbers and I could get engaged in that process and one of the things—one of the reasons I build Heads Up was because I genuinely believe that when the patient can get engaged with their numbers and understand what they mean, it helps. It just gets—you get better results and so we saw it, right? We’d—we’d run the test every 3-6 months and we’d look at the new numbers together and I just love that.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  It was really, really effective.

Dr. Justin Marchegiani:  Yeah, and I think we also did—we did some milk thistle as well to help. If I remember correctly you were doing those Insanity workouts, an hour–

Dave Korsunsky:  Yeah, I just crushed—I had crushed my adrenals.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  Like just—I was overtraining. I was in a stressful situation work-wise. You know, my diet wasn’t great. You know, having too much fun on the weekends.

Dr. Justin Marchegiani:  Yeah, you were doing that.

Dave Korsunsky:  Yeah. All—all of the ingredients were there for a—for a disaster but luckily we were able to intervene and—and get things course corrected.

Dr. Justin Marchegiani:  Yeah, I remember you definitely made some changes with your diet. You were getting more—more quality fats, better quality fats in there as well that was helping out a lot.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  And then we got you on the adrenal support, too, which I think made a big difference. And I know we also had some gut issues that came up–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Down the road, too, that I think as we addressed those we had improvements there, too. I think maybe a Klebsiella or some kinda bacterial overgrowth.

Dave Korsunsky:  Yeah, these were all important pieces that we had to work on.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  Actually, another—another big one for me was actually just racking my sleep. I know it—it sounds silly but even just getting some basic metrics from like a wrist worn device, a FitBit. In my case, I’m wearing one on my wrist now. Just having some data about when I was going to bed and when I was getting up, and how much sleep I was getting on a regular basis. Until you see the numbers, I didn’t realize that I was maybe 6 hours not getting enough and when you’re overtraining and not getting enough sleep and—and you start to see all of that, and you start to see the information that I’m getting from you that are—that are suggesting lifestyle-related stressors, having that that sleep information was—was really, really helpful and it brought a whole new awareness to my sleeping patterns and help me try to move to a—a more natural sleep-wake cycle instead of midnight or one. For example, going bed at 10 and it takes some time to get your body back on a—on a more normal cycle but there’s so much data we were collecting that was helpful along the process and it’s just part of what we wanted to do in Heads Up is give people a place to track it all, but sleep was really important in addition to all of the things that—that you mentioned that we fixed as well.

Dr. Justin Marchegiani: Yeah, absolutely. So kinda just coming back in line here. We talked about the thyroid conversion piece. Sleep really helps because sleep can help curtail cortisol levels, can also help maximizing growth hormone levels which are important for being anabolic and repairing tissue.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  And also can help with recycling neurotransmitters, right?

Dave Korsunsky:  Yup, and—and there was al–

Dr. Justin Marchegiani:  Yeah, go ahead.

Dave Korsunsky:  There was also some antibodies on that thyroid panel–

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  That you always look at as well.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  You were always looking for autoimmunity.

Dr. Justin Marchegiani:  Uh-hmm. Yes.

Dave Korsunsky:  So maybe what—we could talk about that for a bit.

Dr. Justin Marchegiani:  One step ahead of me.

Dave Korsunsky:  Okay.

Dr. Justin Marchegiani:  Let me just—let me just come full circle on the thyroid conversion piece.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Almost there. So the sleep piece is really important.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  The selenium is really important for all the nutrient levels in helping to convert that downstream.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Also insulin resistance, a lot of people that have high levels of insulin, they may have this hard time converting thyroid hormone or activating it T4 to T3. If they have high levels of stress hormone that may help as well or hurt the conversion. If they’re really have—almost low levels of cortisol because of HPA axis dysfunction.

Dave Korsunsky:  Yup. That–

Dr. Justin Marchegiani:  Where the brain is numb talking to the thyroid that can really help decrease that conversion, prevent the T4 from going to T3. Certain nutrients like copper and selenium and zinc. Also high levels of mercury can also be a big factor. So those are kinda just some—some good generalizations there. Now getting to your next question that you asked—perfect timing was was the thyroid antibodies. So, so many of the thyroid—so many thyroid conditions are actually brought upon by autoimmunity, meaning your immune system is making specific antibodies that are attacking the thyroid gland.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  One is known as TPO or thyroid peroxidase enzyme. It’s an enzyme that puts thyroid hormone together and then the other one is the thyroglobulin antibody which is the surface protein of the thyroid. And if you’re making antibodies and you’re tagging the thyroid then you’re gonna be attacking it and breaking it down and these B cells and B lymphocytes are gonna be getting in there and attacking it.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  And that’s not good because as it’s being attacked, it’s like stag—stabbing a knife into it and thyroid hormone drips out.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  So your TSH and thyroid hormone levels can be off for a long time. You could have hot flashes and anxiety, and tachycardia and be sweating a lot and that’s a really good sign that you’re starting this whole autoimmune progression and again, conventional medicine will not get to the root cause. They ignore the immune mechanism, i.e., the antibodies. They forget what’s driving it and they just say, “Here’s Synthroid,” and they just wanna get that thyroid TSH back nice and low again but we’re not getting with—with the simple things like the gluten and the grains and the inflammation and the insulin resistance and the infections that are so commonly addressing it.

Dave Korsunsky:  Yup. I know there’s a lot of people really close to me that are dealing with autoimmune conditions and so that’s something that—that comes up all the time. You—you’ve worked with many of those people directly.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  And have helped them–

Dr. Justin Marchegiani:  Yup.

Dave Korsunsky:  Make the changes necessary to—to work on those antibody numbers specifically.

Dr. Justin Marchegiani:  And I think that’s why you did really well off the bat, too, because one of the big changes you made, because you were like just starting to get into Dave’s Bulletproof Diet and you were–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Cutting out grains and really cutting out mycotoxins.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  And you were eating more fat so you were stabilizing your blood sugar and getting your insulin better. I think that really helped with calming down any potential autoimmunity that may have been present.

Dave Korsunsky:  Yeah, and if I think back to some of the things that were going on at that time, it was—it was definitely going on to the Bulletproof Diet at that time that helped a lot. That helped with a lot of the blood sugar stabilization.

Dr. Justin Marchegiani:  Big time.

Dave Korsunsky:  And you mentioned that that’s one of the reasons there—there may be T4 to T3. working on stress, getting the GI stuff fixed up. You ran the tests to do that. You also ran the adrenal test which I think just are more indicative that there’s–

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  A stress—a stressor in the system whether it’s physical or mental, so we worked on that and then some—some supplements to help. Selenium being the—the most obvious one, and all of those things worked and then we re-ran the numbers and it was—you know, it took a while. Maybe this was a 12-month process, 18-month process where we worked everything out, but it was great. And there’s that—that functional medicine type process where you’re doing what we just described. I mean, how common is that in—in your practice with patients you’re seeing?

Dr. Justin Marchegiani:  Well, it’s really common especially the autoimmune piece because people are stressed. They’re not eating good—good meals. They’re insulin resistant because of the suppressed immune system of all the things I’ve mentioned, opportunistic infections kinda take hold as well. So that’s a multi-layer kind of system that we’re looking at so you really gotta wade through it systematically so we can get to all of the key lynch pins.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  If you’re just doing one thing to systematically or symptomatically make you feel better, may not be what kinda unlocks the healing long-term.

Dave Korsunsky:  Yup, makes sense. And so just going back to the—to the thyroid panel, I mean, when we first started working together, you—you didn’t see that in any of my previous lab testing so it’s something you ordered right away.

Dr. Justin Marchegiani:  Yes.

Dave Korsunsky:  Is—is that something you like to do upfront with—with all patients? It’s just to see where those numbers are or is it case by case?

Dr. Justin Marchegiani:  It’s case by case. It depends what symptoms are present off the bat. If we’re going to the person’s history and there’s lots of energy issues and lots of mood issues like let’s say hair loss, outer third eyebrows, let’s say cold fingers, cold hands, tingling, numbness, things like that. We will definitely order a thyroid. If we don’t have a lot of the hair loss and the cold hands and cold feet-

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  Stuff off the bat, we typically stick to the adrenals first, see how good or bad the adrenals are and then I have them do temperature testing over the next month and we monitor through there.

Dave Korsunsky:  Cool.

Dr. Justin Marchegiani:  And if symptoms are improving on the adrenal protocol and their temperatures look decent, we won’t necessarily jump to the thyroid off the bat. If we’re not quite getting the improvement we’re looking at and temperatures are low, then we’ll go and we’ll dig in to that thyroid.

Dave Korsunsky:  Yup, that makes sense. And I’ve, you know, personally for the last 8 months I’ve been on a–on a Ketogenic Diet and have been doing really well with it but I’d love to run another panel to see how my numbers stack up and that kinda leads into my next question which is a lot of people when they go the doctor, they—they may not be able to get the full panel ordered for—for various reasons. There has to be a diagnostic code of something like that.

Dr. Justin Marchegiani:  Oh yeah.

Dave Korsunsky:  So, I know you have the panel available. Is that one of the panels people can get from you and just go to Lab Corp and get it? I realize you gotta pay out of pocket, but sometimes that’s just the most—the quickest and easiest way instead of having to negotiate with—with your doctor.

Dr. Justin Marchegiani:  Oh, yeah. The panel that we have online, the complete thyroid panel in the store, so, click on the Healthy Living Store, you’ll see the lab test button. Click it and look for the complete thyroid panel. And that panel I think it’s about $150 and that’s a complete–

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  You can’t run anything for the most part.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  On your thyroid.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  It’s got all of the thyroid markers you need. Typically if that panel is not covered by insurance, right? That’s over a $1000.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  So by just paying cash, you kinda cap—you cap your losses so to speak and that’ll give you everything you need. That’s a really good first line for anyone with thyroid issues. That’ll give you everything you need to—to get a complete picture of what’s going on.

Dave Korsunsky:  Yeah, and I see—I see a lot of people who we communicate with and just a lot of people who are asking questions and stuff who—who may not be making progress as they move to—they make the nutritional changes. They go Paleo. They make the dietary changes. They’ve adopted Keto or some of those principles and they’re not seeing any changes in body composition and so it’s—that’s often something that I think of and are those correlated? Would you start to look at—at thyroid and metabolic if you’re not seeing changes once you make the—the nutritional interventions?

Dr. Justin Marchegiani:  Absolutely. The thyroid can control metabolism, heat and energy, so it’s definitely a place that you wanna look at for sure. When people have their thyroid working better, they tend to be able to have a higher metabolism, burn more calories, burn more systemic body fat which is a really good thing.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  But not all the time. Some people—it’s just, we get their thyroid working better they’re no longer depressed and constipated and their hair starts growing back.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  So I see the thyroid kinda being a different—having different priorities, you know, they may not be the priorities that you want so to speak, fair enough. But it’s—it’s amazing we see different things happen and I can’t tell you how much depression and mood changes with better thyroid.

Dave Korsunsky:  Yeah, and—and a lot of the people, a lot of our users who are on Keto actually, it’s a—it’s a small percentage but they do start to report hair loss in some cases and can you talk about when it may be for example a nutrient deficiency vs a thyroid for example? Is it hard to tell? Any thoughts on that?

Dr. Justin Marchegiani:  So you’re talking about looking at the lab work? How can you tell it’s a nutrient issue?

Dave Korsunsky:  Well, let’s say you were dealing with hair loss for example and you mentioned that thyroid could be one option, could it also be jus due to dietary issues, for example?

Dr. Justin Marchegiani:  Absolutely, absolutely. I mean we need protein. They tend to be all connected because if we have a protein issue, well, if we are having a protein malabsorption where it’s affecting the hair, it’s probably affecting the thyroid because we need certain amino acids that would be in those foods to help make thyroid hormone like tyrosine for instance. So if it’s showing up on the gut level, it’s probably gonna eventually make its way to the thyroid level, too. So–

Dave Korsunsky:  So protein specifically in the diet is what—

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  What we’d be looking for?

Dr. Justin Marchegiani:  Yeah, I mean high quality protein. I mean if we have people with gut issues, we’ll use like various collagen peptides and/or free form amino acid products to deliver the protein in a way where there’s no digestion required to really process it.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  That way it gives the digestion some time to relax while we work on fixing it.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  But I never just isolate variables. If I see the thyroid and I see protein and gut issues, we’re gonna fix everything, you know?

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  As we go through body system 1, 2, and 3 and if it’s something we tr—address in body system 1 with the thyroid, meaning where we’d look at ATF or ATM—adrenal, thyroid and male hormones or adrenal, thyroid, female hormones—and we start to see the hair start coming back with thyroid hormone, that’s a great sign.

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  And then it may come back as we start repleting nutrients in body system 2 with the gut.

Dave Korsunsky:  Uh-hmm. Makes sense.

Dr. Justin Marchegiani:  So I mean we’ll trace it back afterwards and kinda use this retrospective look at it and say, “Hey, when we did this, that happened more and when we did this, this happened more.” Sometimes you can’t tell because there’s a delay.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  So we try to do our best and just fix what we find.

Dave Korsunsky:  Yup, makes sense.

Dr. Justin Marchegiani:  But–

Dave Korsunsky:  Well, I know I’m due for a full set of labs.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  Thyroid panel included and—and you’ll be the first to take a look at them once they’re ready, so yeah, I’ve to get working on that and part of—part of what you were helping me with was—was building Heads Up Health to help people track all of this information.

Dr. Justin Marchegiani:  Yeah.

Dave Korsunsky:  Particularly when you’re working with health experts outside of the conventional system, just having everything in one place and being able to share it with any doctor you want, so you and I will be working on that together in the near future.

Dr. Justin Marchegiani:  Absolutely and I wanted to touch upon one last thing because I know you’re—we’re really getting out there to the Keto community which I think is great. One situation that I’m seeing is most thyroid conditions, I’d say 99% off the bat, they’re gonna do so much better off the bat especially if they’re coming from a standard American diet going Keto–

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  Because that’s gonna help insulin resistance. It’s gonna help this–

Dave Korsunsky:  Yup.

Dr. Justin Marchegiani:  Kinda numbness to this insulin receptor where–

Dave Korsunsky:  For sure.

Dr. Justin Marchegiani:  You know, we’re not getting the insulin low enough because these receptors are so numb to get sugar into the cell.

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  Right?

Dave Korsunsky:  Uh-hmm.

Dr. Justin Marchegiani:  Insulin’s the—insulin’s the key. The receptor is the lock and basically the receptor site’s not accepting the key so we have to put—put—essentially push more keys into the hole to get that key out, to get that essentially door open to let the sugar in. So we get this insulin resistance where more keys getting into the cell. So that’s not a good thing because insulin when it’s too high can cause lots and lots of hormonal issues. One of them being thyroid conversion or T4 to T3 thyroid hormone activation. So getting on a Ketogenic Diet is gonna be essential because it’s gonna really get that insulin level down. The only thing is I find sometimes when people are long-term Keto, sometimes we may be get a little bit—we may go a little too low on the insulin and if we add just a small amount of carbs even just 10-20g, it can be enough to get your insulin levels a little bit higher and we see an aid in thyroid conversion. We’ll see T3 go up on the lab work. We’ll see hair—hair improved or maybe even temperature improved but that tends to be when people are Keto chronically or long-term. Everyone’s gonna–

Dave Korsunsky: Yup.

Dr. Justin Marchegiani:  Benefit on off the bat and get a really big benefit. It’s long-term afterwards. We wanna fine tune it and I’m totally non-dogmatic about it. If you can keep at a Keto level or—that’s great. If not, we just up it 10-20g to see how we do. I had a patient just yesterday we upped it about—we add about a quarter of sweet potato at night and a lot of her low thyroid symptoms went away.

Dave Korsunsky:  Makes sense. Yeah, well, I mean this is all good stuff, Doc. I think there’s so many people that need the—the full thyroid panel. Maybe have never had it before or maybe they‘re stuck just where they are in terms of their health transformation. I know it was a huge step for me, just seeing these numbers, figuring out how we address them. I know you make the panel available to people who can’t get it from their doctor which is awesome. Heads Up Health has got the software to help people track all of this stuff especially if they’re getting data from different labs and they wanna manage it all in one place. So hopefully there’s some people who can use the information here, get their own panel run and it may be an important diagnostic piece for them as they work on their own health goals.

Dr. Justin Marchegiani:  Absolutely. I’m gonna put the complete thyroid panel in the link below so if you’re interested in it, feel free and click on it. That’ll be a great way to access that panel.

Dave Korsunsky:  Yup, and I can include some information for people who want to start getting all of their health records organized using Heads Up Health. There’s a couple videos we put out there that just showed how to integrate all the medical records, basal temperature, macro nutrients so I can send that along as well.

Dr. Justin Marchegiani:  Great. Any other questions, comments or concerns, Dave?

Dave Korsunsky:  No, this was great. I see this topic come up all the time. So I’m glad we were able to address it and—and provide some information on what the full thyroid panel is and—and what the markers are and some of the things you can start doing to—to fix it.

Dr. Justin Marchegiani:  So anyone listening to this and kinda, you know, has all these labs in front of them and not quite sure you know what to do with it, get over to Heads Up Health. Get it integrated in there so you can start seeing patterns and then it’ll be really fun as you go forward tracking your labs. You’ll be able to see trends that you may have not seen otherwise.

Dave Korsunsky:  Yup, sounds great.

Dr. Justin Marchegiani:  Alright, Dave. Great talk! You have an awesome day.

Dave Korsunsky:  Yup, likewise. Thanks, Doc. Take it easy.

Dr. Justin Marchegiani:  Thanks, bye!


Thyroid Test:
Heads Up Health:

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