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

Dr. Will Cole Video: Hypothyroidism, Hashimoto’s and Fatigue – Podcast #36

Hypothyroidism – The most common cause of hypothyroidism is Hashimoto’s thyroiditis. “Thyroiditis” is an inflammation of the thyroid gland.

In this interview with Dr. Will Cole, we talk about thyroid dysfunction and how to fix it! Over 30 million Americans are suffering from hypothyroidism or low thyroid function. Our thyroid gland produce hormone that helps keep our metabolism working optimally. With less thyroid hormone, our metabolism gets slower while at the same time many symptoms occur. Many people have Hashimoto’s thyroiditis which is an autoimmune thyroid condition. Conventional medicine does nothing to address the root cause of autoimmune thyroid conditions.

Dr. Cole

Listen to this podcast as they discuss about nutrients to maximize thyroid conversion as well as nutrient testing. Dr. Cole also shares how he deals with his thyroid patients and tests he orders for them. After you listen to this interview, you’ll be able to learn a lot of information on hypothyroidism and Hashimoto’s.

In this episode, we cover:

7:22   Main differences between functional medicine and mainstream medicine

12:06   About medications and the focus on TSH

21:50   Different kinds of tests being run for thyroid

31:30   On iodine

36:30   Importance of selenium

38:30   About gluten and Hashimoto’s patients


itune subscribe






Podcast: Play in New Window | Download


Dr. William Cole D.C, graduated from Southern California University of Health Sciences in Los Angeles, California. He has his post doctorate education and training in Functional Medicine and Clinical Nutrition. Dr. Cole consults in the Pittsburgh area and phone or webcam consultations for people around the world. He specializes in clinically investigating  underlying factors and customizing health programs for chronic conditions such as thyroid issues, autoimmune, hormonal dysfunctions, digestive disorders, diabetes, heart disease and fibromyalgia.

Dr. Justin Marchegiani: Hey, there! This is Dr. Justin Marchegiani and welcome to another awesome episode of Beyond Wellness Radio. Again, we have a great show in store for you. Before, go to, click on the Newsletter Sign Up button and you can sign up for our newsletter and get show updates right in your inbox before anyone else. You can also click on the Questions button and even speak questions live, and we’ll be able to answer it on the air for you.

You can also click on the Write A Review button. If you really enjoy this show, write us a review. Let us know on iTunes. Let the world know. Think of one person that would benefit from listening to this show and share it with them. Sharing is caring.

Also, check out, which is my personal site. And I have some complimentary functional medicine consults available. You can also sign up for the Free Thyroid Series and Female Hormones Series as well.

You can also go to That’s Baris Harvey’s website where has some great articles and blogs and videos for you there as well and even some consultations. Again, we have an awesome show in store. Stay tuned.

Hey there! It’s Dr. Justin, welcome back to Beyond Wellness Radio. Again, we have an excellent guest on today’s show, Dr. Will Cole. Dr. Cole’s practice is over in Pittsburgh, Pennsylvania. He also has a virtual clinic worldwide. Dr. Cole’s a functional medicine doctor. He specializes in thyroid conditions and–and much more. Again, as functional medicine doctors, we really have to specialize in the whole body, but again Dr. Cole, welcome, tell us about yourself a little bit.

Dr. Will Cole: Hey! Thanks for having me, first of all. My–like as you said, we have a clinic here in Pittsburgh, Pennsylvania. We have a virtual functional medicine practice where we do webcam and phone consultations for people in the United States and around the world. Clinically, this–my education background, my doctorate is from Southern California University Health Sciences in Southern California and my post doctorate as you’ve mentioned is in functional medicine and clinical nutrition. So, I also write for the mindbodygreen, one of the largest health websites in the world, one of their health experts for the last couple of years, and I have a passion for education people about chronic and autoimmune conditions and it’s–I’m really excited to talk with you about the thyroid today.

Dr. Justin Marchegiani: Well, really good! So, tell me about your health story, every functional medicine doctor has their own story of how they got into this field. So, how did you get into this field?

Dr. Will Cole: For me, it was just kinda growing up around it. I, my–my father was in the healthcare field and just kind of seeing some great minds, people like Dr. Mercola, that has kinda change the–the landscape of–of the healthcare in the United States and really everywhere and they just inspired me and saw people that are really struggling with chronic issues, getting more and more medications and seeing that all be reversed and get healthy and the doctors are able to take them off that medication, that’s hugely inspiring as–as a young kid growing up and I kinda knew in high school, “Hey, I wanna be a part of this, too. I wanna–I wanna make–make some changes in people’s lives for the better, too.” So, that’s kinda with–with me. I know a lot of clinicians have kinda gone through some–some major health issues that kind have been–that was the catalyst to make them where they’re at today. For me, I’ve been blessed and lucky to not have to go through that, so, that’s my story.

Dr. Justin Marchegiani: That’s great, awesome! And again, we are really fortunate because Paleo f(x) is coming up here the end of April. So, anyone that’s gonna be in the Austin area, Dr. Cole and I will be on a panel with another naturopathic physician. We’ll be talking all about thyroid, so we’re–the goal of today’s talk is to kinda give everyone a sneak preview of some of the things that we’re going to be talking about in the thyroid realm. And again, thyroid is one of these conditions, it’s so common in the U.S about 30 million people have this condition. About 1 in 5 are autoimmune and functional medicine really is the only field that’s equipped to addressing the autoimmunity because that’s kind of a one-size-fits-all in conventional medicine. Can you talk more about how you addressed, just your typical thyroid patients? So, they–they come to you. They have maybe hair falling out, fatigue, depression, weight gain, the whole nine yards. How do you work them up?

Dr. Will Cole: Yeah! I think that–you’re right. This is a huge problem in the United States and I think research says like 20 million Americans have low thyroid issues. One in 8 women will develop a thyroid issue in her lifetime and worldwide, it’s insane, that’s like upwards of 250 million people around the world have some sort of low thyroid issue. Huge! And the–the inadequacy of standard model of care is like glaringly obvious because they’re just running these basic labs, TSH, maybe T4, and based on just, “Hey, here’s Synthroid. See you in 3 months.” And that works for some people and for a lot of people it work for a little bit, but then, plateaus and they’re kind of left where they began.

Dr. Justin Marchegiani: Right.

Dr. Will Cole: And the reality as–as you know, I know, that you’re kind of seeing this on a daily basis in your clinic is that we have to look beyond those sort of basic labs and that’s where it kinda starts with for myself. I’m assuming you as well. We need to run a full functional thyroid panel to kind of see the–the intricacies, these underlying pathway dysfunctions that are at play that will not be effectively addressed with Synthroid alone or at all.

Dr. Justin Marchegiani: Right, right, right.

Dr. Will Cole: So start with–starts with diagnostics, so full thyroid panel which you probably talked about in your show in the past kind of the–the extended panel and then we look at all the–the implications hormonally that–that are interplayed with the thyroid as well. So we look at adrenal function. We look at hormonal function as far as estrogen and progesterone imbalances and then obviously the gut is a huge component–component of that as well.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: So the conversion pathways as well as the total immunological standpoint because a large–a large part of these people are having autoimmune component to their case. So until you deal with the root issue what’s causing the low thyroid problem in the first place, which in–I would say the majority of them are autoimmune in nature. They may not be full blown Hashimoto’s disease but they are in some degree, they’re immune system’s attacking their thyroid. So we have to have a comprehensive view of it and then you kind of know definitively, “Okay, this is why you feel the way you feel and let’s start these addressing these–these issues one by one.”

Dr. Justin Marchegiani: That’s great. Now you talked about a full thyroid panel. Can we just for all the listeners, just kind of contrast maybe what a conventional thyroid panel would–would entail and how a complete thyroid functional medicine panel would be different and what extra information are we getting from that?

Dr. Will Cole: Great. So I–I think it would be good for us to go back up a little bit and look at the main differences between functional medicine and mainstream medicine.

Dr. Justin Marchegiani: Mmm.

Dr. Will Cole: The first thing that you and I are gonna be different than their standard endocrinologist or PCP is that we’re gonna interpret the labs that are run currently, the ones they typically ran–we’re gonna interpret those labs differently because, you know, on that reference range, they have, you know, from X to Y, this is what your numbers should be, anything outside of that range is high or low; if they’re both fine, and you know, there’s a problem there. When we get that–that­ average through a statistical bell curve average of the people–the population of that lab–

Dr. Justin Marchegiani: Exactly.

Dr. Will Cole:   People that typically go to labs are not the healthiest population so if your doctor is saying, “Hey, your labs are normal,” and then you’re still going through these laundry list of symptoms, what they’re really saying is you’re a lot like a lot of other sick people because that’s just looking at this general huge reference range. So we as functional medicine practitioners are looking at a much thinner range of where your body is functioning the best, where your health is great, you’re off of medications, you’re not having symptoms, you have all that energy back, you’re at the weight that you wanna be. That’s the optimal range and that’s gonna be a lot thinner range than that huge reference range. So we’re interpreting the labs that are run currently, the ones that you guys have from your PCP or endo differently using a much thinner guideline and then I would say, number two, we’re running more extensive labs that aren’t run. And the reason why they’re not run is not because your doctor is some mysterious, you know, keeping you–keeping you in the dark. What–it just doesn’t change the treatment. You’re gonna get Synthroid of levothyroxine whether you have true primary hypothyroidism or an autoimmune disease attacking the thyroid or whatever other conversion issue or metabolic issue you’re–you’re dealing with. The end result is gonna be the same, so why would they run more labs if ultimately the only option they have to give you is that Synthroid or levothyroxine. So the full thyroid panel in–in regards to your–your question is that we are running beyond just the TSH and T4. We’re looking at free T4, free T3, so those are the free forms of that thyroid hormone. What’s biologically, metabolically active to the body, what’s getting in the cells that’s–that’s usable by the body, and then we’re looking at T3 uptake which looks in our–our realm, the functional medicine realm looking at estrogen and testosterone imbalances and we’re looking at again all the other implications beyond that, too. So the free fraction hormones we’re looking at–the T3 uptake and of course, we’re looking at the antibodies, thyroid peroxidase and thyroglobulin antibodies, to rule in other autoimmune components to the patient’s case. So the most common being Hashimoto’s disease and so I’m assuming many of your listeners are–are the well, you know, learned. They do know what they’re talking about and are aware of the–the rise of autoimmunity in their–in the world and–and how we need to address it.

Dr. Justin Marchegiani: Yeah. And is TSH a thyroid hormone, Will?

Dr. Will Cole:   Well, it’s secreted by the brain.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: Secreted by the pituitary gland so it’s not a thyroid hormone. It’s kind of like the analogy that I use and maybe it’s not the best. But I always say it’s the communication with the brain and the thyroid. So if your TSH is high, this is like inversely proportional. A lot of people get confused. A lot of my patients do, they’re–they’re looking at this high TSH and they think, “Well, maybe why shouldn’t I be hyperthyroid? Why am I not losing weight? Why am I not feeling like hyperactive?” Well, this is an inversely proportional number to your–from your brain to your thyroid. So it’s–it’s basically your brain screaming at your thyroid if you have a high TSH saying, “Work more, work more,” because it’s not secreting hormones for whatever reason. But again, there’s a lot of people with normal TSHs that have low thyroid issues. One of them being a pituitary hypofunction. If your pituitary gland is not working well because of stress or inflammation or chronic infection, your brain is not communicating with your thyroid. So you can have a normal-looking, pretty looking piece of paper wrapped TSH, but you’re having low thyroid symptoms and that’s why we have to look at these communication lines with the brain. So that’s why a large part of my clinical approach is having a brain-based component to it of addressing these–these neurotransmitters issues and these hormonal communication lines with your endocrine system.

Dr. Justin Marchegiani: Yeah and a lot of patients I see, again their TSH may be normal but then their T4 and T3 conversion is off, or let’s say a patient had thyroid issues. Let’s say, you know, they had elevated TSH, they were put on some Synthroid. Now their TSH is back to normal, so the doctor thinks they’re fine but we run a full panel, you see T3 free and total is–is totally low. And one the big things I think a lot of medical doctors don’t realize is that the cells of the anterior pituitary are very sensitive to thyroid hormones. So once someone’s on a thyroid medication or supplement that may have endogenous thyroid in it, TSH will be the first thing that drops, and you may not get that conversion across. Can you talk about medications and how doctors are so just focused on TSH and not the–the other downstream hormones?

Dr. Will Cole: Yeah, I–I think that they’re really is–is part of the bigger picture that we see across the board with all chronic disease is the training and the standard model of care that has its place but their training is diagnose the disease and match it with the corresponding drug. It’s really the only option they have as far as the PCP setting. So if you have high cholesterol, you’re gonna get high cholesterol drug. If you have diabetes, you’re getting diabetes drugs. If you’re depressed, you get the anti-depressants. It’s just the–

Dr. Justin Marchegiani: Right.

Dr. Will Cole: There’s a medicinal matching game. But when it regards to–to the thyroid is that, it’s just a very incomplete view and kind of hanging your head on this one number–we’re all more complex than just one number on a piece of paper and you kinda have to look at the downstream, like you said, conversion issues that–that the thyroid has to go through to actually be used by the body, so as you mentioned, low T3 syndrome is a huge problem around the country because the conversion happens in the liver and a large, smaller part in the gut, this is where the conversion of T4 to T3 occurs and if your gut’s not working well and if your liver is not well, you can have low T3–T3 syndrome or that just under-conversion issue, and yeah, you have to deal with the conversion at that point. It’s really not a thyroid problem, it’s a conversion of the thyroid problem.

Dr. Justin Marchegiani: Yeah, that makes sense. Now regarding, you know, thyroid issues, we know T4 is this inactive thyroid hormone, are you aware of any-any physiological uses in the body for T4 or is it primarily T3?

Dr. Will Cole: Yeah, it’s primarily T3, I think to a lot–a smaller degree, it’s usable to some degree, but no, the more metabolically active is gonna be T3.

Dr. Justin Marchegiani: That’s right and most people or most doctors aren’t looking at this conversion. What factors are you seeing that are affecting T4 to T3 conversion? You mentioned gut bacteria with the–with the acetic acid and the sulfatase enzymes. You mentioned liver with the whole deiodinasation process, that’s your body cleaving iodines off–it’s a selenium-based process. We need selenium to do it. What other processes are really important for that T4 to T3 conversion?

Dr. Will Cole: Yeah, I would look at, again, a full mapping of the hypothalamic-pituitary-adrenal axis–

Dr. Justin Marchegiani: Uh-hmm.

Dr. Will Cole: The HPA axis because if someone has sustained high cortisol levels or if anyone has sort of andrenal fatigue–

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: As we call it, spectrum, even just chronic stress levels–chronic systemic inflammatory issues will decrease the conversion ability of T4 to T3. So you kinda have to look at the complete history and I don’t think a–I think a lot of clinicians aren’t even taking the time to really look at it. You have to look at these underlying issues that give rise to chronic thyroid symptoms.

Dr. Justin Marchegiani: Exactly. And you mentioned cortisol there and we know that high cortisol will actually block T4 to T3 conversion, and we know if it’s too low if we’re on a full out adrenal fatigue stage 3, not enough cortisol will prevent conversion as well, because we need some cortisol for this conversion and I see a lot of patients, we’ll kinda look at their full thyroid panel on one side and then we’ll look at their adrenal panel on the other and some people, their–their adrenal will be in worse shape than their thyroid. How many people or just on general, how many patients are you seeing on average that are coming in where their adrenals are actually in worse shape than their thyroid even though they thought maybe they had a thyroid problem pri–primarily?

Dr. Will Cole: A huge percentage of people. I mean, because if we’re talking these all compassing typi–classical low thyroid symptoms and then then they think that’s what they’re going through, that gets the most buzz, it’s the most popular, that’s the most people are aware of in their–their consciousness but when you run the labs, you’re seeing, “Okay, actually you have a lot of other hormonal things going on but it’s actually not thyroid.” I see that on a daily basis. So you cannot sort of pigeonhole these issues and just assume they’re all thyroid issues because thyroid may be a part of it but it’s–

Dr. Justin Marchegiani: Yeah, yeah.

Dr. Will Cole: Basically victim of these other hormonal problems.

Dr. Justin Marchegiani: Yeah, that’s really true and what nutrients are you also looking at to assess or what nutrients are you making sure that patients have enough of to maximize thyroid conversion?

Dr. Will Cole: Yeah, I would definitely look at selenium, zinc issues which help with the conversion issues and just help with thyroid physiology as whole, and that’s something that you can measure on a–on a simple blood test to kinda see what’s going on as far as the micronutrients are concerned and many people are deficient in these–these nutrients. So those are two main, main–main nutrients that we will work on.

Dr. Justin Marchegiani: And what objective tests are you doing to assess these nutrient levels?

Dr. Will Cole: We’re running a blood panel. Full blood panel to–to kind of see the micronutrient aspects of it and as far as the nutrients, it’s mainly through blood.

Dr. Justin Marchegiani: Are you doing like a SpectraCell? Are you doing like a NutrEval? Are you doing–

Dr. Will Cole: SpectraCell is typically what we use.

Dr. Justin Marchegiani: Okay, got it. Do you have any experience doing like a NutraEval by Genova or–

Dr. Will Cole: I’ve seen them before from other clinicians–

Dr. Justin Marchegiani: Organic acid test?

Dr. Will Cole: Yeah, I’ve seen them before. We don’t run them on a regular basis. Do you run them?

Dr. Justin Marchegiani: I do the organic acids a lot. I mean, you know, there are some markers on your conventional blood panel where you can kind of infer some nutrient deficiency, you know, alkaline phosphatase and zinc and RDW and–and selenium–

Dr. Will Cole: Uh-hmm.

Dr. Justin Marchegiani: But they’re indirect markers, but yeah, that SpectraCell is a good one, too.

Dr. Will Cole: Right, that’s my favorite one to looking at the nutrients.

Dr. Justin Marchegiani: Yeah, and what are you doing to look at liver function? Because you–we know liver is so important for thyroid hormone conversion.

Dr. Will Cole: Yeah, what I’m doing is I’m running a comprehensive metabolic panel and looking at the AST, ALT, and the GGT and looking at the functional range, not just the–the huge reference range. But looking at the liver enzymes in the optimal range on the blood test that a lot of these people have already. So I always tell patients like, “Look, we can start with the labs you have already and just the functional medicine interpretation of those labs to kind of see,” and you know what, so many people don’t even know what all these biomarkers mean and just explaining to them, “Hey, look, this is what’s been going on. Your doctor hasn’t talked to you about it mainly because there’s no medication for it. But it’s actually a problem and your doctors ran these labs but there hasn’t been a conversation about it.”

Dr. Justin Marchegiani: Yeah, that makes a lot of sense. That really does. Now on that note, I have a blog up here in front of you that you wrote a little while back on autoimmunity and some–

Dr. Will Cole: Yeah.

Dr. Justin Marchegiani: Of the triggers. Can you talk about, just comparing contrasting, you know, your run-of-the-mill, your primary or secondary hypothyroid patient, whether it’s a pituitary or conversion issue, and then compare that to just, you know, an autoimmune thyroid. What’s the difference and how would–

Dr. Will Cole: Yeah.

Dr. Justin Marchegiani: You treat them?

Dr. Will Cole: And I would–they–there can be separate cases but my finding is that a lot of these patients are–have more than one thyroid category where we put them in. They are autoimmune, the majority of them.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: Even if the antibodies are below the level where we can classify them as Hashimoto’s, there’s some sort of autoimmune response going on there, and then they have conversion issues. And they have pituitary hypofunction, so–and they have thyroid resistance which is similar to–to the insulin resistance because of the chronic inflammation they’re going through. So they have this multi-tiered faceted aspects that–that are pieces of the puzzle to them healing when they overcome them. So, but again, most of the patients that I see are autoimmune patients and a large majority have been diagnosed or will be diagnosed with Hashimoto’s disease or autoimmune thyroiditis and a large part of autoimmune patients is finding out their food triggers, because autoimmune patients as you know they’re given very little options in the standard model of care. They’re really given steroid therapy and that’s basically it. And they–they’re kinda left to fend for themselves, so and then they don’t realize and they’re told by their doctor that what you eat doesn’t really matter at all. You can kinda eat whatever you want. It’s not gonna play a part in your autoimmune disease and that’s just not what research is showing as the foods you eat have direct implications to the rise of your inflammation and autoimmune response in your body. And I’ve seen every food under the sun, even healthy foods, I’ve seen autoimmune patients flare up against these seemingly innocuous healthy benign foods. So you have to kind of cut through the confusion so people that have cleaned up their diet, people that have–that are eating a Paleo diet or–or kind of conscious eaters and clean eaters that are still having symptoms, we need to kind of cut to the confusion what is their immune system flaring up against.

Dr. Justin Marchegiani: Got it. Alright, so you mentioned some of these triggers. You mentioned some foods and now with these foods just kind of be all the foods that would be, you know, cut out of an–kind of your basic autoimmune diet, your nuts, your seeds, your nightshades, your gluten–

Dr. Will Cole: Yeah, those are the–

Dr. Justin Marchegiani: Sweet potatoes, eggplants, peppers. Go ahead.

Dr. Will Cole: Yeah, I know. That’s the–the big guns for sure. We would–

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: Clean those guys up right out of the gate and then we typically I run the Cyrex multiple–multiple autoimmune food panel, the–the newer one they have that kind of–

Dr. Justin Marchegiani: Array 4? The Array 4?

Dr. Will Cole: I believe so–I don’t know for sure. I think it might be autoimmune because that’s like molecular–that’s the cross-reactive foods–

Dr. Justin Marchegiani: Yes.

Dr. Will Cole: I believe. So it’s not the cross-reactive foods which we would run that as well, but they have, I think it’s Array 10. It’s higher up in the–in the arrays, that kinda looks at just food intolerances as a whole and obviously I–no one really has like a spinach intolerance but if their body is reacting against this, it’s really due to the gut. So what I have them do is while they’re healing the gut, avoid those foods, so they do not have this inflammatory response against these healthy foods.

Dr. Justin Marchegiani: Got it. So patients come in to you, what are the average tests that you’re running off the bat? I know it’s gonna be different for each patient depending on what their goals are but just on average, how many tests are you typically running off the bat and what are they in general?

Dr. Will Cole: Yeah, the first–my first tier test is gonna be a functional blood testing, just through their–

Dr. Justin Marchegiani: Mmm.

Dr. Will Cole: Labs, typically. Their Quest or LabCorp we typically use. So it’s gonna be a comprehensive metabolic–metabolic panel. We run a nuclear magnetic resonance to look at the subfractionation of the lipids. We’re looking at the micronutrients. We’re looking at a full thyroid panel obviously.

Dr. Justin Marchegiani: Mmm.

Dr. Will Cole:   We’re looking at homocysteine, C-reactive protein–

Dr. Justin Marchegiani: Uh-hmm.

Dr. Will Cole: We’re looking at MTHFR, gene mutations. That’s kind of basic testing for us.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: And then the secondary testing is gonna be a full saliva adrenal stress index through diagnostics, looking at cortisol rhythm; looking at estrogen, progesterone, LH, and FSH; some basic food intolerances, and then we run a 2-day collection stool test from Doctor’s Data to look at the microbiome, so predominant bacteria; any yeast, fungal, parasitic issues; bacterial overgrowth, leaky gut syndrome, and digestion and absorption abilities because we see impairments of that a lot because of the population of the autoimmune patients that we’re seeing. So that’s basic testing that we run and then we go a little bit deeper for patients that have cleaned a lot of their lives, that are eating healthily, but they’re just at a plateau and we run sort of these–these deeper tests for those people.

Dr. Justin Marchegiani: That’s great, doc. And I know in your article here on 6 Triggers for Autoimmune Thyroid Disorders and How to Avoid Them, you mentioned infections and you talked about your 2-day sample from Doctor’s Data. Is there a reason why you do the 2 versus the 3?

Dr. Will Cole: I just think it uncovers things that may be missed on the 1-day and they have a 3-day collection, too, where we use that often as well.

Dr. Justin Marchegiani: Okay.

Dr. Will Cole: So I think that you’re just gonna uncover things that maybe fall through the cracks, no test is perfect, and I just find that maybe things negative on day 1, and day 2 and day 3, they’ll be positive. And a lot of people can get these false negatives and they go on for years of their lives not knowing why they’re sick, and it’s just if we just took the extra day to run these labs, we can give them insight into these underlying things that are lurking but aren’t easily detected.

Dr. Justin Marchegiani: Yeah, a lot of times I’ll run 2 different stool tests from 2 different companies, you know, minimum of 3 days each, sometimes we’ll even throw in one of the genetic stool tests, too, and almost all the time, one will pick up an infection where the other one didn’t quite pick it up.

Dr. Will Cole: Yeah, that’s brilliant. That’s even better. So I think the more you can kind of give people answers and say, “Hey, this is why you’re struggling,” and it’s just that’s the beginning of healing and I’m just getting that relief off their shoulders that “Hey, I’m actually feeling this lousy for a reason. It’s not just all in my head.” I’ve told many people as you know are told this for years–

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: “You’re just crazy or you’re just depressed. Here’s an anti-depressant.” And then they start second guessing themselves and thinking, “Well, maybe this is just in my head.” It’s not in just in your head. It’s–this is a real physiological issue that’s really just, you’re not getting the answers because of the inadequacy of–of the standard model of care.

Dr. Justin Marchegiani: Yeah, I had a patient just the other day come in and she’s a young high school student and she has a bowel movement on average once a week if she’s lucky. And she goes into her primary care and, you know, obviously they just throw her the prokinetics, you know, your–your laxative medications, your enemas. But then while leaving the doctor’s office, the doctor tried prescribing her with anxiety. And it’s like, “Wait, wait a minute!” Like I think anyone would just naturally feel anxious if they couldn’t poop.

Dr. Will Cole: Right.

Dr. Justin Marchegiani: You know, less than one time a week. It’s like, “Come on.” So that’s the kind of standard of care where even when we have blatant imbalances in physiology, we’re still gonna try to make you feel like it’s all on your head and we’re gonna give you some medication that’s gonna probably cost more side effects than help.

Dr. Will Cole: Yeah, exactly. I think it’s very well said and it’s just this very symptom-based model which we’ve seen for–for–for decades here and it’s just where–as far as crisis care, I think emergency care in this country we have some of the best emergency care systems in the world, but when you’re talking about chronic care, daily chronic disease that are–it’s really what’s killing the United States, chronic disease and autoimmune conditions, we’re a dismal failure. We’re really very, very inadequate as far as the options that people are given.

Dr. Justin Marchegiani: I totally agree. And are you seeing a lot patients of yours that are having these issues and are being scapegoated with anti-psychotic medications?

Dr. Will Cole: Oh, absolutely. They just–that’s the easy drug to give. That’s the easy solution. You have anxiety, you have depression and–or you have these unexplained health issue, and they basically are saying it’s a mental issue. They’re basically making it up. It’s part of a mental disorder and they’re given these anti-psychotic drugs and it’s just–it’s not dealing with the root issue of why they’re going through what they’re going through. And we know just through the cytokine model of cognitive function, basically how inflammation impacts brain function, depression and anxiety and these type autistic symptoms, all of these things have implications to the gut, to the microbiome, and to inflammation. Until you deal with those issues, these real measurable physiological issues, you’re gonna have these symptoms and you can be dealt up from medications but ultimately you’re not dealing with the reason why you have the problem in the first place.

Dr. Justin Marchegiani: Yeah, I totally agree. That makes a lot of sense for me and I know that you being a functional medicine doctor, you have a system-based, a systems-based approach, where when someone’s talking about their symptoms, right? They may take about fatigue or brittle hair or my fingernails are this, you’re in your–in your mind like going back, “Oh, maybe they’re adrenals are off, maybe they’re not absorbing fatty acids and protein,” where maybe the average doctor is like, “Ooh, let’s see depression, SSRI, stomach pain, mmm, proton pump inhibitor.” So your mindset is totally different. You’re working in a different way mentally when you’re listening to these histories versus the conventional MD, is that correct?

Dr. Will Cole: Yeah, absolutely. In other words, functional medicine is systems medicine or, you know, mechanism medicine. So we’re looking at these underlying mechanism dysfunctions that give rise to chronic and autoimmune conditions. So yeah, the symptoms are a–a–are a–are just the tip of the iceberg. Symptoms are a result of something going on underneath the surface that we need to kinda backtrack and come up with a hypothesis of what’s not working well and then implementing tools, natural tools, to fix these underlying dysfunctions.

Dr. Justin Marchegiani: Yeah, I love that. That’s why functional medicine just makes so much sense.

Dr. Will Cole: Yeah, it’s logical. I mean, people that have a logical mind or they just wanna find out why–who doesn’t wanna find out why they feel the way they feel? I think ultimately most people do not want to just mask symptoms. They may want it for the meantime, in the short term if they’re suffering, I understand that. But then long term, we have to ask the question, “Why do I have this problem in the first place? It’s not a medication deficiency. So let’s find out how we can get better so eventually as I’m getting healthier, I can get myself off these medications with my doctor’s help.”

Dr. Justin Marchegiani: That makes sense. Now in your blog article which I recommend everyone to read here. The 6 Triggers For Autoimmune Thyroid Disorders at, click on the blog link there. But you talked about infections, we touched upon, you know, how you assess that with, you know, certain stool tests–

Dr. Will Cole: Uh-hmm.

Dr. Justin Marchegiani: 2-3-day ones, et cetera. What infections are you seeing on average with your patients?

Dr. Will Cole: Yeah, we’re seeing bacterial pathogenic infections–

Dr. Justin Marchegiani: H. pylori?

Dr. Will Cole: Yeah, H. pylori–

Dr. Justin Marchegiani: SIBO kinda stuff?

Dr. Will Cole: Yeah, and strep infections, too. Overgrowths of those–those coliform units of bacteria, and we’re seeing candida, not just the Albicans. There are different kinds of species of candida, yeasts, fungal issues, and occasionally we’re seeing parasitic infections as well. So these types of things are constant, cyclic inflammatory triggers to people that are struggling with these unexplained health issues that may be thyroid-related, may have a thyroid component and they’re–

Dr. Justin Marchegiani: Uh-hmm.

Dr. Will Cole: Just think it’s entirely thyroid, but as we talked before the–the call started, the body’s all interconnected.

Dr. Justin Marchegiani: Yeah.

Dr. Will Cole: And the idea that one of these separate boxes where we’re just gonna have a pill for each of our problems, the reality is that we need to look at the body as a whole entire system and–and start fixing these issues one by one.

Dr. Justin Marchegiani: Yeah, that makes a lot of sense. Now, what kind of parasites are you seeing in your clinic with patients?

Dr. Will Cole: We’re–we’re seeing really everything as far as the parasitic infections, but it’s not–to pinpoint one, I don’t really. Yeah.

Dr. Justin Marchegiani: Yeah, I know how science–

Dr. Will Cole: The scientific–

Dr. Justin Marchegiani: Yeah, I know the scientific literature is really keen on for instance H. pylori is a big o

The entire contents of this website are based upon the opinions of Dr. Justin Marchegiani unless otherwise noted. Individual articles are based upon the opinions of the respective author, who retains copyright as marked. The information on this website is not intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. It is intended as a sharing of knowledge and information from the research and experience of Dr. Justin and his community. Dr. Justin encourages you to make your own health care decisions based upon your research and in partnership with a qualified healthcare professional. These statements have not been evaluated by the Food and Drug Administration. Dr. Marchegiani’s products are not intended to diagnose, treat, cure or prevent any disease. If you are pregnant, nursing, taking medication, or have a medical condition, consult your physician before using any products.