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, headsuphealth.com. 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 HeadsUpHealth.com, 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 1^st 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 JustInHealth.com. 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 justinhealth.com, 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!