From Fatigue to Freedom: Healing the Thyroid Beyond Lab Tests

0:00Coming up on this episode of the Dr. Hyman Show. About 60 to 70 % of people with hyperthyroidism are graves. It happens to about 1 in 200 people, women more than men, 10 to 1. And it usually peaks around in the ages of 40 to 60 years old, but it can happen younger. We're missing a nutrient essential for healthy aging, and it's not a trendy supplement. It's called C15, the first essential fatty acid to emerge in over 90 years. C15 helps stabilize cell membranes, keeping your cells resilient, repairable, and functioning optimally as we age. The problem is it's getting harder to get enough from your diet.

0:35Its natural source is full fat dairy, which many people avoid. Additionally, many industry practices are reducing the amount of C15 in dairy fat. Even eating a clean, plant-forward diet like mine, most of us are short on this nutrient. That's why I take Fatty15. Scientists who were funded by the US Navy created a pure, bioavailable form of C15 so you get the benefits without relying on dairy. Studies show that C15 has over 36 cellular benefits that support metabolism, immunity, and liver health, and 70 % of Fatty15 users report benefits within 16 weeks, including steady energy, deeper sleep, and overall balance.

1:09I've been taking Fatty15 daily for over two years to support my long-term wellness. It's one small capsule with a big impact for healthy aging. Try it for yourself at fatty15.com, Hyman, and use code HYMAN for 15 % off a 90-day subscription. Before we jump into today's episode, I want to share a few ways you can go deeper on your health journey. While I wish I could work with everyone one-on-one, there just isn't enough time in the day, so I've built several tools to help you take control of your health. If you're looking for guidance, education, and community, check out my private membership, The Hyman Hive, for live Q &As, exclusive content, and direct connection.

1:43For real-time lab testing and personalized insights into your biology, visit Function Health. You can also explore my curated doctor-trusted supplements and health products at drhyman.com. And if you prefer to listen without any breaks, don't forget you can enjoy every episode of this podcast ad-free with Hymen Plus. Just open Apple Podcasts and tap try free to start your seven-day free trial. What is a thyroid function? What is your thyroid gland? It's this little gland in your throat. And think of it as your overall metabolic regulator. It really controls everything. It's like your motor. It's like, you know, in terms of the RPM on your engine.

2:18So you know some things like a golf cart or something, have a governor and you can only go so fast. It's a little like that. So if it's slow, your whole system slows down. If it's fast, your whole system speeds up. That's hyperthyroid. Not that common, but it can be a problem for some people. But low thyroid or hypothyroid function is really common. And your thyroid gland produces hormones T4, which is the inactive thyroid hormone. And your brain produces something called TSH, which tells your thyroid to make more thyroid hormone if it's low, or if you have too much thyroid hormone, your TSH goes down.

2:54So it's a way we sort of track things. Now the inactive hormone is T4. That has to get converted in your body to the active hormone, which is T3. Now T3 is only about 7 % of your hormone, thyroid hormone, but it's really important because it does all the work. It actually binds to the nuclear receptors that then translates into gene expression, into all these downstream metabolic effects. And it sends these messages to your DNA to turn up your metabolism. There's not fat burning in your mitochondria to basically get all systems go. And if you have a good T3 level, your cholesterol is in check, your memory is good, your metabolism is good, you stay thin, it helps your hair grow, it helps your muscles, prevents muscle aches, constipation, and even improves fertility.

3:48So if you have your T3 working, it's really great. But the inactive form often doesn't get converted. And there's a lot of reasons for that into T3. And it can be environmental toxins. It can be stress. It can be lack of certain nutrients. I will talk about that like selenium. It can be overgrowth of yeast. So there's a lot of things that affect this conversion. And often we'll see people with inadequate levels of T3. So the main role of thyroid is to stimulate metabolism. And it really affects almost every single function of the body. And it can cause so many weird, vague symptoms that people don't even often identify it.

4:26Because it's like, oh, I'm a little this, a little that. And you don't really get it. And the main reason it's not diagnosed is that the symptoms aren't specific. You're a little achy. You're a little tired. You gain a little weight. Your skin's a little dry. You're losing a little bit of hair. You're maybe sluggish. You have trouble concentrating. You're a little depressed. You know, you're maybe a little cold when, you know, everybody else is warm. You get whole hands and feet. You get, you know, low libido. You might get a little flu retention. Your cholesterol is a little high. These are really non-specific symptoms that can be caused by many, many things.

4:57But when you add it all together and you look at this list, it's feeling, oh, I have all that. You know, like that's really a clue that you might have thyroid issues. So when we're taking a thyroid quiz, which is really important, we can link to it in the show notes, gives you a pretty good sense of if you're having a likelihood of having low thyroid. And then you need to do the right testing. Now, the problem is that it's often what we call subclinical. So it might not be full-blown thyroid disease, but, you know, in functional medicine, we like to think about how do we get to optimal function, not just what's normal.

5:32if you look at the normal lab tests, they're often misleading because they're based on a population that may not be healthy. So, you know, the range of, for example, TSH, which is what most doctors look at to check your thyroid, is 0.5 to 5. That's a tenfold range of what's considered normal. The American College of Endocrinology has lowered the top number to 3.5 or 3, but what's optimal might be one or two or 0.5 to one. So what's really optimal is very different than what's quote normal. And that's why it's often missed and doctors will often miss it because they just check the TSH and not the whole panel of tests.

6:15It gives you a really comprehensive view. If you just check TSH, it could be normal, but you could still be, for example, having an autoimmune thyroid condition, or you could still have a low T3, and doctors will not check that. They'll only check your other numbers if your TSH is abnormal, which is really a bad way to go about it. So I think it's really important to do a comprehensive thyroid panel, which includes TSH, free T3, free T4, and thyroid antibodies, thyroid peroxidase and antithyroglobulin antibodies. Now, a lot of doctors will check thyroid panel on a lab rec, and the old lab recs have very old thyroid panels that use all kinds of antiquated tests, which I still see, unfortunately, like T3 uptake and all these weird things that are not really accurate, given how sensitive these current new tests are for free T3, free T4, and ultra-sensitive THH.

7:12And also, you know, if you're really stuck and there's other things going on, there's more advanced tests like thyroid releasing hormone that we can use by using a stimulation test. So we won't get into that. But the key is the basic test should be TSH, free T3, free T4, thyroid antibodies, TPO, and antithyroglylin antibodies. antibodies. If you get that whole panel and you can see, for example, cases where there's high antibodies, but normal thyroid testing, those people still need to be treated or you'll see a low T3, but normal TSH. So it's really, really important to do a whole panel. Now let's talk about what causes thyroid problems because, you know, why are we seeing so many people with thyroid issues?

7:54Is this a genetic defect in human beings? I don't think so. It's really because we are living in a toxic world in many ways. One, environmental toxins are really impactful on the thyroid function. Think of your thyroid as the yellow canary in your body. The yellow canaries were put in coal mines, and when the canaries died, the coal miners knew the air was bad. They had to get out of the coal mine. So the thyroid is like the yellow canary of the body. Very sensitive to pesticides, heavy metals, environmental toxins of all sorts, which are super abundant. And it's 80 ,000 in these compounds in the environment.

8:33Only 1 % have been tested for safety. They're ubiquitous. The average person is basically a walking toxic waste dump, dioxin, PCBs, phthalates, DDT, all this stuff is still in us, even though it's been banned. Some of this stuff has been banned. And most of us can handle it, but it's really important to focus on identifying these toxins. Heavy metals are a huge factor, particularly mercury, and a big factor. Also stress, you know, there's a deep connection between your adrenals and your thyroid glands. So people who are overstressed, you know, by psychological stress, physical stresses, lack of sleep, those stresses register in the body directly in terms of adrenal function.

9:16And when your adrenal function is low, you often will see kind of this thyroid function go low. So for example, if you put young soldiers on a forced march, you'll see their thyroid function decrease just because of the stress of an overnight march with carrying a 50-pound pack. And they'll look like they're hypothyroid, even though they're really not. So stresses are a big factor. The other one is gluten. Gluten is a huge factor in about probably 20, 30 % in my experience, I've seen thousands of patients and testing them. Everybody who's got low thyroid or anybody's to thyroid, I check their gluten antibodies too.

9:56About 20 % to 30 % of people who have low thyroid function can be a result of gluten sensitivity, their celiac disease or non-celiac gluten sensitivity. and it's really important to track because if you keep eating gluten or you keep having mercury, your thyroid is just not going to work. And this can affect about 10 to 20 % of the population, so it's really common in terms of the inflammation in the thyroid. Also, nutrient deficiencies. Thyroid function needs iodine to make the thyroid hormone. You need selenium to convert T3 to 4. You need vitamin D and vitamin A to have it bind on the nucleus to work and do its thing.

10:35You need the right omega-3 fats and many other nutrients to help optimize thyroid function. So what do you do if you think you might have low thyroid? What steps should you take? Well, first do the symptoms check. Look at the questionnaire, the link, the things that I just mentioned. You can kind of do a mental checklist or you can fill out the thyroid questionnaire we're going to link to in the show notes. That's the first thing. And if there's some suspicion, you need to get the right tests. And there's a lot of ways to do that right now. You have to ask your doctor. There are labs that are coming online, like Function Health, where you'll be able to do your own ordering of tests, which is important.

11:15But you want the full spectrum, like I said, TSH, free T3, free T4, thyroid antibodies, TPO, and antithycologin antibodies. You also want to check for celiac or gluten sensitivity with deaminated anti-gliden antibodies, tissue transglutaminase antibodies. bodies. We'll write all this up in the show notes so you can keep a track of it. We might also want to do a heavy metal test. Look for heavy metals with a DMSA challenge test to look for urine toxic metals after a six-hour collection. There are tests to look at pesticides and chemicals in your body through urine testing. Sometimes I'll do that, but we're all pretty exposed.

11:52We just want to reduce our exposures. And you can do that by going to ewg.org and learning about how to reduce your exposures across skin care products, household products, food products. vitamin d plays a huge role if you're vitamin d deficient you want to see that for sure because by correcting that it'll help your thyroid work better you can check for selenium levels often there's selenium deficiencies iodine deficiencies we can measure that as well so we do a really close inventory of nutritional status that's how i kind of evaluate it so what do i do to help mix thyroid function well first you deal with all the causes gluten stress i've been microbiome we didn't really talk much about that, but that can play a role in generating inflammation that causes problems and obviously environmental toxins.

12:39And then what do you do to optimize your thyroid function? Well, first thing is eat the right foods that support your thyroid function. My favorite is seaweed. Seaweed is full of iodine, minerals. It's great for your thyroid. Fish also great. Sardines, wild salmon, mackerel, herring. Also fish contains a lot of iodine. Omega-3 fats, which you also get from the same foods. Make sure you get vitamin D. You probably need to supplement. You know, herring, mackerel are a great source of vitamin D. Mushrooms, like porcini mushrooms, but it's hard to get enough. So sunlight and obviously checking your vitamin D and taking vitamin D.

13:15Also, you can get your vitamin A, which is important for thyroid fungus, from dandelion greens, mustard greens, dark green leafy vegetables, liver, organ meats. Also, if you like that, I do. um also selenium is super important and that can come from herring scallops uh smelt which are tiny little fish brazil nuts probably are the best source you get 50 micrograms of per brazil nut so i would i would i would make sure you have plenty of those foods and the things you want to avoid if you're having thyroid function issues well i would get off of gluten dairy which are inflammatory for most people and processed soy if people are eating a lot of um processed soy it can affect thyroid potentially also uh kale and some of the cruciferous vegetables uh if you if you juice a lot of kale for example it can cause a problem i once read a report of someone who who uh i thought of the broccoli family vegetables was good for them and they ate two pounds of bok choy raw every day now if it's raw it's worse so don't eat raw cruciferous vegetables that much and she went into a hypothyroid coma.

14:19So that's an extreme case, but if you're juicing raw kale every day, you can get into trouble. And then what should you do in terms of supplements? A good multivitamin that contains selenium, iodine, zinc, vitamin A, and then you might want to add in vitamin D and omega-3 fats. If your adrenals are stressed out from chronic long-term stress, you want to deal with that through regular circadian rhythm, lifestyle management, getting sunlight exposure in the morning for 20 minutes, waking and sleeping at the same time every day, having meditation practice, yoga, deep breathing, all the lifestyle practices for resetting your adrenals.

14:55And then you can use herbs like rhodiola, Siberian ginseng, various adaptogenic mushrooms. This is really a way to kind of boost your adrenal function. And then if you're stuck, you know, you kind of might need to work with a doctor to optimize what you need in terms of thyroid treatment and adrenal treatment. So let's say you need thyroid replacement, and a lot of people do. Sometimes you can get away without it. But if you've done all the things that I just said and your thyroid is still not optimized, then you need to know what should you take. Now, the traditional approach is everybody should take Synthroid, which is libothyroxine or T4.

15:29And that works for some people. But many people, it doesn't. And they'll be partially treated. And if you check the T3, their T4 will be good because you're getting it. But their T3 will be low. And I think it's better to use a bioidentical form of thyroid, which is actually how all the hormones were first developed. And it may sound kind of weird or gross, but it comes from pig thyroid, porcine thyroid. And it's very similar or almost identical to ours. And it contains T4, T3, something called T2, which is really unusual if you might not know about, which actually helps metabolism and is very important.

16:06And so most doctors just assume that the synthroid will get converted, but it really doesn't because all the pesticides in the environment, the heavy metals, the stress, the food sensitivities, gluten, you know, deficiencies of nutrients. You know, 100 % of us have toxins in our body. So it's better to just take a combination bioidentical thyroid replacement. And that usually is armor thyroid. In the old days, it wasn't well manufactured. And so the dose was variable. but now it's really well controlled. And a lot of doctors don't like it, but I encourage you to think about trying it because it really can help.

16:42You need to check your thyroid. If you change your thyroid or put yourself on thyroid or take thyroid, you need to check it probably about six weeks after you take your whatever dose you're on and then you can see how it's working and then adjust it. If you take too much, you want to be careful because you can take too much and that can cause bone loss. It can make you a little hyper, insomnia, palpitations. So you have to track it. But your thyroid gland is important to understand and take care of, to love and figure out. We're missing a nutrient essential for healthy aging, and it's not a trendy supplement.

17:16It's called C15, the first essential fatty acid to emerge in over 90 years. C15 helps stabilize cell membranes, keeping your cells resilient, repairable, and functioning optimally as we age. The problem is it's getting harder to get enough from your diet. Its natural source is full fat dairy, which many people avoid. Additionally, many industry practices are reducing the amount of C15 in dairy fat. Even eating a clean, plant-forward diet like mine, most of us are short on this nutrient. That's why I take Fatty 15. Scientists who were funded by the U.S. Navy created a pure, bioavailable form of C15 so you get the benefits without relying on dairy.

17:50Studies show that C15 has over 36 cellular benefits that support metabolism, immunity, and liver health. And 70 % of Fatty 15 users report benefits within 16 weeks, including steady energy, deeper sleep, and overall balance. I've been taking Fatty 15 daily for over two years to support my long-term wellness. It's one small capsule with a big impact for healthy aging. Try it for yourself at fatty15.com, Hyman, and use code HYMAN for 15 % off a 90-day subscription.

18:23So tell us about this case.

18:25Mark Hyman:So she came in and she wasn't feeling good at all, but her TSH was normal. So we did the full panel and we saw that her thyroid antibodies were elevated. And so then we had to - But was her TSH and the rest abnormal or not really? No, her TSH was pretty normal. I can't remember exactly, might've been a little on the high side, but I don't even know if it was. I think everything looked really normal, but she had those thyroid antibodies. And so I had to ask that question, why, right? Why do you have these thyroid antibodies? And then it brought us down this whole pathway of what's going on with, you know, what's going on with her digestive system, what's going on with food sensitivities, was there any signs of increased intestinal permeability.

19:06Mark Hyman:And so we pulled her off of gluten. And, you know, we measured things like her iodine level and her selenium level, just to get the right balance. And we actually, we gave her some thyroid hormone, we gave her some glandular thyroid hormone, I used armor thyroid on her, which is a combination of T4 and T3. And she started, she really responded well. She felt better. She noticed her hair starting to come back in. You know, her skin's starting to be less dry. Her bowel movement's improving. And so, you know, I think it's important that we take that step and go a little deeper. And people don't often realize how bad they're feeling until they start feeling better on this stuff, right?

19:44And I think just to back up a little bit, you know, you did something which was kind of unusual, controversial, and most traditional endocrinologists would scoff at, which is you used a combination of T3 and T4 in a hormone that comes from pig. Yep. That is the entire thyroid combination of hormones, including T2, which we don't even talk about, that is actually really important to replace your own because you make a complex array of hormones and often the T4 can't get converted to the T3 in your body, which is the active hormone. Right. So even if you're taking T4, which is what most doctors recommend, like Synthroid or Lavoxel or any of these, And they're not terrible, but they're just challenging because you actually may not be giving the person the T3 that they really need because their body's not able to make it as well.

20:30Mark Hyman:Right. So then we ask that. So some people, as you mentioned earlier, feel fine on T4 thyroid hormone. That's like Synthroid or, you know, so they do okay with it. But a large percentage of people don't. And that might be because they have deficiencies in nutrients that help the body go from T4 to T3, right? So they might be deficient in iodine or selenium, as we mentioned, in vitamin A or iron and zinc. We talked about that earlier, that they can't make that conversion as easily. And so the medicine doesn't work as well for them. Or it may be because they have a variation in a gene. We know there's this gene.

21:13Mark Hyman:It's kind of a really interesting, low-impact type of gene. So what that means is that it, you know, it can - Not gonna kill you. Right, thank you. It's not gonna kill you, but it can make you not feel so good. And it helps us know how to treat people. So the gene is this DIO2 gene that encodes for this enzyme, the DI2 enzyme, which helps the body convert T4 to T3, you know, especially in the brain, but also in all throughout the body and make that active T3 thyroid hormone. And what we're learning is that some people have this gene variation. And so when you give them just T4, thyroid hormone, they don't get the benefit.

21:59Mark Hyman:And studies have shown even when lab work looks normal. So even if their T3 looks normal, even if their TSH looks normal, that they do better when you give them some T3, which could be like a glandular thyroid hormone like armor, which is a combination of T4 and T3, or it could be a synthetic T3. We sometimes use like Cytomel, and we'll add that to Synthroid, for example, or a T4. And so sometimes we see those people who just start to feel better, especially mentally, energy-wise, mood-wise. They really start to feel better, finally. I don't realize that depression is really into thyroid and that often psychiatrists in treatment-resistant depression, when drugs don't work, they'll give them T3 as a treatment for depression.

22:54Mark Hyman:They've been doing that for a long time. It's not anything new. Right, right. But it's weird for the rest of it. And also, the T4 thyroid replacements, there are challenges with that because there's often fillers, things like lactose and gluten even. Right. Could be other reasons why people don't feel well on those. So those are important to recognize. And a lot of the traditional doctors really scoff at the use of glandular. It's like Westroid, Naturethroid, Armored Heart. Why is that? And should we be worried? You know, I don't think so. I think maybe it's, maybe during their training or many years ago, there was a question of regulation of those or the dosage.

23:32Mark Hyman:But I don't find that to be a problem at all that we can definitely regulate dose with our patients. It's very reproducible in terms of the medication. And I mean, a good portion of our patients, I think we've talked about this before, right? We'll say like, maybe it was at 80 % of our patients or a good portion of our patients do really well when we use a glandular. I mean, there are some that don't. There are some where that might actually cause more autoimmunity, maybe for some, or they just don't feel good on them. And we use synthetic. but for a good portion it works really well and you can combine t3 and t4 we'll talk about the next case uh you know that are separate not as a glandular but just as a prescription drug right and and i think you know um the other problem with the glandulars and the things like armor west right is that doctors can misinterpret the lab tests because yes the thyroid the tsh goes really low because the t3 suppresses the feedback loop but you have to look at the t4 and t3 separately and also the symptoms of a patient.

24:39Mark Hyman:Absolutely. So tell us about that. Well, sometimes like when you give T3, right, then you might see a low T4 on, and like you said, TSH, but definitely a low T4 on the lab test because you're giving some of your thyroid in T3. And with the feedback loop, it causes that your body doesn't make as much T4. So... And the TSH goes down, which worries doctors that you're taking too much or treated. Right. And actually it's not true. It's really important to pay attention to the patient's symptoms. And I find that everybody's different. You know, I have patients who are so sensitive to thyroid that, you know, if their TSH gets a little too low, they feel awful.

25:20Mark Hyman:They get palpitations, they get anxious, they have trouble with sleep. But then other people, you know, if you don't get their TSH low enough, or if you don't give them enough thyroid, then they're feeling all those signs of low thyroid. So what I think the takeaway is, is paying attention to your patient and their symptoms and getting that feedback and listening to them. So like what William Moulter said, treat the person who has the disease, not the disease that the person has, right? Absolutely, right? That's what we're working to get to. It reminded me of a case I had years ago where this woman was so symptomatic on hypothyroid.

25:57And her TSH, her T4, her T3 were totally normal and her thyroid antibodies were off the chart. And I treated her and it was like a miracle. She lost like 21 pounds in six weeks. She had all her symptoms get better. She had fibromyalgia. She had all these quote things that were symptoms of low thyroid that weren't being treated. So it's really powerful. So tell us about the second case of your patient who'd actually been on thyroid for 15 years and really struggled.