Podcast 9 - Thyroid & Synthroid

Transcription

Dr. Chad: This is Dr. Chad Edwards and you are listening to podcast number 9 of Against the Grain.

 

[background music]

 

Presenter: Welcome to Against the Grain podcast with Dr. Chad Edwards. Where challenges the status quo when it comes to Medicine. We get in to hot topics in the medical field with real stories from real patients to help you on your way to a healthy lifestyle. Get ready because we’re about to go Against the Grain.

 

Brian: What an intro, this is Brian Wilks here with the number one, Dr. Chad Edwards.

 

Dr. Chad: How are you today, Brian?

 

Brian: Good. America’s Doctor. That’s what I’m going to start calling you.

 

Dr. Chad: [laughs] I love it.

 

Brian: America’s Doctor. You like it?

 

Dr. Chad: I do, like Captain America?

 

Brian: Yes, I like it. Hey, I got to story for you. And this will introduce and then we’ll go right into what pays the bills around here, right? It’s a recent topic, though.

 

Dr. Chad: Okay.

 

Brian: When I was a boy, my mom wore a mood ring, right? When she was in a good mood it turned blue. When she was in a bad mood, it left a big red mark on my forehead.

 

Dr. Chad: I love it.

 

[laughter]

 

Brian: So, today we’re going to talk about the thyroid. So particularly the moms out there, right? Could be causing me other than the sloppy husband and the bad kids, and all the other stuff a mom has to deal with in a given day. What could be causing me to have such low energy and to be so upset. Tulsa Prolotherapy

 

Dr. Chad: Yes, so obviously thyroid is way up on the list, and we’re going to be getting into some stuff with thyroid and how we commonly address thyroid and how we try to help that in traditional medicine, and then how I kind of disagree with some of that.

 

Brian: Bingo. Let’s do it. So let’s talk about Revolution Health and Wellness Clinic.

 

Dr. Chad: Am I doing that or you?

 

Brian: You’re doing it.

 

Dr. Chad: Okay, Revolution Health and Wellness Clinic. If you’re tired and fatigued, if you have musculoskeletal problems, low back pain, knee pain, sports injuries, neck pain, any of those kinds of pains, come see us. We do Prolotherapy, Platelet Rich Plasma Therapy, Stem Cell Therapy. We do some amazing regenerative injection techniques to try and get you back to peak performance without pain. Give us a call at 918-935-3636 or visit us on our website at revolutionhealth.org. Tulsa Prolotherapy

 

Brian: That’s not bad for a Doctor.

 

Dr. Chad: Hey, thanks.

 

Brian: I didn’t think you guys could do that.

 

Dr. Chad: I stayed up all night practicing.

 

Brian: In the mirror. This is radio though, right? A podcast

 

[laughter].

 

Dr. Chad: But yes.

 

Brian: Upper Cervical Health Centers. Upper Cervical Health Centers is not your typical Chiropractic office. Different in that they never jerk, twist, snap or crack your spine. How many times have you been to a Chiropractor? Where you don’t feel better when you walk out, It feels like they’ve broken something. Tulsa Prolotherapy

 

Dr. Chad: [laughs]

 

Brian: Not these folks. That’s what’s good about them, right?

 

Dr. Chad: And they look at the hollistic, from top down looking at over-all health. They do some amazing things.

 

Brian: Yes, good people over there. 918-742-2300, or you can visit their website at www.uppercervicaltulsa.com/newyou. Chad, let’s talk about the thyroid. What is it and where do they come from?

 

Dr. Chad: [laughs] So, it came from your mom.

 

Brian: [laughs] That’s not-

 

Dr. Chad: It’s not really your mom joke, although maybe now it is.

 

Brian: Now I’m convinced doctors can’t do plugs, and they can do jokes. So what’s-

 

Dr. Chad: Can’t?

 

Brian: Can’t. I would say most doctors are not funny.

 

Dr. Chad: Challenge accepted.

 

Brian: [laughs] Challenge accepted. Right.

 

Dr. Chad: So, thyroid. This is a gland that lives in your neck. And it kicks out a series of hormones, so, T4, T3, T2, T1. There’s a couple of other hormones that it will play with. But, so, when we talk about thyroid and the thyroid hormones, you have thyroid hormone receptors in virtually every cell in your body. These thyroid hormones go inside the cell, and cause a whole host of changes that are basically the gas pedal for your metabolism. Tulsa Prolotherapy

 

So when you don’t have adequate thyroid hormone, then you can feel fatigue, you can feel weak and draggy and all these kinds of things. The way I was taught to evaluate the thyroid in Medical School, so this patient comes in to see us, we think okay this patient has a thyroid problem. Let’s check a TSH. TSH stands for thyroid stimulating hormone.

 

So we’re taught that all we need, this is what I was taught about anyway, all we need is the TSH and we can manage your thyroid from there. If you TSH is high, that means your thyroid function is actually low, we’ll talk about why. And if your TSH is low, it means your thyroid hormones are actually too high. So it’s opposite. Tulsa Prolotherapy

 

Brian: Is the thyroid in the Goiter? I mean have your heard of a Goiter?

 

Dr. Chad: So the Goiter is a thyroid condition.

 

Brian: I got you.

 

Dr. Chad: So, a Goiter is an enlarged thyroid, usually because of Iodine deficiency. So stuff just gets trapped in there can’t get out. And we give them iodine; we use to see that way way way back. We still see some, not much. But yes, so, the goiter affects the thyroid. It’s actually when you see these big necks because the thyroid gland is so enlarged. So the thyroid stimulating hormone, it comes out from the brain. And, so it’s actually a brain hormone, it’s not a thyroid hormone. Tulsa Prolotherapy

 

Brian: All right.

 

Dr. Chad: It’s comes from the anterior pituitary gland and it stimulates the thyroid gland to make more thyroid hormone, T3 T4, all that stuff. Which then goes out to the body and does what thyroid does. So, again, going back to what I was taught. All you need is the TSH, if the TSH is you know, in this normal range, then their thyroid’s normal.

 

And really all they do is evaluate the TSH. Now, there’s a number of problems with this. The first one is go back to our podcast before when we talked about labs, and where does normal come from. And I will tell you that there are a lot of abnormal thyroid hormone level patients that have what are considered to be normal thyroid hormone, or normal TSH levels. And I argued, in fact, the American Academy of Clinical Biochemists changes the range for thyroid. Most labs are going to be roughly 0.5 to five on the TSH.

 

The American Academy of Clinical Biochemist says it’s 2.5 or less. I’ve seen some stuff talking about the American Academy of Clinical Endocrinology changing it from 0.5 to five down to 0.3 to three. So, you know, changing these reference ranges because we’re missing, I think, even traditional medicine has latched on to some of that. This thyroid stimulating hormone, when it’s low thyroid hormone, hormones themselves tend to be elevated and vise versa.

 

The issue if you look at the guidelines, what are called Clinical Practice Guidelines for the management of hypothyroidism. So hypo, meaning below thyroid, so not enough thyroid hormone, and underactive thyroid gland. These Clinical Practice Guidelines we’ll talk about this, what’s called sub-clinical hypothyroidism. Sub-clinical meaning that we don’t detect any clinical problems. Patients say that they are doing fine. But their TSH is too high. So it’s traditionally between five and 10.

 

And the Clinical Practice Guidelines say that you have to approach that individually. And the decision to treat these patients when it’s less than 10, you know, you got to take all things into consideration; Individual, one-on-one basis kind of thing. My thought is, aren’t we supposed to do that anyway? Aren’t we supposed to evaluate risks and benefits anyway? But, I have never seen a patient that felt great with a TSH of eight. I’ve never seen it.

 

Brian: Why are so many, it seems like this is kind of becoming an epidemic, hypo thyroid problems? And what’s the cause?

 

Dr. Chad: Okay, so that portion would have to be another podcast, because it can be from a number of issues. You have to look at is this an auto-immune thyroiditis, like with Hashimoto’s thyroiditis. And there are a whole host of problems, it can be iodine deficiency, it could be environmental toxins, heavy metals. It can be a, what some people would call a leaky gut, or an altered gut permeability.

 

Brian: That sounds sexy.

 

Dr. Chad: Does it?

 

Brian: Leaky gut.

 

Dr. Chad: We’ll have a podcast on sexy someday too cause we’re bringing sexy back.

 

Brian: I love it.

 

Dr. Chad: Oh come on, that was a doctor joke. Come on.

 

Brian: One thyroid patient at a time.

 

Dr. Chad: [laughs]

 

Brian: It is important to know that I am looking at some facts here, again from my friends at Google. And it says that an estimated 27 million Americans have some sort of thyroid complications. We think. [laughs]

 

Dr. Chad: Exactly.

 

Brian: But it’s a high number.

 

Dr. Chad: But it is very common. Now the issue for me is you know, some, with the way I was trained again, goes back to the TSH. And we’re managing TSH. The issue for me is that, you know one of my, kind of one of my heroes is Sir William Osler; he was a physician in the early 1900’s. And one of his quotes was, “Listen to your patient. They’re telling you the diagnosis.”

 

Brian: That’s good.

 

Dr. Chad: So, when you actually listen to what the patient tells you, then you can get a better solution for that patient, and I used to have patients come in that say, “I feel awful.” They were on Synthroid and that’s the brand name, or one of the brand names, of Levothyroxine, or synthetically derived, commercially available, T4 only medication; thyroid replacement. And they’ll come in and they’ll say, “I feel awful.”

 

They start on Synthroid, or any of the T4 in Levothyroxine, or any of the other names of it. They started on that because that’s what most doctors are trained to do. And they are managing their TSH. Their TSH is too high. They’ll put them on Synthroid and they’re lower the TSH levels. And their TSH gets down to two, one and a half, voila you’re fixed. And the patient’s like, no I’m not. My hair is still falling out. My skin still feels like crap. I still feel horrible. I can’t get out of bed.

Brian: Rundown.

Dr. Edwards: What’s going on?

Brian: No energy.

Dr. Edwards: And then what I hear so often is that the patients tell me that their doctor said, “Well no, it must be in your head. You’re crazy, you’re depressed, you need an antidepressant, something’s wrong with your hormones.” I mean any number of things.

Brian: It’s hard to believe doctors have the courage to tell women that.

Dr. Edwards: Oh, but you have no idea. Oh my goodness, I hear it every day.

Brian: But seriously, there’s got to be some sexism involved there like you’re emotional. You’re just emotional. There’s this perception, you’re just emotional. Get over it rather than training some serious politicians.

Dr. Edwards: I don’t know that it’s so much sexism as it is patientism.

Brian: Well another quote by Sarah William Osler said. Is that right, Osler? Did I get it right?

Dr. Edwards: Yes.

Brian: “The good physician treats the disease. The great physician treats the patient who has the disease.”

Dr. Edwards: You are awesome. That’s another one of my favorites.

Brian: It’s a tough one. That’s a tough one.

Dr. Edwards: Did you look over my shoulders at my notes?

Brian: I did. I did.

Dr. Edwards: Because I love that one. That’s great.

Brian: Yes, I cheated.

Dr. Edwards: Are we treating, to use a little bit of the story. I remember the first time I took ACLS, and it’s Advanced Cardiac Life Support. It’s where you learn how to run a code, and their heart stopped, and all those things. I took this and we’re going through the different rhythms, and we look at there’s a rhythm called pulseless electrical activity. And what that means is that the heartbeat looks normal on the monitor. It looks like it’s normal, but you check the pulse and there’s no pulse.

Brian: Wow.

Dr. Edwards: If you look at the monitor, the patient looks fine.

Brian: Is it some sort of an electrical way that it’s giving out?

Dr. Edwards: Well, the electrical activity in the heart usually corresponds to the mechanical activity of the heart. Usually, those two go together. The old term I think was Electrical Mechanical Dissociation, EMD. That was an old term. Probably dates me back to Paul Harvey and the other stuff that you’ve mocked me about in the past.

Brian: I love hanging out with doc, because all of the discounts you get for AARP, and stuff like that.

Dr. Edwards: You’re awesome.

Brian: It’s fantastic.

Dr. Edwards: I love Brian.

Brian: It pays to have all your friends. I want to see you contend with this. By the way, I know you’re old, but I love this analogy though. You can literally look at the pulse on the monitor and you’ve got no pulse with the person. That’s amazing.

Dr. Edwards: The monitor looks normal the patient is dying.

Brian: Wow.

Dr. Edwards: If you ignored what the patient said and just treated the monitor, you’re doing a great job. And they’ll tell you in the ACLA course. They often say treat the patient, not the monitor. Treat the patient not the monitor. Yet when I get out and start doing my clinical rotations from medical school, I go in and start working on thyroid. And the patient says they feel awful, and their TSH is normal because they’re on Synthroid.

And I come out and I say, “The patient says they feel awful, but the TSH is normal.” And they are saying treat the monitor and not the patient. Treat the monitor and not the patient. And I’m like, “But you just told me to treat the patient not the monitor.” And so we completely disconnect that. Or we’ll blame it on something else, or we’ll not know. And most of the time it’s because we don’t know.

And it’s another reason is this interconnected nature of the body. And when we talk about a functional medicine approach, we’re looking at how everything interacts with everything else.  We can have a stress response from the brain altering what’s called the Hypothalamic Pituitary Adrenal Access, which can have an effect on the thyroid.

Brian: That’s a mouthful.

Dr. Edwards: I know. I practice that also.

Brian: You went all doctor on me.

Dr. Edwards: These different processes that are impacted by a number of different things alter the function of the thyroid. And so we talked about T4. TSH is this brain hormone that tells the thyroid what to do. We give Synthroid, which is T4. Which T4 feeds back to the brain, and says we’ve got enough, shuts down production of T4. And so your TSH goes to normal. That’s this concept.

And so we think we’re doing a great job. But the problem is that T4 has a fraction of the activity of the active hormone, which is T3. Now your thyroid gland primarily produces T4 but it does produce a small amount of T3. When we give you Synthroid we’re decreasing the brain telling the thyroid gland to do something. We’re basically, if you think about it like a factory making cars, we’re outsourcing. This factory is no longer making cars.

Well, the T3 that you were getting from your thyroid gland, which is roughly about 10% depending on what study you look at, roughly about 10%. If we shut down the production from the thyroid gland, you’re not getting that 10% either. In some cases, patients can actually feel worse, because T3 is the form of the hormone that you really need.

And I have seen patients that were on T3 only medications, with T3 levels that look fantastic. Their T4 was in the toilet, as in very, very low. And then their TSH levels were very, very low. But their T3 levels were appropriate and they felt fantastic. T3 is what you need. T3 is what you need, not Synthroid, not T4. Patients can have great T4 levels, great TSH levels, and feel like crap.

And you adjust their thyroid. And I can tell a story about that as well. That was actually a shocking story and I can tell it now or I can wait in a minute.

Brian: Well, let’s tell a story.

Dr. Edwards: Okay.

Presenter: It’s story time.

Dr. Edwards: I had a 94 year-old lady come in to see me. This was a very high functioning 94 year-old lady who lived at an assistant living facility. She walked with a walker but a very, very pleasant lady. And she had been doing very well. She was on a low dose Synthroid. And I’d been seeing her for a while. And then she comes in to see me one day with one their caregivers, one of the activity directors, in this facility. And this lady was slumped over in her wheelchair. Couldn’t sit up straight.

And she said “I’m weak.” And they said, “She is not acting like herself at all.” This is a problem and a definite change in how she was doing, and we don’t know why. And, of course, because of the way she looked I’m like, “My goodness this could be neurologic. I want to make sure she didn’t have a stroke.” All of these kinds of things. Let’s check into that stuff.

I actually sent her to a neurologist. I obtained an MRI of the brain, and of course I got labs. One of the labs that I got is what’s called a Reverse T3, but I also got TSH T4, T3. And I was taught in medical school that Reverse T3 it’s hogwash, it’s not real, it doesn’t really matter. I’m here to tell you that it does.

This patient’s T4 was very appropriate. She was on Synthroid. Her T3 was very low and her Reverse T3 was extremely elevated. Now, when you look at the biochemistry T4 is like the parent compound. And it goes through an enzyme called a Deiodinase and there’s different versions of that, 1, 2, 3, blah, blah, blah, blah.

It converts T4 to T3, but there is a normal biochemical mechanism for creating this Reverse T3. You remove a different iodine and that chemical then behaves very differently. And one of the issues is that not only does it take away that T4 molecule that can no longer become T3, but that Reverse T3 binds to the same receptor that T3 binds to. But it doesn’t exert physiologic effect.

And so in effect you’re diverting away the T4, so you’re making something that doesn’t work, and it plugs the spot for the one that actually does. We look at this T3 Reverse T3 ratio and it can give me an idea of how the patient feels. And her TSA tremor was completely normal.

And we talked before about, I forget what we called her, but I think we called her Sally, about her TSH level being normal. It was in one of our earlier podcast. Her Reverse T3 was way high. This lady her Reverse T3 was way high. I was like; I don’t know if that’s what’s going on, because that can be elevated in older patients. I didn’t really know what’s going on.

Long story short, I ended up taking her off Synthroid and putting her on T3 only. That was on a Wednesday. On Monday she had a follow-up appointment with her neurologist, and I got a letter Monday afternoon from that neurologist that said, “There’s nothing we need to do. She’s completely back to normal.”

Brian: Wow.

Dr. Edwards: In four days. And this isn’t a patient — There was nothing wrong with her thyroid, but it felt like it was a thyroid problem. But it was because she was on T4 only, Synthroid. And her real problem was a conversion problem where she was converting that T4 that we were giving her to Reverse T3, why is another topic and we can have a podcast about that in the future but she felt dramatically different on T3 only.

Brian: Dr. Chad, America’s doctor.

Dr. Chad: I did the best I could.

Brian: I’m pretty impressed by the story and I’m more impressed because I know one thing because I had grandparents; once you had 90 years old you don’t mind telling somebody they did a bad job. You know what I mean?

Dr. Chad: Yes. [laughs]

Brian: And very well the way you say, I feel better.

Dr. Chad: Right.

Brian: It’s pretty impressive story because obviously at 90 years also, percentage wise it’s pretty special when someone feels like there’s an improvement.

Dr. Chad: Yes.

Brian: And I would think it’s pretty sad to say, that it possibly took long time for her to get to you to have really get some help, right?

Dr. Chad: Yes.

Brian: There’s no telling how long this lady had suffer through this, right?

Dr. Chad: Yes.

Brian: So, it’s pretty amazing story.

Dr. Chad: It just underscores how Synthroid isn’t always the answer, it certainly has its place Synthroid isn’t always the answer, TSH following TSH alone is definitely not the answer. But you got to understand the whole picture and it’s very new answers a lot to it and we’re just scratching the surface, but just as an introduction TSH is not the only lab checking for thyroid.

Brian: Before we bounce here let’s hear let’s talk about the symptoms of a thyroid problem specifically for listeners out there if you’re feeling what?

Dr. Chad: If you’re feeling tired and fatigued, can’t get out of bed in the morning you could have lower basal body temperatures, in the 97s instead of 98.6, you can definitely have some lower average body temperature, you can have some skin problems, dry skin those kinds of things. You can have constipation, you can have hair loss; there’s a whole host of symptoms but those are the big ones.

Brian: I got naughty to ask about NDT.

Dr. Chad: NDT is natural desiccated thyroid, that is like Armour Thyroid or natural thyroid. The interesting thing about this is a lot of endocrinologists are opposed to therapy with natural desiccated thyroid. There’s a website that talks about your kind of quackery and stuff like that and they will tell you don’t ever use natural desiccated thyroid.

There is nothing in the scientific literature that says not to, there’s one particular manufacture of natural desiccated thyroid, it has some recall in the past, they were recalled by the FDA. Those medications are controlled by the FDA, they are the particular thyroid that are used that I recommend. The natural desiccated thyroid that I recommend has not had a recall, we get very consistent results, we’ve not had issues and it’s not it’s not the version that a lot of people would hear about, I use natural thyroid.

Armour had a recall, I think in 2005 [unintelligible 00:23:08] the natural thyroid have ever get success with works really well but it has T4 and T3, so both of those –it’s the T3 that tends to help people feel better. I have had patients, I have got them on my website you go to testimonial section and I have had patients suggest they come back in tears because it made all the difference in the world for them.

There’s nothing in the hypothyroidism guidelines that say, “Don’t use it’ yet I hear it,” from so many physicians you should never do that. It doesn’t say that anywhere in the literature; this is bad advice and it’s been propagated over and over and over again.

Brian: Again before we go on Chad, just 30 seconds on a compounds and why they are important.

Dr. Chad: So you the normal human thyroid is roughly 90% T4 10% T3. The natural desiccated thyroid is either bovine or porcine derived and is generally in that 80/20 kind of role so that 80%, T4 20% T3, so you end up getting a little higher proportion of T3. It’s not uncommon that will measure their levels and their T3 levels are little bit higher. We can through compounding, we can get the ratio exactly what we want and the patient needs.

Brian: Let me say for the people, they don’t understand what compounding is; imagine your stomach is upset you have tums and you’ve got a headache, instead of taking extra high doses to fix both problems you would compound those two together?

Dr. Chad:  Right.

Brian:  For a natural occurring effect to both?

Dr. Chad: Right.

Brian: Rather than overdosing on both?

Dr. Chad: Right, through compounding we can really, any chemical we can put it in the proportion that the patient needs and customize it for that patient

Brian: Right. It’s like a custom car men.

Dr. Chad: I don’t own a compounding pharmacy, I have no stock, I have no financial ties to compounding whatsoever, but I believe it’s one of the best things that we can do to take care of a patient because it’s customized for that patient.

Brian: It’ a knock on the healthcare industry, everyone is uniquely created by God, right?

Dr. Chad: That’s right.

Brian:  So they should be uniquely cared for.

Dr. Chad: That’s right.

Brian: And we should have unique medicine.

Dr. Chad: Like ‘Unique New York’.

Brian:  Unique, unique, Keyword. Alright thanks everyone will see you on the next podcast.

Dr. Chad: Thanks Brian.

Presenter: Thanks for listening to this week’s podcast with Dr. Chad Edwards; tune in next week we will be going Against the Grain.

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