Boost Your Thyroid, Boost Your Mood

Boo st Your Thyro id, Boost Your Mood

     

Presenter: Dr. Kelly Brogan The following transcript and information is not intended to take the place of medical advice and/or treatment from your personal physicians. Sean: And we are live! Welcome to the Boost Your Thyroid, Boost Your Mood Google hangout with Dr. Kelly Brogan and myself. We really appreciate you guys tuning in live today. If you’re watching this during the actual Thyroid Sessions event, we filmed this one live to a huge audience of like two thousand people. So, again, thanks so much for attending. Today we’re talking about mood and how that is impacted by your thyroid—depression and anxiety. We’ll talk about postpartum stuff, as well. And, of course, we’re going to answer as many of your questions as we possibly can. Dr. Brogan and I will speak for maybe a good forty-five minutes or so. We’ll maybe take about twenty, thirty minutes of your chat questions. So if you have a question, just go ahead and punch it into the chat. And we will go ahead and get back to you. Let me give you Dr. Brogan’s bio. Dr. Kelly Brogan is boarded in psychiatry, psychosomatic medicine, reproductive psychiatry, and integrative holistic medicine, and practices functional medicine, a root cause approach to illness as a manifestation of multiple interrelated systems. After studying cognitive neuroscience at MIT, and receiving her M.D. from Cornell University, she completed her residency and fellowship at Bellevue NYU. She is one of the nation’s only physicians with perinatal psychiatric training who takes a holistic, evidence-based approach in the care of patients with a focus on environmental medicine and nutrition. She is also a mom of two, and an active supporter of women’s birth experience, rights to birth empowerment, and limiting of unnecessary interventions. She is the medical director for Fearless Parent, and an advisory board member for greenmedinfo.com, Pathways to Family Wellness, NYS Perinatal Associations, and Fisher Wallace. She practices in New York City, and is on faculty at NYU Bellevue. And her website is kellybroganmd.com. Dr. Brogan, welcome to The Thyroid Sessions! Dr. Brogan: Great to be here! Very excited to be here!   1

Boo st Your Thyro id, Boost Your Mood

     

Presenter: Dr. Kelly Brogan Sean: Very, very great to have you here. Let’s get to our first question. Of course, I have to ask this. How did you become so interested in thyroid health? Dr. Brogan: So I think most practitioners who crossover to the other side and develop an interest in functional medicine or holistic medicine do so because of a personal compulsion. Right? So they have some sort of health crisis or they bump up against the limitations of allopathic medicine. So, for me, I was one of those, it’s sort of a mixed blessing, I guess. I was one of those girls who could sort of eat whatever I wanted and trash my body. And I never gained weight. So I did that for the better part of thirty years. And all throughout my residency, I ate McDonald’s and drank Red Bull and White Castle and Snickers every day. And it wasn’t until I had my first daughter in my fellowship that I went back to work about three weeks postpartum. I was super energized. I lost all my baby weight really quickly. And I felt actually probably unusually well for how much I was working, about an eighty-hour work week. And at about nine months postpartum, the other shoe dropped. And I started to become incredibly like lead-limbs fatigued and super forgetful, incredibly disorganized mentally, which I had no room for at all because I had a private practice and I was working at the hospital full time. And I started double booking patients and forgetting my ATM pin number and all that sort of thing, which is easy to attribute to just sort of being a new mom. And on a routine physical with a relatively holistic internist, I was diagnosed with Hashimoto’s, which in this setting is called postpartum thyroiditis. And I was told I should take Synthroid for the rest of my life. And I’d be fine. It’s not a big deal. But I had never taken a medication before. I had never even had a diagnosis before. So I was very questioning of that. I’m generally rather skeptical of anyone’s recommendations. I was a bit of a rebel, I guess. And so I started doing my own investigating. And I had the good sense to go see a naturopath for a consultation. And that’s where I really was introduced to the world of naturopathic medicine and sort of the interconnectedness of all systems in the body and the fact that this diagnosis was not a thyroid problem, in fact. It was an immune system misregulation. So my journey was really to resolve this because I consulted with some of my soon-to-become mentors about what my options   2

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan were. And even they said probably I’m going to have to take even a natural thyroid hormone for the rest of my life. And I was very determined to really resolve it. And it took me about two years to do so. And then I had another pregnancy and a bit of a slide back, I guess, postpartum again. And now I’m back on the horse. So that’s like anyone else who specializes in something, it’s often because you have a personal experience with it. So I know a lot of the outside-of-the-box thinking that goes into treating autoimmune thyroid conditions. Sean: I want to get more into that in a minute about how this was kind of triggered by pregnancy. But, first, you took the naturopathic route looking for the root cause. And that’s the whole point of having this Thyroid Sessions event, is looking for that root cause. And you’re a medical doctor. And you’re not just a medical doctor. You’re a functional medicine doctor. So I know functional medicine doctors look at everything. So talk about where you think conventional medicine is really missing the boat with thyroid health, and a lot of other illnesses, as well. Dr. Brogan: Yes. So I’m sure probably everyone you’re speaking to would agree on this front. It’s really a matter of underdiagnosis and then mistreatment from my perspective. So the diagnostic parameters when it comes to detecting thyroid dysfunction and specifically hypothyroidism, which is much more insidious…Hyperthyroidism, Graves’ disease or thyroiditis tends to declare itself more readily. But hypothyroidism is something you often have to go digging for. And there’s a lot of controversy around the legitimacy of the diagnostic parameter, which is usually limited to one blood test, TSH. And the problem with the reference ranges, for example, when it comes to TSH is that they were developed based on an unscreened population. So people who may or may not have themselves had undiagnosed hypothyroidism, and they worked at the lab or they were somebody’s family member, it was a nonclinical population. And so this reference range essentially dictates that only 2.5 percent of the population can have hypothyroidism. Everybody else is totally fine. And it’s really the classic example in conventional medicine of the fact that you’re normal, normal, normal, normal, normal until you’re sick. You know? There’s no continuum. And you just reach over at a hundredth of a point on that reference range and then you’re sick. And everything prior to that   3

     

Boo st Your Thyro id, Boost Your Mood

     

Presenter: Dr. Kelly Brogan you’re fine. You’re fine. Your complaints are—and this is what I like to emphasize—because often they’re told that their complaints are in their head, psychiatric, right? So there’s a lot of underdiagnosis. Doctors don’t know how to look at the whole picture. They don’t know how to look at free hormone levels. They don’t know how to look at, again, as you mentioned the root cause, which the vast majority of the time is autoimmune. And they don’t look for antibodies because they don’t know what to do with them and because it wouldn’t change their intervention, which is a one-size-fits-all storage hormone, synthetic T4. So I think it’s a matter of underdiagnosis because they don’t appreciate this interplay between so many different factors. So they’re just looking at a brain, a pituitary hormone, which is just a very indirect measure of what’s up with the thyroid. And they’re not interested in the fact that it’s really this incredible dance between the brain and glands, free hormone levels floating around. Those hormones have to lock into receptors at the cell. They have to interact with mitochondria in the cell. And then the immune system can interfere in a very important way. So I think it’s a matter of that. And then it’s a matter of this very limited treatment paradigm. I dialogue with endocrinologists in Manhattan every day. And it’s really taught me a lot about Zen philosophy and meditation because it’s so frustrating to interact with them. But I just have to really center myself every time because for whatever reason there’s like a war over thyroid treatment when it comes to holistic versus allopathic medicine. And there’s a very strong embedded beliefs based on very compromised science, frankly, that states that T4 synthetic like Synthroid or Levothyroxine, that that should be sufficient for every patient. And if they still have symptoms, they can go to their psychiatrist or maybe their internist will prescribe them an antidepressant. And so that’s why I feel so passionately about this in my field as a psychiatrist. And I really feel like this was why I had this problem to deal with. This was sort of the purpose of my own struggle was to be able to identify the fact that so many patients are being shepherded into the psychiatric medication mill because of, as I mentioned, this underdiagnosis and then mistreatment. Because when they have residual symptoms like you’ve been talking about…So they have brain fog. They have changes in metabolism. They have depression. They have agitation and anxiety. They have insomnia.   4

Boo st Your Thyro id, Boost Your Mood

     

Presenter: Dr. Kelly Brogan I mean, that’s basically like a Cymbalta commercial. That’s basically, the laundry list of symptoms that you’re told should bring you to your doctor, your internist, or your psychiatrist for an antidepressant prescription. And that’s like putting a band aid on a festering wound. It’s just absolutely missing an opportunity to resolve it from the root. So it’s sort of an iconic example of how conventional medicine can make grave mistakes. Sean: I really want you to run with that one in terms of the psychological/mental health aspects of things. How does the health of the thyroid impact someone’s mental health? You can just talk about that as long as you want. I’m going to hang back here and take notes. Dr. Brogan: Okay. So we have a pretty good understanding, although it’s something that we’re really still elucidating. So active thyroid hormone has a major influence on mitochondria, which essentially are responsible for producing energy in every cell but our red blood cells. So it’s probably the most powerful way to influence your mitochondria. So we have a lot of different nutrients that we can use—carnitine, CoQ-10, things like that. But if you really want to juice them up, it’s active thyroid hormone. So when you think about the way that mitochondrial health influences your health overall, you’re really starting to understand how thyroid dysfunction can look so varied. So it can be cognitive symptoms. It could be energy symptoms, metabolic symptoms, and then myriad psychiatric symptoms. So it’s the whole range. People think hypothyroidism and they think depression. But I think that actually can be misleading because more often than not, it’s depression with an overlay of agitation and anxiety. There’s some theories about that when it comes to autoimmune hypothyroidism. There’s some theory that actually as the gland is attacked and some of the tissues are actually destroyed, there are these boluses of hormone that are released into the bloodstream. And maybe that explains some of the intermittent symptomatology around anxiety and agitation. I have in—I don’t know, a decade—I can’t even remember the last patient I saw who was just melancholic, and sad, and heavy, and depressed like on a TV commercial. All of my patients experience anxiety. They experience this inner kinetic discomfort, sort of a restlessness, unease, a   5

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan lot of insomnia. And I think it’s a cardinal manifestation of autoimmune hypothyroidism and maybe we’ll talk about it. It’s particularly relevant in postpartum. Sean: Can you clarify that just a little bit more? So the thyroid is being broken down, destroyed by the autoimmune attack? And I don’t fully get what’s happening there. Little pieces of thyroid falling off? Tell us about that. Dr. Brogan: Basically. Yeah. So there are many different theories about what is…So if we’re going to talk about autoimmune thyroid, there are many different theories about what can actually trigger that. Okay? The primary issue often is that something in the tissue is signaling. There’s some oxidative stress that is signaling the immune to clear the problem. So it can be things like fluoride, is an important example, so in fluoridated water or in toothpaste, for example. Once that is taken up by the tissue, it can cause oxidative stress and can actually send a signal to the immune system to actually try and clean it up or clear it up. And part of that process can be a destructive process. If you have undiagnosed Hashimoto’s, for example, that you never treat, eventually your gland’s ability to produce hormone is going to be compromised severely by the destruction of the tissue because your body has flagged that tissue as problematic. And it’s trying to eradicate it, essentially. There are other things, bromides or chlorine, even iodine when it’s misused in the setting of selenium deficiency can do that, as well. And then there’s this concept of molecular mimicry. So I am a very passionate gluten hater. And this is one of the reasons because the literature has looked and the researchers have looked at this overlap between Hashimoto’s and celiac disease, which is too great to ignore. It’s just an incredible comorbidity, as we call it. And we’ve also seen that people with celiac disease, for example, who do have thyroid autoantibodies, which is many of them, are more likely to have depression and panic disorder, for example, than patients who do not have thyroid. So we can sort of like triangulate around psychiatric symptoms, thyroid dysfunction, and celiac disease, intolerance to gluten.

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Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan And we have this compelling body of literature in psychiatry that also has linked gluten intolerance. Even a paper that came out this week that was a randomized crossover trial that took patients who were on gluten-free diets and who had IBS, and they exposed them to a gluten provocation. And it turned out they didn’t even really have flares in their gastrointestinal symptoms. But they developed depressive symptoms within a day, statistically significant depressive symptoms within a day. So we know that gluten can be a brain toxin. I’m certainly not the first person to tell you that. But the way that it can participate in destruction of thyroid tissue is through something called molecular mimicry. So this crossover tagging by the immune system of peptides in gluten-containing foods and thyroid tissue. So it’s just amino acid homology. So it’s amino acids that they have in common. And that’s one of the reasons that you can actually reverse Hashimoto’s through gluten elimination, through a gluten-free diet. And this is not just my clinical experience. This is in the literature, as well. So it’s another mechanism. Sean: So somebody with depression, anxiety, blanket recommendation right now, remove gluten from the diet? Dr. Brogan: Absolutely! I couldn’t scream it louder from the mountaintops. Yeah. Sean: A couple of our presenters said that when they first started to feel thyroid symptoms, they would fluctuate back and forth from hyperthyroidism to hypothyroidism in terms of those symptoms. And then they mentioned as it got worse, then they kind of felt more of the symptoms of hypothyroidism. Dr. Brogan: Exactly. Sean: And so in the beginning, people who are feeling depression and anxiety as this begins, as it continues do they feel less anxiety and more depression? Dr. Brogan: That’s a great question. So just to circle back to your other question, which is related, again, one of the theories is that when the actual thyroid cells are being attacked and destroyed,   7

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan there is release into the bloodstream of thyroid hormone in these sort of like blobs—I don’t know how else to put it—in these like sort of dumps. And that that actually may be responsible for things like racing heart, sweating, agitation, and anxiety that is intermittent. So you remember how I told you about my experience postpartum? That’s pretty typical. I had a crazy amount of energy. I lost all this weight. I was ready at three weeks postpartum to work like an eighty-hour work week. And I was hyper energized. I didn’t have some of the symptoms that you can have because there’s a really important study in the postpartum population, actually postpartum psychosis, where they looked at women who were admitted to a hospital for first episode postpartum psychosis. They found that nineteen percent of them were positive for thyroid auto-antibodies, and that sixtyseven percent of them eventually developed hypothyroidism. So the majority of them, ultimately, within nine months postpartum, developed hypothyroidism. So this is the trajectory. So it’s a hyper simulation where you can have hyperthyroid symptoms. But you can also even have symptoms of psychosis. It can be very dramatic. And then it starts as your gland is sequentially destroyed, you start to develop hypothyroid symptoms. And that typically is somewhere…It varies. I’ve had patients where that process has stretched out over years. Postpartum, it tends to be pretty typically within the year. I’ve had patients who come to me with very, very suppressed TSH. So that would tell you that they’re in this hyperthyroid state. And their doctor wants to put them on thyroid destructive medication—things like methimazole—and wants to slow down their thyroid. But they have Hashimoto’s antibodies that nobody has checked for. And so really what’s happening is they’re in the first stage of this destructive autoimmune process. And eventually their TSH is going to start to bump up. But we’re only going to exacerbate the process if we actually assault their thyroid further. So you can see there’s just so much room for mistreating patients if you look at it in this really black and white way. Sean: You said after your first pregnancy that you lost the weight pretty fast. Is this one of the reasons, because your metabolism was just in overdrive?   8

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan Dr. Brogan: Yes, and that’s always a red flag for me when I see postpartum patients. I’ll see them through their pregnancy. And I’ll see them often three to four weeks postpartum. And when they come in in their skinny jeans, I know something’s up. Sean: Do a lot of doctors attribute this to reproductive hormone problems after a pregnancy? Dr. Brogan: Attribute the thyroid dysfunction? Sean: Maybe not even find the thyroid dysfunction. Maybe the woman comes in and she’s got some mood issues going on or what not. And the doctor might say, “Well, maybe this is an estrogen/progesterone thing after a pregnancy,” and completely skip the thyroid part. Is that possible? Dr. Brogan: They won’t even go there. They won’t even go there. They’ll go straight to psychiatry. So, yeah. So psychiatry is sort of the trash bin for whatever we don’t understand. And it’s so easy to diagnose someone with a psychiatric problem. Why? Because psychiatrists have no tests. There’s no objective measures. There’s no brain scans, body scans. There’s no blood test. There’s no nothing. It’s a subjective survey, essentially. And there has been some provocative literature to suggest that the concordance between two psychiatrists agreeing on a diagnosis is like thirty to forty percent. So we’re really working with like a dictionary, essentially, and we’re trying to agree on the meaning of these terms. So it’s very easy to just slap a psychiatric label on someone and then to reach for one of these medications that is sort of like a cure-all, a Zoloft or a Prozac is a cure-all anxiety, depression, OCD, eating disorders, all manner of different pathologies. But the symptoms that we’re describing, in my opinion, are almost always endocrine. So if it’s not thyroid, it’s going to be one of thyroid’s very related endocrine sort of partners, whether it’s adrenal or it’s blood sugar regulation, sort of like insulin, leptin, that sort of end of things. And then it’s the sex hormones. We think a lot about sex hormones like progesterone and estrogen in the postpartum period. And they seem to be relevant, obviously. You lose ninety-five percent of your estrogen in twenty-four hours postpartum. It’s obviously relevant. But a lot of the literature   9

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan has focused on the role of adrenal hormones and cortisol, specifically. And we know that cortisol is a major player in immune system regulation and specifically in the conversion of storage thyroid hormones. So T4 to active thyroid hormone T3. So it’s a pretty important assessment to make if you want to understand why one person with these lab tests in their thyroid realm is looking this way, and why another person might look totally different. The explanation is usually in the adrenal function and its impact on thyroid health. So, yeah. Sean: Gotcha. We covered this a lot during The Thyroid Sessions, but this is kind of like an early bird session. So people haven’t seen those. Would you mind talking about what tests somebody should ask for? What antibody tests are they asking for? Dr. Brogran: Yes. It’s really important. In this day and age, people can order their own test. Not that I’m advocating for winging it without a practitioner because really if you go to any naturopath doctor or most chiropractors, they know all of this. It took me six years to unlearn everything that I had learned in my decade of training to just catch up with naturopaths, basically. So the best way to get a really broad look is, of course, to include the TSH with the understanding that we’re not going to look at the reference range. We’re really going to shoot for—to generalize about it—for a number less than two because the range will often extend four, five. Sometimes I’ve even seen six and higher. It’s totally antiquated. Even the conventional authorities on thyroid and endocrinology agree that three should probably be an upper limit of normal. And, in fact, if we’re looking from a functional medicine perspective, that two should really be your upper limit. It’s interesting, I think it was in the 80s, this Scottish study that looked at treating patients with thyroid hormones. So they did use the synthetic famous kind, the Synthroid kind. But they still said, “Let’s forget about the lab test altogether. And we’re just going to give them more and more until they feel better.” And they found after they had treated patients to remission—so they all are feeling fine—they then checked their TSH. And they found the vast majority of them had incredibly suppressed TSH that would freak any conventional doctor out because they would have thought, “Oh, we’re going to cause osteoporosis and arrhythmias. And we’re causing hyperthyroidism in this patient. This is   10

     

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Presenter: Dr. Kelly Brogan dangerous.” But it just tells you that many patients need to be below the reference range to feel well, and that the dosing is really clinical. Okay, so that’s the caveat. So other things that you want to check for are going to be free hormone levels. So we asked about what the brain is making so that TSH is a pituitary hormone. Now, we’re going to ask about what the gland is making. So it’s free T3 and it’s free T4. Those are the storage—as far as we understand— the storage in the active form. Although, not to get overly complex, but the T4 does play a role beyond storage. In fact, it seems to participate in the methylation processes. So it is important, too. It’s not just the package. But, okay, so free T3, free T4. And then we want to know about antibodies. And for the most part there are three kinds. There’s something called thyroglobulin antibody. Sean: Real, real quick. You mentioned the three is upper limit of normal for TSH. But two is optimal. What about free T3 and the free T4? What should people be looking for? Dr. Brogan: So that actually can vary. That can vary lab to lab. The general idea is that you want to be in the upper third, ideally. The upper third of the reference range. But you also want to look at the relationship between free T3 and free T4 because if we’re going to assume that the conversion is depending on things like cortisol being optimal and also on several nutrients for the conversion, it also depends on whether or not you have genetic variance in things like deiodinase enzymes. It’s really complicated. So we want to see what’s going on. So let’s say you have your free T4 is in the upper third. But then you look over to the free T3 and it’s in the lower third of the range. Then you’re seeing that you’re not converting. If both are in the lower third of the range, then you’re getting a different impression that actually you’re just low across the board, right? Your starting product is low. So where you are in the range is probably a better indication. Similarly, the antibodies are going to have different ranges with different labs. You’re really just, hopefully, looking for a negative antibody. You’re looking for within the normal range. And there are three kinds. There’s thyroglobulin antibody. There’s thyroid peroxidase antibody, which are the   11

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan primary markers of Hashimoto’s hypothyroidism. But of course, we’re just going to call it that. And then there’s thyroid receptor antibody, which is used to diagnose autoimmune hyperthyroidism, also called Graves’ disease. And you can present with all of them at once. That’s also a complex, but very possible picture. And the other one I’m just going to throw in, although there are even more beyond this. But it’s rather unappreciated, I think. And it’s called reverse T3. It’s normal. It’s not necessarily a bad guy. But under conditions of stress or hypercortisol production. So let’s say you’re sick. Like, literally, you have the flu or something like that. Your body may enter something called euthyroid sick syndrome, is one of the names for it. But it’s basically going to ramp up this brake on your thyroid because it wants to actually conserve resources and slow your body down. And you don’t want to waste metabolic energy. So it’s like the analogy that’s used. It’s like if T3 is the perfect key in the lock and it turns, reverse T3 goes in the lock, but it doesn’t turn. So if you have high reverse T3, it means that you’re not actually converting to the usable form of this free thyroid hormone well. And if you’re taking synthetic T4— like you’re taking your Synthroid every day but you still feel like crap—this could be a very important diagnostic tool because it’s telling us that even though your doctor says you should be totally capable of converting that T4 to active thyroid hormone, it tells you that you’re not. That, in fact, you’re turning it into this sort of ineffective version of the free thyroid hormone. And that’s why you’re feeling how you’re feeling even though your TSH looks fine. So it’s an easy way to miss the boat if you don’t look for that. Sean: So on our test results are we looking for a ration of T3 to T4? Dr. Brogan: Well, I don’t look for a ratio, necessarily. You can look for ratios of total T3 to reverse T3. Really you’re looking for where you are in the reference range. And then you’re looking for reverse T3 that’s just out of the normal range. Sean: Gotcha. Okay, these tests that you just mentioned. Now you said TSH, free T3, free T4, the three antibodies, reverse T3, are these tests that everybody should get? Do you recommend everybody have these tested? Or are there special populations who should really get them?   12

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan Dr. Brogan: I mean, if you have any health problems, I think you should probably take a look at this because as I mentioned, thyroid hormone is just at the root of so many myriad neurologic type systems, neurologic, psychiatric. You’re sort of a rheumatologic. So you could be somebody who has aches, and pains, and fatigue, and like a chronic fatigue type picture. But I want to emphasize that you can’t just throw a thyroid hormone at everyone. That’s not the solution because the solution is still why is this going on? Is it autoimmune? Why is your immune making these “errors” even though they’re not mistakes if you really are understanding why the immune system is reacting this way. It’s actually pretty adaptive. So you want to know why. You want to know is it driven by infection? Is it driven by food intolerance? Is it driven by stress? Is it driven by environmental exposure? So things like endocrine disrupters, which now we have a really appreciation that exposure to endocrine disrupting plastics, for example, or perchlorate from your dry cleaner. In utero, especially, you can really mess up your baby’s thyroid through those exposures. So we have a good understanding that the environmental component is pretty relevant. So you don’t want to just pick up your hormone prescription even if it’s a natural hormone prescription and call it a day. I mean, I don’t think that’s the answer. If you have any symptoms like brain fog or malaise, or depression, anxiety—any psychiatric symptoms period, but even things that seem neurologic or just sort of like nobody’s been able to diagnose otherwise conventionally, you want to look just a little bit deeper because it could be non-obvious from these limited labs. And the other thing I have a lot of my patients do is check their temperatures. And the classic way—the Broda Barnes way—to do it is in axillary. So an armpit temperature right when you wake up for ten minutes with a mercury thermometer. But more contemporary practitioners have adapted those protocols to just check it with a digital thermometer three times a day, three hours after waking, in three-hour intervals to see if your average body temperature—and for women this would be done in the first half of their menstrual cycle—to see if their average body temperature is below 98 because, of course, it’s enzymes and all these bodily processes function at a 98.6. So if it’s below 98, that can be a surrogate indicator that you’re metabolically impaired. And, of course, when we think metabolism, we have to think about thyroid.   13

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan So you can triangulate all these different things. And, of course, a physical exam and old fashioned diagnostics on the physical exam, things like peripheral swelling, changes in your reflexes. And then, of course, signs that patients can report like changes in the texture of your hair, hair loss, dry, flaky skin. All of these things can complete the picture and really make a convincing argument in the context of all those labs that something’s going on. Sean: Dr. Brogan, I wanted to ask you about antibodies. Let’s go back to that for a second before we get into treatment. I think it was Dr. Allen who said that forty percent of the time the antibody tests come up negative, and someone still would have Hashimoto’s. How do they go about detecting that if the antibodies are negative? Dr. Brogan: That’s a very interesting point. And I’ve discussed with colleagues about that too. So here’s the thing, there’s maybe two points about antibodies. One is that it’s important to bear in mind that when they do exist, they can exist for many, many years in advance of any changes in the hormone levels or TSH. So one important paper that I’m sure you have had your speakers reference states that antibodies can predate any changes in hormone levels and TSH by seven years. So this process can be going on a long time. You actually have to have sufficient immune responsivity to generate antibodies. So there may be a subset cohort of patients who actually don’t generate antibodies well. And that could be like a pretty dire part of the problem that their immune system is just that unresponsive. But, then, of course, there are limitations to this type of testing. When I think about antibodies, I always think we’re looking at two or three. And there’s just literally an infinite number of potential antibodies pretty much to every protein and enzyme and everything else you could name in the body. So it’s just an indicator. Another thing that I check in all my patients is antinuclear. It’s an ANA, which is a very vague bodily response to DNA that says that indicates to me that the body is starting to misfire in this way. And that’s sometimes even if I don’t have thyroid antibodies, but I have that, my interventions are still going to be in the autoimmune category. I basically assume that autoimmunity is at the root of thyroid dysfunction unless there is a compelling reason to think that it’s nutrient related. So things like zinc, selenium, iodine,   14

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan magnesium, these are major players in thyroid hormone production. And so if I have a patient who does not have antibodies but does have suspicious elements like low free hormone levels, or let’s say they do have a frank TSH elevation, I actually might start with what’s called orthomolecular dosing of iodine after I treat them with selenium. And this is very controversial. People really get their panties in a bunch about iodine. I happen to think that Dr. Brownstein, who’s probably the authority on iodine, has some pretty intelligent perspectives on this. And I just don’t think there’s a one size fits all. You have to be able to know what patient is the best candidate. For me personally it wasn’t an important part of my recovery. So maybe that’s why I’m a bit biased. But I don’t use high-dose iodine in patients who come to me with frank raging Hashimoto’s. But certainly, I could be using them in someone whose antibodies I just am not seeing. So I do think that’s a real possibility. And then, of course, then the risk would be that you could actually induce potentially thyroid dysfunction if you’re using high doses of iodine. So that’s obviously not what you want to do. But the vast majority of the data suggests that that only happens in the setting of selenium deficiency. Sean: Gotcha. Dr. Brownstein’s presentation was amazing! Dr. Brogan: Oh, great. Perfect. Sean: That was some really good stuff. How do you feel about ultrasound testing for Hashimoto’s? Dr. Brogan: For nodules, most of my patients don’t do that. Actually, he might have mentioned this. But when it comes to thyroid nodules, cystic breasts, and ovarian cysts there’s at least some physiologic theory that iodine deficiency can drive all of those pathologies. If you look with ultrasound, you probably will find in a lot of patients—particularly reproductive age women—the presence of these nodules that are not actually precancerous. It’s just sort of more like cysts, I guess. And that would be a compelling reason to consider iodine.

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Presenter: Dr. Kelly Brogan And actually this is a whole other conversation. But the thyroid cancer diagnosis is another controversial element where there’s a good possibility that many, many patients are being unnecessarily treated. Sean: What about Hashimoto’s itself? What about there’s no antibodies? You don’t see antibodies on the test. And you just really think that someone has Hashimoto’s. Would you do an ultrasound? Dr. Brogan: I wouldn’t. I would just treat them in the same manner. Yeah. I think there should be like a very low…There’s certain sort of assumptions. When it’s clinically so apparent, there’s like a saying in medicine, “When you hear hooves, you don’t think zebra. You think horses.” So when you have hooves, it declares itself as being very obvious. The interventions are so potentially high yield and low risk that I just proceed with it. Sean: So you’re working with somebody who has depression, anxiety, postpartum stuff going on. What are the treatment options there? Dr. Brogan: So it sort of depends on the severity. If labs come back and they’re just out of control, off the page antibodies, TSH in the fifties or sixties or higher, then it probably would be wise to implement hormone treatment because you want to suppress that TSH. And you want to stop this destruction of the tissue. I choose in my practice either I work with a compounding pharmacy if somebody is very sensitive to additives in prescription Nature-Throid, which is desiccated pig thyroid gland. So if somebody is very sensitive, I’ll use the compounding pharmacy just with the active ingredient. But that tends to be my choice in my practice, anyway. And basically that is a glandular sort of extract that has not only T4 and T3 in it. The ratio is four to one. So some people argue that that’s not a human physiologic ratio. But, nonetheless, I think that this is almost an ancient practice at this point of using this treatment. And I think for the vast majority of patients it’s a pretty good fit. You can make yourself a little bit nuts and you can compound extra T4 in with the desiccated thyroid so it becomes a ten-to-one ratio, more like human physiology, but most patients don’t require that.   16

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan So you might, in some cases, want to use hormones. Start with hormones. When I do that I ramp up the dose once a week until people essentially are feeling better. It’s very clinical. Of course, I’ll check their labs at some point. But it’s not like I’m checking their labs, like I’d start them on a starting dose and tell them to come back in six weeks because it wouldn’t make any sense to me because you’ll feel the difference within three to four days of the right dose. But, let’s say for the most part there’s some mild depression, a little bit of anxiety, and some insomnia in a postpartum breastfeeding patient. And their TSH is actually in normal range, but they have these antibodies. I found them. So I know this process is going on even though if you’d only looked through the keyhole and seen just the TSH, you would say, “They’re fine.” So I know the process is already under way. That’s when the lifestyle stuff really comes into play. So that’s where starting with dietary modification. My particular orientation is prioritizing elimination of gluten and its primary crossreactant, which is casein—so dairy. I don’t usually have to put people on a full autoimmune Paleo diet restricting nightshades and eggs and nuts and all of that. I’ve had tremendous success reversing antibodies in my practice with gluten and dairy plus/minus restricting grains on the whole. And then really looking to the role of, while we’re doing this dietary modification, looking to the role of that adrenal picture because if they—which they almost always do postpartum—if they have adrenal hypo function or their cortisol pattern really looks like a flat line, then we’re not going to make the progress we would otherwise make if we don’t address that. So the things important to addressing that are primarily blood sugar stabilization. So eliminating added sugar, and sugary drinks, and grains from the diet. I actually don’t focus on fruit. My patients eat fruit. I’ve been convinced by literature and diabetics that suggests that the fructose in fruit actually doesn’t make a big difference to things like hemoglobin A1c. So, anyway, I’ll primarily just take a look at what’s happening adrenally and see if we can work on that piece of it so that we get more yield out of the lifestyle changes from the thyroid. And then like I mentioned, selenium, zinc, magnesium, plus/minus iodine, depending, are very critical players. And then your choice of antioxidant. I happen to use a lot of n-acetylcysteine in my   17

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan practice, which is a glutathione precursor. But there are a lot of different immunomodulators. There’s a long list like rosmarinic acid. And you can use beta glucans. You can use colostrum. It’s a bit of a long list. There’s something called low dose naltrexone, which is actually a prescription that can sometimes—I use it more as a last resort—but can sometimes be an effective immunomodulator. So these are sort of the first things. And then cleaning up the environment, as I’m sure you’re going to get to. So hyper filtering the water, filtering your air, eliminating plastics, and looking at other sources of endocrine disrupters are going to be essential. Even the chlorine in your shower water. It’s sort of a bit of a ubiquitous issue. But there are ways to control your home environment so that your thyroid feels less under assault. It’s like a canary in a coal mine. It’s for many people sort of the first thing to show you that something is not jiving about where you’re living, how you’re living. Sean: Mmm hmm. Yeah. And the audience, when you attend The Thyroid Sessions you’re going to learn about all of this stuff. And I’m just shaking my head going, “Yeah, we covered that one at The Thyroid Sessions. We covered that one.” I want to get to questions in a minute. And the audience might see that I just posted a link to Dr. Brogan’s “Top Seven Therapeutic Foods” PDF. So just go ahead and click on that link. And you can sign up for that in the sidebar. And I want to ask you about that in a second. But my question before that is is any patient of yours, are they ever on this protocol in conjunction with antidepressant medications? Dr. Brogan: I no longer—it’s been a couple of years—I no longer prescribe antidepressants. I don’t start patients on antidepressants. That’s a whole another webinar because I believe that they are not based in adequate science. And I believe that they’re harmful. But many of my patients do come to me on antidepressants. And a lot of what I do in my practice is taper them off. But, certainly, this is impossible to ignore because antidepressants, for many patients, are insufficient treatment. So a lot of people are symptomatic on antidepressants. And, in fact, some antidepressants actually have fluoride in them. Prozac, for example. And so it’s an important means of investigating why somebody who is “treated” already might still be symptomatic.   18

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan And you can even get deeper into it, into papers that have demonstrated that antidepressants and other psychotropics are actually mitochondrial toxins. Maybe they’re perpetuating part of the picture. So certainly, these things can be done in conjunction and should be done in conjunction because before if you’re ever interested in coming off of medication, you really don’t want to leave yourself vulnerable to residual symptoms. What if that was the original reason for your symptoms? You were treated with an antidepressant. If you come off that antidepressant, the original symptoms are going to come back, not because you need the antidepressants, but because you’ve never addressed the root cause. So this is a very common instance. Birth control is another perfect example of that type of a cycle. So you have PMS, which is highly related to thyroid dysfunction. You’re treated with birth control, which actually increases thyroglobulin, which messes with your thyroid. And then you come off birth control at some point because you want to get pregnant, let’s say. And all of those initial symptoms are going to come back because you never addressed the root, and maybe you’ve even exacerbated throughout the “treatment.” So yeah, I think there’s probably no time where doing this sort of investigation— maybe on an annual basis if you’re just screening—wouldn’t be prudent. I think it makes sense for pretty much everyone, but particularly women. Sean: Great stuff. Tell us about your “Top Seven Therapeutic Foods” PDF. Dr. Brogan: So, yeah, I just put it together because I get a lot, a lot of questions about patients who have limited tolerance for supplements. I’m somebody who would take supplements by the fistful. I do a lot of self-experimentation. I check my labs every month. I want to see what two grams curcumin does to me. I want to see what eight grams of fish oil does. So I’m very interested in that. But many of patients are not interested in taking supplements. They’re overwhelmed by it. But they do know that if they come to my office, we’re going to be talking about food. So these are sort of just like food tricks that I use where it’s stuff you can have in your kitchen, but actually can have a clinical effect—often even evidence-based clinical effect—and doesn’t require swallowing a bunch of capsules. That’s all.   19

     

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Presenter: Dr. Kelly Brogan Sean: Gotcha. Very cool. That’s at kellybroganmd.com. Also you can click over there on the sidebar to go straight to the website. Do you have about fifteen, twenty minutes to answer questions? Dr. Brogan: Oh, yeah. Absolutely! Sean: Okay. Cool. Perhaps this is a place for a question. “I’ve been on a T3/T4 combo for fifteen years and was showing hypothyroid symptoms thirty-seven years ago. Now at age fifty-six is it too late to get well by treating the root cause?” She’s motivated by the way menopause has compounded issues. Dr. Brogan: Yes. Well, when it comes to menopause, probably the most important element to assess is going to be, again, that adrenal function because that’s probably the biggest culprit in a lot of the symptoms, the weight redistribution and fatigue and cloudiness and depression that women do experience. So I do think that often you can get a lot out of your, again, like I said, thyroid function, if you do support adrenals, whether it’s through herbs or licorice or depending on what the pattern is, or meditation or glycemic control. There’s some suggestion that if you take thyroid hormone for more than eighteen months, it can be difficult to taper off it. So I don’t think it’s impossible. But whenever you take hormones, you’re obviously deliberately interfering with that feedback loop. So there’s some possibility that it could be difficult to jump start your own gland. But a lot of that depends on how much was destroyed before you started to suppress your TSH. So I certainly don’t think it’s impossible. But I would do as much as you can to support things like blood sugar and adrenal health and hormonal health before you even try to taper off it. And if you have residual symptoms on a T3/T4 with a desiccated thyroid like Nature-Throid or compounded, there are other things in there like T1 and T2 and calcitonin and iodine. We don’t really even know what T1 does. So it may even sometimes be worth thinking about switching the type of hormone that you’re taking. But I certainly wouldn’t say that it’s too late. It’s never too late.   20

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan Sean: Next one. “All my symptoms are getting much worse. But my endocrinologist will not increase my Naltrexone above seventy-five or give me T3 because he said at my age of sixty-five, I have an increased risk of 300 percent of getting a stroke or heart attack. So how do I deal with the skin rashes, eye problems, food intolerances, and weight problems that are getting so much worse despite exercise and taking care of myself?” Dr. Brogan: Okay. First of all, you find a different doctor. That’s number one because I don’t believe—I have a lot of radical perspectives on health—and I don’t believe that anyone should fight with their doctor. There are a lot of enlightened folks out there. And, again, you probably have to…You can look on the Institute for Functional Medicine website or you can find a naturopath because like I said, it’s part of their training to think about things this way. You should not be tolerating your symptoms. Just to speak to some of this fear mongering around T3 treatments is interesting because any type of thyroid treatment is just going to accelerate cellular processes and bodily processes. So if you have osteoporosis, for example, and you “overtreat” your thyroid, you may actually accelerate that process. If you have an underlying arrhythmia and you take a whole bunch of T3, you may actually expose and reveal that. But thyroid hormone is not the same as hyperthyroidism. There’s a lot of confusion on the part of allopathic doctors around taking extra thyroid hormone—maybe more than might be physiologically indicated by your tests—and hyperthyroidism. They’re not the same thing. So there’s a lot of misunderstanding about it. Randomized trials have told us that patients feel better and lose more weight on desiccated thyroid relative to Synthroid. So we know that there’s something to that type of treatment that is not being achieved by just the synthetic storage form of the hormone. Sean: Awesome. Maybe we can point Traci in the right direction with this one. “What literature specifically is there to show my physician about the possible ineffectiveness of thyroid replacement therapy and the gluten connection?” Dr. Brogan: Well, there is on my website on the resources page, there’s actually a society for reevaluating hypothyroidism that has some resources on it. I actually have an article that I wrote   21

     

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Presenter: Dr. Kelly Brogan summarizing a lot of this, and particularly on the gluten element of it, coming out in probably another week or two. And I know that there are other folks that have written about this. So it’s definitely out there. Again, I feel like when it comes to minimizing stress in your life, it’s just not worth arguing. I mean, yeah, it would be great service if all patients would educate their doctors about functional medicine. But you have to appreciate the embeddedness of this type of indoctrinated thinking on the part of these doctors. They’ve been probably practicing this way for a really long time. They’re invested in continuing to practice the way they practice. And I just don’t know that it’s worth the effort to argue about it. The data is out there. It exists. And people who are interested in better clinical outcomes have compiled it. And I’m certainly not the only one. I know that my patients with hypothyroidism feel a lot better than the patients of the endocrinologist down the street. And for me that’s what really matters in the end. Sean: Next one’s from Fannie. “I have been on Levothyroxine for many years. How do I stop taking it? TSH, T4, and T3 were normal on last exams.” Dr. Brogan: So you’re probably not going to want to stop taking it, again, until you start to investigate why you needed it in the first place. So this is where it becomes a bit overwhelming and why it’s helpful to have a practitioner because if it was diet related, which I do believe it almost always is to some extent, you’d want to address that. If it was related to an environmental exposure like fluoride, you’ll want to know that. If it’s related to something else that’s stressing your adrenals, whether it’s a chronic infection, whether it’s chronic stress, whether it’s, again, an environmental exposure, metals, you’ll want to assess your adrenals and you’ll want to know that. You need to address why it happened before you think about abandoning the treatment. And, again, that’s why if you don’t feel totally well, but you’re not ready to taper it or undertake this investigation, you might just want to consider either adding on T3 sustained release or taking a glandular version of the hormone because according to the data, it can actually make a big difference in your subjective experience.   22

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Presenter: Dr. Kelly Brogan Sean: We’ll do this next one from Beth. “Is there a link between thyroid problems and heart palpitations?” Dr. Brogan: Yes. Both directions. Hypothyroidism and hyperthyroidism is associated with arrhythmia and palpitations. If you are somebody who “cannot tolerate” T3 formulas—so either T3 on its own or when it’s included in one of these animal glands—that in our best understanding is an indication that you have hypoadrenalism, that you actually have low cortisol insufficient to sustain the thyroid effect. So you’ll want to address that first before you increase your dose at all because it can be a “side effect.” But, again, it’s really this unmasking effect that I mentioned because patients can have resolution of palpitations with thyroid treatment. But thyroid treatment can also “cause.” But I think it’s more of an unmasking. Sean: Next one’s from Leah. “Can thyroid and/or fungal/parasitic infections be linked to skin problems?” Dr. Brogan: Can thyroid infections? Sean: Can thyroid and/or fungal or parasitic infections be linked to skin problems? So separately. Dr. Brogan: Hmm. I would probably have to say the answer is yes. I mean, the most common skin issue when it comes to hypothyroidism is going to be excessive dry skin. So often I’ll hear patients admit to that. But then they’ll dismiss it because, you know, I work in Manhattan. And it’s cold ten months of the year. So they don’t take it seriously. But often that’s an important element. The connection between immunity, cortisol, and thyroid is very intricate so that chronic infections, including fungal infections, can certainly be something that ties all of those things together. And certainly fungal infections can manifest dermatologically often. So, yeah, that relationship is plausible is absolutely the case. Sean: Alrighty. There’s so many coming in. It’s moving. It’s hard to keep track of them right now. Fannie, your question about infertility and thyroid, Kim Schuette does forty-five minutes on that one. So I’m going to save that one for Kim Schuette in The Thyroid Sessions.   23

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan There was another one that I saw here. Myra wants to know—she has no thyroid—she wants to know if she should have her iodine and her selenium levels checked if she has no thyroid? Dr. Brogan: Okay. If you have no thyroid, it’s going to be more—I’ll just make this point instead— it’s going to be more important than ever, in my opinion, for you to take a combination replacement. So, again, like I said, the easiest type to take is going to be something like a NatureThroid or an Armour Thyroid or a compounded version of it because that’s the closest you’re going to get to replacing all of the hormones, and, again, has iodine already, by nature of it. And then selenium, and zinc, and magnesium, these are the other micronutrients that are going to be important for your body, generally. So checking levels like red blood cell levels is certainly something you can do. Testing for iodine is a bit controversial how to do that best. But for the most part, I think you’re going to get a lot of bang for your buck out of a combination formula in that case. Sean: Okay. Another one from Fannie. She wants to know if she can listen to the interview with Dr. Brownstein? It’s bit.ly/freethyroidcancervideo, I believe. I’ll put it in the chat box in just a second. That was one of our early bird presentations. Dr. Brogan: A very uplifting URL. Sean: [Laughs] Let’s go to Kay. She says at about the twenty-five minute mark today, she says that 2.0 is the target for TSH levels. “My current doctor is aiming for 0.2. My naturopath thinks that is way too, low. My TSH has been in the four to six range the past several months. My T4 and T3 levels are okay. Dr. Brogan’s opinion?” Dr. Brogan: So that your free hormone levels are okay, again, you’d want to know are they at the higher end of the range. That would be great. The TSH, it’s just totally ridiculous to me to get fixated on it or make rules about it because it depends on how you feel. If you started out with a   24

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan TSH of three and now your TSH is 0.02, that change for you might be too dramatic. We’re talking about relative to where you were starting, where are you now? And I aim often for less than one. So I probably am closer to—I believe it was your endocrinologist, I don’t know, who said that—but I certainly don’t think that if you are symptomatically well, I’d never worry about over suppression according to TSH. And, frankly, that study that I mentioned, the Scottish study, helps to support me in that because the reference range does not encompass for many patients wellness. And one of the reasons—I’m sure this is spoken about with some of your speakers—is the idea of cellular resistance, so peripheral resistance to thyroid hormone. So you may actually have to take a whole lot of thyroid hormone to overcome resistance at the cellular level. So you’re going to have to really ram down that TSH before you’re feeling anything from your thyroid hormone. There’s a great book by Mark Starr, who’s an M.D. who talks about this type of hypothyroidism that is a peripheral resistance type of hypothyroidism. And he uses whopping doses of Armour and desiccated thyroid in his practice to achieve clinical remission of symptoms. So it’s an art in the end, unfortunately. Sean: And that’s a good segue into our next question from Beth. Beth’s TSH was originally 8.5. She was started on only a half grain of Nature-Throid. Is that enough? Dr. Brogan: No. [Laughs] No. No. And that’s why I advocate for the clinical model where you just increase by a quarter to a half a grain every week until you feel better. And you may get up to two to five grains and that freaks a lot of people out, obviously. But if you’re doing it as a clinical therapeutic trial, take six months to do that and know where you fall in the range. Don’t take ten years sitting at half a grain with residual symptoms. Doesn’t make any sense to me. Sean: Joanne says, “My new endo doc just told me that they don’t prescribe Armour in Europe anymore due to mad cow disease so he wouldn’t give it to me. Have you heard of this? He also said it is really hard to dose. I’m in menopause, have Hashimoto’s, and had to figure out this stuff by   25

     

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Presenter: Dr. Kelly Brogan myself. Finally, I am taking Synthroid and T3. Yay, I’m feeling better! Started gluten-free, sugarfree, and try not to cheat on the dairy. This interview has been very helpful. Thank you.” Sean: You’re welcome. Dr. Brogan: Yeah. So I don’t prescribe Armour. I know that there was a change in sort of like corporate ownership of it that a lot of patients were upset about. There’s a great website called, Stop the Thyroid Madness that sort of documented the whole event in terms of what patients were experiencing. I think that there’s a lot of misunderstanding about the nature of T3 being this very volatile hormone. It is on some levels very short acting. And for the most part, that’s why you’d want it in this type of natural preparation. Or if you’re going to take synthetic—if you’re going to take Cytomel for example, which is the prescription form of the synthetic—you really would need to dose that four times a day. If you take a compounded sustained release, you can do it twice a day. Or you can take it in the form of Nature-Throid or a desiccated thyroid. So the dosing is going be, again, individualized. Some patients do take desiccated thyroid twice a day, twelve-hour intervals. And they feel a lot better splitting their dose that way. But it’s certainly not the case that…And by the way, Synthroid/Levothyroxine is the most recalled as far as I have read of any prescription medication. It has had more recalls in its history for lack of integrity of the product, certainly than T3. So it’s a bit misleading to suggest that T3 is a dangerous prescription. Sean: Kay asks, “I am using Armour. If I take more than thirty milligrams per day, I have awful tachycardia and agitation and anxiety. I discovered that my ferritin is very high. And it’s 224 to 240. I’m pretty much menopausal at this point. I have a short period every thirteen to fourteen months. I read that if my ferritin comes down that I should be able to take more Armour without feeling so awful. Do you agree? If so, would you recommend blood donation as the preferred way to lower my ferritin. I stopped using cast iron and reduced my grass-fed beef consumption about three months ago, but my ferritin went up!”

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Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan Dr. Brogan: That’s interesting. So here’s where it gets a bit technical because ferritin is what’s called an acute-phase reactant. So that means that it can actually indicate that your body is under stress. It’s one of these reactants that can tell us that it’s a nonspecific indicator that your body is under stress. And I mentioned earlier that when you have that type of reaction to increased dosing of thyroid, it’s an indication that—maybe you’ve had this testing done—but it’s an indication that you probably have hypocortisolemia. So your cortisol pattern is a bit suppressed. So you would want to know. Chronic infection is screaming out to me. So what does that mean? So the easiest place to look as far as interfacing between the environment and your immune system is going to be in your gut. So if you’re working with somebody who can do a specialty lab stool test for you, that’s going to be an important at least glimpse onto the world of your immune system and potentially infectious status. But there’s something that is stressing your body and is fatiguing your adrenals. And that is probably why you can’t tolerate the higher dose of thyroid. Sean: Next one. If a child started taking Synthroid at the age of nine and now she is fourteen, can she be brought back with functional medicine? Dr. Brogan: Oh, gosh. I don’t treat kids. I have two of them. So I guess, in some ways I do. But they’re so resilient. Yes. I do think that, again, I mentioned Mark Starr. He writes about actually treating kids actively to avoid the perils of undiagnosed hypothyroidism. So maybe there’s actually some reason that this child was recommended hormone to begin with. And taking thyroid hormone for the rest of your life, even though it wasn’t my preference, is not the end of the world. It’s certainly preferable to five to ten prescription medications to cover the thyroid symptoms instead. So I guess it depends on why it was prescribed in the first place. Sean: Melanie. Christa Orecchio covers hyperthyroidism and diet in depth. I want to say she is next Tuesday and Wednesday, I believe. So look for that. Marianne asks, “Can you clarify how thyroid nodules are related to Hashimoto’s?”   27

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan Dr. Brogan: So thyroid nodules and goiter can form basically when the gland is over-stimulated. It can be for a number of different reasons, however, and actually can also be totally benign and somewhat meaningless. So when you have them assessed, they’ll want to know if they’re “hot or cold,” which is an indication of whether or not they’re actively potentially representative of changes, dysplastic changes in the tissue or whether it’s just more like a cyst. Like I mentioned, they’ll want to know the size of it. But, again, the role of iodine—and maybe Dr. Brownstein addresses this—the role of iodine treatment in that situation is very relevant. So that’s probably where I would start. Sean: Myra. “Is drinking kombucha good for thyroid-related mood disorders? Dr. Brogan: Huh. That’s interesting. So what’s kombucha? It’s probiotic. So it’s saccharomyces and it’s also full of B vitamins. So certainly, I think that that plays an indirect role. I think that there’s some people who don’t do well with kombucha for myriad reasons related to the things that it primarily contains, obviously. But I wouldn’t think of it as a primary treatment. But I think it’s indirect support, for sure. Sean: All right. I missed Ashley’s question. My bad, Ashley. This thing just keeps on moving. So, sorry. “My client has vertigo that came on during her pregnancy. She has had all the standard tests, inner ear, etc. And none of her doctors can explain why she still suffers from vertigo. Her baby is now ten months old. She had thyroid cancer and her thyroid removed six years ago. I feel like this is connected to her vertigo, but none of her doctors do.” Any comment on that? Dr. Brogan: That’s interesting. So when I—and again this may not be relevant. She may have already done this—but when I think vertigo or particularly any neurologic symptom, I think of two things. I think of gluten, right. So there are many patients with undiagnosable neurologic symptoms that respond to gluten elimination. I also think of B12, again, as another driver of a number of difficult to diagnose neurologic conditions. The role of thyroid in her presentation could certainly be relevant. She’s definitely somebody who should probably be on a combination therapy. And then if she’s syncopizing, like if she’s passing out or fainting, then again the role of her adrenal health, particularly for its ability to support   28

     

Boo st Your Thyro id, Boost Your Mood Presenter: Dr. Kelly Brogan maintenance of her blood pressure. So that type of dizziness—and we call it orthostasis—is often a symptom of hypocortisolemia, which is very common in pregnancy and even more so postpartum. Sean: All right, let’s do two more and then we’ll let you go, doc. Thanks for taking so much time with us. Bobbi. She says, “Question. Here’s my background history. Forty-two years old. History of infertility, which led to a diagnosis of Hashimoto’s just four weeks ago. Just retested after taking Synthroid for the past four weeks. And my TPO antibody increased. My fertility doctor is increasing my Synthroid dose and adding Prednisone to the treatment. I have been gluten-free for nine months. Any other suggestions? I still feel a lot of fatigue. What tests would help find the root cause?” Dr. Brogan: Okay. The Prednisone freaks me out a bit. Not to sort of mix messages for you or interfere with your treatment, obviously. But as a psychiatrist, Prednisone is something I have many concerns about because of its psychiatric symptoms. Here’s the thing. Synthroid is not doing anything to reverse the autoimmune process. So it’s only suppressing TSH. So it’s only actually keeping, to some extent, it’s keeping your hormone levels in a certain range. But that’s why most endocrinologists don’t check for antibodies because they don’t do anything about it. And it doesn’t actually change their treatment, which is just the Synthroid. So, again, I would start with the basics. Just keep it really simple. Forget about further testing, stressing yourself out about it, and just do the simple lifestyle interventions. So an ancestral diet. Looking at endocrine disruptors, which are going to be reviewed. Looking at any other potential medications you’re taking that could interfere with thyroid. If you had a history of taking oral contraceptives and you stopped, that could just be a matter of time and proper supplementation to reverse it. And then if you don’t make progress that way, then you can work with a provider who knows how to use nutrients—things like antioxidants, minerals, vitamins, amino acids—knows how to use them to actually support immune system re-regulation. So, again, things like I mentioned like low dose naltrexone, these tricks to try and reeducate the immune system. That would definitely be the way to go I think.   29

     

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Presenter: Dr. Kelly Brogan Sean: Last one from Estee. “What does the MTHFR defect have to do, if any, with thyroid problems?” Dr. Brogan: Great question. So it seems to have a lot. There’s a ton of overlap. I mentioned earlier that there’s a role for T4 that is more than just storage hormone. And actually methylation and activation of NADH is an important role for T4. And somebody who is really sort of like the world’s expert on this is Dr. Ben Lynch. He has a great website mthfr.net where he talks a lot about this. There is a very relevant relationship. And it’s mostly that hypothyroidism can interfere with methylation processes. But if you already have it, it’s like having two broken legs. So if you already have an MTHFR polymorphism and then you also have hypothyroidism, you could be doubly impairing that process. Sean: Dr. Allen, Christa Orecchio covered MTHFR. So thank you so much, Dr. Brogran. Your website is kellybroganmd.com. Do you work by phone, over Skype, or only in person? Dr. Brogan: I do. I do. I obviously prefer in-person because I have all my labs and stuff up the street. But I do. Yeah, it’s come to that because of there are, I guess, not too many psychiatrists who have this perspective . So I certainly don’t want to leave people hanging. But I definitely am of the belief that any functional doctor medicine—it doesn’t even need to be a psychiatrist—or a naturopath can help you with these principles. I’m just bringing it to the realm of psychiatry. But for the most part, everything that I do is something that most functional medicine doctors are well versed in. Sean: I love it. Thank you very much. You have a good night. Dr. Brogan: Awesome! Thank you, Sean.

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