Dr. Holly Lucille talks about Thyroid Health with Dr. Ben Weitz.
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Podcast Details
1:05 I introduced the topic by explaining that thyroid enlargement, known as goiter, from a lack of iodine was the main cause of hypothyroidism for many years until we started the nationwide iodine supplement program where we added iodine to salt. We saw goiter go away but rates of Hashimoto’s autoimmune hypothyroid skyrocketed. And restricting iodine intake is often helpful for autoimmune hypothyroid.
4:25 I asked Dr. Lucille what alerts her when she sees a patient in her office that they might have thyroid problems? Dr. Lucille explained that active thyroid hormone, T3, getting into our cells is responsible for our metabolism and any signs of hypometabolism, such as weight gain, fatigue, constipation, hair thinning, and depression, alert you to the possibility of a thyroid problem.
5:35 I asked if hypothyroidism is suspected, what lab tests should be ordered? Dr. Lucille explained that the reason we run lab tests in the first place is to confirm what we already suspect clinically. She prefers to be comprehensive in her lab testing for thyroid, rather than just running the TSH, which is what many doctors run. Dr. Lucille used an analogy of a runner running a 440. Leg one is the higher brain center of the hypothalamus and the pituitary that are getting signals from the rest of the body as to the need for thyroid hormone. Leg two is the communication down to the thyroid itself. Leg three is the making of thyroid hormone directly at the level of the thyroid, mostly T4. Leg four is the conversion of T4 to active T3. She likes to run a total T4, a free T4, A free T3, TPO and TGB antibodies, reverse T3, and Thyroid Binding Globulin.
9:02 I asked, just to play Devil’s advocate, if I am an insurance company or a conventional MD, since T3 and T4 correlate with TSH, why do you have to run all these other tests? Dr. Lucille said that in some of the problematic cases she sees, these don’t necessarily correlate. These tests allow us to figure out where the problem of an under-functioning thyroid is and how to fix it. Also TSH is unpredictable with age, infection, stress, calorie restriction, inflammation. Also, there is a big controversy as to what the healthy range for TSH is. Normal at one time was up to 4, then 3.5, and now many consider up to 2.5 as normal. Dr. Lucille mentioned that the National Academy for Clinical Biochemistry has said since 2002 that the TSH should be between .5 and 2.0. Many studies show that TSH above 2.5 is associated with metabolic syndrome, elevated fasting triglycerides, increased blood pressure and an increase in body mass index. TSH is not enough to properly assess thyroid disorders, other than thyroid tumors.
10:55 I told Dr. Lucille that I would play Devil’s Advocate one more time and asked, why do we need to do these tests for autoimmune thyroid (TPO and TGB antibodies) if there is nothing that we can do about autoimmune conditions? Dr. Lucille related a conversation she had with a prominent endocrinologist that since we know that most cases of under-functioning thyroid is related to autoimmune destruction why doesn’t he regularly run these antibody tests and he said that because his treatment would not change. Dr. Lucille said that she is concerned that if all you do is place the patient on Synthroid and you don’t do anything about the underlying autoimmune condition, then the autoimmune condition will progress into attacking another organ of the body. Even though their TSH is within normal limits, such patients will continue to suffer.
13:22 This is why it would be beneficial for most patients to not only see their conventional MD for diagnosis and treatment,