Ep. 491 Thyroid Masterclass: Top Triggers in Women Over 40 with Dr. Anshul Gupta, Dr. Carrie Jones, and McCall McPherson

We have the first episode in a series of thyroid-focused podcasts today.

In this episode, Dr. Anshul Gupta, Dr. Carrie Jones, and McCall McPherson join me to explore why Hashimoto’s tends to become problematic for women during perimenopause and menopause, and the root causes that drive it. We explore molecular mimicry, the effects of heavy metals, mycotoxins, mold, and other toxins on the thyroid, and explain how perimenopause impacts thyroid gland and immune system function. We cover non-thyroidal illness syndrome and cellular hypothyroidism, also focusing on Graves’ disease, which is due to a hyperactive thyroid gland, highlighting the standard of care it receives, preferred medications, and low-dose naltrexone.

Dr. Anshul Gupta explains why so many women with thyroid issues are unknowingly living with Hashimoto’s. He outlines the five root causes of Hashimoto’s, especially during perimenopause and menopause, highlighting the importance of addressing the underlying autoimmune process rather than simply replacing hormones. 

Dr. Carrie Jones explains why thyroid dysfunction in women often emerges during major hormonal transitions like perimenopause. She also points out that many cases of hypothyroidism involve issues that we cannot resolve with medication alone.

McCall McPherson discusses the challenges of diagnosing and treating Graves’ disease, which is often overlooked or mistaken for psychiatric issues. She explains the importance of proper testing, sharing some therapeutic approaches that can help stabilize thyroid function and calm the immune system.

You will not want to miss this invaluable compilation of powerful insights from three leading thyroid health experts.

Bio: Dr. Anshul Gupta

Dr. Anshul Gupta is a best-selling author, speaker, researcher, and the world expert on Hashimoto’s disease. He educates people worldwide on reversing Hashimoto’s disease.

He is a Board-Certified Family Medicine Physician with advanced certification in Functional Medicine, Peptide therapy, and Fellowship trained in Integrative Medicine.

He worked at the prestigious Cleveland Clinic Department of Functional Medicine alongside Dr. Mark Hyman and helped thousands of patients to reverse their health issues by using the concepts of functional medicine.

His dedication towards his patients was recognized when he was awarded Readers' Choice, Best Doctor in the Northern Neck Area.

He is now on a mission to help 1 million people reverse their health conditions. To achieve this mission, he has written a best-selling book called Reversing Hashimoto’s. He has also started a virtual functional medicine practice, a blog, and a YouTube channel so he can reach people from all over the world. And recently, he also hosted a Reversing Hashimoto’s summit.

Through his innovative approach to Hashimoto’s disease, he has helped several patients reverse their unresolved symptoms and live their lives to the fullest.

Bio: Dr. Carrie Jones

Carrie Jones, ND, FABNE, MPH, is an internationally recognized speaker, consultant, and educator on the topic of women's health and hormones with over 20 years in the industry. She has her Master’s in Public Health and was one of the first to become board certified through the American Board of Naturopathic Endocrinology and currently serves on the board. She was the Medical Director for the DUTCH Test for several years, and currently, she is the Head of Medical Education at Rupa Health and host of the Root Cause Medicine podcast.

About McCall McPherson: 

McCall McPherson is the Founder of Modern Thyroid Clinic, a thyroid-centered functional medicine practice in Austin, Texas, and the owner and Chief-Hope-Giver of Thyroid Nation. She is a physician assistant, TEDx speaker, and thyroid expert by way of being a thyroid patient. Her passion is helping women rebuild their lives from the devastating effects of thyroid and hormonal disorders. Her philosophy is simple: There is no reason to still have thyroid symptoms.

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“Any kind of stress on the body- emotional, mental, or physical, definitely will lead to triggering Hashimoto's.”

– Dr. Anshul Gupta

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Connect with Cynthia Thurlow  

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Connect with Dr. Anshul Gupta

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Connect with Dr. Carrie Jones

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Connect with McCall McPherson

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• Modern Thyroid and Wellness Podcast

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Transcript:

Cynthia Thurlow: [00:00:02] Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. 

[00:00:29] Today is the first in a series of thyroid focused podcasts. Today, I am joined by Dr. Gupta, Dr. Carrie Jones and McCall McPherson. We dove into why Hashimoto's becomes problematic for women as we navigate perimenopause and menopause and many of the root causes, we discussed molecular mimicry and the role of heavy metals, mycotoxins, mold and other toxins and how they impact the thyroid physiology and gland, how perimenopause specifically affects the thyroid and immune system function, nonthyroidal illness syndrome as well as cellular hypothyroidism. And lastly, disparity of focusing on Graves’ disease, which is the other end of the spectrum from Hashimoto's, really speaking to a hyperactive thyroid gland.

[00:01:22] Specific standards of care for Graves’ disease, preferences on medications as well as low-dose naltrexone. I know you will find this to be an invaluable compilation with several leading experts in the space. 

Dr. Anshul Gupta: [00:01:38] Absolutely. So again, you point out a very interesting fact that a lot of women are suffering from thyroid disorders and majority of them have no idea they actually have Hashimoto's because most of the physicians are not checking for it. They're not getting the right testing done. So, they have no idea they're impacting with an autoimmune condition and the treatment they are getting is just a hormone which their thyroid is not able to produce. Very different scenarios. So, Hashimoto's is an autoimmune condition. What that means is that your body is producing antibodies which is destroying your own thyroid gland. Now, over the course of weeks to months to years, this slow destruction ultimately leads to hypothyroidism. And that's where females get diagnosed with hypothyroidism and they get put on this medicine called levothyroxine.

[00:02:31] But levothyroxine is not doing anything to tackle this autoimmune process. This destruction continues to happen every day. What happens is that everybody gets started on a very low dose of the medicine and slowly and slowly their doses kept on increasing because the thyroid keeps dying every day. So, that's very important to know that, okay, well, you know, whether you have antibodies or not, whether you have Hashimoto's or not. And what can you do to actually stop this autoimmune destruction so that you can regenerate your thyroid gland and also feel better? 

Cynthia Thurlow: [00:03:05] I think it's really significant because I know when I was an NP in cardiology, we saw a lot of hypothyroidism. I would have patients that would say, “I'm not taking generic Synthroid or levothyroxine when I'm in the hospital.” They would ask permission to bring their medications from home because it made such a big difference. And I think most of us don't realize that those increasing doses of medication are really identifying that the thyroid gland is really less optimized than it was when you started medication and that's an important distinction. What are some of the common root causes for Hashimoto's? Because this is important. We are heading hopefully out of the last two and a half years an unprecedented pandemic and a lot of extra stress.

[00:03:53] So, imagine additional stress already on top of individuals that are less apt to deal well with stress as they transition from perimenopause into menopause. And I would argue that there's some degree of adrenal pause that goes along with that. So, let's start there. Some of the common reasons why women will develop Hashimoto's at this stage of life. 

Dr. Anshul Gupta: Absolutely. So, I have basically identified five major root causes which leads to triggering of Hashimoto's. So, the number one is food. You know, food is medicine. But food can also cause a lot of diseases. Especially, the way we are handling food industry currently. We are not being fed real food. So, it's very important to know about it. So, several foods we know that like gluten, dairy, soy, corn, processed food, excess sugar in our diet, all of those things have impact on Hashimoto's and can definitely trigger Hashimoto's. The second one is toxins. Every day new and new toxins are being poured into our environment. Whether those are heavy metals like lead, mercury, aluminum, whether those are environmental toxins like organophosphates or pesticides or mold toxins. Now mold toxins are a very, very big trigger. And a lot of people are not aware of that they're exposed to mold. So, second is the toxins are very major cause.

[00:05:17] The third is nutritional deficiencies. A lot of people are eating nutritionally rich food or they think so that they're eating healthy food. But our food itself is low in a lot of vitamins and minerals especially needed by our thyroid, like magnesium, selenium, zinc, you know, our food is very low into them. And that definitely again leads to triggering of Hashimoto's. Then comes the very important factor of infections. We are obviously going through this pandemic almost hopefully at the end of it, but several infections, especially viral infections, have been associated with Hashimoto's. The most common being Epstein-Barr virus infection.

[00:05:53] But other infection, like parasites in the gut, like Blastocystis, Candida, all of those things can also lead to Hashimoto's. Then there comes the chronic Lyme disease, and chronic parasites which can cause them. Then last comes the stress. And he said, like stress is the last. But this is probably one of the number one reasons of triggering Hashimoto's. Several females, if they go back to when they were finally diagnosed with Hashimoto's, they will always remember that a stressful event happened in their life. Whether it was a personal relationship or it was work related or even post delivery. Post delivery, lot of hormonal shifts are happening. Female body goes to a lot of stressful moments and they do get diagnosed Hashimoto's. 

[00:06:39] The second stressful is again, when they hit menopause again, a lot of shift is happening in their body. A lot of stress is happening. So that again will it trigger Hashimoto's. So, any kind of stress, whether it is emotional, whether it's mental, whether it is physical, any kind of stress on the body definitely will lead to triggering Hashimoto's. So, these are the five main root causes, big categories, which are there, which definitely causes Hashimoto's. 

Cynthia Thurlow: [00:07:03] Yeah, that's a really great place to start the conversation. So, when I have investigated the role of nutrition, so let's start there. The role of food choices and the net impact on thyroid function. The term molecular mimicry seems to come up with some frequency. And so, it's usually my go-to explanation for why things like gluten and dairy in particular can make it so much harder for the thyroid gland to work properly. Can we touch on this because I think it's a term that most people are not familiarized with, but one that can help reinforce why those good nutritional choices can make a big impact on how or whether or not your thyroid is properly optimized. 

Dr. Anshul Gupta: Absolutely. So, how we discuss that, Hashimoto's is an autoimmune condition where your body is making antibodies, against something, let's say, in this situation, gluten and dairy, because they have been processed so much, because they have been completely differently changed from the original form. The body basically recognizes them as something foreign. And whenever you ingest something foreign, your body starts producing antibodies. Now what happens is that body is trying to produce antibodies against this gluten and dairy. But their molecular structure, we know, which body recognizes is very similar to thyroid gland. So, when they are actually producing these antibodies, these antibodies are basically kind of blind missiles which have been launched and they are going to destroy certain sequence of genetic sequence. Now, they cannot differentiate between gluten and thyroid gland. 

[00:08:40] So, unfortunately, over the course of time, they start destroying a thyroid gland. This molecular mimicry unfortunately leads to the destruction of the thyroid gland, while in reality, they're trying to target gluten and dairy. So that's the reason gluten and dairy, when you ingest it, slowly and slowly they start building up these antibodies and they start destroying your thyroid gland and that ultimately leads to Hashimoto's. 

Cynthia Thurlow: It's really interesting because one of the proposed explanations for why my antibodies have never been positive is that I have been gluten free for over 11 years. And that very likely, maybe, and I'm also dairy free. But it was something that I try to-- When women are struggling with these elimination diets, when they're really not 100% in, they don't really want to remove the gluten, they don't want to remove the dairy in particular. I just remind them that, we have to have these reframes about if we're really looking to heal our thyroid or get to a degree of thyroid optimization, sometimes we have to subtract in order to improve. And so that reframe can be really interesting.

[00:09:45] I also think that when we reflect on the processed food industry and we talk about processed sugars in particular, and I think the latest statistic I read was that the average American eats 160 pounds of sugar a year and 200 pounds of white flour per year, which was astounding. Is it any surprise, especially with the last two and a half years, that if we're consuming more carbohydrates, processed carbohydrates, more sugar, that leads to more stress in the body, that leads to higher glucose, higher cortisol, higher insulin, can lead to gut microbiome changes, which I know we'll talk more about, which exacerbates that inflammation, the poor nutrient absorption, all the things that you were kind of alluding to. So really helping people understand that we are-- a lot of the food choices we make can either improve our health or can make it harder for us to optimize our health.

[00:10:36] And I think unfortunately, in the traditional allopathic model, we don't talk enough about the role of nutrition. I'm grateful for people like yourself that are talking to patients about the role of lifestyle and how critically important that is. 

Dr. Anshul Gupta: [00:10:49] No, absolutely, this is such a missing piece because again, all of my patients, they have already asked their physicians, “What can I do? What food should I be eating? Or is there any impact on any food choices?” And the answer, they will say, “Just eat whatever you like.” And I was like, “There is no way that, you know, the poor food choices are not the reason that you're having Hashimoto's.” So, people are asking the right questions, but they're not getting the right information. So, that's very important that we follow like a proper nutrition plan and focus on the foods which are healing for thyroid and removing foods which are actually destroying a thyroid gland. So, very important to know that aspect. 

[00:11:26] And you pointed out very correctly that a lot of people might have given up gluten or dairy and their antibodies are negative. So, we have this antibody negative Hashimoto's, which a lot of people will have. And obviously, the blood test results will not show it. And they will believe that they don't have Hashimoto's. But obviously, their body is producing this inflammation which is destroying the thyroid gland. And we know that the number one reason of hypothyroidism is Hashimoto's. So, definitely majority of the females have Hashimoto's ongoing, which is resulting in hypothyroidism. 

Cynthia Thurlow: [00:12:00] Yeah, it's really interesting. And then when we tie in the piece about toxins, and I actually did a webinar talking about this, just talking about personal care products and the toxins that are in those. But I found it very interesting that mercury in particular is highly thyroid toxic. And are most people that are impacted adversely? I’m sure, you're probably doing heavy metal screening, amongst other things. Are most people getting exposure from mercury related to having mercury amalgams or their mother having mercury amalgams? And I say this a little bit selfishly because I'm curious to ask you this. I've never had a mercury filling, but my mom had many. 

[00:12:38] And so it wasn't until I had my thyroid diagnosis that my functional medicine provider said, “Let's do a heavy metal panel and my mercury levels were off the charts to the point where she thought I actually needed to have chelation therapy, which is a whole separate tangential conversation.” But I thought for the purposes of our discussion, the heavy metals that you're testing your patients for, are you seeing a lot of mercury in your patients and are they getting it exogenously from potentially foods they're eating, or is their fetal transmission or from their own mercury amalgams? 

Dr. Gupta: [00:13:11] Yes. So heavy metals are a big issue because unfortunately, thyroid is like a sponge. As soon as, any heavy metal gets ingested in your body, it directly goes to the thyroid because they have a very strong affinity towards a thyroid. So, slowly, over the course of time, the amount of these heavy metals increase in your thyroid and obviously one day the threshold is gone and that leads to Hashimoto's. Now, definitely we are seeing very heavy levels of mercury, high levels of lead in a lot of a thyroid patients. Toxins are a very major issue. Sometimes, people who do not want to check, I always tell them, I know that you do not have a history, but trust me, there has to be a toxin which is causing this Hashimoto's or your thyroid problem. 

[00:13:54] And the problem is research with these heavy metals is still very rudimentary because all these research follows the toxicology protocol where, okay, well, if particular dose is lethal for your body, then only it is considered that it can destroy your body. If it is anything lower than that, they will not even consider doing further testing for it. So that's the reason that we do not know that where all this mercury is coming from. We definitely know it comes from amalgams. We definitely know it can come from our environment, especially eating fish, which is high in mercury. We definitely know it is being added to a lot of spraying which is happening around our environment, organic sides, all these pesticides.

[00:14:37] And as you mentioned, a lot of skin care products are adding mercury without even mentioning it on their labels. And this interesting piece of fetal transmission from maternal transmission to fetus, we do see that happening also because again, women which are high in mercury becomes pregnant, we see that they excrete these toxins not only through placenta, but unfortunately through breast milk also, because all of these things are basically getting out of your body. And whenever anything leaves out of your body, sometimes they can have toxins. By no means I am saying any woman that they should not be doing breastfeeding. So, please don't take it in that way. But I'm just mentioning that these all things are present.

[00:15:19] So, it is very important for women to even realize that if they are getting pregnant, to take care of their body, because it is not only for themselves, it is also for their baby or for their children that they're doing a service. Unfortunately, these toxins are being hidden all of these places. Sometimes to find a perfect source is very difficult because sometimes they can be multiple sources, not just one. Again, very important issue is that fish oil supplements, a lot of people hear a lot of webinars a lot of places, and they will start taking fish oil supplement, but those supplements itself can be contaminated with mercury. So, very important to get a good supplement from a good source, which they do check themselves for mercury. It's a very important thing. 

[00:16:02] So as you said, these things are hidden in so many different places. So,. you have to be real detective to know where they're coming from. 

Cynthia Thurlow: [00:16:09] No, it's such a good point and it's interesting. Years ago, I used to recommend fish oil a lot. And then as I started learning about the degree of rancidity and contaminants, it really gave me pause about recommending it. And now I've actually started recommending just having a certain amount of fatty fish a week, wild caught fish. And so, it really begs to understand that starting from the food first, and then adding in supplements only if they're really necessary. Now, I do want to just briefly touch on mycotoxins and mold. We know that 25% of the population is more susceptible to mycotoxins. I happen to be part of that 25%, which is why I wanted to make sure I interject that you could have a whole community of people all exposed to the same mycotoxins.

[00:16:56] And the 25% of us that are the canary in the coal mines, we are going to react much more significantly. And do you find that when individuals are removed from where the mycotoxin exposure is, whether it's their office or their personal home. And I know much more of an issue if you have mold exposure at home, because it can impact whether or not you can take your belongings with you. And that's a whole-- very challenging situation to be in. But do you find for those that are more thyroid and mold susceptible, that removing them from whatever environment they're in, that they're getting the exposure can be helpful in and of itself? 

Dr. Gupta: [00:17:31] Well, definitely. So, again, it depends on person to person. Some people have been exposed and as you said, they are very, very susceptible. And unfortunately, the problem is that we only have one detox system. All of these toxins are going to that same funnel. So, a person has high mercury, has high mold toxins plus has a lot of environmental other toxins like organophosphates. Then those people are very, very sensitive. So, small amount of mold in their system can trigger big reactions. Unfortunately, mold mycotoxins lead to something what we call as CIRS, chronic inflammatory response syndrome. So, the mold toxins create more inflammation. Your body already has inflammation with Hashimoto's, creates more inflammation which starts destroying your mitochondria.

[00:18:18] And that again is a very, very important reason of, with mold patients having brain fog or feeling tired or having chronic pain because the mitochondria is not functioning. So, for these females, yes, removing from the environment is necessary and important, but unfortunately just removing from the environment alone is not enough because that damage which mold has done in the body also has to be remediated. And that's what again a lot of people when they're reading on Internet, they said, “Oh, I've been exposed to more, let me take these couple of supplements to detoxify my body.” But they don't feel better. The reason is that they're not doing anything to remediate the damage which mold toxins have already done in their body, especially mitochondria.

[00:19:00] The mitochondria has to be fixed and other inflammatory markers needs to come down, then only people will start feeling better.

[music]

Cynthia Thurlow: [00:19:11] Thyroid is a hot topic for middle-aged women largely because so many of them have either subclinical hypothyroidism, many of them have Hashimoto's. And so, a lot of questions that came in for the good doctor were asking about thyroid testing, what to be asking for. I admittedly years ago used to just order a TSH and a free T4 and I thought that checked the box and now I know better. So, I always like to admit that. But let's talk a little bit about what starts to happen to thyroid function as we have these fluctuations in progesterone and whether or not vis a vis we become insulin resistant. All these things that impact thyroid function and why so many women at middle age are dealing with thyroid issues. 

Dr. Carrie Jones: [00:19:54] And we say at the big P's that's when thyroid issues hypothyroidism so low thyroid tends to hit women, I think like 4x over men. When it's a true thyroid issue, there's something else called central hypothyroidism, which can affect men and women equally. But we hear about hypothyroidism is generally women that get affected. So, the big P's, puberty, pregnancy, postpartum, perimenopause and menopause, these big grand hormonal shifts will really affect the thyroid at a variety of levels. So, these shifts and hormones affect our brain. So, our brain communicates to the thyroid. It'll affect the thyroid gland itself in our neck. So, we do or don't produce hormone in our thyroid gland, we predominantly produce a hormone T4, which you mentioned, and a little bit of T3.

[00:20:42] But T3 is the active one. That's the big guns. It's 10x stronger than T4 and then out in what we call our periphery. So, our tips of our toes and tips of our fingers and our liver and your ovaries, your testicles, whatever, we can convert and make T3, which is the active guy. So, these shifts in hormones, estrogen, progesterone, testosterone, can work with or work against the creation of that, the formation of T3. And so, as we make these big shifts, hormones also affect our immune system. So, if you were sort of subclinical, maybe you never really ever pop positive for an autoimmune thyroid like Hashimoto's. As we make these shifts in estrogen particularly, which has grand influence on our immune system, it can actually push you into-- Now really seen on lab work, like maybe you were always sort of borderline on like your Hashimoto's antibodies. 

[00:21:36] And by borderline, I mean like you were not quite over the edge, but you were pushing close, which I know there's arguments that you probably were there and just didn't catch it. But what I see then in perimenopause is these grand shifts in estrogen, grand shifts in the immune system. The body's like, “Forget it.” Like here are the antibodies and it will really show up on blood work. It'll make it stupid obvious once we hit into perimenopause, whereas kind of gray area before. So, when we couple all this is why women in perimenopause and then you add insulin on top of it, then you add cortisol on top of it, then you add years of gut disturbance on top of it, you know, etc., etc., etc. And the risk for autoimmune goes up exponentially. 

Cynthia Thurlow: [00:22:15] It's interesting because I did not know that even though I've never had positive thyroid antibodies, that my acting functional medicine doc said, “Oh, you definitely have Hashimoto's. You just have been gluten free for so long that we have never seen positive antibodies.” So, if you're listening to this and you've been told you don't have Hashimoto's, statistically, if you're a woman and you have hypothyroidism, more likely than not you actually have an autoimmune issue. And so that really started to make sense to me. But I think for years I'd been told by another provider, “Oh, you don't have Hashimoto's because you've never had positive antibodies.” So, if anyone's listening and if that provides an enlightenment for me, I took it much more seriously because no, it wasn't related to mercury, no, it wasn't related to low iodine. 

[00:23:02] When you were working with patients clinically, how often did you see these of rare etiologies for hypothyroidism? Because now I'm understanding it, that it really is driven by these hormonal shifts, as you mentioned, but also this immune reaction, leaky gut and all these other things. It's this piling on of years and years and years of stress and other things when we haven't been taking care of ourselves that really impact our susceptibility to Hashimoto's. 

Dr. Carrie Jones: [00:23:30] And in fact, now we know there are other autoimmune markers that aren't just commonly tested for. So TSH receptor, for example. So, Hashimoto's is not defined by a positive TSH receptor antibody. It's defined more by thyroid peroxidase, a positive thyroid peroxidase antibody TPO, many of you may know it as. And so, when I was doing all this research into autoimmune thyroid, while Hashimoto's is definitely the most talked about and what we would call the most common, there are other autoimmune types of thyroids you can have. We just don't routinely hear about them or get tested for them. Then on top of that, you can have something called nonthyroidal illness syndrome. So, what that means is-- and the big three reasons are big inflammation, big infection and sepsis, sepsis being worst case scenario. 

[00:24:20] And because you have this infection, inflammation, sepsis happening through the body, the thyroid, the cells themselves are trying to protect them, so they downregulate the ability of T4 to get into the cell and then convert into that active form of T3. So, it actually has nothing to do with the thyroid gland itself that you don't have a gland issue. And you may not have an autoimmune issue, but you do have thyroid symptoms and pathology on labs driven by inflammation and infection that you've got, and of course, worst case scenario, sepsis. But by then, you're probably in the hospital and you can have both at the same time. You can have developed, caught a major infection, and at the same time, you might also have Hashimoto's. And so, you get this double drive against your thyroid. 

[00:25:10] So when people say to me, “Oh, yeah, I have thyroid issues? Where do I start? I was put on medication. I don't feel any better.” I'm like, “Well, there's a slew of reasons that the body does or doesn't make thyroid. And so, let's work to figure out why aren't you making your T3? Why are your cells mad and not letting your T4 inside? What's going on with your immune system? What's triggering and worsening the autoimmune system?” So, it is like anything else in the body the thyroid is not one and done. It's not here, take this medication and you're fixed. It does take everything some work to backpedal and figure out what's pissed it off and what can we do about it?

Cynthia Thurlow: [00:25:49] Well, I think it's really important. I know Dr. Eric Balcavage, who's coming on the podcast again in next month to talk about his new book. He talks a lot about cellular hypothyroidism. And I don't see a lot of clinicians talking about this because I think to your point, a lot of individuals, they're told they have an underactive thyroid. They get medication. They're like, “Okay, check box fixed.” And then they realize that's just the tip of the iceberg. There's so much more. You can take medication and still feel terrible.

Dr. Carrie Jones: [00:26:19] Because at the cell, he has a great example in his book, actually, where he talks about-- and I found this in the literature. It's interesting how researchers and what they publish around thyroid, and what endocrinologists teach don't always line up. I'm like, it's literally in the research. It's literally the sentence right here in this study says, like, we've known for decades or like, they know this, it just doesn't get translated. But Eric has an example in his book of if you’re with cellular hypothyroidism-- So, you can take thyroid medication, you're given T4. Let's say you're given thyroxine or Synthroid. And so T4 comes into the system, and it's super excited, and it goes up to a cell, and it knocks on the door and it says, “Okay, I'm here. I'm here. I'm T4. I'm here.” And the cell is like, “No, you can't come inside.”

[00:27:05] So now when you test, maybe you test some blood markers, and the T4 looks good because it's still hanging out in the blood, but it can't get in the cell, and it can't convert into the active form of T3. So, then somebody says, all right, “We're going to add T3. I'm going to add T3 to your mix. Either liothyronine or Cytomel. I'm going to compound you some sort of combination, something.” So now you just flood the system with T3. What can happen in some cases is that, again, the cell is like, “No, I don't want you in here. We have inflammation and infection going on. Like, you need to go away.” 

[00:27:36] And I'm protecting my cell. And so now you test. Now you're like, “Well, I feel anxious when I take T3. I feel nervous. I can't sleep. I have heart palpitations because you have all this T3 going other places, floating around your circulation, and so it can't get in the cell or the body goes, okay, cool. I'm just going to deactivate it.” I don't want all this T3. I'm literally downregulating to protect you because of whatever infection, inflammation, etc., etc., etc. So, I'm just going to deactivate you to something called reverse T3. 

[00:28:04] So, you give T3, and then they end up just deactivating it. And again, just like you said, they're like my symptoms didn't go away, or they felt better for a couple weeks or maybe a couple months, and then they come back and go, “I need more. I need more. That didn't work.” 

Cynthia Thurlow: [00:28:17] Yeah. And I think it's important for people to understand that taking the medication is not the end story. I'm now working with someone who has been making little adjustments every two weeks with compounded T4 and T3. And it's the best I felt in a really long time. But I think for anyone who's being treated for thyroid issues, if you don't feel better, there's probably something that's mitigating this. So, when you are recommending to clinicians or talking to clinicians or doing the amazing education that you do across social media and in talks, where's a good starting point? 

[00:28:52] I know that we talk about a full thyroid panel, but you also mentioned some of these antibodies and certainly like TPO, I'm very familiarized with, not as familiarized with this TSH receptor antibody, but when would be the time to be advocating for additional testing along with the basic labs? Because I think actionable advice is really very helpful on this podcast because then people take notes and then they go advocate for themselves, which I think is so important. 

Dr. Carrie Jones: [00:29:18] So, first of all, if you're symptomatic, if you've done a quiz online, if you've listened to past podcasts, when you listen to Dr. Eric, and you're like, “I have all the symptoms-- I have all the symptoms of hypo or hyperthyroidism,” then that's when you need to get more thorough workup. I saw a post on Instagram yesterday where somebody was like, “Doctors who run full thyroids is a red flag.” I'm like, “No, it's not.” I can understand not running it on absolutely every person who walks through your office if it doesn't fit at that time. But if somebody comes in and says, like, “I'm tired, I have weight loss resistance, I'm losing my hair, I have dry skin, I'm constipated. I have a family history of thyroid, or I've subclinical thyroid issues. I was told a couple years ago. And they didn't do anything about it. I didn't know what to do.” So, as these boxes are being checked for me, I'm like, “We're doing a full thyroid panel.”

[00:30:07] So, I'm looking at the TSH, which is what you mentioned earlier, thyroid stimulating hormone. I look at free T3, I look at free T4. So, I do look at both. I look at reverse T3 because I want to see how much is getting deactivated. That helps me to understand if it's more of a cellular issue. And then I do look at the two big antibodies. So TPO, thyroid peroxidase antibody, TgAb, thyroglobulin antibody. And I just usually start there now. If the TSH receptors, there's like four or five other antibodies, thyroid antibodies, I don't generally start with yet I may add them later as we're working through. For example, if the antibodies are negative and very symptomatic family history, I'm like, there's autoimmune somewhere. Let's just go ahead and check some of these other markers and make sure. 

[00:30:57] But that's usually where I start with a panel when somebody comes in like that. I should say most of those labs are not weird. They're not hard to find, they're not rare at all. Hopefully your practitioner is willing to order them for you the one that's tough to get sometimes is the reverse T3, the rT3. I have had HMO groups refuse. I have had hospital groups refuse. And I know in some countries it's nearly impossible to get. They don't do or believe in reverse T3, but if you can get it's helpful. 

Cynthia Thurlow: [00:31:33] Yeah. And I always think about reverse T3 as the brakes.

Dr. Carrie Jones: [00:31:36] Yeah.

Cynthia Thurlow: [00:31:37] You know, what is driving the brakes? I think when reverse T3 is normal, I don't worry about it. But when I'm looking at labs and I'm looking for playing detective, like we all do, we're like, “Okay, what is raising a red flag? What is something that we need to lean into?” And I think, something else that has certainly been apparent to me is, since I'm allopathic trained, I also have functional training, is understanding that both can be-- It's like playing in a sandbox. I'm going to use one of your analogy explanations. We can all play in the same sandbox. 

[00:32:10] But understanding that those traditional labs can be helpful as well as the integration of some of these functional integrative medicine labs, which give us a different perspective. And one of the really great things that I think about is blood labs for estradiol and estrone and progesterone and free and total testosterone versus looking at them on a Dutch. So, let's pivot a little bit and talk about the sex hormone piece, because this is in particular an area that I found it really beneficial to have both to look at both of them. Unfortunately, I hear from many women, “Oh, my doctor said, I'm in menopause, we don't need to check my hormones.” And I'm like, “Oh.” [laughs] it's like, “We need to get you hooked up with a different doctor, that is for sure.”

[music]

Cynthia Thurlow: [00:32:57] As you made that arc from clinical psychiatry to really this burgeoning thyroid practice, do you have an equal mix of patients with Graves’ disease and Hashimoto's? Because this is like a personal statement. I just had a podcast that came out focused on Hashimoto. First one I've done, solely focused on that. And I had so many women saying, “Can you please do a podcast talking about Graves’ disease? Because no one's talking about it.” And before we started recording, you admitted that it's a really underserved. Like thyroid disorders are underserved to begin with, but even more so for people that are dealing with an autoimmune hyperthyroidism. So, an overactive thyroid. So, in your experience, is it an equal amount of patients that you're seeing, or do you see more Hashi’s over Graves’, or is it just an equal amount? 

McCall McPherson: [00:33:48] It's 100 to 1 I would say. I see 100 Hashi patients for every Graves’ patients, which I think is why there's a disparity in access to information and the progression of treatment in Graves’ disease. But the severity of Hashimoto's and hypothyroidism is absolutely debilitating. But Graves’ has just expanded exponentially on that, and they really and truly suffer. And the standard of care treatment lacks so much for them that they need access, information, help, progression.

Cynthia Thurlow: [00:34:26] Yeah. And so perhaps for the benefit of listeners, explaining what Graves’ is, it's not just hyperthyroidism, but it's the extreme symptoms. So, these are people that could probably be treated for anxiety, they could probably be treated for chronic diarrhea, they could probably be treated for an inability to sleep, very likely with medications that are not helping this thyroid issue. 

McCall McPherson: [00:34:50] Yeah, it goes back to the same, to the psychiatry piece. And a lot of thyroid patients do end up in a psychiatric office being treated for something that isn't going to help them. So, Graves’ disease is an autoimmune condition where your body attacks your thyroid gland with different antibodies and it triggers a hyperthyroidism. But even more than that, so the symptoms are like anxiety, palpitations, sweating, weight loss, hair loss, sleeplessness, shaking, restlessness. It's super common that I see postpartum for women especially, they go into this transient Graves’ state. So that's definitely a time to be attuned. But the most difficult part about it too, is it creates this instability where people will be really hyper and then they'll crash and be hypo. And they're strapped into what I call this Graves’ roller coaster. 

[00:35:47] So as soon as you finally might make it to the doctor to talk about your symptoms, they could have completely flip flops and you're just up and down. And it really does take a unique advocate for yourself because the first line, the first thing that you're getting worked up for will not be Graves’ disease, it'll be one of the last. 

Cynthia Thurlow: [00:36:07] Yeah. And so, in terms of a traditional allopathic lens for Graves, let's talk about that combined or in contrast to a more functional root-based approach, because they're so significant. I saw a lot of Graves’ patients who, much to your point, they would be hyper and then the treatment for Graves would make them hypo. And so, they would go from one extreme to the other and I had patients, especially females, telling me, “I feel like I'm losing my mind,” because they would go from one extreme to another. And it wasn't because they weren't being compliant with treatment. It was just the way that they go about treating Graves’ here in the United States. 

McCall McPherson: [00:36:45] Yes, yes, absolutely. So, that is the biggest struggle with Graves’ disease, is the standard of care approach is one diagnostic. Often, they just check some thyroid function labs, very limited ones, so they don't get clarity. If these people truly are hyperthyroid, they'll check maybe TSH and T4, which again, paints this small picture that isn't clear. I've seen people that transfer to me from an endocrinologist that say, “My endocrinologist told me I may have Graves’ disease, but they're not sure.” Well, this is a finite, differentiated medical problem that can be black and white diagnosed. And people need a full thyroid panel and then antibodies for Graves’ disease. So, of course, I would categorize that as being in the allopathic model, but those are thyroid stimulating immunoglobulins and thyrotropin receptor antibodies. 

[00:37:41] So, people need that full whole panel along with free T3, free T4, reverse T3, TSH. And so that is the standard diagnostic approach with a more limited algorithm. But the treatment is where it really starts to fail these people. And it is exactly what you said it is. We really just want to make sure you're not hyperthyroid. So, we are going to put you on methimazole, PTU, something to shove you down into a hypothyroid state, because our priority in medicine is protecting people from acute medical issues, like heart attack, stroke, that kind of thing. They have no problem allowing these people to be hypothyroid. And for all of you hypothyroid listeners out there, you know how miserable that is. 

[00:38:28] And this is really where, in my opinion, a functional medicine and integrated medicine approach shines, especially at Modern Thyroid Clinic. We have a super unique approach. So, in part similar to Hashimoto's, we're actually trying to reduce Graves antibodies measurably, with that takes the roller coaster from extreme swings of high and low to the lower their antibodies get, the less the swings and the less frequent and severe the roller coaster up and downs are. So, immediately people get relief from that roller coaster, but they also get to reduce their methimazole, they get to reduce their medication. But the coolest thing that I always tell Graves’ people on social media when they pick my brain, I'm like, “Listen, I have a couple things to share with you that I want you to research. One is block and replace therapy, life changing for these people.” 

[00:39:27] So, we block just enough of their thyroid function with methimazole to garner control, to stop the roller coaster ebbs and flows. And then we actually go in and we replace their missing hormones so that they too get to live a life of like perfect thyroid balance. They're not stuck in one extreme or the next. And then the other piece of advice I always give Graves’ people that 100% of my patients on Graves’ with Graves’ are on at Modern Thyroid Clinic is LDN, low-dose naltrexone. Single handedly that will often help me completely get control so quickly that they need micro amounts of Graves meds, micro amounts of thyroid medication. It just really lowers their antibodies in a hugely significant way. 

Cynthia Thurlow: [00:40:14] You know, it's interesting. So, in prep for our conversation, I was down the TikTok rabbit hole because you have these really great vignettes. I was like playing them while I was sitting at my counter last night. My kids were like, “Who are you watching on TikTok?” I was like, “This is the clinician I'm talking with tomorrow.” And I think you have a really unique lens because to me it is criminal that our standard of care is that we block and we're not replacing. So, when I saw that, I was like, “Oh, that's brilliant because no one's suffering needlessly.” When you go from having too much and then having not enough and you're very symptomatic. 

[00:40:49] The other pieces are using synthetics like Cytomel or Synthroid, are using Nature Thyroid or using compounded thyroid replacement or is it dependent on the patient. I would imagine there's a lot of bio-individuality. 

McCall McPherson: [00:41:04] Such a good question. So, my end goal and what I found honestly in my decade of thyroid care is if I get people to narrow controlled margins of exactly what I dictate as perfect thyroid function, which is completely neurotic levels, just hyper focused ranges, they get their lives back. I find that irrespective of if it's synthetic or natural in the form of desiccated thyroid. So, I use both. The only thing I actually won't use is compounded thyroid medication. The reason is because I stopped using it in about 2018, I believe.

[00:41:42] And I'll give you analogy Dr. Alan Christianson gave me at one point, which is analogy to baking muffins. When you're baking muffins and you need to make an equal amount of blueberries in every muffin, you kind of can’t with pretty good accuracy. And that's like when you're dealing with milligrams, progesterone, estrogen, testosterone. When you're dealing with micrograms like you are with thyroid medication, it's like baking muffins and trying to get an equal amount of poppy seeds in every muffin. It's impossible. And that's what I would find. People that would be perfectly stable for months, years would all of a sudden swing. And the last time I decided to stop using it, my stable patient swung to a TSH of 12. 

Cynthia Thurlow: [00:42:24] Wow. 

McCall McPherson: [00:42:25] Because she had a 90-day supply of thyroid medication that was not correctly potent. And so now I discourage the use of that in general because eventually you'll get a bad batch and 90 days is enough to throw off the corset a lot with thyroid. 

Cynthia Thurlow: [00:42:39] Yeah, I can imagine. And I part of that question was just out of curiosity. I have been on all of those and finally there was a product I was on in 2000 and that was taken off the market. And it's taken two and a half years to get me therapeutic finally. But on compounded, because we had such small doses. 

McCall McPherson: [00:42:56] Yeah. 

Cynthia Thurlow: [00:42:57] But again, I completely respect the decision. If you can't get consistency with medication, I can completely understand the desire to no longer facilitate that. Now let's talk about LDN because LDN is really interesting, so low-dose naltrexone. I myself am taking this very small doses. Let's talk about how it acts in the body because this is not just for Graves’ patients, this can also be for Hashi patients. And there's a lot of different uses. But let's talk about what it does for the thyroid patient that's so substantial and significant. 

McCall McPherson: [00:43:33] Yeah. So, it's a unique medication in that naltrexone in normal conventional doses is an opioid blocker. It will block pain medicine. It will block opioids. When you compound it, you make it into a microscopic amount, which starts at almost a 50th of the lowest traditional dose. It does something unique in our physiology and it tells our body, “Hey, we're a little short on opioids. We blocked a little bit. We actually need more.” So, our body upregulates to surmount that depletion and we end up in a state of mild excess opioids. And what happens in that case is it lowers inflammation and therefore autoimmune disease of any kind. So, it takes the volume of whatever is driving your inflammation, whether it's food, whether it's your physiology, your genetics, your environment. It takes that inflammatory response and turns the volume down. 

[00:44:26] And what you see in thyroid patients specifically is a significant, often reduction in antibodies. I've seen someone's TPO antibodies, which is classic Hashimoto's antibody, reduce over 500 points in three months with no other lifestyle changes, which it's hard to mimic that any other way. 

Cynthia Thurlow: [00:44:48] Yeah, it's pretty amazing. And what's interesting is when I brought it up with my functional medicine doc, I said, I'm just reading a lot, seeing a lot and he just said, “Cynthia, I cannot predict who it's going to work well in,” but he said “It's worth trying.” And he said, “But when it works, it's miraculous.” 

McCall McPherson: [00:45:06] Yeah. And I tell people there is this idea propagated, I think on forums, that LDN in a matter of days is going to make you feel so different and amazing. I see that maybe 5% to 8% of the time. I never aim for that to be my result. I aim more especially in the realm of Hashi and Graves. I want to see that antibody reduction elicited, even if you don't necessarily feel a world of change. And so, I always look for those objective markers. If they subjectively feel better, if their symptoms improve, all the better. But we are definitely aiming for long-term outcome improvement. And LDN has new studies coming out about that on a-- I read one this morning about treating treatment, refractory seizures with it. Like, it's just endless, the benefits of this medication, so very, very powerful for sure. 

[00:46:00] I don't even have Hashimoto's autoimmune disease anymore. Haven't had it for 15 plus years. I'll take LDN forever myself. I make my husband take it. He'll take it forever. 

Cynthia Thurlow: [00:46:11] Well, and it's interesting. I was listening to a talk that a female physician was giving, and she was saying that “1.5 mg of LDN can lower your risk of breast cancer,” which I thought was really interesting. She's antiaging-- This is Dr. Pam Smith. I was at a talk that she was giving and she has a very strong family history. So, she said, “I will take this till the day I die.” And she's like, “1.5 mg is like nothing, it's like breathing.”

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