Recently, I interviewed Agnieszka, and we discussed the her journey with Hashimoto’s, symptom development, the various tests she has done, the changes she has made since her diagnosis, the main symptoms she’s continuing to experience, her experience with thyroid hormone replacement, my recommendations for dietary adjustments and testing, alternative thyroid treatment options, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Welcome to another Save My Thyroid audit. I am very excited to chat with Agnieszka here. She is joining us from Poland. Her health journey is with Hashimoto’s. Thank you so much for joining us. 

Agnieszka: 

Thank you so much. I’m really happy to be here.

Dr. Eric: 

I’m happy you’re here, too. You’ve been dealing with Hashimoto’s for a little over four years. Is that correct? 

Agnieszka: 

Yes, that’s right. I was diagnosed around four years ago. I don’t know how long before that I had it. When I was diagnosed, I didn’t really have any significant symptoms. I was just running a regular hormonal check-up. My sister also has Hashimoto’s, so I decided to check antibodies. That’s when I found out. 

Dr. Eric: 

I was going to ask you if there is a family history, and you just answered that question. Your sister has Hashimoto’s as well. Any other family members? 

Agnieszka: 

Not that I know of. My mother doesn’t have thyroid issues or autoimmunity. It’s just my sister that I know about.

Dr. Eric: 

You are taking thyroid hormone replacement, correct? 

Agnieszka: 

Yes, that’s right. I started in May this year, so around five months ago. I tried natural methods. I tried cleaning my diet and doing different things that I thought would support me, but symptoms started to appear and became stronger. In the end, my doctor decided to check if thyroid hormones could be helpful. So far, I haven’t noticed a big difference actually.  

Dr. Eric: 

You haven’t really noticed it helping much, being on thyroid hormone. 

Agnieszka: 

Unfortunately not. I also looked at the test results and confirmed one of the ones I had before. Apart from TSH, which lowered, my thyroid results of free T3 and free T4 are more or less the same. Hasn’t improved. 

Dr. Eric: 

You’re on synthetic T4, right? Levothyroxine? 

Agnieszka: 

Yes. 

Dr. Eric: 

You said it’s been about six months. That’s all you’ve taken. You haven’t tried anything else like desiccated thyroid. 

Agnieszka: 

No. It’s not available in my country. Only T4 is prescribed by doctors. 

Dr. Eric: 

For prescription, you can only get T4. In the United States and some other countries, they have glandulars that are not prescription. 

Agnieszka: 

I am trying to contact an Italian doctor, and hopefully I will be able to experiment with some other treatments as well. 

Dr. Eric: 

Hopefully that works out. Obviously, you want to try to address the cause of the problem and focus on the immune system since Hashimoto’s is more of an immune system problem. Some people do need to take thyroid hormone replacement as well. 

Before we have this conversation, I have everybody fill out a brief application and ask about some of the major health challenges. You put fatigue, brain fog, and hair loss. Wasn’t too long ago that you filled out the application, so I assume you’re still having these symptoms. 

Agnieszka: 

Yes. The most challenging is the fatigue and brain fog. It makes my life difficult and working difficult. It has a huge impact on the way I live and everything I do. 

Dr. Eric: 

I can imagine. One question I have been asking most people in this audit: How would you like your health to be six months from now, 12 months from now? Obviously, you want to be filled with more energy, you want the brain fog to be gone, and you want the hair loss to stop. Anything else that if you had to paint a perfect picture? Are those the main things? 

Agnieszka: 

What you said is the best summary of what I would want for myself. I would like to get my energy levels back and to be able to have a normal life and to enjoy it. I have always been an energetic person and doing a lot of things. Now, I find it sometimes difficult to get through the day when I just do my job. I work and don’t have much more energy for other things. I also struggle at work; I work as a teacher, teaching language. It requires mental clarity.

Dr. Eric: 

The fatigue is all the time then? It’s not worse at certain times throughout the day? 

Agnieszka: 

I have noticed that it gets worse around half an hour after meals. I try to eliminate the foods. Since the diagnosis, I have been gluten-free. I also try to limit dairy. I tried other products. I don’t eat red meat generally since I was 14. But I eat fish. I’ve tried to eliminate different products and see how I would feel. I haven’t noticed big differences. 

Basically, after a majority of my meals, I feel weakness and brain fog. That lasts around 2-3 hours after a meal, starting half an hour after. Then it gets better again. In the evenings, I also feel more fatigue as well. 

Dr. Eric: 

After any meal, whether it’s breakfast, lunch, or dinner, you feel fatigue about 30-45 minutes after. 

Agnieszka: 

That’s right.

Dr. Eric: 

Have you had your blood sugar checked? Not just glucose, but hemoglobin A1C and fasting insulin. 

Agnieszka: 

Yes. I had my glucose tested. I had my insulin tested. I haven’t had that test done. I’m not sure about its professional name, when you drink a lot of glucose- 

Dr. Eric: 

The glucose tolerance test. 

Agnieszka: 

Right. One of the doctors suggested that to me. I haven’t done it yet. Although he said that if it was connected with glucose, I would probably feel lower energy later, not so quickly after eating or having a meal. I haven’t explored that possibility yet.

Dr. Eric: 

How about weight? Is it pretty stable? Are you gaining weight, losing weight? 

Agnieszka: 

My weight is pretty stable. Let me think. I’m rather a slim person. I’m in Europe, so it’s other measurements. I guess it would be around 116 pounds. My height is 5’7”, I would say. I’m rather slim and have always been like that. I don’t see any fluctuations in my weight. 

Dr. Eric: 

That’s good. Any digestive symptoms: bloating, gas, constipation, loose stools? 

Agnieszka: 

Absolutely. Bloating after most meals. Maybe now it’s gotten a little better. I would not say I’m constipated because I’m quite regular, but the stool is hard. That’s something I’ve experienced for more than a year. It doesn’t come easily. 

Dr. Eric: 

How has stress been over the last four years since you’ve been diagnosed? Who knows how long prior to being diagnosed you’ve been dealing with Hashimoto’s. How is your stress handling? 

Agnieszka: 

For the past 2-3 years, I must say that it’s been really great. I feel balanced and peaceful. I meditate every day. 

Prior to my diagnosis, I had a very stressful period. I had a challenging long-distance relationship, so I suspect it might have been one of the triggers, if not the main trigger. I was trying to do my best using my tools, but I definitely was much more stressed back then.  

Dr. Eric: 

Sounds like stress might have been a trigger, or at least one trigger. More recently, over the last few years, hasn’t been as bad. You’re doing things to help with stress management, such as meditation. 

Agnieszka: 

Yes, that’s right. 

Dr. Eric: 

Have you done any type of adrenal testing, like saliva testing or DUTCH testing? 

Agnieszka: 

No, I haven’t. My cortisol was checked, but it was a single test, like one time. Of course it didn’t show the curve. 

Dr. Eric: 

The Circadian rhythm, yes. You just did a morning cortisol in the blood? 

Agnieszka: 

Yes, that’s right. 

Dr. Eric: 

How is your sleep? 

Agnieszka: 

I don’t sleep long. It’s around 6-7 hours. Now, I believe I sleep much better than I used to. Earlier, I had problems, and I would wake up at night around 4am, and I couldn’t fall asleep again. That was one of the first symptoms I started experiencing. After introducing some treatment and sleep hygiene, and I got rid of a parasite because I also received a diagnosis, I noticed changes, and it improved. 

Dr. Eric: 

Since addressing parasites, you noticed that your sleep has improved. 

Agnieszka: 

Yes, that’s right. 

Dr. Eric: 

You did stool testing. You put down GI Map. You did a mycotoxin test for molds and an organic acids test. Correct? 

Agnieszka: 

Yes. 

Dr. Eric: 

It was the GI Map that showed the parasites? 

Agnieszka: 

No, the GI Map was done afterwards. It didn’t show any parasites. It was early at the beginning of my diagnosis that I had a stool test. It was roundworm and ringworm that were discovered. I followed the treatment prescribed by my doctor. I did natural treatment and medicine. I retested. There were parasites again, so I continued the treatment. Then it was negative. 

I’m not sure if it is gone because I know these tests are not super reliable, and they often can be false negative. That’s what I did, and I think it took me quite a lot of time, almost one year, the whole treatment. 

Dr. Eric: 

You did not do the GI Map initially. That was maybe the last stool test you did. You did another stool test that showed that you had parasites. You underwent treatment and did a retest, and it sounds like it still showed parasites. You continued treating and did another one, not the GI Map. The GI Map was negative, but you did another test also, which was negative for parasites. Correct? 

Agnieszka: 

Yes, that’s right.  

Dr. Eric: 

With the symptoms, we’re not sure of the digestive symptoms as related to parasites. Did they improve at all after treating for parasites? Were they worse before you had the treatment? 

Agnieszka: 

The main symptom that changed was the improved sleep. It got better. Since then, I have been sleeping better.

As for fatigue and brain fog, I think they came a little bit later on, which might be connected with my age. I’m in perimenopause; I’m 45. I could see the symptoms start to get worse with time. 

Dr. Eric: 

What did the mold test, the mycotoxin test, and the organic acids test show? Anything significant? 

Agnieszka: 

The mold test showed stool strength of mold. I had the consultation with a functional medicine practitioner in the U.S. I didn’t retest after taking supplements. What was said was the numbers weren’t extremely high, but there were two strains of mold. 

Dr. Eric: 

Did you have your house tested for mold, too? 

Agnieszka: 

Unfortunately not. I’m renting an apartment. I don’t see any signs of mold outside, but I realize that things might be hidden somewhere. 

Dr. Eric: 

That is a possibility. Anything significant on the organic acids test? 

Agnieszka: 

No. Most of it looked okay. We were correcting these things with the other practitioner in terms of nutrients. There were no pathogens or anything like that. 

Dr. Eric: 

Getting back to diet, because you put this on the application, you’d like to try an elimination diet but are concerned about protein intake because you don’t eat meat, only fish sometimes. That’s why you didn’t do AIP. You made some changes like eliminating gluten, as you mentioned, and some other changes, like avoiding eggs. But you haven’t followed a strict AIP diet because you’re more of a pescatarian, not a vegetarian. 

When it comes to diet, there is no diet that fits everyone perfectly. Typically, with Hashimoto’s and Graves’, I will recommend AIP. It is more challenging if someone isn’t eating a decent amount of meat for protein. It’s not like it can’t be done. Regular paleo diet is a little bit easier because it allows you to eat eggs. You avoided eggs, but you currently eat eggs. 

Agnieszka: 

Yes, I currently eat eggs. I didn’t notice any particular changes when I stopped eating them. 

Dr. Eric: 

I know you said you went gluten-free. Have you tried avoiding grains altogether as well as nightshades?  

Agnieszka: 

No. I don’t eat a lot of grains because I’m on a low carb, high fat diet currently. Still, of course, there is some buckwheat or millet. From time to time, I eat rice. I haven’t tried avoiding them totally. 

Dr. Eric:

How about dairy? Have you gone dairy-free? 

Agnieszka: 

I can see dairy doesn’t serve me very well, especially things like cream or milk. I feel bloated after. There is some reaction. I try to avoid it in general. 

Dr. Eric: 

I would listen to your body. I would continue avoiding gluten and listen to your body with dairy. 

I mean, I think it’s worth taking a break from grains. I’m not saying that’s the magic bullet in your case, but there is a good book No Grain, No Pain. For some people, grains could be holding someone back from recovery. It could be harsher on the gut and sometimes cause inflammation, even gluten-free grains. That might be something to consider. 

And nightshades, too. If you haven’t taken a break from tomatoes, eggplant, peppers, and white potatoes, just to try. Not everyone has a problem with nightshades. 

There are reasons why those foods are excluded from an AIP diet. Even a paleo diet, grains are not allowed for the reason I mentioned, that they could be harsher on the gut. Grains aren’t a great source of protein. Same thing with nightshades. Those two, from a protein perspective. 

If you’re eating things like legumes, make sure they’re well prepared, pressure cooked, so they are easily digestible.

I agree with the mold. Maybe look into it. I know you’re renting. That’s challenging because you don’t want to spend a lot of money when it’s not your place. Even when it’s your place, you don’t want to spend a lot of money testing for mold. Like you said, you can’t always go by seeing mold. It doesn’t sound like it was too bad as far as the levels on the mycotox test. Something to keep in mind. 

When someone has mold, or even if someone doesn’t have mold, thinking about fatigue. A lot of things can cause fatigue. You mentioned brain fog. Those are your two main symptoms. The hair loss, which some of that could be thyroid hormone-related. Your thyroid levels are still not optimal. There could be other things like nutrients.

Maybe something to look into, adrenals. Doing adrenal saliva testing or a dried urine test that looks not only at adrenals but other hormones and metabolism of hormones. That could play a role sometimes in energy levels and cause other symptoms like hair loss.

Nutrients. I assume you probably had a full iron panel, looking at iron and iron saturation. 

Agnieszka: 

Yes, I had my iron checked. I had lipids checked. I had B12 checked. Some other ones. 

Dr. Eric: 

Were they looking good? Were they not the lab range but optimal range? 

Agnieszka: 

They look good. I supplement as well. I also supplement B vitamins. Not all the time but every couple of months. 

Dr. Eric: 

Iron, a lot of people are lower. The iron saturation should be between 30-40%. A lot of people are in the low or mid-20s, which for some people is enough to cause low energy. If that’s looking good, and B vitamins are looking good, like B12, that’s great.

Even though your nutrients look good, your gut seems to be an issue because you’re having bloating. Maybe it’s food-related. It may be worth eliminating more foods before diving even deeper. But going on an elimination diet, eliminating grains, nightshades, continuing to eat, whole, healthy foods. If those aren’t helping, you might need to dig deeper.

That is the challenge with parasite testing, like you said. The GI Map, I love it, but it only looks at 12 different parasites and worms combined because it uses PCR DNA testing, which is great, but there are limitations as to how many parasites it can look at.

The other test you did that showed you were positive was negative. Maybe that was a true negative. Maybe not. May be worth redoing that test again. If not, then there could be something else. 

It could be SIBO, when someone has bloating and/or gas. Maybe it could be too much bacteria in the small intestine. That’s something to look at. That could cause a lot of different symptoms, including fatigue, brain fog, and others. 

I’m not saying to do all of this. These are things to keep in mind. 

I don’t know if you looked into stealth infections like Lyme or bartonella. There are limitations with the test, too, if you just go to a regular lab. Lyme is often negative, even if you have Lyme. Not to say that you have it, but to keep in mind. I dealt personally with chronic Lyme, so I am more aware of the impact of these tick-borne infections. It can come from other places, too, like fleas potentially. You definitely need to dig deeper.

It sounds like stress is good. Sleep could still be better. You said 6-7 hours. Trying to get 7-7.5 hours at least because that will affect energy. Continuing to get more sleep. Sometimes, with sleep, you have to look at adrenals, too. That’s all you’re able to get on your own maybe, so you may need to look into adrenals and sex hormones and see if there are issues there. 

It sounds like you might need to dig a little bit deeper. You have done a lot, which is great. I know it costs money for the GI Map and organic acids test and mycotox tests. These are not cheap tests. That’s why I’m saying to make some of these dietary changes and see how you feel. 

If things are not heading in the right direction, maybe the adrenal saliva test or the DUTCH test. Maybe another parasite retest. Not necessarily the GI Map, but the one that was initially positive for parasites to see what it looks like. If that is looking good, maybe look into something like SIBO testing. If you absolutely have to, stealth infections. 

When I dealt with Lyme, there was no evidence of a tick bite, no rash. Everybody is different. I didn’t have fatigue; mine was more neurological symptoms. With Lyme, you often have other symptoms like migrating muscle and joint pain. If you don’t have that, it doesn’t mean you don’t have Lyme. I would look more into Lyme if you have pain that moves around. The fatigue and brain fog, a lot of different things can cause that. I’m just saying that’s something I wouldn’t overlook.

Those are some things to consider. I know it’s a lot that I threw at you. 

One more thing: optimizing thyroid hormone. When we want to address the cause of the problem. Your most recent TSH was 2.99, which is within the lab range, but not optimal, so you are working on that. The synthetic T4 is not a good fit for everyone. I know you can’t get desiccated thyroid, but you are working on getting the glandular. 

Everything else could play a role in the autoimmune response. There is a time and place for thyroid hormone, but if the synthetic T4 is not working for you, hopefully you can get something else in its place. 

Agnieszka: 

Yes, great. Thank you so much. You have given me a lot of tips and next steps. Honestly, I felt a little bit lost. I knew there could be a lot of root causes. Now I feel like I have a clear path and step-by-step things I can explore and look into. Thank you very much for that. 

Dr. Eric: 

You’re very welcome, Agnieszka. Have you read my book Hashimoto’s Triggers? 

Agnieszka: 

Yes. 

Dr. Eric: 

That goes into a lot of detail with different triggers. Thank you for reading that. Thank you so much for doing this audit. I really appreciate it. Hope you found it helpful. It sounds like you did. Hope everyone listening found it to be helpful. Thanks, everyone for tuning in, and catch you in the next episode. Bye, Agnieszka. Take care. 

Agnieszka: 

Goodbye.

Recently, I interviewed Nanette, and we discussed the  long-term medication use, her treatment with propylthiouracil (PTU), dietary changes, the importance of stress management, why we need to address underlying causes like insulin resistance and inflammation, my approach to testing and lifestyle modifications, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

Welcome, everyone. I am very excited to do a Save My Thyroid audit. We are going to be talking to Nanette here on her experience and personal journey with toxic multinodular goiter. How are you doing today, Nanette? 

Nanette: 

I’m doing really well, thank you. Thanks for having me. 

Dr. Eric: 

It’s a pleasure. Looking forward to this. If you could give a little bit of your background. How long ago were you diagnosed with toxic multinodular goiter? 

Nanette: 

I’m 63. When I was 16, I had a nodule on my thyroid. My dad noticed it. This is 1978, and I had that removed surgically. I went 10+ years with no thyroid treatment at all. Then I hit 30, and I got another nodule. I had that one removed. I had most of my thyroid, but I had two surgeries with two nodules removed. At 30, they put me on some Synthroid. I had been back and forth for a little while taking the Synthroid. I was euthyroid. Then I was off all thyroid medication. 

Almost 20 years ago now, I had a change. I felt bruised, like I had been in a fight or something. I couldn’t figure that out. Then I went to the doctor, and they said, “Oh, I think you’re hyperthyroid.” I was moving at the time. It turns out for the last 20 years, I’d had toxic multinodular goiter. Really, only the last 10 years, I had been treated for that. 

I tried methimazole, which made me crazy, not crazy but really got my heart rate up and going. My local doctor didn’t want to try PTU, so I went down to Phoenix and found a doctor there who wanted to try PTU. I have been on that for five years now almost. 

I listened to one of your podcasts, which made me real nervous, that that’s not good. Just yesterday, I saw the doctor, and she said I’m really on a pediatric dose. Just enough to calm my thyroid enough. I’m actually feeling pretty good. 

Nicely, she said yesterday, “I really don’t want surgery on you.” A lot of doctors are resisting it because I’ve had two surgeries with scar tissue. That inadvertently saved my thyroid. I had more than one doctor say, “Too bad they didn’t remove your whole thyroid.” I still have it. It does work a bit. If I don’t take the PTU, my TSH goes really low, like .002. I get heart palpitations, which is really my biggest and only symptom. 

I’ve had sonograms every year. Yesterday, I had one. My nodules are stable. I will follow up in a year. I asked about the radio ablation. She said, “Well, you have at least three nodules we’d have to do that to, and that’s a little invasive. You’re doing well.” My liver enzymes have been well, so so far, I’m sticking with what I have. I’m hoping to learn from you.

Dr. Eric: 

Wonderful. Thank you for sharing your background. We were chatting a little bit before I pressed Record about the radiofrequency ablation, how they didn’t have that years ago, and that’s why you got the individual nodules removed. 

I also mentioned how they usually don’t do that, so you got lucky that they didn’t remove your entire thyroid gland. At least these days, I don’t hear much about doing even partial thyroidectomy, where they remove half the thyroid gland, let alone the single nodule. That’s not great that you had the nodules, but it’s great that they didn’t remove the entire thyroid gland.

As far as PTU, I mean, everything is risk versus benefit. When I talk about medication on the podcast, I try not to talk too negatively. Sometimes, I do get into the research about some of the negative consequences. Obviously, with both methimazole and PTU, it can put stress on the liver. Everybody’s different. That’s why there’s liver panels available to monitor that. I know you’ve been given the liver panels. 

You mentioned you’re on a pediatric dose. If you’re tolerating it well, you don’t want to be on that forever, but for now, if it means preserving the health of your thyroid gland while trying to figure out what you can do, which is why we’re chatting here. Some endocrinologists will recommend surgery or radioactive iodine right away if someone is unable to tolerate methimazole. It sounds like you had to go to Phoenix to get that prescription. They were resistant in your area to switch you to PTU. 

Long story short, I’m glad that you were able to get the PTU, so at least, it buys you time, and everything seems to be stable. Hopefully, I will give you some helpful advice to put you on that road to recovery.

As far as you know, you have been dealing with it for a long time. Maybe not toxic multinodular goiter specifically, but having nodules. That all started when you were 16. Do you know of any other family members with a thyroid condition? 

Nanette: 

Definitely. My grandmother, my dad’s mother, had the same thing. Multinodular goiter. Her daughter, my aunt Linda, she had thyroid cancer and had her thyroid removed. Then her daughter, my first cousin, she had free thyroid cancer and had her whole thyroid removed. She is a little younger than me. Family history there definitely. 

Dr. Eric: 

Okay. Has the PTU pretty much controlled all your symptoms, or are you experiencing any currently? 

Nanette: 

It has helped my symptoms very much. I have tried to wean myself off of it before with the doctor. My symptoms just came roaring back, or I feel my heart palpitations lying in bed, thinking, “Oh no.” I can’t hold a glass of water because it shakes. It definitely helps. That’s been my only symptom, the heart palpitations. I’m just thumping. 

Dr. Eric: 

Is it occasional or pretty much all the time? 

Nanette: 

Now I’m good. Occasionally, I feel my heart fluttering in my chest.

Dr. Eric: 

Before being on the PTU, that was the main symptom. 

Nanette: 

Yes. Tremors in my hands as well. 

Dr. Eric: 

Okay. I’m glad the PTU is helping with that. 

My next question, looking into the future, if you had a crystal ball, ideally, what would you like your health to be like six months from now? 

Nanette: 

I would like to be off the PTU totally. That would be nice. I have been trying your Level 3 diet. I am about five weeks into that. The doctor was familiar with that. My endocrinologist yesterday mentioned some people try that. She didn’t elaborate too much. 

I’d love for my nodules to go away and me to get off the PTU. That would be wonderful. 

Dr. Eric: 

Okay. The doctor was a little bit supportive of the diet, it sounds like. Many are not supportive and just say it’s a waste of people’s time. That was the endocrinologist that you’re seeing? 

Nanette: 

Yeah, down in Phoenix.  

Dr. Eric: 

That’s great that the endocrinologist wasn’t just dismissive of diet because many of them are. Obviously, it’s great that you’re following a Level 3, which is like an AIP, modified autoimmune protocol. You don’t have history of autoimmunity. On the application, you did say something about in the past Hashimoto’s, but all of your current antibodies seem to be negative, correct? 

Nanette: 

Right. I was told when I was first diagnosed at age 16, it was an autoimmune thing. Then I heard the word “Hashimoto’s” somewhere in the next 20 years. I really never paid attention to thyroid antibodies until you mentioned them. I guess I don’t have Hashimoto’s. If I did, it’s gone.  

Dr. Eric: 

It is possible. It’s also possible that they misdiagnosed you. The only way to know is by looking at the blood test years ago. If you had elevated thyroid antibodies back then, those are the antibodies for Hashimoto’s. It is possible that at least from what we see, you no longer have them. There is always the possibility of false negative antibodies, so the blood test is not perfect. That’s something to think about. 

Also, one question I almost forgot to ask you until now: How did you find out about me, Nanette? 

Nanette: 

I think I had signed up for a health summit, and I found Dr. Amie Hornaman. I looked at her website and sent her a note. She said, “I work with hypothyroid. You need to talk to Dr. Eric. He works with hyperthyroid people,” which is rare. Most people are hypo/Hashimoto’s. To find someone who concentrates on hyperthyroidism. That’s how I found you. I signed up for your Thyroid Boot Camp. I bought your book. Here I am. 

Dr. Eric: 

I’m glad Dr. Amie referred you to me, and you signed up for the live event that I had not too long ago, the Thyroid Healing Diet Boot Camp, and got my book. Wonderful.

My next question: Do you feel like there is anything preventing you from reaching your goals, from getting off the PTU, from restoring your health? Any roadblocks? 

Nanette: 

I don’t think so. The diet is a little tough. I miss potatoes and rice and bread. That’s harder than I thought. 

I don’t think so. It’s really hard to believe how much I have learned in the past month and a half. I’ve paid attention to my lab results. I’ve had thyroid problems for 46 years. I don’t think there’s anything stopping me from reaching my goals. 

Dr. Eric: 

Okay. Awesome. Have you done comprehensive testing at all besides getting thyroid panels? I’m sure you’ve gotten CBCs, metabolic panels, maybe lipid panels. I don’t know if you’ve had Vitamin D, iron panels, other types of blood tests. 

Nanette: 

Yes. Those are all good. I had follicular lymphoma 10 years ago. I was diagnosed with that. I don’t know where that came from; it just showed up. My bloodwork is followed closely, especially my liver, because the lymphoma was in my spleen and bone marrow. I was a bit nervous about taking some PTU because that can affect your liver. Everything has been very good. My panels are great.

My immune system is a little squished because of the chemo, which I had because my spleen was so enlarged. My bone marrow was affected greatly from the non-Hodgkins lymphoma. Besides having a low IgG level, my panels have been good on everything. 

I take Vitamin D. I’m out in the sunshine. I live in Arizona. I’m outside every day. I go for walks every day. I try to do all the good stuff. 

Dr. Eric: 

I’m sure they have done fasting glucose as part of a metabolic panel. Have you looked at hemoglobin A1C and fasting insulin in the past? 

Nanette: 

I don’t think I’ve ever had that done. My glucose has always been good. Did I get that done? 

Dr. Eric: 

Well, if you read some of the materials on my website as well as the podcast, when I speak about goiter and nodules, whether it’s multinodular goiter or just goiter without the nodules or just nodules without the goiter- In your case, it’s toxic multinodular goiter. There is a few different factors. 

One could be blood sugar imbalances, such as insulin resistance. Fasting glucose of course is usually tested as part of a metabolic panel. That is far from a perfect test. Hemoglobin A1C is the average blood sugar over 2-4 months. A lot of doctors do test for hemoglobin A1C, but most don’t test for insulin, which could also be helpful. 

If someone has maybe a hemoglobin A1C that doesn’t look too bad—it might be on the higher side but within range—then we want to see insulin ideally less than 5 in a fasting state. If we see that in double digits, or even an 8 or 9, and the hemoglobin A1C is creeping up, like 5.5, 5.6, which is still within range, but on the higher side, it’s not officially an insulin resistance or type 2 diabetes or prediabetes diagnosis until someone’s A1C is 5.7. 

Most endocrinologists, if someone has a hemoglobin A1C of 5.5 and a fasting insulin of 9, which they usually don’t test, they usually won’t say anything. That usually is not optimal when it comes to blood sugar. That could at least be a factor. Doesn’t mean it’s the only factor. That is something to look into.

Yeah, I would at the very least test those two markers and see what those show. Hemoglobin A1C ideally, you want that less than 5. Even if it’s 5.1, 5.2, that’s still really good. If insulin is less than 5 or even honestly 5 or 6, it’s still not too bad. If you see those numbers on the upper end, or at least hemoglobin A1C on the upper end of the range, 5.5, 5.6, and insulin above a 7, that’s when you might suspect blood sugar imbalances.  

Nanette: 

Okay, I’ll follow up on that, thank you. I never thought about it. 

Dr. Eric: 

You’re welcome. Another potential factor when it comes to nodules and goiter, problems with estrogen metabolism. I think you said you’re 63. It’s been a long time since you cycled probably. As we get older, both men and women’s hormones are going to decrease. 

You still have some estrogen. Even if you have a smaller amount of estrogen, which you do compared to 20/30 years ago, you still have to detoxify that estrogen. You still have to metabolize it. Some people have problems metabolizing the estrogens. 

Do you have any history of uterine fibroids, ovarian cysts, endometriosis, any breast cancer? I know you mentioned follicular lymphoma, but not breast cancer history or fibroids or cysts? 

Nanette: 

Not in me, no. I had some endometriosis toward the end. Didn’t bother me. I should check for estrogen metabolism? 

Dr. Eric: 

Something to consider. The problem with testing for it is you can’t do it through the blood. There is a dried urine test called the DUTCH test. There are a few dried urine tests; the DUTCH is the most well-known test that looks at adrenals, hormones, but the big thing is looking at how you metabolize your estrogen. With your history and background, you might want to consider doing that type of test. 

Nanette: 

Will do, thank you. 

Dr. Eric: 

There is more information. Even if you just do a random search, you’ll see a lot of practitioners who do that test. There is a lot of information out there. Those are two areas. Inflammation in general could be a factor.

There is the controversial iodine. Too much iodine isn’t good, but too little iodine can cause problems. This can lead to nodules and/or goiter. With toxic multinodular goiter, you want to be careful. Have you tinkered at all with iodine on your own? 

Nanette: 

No. It’s in a multivitamin I take. 

Dr. Eric: 

Sometimes, the iodine can worsen, like exacerbate the toxic multinodular goiter. That’s where you might want to consider working with someone if you look into that. Even doing something like DUTCH testing, maybe consider working with a functional medicine practitioner. 

With iodine, there is urinary testing if you were interested in doing that. Blood testing is not too accurate. Even urinary testing is not perfect. There is a lab, Hakala Labs. They have different types of urinary iodine tests. Iodine spot test is what a lot of people choose.

There is also the loading test, but that involves taking a 50mg tablet of potassium iodide, which many people do fine with, but some people might not. 

Usually, with patients, I start with blood sugar, problems with estrogen metabolism. Most of the people I’m working with have some type of inflammation. The iodine, it depends. Some people are gung-ho and hear a lot about iodine and want to look into it. Others, based on what I say, they might be a little bit nervous. 

I personally had a good experience with iodine, so I am not anti-iodine. I have worked with a lot of patients over the years, and I have seen both good and bad. You just never know how someone is going to respond. I can’t say it’s something I test for in everybody but wanted to make you aware of it. 

Nanette: 

Okay. 

Dr. Eric: 

Diet and lifestyle. You are following a Level 3 diet, which is more autoimmune-focused. It won’t hurt for you to do that. You said you have been following it for five weeks? 

Nanette: 

Yes. 

Dr. Eric: 

You can keep that up. A lot of times, for non-autoimmune thyroid conditions like yours, I might recommend AIP, if you’re having gut issues. Otherwise, a Level 2, which is a modified paleo diet. You have already followed it for five weeks, so if you want to continue for 2-3 months, like another 3 weeks, or make it a full 90 days, that’s fine. It won’t cause harm to do that. But if you’re finding it really difficult and challenging, and you wanted to transition to a regular paleo diet, a Level 2 diet, as I talk about in my book, you definitely could do that. 

Nanette: 

I get to move up then! Yay! 

Dr. Eric: 

There you go. You got my book and attended the Thyroid Healing Diet Boot Camp. If you do that, you might still want to do the reintroductions, which I talk about in the book, rather than just make the transition. Since you have already done it for five weeks, it’s up to you. 

Nanette: 

I’ll go back to the book. 

Dr. Eric: 

Diet and lifestyle for any thyroid/autoimmune thyroid condition is important. You’re already doing everything you can from a dietary standpoint, it sounds like.

Are stress and sleep okay on your end? 

Nanette: 

Yeah, I’m good there. My husband and I are retired. We do a lot of volunteer work. We do a lot of church work. I’m at a stress-free side of life. My kid is all grown up; he’s good. 

Dr. Eric: 

I can’t advise you to get off the PTU, but first of all, what we mentioned here, hopefully by addressing the cause of the problem, over time, you will see changes. 

It can be tough with nodules. I can’t say everybody who has toxic multinodular goiter, moreso the nodule part, all the nodules shrink and go back to normal on an ultrasound. But everybody is different. We do sometimes see some really good changes. Other times, we’ll see changes, but it depends on the person. 

We do get people with both Graves’ and toxic multinodular goiter to the point where they don’t need it. The only way to know is by incorporating these changes. If you don’t need the PTU, eventually the numbers on the thyroid panel should be hypo. Then the doctor should gradually wean you off. 

You might have heard me talk about natural agents like bugleweed and L-carnitine. Have you tried those at all? 

Nanette: 

I have not. 

Dr. Eric: 

That’s something to consider. It depends on the person. If someone is taking methimazole or PTU, and they’re tolerating it well, and they’re okay with taking it, there will be people who will continue taking it. 

Your situation is a little bit different because you have been on it for five years and are tolerating it well. If you have to take it for good, you will, but if there is an alternative, then you’d rather do that. 

The thing about bugleweed and L-carnitine. A couple things actually. They’re also not doing anything to address the cause of the condition. You would just be managing your symptoms naturally while still trying to address the cause of the problem.

Also, they don’t work for everyone. If someone is taking a medication, I can’t tell them to stop it. Even if I could, I wouldn’t tell them to do that because I don’t know if the bugleweed or L-carnitine would help. 

Commonly, what I tell people to do is if they are taking antithyroid medication and are looking to get off of it as soon as possible, I can’t tell them to do that, but I could say to continue doing what you’re doing. Let’s add some bugleweed to that, like half a teaspoon, twice per day, for example. The dose depends on the person and the levels. Some people might be a full teaspoon twice a day. According to the literature, 2,000-4,000mg per day of divided doses of L-carnitine tartrate. 

If it’s working, and you’re on PTU and bugleweed, then a few months from now, you do another thyroid panel, and it tends to be on the hypo side, then the goal is for the endocrinologist to say- If you don’t tell them what you’re doing, he/she might not know, but if you’re more hypo, let’s cut the PTU further. Eventually, if you continue that pattern, get to the point where you’re just relying on the bugleweed and/or L-carnitine.

As you’re addressing the cause of the problem, hopefully get to the point where you don’t have to rely on anything. That’s the ultimate goal.

If someone had to rely on a choice, where they were taking long-term bugleweed or long-term PTU, I’d rather them take bugleweed. Everybody is different. Some people would prefer the medication since it’s covered by insurance, whereas bugleweed is not. They are paying the money for that. 

Like I said, the ultimate goal with all these conditions, whether it’s Graves’ or toxic multinodular goiter or Hashimoto’s, is to address the cause of the problem. It’s different with Graves’ because Graves’ is autoimmune, and we’re doing things to address the autoimmune component. Even with toxic multinodular goiter, there is an underlying cause behind that. 

I gave the more common causes according to the literature and my experience working with patients. The insulin resistance, problems with estrogen metabolism, inflammation, sometimes iodine deficiency. Those are some of the things to look into.

I’ll wrap up by saying obviously, I will be biased because I am a natural health care practitioner. Some things you could do on your own, like the Level 3 diet. Testing the hemoglobin A1C, fasting insulin. You could get that through your doctor. 

As far as doing some of these other tests, one thing I didn’t mention is the dried urine test will look at estrogen metabolites, but also the gut plays a role in metabolizing estrogen. Some people could benefit from doing a comprehensive stool panel to see what’s going on. If they have a lot of imbalances in the gut, then they might need to do things to improve their gut health, even if they are not experiencing gut symptoms.

The point is, it can get complex. You try to do as much as you can on your own. Take advantage of my book and the information you gained from the boot camp. But if you feel the need, there is me and other functional medicine practitioners; consider working with them. 

Any questions on your end? 

Nanette: 

That was interesting about how I might have gotten this in the beginning. I grew up on a farm, inland, West Virginia. Maybe iodine deficiency, I’m not sure.

Dr. Eric: 

Could be pesticides. If you grew up on farmland, I don’t know your farm, but other surrounding farms, being exposed to the toxins that could also act as endocrine disruptors and could affect the metabolism of estrogen as well. There is a lot of possibilities. Maybe you don’t do this now, but drinking water out of plastic bottles for a period of time. Could get exposed to the xenoestrogens that way. 

This happened when you were really young, as far as the start of it, the nodules. It does seem like something happened prior to turning 16. 

Nanette: 

Right. Maybe some trauma, too. When I was about eight, I was pushing a chair into the table, and I slipped. I hit myself right here with the table. Maybe that was a little trauma. Certainly was trauma. Maybe that contributed over time. 

Dr. Eric: 

Yeah. That definitely could have caused inflammation. You formed the nodules when you were 16. Chances are the doctors that you looked at didn’t think about the cause. They just said, “You have a nodule. We need to remove it.” Then you got another nodule and needed to remove it. 

That’s the problem with most medical doctors, including most endocrinologists. They never ask what the cause is. That just comes down to the training in medical school. There are some who go on to focus a little bit on functional medicine and open up their minds. Unfortunately, that’s not the case with most doctors. 

Nanette: 

Things have improved. Of course, I want to know why I got this and where it came from. I will check for insulin resistance. 

Oh, you mentioned gut tests. I actually did do a gut test. For the most part, that was good. I had some high H-pylori. I took some mastic gum to get rid of that. I don’t know if it’s gone, but I did the mastic gum. I have been taking a lot of supplements to build up my gut. I am still doing that along with your diet.  

Dr. Eric: 

Wonderful. 

Nanette: 

I’ve been working really hard to get better. I would love to get rid of my nodules and the PTU. You don’t think that being on PTU at a low dose for five years is alarming? I seem to be tolerating that well. You’re not telling me to run away. 

Dr. Eric: 

I have an episode on my podcast on low dose antithyroid medication for a long time, talking about this. Most of the research out there is on taking lower doses of methimazole. There are people who have been on methimazole for 10-15 years, even longer, without a problem. It’s been a little bit since I put together the episode. 

There wasn’t a lot on long-term PTU. It really comes down to monitoring the blood tests. It’s not ideal. Even being on methimazole, if someone works with me, and the end result is them on methimazole, that’s disappointing to me because I want to get them to the point where they’re not on medication. That’s why they’re coming to see me, not for me to tell them to get off, but to get them to the point where their thyroid is working properly, and their immune system is working properly. Their endocrinologist, based on the results, will wean them off. 

It’s not ideal to be on PTU for five years or longer, but risk versus benefits. If you’re monitoring the liver enzymes, and if the white blood cell count is remaining okay, because sometimes the antithyroid medication will affect the white blood cell count. If your liver, white blood cell count, kidneys all look okay, and you’re on a lower dose, then let’s put it this way. 

If I was in your situation, and if I had to choose between low dose PTU and getting radioactive iodine or thyroid surgery, I am pretty confident I would be doing what you’re doing and staying on the PTU, as long as my bloodwork continued to look okay. I wouldn’t be happy that I’m on the PTU, but that’s why we’re having this conversation, too. If you were happy, you wouldn’t be doing this audit. 

From a risk versus benefit standpoint, yeah, if I had a choice, if the option was being on low dose antithyroid medication or getting surgery or radioactive iodine, I am pretty sure I would choose low dose antithyroid medication. 

Nanette: 

It’s nice to keep your thyroid. 

Dr. Eric: 

Exactly. That’s obviously the goal: try to help people save their thyroid. 

Thank you so much, Nanette, for doing this. I really appreciate this. Hope you found the feedback to be valuable. 

Nanette: 

I did. Thank you, Dr. Eric. 

Dr. Eric: 

Thank you. Take care. 

Nanette: 

Okay, bye.

Recently, I interviewed Dr. Nayan Patel, and we discussed the role of glutathione as a master antioxidant, its significance for individuals with thyroid conditions, and its impact on autoimmune disorders like Hashimoto’s and Graves’ disease, the benefits of N-acetylcysteine (NAC) for boosting glutathione levels, the limitations of intravenous glutathione, why a balanced diet and proper supplementation are crucial, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I’m excited to be joined by Dr. Nayan Patel, as we are going to have a comprehensive chat about glutathione. Really excited about this conversation. Let me go ahead and dive into Dr. Patel’s bio here.

Dr. Nayan Patel is a sought-after pharmacist, wellness expert, and thought leader in his industry. He has been working with physicians since 1999 to custom develop medication for their clients and design a patient-specific drug and nutrition regimen. He has been the pharmacist of choice to celebrities, CEOs, and physicians themselves. Not included in this bio, you have a book as well, so check out The Glutathione Revolution. 

Dr. Nayan Patel: 

That’s right. Thank you.

Dr. Eric: 

Thank you so much for joining us, Dr. Patel. 

Dr. Nayan:

It’s a pleasure. Thank you for inviting me.

Dr. Eric: 

Really excited to talk about glutathione, something that a lot of practitioners use in their practice in different forms. As far as understanding it and the general public, it’s more common, but you’re going to go into detail. 

For those who are unfamiliar with glutathione, can you talk about what it is? Why is it considered to be the master antioxidant? 

Dr. Nayan: 

Absolutely. Hopefully, you will get it by the end of the day today. The reason is because it is the most abundant peptide or molecule or any kind of component that is produced in the human body. It is ubiquitous with anything else that you can think about. Next to water, glutathione is the most abundant molecule there is. The reason that it’s produced there is because of all the things that it does for us. 

You just mentioned antioxidant. In the simplest terms, glutathione is a tri-peptide, which means it’s three amino acids coming together. Glycine, glutamine, and cysteine. It is one of the simplest forms of a peptide, so to speak. The simplicity is not something to be undertaken because the work it does, it’s way more than any other molecule inside your body. 

Dr. Eric: 

Thanks for the explanation. I need to ask you: What motivated you to start doing extensive research on glutathione, let alone write an entire book on glutathione? 

Dr. Nayan: 

If there is one thing that I can do that can change the complete course of a trajectory, what would that be in medicine? When I was doing my research, everything led to me asking, “What can we do to reduce oxidative stress? What can we do to help our body heal from inside? How could we keep the body clean from inside?” 

The body produces an abundance of glutathione. We have known of this product for about 140+ years. The thing is, nobody has ever figured out how to enhance it inside your body. Wait a second. We know something is good for us. We know this is the best thing there is. How come nobody has ever figured out how to get it inside your body? 

Let’s take it on. I have some spare time. I have nothing else to do. My business was not doing great anyway. We started working on this project very early on. Tried to figure out how we can get this inside our body. 

Dr. Eric: 

Okay. I’m glad you did. We wouldn’t be having this conversation otherwise. You wouldn’t have been helping all these other people with your research. Thanks for releasing the book. 

Maybe starting off with food sources, what sources of food can you get at least a precursor of glutathione? You mentioned some of the precursors, like glycine, cysteine, glutamine. Those are amino acids. I’ll let you take over from here.

Dr. Nayan: 

Before I talk about sources and where we get it from, I really want people to understand why we need this thing. It’s the most abundant molecule. Why do we need it?

The why is what will help you understand what to do now. If there is no why, people won’t do it. I will explain the why first if that’s okay. 

The why is because glutathione has two purposes inside your body. It detoxifies or neutralizes all the free radicals that you’re exposed to. If you’re breathing, you’re consuming oxygen, which is a free radical. At a low concentration, it is great for you because it is a source of energy and helps your body heal from inside. 

But excess amounts of oxygen can also cause what we call reactive oxygen species, and those are toxic to the human body. The body produces glutathione to quench all those free radicals, so oxygen stays low enough.

There is a second source of free radicals coming to the body, like sun, pollution, chemicals we ingest, chemical reactions that happen inside the body. Every single reaction that happens inside your body produces a byproduct. The byproducts are all reactive oxygen species. When you break down amino acids or proteins, it also creates what we call a reactive nitrogen species. 

All those things have to be neutralized every single day because you eat and breathe almost every single day. You have to have a system in your body to neutralize those things. That’s the first function. Sleeping, you’re awake, doesn’t really matter. Your body is working for you. 

The second part, which nobody talks about, which is as much or even more important, is it helps detoxify your liver. Your liver is the garbage disposal of your body, trying to process every single thing and dumping into the kidneys or your intestines. You can just get rid of it from your body. The processing requires chemicals. The most important one is glutathione because it helps bind to all these chemicals and hopefully get rid of them. 

Those two processes are very critical for us. That’s why we need to make sure our glutathione levels are high at all times. I don’t care if you’re 20 or two years old or 100 years old. Our needs are not going to decrease as we age. Our needs are going to be the same no matter what. 

If the needs are the same, and the body cannot produce enough, we have to make sure that we are doing everything possible to give our body a fighting chance to improve the levels, so it can keep our body clean from inside.

The question that you asked me earlier about how do we get glutathione in there? The #1 choice is always going to be food. Which foods can I eat to get the glutathione that I need? 

Your body actually does not have the receptors to accept glutathione by itself as is. That means we have to consume all the building blocks, which are the amino acids, and the body has to make it from there. The foods that have glycine, glutamine, and cysteine are going to be great for it. 

Let me tell you one more thing. Our body has enough glutamine and glycine coming from all the food we eat. The issue is we are not getting enough cysteine in our diet. If you just put in your favorite search engine “cysteine-rich foods,” you are going to get a list of, if you’re vegan or vegetarian or a meat eater, doesn’t matter. They have four choices in every category you have to consume those products to get the cysteine in your diet. 

Cysteine is actually getting used up by your body to produce glutathione. That’s the easiest way to do it.

Before you go into the diet, first of all, I would suggest reducing toxins. Reduce exposure to excessive sunlight. Reduce exposure to pollution. Reduce exposure to toxic chemicals that you may ingest knowingly or unknowingly. Alcohol depletes glutathione levels. Smoking can deplete glutathione levels. Avoid toxins. Reducing all these things can also reduce the need for glutathione to let your body use it for other purposes.

Dr. Eric: 

Makes sense. The two main purposes of glutathione are to help with free radicals, essentially reducing oxidative stress, and also detoxifying the liver, so that makes sense that you want to do as much as you can to reduce your toxic burden as well as excess sun exposure and some other things you mentioned. 

Food sources. Mainly focusing on cysteine-rich foods rather than food sources of glutamine and glycine, correct? 

Dr. Nayan: 

That’s right. In fact, we’re doing some brain trials. What we are finding out is even at the 70-year-old person, they have an abundance of glutamine. What we are suspecting is glutamine might be an issue as well, if it’s in the brain. Having a cysteine-rich diet can actually bind those excess glutamines and get them out of the body. Hopefully, that’s a good thing. Cysteine-rich foods is what we recommend most of the time. 

Dr. Eric: 

For those who have an increase in intestinal permeability with a leaky gut, would glutamine be beneficial for those people with gut support? 

Dr. Nayan: 

Absolutely. Even though glutamine may be too toxic in your brain, not enough glutamine can cause all kinds of leaky gut issues and permeability issues or cells not developing correctly. Having a glutamine source between 1-5g a day, if you have the problem, is a great idea. 

Keep in mind if you can enhance the glutathione levels in the body, it will do the same exact thing as well. 

Dr. Eric: 

Are there any other symptoms associated with glutathione deficiency? 

Dr. Nayan: 

What you mentioned earlier was oxidative stress. That’s the key component of what we are trying to reduce with glutathione. If you look at oxidative stress, what are the symptoms? 80% of all diseases known to mankind are related to oxidative stress. 

The key is do we want to wait until we get diseased, or can we stop it from getting into the cracks of it? The idea is we are not looking for symptoms at this point. All we’re looking for is do I optimize my lifestyle to the point that I am making sure that my glutathione levels are going to be high at all times? 

If we are looking for symptoms specifically, by the time you get diagnosed with, for example, having high insulin resistance or high triglyceride levels or Alzheimer’s or cancer or heart disease or anything else, it’s too far gone. 

The goal is to treat the problems or avoid the problems. If you want to avoid the problems, then you have to work on your lifestyle and your habits. 

If that’s the case, do I take glutathione supplements from the day I am born? The answer is no. I’m not saying that either. You cannot supplement your way out of all your problems. Having a better lifestyle is what I’m advocating. I want to make sure people are reducing exposure to known toxic chemicals and pollution and gas, things like that. 

The second part is having a healthier diet that encompasses all kinds of amino acids, not just cysteine, although cysteine is part of one of the most important ones. By all means, cysteine is not one of the essential amino acids to take every single day. Having essential amino acids coming from your eggs or meats or vegetables, having good source of proteins that your body can clear out and use the amino acids from inside is a key component. 

Symptoms-wise, if you really want to call out a couple of symptoms, at the age of 30 is where we first start seeing lower glutathione levels. That is the first time we see the body get fatigued and tired. In your 20s, you’re never tired, ever. At 30, all of a sudden, you’re not feeling fantastic anymore. The fatigue kicks in. 

Sleep patterns are not ideal. These are all oxidative stress markers. 

You have liver spots. Your skin may get discolorations. You can see visible signs. The forgetfulness kicks in. Keep in mind 20% of all the oxygen that you breathe in goes to your brain first. The brain is only 2% of the whole body weight, yet it consumes 20% of all oxygen. Your brain has the highest amount of oxidative stress in your whole body. After that is the liver. Then other organs. The first one is the brain. 

If your brain is getting taxed or has too much oxidative stress, it will show signs of memory issues and fatigue. You are not feeling yourself. 

All those signs and symptoms are not great, but don’t wait for those. Start doing things today to help yourself. 

Dr. Eric: 

Makes sense. Even if you’re feeling great, you could still have lower glutathione levels and have potentially a glutathione deficiency. The audience consists of mostly people with thyroid conditions, many of whom have autoimmune conditions. When you have autoimmunity, that’s associated with oxidative stress. Based on that, can we assume that people with autoimmune conditions of different kinds are more likely to need glutathione than others? 

Dr. Nayan: 

Patients with autoimmunity, their levels are actually below zero. It doesn’t exist in those people. They are constantly deprived of glutathione being available because the body is trying to fight a ghost. Patients with autoimmune conditions, their needs are extremely high. We have made a product just for those people with a higher concentration. Normally, I do not prescribe that to anybody else besides people with the needs that are very high. People with severe oxidative stress, especially patients with autoimmune conditions, their needs are extremely high.

The issue is if they have not had glutathione for a while, the body has become toxic. If I give a high dose of glutathione from the get-go, the patient will have a lot of detox reactions. The first month, I always say to go slow. Let’s slowly build up your levels, so you have no side effects from the product. 

Once they’re better, they can tolerate some levels, and they can go to a higher concentration. They can see the benefits in less than six weeks. 

The idea behind this is that it’s not going to get rid of autoimmune conditions at all. Autoimmunity is preventing your body from staying clean and agile all the time. Autoimmune conditions don’t stop there. The body is trying to fight this issue. Doesn’t know what it’s fighting. Opportunistic infections and diseases creep in again. 

I want to make sure people understand that autoimmune conditions are not the single focal point, but they are the gateway to major illnesses in the future as well. Having something like glutathione or a healthier lifestyle to support what our body needs is going to have a fighting chance to keep the conditions under control. Hopefully, reduce the load down, so the body can handle it. 

Dr. Eric: 

Okay. Chronic stress. Does that have a negative impact on glutathione? 

Dr. Nayan: 

When people talk about stress, there are two types of stressors. One is oxidative, as we have discussed. The second one is endocrine stress, which comes from cortisol and adrenaline. Those are regulated by the adrenal glands right above your kidneys. 

I wish our body was compartmentalized. That means nobody knows what the other parts are doing. Our body internally is all one giant fluid. It is crazy how things work inside the body. All those liquids are mixed together. 

When it comes to stressors, yes. Even though they are causing excessive cortisol production or adrenaline coming into the body, it has a profound impact on inflammation. It has a profound impact on cytokines, which are known products that help keep our body in check, like all the interleukins 2 and 12. I don’t want to bore everybody. The cytokines are released by the body to mitigate some of these problems. When we have those things, our body is in chaos. 

At that time, the need for glutathione also increases. Regardless of what stress you have, oxidative or endocrine or physical or mental, all those things will deplete glutathione levels. Some more than others, but they all have an effect on reducing glutathione levels. Having a proper lifestyle and diet and supplementation to improve glutathione levels is key in managing any of these conditions. 

Dr. Eric: 

Testing. What would you say is the best way to measure glutathione? Doing glutathione in the blood? There is also pyroglutamate through urine testing. 

Dr. Nayan: 

When you’re measuring pyroglutamate in the urine, that’s part of the metabolites. It’s not a true indicator of how much glutathione you have in the body. It’s an assumption of how much you have. I don’t do too much urine testing at all.

I do serum testing. Even the serum testing, there is a drawback there. By the time you draw the blood and put it in a tube and ship it to the lab, before it leaves the office, it’s already been oxidized. What you’re really measuring is the total glutathione levels and total offset glutathione levels. 

In theory, you would assume that if you’re otherwise healthy, 50% is oxidized and 30% is reduced inside your body. 

If you have autoimmune conditions or metabolic disorders or cancer, then what you have is too much glutathione and very little of the reduced form. It’s very hard to measure that part.

The true measurements of glutathione can come in lab settings or research settings, where you can draw blood, put the blood sample in the machine right away, and get results immediately. That is the only way to get accurate results from tests. 

We have done this part. We have done the study at the university hospital. Our study was med students and some professors. Most of the med students have a good ratio, 50/50, of reduced versus oxidized glutathione. 

The professors have way too much oxidized glutathione in the body. That tells us that even though they are healthy, they are professors at a med school, the oxidized glutathione is much higher than everybody else. Something is better than nothing. 

If you test, please test your blood levels. Don’t measure the whole blood. Glutathione in the plasma doesn’t have a good track record. Make sure you measure the red blood cells (RBC) level of glutathione. That is the true indicator of how much glutathione you should have in your body. 

Dr. Eric: 

Okay. You don’t pay much attention to urine testing. Blood, more RBC levels of glutathione. 

How about the impact of genetics? Having genetic polymorphisms, which are common genetic variations. That can definitely play a role in who might need more glutathione compared to someone else. 

Dr. Nayan: 

Yeah. Thank god genetic testing has gotten cheaper as the years go by. 15 years ago, used to cost $5,000 for a full genome testing. It’s gone down to $500 or less nowadays. It’s gotten very inexpensive, relatively to what it used to be. 

Because of that, over the last 15 years, the data has come out as to how many percent of people have gene mutations, what we call SNPs, that are not either able to produce glutathione, or their need for glutathione is extremely high. The gene SNPs are telling a lot of stories. 

If you have a gene problem to begin with, like they are born with it, early on, you will get a deficiency of glutathione, and you will see signs and symptoms of spectrum disorder most of the time. People either have autism or Asperger’s. Not all autistic or Asperger’s patients are glutathione deficient, but a lot of them are. 

If they are early on, you can figure out the issue. As we age, we get exposure to cosmic rays, UV lights, foods we eat, some of the gene mutations are happening afterwards. Those gene mutations can change the course of how much glutathione we actually need or that the body is able to produce.

For example, MTHFR is a common gene mutation that we see in a lot of patients. It’s not a gene mutation where your body cannot produce glutathione. What happens is because of MTHFR, there are not enough methyl groups, so you can’t detoxify a lot of chemicals. The job of glutathione becomes extremely difficult, and the need for it increases dramatically. Even though your body can produce, it cannot keep up with the demand.

If the audience is interested in that part, I would strongly suggest working with a physician who knows gene SNPs. I work with a couple of doctors myself. I am doing a presentation to a physicians group next week on gene mutations and how it’s affecting glutathione levels. 

The more we are finding out what the gene SNPs are doing, the better off we can prepare ourselves. We can’t change the mutations, but we can change how we respond to them. Working with a physician is critical. 

Typically, if you do a full genome mapping, it will take you months to go through each and every gene mutation to see what should I do with each one? It’s not a one-hour visit or 10-minute visit. It’s probably over time, maybe 5-10 visits to figure out every single thing about your body. 

Dr. Eric: 

Let’s talk about supplements. That’s a great interest to listeners. There are different forms of glutathione supplements. 

There are other ways to administer glutathione, such as IV. A lot of people get IV glutathione. I’d love to know your thoughts on IV glutathione as well, like liposomal glutathione. Even taking something as simple as NAC (n-acetyl cysteine), which is a form of cysteine, as you were talking about earlier when discussing food sources. 

Dr. Nayan: 

Supplementation is a very confused market. There is a lot of marketing going on, a lot of hype going on with not too much data behind it to back it up. I want to make sure the consumers are getting information and learning from here to see. Become a skeptic for yourself, and question every single thing. That way, you know you are making informed decisions. 

Just to let you know, first of all, your body has no receptor to take glutathione as is. In the last 140+ years that we have known about glutathione, there is one FDA-approved product to improve glutathione levels. That is NAC. It’s cysteine given in a capsule form. The body takes cysteine, combines it with glycine and glutamine, and produces glutathione. It works great.

As we age, our body is not able to keep up with the demand of gene mutations. There is always going to be a need for supplementation. Guess what? Let me inject it into the body. If I can get an injection into the veins, my job is done. 

A study was done in 1991, where they gave 2g of IV infusion of glutathione. What they found out was 100% of the glutathione was still in the plasma only. Nothing entered the blood cells. Zero. What happened then was they checked further out. Where is this plasma glutathione going? In 5-15 minutes, everything was in the urine. Really, IV glutathione is actually not sustaining the glutathione levels for long term.

They continued the study for another few hours. What they saw was the body broke down the glutathione into various amino acids. NAC was sitting in the blood a couple hours later. 

What the research basically concluded was when you infuse glutathione, the body breaks it down and absorbs the cysteine. The cysteine is being used to produce glutathione again. That is the conclusion the researchers came to. That was the research on IV.

Even today, it is very popular. I, as a pharmacist, am guilty of doing that as well. For 20 years, I was also making glutathione to sell to doctors’ offices to infuse into patients. That was the only option I had.

The second option that came to me was in 1999. Can you make some liposome form of glutathione? The researchers that hold the patents for this technology already had drugs in the market through the FDA approval process. They gave us the technology and asked me to make nutraceuticals like Vitamin C or glutathione or CoQ10 and things like that. Sure enough, we made some products and gave them back to the researchers. He sold the product to some other company. 

One thing he could not sell off was the glutathione because it did not work. They couldn’t figure out what was happening. It worked four weeks later but not right away. Something else needs to be happening.

In 2011, University of Texas did a study on 26 kids. They gave them a liposomal form of glutathione, both oral and transdermal. What they found out was again, same thing. Nothing was in the blood cells. 100% was in the plasma. The plasma will break it down into amino acids. We saw an increase in cysteine, glutamine, glycine, and other amino acids. 

The researchers came to the same exact conclusion. The body does not absorb glutathione. It breaks it down, absorbs the cysteine, and later uses it to produce glutathione again. 

All the research that is out there tells the same thing. When I started doing my research, I needed to figure this out. If the body does not have the receptor to accept glutathione, how do we get it inside the body? 

We figured out that your body has a receptor to accept dextrose sugar molecules. What I did was took the sugar molecules, made them into a ring structure, and put inside the ring a glutathione molecule. The body thinks this is a sugar. It takes it. inside is glutathione. I put a Trojan horse inside the dextrin molecule. 

Dextrin has no properties of glucose levels in your body. It’s not for that purpose. It’s a simple carb, but it doesn’t raise blood glucose levels at all. That’s our technology. 

When we discovered the technology for the first time in 2007, it was too premature. Now what? How much do I give it to you? How often? How am I going to do a study? It took me three or four years to figure that portion out. 

We figured out I can give it twice a day, 100mg. I got the results I was looking for. That’s what we did. 

How fast can I see the results? The absorption through your skin was within 15-20 minutes. At 45 minutes, we saw blood levels rise to high normal into the blood cells. That’s how we figured out. This was nuts. 

It took me another 13 years to figure out what conditions can I give it to? How often? In all my research before I released it to the public, all I was trying to figure out is if I improve glutathione levels, does it reduce oxidative stress levels? If I reduce oxidative stress levels, does it trickle down to all the major diseases? 

I have diabetes. Can I reduce blood sugar levels down? Just because I reduce blood sugar levels doesn’t mean the insulin load is gone. You have a huge resistance problem still. You will still die of some complications of diabetes. 

My goal has always been to reduce oxidative stress down, and if I do that on one end, is there a positive impact on major diseases? 

We have a couple of published articles. By reducing oxidative stress levels down, in fact, it will improve your immune system to get rid of infection, like bacteria. We already published that study.

Our goal has always been to not go after bad data. If I can fix the problem on the far back, can I see a positive impact on what the problem you’re facing today is? Yes, we can. 

Some things take time. Some things may take two days, and some things may take six months. 

Regardless, oxidative stress, if I can reduce it down, has a profound impact on every disease that is linked to it. That’s the technology that we have. The topical spray, that’s what we use it for right now. We launched the company in 2020. It was bad timing. The whole world was shut down, not just us. We just are back in business as of last year.   

Dr. Eric: 

Wonderful. Sorry about the timing. I’m glad you persisted. It’s great that it’s available. 

It’s a topical spray. With both IV glutathione and liposomal glutathione, it sounds like the glutathione actually isn’t getting into the cell. It’s more that the body is utilizing the cysteine. Your product would be the most bioavailable, the topical spray. Next to that would be NAC rather than spending the money on IV glutathione or liposomal glutathione. They are both pricey compared to NAC. 

Dr. Nayan: 

Exactly. If you are going to take NAC, just Google “cysteine-rich foods” instead. Make that part of your daily routine. You can only take a supplement once or twice a day. The supplement works as food. The food you see, you will eat anyway, so you might at least eat some avocado or Brussels sprouts or chicken or turkey. They all have cysteine. 

Dr. Eric: 

Do you personally try to do as much through food? With the topical spray, do you use it consistently once or twice a day on a wellness basis? 

Dr. Nayan: 

Yes, I do. I am in the age group of 50+. My needs for glutathione will always be there. Today, I’m in better shape than I was in five years ago when I first started taking glutathione. I am in much better shape than I have ever been. I have too much energy. I travel close to 37 weeks out of the year. I’m always on the road. I’m never tired. I get frustrated sometimes because going through TSA Precheck can be frustrating. Besides that, my energy levels are always very high. I perform. I talk. I lecture. I’m always full of energy. I take it twice a day myself. 

Besides that, I make sure my diet is full of amino acids that I need. There is nothing to replace diet. Please make sure that diet is good enough to get all your amino acids in. Then the supplementation is an extra bonus tool. 

Dr. Eric: 

Definitely agree with that. With supplements, can you take it with food? Do you take it away from food? 

Dr. Nayan: 

This is a topical product, so it doesn’t matter. Food has zero impact on it. In fact, since it’s topical, we always say to apply it on clean skin. Before you apply the product, make sure you clean the skin off. Make sure there is no debris in there. We want to make sure the product has as good a chance of getting inside your body without having to deal with some debris on your skin or dead skin cells. 

Dr. Eric: 

How about if someone takes NAC. I usually recommend taking NAC away from food. Is that necessary if someone took it with a meal? 

Dr. Nayan:

It should be okay. NAC is very easily absorbed. I would not worry about NAC at all. You can take it with food or without food or with drinks, coffee and tea. They won’t be an issue. 

Dr. Eric: 

It’s not so much the bioavailability. Some say if you take it with other foods with protein, it will compete with the other amino acids. I’m not sure. 

Dr. Nayan: 

No. The bigger issue we have today more than anything else is the pH of your stomach. Most Americans today are taking some sort of products to reduce acid reflux. Antacids or some other form. Or drinking alkaline water and increasing the pH of your stomach. 

The pH is supposed to be between 1-2 for protein. Then the enzymes to chop the protein off into various amino acids. If you’re taking alkaline water, if you’re taking antacids, the pH of your stomach is rising. Because of that rising pH, they can’t unfold the protein. If you cannot unfold the protein, you cannot chop down to absorb amino acids. That to me is a bigger issue than taking NAC with food. 

Dr. Eric: 

Okay. You want to have a lower pH for stomach acid. Very important for breaking things down. 

Getting back to your product. You mentioned for autoimmunity, you start people slower. You said there is another product. It’s also a topical spray, but a higher potency? 

Dr. Nayan: 

I’m sorry to give a shameless plug to myself. The product name is Glutaryl. We have Glutaryl and Glutaryl+. The + version is 1.75x stronger than the regular stuff. I would say all the work I have done, every single thing I have done, is in the regular Glutaryl. 

As you can imagine, I have patients that are suffering from chronic oxidative stress, which has led to multiple diseases or conditions that regular is not going to cut it for them. I had to make something stronger for them. 

The stronger version is good for 3-6 months, maybe a year. After that, they all switch back to the regular one for maintenance. That’s all they need to maintain the levels high enough in your body. 

Dr. Eric: 

Okay. Anything else that you want to discuss when it comes to glutathione? Anything that I should have asked you that I didn’t ask you? 

Dr. Nayan: 

I think you were pretty thorough in terms of your questions. One thing I would want to let people know is if you read glutathione in oxidative stress, it will sound like this is better than snake oil. It is. 

Keep in mind that it’s only as good as how you treat the rest of the body with the rest of the habits you have. If you have good habits to begin with, and you work on getting good habits, you work toward eating the right fruits and vegetables and everything necessary for your body to sustain life. Having glutathione levels to reduce oxidative stress, I believe that’s the best chance we have to improve our health span. Improving life span is only there if we can improve health span. 

The question I get all the time is: Do you consider glutathione a longevity drug? I say that the true longevity drug was penicillin. Penicillin in the 40s raised the life expectancy of 40 years to 55 years singlehandedly. Not only can you get rid of infections. By all means, it’s not a longevity drug. All we did was improve the health span of the health of the human being.

I’m saying that glutathione is not a longevity drug, per se. It is definitely going to improve your health span. In fact, I do that part. There is a potential that we can live longer, healthier without being in a nursing home. That’s my hope. 

Dr. Eric: 

Wonderful. Dr. Patel, where can people find out more about you, learn more about your work? If they’re interested in purchasing the Glutathione product? 

Dr. Nayan: 

My website is AuroWellness.com. I spend a lot of time and energy in writing blogs. Please subscribe to my blog. Get yourself educated. 

The idea behind this is I want to make sure that people make informed decisions for their life. I want to bring information to them. I am always doing some research. Anything new comes out in my database, so I will send it out through the newsletter. Subscribe to the newsletter. We send it 2-3 times a month. Hopefully, that’s good information for you to learn from. 

Dr. Eric: 

Really appreciate you taking the time to chat about glutathione. Really enjoyed this conversation, Dr. Patel. 

Dr. Nayan: 

Thank you very much.

Recently, I interviewed Reghan, and we discussed holistic strategies for managing Graves’ disease, how to think about diet and lifestyle changes, which natural supplements to consider, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: Welcome, welcome. I’m with Reghan here, as we are going to be doing a Save My Thyroid audit that focuses on Graves’ Disease. Thank you so much for joining us, Reghan.  

Reghan: 

Thank you. I’m glad to be here.  

Dr. Eric: 

I’m really excited to talk about your Graves’ journey and give you some helpful advice along the way. Can you let everyone know how long you’ve been dealing with Graves’? 

Reghan: 

I first got diagnosed in around May/June of this past year, but my journey to get my diagnosis took over nine months between seeing a bunch of different doctors, doing blood tests, MRIs, ultrasounds. My doctors and I haven’t really pinpointed a direct point of when the Graves’ could have started, but I could have been dealing with it for five years, and we just are getting a diagnosis right now. 

Dr. Eric: 

Is there any family history of any thyroid or autoimmune thyroid conditions? 

Reghan: 

No, but I do have family with other autoimmune diseases. No one else has thyroid issues. 

Dr. Eric: 

Okay. Are you currently taking any antithyroid medication for Graves’? 

Reghan: 

No, I am not. I have an endocrinologist who tried to prescribe me one, but I was worried about the health side effects. They seemed very harsh, so I am trying to hold off until I finish college. I am a senior right now in college. If I want to take a thyroid medication, I want to be in the best hands and not away at school and worried about it. 

Dr. Eric: 

I understand. Are you doing anything naturally to help manage the symptoms? 

Reghan: 

Yeah, I am probably about 75% gluten-free at the moment. I take supplements. I take Vitamin D, Omega-3, turmeric, and a probiotic. I try to cut out any refined sugars and add more protein to my diet. 

Dr. Eric: 

Okay. Wonderful. As of now, not this very minute, but overall, what are some of the more common symptoms you’ve been experiencing? 

Reghan: 

I don’t seem to have too many crazy symptoms. Something I have is hand tremors that go off and on. Sometimes, I won’t be shaking, but this morning, my mom felt my hands, and she felt that I was shaking. Besides that, my thyroid and my neck are a little bit enlarged. 

Dr. Eric:

Symptoms aren’t too bad. Having some tremors. Do you know if you have an elevated resting heart rate? I don’t know if you measure your heart rate. 

Reghan: 

I don’t measure my heart rate regularly, but I’m pretty sure it’s not. Every time I go to a doctor, they’ve never said it was an issue. 

Dr. Eric: 

No heart palpitations? 

Reghan: 

No. 

Dr. Eric: 

That’s good. How long ago since your last thyroid panel? 

Reghan: 

I got bloodwork done about three/four weeks ago. 

Dr. Eric: 

It’s an endocrinologist you’re working with? 

Reghan: 

Yes. 

Dr. Eric: 

Either way, but especially with endocrinologists, they don’t reveal a lot of information in most cases. Did they mention if your thyroid hormones—T3/T4—are actually elevated? 

Reghan: 

Yes. I previously had bloodwork in January, where my levels were extremely high. When I got bloodwork in May and June, my levels have gone down a little bit, but they’re still consistent with Graves’. 

Dr. Eric:

Just wanted to make sure. You’re not really subclinical as far as your blood test? You just don’t have a lot of symptoms overall, but your thyroid hormone levels are still elevated as of the last test. 

Reghan: 

Yes. 

Dr. Eric: 

If you could paint a perfect picture, 6-12 months from now, how would you like your health to be? 

Reghan: 

I ideally would really like to keep doing the holistic method I’m doing with my diet and lifestyle changes. That will help lower my thyroid hormone levels. That’s my big issue. My body doesn’t react well to medication. I want to be able to put off the medication if possible and be able to manage it holistically just by lifestyle changes. 

Dr. Eric:

In your opinion, is there anything preventing you from restoring your health? Are there any potential roadblocks? 

Reghan: 

No. At the moment, I’m in college. I go to the University of Alabama. The school is not located- I want to wait until I’m finished with my senior year if I wanted to go the medication route and if the holistic medicine I’m doing isn’t working. 

Dr. Eric: 

Okay. Sounds good. I had you prior to this fill out a form. Some of your biggest health challenges: keeping your weight healthy, preventing your hyperthyroidism from progressing, keeping your T levels down. All of these are really good goals. Have you worked with a natural healthcare practitioner at all? 

Reghan: 

No, I have not. I am working on getting a nutritionist to work with. It’s more just looking at what other people have said works for them holistically. Reading books and doing my research. 

Dr. Eric: 

Just out of curiosity, how did you find out about me? I don’t know if you remember. 

Reghan: 

My mom has been doing a lot of research on thyroid health and holistic methods, people who have really seen results from doing it. She came across your name and sent it to me. 

Dr. Eric: 

Cool. She has more of a natural mindset as well? 

Reghan: 

Yes. 

Dr. Eric: 

That’s awesome. You’ve made some diet changes, trying to eat a healthy diet. How about stress? Going to college, it doesn’t matter what stage in life you’re at. Being an adult in the workforce after school. How would you say currently stress is as well as over the last year or two? Like you said, this has been developing over time. 

Reghan: 

I am going back to school in two weeks. At the moment, my stress level is very low. I am not doing too much stuff that would stress me out. I work at night. I’ve been at the beach all summer, which is a very relaxing place for me. When I go back to school, I’m a naturally anxious person, so I tend to be a little more stressed in school. I’m trying to destress at the end of the day and focus on that every single day. 

Dr. Eric: 

Are you doing anything specifically besides going to the beach, which I’m sure is very relaxing, for stress? 

Reghan: 

I try to get out for an hour a day to exercise, whether it’s going for a run or a walk. That really helps me get to a good mental place, so I’m less stressed at the end of the day. 

Dr. Eric: 

How is your sleep now? How is it when you are in school? 

Reghan: 

My sleep is good. I’ve never had issues with my sleep. I naturally wake up early in the morning, like 7am/8am, and I go to bed usually around 10pm/11pm. Once I go back to school, that probably will change because of the environment I’m in. 

Dr. Eric: 

Even when you’re in school, it sounds like you’re not sleep-deprived. You do your best to get a good night’s sleep. 

Reghan: 

No. 

Dr. Eric: 

Good. As far as testing, you mentioned you had a thyroid panel done. I assume they tested antibodies? Do you know if that’s how they came up with a diagnosis? Did they do an uptake scan? 

Reghan: 

Yes, I did an uptake scan probably mid-May. That was with my endocrinologist. He already thought that I had Graves’, but we got that to confirm. I got bloodwork with that as well. 

Dr. Eric: 

Did he mention anything about radioactive iodine or thyroid surgery, or just pretty much talking about medication? 

Reghan: 

Mainly medication. I wanted to avoid doing any thyroid ablating, anything that I would have to be on life-saving hormones for the rest of my life. 

Dr. Eric: 

Yes, I definitely agree with that. Any other blood testing that you have done? I assume they probably did at least a metabolic panel, a CBC. Have you had Vitamin D tested or an iron panel or B12 or any blood sugar markers? 

Reghan: 

No, not recently. I probably had in past bloodwork, but not in the recent four times I’ve gone. They just have been strictly to look at my thyroid hormone levels. 

Dr. Eric: 

Have you ever had any functional medicine testing such as adrenal or saliva testing or dried urine testing or stool testing? 

Reghan: 

No. 

Dr. Eric: 

How about environmental toxins? We live in a toxic world. It’s not getting any better. Do you do anything- Diet-wise, you try to eat organic at home. I don’t know if in college, it might be more challenging. Do you do anything else? Do you do regular conventional care products or cleaning products? 

Reghan: 

I have been trying to drink more out of glass cups and not do as many plastics. That was one big thing. As far as shampoo and conditioner, body care stuff, I have been using what I have always used. I haven’t really changed that. 

Dr. Eric: 

At your age, I’m hoping that you don’t have any silver fillings, mercury amalgams. I know it’s not that common these days. Any root canals? 

Reghan: 

No. 

Dr. Eric: 

Is your oral health pretty good?

Reghan: 

Yes. 

Dr. Eric: 

My next question has to do with mold. Do you live in the dorms? 

Reghan: 

I did live in a dorm my freshman year, and it was probably 100 years old. There was black mold. At one point, I had black mold in my bloodstream, and I had to be on some special probiotic to help fix whatever was going on. This was from drinking the water that wasn’t cleaned properly. 

Dr. Eric: 

How long ago was this? 

Reghan: 

This was about two/three years ago. It’s my freshman year. So almost three years ago. 

Dr. Eric: 

Did you get tested for mold? You took the probiotics and got the recommendation. 

Reghan: 

I did a bloodwork panel, and they said this happens. If you live in an older dorm, this can happen more frequently. I am not really sure. There could be mold in your bloodstream or your body, so they just put me on an extra-strength probiotic, and it fixed the issue. 

Dr. Eric: 

Thankfully, you’re no longer in the dorms. Hopefully, where you are, not that you can’t have mold in an apartment or house. I have a daughter who currently is at NC State in the dorms. There is that concern. Thankfully, you’re not in that environment. 

Reghan: 

No. 

Dr. Eric: 

Before giving my feedback, any questions you have for me? 

Reghan: 

At this moment, no. I am more interested in what you have to say from your medical perspective. I know you focus more on holistic medicine. I want to know what your opinion is and how I can change my lifestyle based on what you think and not just based on this stuff I’ve read. I feel like I’ve read all these different opinions on what I should do. I would love to hear it from someone who really knows what they’re talking about. 

Dr. Eric: 

Sure. You’re doing a number of good things. You’re cleaning up the diet. You’re active, going for a run or walk every day. Is it on a daily basis? 

Reghan: 

Yeah, usually a daily basis. Weather-contingent, I will usually do an hour and a half walk or run per day. 

Dr. Eric: 

Taking care of your sleep. Those are some good things. Definitely want to continue doing things from a diet and lifestyle standpoint. 

With exercise, I would make sure not to overdo it, but the walking should be fine. With hyperthyroidism, if you have an elevated resting heart rate, which I know you don’t monitor, and you feel okay from a symptomatic standpoint other than tremors, I would be cautious with running. I am not saying not to run. 

One thing I do have my patients focus on is resistance exercise, doing some type of weight-bearing exercise. It doesn’t have to be with weights; it could be using your own body weight or with bands. You said the University of Alabama? 

Reghan: 

Yes. 

Dr. Eric: 

I’m sure they have a pretty extensive fitness place if you wanted to use their equipment. You don’t absolutely have to do that. With hyperthyroidism/Graves’, low muscle mass is common as well as low bone density. Doing some weight-bearing exercises definitely could be helpful. 

There’s no single diet that fits everyone perfectly. I do have a book that recently came out called The Hyperthyroidism Healing Diet, which actually has three different diets. I talk a lot about AIP. Might be a little bit challenging for you to follow while at school. Even following a regular paleo or modified paleo diet. Maybe you are currently following something similar to that. 

The #1 thing I would make sure to try to focus on eating is whole healthy foods. Trying to avoid refined foods and sugars. Might be a bit of a challenge when in college. Since you’re not in the dorms, I don’t know how it works. Do you not have a meal plan? Do you get your own food and do your own cooking? 

Reghan: 

I do not have a meal plan. I just do my own cooking. I have been looking into doing Thrive Market. There is a box of protein that gets sent to my house. I have been trying to look into stuff that could promote me buying healthier foods and keeping my diet going. I know it will be hard when I get back to school. I will try my best to keep everything pretty much the same as what I’m doing right now. 

Dr. Eric: 

With the meal plans and eating at the cafeterias at school, not that they don’t have some healthy food, but usually not organic. At least not at NC State. Just try your best with your diet. Check out my book if you haven’t already. I also have a lot of information on the podcast and my website.

I asked you about thyroid hormones still being elevated. When I dealt with Graves’, I didn’t take antithyroid medication, so I can relate with you not wanting to take that. Some of my patients do choose to take it, and that’s fine. You want to do something. Have you taken bugleweed or L-carnitine? 

Reghan: 

No. I have looked into getting bugleweed. I just went to a supplement store near me, and they didn’t have it. I was going to order it, but I haven’t gotten around to it. 

Dr. Eric: 

It’s not a common supplement, so it’s not a shocker that it wasn’t in the health food store. You can definitely get it online. It doesn’t work for everybody, but I would say 70-75% of people, it works for.

L-carnitine in higher doses, like 2,000-4,000mg according to the research, also helps block the entry of thyroid hormone into the cell. 

Whether it’s bugleweed or L-carnitine, and some people take both, you want to do something to lower thyroid hormone levels. I took motherwort, too, but I was experiencing heart palpitations. If you are not experiencing that, you might be fine with just bugleweed or L-carnitine. Definitely something to keep in mind, which it sounds like you are. 

Toxic load. Keep up the good work. Glass, trying to minimize plastics as much as you can. Maybe look into some natural products that you use on an everyday basis. It doesn’t mean that you need to switch everything. Slowly make a transition to more natural products to reduce your toxic burden. 

When it comes to Graves’, it’s more of an immune system condition than a thyroid condition. You need to lower your thyroid hormone levels to keep you safe and make sure it doesn’t affect the heart and bones, which it does when it’s elevated. At the same time, you want to do things to improve the health of your immune system: finding and removing triggers, correcting underlying imbalances. Diet and lifestyle definitely play a big role in that. 

Sometimes, you need to dig deeper. This is where potentially working with someone, like a functional medicine practitioner, may be something to look into in the future. If you can’t do that now, especially with college, focusing on diet and lifestyle. Looking into certain types of testing. It depends. 

We didn’t do a comprehensive health history here. With most of my patients, I will do some type of adrenal testing. I’ll do more blood testing that you mentioned. If you didn’t get Vitamin D, that’s a good marker to start out with blood test-wise because healthy levels of Vitamin D, above 50, is important for an optimal immune system. A lot of people are deficient in Omega-3 fatty acids, so you could do a fatty acid panel. Did you say you’re taking Omegas? You said turmeric and a probiotic. 

Reghan: 

Yes, I’m taking Omega-3 and Vitamin D. 

Dr. Eric: 

Okay. You haven’t tested for Vitamin D? 

Reghan: 

No. 

Dr. Eric: 

Eventually, you might want to test. Maybe your levels are optimal; maybe it’s less than optimal. Don’t want it to get too high. Do you know how much off the top of your head of Vitamin D you’re taking? 

Reghan: 

No. The bottle I have recommends taking two supplements, but I take one a day. 

Dr. Eric: 

I would eventually retest when you get a chance. Diet and lifestyle. If you’re doing that while managing the symptoms. If things head in the right direction, that’s great. It might head in the right direction because you’re taking bugleweed, and you really won’t know until eventually you get to a point where you may not have to be on bugleweed. 

That’s what happened with me when I dealt with Graves’. I was on bugleweed but also doing other things to improve my health. While taking bugleweed, my thyroid numbers would go on the hypo side, which was a sign that I didn’t need as much bugleweed and was able to wean off. if you don’t get to that point, then you know there are still things you need to do to address the underlying cause. 

That’s where working with someone to do some testing besides the testing that the endocrinologist does. That’s what I do, but other practitioners do it as well. There are other functional medicine practitioners, including I’m sure in Alabama. A lot of others like me work remotely. Something to consider. 

Definitely makes sense to do as much as you can from a diet and lifestyle standpoint. Try to keep that up while you’re in school, which you mentioned you will try to do. 

Before we wrap up, are there any last questions on your end? 

Reghan: 

No, I don’t think so. I really appreciate what you’ve had to say. I’m going to take it to heart and really do some of your suggestions. I’m going to go on Amazon right now and get some bugleweed. When I do my next blood test, which I’m doing in the next two weeks, if I start taking it, it will hopefully lower my hormones. 

Dr. Eric: 

Have realistic expectations. It will take some time. if you start taking it tomorrow, for example, you might not see it decrease the next blood test if you are getting it in two weeks. It might be the one after that. Keep realistic expectations with that. 

Also keep in mind, which you might already know. There is a lot of free information out there. You have to be careful about the free information. I have my podcast, which this will be on. My books, I have two specifically on hyperthyroidism. Those obviously aren’t free, but they’re low cost, and they do give a lot of good information as well. If you’re not in a position to work with a functional medicine practitioner, definitely check out the podcast as well as the articles on my website and the books. 

Reghan: 

Okay, great. Thank you so much. 

Dr. Eric: 

All right, thank you so much, Reghan.

Recently, I interviewed Dr. Roy Steinbock, and we discussed how thyroid conditions present in children, the importance of early diagnosis and comprehensive testing, the challenges of diagnosing thyroid issues in children, the role of nutrition and lifestyle, why treatment approaches must differ for adults and children, the need for a holistic approach to pediatric thyroid health, and more. If you would prefer to listen to the interview you can access it by Clicking Here.

Dr. Eric Osansky: 

I am super excited to chat with Dr. Roy Steinbock. We are going to be talking about thyroid conditions in children. Very interesting conversation. Even though I have a practice where I see mostly adults, I do see some children. It’s great to speak with someone who focuses on them. I know we’ll talk about you seeing some adults, too, so it’s not exclusively children, but you see more pediatric patients than I do. Great to have this conversation. 

I should mention that Dr. Roy is a repeat guest. Recently, I had him and his wife Debbie on the podcast as we chatted about the Elemental Diet. You want to check that interview out. 

Dr. Roy Steinbock is a board-certified pediatrician with an integrative and patient-centered approach. With over 20 years in primary care, he built a solid foundation assisting patients and families dealing with the diverse range of medical conditions. He believes that investigating the root cause rather than only addressing symptoms is the best route to achieving and maintaining optimal health and wellbeing. 

In 2006, Dr. Roy founded Mindful Pediatrics, so he could combine evidence-based western medicine with a functional and mindful approach. It is his own nutritional, spiritual, and lifestyle choices that complement his pediatric practice and continue to influence his approach as a physician. 

His degrees include a BA with honors from UC Berkeley and a doctorate in medicine with honors from the University of Tel Aviv, Sackler School of Medicine. Dr. Roy completed a pediatric residency at the Schneider Children’s Hospital in NY. Since residency, he has worked as a pediatric in-patient doctor in a newborn nursery and neo-natal ICU in several pediatric emergency rooms and for a large pediatrics private practice in Denver. He has completed advanced courses in functional and integrative medicine and maintains a lifelong passion for learning. 

What an impressive bio. Welcome, Dr. Roy. 

Dr. Roy Steinbock: 

Thank you. It’s always funny hearing someone else talk about you like that. 

Dr. Eric: 

You have gone through a lot of training. Usually, I tell people if they could give their background, but we did. If you want to expand a little bit. Why did you decide to name your practice Mindful Pediatrics? 

Dr. Roy: 

It’s funny because now “mindful” is a household term. When I named my practice Mindful Pediatrics a little over 20 years ago, people didn’t have a clue what that was at the time. I have always been a bit of a spiritual seeker. I actually got turned onto eastern philosophy, Buddhism, in my college years. I meditated regularly, but it wasn’t until the year before I opened my practice that I got turned into vipassana meditation. I did a couple of these silent 10-day retreats, and that’s what inspired me to quit my job at a big pediatric practice in Denver and start my own thing and do it the way I wanted to do it. 

Mindfulness is an approach to life, and it certainly has influenced my approach to medicine. It’s part of my meditation and mindful practice. It’s a lot of what informs the decisions I make day to day in my practice. It keeps me focused and present. It felt appropriate at the time and still does. 

Dr. Eric: 

Makes sense. One thing when it comes to your training, especially with pediatrics. In medical school, in your residency, did they get into any functional medicine or nutrition? Anything about actually improving children’s health? Obviously, some sort of wellness, but not really when it comes to diet and stress management. 

Dr. Roy: 

Not in medical school. I always joke that my nutrition course was nutrition pathology, so it’s things like scurvy and Rickett’s, which I have seen. That is the only serious nutritional deficiency I have seen in my career.

In residency, you learn a lot about children’s wellness when you are doing training. I did the primary care track, so I did a lot more work in primary care practices because I knew that’s what I wanted to go into initially. 

It was really my own personal interest. I have always been an athlete and interested in my own personal health. I have experimented with different diets growing up in high school, college, and afterwards. When I finished residency, I realized I had this big gap in my knowledge base, so I started taking courses in nutrition. That led to meeting naturopaths and chiropractors. I had never heard of a naturopath until I finished my residency. I met all of these other people who were practicing more holistically.

It was right around the time Andrew Wyle came out with his first real big book, not to date myself. I read that, and I was like, “Oh, this is exactly what I want to do. Of course I want to look at everything. I want to look at the whole picture. Why wouldn’t every doctor want to do that?” 

Dr. Eric: 

Yeah. 

Dr. Roy: 

Nutrition was really the gateway for me. Then I learned about supplements, herbs, and functional medicine testing. 

Dr. Eric: 

In your practice, your wife Debbie handles nutrition. I’m sure you have some basic conversations. I don’t know so much about the child, but also the parents are there most of the time when dealing with children. Teenagers as well. 

Dr. Roy: 

Absolutely. Because I’m fortunate enough to have who I would argue is one of the best nutritionists on the planet in my actual practice, it’s a little different. I do talk about basic stuff with people. 

Really what I do more is a diagnosis, come up with a bit of a plan, but I really rely on Debbie. She is the boots on the ground to get the people to make the changes. She is amazing at meeting people where they are and getting them to move forward with their lifestyle. I don’t have long conversations.

It’s also age appropriate. Little kids, oftentimes, you say one thing, and they don’t remember it the next minute. Teenagers depend on their receptiveness. Debbie frequently works with the parents, depending on age. 

Dr. Eric: 

When I do work with a thyroid patient, sometimes the child isn’t even on the call. It depends on the age. If it’s a teenager, maybe. 13/14, in that case, maybe they will make a brief appearance. 

Dr. Roy: 

Agreed. It’s the same thing with me. I always like to do a physical exam, so they will come for the first appointment unless it’s a distance educational kind of thing. Oftentimes, then I won’t see the child again for a while, 3-6 months, depending on what labs we do. The kids don’t want to hear all the lab results most of the time, unless it’s an older teen or someone who is precociously interested. 

Dr. Eric: 

I was going to ask. The example I was giving, I am pretty much working remotely with people, but you are seeing people in person. At least for the initial visit, you will have the child and parent, I’m sure. Do you do follow-up telemedicine visits as well, or do they always come in? 

Dr. Roy:

I do both. 50% of my practice right now, and it really is growing because of COVID and people’s receptiveness to telemedicine, is telemedicine, even the initial visit. It really depends on the subject, what’s going on, the issues going on with the child. Some things absolutely need to be seen in person, and some things don’t. 

I do a lot of distance consultations. They’re different because as a medical doctor, I have a license in Colorado, so I can only practice medicine in Colorado. But I do give second opinions and work with their doctor in other states; it’s a big part of my practice now. As you get more specialized and get expertise in specific things, people seem to find you for those specific things. 

Dr. Eric: 

Makes sense. This is getting into the thyroid side of things. Have you seen a greater number of children with thyroid conditions, especially autoimmune thyroid conditions, like Hashimoto’s and maybe some Graves’? 

Dr. Roy: 

Yes. For me in my practice, absolutely. It seems like the numbers are increasing. Interestingly, when I have talked about it with colleagues of mine who are endocrinologists, they say there isn’t an increase. I have scoured the internet to see: It’s not really clear whether it’s really increasing. It seems like autoimmunity in general seems like it’s increasing. I would argue it is. 

Part of it might be selection bias. People come to me when they have a lot of problems/second opinions/people who are not getting diagnosed in their first round of seeing doctors. I have become much more aware of it in all fairness. Debbie and I both have Hashimoto’s, so that has made us more expert at understanding. We have done our own research, and both have very strong family histories of it.

In general, I see more sicker kids in general. A lot more autoimmunity that I saw early on. Maybe some of that is selection bias because that tends to become what people have gotten good results with in my practice, so they tell other people. Then they send people who are sicker to my practice. It seems like it’s on the rise to me certainly. 

Dr. Eric: 

I agree. You mentioned maybe not just children, but autoimmunity in general. Since you focus more on the pediatric side, it would make sense that you see more children. Maybe with the endocrinologist, if they are seeing a mixture of adults and maybe some children, they just don’t notice as big of a difference as far as focusing on the children. I would agree, with the toxic world and the stressors we have dealt with over the years and other factors, overall, in both adults and children, there has been an increase in not just Graves’/Hashimoto’s, but autoimmunity in general. 

Dr. Roy:

Absolutely. It seems pretty obvious to me, but again, I only have my sample size. 

Dr. Eric: 

Is there a difference between diagnosing thyroid conditions in children compared to adults? 

Dr. Roy: 

Not really. What I was going to say is, this will tie into the diagnosis piece. Thank you for reminding me. Thyroid is tricky. What I mean by that is people can have symptoms before their labs show up as abnormal for a long time. People can have really abnormal labs because unlike adults, where it’s much more standard to do a screening annual lab test, people don’t do that with children in general. Even they don’t typically look at thyroid as a test. It’s not a screening test for kids. 

If you look at the symptoms particularly for Hashimoto’s or even Graves’, it encompasses pretty much every system in our body, everything from your joints to your energy level. In kids, commonly growth and development, school performance, anxiety, mental health. Often, people are missing the diagnosis for many years. That is maybe part of the reason why endocrinologists don’t see this rise. It’s really just such a lag between symptom onset and diagnosis oftentimes for children and adults. 

In terms of the testing, it’s not really different. Anyone who comes into my practice and is suffering pretty much from any condition that is either chronic or new onset, unusual, not something obvious like strep throat or a tummy bug. People who are coming in with long-standing or really acute new onset symptoms that don’t make sense, I will check thyroid. Depending on what it is. If it’s not very serious, I will start with just TSH or TSH and free hormones, free T3/free T4. 

But if I am not really sure what’s going on, I will also check thyroid antibodies, both the Hashimoto’s antibodies, the TPO and antithyroid globulin, and also thyroid stimulating. What I have seen frequently in kids is if you catch it early on, they will both have TSI and Hashimoto’s antibodies. Usually, if you wait long enough or miss the diagnosis early on, they will generally just end up having Hashimoto’s. 

That’s one of the reasons you won’t see an elevated TSH right away. They’re actually getting stimulated by the thyroid stimulating immunoglobulins, so their TSH actually looks normal, but they are not feeling well.

I don’t know about you, but I find that people, even if their thyroid numbers are normal, sometimes they are still not feeling great if they have antibodies. That might be particularly early on, the first signs. If you do early treatment, then you can get them to improve much more quickly oftentimes rather than waiting until their thyroid is really imbalanced with an elevated or low TSH. 

That’s what I start with. I also look at things like why this person has an autoimmune condition. That is where I get more into stool testing, allergy testing, nutritional testing. I have what I call my dealbreakers. If these things aren’t balanced, you can’t expect the body to work well, particularly the immune system, both for kids who are getting sick a lot and kids who have allergies, eczema, asthma, hyperimmune type stuff, and autoimmunity. 

I at a minimum look at things like Vitamin D deficiency, which is shockingly common. I just saw someone who had a Vitamin D of 10. I have had one lower than that, 9, before in my practice. That is a level where you can have Rickett’s, especially living in Colorado, which is so sunny.

I will look for, especially really important at altitude but at sea level, too. I will look for iron and storage, ferritin. We don’t see a lot of anemia here because people have a higher amount of EPO. That’s why people train at high altitude because we have higher hemoglobin levels. The average is 13 or 14 versus 10-12, which is at sea level. The definitions for anemia don’t really apply so well here at altitude. 

I have to check things like ferritin level, iron storage. If you are not anemic but have low iron storage, that can affect the immune system, sleep, nervous system, development. I’ll aim to work for that to get those elevated. 

Zinc also seems like one of those real dealbreakers. If zinc is really low, I find people’s immune system doesn’t work well. Zinc is really involved in cell turnover, growth and development for children. 

Those are three basics I check for anyone coming in for basically any condition besides optimal health. Those are great places to start. Looking at things like stool testing. It depends on what’s going on. We can get into the weeds with mold testing and that stuff, too. That’s not where I start. 

Dr. Eric: 

Makes sense. Vitamin D, iron panel. You can’t just go based off a CBC. If someone doesn’t have anemia. That’s true in general. Not everybody with an iron deficiency has anemia, even if they are not living in higher altitude. I like to test pretty much with all my patients. I like to look at a full iron panel with everybody. If ferritin is elevated, that could be related to inflammation. You can’t just conclude someone has iron overload based on that.  

Dr. Roy: 

Exactly. That’s why I will look at CBC and ferritin at the same time. Especially with kids who get sick so frequently, because even if you just have a cold, your ferritin level can be elevated as an acute phase reactant. 

Dr. Eric: 

Do you just do a regular serum zinc, or is it an RBC zinc? 

Dr. Roy:

I love RBC zinc. I dove into the research on this. I never got into the hair analysis. I see a lot of mental health stuff, so I am thinking about doing it, specifically to look at lithium levels because there are not great ways to look at lithium otherwise. 

In any event, I do an RBC zinc. I think it reflects a longer time frame, whereas serum zinc can change pretty dramatically depending on what you have eaten. It’s more moment to moment. As an acute thing, maybe serum zinc is better, but I prefer red blood cell zinc. I know that’s a little bit debated what the best form is, but that’s the one that I’ve had the best luck with. 

Dr. Eric: 

I agree with you. Same thing with magnesium. I prefer RBC magnesium over serum magnesium. There is selenium. Do you ever test selenium levels? 

Dr. Roy: 

I don’t. Is there an RBC selenium level to test? 

Dr. Eric: 

There is. I can’t say I recommend RBC selenium to everybody, but that is an option. There is RBC selenium along with magnesium and zinc. 

Dr. Roy: 

I think the reason my logic for it is first of all, the red blood cells last for about 120 days, so it’s giving you a bigger time frame. Then we also know that the majority of zinc is found intracellularly anyway. It’s 10:1 amount of zinc in the cells versus what’s in the serum, so it reflects a larger volume of what’s in our body, functionally what’s being used, I think. 

Dr. Eric: 

Let’s talk a little bit about some of the other tests. It sounds like it varies depending on the person. Food sensitivity testing sometimes. Stool testing. 

Dr. Roy: 

First and foremost, anyone who’s got any autoimmune condition, I will check a Celiac test. There is a very strong association between autoimmune conditions and your propensity to have another autoimmune condition, especially thyroid and Celiac. I think there’s a 20% connection between Celiac and thyroid conditions. That’s #1. 

Celiac is really one of those things because it’s the yield of treatment. If you catch someone who has Celiac, it’s such an easy fix. The cost of the test is not very high. I tend to do those a lot with anyone with chronic health issues. Especially someone with thyroid. 

I’ll do a full Celiac panel. In that, I include both the tissue transglutaminase and the deamidated gliadin antibodies. Of course, a total IgA as well, to make sure they are not IgA deficient.

I’ll sometimes do more food allergy or sensitivity panels when those seem appropriate.

I’ll do a stool test on everybody who comes in for a thyroid condition because the gut is so important for immune regulation and inflammation. Oftentimes, that’s the first place to look. 

The first functional medicine course I ever went to, do you know who Patrick Hanaway is?  

Dr. Eric: 

From IFM. 

Dr. Roy: 

Yes. I randomly sat with him at a lunch and started talking to him. I didn’t realize who he was at the time, the bigwig in functional medicine that he is. He saw I was fresh with it and basically said, “Do yourself a favor. Focus on the gut first. Learn everything you can about the gut first.” That’s what I did. That’s obviously paid huge dividends. 

It’s still really the mainstay of my practice. Digestive disorders of course, but all the things that follow it, things like autoimmunity. I really focus on gut health. That’s with Debbie’s initial expertise as well. It’s expanded over the years. It’s a big part of our workup. 

Dr. Eric: 

When I interviewed you and Debbie, that was a big focus of our conversation, including the Elemental Diet. 

Dr. Roy: 

That is such an amazing thing for people who have flares of autoimmunity or even to calm things down. 

Dr. Eric: 

Gut tests. A comprehensive stool test on everybody. Food sensitivity testing, depending on the person. Maybe some other tests. 

Speaking of the Elemental Diet, how about SIBO? I assume you don’t do it on every single person, but if you suspect it. 

Dr. Roy: 

Kids have a lower incidence of SIBO in general. But I do test it. It is a frequent test I do. If I diagnose someone with a thyroid condition, and they have any digestive symptoms, and they’re old enough, because I have had some kids with Hashimoto’s and Graves’ who are under two or three years old, as it is very difficult to do a SIBO test on those kids. Anyone who is old enough, I might do a SIBO test. 

It’s not my first thing. I’ll do a stool test first. If the symptoms make sense, then I will do a SIBO test. If I am not getting results from a basic stool test, I’ll do a SIBO test as well.

Because of Debbie’s practice and her focus on SIBO, that’s been in my consciousness maybe more so than it would be had I not been married to her and learned everything she teaches me. I am more aware of it than maybe the average pediatrician. But I see it much less frequently. I get more negative tests than Debbie does. Part of that is patient selection. 

Dr. Eric: 

Circling back to the thyroid. When do you get uncomfortable with the TSH? Obviously, TSH alone, you can’t just rely on that. Like you said, there could be other variables like the TSIs. I would argue most doctors, including pediatricians and endocrinologists, don’t pay attention until the TSH is above the lab range, like 4.5 or 5.0, depending on the lab. 

Dr. Roy: 

Or even higher. If you look at some of the recommendations, some people say in pediatrics not to treat until the TSH is above 10. That seems crazy to me. I really focus on what I was taught in medical school to focus on patient symptoms. If the symptoms make sense. 

A couple things with that, Eric. Kids tend to run higher TSH. It makes sense if you think about what the thyroid is doing. The thyroid is intimately involved with development and growth and energy in the body. Kids are using a lot more energy; they’re growing. Their thyroid is working harder. It would make sense if your thyroid would be higher to stimulate your thyroid gland to produce more thyroid hormone. So you have to be careful.

If you look at normal TSH, in the first few days of life, 15-20 can be normal. Really high amounts of TSH. Quickly, within the first few weeks, it does normalize close to adult levels. At least what the standard endocrinologist will say is 0.5-5. 

What I do in my practice is when it’s adults, and we can talk about the type of adults I treat in a minute, I do try to stay between 0.5-2, maybe 1.5, depending on how someone is feeling. With children, you have to let it go a little bit higher because of their natural propensity to have higher TSH. 

If someone has frank hypothyroid symptoms—constipation, cold intolerance, their hair is falling out, super dry skin, really extreme fatigue, anxiety—then I would treat at a lower number than if someone was what they would call subclinical. I don’t love that term. In any event, I will base it mostly on symptoms. 

If they have thyroid antibodies, obviously, I might be quicker to treat than somebody who is not. Most of the patients I’m putting on thyroid either have frankly elevated TSH, above 5 or 6, even without thyroid antibodies. Or I have diagnosed them with thyroid antibodies, and I see their TSH creeping, so I’ll watch over a period of time and watch their symptoms. 

If their TSH is 3, 3.5, I might just watch it if they are not having symptoms. If I see it creep up to 4, 4.5, 5, I will start treating sooner than later. I don’t necessarily want to wait for them to feel terrible before we start treating them, especially if they have antibodies and creeping TSH numbers. That’s how I do that. 

The other interesting piece is though I myself take natural thyroid- 

Dr. Eric: 

I was about to ask you this. 

Dr. Roy: 

I knew you would ask this. We know that thyroid conditions are much more common in females than males. That’s true with children as well. It’s almost 10:1 in children as well. I definitely see that. The number of boys I have seen with thyroid conditions have been a handful, whereas I can’t count the number of girls I have seen in my practice, particularly peripubertal. I see a lot near hormonal changes. There is the rare kid who gets a thyroid condition at 2, 3, or 4. It’s often 11, 12, 13 for girls. 

I found that during that time, it’s really challenging for me, at least from what I have been able to tell. It’s harder to control them with natural thyroid than just using synthetic T4 only. Though I did use that for years, I just found the ups and downs during puberty are really challenging to manage for girls with hypothyroidism. Once I switched to using synthetic only, it’s still hard, but it feels less difficult. I’ll do that. If they are doing amazing, I’ll leave them on that. 

At some point, if we have additional symptoms, things we typically think of with low T3 like hair loss or insomnia, then I might add in the natural thyroid or switch them. 

If someone is doing really well, I don’t like to make changes. I want to keep them happy and thriving. 

Dr. Eric: 

Makes sense. Adults like yourself, usually you will recommend the desiccated thyroid hormone. With children, you find on average they seem to do better with, say, levothyroxine. 

Dr. Roy: 

The adults I treat are really specific. I don’t have a general adult practice. I am a pediatrician. I do see a lot of young adults, so people who are college age, maybe into their mid-20s. That’s a pretty common thing, especially living in a college town, which is minutes from my practice. 

Because a huge part of my practice is focused on mental health, and so many young adults have a lot of anxiety these days, that’s been a gateway into my practice for young adults. A lot of them have thyroid conditions, too. 

Anxiety might be the #1 way I have diagnosed kids and adults with thyroid conditions. It’s really been insomnia, anxiety, panic attacks, new onset extreme symptom versions of that. 

The #1 adult I see is moms in my practice. As they come in, I ask them how they’re doing. Of course, I care about how the moms are doing because they are people I care about, but also because they are taking care of the children, which is my #1 focus. I start asking them questions. I’ve had many moms tell me, “I can’t go out in public anymore. I’m having panic attacks.” Then I’ll do my workup. I’ll do those things I mentioned, like the nutrient deficiencies. I’ll start with a full thyroid antibody panel. I have probably diagnosed more moms in my practice with thyroid disorder than kids over the years. It’s probably double the number. 

I’ll end up monitoring them and treating them if they want. Usually, they seem to want that. Oftentimes, it’s so bad that we need to treat the anxiety very intensely, maybe even use medications for anxiety to calm it down until we get the thyroid balanced. Then almost invariably, I find we can get them off an SSRI once their thyroid is calm within a few months. Their mental health improves dramatically. 

Dr. Eric: 

Would you say that most of the moms you work with with thyroid conditions have children with thyroid conditions or not necessarily? I am sure you see some with seeing their children with something else or a wellness visit, and you end up diagnosing the mom. 

Dr. Roy: 

1 in 5 women have Hashimoto’s or some thyroid condition. Maybe the number is higher than that. No, not 1 in 5 kids have it. I would say there is a higher propensity for, and we know there is a genetic component for autoimmunity in general. Hashimoto’s, we do see runs in families for sure. My mom has it. I have a very strong family history, as does Debbie’s family. 

I’m more cautious. When I see someone who’s had thyroid cancer, Graves’ or Hashimoto’s, when their kids come in, I will do more regular screening, even if they’re totally well. The earlier you catch these things, the better it is, and the less likely they will have serious long-term problems. We will focus more on things like diet and lifestyle that decrease the risk of autoimmunity, maybe moreso than I would for the average healthy kid without a family history. 

There is an increase, but a relatively small increase. We see thyroid conditions really develop around puberty for women, pregnancy, post-partum, menopause. Those are the big risk times. It can happen any time. That’s much later on. Kids typically come to me when they’re very young. Around that time, there is an increased risk. We will see more in families that have thyroid conditions. 

Dr. Eric: 

Graves’. I know you see a lot more children with Hashimoto’s, children and moms, because it’s much more common to have Hashimoto’s. When you do have someone that you end up diagnosing with Graves’, do you usually refer them out to an endocrinologist? Do you actually prescribe antithyroid medication for the few children that you have seen with Graves’? 

Dr. Roy: 

I usually refer to an endocrinologist for that. I will do the initial workup. I’m curious about your thoughts on this. I really do like to do thyroid ultrasounds for anyone who becomes positive with antibodies. Anyone who has a goiter, I’ll do an ultrasound on them. 

I know it’s not the standard recommendation. I think that’s partially financial. Maybe it doesn’t make sense to screen everybody financially as a gigantic population from a public health perspective. But I think as an individual, it makes sense in my opinion. 

You want to make sure there are no significant nodules to follow and things like that. I’ve had one patient only who had thyroid cancer at a very young age. That alone is worth it in my opinion. That could have easily been missed and would have been life-threatening for this little boy, who is doing amazing right now. 

I find it’s so much harder to treat. That’s why I will often consult with you if I need to. It is so much easier to give thyroid replacement. If your thyroid is not working and work up the cause. When the thyroid Is overactive, I will try herbs. Sometimes, I’ve had some success. 

Fortunately, if you wait long enough, most of the time, Graves’ will burn out. But I’ve had a few patients where it doesn’t, and they have needed a thyroidectomy or radioactive iodine unfortunately. 

It’s a little out of my scope, I would say, to prescribe the thyroid depressing medications, just because they do have their own risks. It’s something I feel more comfortable when an endocrinologist follows. I will also follow them. 

If someone has Hashimoto’s, they stop with an endocrinologist and continue with me, if it converts from Graves’ to Hashimoto’s, which is common. 

Dr. Eric: 

Yeah. Is that what you meant by what you said when most people “burn out?” They develop hypothyroidism? 

Dr. Roy: 

I have seen it in moms quite a bit as well. Particularly with post-partum thyroiditis- 

Dr. Eric: 

And Hashimoto’s. 

Dr. Roy: 

Fortunately, most of the time, eventually, if you can just wait it out and use some supplements or even thyroid-suppressing medication, you can wait it out and that swill switch over. There is a handful where it doesn’t. It’s not something I see a ton of. Because of that, I prefer to have an endocrinologist involved. 

Dr. Eric: 

Yeah, I get it. I do agree with you with the ultrasounds. Especially if someone has an existing thyroid condition, or you suspect they have one. They’re not that expensive when compared to other diagnostics. When I dealt with Graves’, the endocrinologist I saw recommended not to get an ultrasound, and I talked her into getting me one. I was paying out of pocket, so I think she was trying to save me money. It was $200 at the time. 

Dr. Roy: 

I think it’s still about $200. I do one every once in a while for myself. Debbie and I will do them. She just did one a year ago, and it was $200. 

Dr. Eric: 

It’s cost-effective to me, even if you have to pay out of pocket. I think the insurance companies would pay if there is justification. If someone has a thyroid condition, to me, that’s justification. Like you said, try to rule out if someone has thyroid nodules or if it looks good. if it looks good, maybe that will be the only ultrasound they need. 

Anything else? I know we covered a lot. Is there anything I should have asked you that I didn’t ask you? Anything else you want to cover when it comes to thyroid health and pediatrics? 

Dr. Roy: 

I mentioned this before, but the take-home message, if I could tell anybody who is either a parent or a practitioner is that I think you have to look at thyroid very liberally to test it. Considering the list of symptoms, just spend a moment on the internet and google symptoms of Hashimoto’s or Graves’, and it can be almost anything. Everything from joint pain to the more obvious symptoms we know of. I just liberally look for it. If you look, you will find it more frequently than you think.

It could be patient selection for me. Selection bias on the type of people who find my practice. I would say anxiety is really the #1 way. The most common patient I find who has thyroid problems is a patient with relatively new onset anxiety or significantly worsening anxiety coupled with things like insomnia. 

I have not studied the DSM-V. When I was in medical school and doing my psychiatry residency, I was interested in it because mental health is a huge area of interest for me. Ruling out thyroid disorder is mandatory for every mental health condition. It’s not done. A lot of psychiatrists don’t do blood tests on patients, but I think it needs to be ruled out. 

If your child is struggling with any weird symptoms or chronic onset symptoms, thyroid testing is not super expensive, and it is one of those things where if you catch it early, you can prevent not just problems in the near future but problems really long term. Thyroid is that important. 

I think that would be my take-home message. When in doubt, test it. The tests aren’t perfect, but they are decent. If you get positives, you want to address it, arguably relatively aggressively. 

Dr. Eric: 

Agreed. Thank you so much, Dr. Roy. Where can people find out more about you? 

Dr. Roy: 

You can go to our website, MindfulFamilyMedicine.com. Or you can go to MindfulPediatrics.com or evenDrRoy.com. That is the main place to find us. We don’t have a real presence on social media at this point. I don’t know if that will ever happen. We have a great newsletter and lots of free information on the website. 

Dr. Eric: 

Wonderful. This was a great conversation. Thank you so much for sharing. Continue doing the amazing work that you do. 

Dr. Roy: 

Thank you. Likewise.