Many people with hyperthyroidism are pressured by their endocrinologist to receive radioactive iodine.  And while there is a time and place for conventional medicine, in my opinion radioactive iodine is the least desirable treatment option recommended by endocrinologists for hyperthyroidism.  Sure, side effects are common with antithyroid medication, and thyroid surgery also comes with risks, but I still don’t think radioactive iodine should be the first treatment option given.

Obviously neither radioactive iodine treatment or thyroid surgery is desirable, and hopefully you’re looking to avoid both.  And of course ultimately the decision is yours to make regarding what treatment to receive, but if you’re reading this blog post then you most likely are interested in avoiding radioactive iodine.  For those who need more convincing, here are three reasons why you would want to avoid this treatment:

1. Radioactive iodine doesn’t do anything to address the cause of the condition.  You probably already know this, as obliterating the thyroid gland doesn’t address the underlying cause of the problem.  Endocrinologists don’t consider this because their main concern is to manage the person’s hyperthyroidism.  But not addressing the cause of the problem can lead to other health issues in the future.

For example, someone with Graves’ disease is more likely to develop other autoimmune conditions in the future if the autoimmune component isn’t addressed.  I discussed this in a past article entitled “Multiple Autoimmune Syndrome in Graves’ Disease and Hashimoto’s Patients“.  And for those with toxic multinodular goiter, insulin resistance and estrogen metabolism are common causes, and ideally these need to be addressed as well.

For those reading this who have already received radioactive iodine, it is still important to address the cause of the problem in order to decrease the risk of developing other health conditions in the future.  But I’m guessing that most people reading this have not yet received radioactive iodine, and are hopefully are already taking action to find and remove their triggers, correct their underlying imbalances, etc.  How you accomplish this is up to you, as I have hundreds of free articles and blog posts on this website, have written a book on hyperthyroidism, and you might even consider working one-on-one with a natural healthcare practitioner who has experience with hyperthyroid patients.

2. Research shows that quality of life is worse in those who receive radioactive iodine treatment.  Although some earlier studies showed that the quality of life is similar among patients treated with antithyroid drugs, radioactive iodine, or thyroid surgery, a more recent study didn’t confirm this (1).  This study involved 1,186 patients with Graves’ disease: 347 patients were treated with antithyroid drugs only, 395 patients treated with radioactive iodine, and 233 patients treated with surgery. Quality of life was assessed using two different questionnaires at an average of 8 years after the diagnosis of Graves’ disease.

Among the three treatment groups, patients who received radioactive iodine treatment had worse thyroid-specific quality of life scores than patients treated with antithyroid drugs or surgery.  The radioactive iodine therapy group had worse scores for the following:

• Hyperthyroid symptoms
• Goiter symptoms
• Fatigue
• Anxiety
• Depression
• Emotional susceptibility
• Impaired social life
• Impaired daily life
• Impaired sex life

In addition, the study also shows that those who received radioactive iodine had worse scores in hypothyroid symptoms, eye symptoms, and appearance than the antithyroid drug group.  Now to be fair, patients in both the surgery and antithyroid drug group were younger than those in the radioactive iodine group (54 years compared to 35 years for those in the surgery group and 43 for the antithyroid drug group), and more patients in the radioactive iodine therapy group had other medical conditions that may affect quality of life.  But these factors alone didn’t explain the decreased quality of life.

3. Radioactive iodine might cause or exacerbate thyroid eye disease.  Not only do studies show this (2) (3), but I’ve also seen people who received radioactive iodine and either developed thyroid eye disease (TED), or experienced an exacerbation of their existing TED condition.  In the former case, the people probably had mild thyroid eye disease without symptoms, and then when they received radioactive iodine they developed overt eye symptoms.  So while many endocrinologists won’t recommend radioactive iodine treatment for those with active TED, this doesn’t mean that radioactive iodine can’t cause overt TED in those without eye symptoms.

You might wonder why radioactive iodine can cause or exacerbate TED.  Well, apparently radioactive iodine leads to prolonged worsening of autoimmunity against the TSH receptor (3).  Taking steroids after receiving radioactive iodine might prevent an exacerbation of TED, and so this is something to consider.  This is especially true with someone who has had Graves’ disease for less than 5 years, as there is an increased risk of new or reactivated TED.

Is Thyroid Surgery Really a Better Option?

While you want to do everything you can to avoid radioactive iodine, there is no denying that there are also risks of getting a thyroidectomy.  Once again, my goal is to help people get into remission, but unfortunately some people will need to make the choice between radioactive iodine and thyroid surgery, which is why I’m writing this blog post.  Anyway, while there are always risks with any type of surgery, there are increased complications with patients 70 and older, a history of congestive heart failure, smoking history, bleeding disorders, and some other health conditions (4).

However, complications can occur even in those without these risk factors mentioned above.  One of the most concerning complications of thyroid surgery is injury to the recurrent laryngeal nerve.  This in turn can cause unilateral vocal cord paralysis, thus causing hoarseness, changes in vocal pitch, or noisy breathing (5).  One study involving 11,370 patients showed that recurrent laryngeal nerve injury occurred in nearly 6% of thyroid surgeries.  I’m pretty sure this number is higher than some other studies shown, although remember that there are other risks of thyroid surgery as well, such as damage to the parathyroid glands (6) (7).

As I mentioned earlier, neither radioactive iodine treatment or thyroid surgery is desirable, as there are risks of both procedures, which is why for most people with hyperthyroidism I recommend trying to address the underlying cause of the problem.  If someone has a non-autoimmune hyperthyroid condition such as toxic multinodular goiter, while you also want to try to address the cause of the condition, there obviously isn’t a risk of developing or exacerbating thyroid eye disease after radioactive iodine.  But of course there are other risks.

Is Taking Antithyroid Medication For a Prolonged Period an Option?

Although I’m sure you understand that taking antithyroid medication doesn’t do anything to address the cause of the condition, and side effects are common, there are some people who do fine taking lower doses of antithyroid medication for many years.  So this is also an option to consider for managing the symptoms for those who struggle to get into remission.  While many endocrinologists are reluctant to recommend antithyroid medication such as methimazole for longer than two years, the research shows that long-term treatment with antithyroid medication is safe, especially in low dose and in adults, indicating that it should be considered as an alternative treatment (8) (9).

Quite frankly, if I was unable to get into remission when I was diagnosed with Graves’ disease, I definitely would have been open to taking a low dose of antithyroid medication instead of opting for either radioactive iodine or thyroid surgery.  Don’t get me wrong, as this isn’t the ideal situation, and perhaps taking bugleweed on a long term basis is another option I would have considered.  Ultimately your goal should be to do everything you can to restore your health, but if for any reason you’re unsuccessful in doing this I just want to let you know that there might be options other than resorting to radioactive iodine or thyroid surgery.  Obviously long-term treatment with antithyroid medication isn’t a good option for those who experience certain side effects such as rashes, nausea, dizziness, joint pain, elevated liver enzymes, etc..

Free 5-Day Hyperthyroid Healing Diet Challenge

Beginning on Monday February 1^st I will be conducting a free 5-day Hyperthyroid Healing Diet challenge, which will show you how to use food to heal your hyperthyroid condition.  Of course there can be factors other than diet, but without question it’s important to eat an anti-inflammatory diet in order to restore your health.  So it’s a necessary piece of the puzzle.  This challenge will benefit people with different types of hyperthyroid conditions, including those with Graves’ disease, toxic multinodular goiter, and even subacute thyroiditis.

To register for the free challenge visit the link below:

www.HyperthyroidChallenge.com

 

Happy 2021!!!  As you probably know, I’ve been helping people with hyperthyroidism/Graves’ disease and hypothyroidism/Hashimoto’s restore their health since 2009.  And while I’m proud of my book “Hashimoto’s Triggers” and will continue to provide content that can benefit people with both hyperthyroid and hypothyroid conditions, in 2021 I will be focusing a lot more on hyperthyroidism.  And the reason for this is simple.  While there are many practitioners that work with Hashimoto’s patients, there aren’t nearly as many natural healthcare practitioners who have experience working with hyperthyroidism.  In addition, since I personally dealt with Graves’ disease and have been in remission for 10+ years, there seems to be a greater affinity for those with hyperthyroidism.

Here are some of my goals for 2021:

• To create more blog posts that focus on hyperthyroidism/Graves’ disease
• To conduct more Facebook lives and Zoom calls that focus on hyperthyroidism/Graves’ disease
• To have at least a couple of free 5-day challenges focusing on hyperthyroidism (with the first one being in February)
• To create a new Facebook group for those with hyperthyroidism looking for a natural approach
• To begin putting together the outline for my next hyperthyroidism-related book
• To release a podcast that focuses on overcoming hyperthyroidism

In order to accomplish these goals, a few sacrifices will need to be made, and one of the biggest sacrifices involves greatly reducing the number of one-on-one consultations I do.  Don’t get me wrong, as I love working one-on-one with people, and I still plan on working one-on-one with patients in 2021.  That being said, I will be limiting the number of one-on-one consults, as I feel that if I accomplish the goals listed above that it will have a much greater impact on those with hyperthyroidism.  In other words, while I can only do a limited number of consultations each month, an unlimited number of people with hyperthyroidism can benefit from the information in my blog posts, books, future podcast episodes, etc.

Speaking of which, my goal is to help at least 10,000 people with hyperthyroidism avoid radioactive iodine and surgery over the next 10 years.  While my articles/blog posts and book have helped thousands of people save their thyroid gland over the years, I feel like I can do so much more.  If you have been following me for at least 5 years you might have noticed that I haven’t been releasing as many blog posts as I did in the past, and the reason for this is due to lack of time.  And while I can’t promise that I will immediately start cranking out more blog posts and other forms of content, I’m confident that as each month passes by you will see more hyperthyroidism-related information.

How To Save Your Thyroid In 2021

So now that you know my goals for this year, I’d like to go ahead and discuss a few things you can do to help save your thyroid gland in 2021.

1. Choose your endocrinologist wisely.  I realize that in some cases people are unable to choose their endocrinologist, and the truth is, most endocrinologists will recommend one of three things: 1) antithyroid drugs, 2) radioactive iodine, or 3) thyroid surgery.  In my opinion it’s not a big deal when an endocrinologist recommends methimazole or a different type of antithyroid medication during the initial appointment.  However, it is a big deal when they start pressuring you to receive radioactive iodine or thyroid surgery from day one.  I don’t expect endocrinologists to recommend a natural approach to their patients, but in most cases, removing or obliterating one’s thyroid gland should be a last resort.

2. Be safe while addressing the cause of your condition.  When I dealt with Graves’ disease I chose not to take antithyroid medication, but this doesn’t mean that this is the right choice for everyone with hyperthyroidism.  While bugleweed and motherwort did a wonderful job of managing my symptoms, these herbs aren’t always effective.  So while I can understand that some people with hyperthyroidism don’t want to take antithyroid medication and/or beta blockers, especially since side effects are common, just remember that everything comes down to risks vs. benefits.  I’m not saying that you should just deal with the side effects of the medication, especially if they’re severe.  All I’m saying is that if you can manage your symptoms with natural agents that’s great, but some people do need to take medication, and not everyone experiences side effects.

3. Eat an anti-inflammatory diet.  A couple of years ago I wrote a blog post entitled “Can Diet Alone Reverse Graves’ Disease and Hashimoto’s?”  In the blog post I discussed how diet is important, but there can be other triggers of thyroid autoimmunity.  That being said, regardless of whether you have Graves’ disease, toxic multinodular goiter, or a different type of hyperthyroid condition, it will be difficult to restore your health if you eat inflammatory foods.

So what type of diet should you follow?  While I commonly recommend an autoimmune Paleo diet to those with Graves’ disease, the truth is that there isn’t a single diet that fits everyone perfectly.  For example, if I work with someone who is a vegan or vegetarian, I usually will have them make some modifications to the diet, but it still will be a diet consisting of anti-inflammatory foods.  Of course there is some debate over which foods are anti-inflammatory, and while I won’t discuss this in detail here, there is no question that the following foods should be avoided while trying to restore your health:

• Refined foods and sugars
• Fast food
• Unhealthy oils (i.e. canola oil, peanut oil)
• Artificial ingredients

You may notice that I didn’t list foods such as grains, legumes, and nightshades, which are not part of an autoimmune Paleo (AIP) diet.  There are reasons why these are eliminated from an AIP diet, but I’d be lying if I told you that 100% of people need to eliminate grains, legumes, and nightshades in order to get into remission.  For example, nightshades are inflammatory in some people, but some people do perfectly fine eating tomatoes, eggplant, peppers and/or white potatoes.  And the same can be said with grains and legumes.  The problem is that there is no way to know who will heal fine while eating these foods, and who won’t recover.  This is why I usually recommend avoiding these foods initially, and then reintroducing them later.

4. Improve other lifestyle factors.  Stress management and sufficient sleep are both important for optimal health.  I have separate articles and blog posts on both of these topics.  With regards to stress management, if you’re not doing something EVERY DAY to improve stress handling I would recommend to block out five minutes and incorporate some type of mind body medicine (i.e. yoga, meditation).  Obviously spending more than five minutes per day would be awesome, but it’s important to first get into the routine of improving your stress handling skills.  Once you’re spending five minutes per day on a regular basis on stress handling you can then gradually increase the duration.  As for improving sleep, I once again would refer to other blog posts I’ve written on this topic.

5. Focus on improving your immune system health.  This is especially true for those with Graves’ disease, but in 2020 EVERYONE realized how important their immune system is.  Of course I’m sure that many people reading this understood the importance of immune health even before the events that took place in 2020.  Either way, you want to do everything you can to optimize your immune system health.  I’ve already mentioned a few things that can have a dramatic impact on your immune health (eating well, stress management, proper sleep).

Having a healthy gut is essential for a healthy immune system, and so you want to do everything you can to optimize your gut health, while at the same time avoid anything that can disrupt your gut health.  This includes food allergens such as gluten, and of course you’ll want to minimize exposure to gut-disrupting drugs such as antibiotics and proton pump inhibitors.

6. Reduce your toxic load. Last January I wrote a detailed blog post entitled “How To Reduce Your Toxic Load To Achieve Optimal Thyroid Health”, and so I definitely would check this out.  In addition, you might want to consider registering for the Free upcoming DIY Detox Summit (I’m one of the guest speakers).  You can register for this free event by clicking here.

7. Take full advantage of the free thyroid-related resources I offer.  I realize that not everyone can afford working with a natural healthcare practitioner like myself, which is a big reason why I decided to focus on creating even more free resources for those with hyperthyroidism.  I also should mention that I’m always open to suggestions for future blog post topics you’re interested in.  While I can’t promise that I will write a blog post every time someone has a suggestion, if multiple people ask me to write about a specific topic I definitely will consider it.

Free 5-Day Hyperthyroidism-Related Challenge Coming Soon!

If you have hyperthyroidism/Graves’ disease then keep an eye out for my upcoming 5-day challenge, which probably will be the week of February 1st.  More details to come soon.

Note: Fees Increasing on February 1st

If you’re interested in working one-on-one with me I would recommend to email my staff person Kate at staff@naturalendocrinesolutions.com asap, as not only will I be reducing the number of one-on-one consultations in the near future, but our fees will be increasing on 2/1/2021.

On Friday December 17^th I interviewed Dr. Evan Hirsch, author of “Fix Your Fatigue: The Four Step Process to Resolving Chronic Fatigue, Achieving Abundant Energy and Reclaiming Your Life”, and below is the written transcript.  If you would prefer to watch the interview you can access it by clicking here:

Here is the transcript:

Dr. Eric Osansky:

This is Dr. Eric Osansky. And I have with me Dr. Evan Hirsch. Dr. Evan Hirsch is a world renowned fatigue expert, and he’s the founder and CEO of the International Center for Energy and Fatigue, and the Virtual MD initiative. Dr. Hirsch suffered with fatigue for five years before he achieved resolution using the Fix Your Fatigue program that he pioneered in medical practice. He also has a best-selling book, a podcast, and online programs.

And through these he’s helped thousands of people around the world optimize their energy naturally. And he’s on a mission to help one million more. I should also mention that he helps licensed functional medicine providers transition to a successful virtual practice, which is big in this day and age in 2020. Also, he’s board certified in family medicine and integrative medicine. And when he’s not at the office, you can find him singing musicals, dancing, and playing basketball with his family. How are you doing today, Dr. Hirsch?

Dr. Evan Hirsch:

Hey, Dr. Thanks so much for having me on.

Dr. Eric Osansky:

All right. Yeah, we’ll have to shoot hoops one day.

Dr. Evan Hirsch:

That’s right.

Dr. Eric Osansky:

So, you’ve dealt with fatigue for five years before you achieved resolution?

Dr. Evan Hirsch:

I did. Yeah. The story actually begins when I started my residency program back in 2004. I was in good health. I just came off of a year off after medical school and before residency. I met my wife about a month in and we fell in love. And three months later, she had chronic fatigue and couldn’t get out of bed. And that lasted for about three years. And I felt incredibly powerless. Here I was, supposed to be at the top of my game, asking everybody and their mother about how to help this person.

And all of my physician friends and whatnot, they couldn’t help. I mean, the stuff was really limited in conventional medicine. And so, she eventually got better doing a number of things from a natural perspective. And then, I came out of residency. I started my business, we got married, we had a child. And then, a couple years later, I got fatigue. And it lasted for five years and just about destroyed my life.

Just about destroyed my business. Just about destroyed my marriage, my relationship with my daughter. My brain fog was so awful that I couldn’t remember anybody’s name who I was treating. My energy was crap so I can only help people for a couple hours a day. I had to keep hiring new practitioners in order to come on to help me out. So, it was awful.

And then, I went through a process of once I realized that I had to find all of the causes, and I just dedicated myself to that and was committed to it, that’s when I found all of my causes. And I was able to get over my fatigue. And now, I’ve helped thousands at this point.

Dr. Eric Osansky:

All right. So, you helped not only yourself and thousands, but you said your wife as well?

Dr. Evan Hirsch:

Yeah, I did a little bit. I mean, at that point, she actually learned and taught me a lot about adrenal gland dysfunction, as well as toxicities. And she got mainly better by taking some adrenal support. We got a sauna. So, she was using that every day. Doing some coffee enemas. And then, the emotional work that she did was huge.

Dr. Eric Osansky:

All right. Very good. So, how does someone know that they have fatigue?

Dr. Evan Hirsch:

It’s a good question. Because a lot of people are like, they think that just because they’re getting older, and they’re getting more tired, it’s just because they’re getting older. But that’s really not the case. If somebody is getting seven to nine hours of sleep a night, and they’re still tired during the day where they need coffee, or they need Red Bull, or they need five-hour energy drink, or Coca-Cola or whatever it is that has caffeine or some stimulant in it, then there’s something not right.

And fatigue is just a harbinger. It’s just ringing the bell and saying, “Hey, there’s a problem here.” You need to pay attention, otherwise bad things are going to happen. So, that’s how you know if you have fatigue.

Dr. Eric Osansky:

As you know, my audience consists of people with thyroid and autoimmune thyroid conditions…Grave’s disease and Hashimoto’s. And so, I would say more with Hashimoto’s, even though a lot of people with Grave’s also have fatigue. Personally, I dealt with Grave’s, and I can’t say I had a lot of fatigue, but some of my patients with Grave’s disease do have fatigue. But it’s more common with Hashimoto’s hypothyroidism due to the low thyroid hormone.

So, that’s one common cause. But you also mentioned adrenals in your wife. And I also see adrenal problems a lot in my practice. So, what do you see besides thyroid, besides adrenals, what are some of the other common causes of fatigue?

Dr. Evan Hirsch:

So, what I found is that there’s actually 10 categories of causes, which can be broken down into 33 different causes. And these can really be divided up into deficiencies and toxicities. So, let’s focus on those top 10 causes. So, the deficiencies are things that aren’t in the body that are supposed to be. So, these are deficiencies and things like hormones. We talked about adrenals, thyroid, sex hormones. Deficiencies in nutrients…so vitamins and minerals.

Deficiencies in lifestyle habits, so not enough water, not enough good food, not enough sleep, not enough good movement. And deficiencies or dysfunction in mitochondria, which is the energy center of every cell in the body. Produces about 70 to 80% of our energy. And then, when we’re looking at toxicities, we’re looking at things like heavy metals. 70% of all the lipsticks that are sold off the shelf have lead in them.

100,000 pounds of mercury are being dumped into our oceans every year. Every time we bite down on a mercury filling or a silver filling, whatever you want to call it, amalgam, mercury vapor gets released into the body and we swallow it. 84,000 different chemicals we’re exposed to on a regular basis. And most of these have not been appropriately evaluated for human use. When we’re looking at something like mold, mold toxicity, about half of all the buildings in first-world countries have water damage.

And most of those have mold. It’s a crazy issue that causes so many things from fatigue. And what’s interesting too for your tribe is that all of these causes of fatigue are also causes of autoimmunity. So, if you’ve got Hashimoto’s, you’ve got Grave’s, those are autoimmune conditions. And the toxicities are going to be the same for them as well. And we can talk a little bit about some anecdotes that I’ve learned about those along the way.

So, that’s mold. And then, infections. CDC came out a couple years ago and said, “Actually, it’s not 30,000 new cases of Lyme every year, it’s actually 300,000.” And we see everything from Borrelia, which is Lyme, to Bartonella, to Babesia, to Epstein-Barr virus, and now we’re seeing COVID. And then there are allergies, which will be also part of that toxicity picture. And then, the mental-emotional stuff, so negative emotional patterns.

And so, that helps you categorize a little bit, simplify a little bit all those deficiencies and those toxicities Now, what’s interesting is that everybody has a different combination of those. And so, that makes treatment even more challenging. So, for me, I had about 30 different causes of fatigue. But pretty much everybody that I see has around 20 plus causes.

But the 20 plus causes that Joe Schmoe has over here is going to be different than the 20 plus causes that Sally has over here. And so that means that their treatments have to be different.

Dr. Eric Osansky:

That makes sense. And so some people just assume that they might have one cause of fatigue. So again, in the case of Hashimoto’s they might blame it on the thyroid. And that might be a big factor, but it could also be adrenals, it could be infection related, it could be environmental toxin related, it could be mold…mold toxicity is huge, nutrient deficiencies. So yes, it definitely can be challenging.

So, let’s talk about nutrient deficiencies a little bit. In your practice, do you address nutrient deficiencies primarily through food, through supplementation, a combination of both?

Dr. Evan Hirsch:

Combination of both. And I find that what’s interesting too that I should mention is that these deficiencies that we talked about, hormones, nutrients, mitochondria, lifestyle habits, except for the lifestyle habits, the other ones really can be caused by the toxicities. So, the end goal is to remove those toxicities that we talked about. And that will really help with those nutrient deficiencies. But yes, we do what we can. But there are certain nutrient deficiencies that I do like to replace like vitamin D, magnesium.

Vitamin B12 can play a huge role in energy and sleep and mood. And those are the big ones. Oh, and then iron. But one of the interesting things with iron, when you do as much work with infections as I do, iron feeds certain infections. And so, I do have to be cautious about replacing if somebody is very deficient in iron. So, if they’re around 40 or 50, it’s borderline for me. But if they’re less than that, generally, I’ll give them some replacement with herbal iron support.

Dr. Eric Osansky:

So, if they have an infection, obviously, you will want to address the infection. Will you try to do other things to help with iron absorption in the meantime, like vitamin C, increase stomach acid, or will you just focus on that infection?

Dr. Evan Hirsch:

I’m usually focused more on the infection. When there’s 20 plus different causes that people have, and they’re going to take one, sometimes two supplements for every single cause, it gets a little crazy in terms of the number of supplements. And so, we try to keep that as simple as possible. And if I think that the iron is going to be the biggest bang for the buck, then I’ll go ahead and recommend that they take it. But most of the time, it’s not going to be the case. And then, I’m going to look elsewhere for the biggest bang.

Dr. Eric Osansky:

All right, good deal. And then, you mentioned Lyme. Some of my audience knows that in 2018, I was actually diagnosed with chronic Lyme. I had more neurological symptoms. I can’t say fatigue was really bad, it was more neurological. But I think a lot of people overlook infections. I mean, maybe they’re a little bit more aware of Epstein-Barr, as there are books on both Epstein-Barr and Lyme.

But I know before I was diagnosed with Lyme in 2018, I would never have imagined that I’d have Lyme disease. And even when I was diagnosed, there was no evidence of a tick bite. There was no bull’s-eye rash. So, it’s definitely possible that for some people, I’m not saying everybody who’s experiencing fatigue, but even if you have no evidence of, again, a tick bite or bull’s-eye rash, it still could be Lyme.

I also tested positive for Bartonella. You mentioned Bartonella before. Fortunately, not Babesia. But can you talk a little bit more about infections? Do you find infections in a high percentage of your patients?

Dr. Evan Hirsch:

I do. Yeah, the people that I’m seeing who have chronic fatigue, infections are very prevalent. So, what’s interesting about the infections is that even according to the Centers for Disease Control in Atlanta, the infections really are clinical diagnoses. So, labs aren’t great. And so, what we’re looking at is conglomerations of symptoms that can determine whether or not somebody has a particular infection. And then, we can treat it using specific herbs.

And then, if we see improvement that can corroborate what we’re seeing based on the clinical picture. So for example, Borrelia, which is associated with Lyme. Borrelia, you can’t really have Borrelia unless you have the following symptoms. You have to have symptoms that move around the body. And so, we’re talking about whether it’s nerve pain, or joint pain, or muscle pain. Where one day, it’s here, and then either a couple of days, or a couple of weeks, or a couple of months later, it’s in the right knee or something like that.

So, it’s moving around the body. And then, the symptoms have to come and go, where you don’t know whether or not you can set an appointment for a certain day because you don’t know how you’re going to be feeling that day. So, some days might be okay. And other days might be crap. Usually, days aren’t great, but some days are better than others. So, you have symptoms that come and go. If you don’t have those symptoms, there’s very few things that cause that.

If you don’t have those symptoms, you really don’t have Borrelia. Now with Bartonella, oftentimes where people will report symptoms of headaches, or migraines, neck pain, body pain, oftentimes, these people are misdiagnosed with fibromyalgia. They’ll have problems with sleep. They’ll have anxiety and depression. They’ll have pain on the bottom of the feet.

And you may not have it now but if you’ve had it in the past, if you’ve been diagnosed with plantar fasciitis, which is a condition that can cause some of that pain or burning on the bottom of the feet, it’s very likely that you have Bartonella. Another symptom is muscle cramps. Oftentimes, in the calves, oftentimes at night. And then sometimes, people will report stretch marks. They’ll say, “Out of the blue, all of a sudden, I have this stretch mark right here.”

“And I haven’t had any weight fluctuations or anything like that.” And then, one of the biggest ones is Hashimoto’s. In fact, the only way that I’ve ever been able to get people off of their thyroid medicine is by treating Bartonella. And there seems to be some correlation there. And it happened quite serendipitously where I had just started treating somebody for Bartonella, who was on thyroid, who had Hashimoto’s.

And she calls up after hours and she’s like, “I don’t know what’s happening. I’m flipping out. I’ve got anxiety. I can’t sleep, da-da-da-da-da.” And I said, “I didn’t know what to do.” I was like, “Well, when was the last time that this happened?” And she’s like, “When I had Grave’s.” I said, “Oh crap, she’s hyperthyroid right now.” I said, “Well, let’s decrease your thyroid dose.” And so slowly, we’re able to wean her off of her thyroid medication completely.

And I find that about 50% of the time, we’re going to decrease people down to about 50 or 25% of what they were taking when they have Bartonella as well as low thyroid. Yeah, go ahead.

Dr. Eric Osansky:

You mentioned Grave’s…you meant Hashimoto’s?

Dr. Evan Hirsch:

No. So, she said, “The last time I experienced this was when I had Grave’s.” So, she had had Grave’s that then turned into Hashimoto’s.  And so, she was hyperthyroid and because I couldn’t figure out what was going on. And she said that the last time she experienced it was when she was hyperthyroid.

Dr. Eric Osansky:

Okay. That’s interesting. And a few things that you mentioned, which is worth repeating. So one, you mentioned the testing. So, the testing, you’re right, especially for Lyme. I mean, I was lucky that the test showed it was clearly Lyme. But there are some people, especially if they go to a Labcorp or Quest Diagnostics, I mean, if it comes out positive, then yeah, you probably have Lyme or Bartonella, whatever you’re testing for.

But if it’s negative, it can definitely be a false negative. And so, there are other labs, there are specialty labs out there. Some doctors might argue not even using labs and just going by symptoms. And that’s another thing too. So, with Lyme, I definitely had a fluctuation of symptoms. I mean, it did move around. Again, I can’t say I had classic fatigue, as I really didn’t have it. And I wouldn’t say I had pain, but I did have electric shock sensations.

Maybe you could classify that as pain, but it definitely moved around. And some days, it felt okay, some days, it didn’t feel okay. So yeah, you are correct. Of course this is just my experience, and everybody is different. So, I didn’t have classic symptoms, and that’s why I wasn’t sure if it was Lyme. I started to have a weakness in my leg. And then, with other symptoms too, I was thinking Lyme or MS.

And the only reason I thought Lyme is due to my experience working with other patients with Lyme. But yeah, symptoms are important. I’m bringing this up because if you’re not experiencing some of the symptoms, or even any of the symptoms that Dr. Hirsch has mentioned, this doesn’t mean that you don’t have Lyme, this doesn’t mean you don’t have Bartonella. And again, I’m not trying to say everybody has Lyme or Bartonella. We all have microbes, we all have viruses in us.

A lot of us have Lyme and we don’t know it and it might not cause a problem. I mean, I might have had it in my body for years. But I just wanted to reinforce that. So, in summary…actually, before I say in conclusion, how about Epstein-Barr? Because again, most people do have Epstein-Barr. Is that a big problem in most people? Or is it with most people they just have it and you don’t really see it being problematic?

Dr. Evan Hirsch:

It can definitely be problematic as well. Oftentimes, these people are going to report a sore throat, but the symptoms are generally more vague. So, they can just have fatigue without any of the other things that I mentioned. And oftentimes, that means that there’s a virus present that we need to go after. The other infection that I didn’t mention that’s pretty prevalent is Babesia. And Babesia is considered the North American malaria.

And oftentimes, people will report getting hot and sweaty from time to time, or having night sweats on occasion, then it’s cyclical. So, sometimes, it’s once a month. And as things worsen, oftentimes, it can increase to every few days. These people generally have awful sleep. So, they’ll say, “I didn’t sleep at all last night.” And they’ll have really bad mood, where anxiety to the point of panic attacks, and depression to the point of suicidal thoughts.

And then, they’ll also have some shortness of breath, or some air hunger, can’t get a deep breath. You don’t have to have all those symptoms just like with Bartonella or Borrelia. But you just have to have some of them in order to start thinking about some of these infections.

Dr. Eric Osansky:

All right. And we will get to questions soon. We’ll spend a few minutes on questions but I just want to pick your brain for a few more minutes. But one person, Denise here, I did want to bring this up since we’re taking for granted that everybody knows what these coinfections are. And so one question Denise has is, “Bartonella, what is that?” It’s a co-infection of Lyme disease, but you can have Bartonella without having Borrelia, without having Lyme, correct?

Dr. Evan Hirsch:

Correct. Yeah. So, Bartonella is a bacteria that lives in upwards of 50% of all domestic animals. So, if you’ve ever been licked in the face by an animal, or they licked your hand, and you put it in your face, most of us have it. And I think for me and my Bartonella that I’ve had since day one, because my mom actually has it. So, if you’re seeing some symptoms that traverse from parent to child, oftentimes, it can be transmitted through the placenta.

So, a lot of this stuff, these bugs don’t become opportunistic until you get a number of hits. So, whether it’s another infection or whether it’s, for me, it was mold, and medical school, and residency and a break up, and all these other things. So, a number of stressful hits that ended up allowing some of these infections to come out in my body. I also grew up in New Jersey, so there was tick bites and stuff like that, too.

But to answer the question, Bartonella, coming from these domestic animals. But oftentimes, acutely, it’s called cat-scratch fever. Where you get scratched by a cat, you get a very large lymph node, usually in the axilla, or in the armpit, could be up here as well. But generally, in this area, just proximal or closer to the body than where the cat scratch was, whatever side of the body it was on. And oftentimes, that gets treated with antibiotics, and it goes away over time.

But what this is we’re looking at more chronic Bartonella, where the Bartonella ends up getting deeper into the body. It’ll have a couple of different phases. One phase is where it’s living in the skin, when it’s causing some of those stretch mark rashes, or what are called Bartonella striae. And the other one is where it’s living in the blood vessels.

So, anywhere that the blood goes Bartonella can go, which is why it’s so pervasive over multiple different systems in the body. Like I mentioned, going from the thyroid, to the musculature, to the joints. So hopefully, that helps explain what Bartonella is.

Dr. Eric Osansky:

Thank you for that explanation. And so, you have something called a four-step Fix Your Fatigue system. Can you discuss this and how you use this to help what causes fatigue?

Dr. Evan Hirsch:

So, my four-step process is, the takeaway from this whole talk is really, it’s all about the causes. So, the first step is figuring out the causes that you have. And so, it’s that 33 potential causes, everybody has 20 plus. So the question is, what 20 plus causes do you have? So, we take you through a process of looking at what your symptoms are first, and then what labs you need to get to confirm those symptoms and then to determine other causes.

So, what I found is that 75% of all of these causes can be determined by your symptoms alone. So, very quickly, you can start the process, print out the workbook, go through it, and within a couple of hours, you’re going to know 75% of your causes. So, the first step is determining those causes. The second step is to replace the deficiencies. Now, I should say that this process is all about step four, which is removing the toxicities. That really is the most important step.

But we have to do step two and replace the deficiencies in order to get you feeling better in order to be able to tolerate the rest of the process. So, that’s replacing the adrenals and the mitochondria and the thyroid. I call those three the big three, because they’re the fastest way to shift somebody’s energy. And then, there’s also working on your lifestyle habits, making sure you’re drinking enough water, getting enough good food, not eating crap food and food toxins.

Making sure that you’re getting enough movement and getting enough sleep. And then, replacing any vitamin and mineral deficiencies as well. So, step two is replacing those deficiencies. Then, step three is opening up the detoxification pathways. So, in order to jump into step four and grab the toxicities there and pull them into the bloodstream so that they can get out of the body, you have to make sure that those pathways, those detoxification pathways are open.

And so, that’s making sure you’re pooping one to two times a day, ideally twice a day. Making sure that the liver is open, that the kidney is open. That the lymph is open, which is the garbage system of the body. That the neural lymph is open, which is the brain length. So that it’s like these tubes, where if you’re going to grab those toxicities and pull it into the bloodstream, now they can come out. All this stuff is natural.

When I operate across state lines in these programs, I’m operating as a coach. So, that means there’s no prescribing. It’s all education and recommendations using natural stuff. So, that’s what we do for step three. And then, going into step four, it’s removing the heavy metals and the chemicals and the mold and the infections and the allergies and the negative emotional patterns. And so, that’s binding them up, it’s pulling them out.

It’s making sure along the way with all these nuances, because as you start killing off infections and removing toxicities, you’re creating a new normal. So, if you haven’t been healthy for a period of time, 20, 30, 40 years in some cases, or even just five or 10 years, we have to hit the reset button. And oftentimes, that can be a little bit bumpy. So, what we’re looking for is a five-step forward one-step back process, where you’re continuing to make forward progress. A journey of 1000 steps begins with a single step, right?

If you are doing five-step forward one-step back, you are eventually going to reach your goal. Just have to know that it can take some time in order to be able to do so and that there are some nuances to this, which is why a big part of our program is the follow-up. It’s the online community that we have. It’s the group Zoom calls that we have in order to make sure you get your questions answered, so that you can continue to make forward progress.

Dr. Eric Osansky:

That sounds great. So even though you’re a medical doctor, so you could prescribe medication for, let’s say again, getting back to Lyme, you could prescribe antibiotics. Or for toxic mold, you could prescribe cholestyramine, which binds to the mycotoxins. But you try to do as much as you can naturally, especially when you’re doing the group programs, correct? There are no prescriptions typically.

Dr. Evan Hirsch:

Exactly. Yeah, there are no prescriptions. And I’m not really using my MD so much anymore, because I’ve found really great tools naturally. And operating as a coach instead of an MD allows me to help more people across state and national lines. About a third of all of our clients right now are in the European Union and beyond. We’re actually changing the time of our group Zoom calls to better accommodate them because right now they’re at 1:00, they’re a little bit too late for the EU so we’re moving them a little bit earlier in the day.

Dr. Eric Osansky:

Yeah. There’s a good number of people from Europe in my group. So yeah, now, patients in the UK, too. So yeah, so this time, there might be people watching from the UK here or not just the UK but other areas in Europe. But what was I going to say? Oh, the deficiencies. So, going back to the deficiencies, you said that there are three main deficiencies. Did you say adrenal, thyroid and mitochondrial dysfunction?

Dr. Evan Hirsch:

The big three, that’s right.

Dr. Eric Osansky:

All right. And mitochondria, I mean, there’s a lot of things that could affect mitochondria. We could probably just have a separate talk just on mitochondria alone. But do you find that nutrients are the biggest factor? Or is it infections that drag down the mitochondria, toxins, or I guess all of the above?

Dr. Evan Hirsch:

Yeah, it’s always a combination of the above. So, the way that I describe it is that the mitochondria gets squashed by all these toxicities, the heavy metals, chemicals, mold, and infections. And then, you have to remove those toxicities, but then you also have to inject some love into that mitochondria in order to bring it back to life. So, it is that two-step process.

Dr. Eric Osansky:

So, as you mentioned, there’s so many potentially different causes of fatigue. How do you know when you can or cannot help someone who is experiencing fatigue?

Dr. Evan Hirsch:

So, it really depends on what’s been done before. So, if somebody has addressed all of their causes of fatigue, they should be better. So generally, if somebody has not, or if they haven’t addressed them appropriately, then that’s where I can help them. Because essentially, if you break it down as simple as possible, it’s a two-step process. You find the causes that you have, and then you fix those causes with a particular treatment that works for that cause.

So, either somebody hasn’t found the causes, or they haven’t found the right treatment for those causes. Because I’ve really never met anybody who has found all the causes, taken the appropriate treatment for them for the appropriate amount of time, and isn’t better.

Dr. Eric Osansky:

So it just comes down to that four-step process that you have? And you’re right, there’s just so many different factors. And some people might, in the case of Hashimoto’s, maybe the low thyroid is causing problems when it comes to fatigue. So, they might be taking levothyroxine or desiccated thyroid. And maybe that does help a little bit or maybe they take it and they don’t notice any difference so you have to look at adrenals and nutrient deficiencies…just so many different things.

So it really depends on the person. There are people who are able to make some changes and see dramatic improvements in their energy levels. And then, there are some people, I’m sure some people might be watching now who have had fatigue for years and it seems like no matter what they do nothing helps.

Every day in my Facebook group, or at least Monday through Friday, I create a post. And so, yesterday I put a post asking who in the group is experiencing fatigue to prepare them for this call. Just to let them know that we’re going to be talking about it. And I was looking at some of the comments, and a number of people have been experiencing it for years.

It’s bad enough for a few weeks or a few months, but experiencing severe chronic fatigue for a long time. But there’s definitely hope. It’s not always an easy process. Again, we’ll get to some questions in a minute or two, but I’m just wrapping things up. First of all, I wanted to thank you for getting together and for this interview, Dr. Hirsch. And I’d also like to thank you for the information.

So Dr. Hirsch, first of all, has a book, Fix Your Fatigue: The Four Step Process to Resolving Chronic Fatigue, Achieving Abundant Energy and Reclaiming Your Life. And even though it is available on Amazon, I’m going to put this in the chat where people could get a free copy or free PDF download of your book.

Click here to get a free PDF copy of Dr. Hirsch’s book

And then also, if they’re interested, I think this also will lead to your website where they could schedule a free call as well if they wanted to chat with you or one of your coaches to learn more about how to overcome their fatigue. Is that correct?

Dr. Evan Hirsch:

Correct. Yeah, to see if they’re a good fit for any of the programs that we offer.

Dr. Eric Osansky:

Okay. Cool. But a good place to start maybe is to get that free book and then if you feel like you want to schedule a call, definitely he’s ready to help. But let’s see if anybody has questions. Well, actually, before we dive into questions, any last words? Anything else that you’d like to say Dr. Hirsch that I didn’t ask you?

Dr. Evan Hirsch:

I think there are two things. So, the first thing is I just like to give you a quick take on my take on thyroid. Where besides the Bartonella piece, what I find is that, and I’m sure you see this as well, doctors are so reliant on their labs. If I had a nickel for every person who is undertreating their thyroid, I’d be a very wealthy man, right? So, I do what’s called the subjective ramp up, where we use glandulars, which are obviously natural. And we ramp up every two weeks in order to get people up to their top dose.

Because I find that thyroid helps everything. What’s the best blood pressure lowering medication, it’s thyroid. What’s the best cholesterol lowering medication, it’s thyroid, right? But I also ramp things up in a specific format where you’ve got to replace the adrenals first and then replace the mitochondria before you go after the thyroid. Because the adrenals and the mitochondria will both make the production of thyroid better, its absorption better.

And so, you’re improving thyroid function along the way, you don’t want to ramp up on your thyroid without working on the adrenals and the mitochondria. So, that’s like my two cents on that. And then, the second thing is really about encouraging people to stay in action. Make sure that you’re moving forward, make sure that you’re working through Dr. Eric’s plan so that you are going to be successful.

If you have questions, you ask them. It seems like the hardest thing for humans, and I totally get it’s just part of our nature, if we get stuck, sometimes we don’t know what to do. So, make sure you’re asking questions. Make sure you’re staying in action, so that you can go through and you can be successful. Because we really underestimate the amount that we can get done long term in the next couple years.

We overestimate the amount that we’re going to get done in a week or two, right? So, you have to remember that baby steps and taking that five steps forward one step back will eventually get you there. And you find a good mentor like Dr. Eric or myself. And in three, six or 12 months, you’re going to have a very different life. And you think about that and it’s not a lot of your life, it’s 1/80th of your life depending on how long you live. And it can transform your life when you find that right person, that right mentor, and you take action.

Dr. Eric Osansky:

All right, well said. And that was interesting about the thyroid and the adrenals. I talk about this sometimes too. Adrenals are a priority over the thyroid and sex hormones. Again, Hashimoto’s is this immune system condition. But I guess to make sure I understand you correctly, before giving a thyroid glandular for example, you’ll optimize adrenal and mitochondrial healthy. Is that correct?

Dr. Evan Hirsch:

Absolutely. Yeah. And then, I see it as two separate conditions, as I’m sure you do, where you have to replace adrenals in Hashimoto’s because you’ve got the low, sorry, replaced thyroid because you’ve got the low thyroid. But then, also working on the autoimmunity.

Dr. Eric Osansky:

Well, thank you for sharing that. And again, thank you for sharing all of this with everyone. And let’s see if there are any questions here. So Sheree says, “Thank you for sharing this.” And you are very welcome. And then we got Ranjeetha. “Just like me. Recent blood work shows have Hashi’s antibodies that are active.” But it looks like her issue is brain fog.

So, I don’t know if you want to say something quick, and I do have on my website some information on brain fog. But what would you say for someone who is experiencing brain fog? Is there overlap with some of the causes of fatigue when it comes to brain fog as well?

Dr. Evan Hirsch:

Yeah. Unfortunately, it very much commingled. Brain fog was one of my worst issues. And the causes are the same. And generally, it’s never just one thing. I mean, sometimes, if there’s one thing predominant like mold, but it’s never just one thing. And so sometimes, it’s like you start taking adrenal and mitochondrial and thyroid support, and all of a sudden, lights come back on. And other times, it’s all about getting to a certain point and removing the mold out of the body.

Dr. Eric Osansky:

So, it really all comes down to addressing the cause of underlying imbalances. All right, let’s see. We have Michele here. So, “Interesting information. I was diagnosed with Grave’s disease a few years ago. And now, I think my thyroid is going the other way due to weight gain. So, not taking any meds at the time. I appreciate the expertise on all these issues.”  Well, thank you Michele for tuning in. And let’s see. We have LaTisha here who needs a reset.

Dr. Evan Hirsch:

Amen. Hit that reset button.

Dr. Eric Osansky:

Yes. Any other questions?  I know sometimes when I do these, actually, most of the time I’ll do these solo and have to encourage people to ask questions.  Just going once, going twice, and then a whole flood of questions come in. But seriously, if there are any questions that you have for Dr. Hirsch, definitely let us know. And especially anything related to fatigue. We do have a question here from Norway.

So, “Dizzy all the time. So, why?” And again, there could be numerous causes, adrenals, infections. I’m sure Dr. Hirsch could expand on this as well.

Dr. Evan Hirsch:

So, one of the main sites that autoimmunity loves to go to is the cerebellum. So, it loves to attack the cerebellum, which is the balance center of the brain. So that’s one of the reasons that I see. And so, anything that can be triggering that autoimmunity, triggering the immune system to attack itself, once again comes down to those toxicities, heavy metals, chemicals, molds, infections, allergies. And so, that’s generally where I will go and have success doing so.

Dr. Eric Osansky:

Yeah, toxic mold is really big. I mean, usually, some will have more than just dizziness. I guess you answered this earlier. So, just where people don’t have just one thing, but if someone has a chronic infection, a lot of times, they also do have mold. And a lot of times, it could even be mycotoxins dragging down the immune system, potentially making them more susceptible to infection such as Lyme or Epstein-Barr.

Dr. Evan Hirsch:

Absolutely. And there’s some research to back this up, that when you remove the mold, people who have these infections get better. So, the immune system wants to bring everything into balance, right? And so, it just gets hamstrung, where basically, you’ve got heavy metals, chemicals and mold that have hijacked the immune system off into left field, and these infections are having a party. So, once you can bring that immune system back and get rid of some of those toxicities it makes a huge difference for getting rid of the infections.

Dr. Eric Osansky:

Yeah, great points. And let’s see. We’ve got Jessica here. So, “With Hashimoto’s, I’ve struggled with both exhaustion and insomnia. So, first steps to feel normal?” So again, I definitely encourage you, Jessica, to sign up for Dr. Hirsch’s to get the free book.

If you go on Amazon, you could get it. But if you want it for free as a PDF, visit that website. But besides reading your book, what’s the first steps that you would recommend?

Dr. Evan Hirsch:

So, the first step is always adjusting lifestyle habits. So, it’s making sure you’re getting seven to nine hours of sleep a night, going to bed and waking up the same time every day. So, 10:00 to 6:00 would be a good eight hours. Going to bed around 10:00 or 10:30. After 10:30, oftentimes, people get an additional wind. And so, you want to make sure that timing is as such. Want to make sure that you’re consuming enough water.

And if you’re tired, most of the times, you’ve got adrenal gland dysfunction, you want to put a little bit of sea salt in your water, okay? It shouldn’t raise your blood pressure because it’s got potassium and magnesium that also lowers blood pressure. The other thing is you want to make sure that you’re consuming mainly meat and vegetables. So, where half of your plate pretty much every time you sit down is vegetables. So, decreasing the sugars, decreasing the grains, decreasing the dairy.

So, focus on that. And if you’re not eating meat, that’s fine. Eat beans, lentils are 100% protein. So, you can vary it that way. But vegetables are the main thing. And then if you’re tired, usually, you can’t do much movement. But if you can, do five jumping jacks a day, 10 jumping jacks a day. That’s the first thing. I call that a level one problem. If you’re going to fix your fatigue by doing lifestyle habits, then that’s a level one problem.

If you still have fatigue at that point, then you need to start in on the big three, optimizing adrenals, thyroid, mitochondria, and then some of the other ones. And if you fix your fatigue after that, then that’s a level two problem. If you still have fatigue after that, then you’re looking at removing the toxicities that we talked about in step four. But that should help give you some information to get started.

Dr. Eric Osansky:

All right, great. Well, hopefully, that helps, Jessica. So, you mentioned refined sugars. Do you find a lot of people do things for Candida overgrowth? Do you find that this also is a big factor when it comes to fatigue?

Dr. Evan Hirsch:

Yes. Once again, it’s all about the causes some people might have. In terms of percentage, a lot of people have yeast overgrowth. But it’s also about total body burden. And what is the biggest priority? So, we always go by symptoms as a guide to determine what’s going to be causing the biggest issues. Yeast, yes, it will cause some fatigue, but not as much as some of the other infections. So oftentimes, we’re addressing some of the other infections, the stealth infections first before we go after the Candida.

Unless somebody’s got really bad itching, anal itching, itching. Now, what’s interesting too is that sometimes those are fungal symptoms, which means they could be mold or yeast. So, depending on what we find in the stool, as well as what their gastrointestinal symptoms are would determine whether how high of a priority that becomes.

Dr. Eric Osansky:

All right, cool. Thank you for answering that. So Heather asked us…the person from Norway, she said she’s dizzy. Does it meaning vertigo is what she was asking?

Dr. Evan Hirsch:

I’m thinking so. I mean, there are other dizzy type symptoms that can happen. There’s postural hypotension where basically you go from a sitting to a standing position or lying down to a standing position too fast and you get lightheaded. That’s more of an adrenal issue, as opposed to the chronic vertigo. There are certain techniques that you can do, going in to see your doctor’s office or a neurologist where they can reset some of the cochlea or some of the in the inner ear.

Sometimes, the salt balance in there gets dysfunctional. When I was in residency, I remember this very clearly, there was a woman who was from Spain, and she had had vertigo for 30 years. And so, I was like, “Well, let’s try an Epley maneuver, which is something that I had just learned. Nobody had ever thought to do it on her. We did it on her a couple times, and her vertigo was gone. So sometimes, it’s simple stuff like that that can really help. And so, you want to make sure that you’re not ruling that out.

Dr. Eric Osansky:

All right. So, we have Dorinda here. So, “Hi, doctors, nice to see fellow functional practitioners giving their genius to the world. Keep up the great work. I started my career as a research immunotoxicologist in the field of autoimmunity. Then I became sick with seven autoimmune diseases myself. Now, I’m healed thanks to the latest science. Everyone, listen to these doctors. Functional medicine works.” All right, well, thanks, Dorinda. And yes, functional medicine definitely does work.

I appreciate you posting that. And okay, so Rose says, “Hi, Dr. Osansky. You probably have seen me here a few times.” Yes, I have. Thank you for showing up today as well. So, “It’s been a crazy ride trying to figure things out. I’ve been in remission with Grave’s for about three years. My new diagnosis is Hashimoto’s. I just had allergy testing and my IgE so far is high for milk, egg whites and wheat. My C1 esterase is high. And then, positive EBV, Epstein-Barr virus reactivated.”

“I’m thinking this has caused my autoimmune issues.” So as you said earlier, doc, I mean, it could be one factor with Epstein-Barr. And then also, what’s causing the Epstein-Barr because most people have Epstein-Barr in their body. So, it’s usually not just an Epstein-Barr problem. It’s usually other things affecting the immune system causing the reactivation of Epstein-Barr. I’m not sure if you want to expand on this.

Dr. Evan Hirsch:

Well, I think what’s a good reminder too is that autoimmunity is a spectrum. It starts off the immune system is reacting to something, and that’s an allergy. And then, if that thing gets inside of some tissues in the body and the immune system starts acting against it or reacting to it, that’s when you get autoimmunity where it’s actually attacking the self. And so, it’s important to remember that those allergies that you have are because of whatever is triggering the immune system.

So, whether it’s Epstein-Barr virus, or mold, or a combination of those toxicities, they’re all going to be triggering the immune system, and you’re going to have allergies. And you’re going to have autoimmunity to muscles, and you might have muscle pain, to brain, to fat to whatever it is going to then cause your symptoms. So, definitely focus on what is you know that Epstein-Barr virus. That’s definitely a good path to go down.

Just make sure that you’re addressing all of them. I think what’s important to remember is that the immune system, a lot of this testing that we’re looking at for infections is called serology testing, which is looking at the immune system’s reaction to something. If the immune system is not functioning well, guess how valuable those tests are? Not very valuable, right? If the tool that you’re trying to use is dysfunctional, then you’re not going to get great tests.

So, if you get a positive test, if you get a reactivation of Epstein-Barr virus, that is really affirmative, indicating that yes, it is highly likely that that’s an issue for you. If you don’t get one, it doesn’t necessarily mean that you don’t have it there. One of the things I like to do sometimes if there’s any question about some of these Lyme type infections is doing a urine PCR test.

So, this is looking at the DNA of the infections in urine. Unfortunately, it’s a $650 test. But that can be helpful to actually see the bug itself instead of looking at the immune system’s reaction to the bug.

Dr. Eric Osansky:

How about doing a just a separate test for a serum immunoglobulin? So, if you get negative EBV markers and doing immunoglobulin G and immunoglobulin M, and if those look good, would you say that the test is probably accurate? Or there’s still a chance that it might be a false negative?

Dr. Evan Hirsch:

Yeah, that can definitely help to determine. But I also think that we’re really at the early stages of testing. We rely very heavily on blood testing. And most of the active stuff that we’re looking at is actually inside the cell. And that’s not what we’re testing for. We’re testing for what’s floating around outside the cell, which could be 30% of actually what’s happening. So, it’s just not the best representation.

But that is one way to determine whether or not somebody has normal immune system function. Though, if they do have autoimmunity, by definition, they just wouldn’t have normal immune system function. So if you’ve got a number of the immunoglobulins present, that’s great. But they still could be reacting, there still could be autoimmune in their activity.

Dr. Eric Osansky:

All right. We got Rose with the follow-up, “Thank you, I’m going to get IgeneX test to rule out all Lyme disease.” So yeah, IgeneX, you’re probably familiar with IgeneX, a specialty lab that focuses on Lyme.

Dr. Evan Hirsch:

I’m not a fan, just because of what I said…it’s a serology test. It’s looking at the immune system’s response. And it’s very hard. You can have all those symptoms that I mentioned of Bartonella, and it may still show up as not having Bartonella. And then, somebody doesn’t get treated for Bartonella. And then, guess what, they continue to have problems with those symptoms from Bartonella.

The lab is such a small part. Even in conventional medical school, I was taught that history and symptoms are 90%. And then, labs and physical exam are 10% of your diagnosis. And so you have to always remember that. And so make sure that you’re looking at those symptoms more than you are at the labs.

Dr. Eric Osansky:

All right, sticking to the topic of labs, doing a complete blood count with differential. Obviously, this alone is usually not going to give you everything you need. But how much do you pay attention, like if someone does have persistently low white blood cell counts? Or if they have elevated lymphocytes, or just imbalance of the neutrophils, lymphocytes?

I know you can’t just go about it and say, “Oh, that person doesn’t have an infection.” But if there are imbalances, does that perhaps give you some clues, or you don’t really even look at that?

Dr. Evan Hirsch:

It’s confirmatory. So, it can be helpful. But once again, it’s not the cause, it’s more of a consequence. So yes, the immune system is going to be off and the levels are going to be lower or higher based off of what other infections are present. Now, the main thing that I’ll use the CBC for is going to be MCV. So, mean corpuscular volume, looking at the size of the red blood cells to determine whether you’re looking at iron deficiency, or whether you’re looking at B12 or folate deficiency.

Dr. Eric Osansky:

RDW as well if that’s usually an iron deficiency, you’ll see that higher? Or maybe you look at MCV more?

Dr. Evan Hirsch:

Yeah, I don’t really look at RDW. If I’m looking for iron, I’ll also combine the MCV with ferritin, as well as the TIBC. I think the TIBC is the most accurate marker, total iron binding capacity. And so, that’s inversely proportional to the ferritin. And so, that’s going to be elevated when the ferritin is low. Ferritin can also be an acute phase reactant, as you know. So oftentimes, if you’ve got inflammation and ferritin is 150, all bets are off.

So, I’ll combine some of those. What’s really like a two out of three, if TIBC is high, and MCV is low, and ferritin is off the charts, then I’ll still say, “Well, yeah, your iron is on the lower side of things.” And I’ll try to do it with diet first, depending on how low it is, and then I’ll use some of the herbal iron supplements like we talked about.

Dr. Eric Osansky:

All right. And this will be, I think, the last question because we’re almost at 3:00. So, Benita, “Just had my gallbladder removed. How does that relate to Hashimoto’s?” So, I do have an article on this topic Benita, on my website. We’ll see what Dr. Hirsch has to say. But I do have an article on bile metabolism, talking about the gallbladder.

Obviously getting the gallbladder removed, sometimes it is necessary. So, it definitely might have been necessary but it doesn’t take care of the cause why the gallbladder needed to be removed. But do you want to expand on that?

Dr. Evan Hirsch:

Sure. So, what I’ve found is that upwards of 95% of all gallbladder issues are allergy related. So, the gallbladder is spasming because it’s reacting to usually a food that you’re consuming, whether it’s gluten or dairy or sugar or whatever. And so, the way that correlates is that Hashimoto’s is an autoimmune condition. Autoimmunity is also going to be exacerbated by anything that you consume that you have an allergy to, or anything that you come in contact that you have an allergy to.

So, that’s where I would say that there’s a correlation there. If you’ve got both of those things going on, gallbladder issues, you had that removed as well as Hashimoto’s, once again, it comes back to those toxicities. And there’s something that’s triggering your immune system to have allergy and autoimmunity to the gallbladder, to the thyroid, and I’m sure to other parts of the body. And so, it’s find the cause and remove it.

Dr. Eric Osansky:

All right. So Jacki just wants to say, “Thank you for this information.” Thank you, Jacki. Thank you for tuning in. And thank you, everyone, for attending, for tuning in to this call. And I appreciate Dr. Hirsch taking time out of his schedule. And don’t forget, you could download a free PDF copy of his book. Again, this is in the Facebook comments section.

And I also plan on sending an email out as well, because I know some people weren’t able to attend this live. And Tanya says, “Thank you, have a good night.” Thank you. And Benita, “Thanks so much.” And Rose says, “Thank you.” Again, thank you everyone. Just again, this probably will be the last Facebook Live this year. Yeah, I guess the New Year is two weeks away. And I usually do these on Fridays, so I definitely won’t be having one next Friday for obvious reasons, being it is Christmas Day.

So, first of all, I want to just again, thank Dr. Hirsch one more time for taking the time. I appreciate all the advice you gave. And again, make sure you visit his website, download his book, and I just want to wish everybody a happy holiday season and a Happy New Year. And I will catch you again in early 2021. Well, take care everyone. And thanks again for attending.

Click here to get a free PDF copy of Dr. Hirsch’s book

When I dealt with Graves’ disease in 2008/2009 I had a mild goiter, which is a swelling of the thyroid gland.  In my case it was caused by the hyperthyroidism associated with my condition. But there can be other causes of goiter, and while I’ve written a few different articles on this topic, since I get a lot of questions related to thyroid swelling I figured I’d put together an updated post which includes five things you should know.

1. Any thyroid hormone imbalance can cause a goiter.  In the opening paragraph I mentioned how I had a mild goiter when I dealt with Graves’ disease, and both hyperthyroidism and hypothyroidism can lead to an enlarged thyroid gland.  When this is the case the obvious goal should be to correct the thyroid hormone imbalance.  While you always want to address the underlying cause, while doing this it might be necessary to take something to increase or decrease the thyroid hormone levels.  For example, if someone has hyperthyroidism then they might need to take antithyroid medication (i.e. methimazole) or herbs (i.e. bugleweed), whereas if someone has hypothyroidism they might need to take thyroid hormone replacement.

2. There can be other causes of thyroid swelling.  Here are some of the causes of nontoxic goiter according to a research article (1):

• Physiological goiter (puberty, pregnancy)
• Iodine deficiency
• Goitrogens (broccoli, cabbage, goitrogenic drugs)
• Radiation exposure
• TSH release from the pituitary glands
• Autoimmunity
• Infections
• Granulomatous disease

I’m not going to discuss all of these, but I will talk about a few of them.  Let’s start with cruciferous vegetables, which are considered to be goitrogens, which in turn can potentially inhibit thyroid function, thus leading to a goiter.  While exposure to goitrogens can be a potential cause of a goiter, most people do fine eating cruciferous vegetables.  This includes those with hypothyroidism and hyperthyroidism.  In fact, in the past I’ve intentionally tried using raw cruciferous vegetables to lower thyroid hormone levels in some of my hyperthyroid patients with no success.  Therefore, I encourage most of my patients to eat plenty of cruciferous vegetables.

Next I’d like to talk about iodine, as an iodine deficiency can potentially cause a goiter.  In fact, this is how goitrogens can cause a goiter, as they can inhibit iodine metabolism.  However, most people with Graves’ disease and Hashimoto’s who have a goiter don’t have one as a result of an iodine deficiency. On the other hand, some cases of toxic multinodular goiter can be caused by an iodine deficiency.

Two other potential causes of a goiter not mentioned above include insulin resistance and problems with estrogen metabolism.  These two conditions not only can cause a goiter, but can also lead to the development of thyroid nodules as well.  As a result, it’s important to address these problems.

3. Essential oils such as myrrh and frankincense might help if the cause of the goiter is inflammatory in nature.  The truth is that other natural anti-inflammatory agents can help to reduce a goiter if it’s inflammatory in nature.  But I’m focusing on essential oils here because a lot of people ask whether rubbing essential oils on their thyroid gland can help.  Once again, it depends on the cause of the problem, as there are people who have received great benefits from rubbing essential oils such as myrrh and frankincense on their thyroid gland, but there also have been people who didn’t see any benefits when using these.  I need to remind you that essential oils are very concentrated, and so you only would need to use one or two drops of each essential oil, and you would want to dilute them with a carrier oil (i.e. fractionated coconut oil).  Then you can put the diluted oils in a roller ball and rub it on the thyroid gland.

4. Surgery may be the best option for some people with larger goiters.  I’m not suggesting that everyone with a large goiter should get thyroid surgery, but it’s important to mention that very large goiters are unlikely to decrease to their original size.  This doesn’t mean that they can’t shrink at all, but if the goiter is very large and is causing any type of obstruction then surgery might be necessary.  And I probably don’t have to mention that another situation when surgery probably is necessary is when there is a malignancy.  That being said, if someone has a very large goiter with no obstruction, and cancer isn’t suspected, then they might as well try to address the cause of the goiter.

5. In order to shrink a goiter you need to address the cause of the thyroid swelling.  It’s not always easy to determine the underlying cause.  If someone developed a goiter shortly after being diagnosed with hyperthyroidism or hypothyroidism then it makes sense to first address the cause of the thyroid hormone imbalance and see if the thyroid swelling decreases.  If this doesn’t happen then other causes are likely, and I listed some of the more common ones earlier.

So when someone asks if there is anything they can do to shrink their goiter, in most cases the answer is “yes”, although how much depends on the size of the goiter.  And you need to find and address the cause of the problem.  Below I’ll list what I would focus on in the order of priority for those who have a goiter:

1. Balance your thyroid hormone levels.  Once again, this includes taking antithyroid medication or herbs for those with hyperthyroidism/Graves’ disease, and thyroid hormone replacement for those with hypothyroidism/Hashimoto’s.  Obviously these aren’t permanent fixes, but they might be necessary to take while addressing the underlying cause.

2. Do things to reduce inflammation.  Just as is the case with balancing the thyroid hormone levels, you want to address the cause of the inflammation.  For example, if someone has inflammation due to a gut infection or eating gluten, then taking a turmeric supplement isn’t the solution.  That being said, sometimes supplementation can help, and I’ll add that having healthy vitamin D levels are essential.

3. Determine if insulin resistance and/or estrogen metabolism are problems, and if so, address them.  I won’t get into detail with these here, as I’ve written separate articles on insulin resistance and estrogen metabolism, and you also might want to check out this video on estrogen metabolism.

4. Consider an iodine deficiency. This is especially true if someone has non-autoimmune hypothyroidism or multinodular goiter. If testing for iodine I would recommend urinary iodine testing.

What’s Your Experience With Thyroid Swelling?

Have you dealt with a goiter, or do you currently have one?  And if so, what have you done to try to address the cause of it?  Please feel free to share your experience with everyone in the comments below.  Thank you for sharing!

2020 was a tough year for many people, but many still have a lot to be grateful for, and I wanted to list some of the things I’m grateful for:

• Another year of serving people with thyroid and autoimmune thyroid conditions
• Connecting more with my followers in 2020 through online challenges and Facebook (through my new Facebook group and Facebook lives)
• Myself and my immediate family staying healthy
• Having regular Zoom meetings with my father and sisters

I know we still have over a month to go until the New Year, but I want to let you know that I look forward to continuing to serve you in 2021!

Happy Thanksgiving!!!

I was doing some recent research and came across a journal article entitled “Thyroid-Gut-Axis: How Does the Microbiota Influence Thyroid Function?“.  Even before finding this article I realized that there was a relationship between the gut and thyroid health, but it was nice to see a published journal article discussing this.  So I’d like to go ahead and summarize the relationship between the thyroid and the gut based on the information in this recent journal article.

In the introduction the authors mention how an impaired microbiota can lead to the development of autoimmune conditions, including Graves’ disease and Hashimoto’s.  They remind us that thyroid autoimmunity likely develops due to the combination of genetics, immune impairment, and environmental factors such as nutrient deficiencies and the gut microbiota.  They end the introduction by mentioning that patients often report changes in their quality of life and thyroid function in relation to dietary changes.  This of course is true, although as I’ve mentioned in previous blog posts, there can be other factors as well.

Intestinal Influences on the Thyroid

The next section starts off by discussing how the gut microbiota modulates both the innate and adaptive immune system, and how it is fundamental in the development of gut-associated lymphatic tissue (GALT). You might have heard that most of the immune system cells are located in the gut, and this article reinforces this, mentioning that more than 70% of the entire immune system is situated in the GALT. It adds that the GALT plays an important role in the development of tolerance to self-antigens.  For more information on immune tolerance you can check out my article entitled ” Thyroid Autoimmunity and Loss of Self Tolerance “.

What You Need To Know About Butyrate and Thyroid Health

In past articles I’ve discussed the importance of regulatory T cells (Tregs), and how these help to keep autoimmunity in check. As a result, you want to have an abundance of Tregs, and the journal article mentions that there is a positive correlation between butyrate and the number of Tregs.  Butyrate is a short chain fatty acid, and the authors also mention how it can help to strengthen intracellular tight junctions together with thyroid hormones.  In other words, butyrate can increase Tregs AND help to maintain the integrity of the gut barrier. I briefly spoke about butyrate in an article entitled “What Thyroid Sufferers Need To Know About Fiber, Resistant Starch, and SCFA”.

Next they discussed how an alteration in the composition of intestinal bacteria, an increase in intestinal permeability (leaky gut), and a shift to proinflammatory cells are some of the ways the gut microbiota impacts the thyroid.  They also mentioned another study where the authors found that intestinal dysbiosis (imbalance of the gut flora) and bacterial overgrowth was more common in those with hypothyroidism/Hashimoto’s when compared to a euthyroid group (1). I will say that it’s possible that bacterial overgrowth can be a consequence of hypothyroidism. In other words, while intestinal dysbiosis might be a factor in the development of Hashimoto’s (and Graves’ disease), hypothyroidism can lead to altered GI motility, which in turn can lead to small intestinal bacterial overgrowth (2).

Celiac Disease, NCWS, and Thyroid Autoimmunity

The authors then went on to discuss how there is a higher prevalence of thyroid autoimmunity in both Celiac Disease and Non-Celiac Wheat Sensitivity (NCWS).  As for why this is the case, they brought up different possible mechanisms, including 1) shared cytokines, 2) cross-reaction of antibodies (molecular mimicry), malabsorption of micronutrients essential for thyroid health, and 4) increased intestinal permeability.

Nutrient Deficiencies and Thyroid Health

Next they discussed how the microbiota influences the uptake of minerals that play an important role in thyroid health.  This includes iodine, selenium, zinc, and iron.  They also mention how Lactobacillus and Bifidobacterium species are decreased in those with Hashimoto’s thyroiditis and Graves’ disease, and this can also have an effect on the minerals.  This is yet another reason to eat probiotic-rich foods and perhaps consider taking a probiotic supplement.

Speaking of probiotics, the authors discuss how probiotics can help support thyroid health.  They specifically mentioned a study in mice that showed that supplementing with Lactobacillus reuteri resulted in an increase in free T4, and another animal study which showed that supplementing with probiotics increased T3 and T4 (3).  I’m sure there might be a few people with hyperthyroidism/Graves’ disease who are wondering if they should avoid probiotics, and all I can say is that I’ve worked with many hyperthyroid patients over the years, I commonly recommend probiotic supplements, and I don’t recall anyone’s hyperthyroidism worsening by supplementing with probiotics.

The authors brought up another study looking at the influence of Lactobacilli and Bifidobacterium species on thyroid hormone replacement…specifically levothyroxine.  They found a significantly lower adjustment requirement of T4 in the study compared to the control group, reasoning that microbiota modification increases the availability of levothyroxine and stabilizes thyroid function. They also concluded that probiotics can play a role in lowering serum hormone fluctuations, and mentioned how probiotics seem to be able to accumulate trace elements such as selenium, zinc, and copper, and incorporate them into organic compounds.

Bariatic Surgery and Thyroid Health

The article also discussed how bariatric surgery can potentially affect the thyroid.  Bariatric surgery is considered for some people who are obese, as it can result in substantial weight loss. In this journal article they discussed a meta-analysis that showed a significant decrease in the TSH, free T3 and total T3 in obese patients after receiving bariatric surgery, but it didn’t affect the free T4 or total T4 (4).  They also said that subclinical hypothyroidism was completely resolved in 87% of Roux-en-Y gastric bypass (RYGB) patients one year after surgery.  Other studies observed an improvement in hypothyroidism in around 35% of patients and resolution in about 15% (5).

Thyroid Cancer, Nodules, and the Gut Microbiota

The final section discusses the relationship between the gut microbiota and thyroid cancer.  They start off by mentioning how those people with thyroid cancer and thyroid nodules present with higher microbial richness and distinct composition compared to the healthy control group, which suggests that imbalances in the gut microbiota is correlated with thyroid cancer and nodules. They then mention that in thyroid cancer there are higher levels of Clostridiaceae, Neisseria, and Streptococcus, while in thyroid nodules there are increases in Streptococcus and Neisseria when compared to healthy control groups (6).  So while in past articles and blog posts I’ve discussed the role of insulin resistance and estrogen metabolism in thyroid nodules, a healthy gut can also play a role.

Then they mentioned how Lactobacillus is significantly decreased in those with thyroid cancer and nodules.  They remind the reader how Lactobacillus is important for the utilization of trace elements such as selenium, which plays an important role in thyroid health. While most probiotic supplements include Lactobacillus, unfortunately no specific species or strains of Lactobacillus was mentioned in the study.

So hopefully you understand how a compromised gut can have a negative effect on thyroid health.  In the past I’ve mentioned numerous times how a leaky gut is part of the triad of autoimmunity, but this journal article gave a much more comprehensive overview of how problems with the gut can affect thyroid health.  Here is a summary of some of the key points included in this journal article:

• More than 70% of the entire immune system is located in the gut-associated lymphatic tissue (GALT)
• An impaired microbiota can lead to the development of autoimmune conditions, including Graves’ disease and Hashimoto’s
• Butyrate can increase Tregs AND help to maintain the integrity of the gut barrier
• Intestinal dysbiosis and bacterial overgrowth was more common in those with hypothyroidism/Hashimoto’s
• There is a higher prevalence of thyroid autoimmunity in both Celiac Disease and Non-Celiac Wheat Sensitivity (NCWS).
• The microbiota influences the uptake of minerals that play an important role in thyroid health, including iodine, selenium, zinc, and iron
• Probiotics can support thyroid health
• A meta-analysis that showed a significant decrease in the TSH, free T3 and total T3 in obese patients after receiving bariatric surgery
• Imbalances in the gut microbiota is correlated with thyroid cancer and nodules

If you have Graves’ disease or Hashimoto’s thyroiditis, and if you want to do more than just manage your thyroid symptoms, then you might be interested in joining our 21-Day Overcoming Graves’ Disease and Hashimoto’s Challenge (starts November 2nd!):

The 21-day challenge will include the following…

Component #1: Daily Overcoming Graves’ Disease and Hashimoto’s Video Lesson

During this daily 20-30 minute recorded lesson I will focus on a different topic that is essential to overcoming your autoimmune thyroid condition. There will be one lesson every day for 21 consecutive days (although a few lessons include multiple videos). If you’re interested in the specific topics that will be presented please check out the video where I discuss the 21-day challenge calendar (the website link is below).

Component #2: Daily 30-45 minute live group coaching session

The live group coaching calls will take place on Zoom, which is very easy to use on computers, mobile phones, and tablets. And if you are unable to attend live you’ll have the opportunity to email your questions during the separate Q & A sessions (discussed below). For those who choose to join live, the way it works is that I’ll send you a link to join the call, and if you are using a mobile phone or tablet you’ll need to install the free app. I will record every coaching session and post the recordings in a private membership area for those who are unable to attend live. As for the time of the coaching sessions, I will rotate them to accommodate those in different time zones. Most of the live calls will take place either 1pm or 8:30pm Eastern time (New York time zone).

Component #3: Recording of each coaching call for those who are unable to attend live

I hope most people will be able to attend at least 2 or 3 live sessions per week, although I’ll add that with my last two challenges there were participants who didn’t attend the live calls, but simply watched the recordings and emailed their questions for me to answer during the Q and A sessions (discussed below).

Component #4: Daily priority action step

I want people to take action, but I want the action steps to be attainable, which is why there will be a single priority action step each day, although at times there will be one or two additional action steps that aren’t as urgent.

Component #5: Access to a private members-only group

We want you to build relationships with one another and enjoy this challenge together. One way we accomplished this in previous challenges was through the live coaching calls, but another way was through the private members-only communities we had. Since not everyone wants to be on Facebook we initially hosted the group on a platform called Kajabi, and while we did have a lot of people participate, we realized that there are some limitations to Kajabi. So for second challenge I had two private members-only groups…one in Kajabi, and one in Facebook, and it worked out well. And so you can join either one of these groups, or both if you’d like! In our last challenge we had in June approximately 100 people joined the Facebook group and around 25 people joined the Kajabi group. I’ll pop into these groups every now and then, but I plan on having my nutritional health coaches moderate the groups.

Component #6: Weekly 90 minute live Q & A session

Although I’ll be answering some questions during the daily coaching calls, these will be around 45 minutes, and I will focus on answering live questions. But there will also be three separate live Q & A sessions (one per week) during the 21-day challenge. These will be at least 90 minutes long, although with both of my longer challenges I exceeded two hours with each of the Q & A sessions, as my goal is to answer ALL questions! I’ll once again rotate the day and times to accommodate those in different time zones, and so they will either be at 12pm, 1pm ET or 8pm ET. However, unlike the daily coaching calls, if you are unable to attend any of the Q & A sessions live you can email your questions ahead of time.

You Get All of This For A Single Payment of $49

If you watch the video on top of the registration page (the link is below) you’ll see dozens of people rave about my challenges, and I think it’s safe to say that just about everyone easily got back their investment.  I do want to mention that this past summer I had a 5-day challenge, but the testimonials on the website are from participants of my two longer challenges.

Optional Upgrade: 45-minute one-on-one diet and lifestyle call with a certified nutritional health coach

Both of my nutritional health coaches are excellent, and I thought it was important to include an option for affordable one-on-one support with all of the stress everyone is dealing with, although I’m confident the daily group coaching calls will also help with this. You have the option of doing this over the phone or through Skype/Zoom. If you listen to some of the video testimonials from members of the past challenges you’ll hear some rave reviews about the diet and lifestyle call! And so if it’s in your budget I’d highly recommend taking advantage of it for the discounted rate of $50. But if not you still will receive a ton of value from the rest of the challenge.

For more information on the 21-day challenge visit the link below:

www.ThyroidHealthChallenge.com/Enroll2020

Since 2009 I have had a practice that focuses on thyroid and autoimmune thyroid conditions, and while I do work with people who have non-autoimmune thyroid conditions (i.e. toxic multinodular goiter), most people I work with have Graves’ disease or Hashimoto’s thyroiditis.  Some people have the antibodies for both Graves’ disease and Hashimoto’s.  Every now and then someone will ask what the difference is between these two conditions, and so I figured I’d put together a blog post that discusses the similarities and difference between Graves’ disease and Hashimoto’s.

Let’s first start out by discussing the differences between these two conditions:

What Are The Differences Between Graves’ Disease and Hashimoto’s?

1. They involve different autoantibodies.  Those with Graves’ disease have elevated thyroid stimulating immunoglobulins, which is a type of TSH receptor antibody.  Hashimoto’s thyroiditis is usually diagnosed when someone has an elevated thyroid stimulating hormone (TSH) in the presence of thyroid peroxidase and/or anti-thyroglobulin antibodies.  However, it’s worth mentioning that many people with Graves’ disease also have elevated TPO antibodies, and some people have all three of these thyroid antibodies.

2. Hashimoto’s involves damage to the thyroid gland.  Whereas Graves’ disease involves the thyroid stimulating immunoglobulins binding to the TSH receptors without causing permanent damage, this isn’t the case with Hashimoto’s.  In Hashimoto’s there is damage to the thyroid gland.  And while the thyroid gland can regenerate, it does so slowly, and sometimes the damage is so extensive that the person needs to remain on thyroid hormone replacement.  Keep in mind that it can take many years before there is sufficient damage to the thyroid gland that results in an elevated TSH and thyroid hormones that are out of range.

3. Graves’ disease involves hyperthyroidism, and Hashimoto’s involves hypothyroidism.  The truth is that not everyone with Hashimoto’s experiences overt hypothyroidism, as many times it’s subclinical.  In other words, they might have an elevated TSH with the thyroid hormone levels within the lab reference range.  It’s also important to mention that some people with Hashimoto’s experience hyperthyroidism due to Hashitoxicosis.  On the other hand, most people with Graves’ disease will experience overt hyperthyroidism, although there are exceptions.

4. The symptom management differs.  Because most people with Graves’ disease experience overt hyperthyroidism, most endocrinologists will recommend antithyroid medication (i.e. methimazole, PTU) to their patients.  Of course many will recommend radioactive iodine or thyroid surgery.  With Hashimoto’s, thyroid hormone replacement is commonly recommended.  This is true even if the thyroid hormone levels are looking good, as many medical doctors will go by the TSH alone.

5. Unmanaged hyperthyroidism is arguably a greater risk than unmanaged hypothyroidism.  The truth is that there are risks of both unmanaged hyperthyroidism and hypothyroidism.  But arguably unmanaged hyperthyroidism is a greater risk, as it can lead to heart arrhythmias, decreased bone density, and in rare cases thyroid storm, which is a life threatening situation.  On the other hand, myxedema is a severe form of hypothyroidism that can be life threatening, although it’s very rare.

6. The autoimmune triggers can differ.  While there is an overlap of certain triggers, there can also be different triggers for different autoimmune condition.  For example, while stress can be a factor with both Graves’ disease and Hashimoto’s, in the research it shows that it’s a greater factor with Graves’ disease.  And while there is a case report suggesting that Blastocystis Hominis might be a trigger of Hashimoto’s, nothing in the research suggests that it’s a potential trigger of Graves’ disease.

What Are The Similarities Between Graves’ Disease and Hashimoto’s?

So now that you know some of the differences between Graves’ disease and Hashimoto’s, let’s take a look at some of the differences:

1. They are both autoimmune thyroid conditions.  Both Graves’ disease and Hashimoto’s are autoimmune conditions that affect the thyroid gland.

2. Most medical doctors don’t do anything to address the underlying cause of either condition.  Every medical doctor knows that Graves’ disease and Hashimoto’s are autoimmune conditions, yet they never do anything to address the autoimmune component.  Of course this comes down to their training in medical school, and fortunately some medical doctors are open minded enough to look into underlying causes, although not nearly enough.

3. It’s possible to reverse the autoimmune component.  Although there are genetic factors behind autoimmune conditions, it still is possible to reverse the autoimmune component of both Graves’ disease and Hashimoto’s.  This admittedly isn’t easy to do, as one needs to find and remove the autoimmune triggers, and since a leaky gut is a factor with autoimmunity it is also necessary to heal the gut.

 

One of the most common questions I have received in 2020 is whether or not those with autoimmune thyroid conditions are more susceptible to getting Covid-19. It’s a good question, as both Graves’ disease and Hashimoto’s are immune system conditions, and viruses are more likely to impact those people with a compromised immune system.  Up until this point my response to this question has been that I don’t think having an autoimmune condition itself is the biggest factor, but of greater concern is that many people with thyroid autoimmunity have other things “dragging down” their immune system, which might make them more susceptible to getting Covid-19 (as well as other viruses).

But now that Covid-19 has been around for awhile there have been a few studies evaluating its effects on thyroid health, and whether people with thyroid autoimmunity are more susceptible to contract this virus.  In June of this year a study came out in the United Kingdom showing that there was no data available at that time suggesting that patients with an autoimmune thyroid condition remain at higher risk of getting Covid-19 (1). The study also mentioned that in patients severely affected by Covid-19, changes in thyroid function might be a result of a “sick euthyroid” syndrome, although the authors did mention that there might be specific thyroid-related damage which requires further investigation.

However, in July a journal article was released entitled “Thyroid disease is associated with severe coronavirus disease 2019 (COVID-19) infection” (2).  The article looked to explore the relationship between thyroid conditions and severe cases of Covid-19. Based on the data the authors concluded that thyroid disease seems to be associated with an increased risk of severe Covid-19 infection, and they gave the following three reasons why this may be the case:

1. Thyroid hormones are important in the regulation of the innate immune response. Therefore, an excess or deficiency of thyroid hormones levels observed in thyroid disease will lead to dysregulation of the innate immune response.

2. Increased levels of proinflammatory cytokines such as TNF-α and IL-6 was observed in patients with thyroid disease. Increased levels of these cytokines were also observed in patients with severe Covid-19 and correlates to the development of severe outcomes.

3. Some thyroid patients, especially those with subacute thyroiditis, were taking corticosteroids. Meta-analysis showed that corticosteroid treatment in Covid-19 patients was associated with higher mortality, longer length of hospital stay, and higher rate of bacterial infections. This isn’t surprising since corticosteroids suppress the immune system.

Most of the people I work with aren’t taking corticosteroids, and I think it’s safe to say that “point #3” doesn’t apply to most people with Graves’ disease or Hashimoto’s, although I should mention that some people with moderate to severe thyroid eye disease will take corticosteroids such as Prednisone, thus making them more susceptible to getting Covid-19 (or another viral infection).  The first and second points mentioned above do apply to most of the people I work with.  But as I mentioned earlier, there are other factors that can be having a negative effect on one’s immune system that can make them more susceptible to viruses such as Covid-19, including having weak adrenals, an unhealthy gut (most of the immune cells are located in the gut), an increased toxic load, certain nutrient deficiencies, exposure to toxic mold, etc.

Can Covid-19 Cause Subacute Thyroiditis?

Subacute thyroiditis is an inflammatory condition of the thyroid gland which causes damage to the thyroid follicles, and as a result, large amounts of thyroid hormones are released into the circulation, resulting in overt hyperthyroidism.  However, unlike Graves’ disease, this state usually self resolves after a few months, although many will first experience a transient period of hypothyroidism.  To learn more about this condition you might want to check out my blog post entitled “Graves’ Disease vs. Subacute Thyroiditis: What’s The Difference?“.

A case study in July showed that an 18-year-old woman developed subacute thyroiditis after getting infected with Covid-19 (3). Another study revealed that a substantial proportion of patients with Covid-19, requiring high intensity of care, present with thyrotoxicosis and low serum thyroid stimulating hormone (TSH) concentrations, possibly as a consequence of subacute thyroiditis induced by SARS-CoV-2 (4).  In other words, SARS-Cov-2 can directly infect the thyroid gland, leading to subacute thyroiditis.

Black Cumin and Covid-19

While on the subject of Covid-19, I would like to mention that there are a few studies which show that Nigella Sativa (black cumin) might benefit those with Covid-19.  Black cumin has numerous health benefits, as it has demonstrated antiviral, antioxidant, anti-inflammatory, immunomodulatory, bronchodilatory, and antihistaminic properties (5).  It also shows anti-hypertensive, anti-obesity, anti-diabetic, anti-hyperlipidemic, anti-ulcer, and antineoplastic activities, which can help with comorbidities commonly found in Covid-19 patients (5).  In addition, the active constituents of N. sativa such as nigellidine and α-hederin have been identified as potential inhibitors of SARS CoV-2, and thymoquinone (the chief bioactive constituent of black cumin) suppresses mRNA expression which downregulate interferon genes and other inflammatory responses (5) (6).

Even though I have written a blog post on black cumin, in the past this is something I’ve mainly given as part of a protocol to those with H. pylori.  And while I’m not suggesting for everyone to take black cumin specifically to reduce their chances of getting Covid-19, keep in mind that it can potentially help to minimize the impact other viruses have on your health as well, and as I listed above, it has numerous other health benefits. So at the very least it might be something to have on hand.  There is one more thing I would like to mention, as the blog post I wrote related to black cumin focused on hypothyroidism and Hashimoto’s, but it’s also fine for most people with hyperthyroidism and Graves’ disease to take black cumin.

In summary, according to the research people with Graves’ disease and Hashimoto’s thyroiditis seem to be more susceptible to getting Covid-19. However, as I mentioned earlier, the reason for this might be related to other imbalances commonly found in people with these conditions that can further compromise the immune system.  Either way the goal should be to do everything you can to improve the health of your immune system, and black cumin might also be something to consider adding to your supplement arsenal when combating viruses.  You also might want to check a blog post I released earlier this year entitled “5 Ways To Improve Your Immune Health Without Taking Supplements”.

I’ve written separate articles on thyroid peroxidase (TPO) antibodies and anti-thyroglobulin antibodies, but I haven’t put together a post on thyroid stimulating immunoglobulins…until now!  These antibodies are associated with Graves’ disease, and it’s unfortunate that some endocrinologists don’t test their hyperthyroid patients for these antibodies, but instead will test the TPO and/or anti-thyroglobulin antibodies.  While it’s common for people to have two or three different thyroid antibodies, everyone with hyperthyroidism should get the thyroid stimulating immunoglobulins tested.

So what are thyroid stimulating immunoglobulins (TSI), and how do they differ from other types of thyroid antibodies?  TSI are a type of thyrotropin (TSH) receptor antibody (TRAB). There are actually two types of TSH receptor antibodies. In addition to thyroid stimulating immunoglobulins, there are also thyroid binding inhibitory immunoglobulins (TBII), which is a type of thyrotropin receptor blocking antibody.  These antibodies bind to the TSH receptor and inhibit the binding of TSH, thus blocking the synthesis and secretion of thyroid hormones.  These aren’t commonly tested, and one reason is because not all labs offer this.

What Do Elevated TSI Levels Indicate?

Elevated TSI levels are associated with Graves’ disease.  What happens is that the TSI bind to the TSH receptors, which results in the excessive production of thyroid hormone.  This is why most people with Graves’ disease have hyperthyroidism, although some people have subclinical Graves’ disease, which is when the TSI are elevated, the TSH is depressed, but the thyroid hormone levels are within the lab reference range.

What Causes Elevated Thyroid Stimulating Immunoglobulins?

As I have mentioned, elevated TSI levels are associated with Graves’ disease, which is an autoimmune condition.  In the past I’ve discussed the triad of autoimmunity, and according to this, in order for autoimmunity to develop the following three factors need to be present: 1) genetic predisposition, 2) exposure to an environmental trigger, 3) a leaky gut.  So just as is the case with any autoimmune condition, someone with elevated TSI levels has a genetic predisposition for Graves’ disease, but having the genetics alone doesn’t mean they will develop thyroid autoimmunity, as they will need to be exposed to an environmental trigger and have a leaky gut.

What Is The Lab Reference Range?

Unfortunately different labs will use different units of measurements, and you can’t compare them with one another.  For example, the Labcorp reference range is 0.00-0.55 IU/L, whereas the reference range for Quest Diagnostics is <140%.  As for the thyrotropin (TSH) receptor antibody test, Labcorp has a reference range of 0.0−1.75 IU/L, while Quest Diagnostics has a range of ≤2.00 IU/L.  If at all possible I recommend getting the thyroid stimulating immunoglobulins tested, although it of course is fine to get both the TSI and TRAB tested.

Some reading this might wonder what the “optimal” reference range is for these markers, and whether the goal should be to have a level of zero.  While you want the levels to be well below the lab reference range, I wouldn’t say that they have to be zero in order for someone to be in a state of remission.  As for the optimal reference range, I like to see the TSI less than 80% or less than 0.30 IU/L, although this is just what I look for, as I haven’t seen any other practitioners list optimal reference ranges.  It’s also important to mention that some labs don’t reveal a numerical value below the reference range.  For example, if the TSI is below the reference range it might show up on the report as <0.55 IU/L or <120%.

The Relationship Between Thyroid Stimulating Immunoglobulins and Thyroid Eye Disease

Because a higher TSI level usually indicates a more vigorous immune system response, typically the higher the TSI, the more likely someone is to have thyroid eye disease.  For example, if someone has a TSI greater than 300% they are more likely to have thyroid eye disease symptoms when compared to someone with a TSI less than 300%.  Of course there are always exceptions, as I’ve had patients with very high TSI levels who didn’t experience any signs or symptoms of thyroid eye disease.

How Can You Decrease Thyroid Stimulating Immunoglobulins?

As for how to decrease and normalize thyroid stimulating immunoglobulins, the approach is similar to lowering other autoantibodies:

1. Find and remove your triggers. I mentioned the triad of autoimmunity earlier, and exposure to an environmental trigger is one of the factors that causes the development of an autoimmune condition.  As a result, it makes sense that in order to reverse the autoimmune component and lower thyroid stimulating immunoglobulins you will need to find and remove any immune system triggers.

2. Heal the gut. Another component of the triad of autoimmunity is a leaky gut, and so you of course need to heal the gut.  Check out the blog post I wrote on the “5R protocol” for more information on how to heal your gut.  But I’ll say here that you usually need to do more than take probiotics and gut healing agents, as these won’t be effective if you don’t address the factor that is compromising the gut.  For example, if someone has a gut infection that is causing a leaky gut, this needs to be addressed. Similarly, if someone is eating gluten and this is causing a leaky gut, you can’t fix this problem by taking digestive enzymes, probiotics, and drinking bone broth.  In this situation you would need to eradicate the gut infection.

3. Correct other imbalances.  Other imbalances can also be a contributing factor.  For example, having certain nutrient deficiencies can make someone more susceptible to developing an autoimmune condition, such as selenium.  In fact, the research shows that selenium can potentially lower both TSH receptor antibodies and TPO antibodies (1), although you still need to remove the trigger and heal the gut.

4. Break the chronic inflammatory cycle.  While removing the triggers and healing the gut will usually resolve the inflammation, this isn’t always the case.  Sometimes additional measures need to be taken in order to break this cycle, such as taking high doses of natural anti-inflammatory agents (vitamin D, EPA and DHA, curcumin, resveratrol).  Low dose naltrexone might also help to break the chronic inflammatory cycle, and thus is something to consider, although I would first try the natural anti-inflammatory agents.

Do You Have Elevated Thyroid Stimulating Immunoglobulins?

If you have elevated TSI levels, I’d love to hear if you have done anything to try to lower them.  Perhaps you took a natural treatment approach, natural anti-inflammatory agents, low dose naltrexone, or did something else to modulate your immune system.  Either way, please feel free to share your experience in the comments section below.