Hi, everyone and welcome to Elevate Your Energy Radio. My name is Evelyne Lambrecht, and I’m really looking forward to tonight’s show, “Fix your Thyroid Trouble” with Dr. Alan Christianson.
Last week we had an awesome show with Christa Orecchio talking about how to kick candida for good. I learned so much from her. You can find that one on blogtalkradio.com as well as on iTunes if you just go to iTunes.com, go to podcasts, search for Elevate Your Energy, and subscribe for free.
So, before I bring Alan onto the show, let me read you his bio. Dr. Alan Christianson is a Phoenix, Arizona based aturopathic medical doctor who specializes in endocrinology and hormone replacement with a focus on thyroid disorders. He founded Integrative Health, a group of physicians who focus on optimal wellness, rather than disease. Dr. Christianson’s publications include The Complete Idiot’s Guide to Thyroid Disease, Healing Hashimoto’s, and the “Hypothyroidism” and “Hyperthyroidism” chapters of the 9th edition of the Textbook of Natural Medicine. His numerous media appearances include the Today Show, The Doctors, CNN, and Shape Magazine. You can read more about him at myintegrativehealth.com.
Alan, thank you so much for coming on the show.
Dr. Christianson: Hey, Evelyne. Thank you so much for having me.
Evelyne: Absolutely. So first of all, how did you get started in natural medicine, and then specifically so interested in thyroid health?
Dr. Christianson: You know, natural medicine is a real direct extension for me of my own health experience. I was an unhealthy, epileptic child and I kind of stumbled across the fact that changing my diet and modifying it had a huge impact. It was apparent to me that there are many ways in which our food, our nutrition, and our lifestyle affected our health, but doctors weren’t always clear on that. And unfortunately people often have to figure that out for themselves. So it became a real calling for me. As far as thyroid disease, in my medical training I had one super memorable patient. Her name was Jamie, she was a 15-year-old girl, and she was about to be dropped out of school for medical disability. She was about to have to repeat the year and be held back. She was bright but she couldn’t attend because of her debilitating fibromyalgia. She had a real strong family history of thyroid disease. Her mother had it, her aunt had it, her older sister had it, and it seemed like she had some possible symptoms. She had been treated before by other doctors trying more holistic treatments for it and had had side effects but not gotten better. And conventional doctors said she didn’t have thyroid issues. I saw that she had measurable signs of there being an active immune response against her thyroid. The doctors I was working under at the time when I was still a student got her on treatment and her life came back again. I ended up working with her myself soon afterwards, and I actually saw her a few years ago. She’s grown up, she’s got kids now, finished school, went to college, everything was fine.
But it’s a huge thing that affects a lot of people and I saw that there were some different perspectives on the alternative side but they weren’t always effective. And I saw the conventional side didn’t have it dialed in, either. So I was just kind of torn to figure out how I could make sense out of this and tie all this together and really help these people. That was 1996 and I’ve been focused on that since then.
Evelyne: Wow, that’s a great story. So before we get into thyroid disease, I kind of want to start off the show talking about what exactly the thyroid does and why it is so important that it works properly.
Dr. Christianson: For sure. You know, one of the best visuals that I put out there, is think about a bowtie: where it would be if you were wearing one, how big it is, its shape — not perfect but almost , and the mass of it too. So that’s kind of where it is and how it’s shaped. It’s our biggest single thermostat. It’s the single biggest thing that dictates how well we burn and generate fuel, and also how well we grow our connective tissues. So if the hormones from it are missing, we would go into a coma in a matter of weeks and die. If they were tripled or quadrupled, our heart would give out pretty fast. The amount of hormone the gland makes is a tiny fraction of a grain of salt, so it’s so critical to our health, and the smallest changes in it can really upset the applecart.
Evelyne: So when something goes wrong in the body, very often it is a sign of low thyroid function. What are some signs and symptoms that someone might have hypothyroidism?
Dr. Christianson: That’s an awesome question and it’s a tough thing because it affects so much of the body that there are many possible symptoms. I teach doctors internationally on this and I try to differentiate when I teach them about possible symptoms versus probable symptoms. There was a big study done in Colorado in 2000 in which they did health screenings for 25,000 people and they did questionnaires about symptoms and they tracked thyroid levels. These were not necessarily people who were on treatment already. And they saw that some symptoms have more statistical correlation between thyroid disease than others. Some of the big ones were things like muscle pain, unusual muscle cramping, unusual weight gain, difficulty swallowing, changes in the voice, drier skin, and thinner hair. They are some of the biggest ones. And specifically, people tend not to have all of the symptoms, people often have between 2 and 4 of the symptoms in kind of a unique pattern. And then also specifically, the symptoms tend not to be things that someone’s had forever; they tend to be things where people can point to a timeframe, like “Somewhere around last spring this stuff started to happen,” or “a few months back I started to feel more run down,” or “I’ve been on the same diet and exercise, but back in August my weight started to creep up,” So those are the kind of patterns that it would show up as.
Evelyne: So who most commonly gets it?
Dr. Christianson: Well, the classic presentation would be a 40-year-old woman perhaps having it come on after a later-in-life pregnancy. That would be like the ultimate classic. It’s more common in women than men. But it’s so common overall that there are still plenty of men who have it, and there are plenty of people at all age ranges who have it. But it is most typical in women and it does get more common each decade that we live. It can often be triggered by something like a pregnancy or a bad infection – some kind of stressful event of sorts.
Evelyne: So how would someone know if they have hypothyroidism?
Dr. Christianson: Well, good question. I’m going to answer this in two levels of depth. There are some common ways that it’s checked, by which it may show up, but the problem is that in those common ways that it’s checked for, it may be there but not show up. So if it’s said to be present, it is. But if a doctor says you don’t have it, you still might.
Here’s how that plays out. The most common approach is that someone has a simple blood test done. There’s a test called a TSH. It’s kind of a backwards indicator about how much hormone your thyroid is making. If you’re making too little, the TSH goes higher as your body is trying to get it to work harder. If there’s ever too much, the TSH goes lower. So in many cases, that’s all that’s done and the TSH certainly can reflect thyroid disease — there’s no doubt about that. But the data’s pretty solid that you could have substantial symptoms from thyroid problems and not have an abnormal TSH.
Evelyne: So then would someone also have to get an ultrasound or what other kind of things would you look for?
Dr. Christianson: That’s a great plan. Ultrasounds are a really helpful idea. They’re helpful for diagnosing, but they’re also helpful because if someone has or is suspected of having thyroid issues, they do run a higher risk of having thyroid structural problems. What I mean by that is that the gland might make the wrong amount of hormone. That’s more of a disease function. Along with that, the gland may also have physical abnormalities. There may be calcifications, nodules, or goiters. There’s thyroid cancer, too. So for diagnosis, ultrasounds are really helpful and there are more detailed blood tests that look at things like the possible immune attack against the thyroid, how the various hormones are made or converted. The final curveball is that what we call “normal” for thyroid function tests is quite a ways away from what really “optimal” looks like. So one should be checked pretty comprehensively and the doctor should have a sense of looking at that with an eye toward optimal values as opposed to just the normal values that come printed on the report.
Evelyne: Right. I actually want to delve a little deeper into that. Which ranges do you go by, and can you also explain why the ranges differ so much? Why would someone show up as normal when that wouldn’t necessarily be considered optimal when you have blood work?
Dr. Christianson: I would love to dive deeper into that. An analogy I give to people is that if you wanted to know the optimal width of an adult human butt [Laughs] and you just went down the street and you measured a whole bunch of butts, you would find an average width but you might not find an optimal width. [Laughs] They’ve actually had to retool stadium seating – I don’t know if you knew that – and also airplane seating. They’ve had to modify those things because the average width of the human butt is moving further and further away from the optimal width. [Laughs]
So even further with thyroid disease, what goes on is that the normal lab values are average lab values. They are averages of people who have had the test done. Now the problem is that there is a very clear bias when you are getting thyroid tests done, it’s much more likely that you have thyroid disease just because you are doing it. Healthy people are not regularly or frequently screened for their thyroid levels. If you are feeling great, you are not going to go in and have your thyroid tested every week if you’ve got no thyroid problems. Roughly 85% of those that have thyroid tests are known already to have thyroid disease, and they’re being screened for dose adjustment purposes. Another 10% of those tested are tested because they have suspicious symptoms. They’re like, “Hey that doesn’t sound right. We should check your thyroid.” And probably five percent of people — maybe even less in some areas — are just healthy and they are having routine screening tests. And that 85% — to go even further into that — the people that get tested that have thyroid disease the most frequently are those that are undergoing the most dose modifications, meaning that they’re not stable on their levels. You put all that stuff together and you can average that population, but that’s going to be pulled a long ways away from healthy scores.
There was a nice study done — one of the larger ones of its kind – it was done in Turkey several years back. They started with a large number of people, and they whittled out everyone — not literally — but they took them out of the study if they had known thyroid disease, a lot of people in the family with thyroid disease, symptoms that could relate to thyroid disease, medications that could skew it, people who were pregnant. If they had anything that could give them possible thyroid dysfunction, they were taken out of the study. Everyone who was left had thyroid tests done over and over again for several months. And they made some pretty good batch samples and distributions of what scores should look like.
So specific numbers: today most reference laboratories call 0.4-0.45 the low end for TSH, and 4.5-5.5 the high end of the normal. I started practicing in 1996, which was not like the Middle Ages, but at that point the high end of the TSH was 10-12 for most labs. So it has changed a lot. In that big study done in Turkey, the healthiest people never once had a TSH score higher than 1.91. So the big difference is on the high end of normal for the TSH. Scores between 1.9 and 4.5 are normal scores but those are not scores that are ever present in the healthy population.
Evelyne: Interesting. So, what is the difference between hypothyroidism and Hashimoto’s hypothyroidism? What is “Hashimoto’s?”
Dr. Christianson: That’s a great question. Hiroku Hashimoto was a Japanese physician. They have much higher rates of thyroid disease of all types in Japan, and that’s really related to higher iodine intake. So he was the first to understand that thyroid disease was caused by an immune attack. And the way it works in medicine is that if you figure out something new, you might get your name tacked on the disease after you die. [Laughs] So it’s kind of an exotic-sounding word. But it was the name of this researcher who figured the disease out.
So what it is, it’s an immune attack where the immune cells — specifically the lymphocytes — are targeting healthy proteins inside your thyroid that are involved with producing hormones. So your body basically gets a taste of blood for your thyroid and starts chipping away at it. When enough of the mass of the gland is broken down, that makes it to where the gland can’t meet your body’s needs for thyroid hormone any longer, and that is hypothyroidism. So hypothyroidism can be caused by other causes, too. So in parts of the world that have less consistent iodine intake, the simple lack of it can cause hypothyroidism. People can also have surgery for thyroid cancer and the gland is removed and that creates hypothyroidism and there are some medications that can cause it as well. There are some other causes that are rather rare and exotic. In the modern world the vast majority of hypothyroidism is caused by Hashimoto’s — probably better than 97%. Now Hashimoto’s is actually a diagnosis where there are a lot of ways you can make the diagnosis, but there really aren’t ways you can rule out the diagnosis. So if someone’s hypothyroid, there is no single way that you can say they don’t have Hashimoto’s, short of taking out their thyroid and mincing it and microscopically looking at all of it. Antibody tests show it sometimes but they don’t rule it out. So most people that are hypothyroid, we assume to have Hashimoto’s.
Evelyne: I learned about this a couple of years ago and just thought it was so interesting because I’d never heard of this before, and then whenever anyone came to me who said they were taking thyroid medication, I said, “Can you please test your antibodies?” And sure enough it was so common I was surprised. I didn’t even realize that it’s so common.
Dr. Christianson: It’s very common. And even those that haven’t had them tested or those that are tested and the tests come back negative, that doesn’t mean there isn’t an immune response.
Evelyne: Right. And what are the two antibodies?
Dr. Christianson: The most common two tested are antithyroglobulin and antithyroperoxidase. There is also thyroid stimulating immunoglobulin, which has a little overlap with Grave’s Disease. But that’s not as typically present in Hashimoto’s, although it can be.
Evelyne: Why don’t endocrinologists typically test for these?
Dr. Christianson: Oh boy. Now I’m going to bust out the soap box. [Laughs]
Evelyne: We opened a can of worms.
Dr. Christianson: Well, we’ve got to go way back to patentability and procedures and reimbursement schedules… My take is that people in healthcare mean well, and they want to do right by their patients. But there is no denying the fact that a lot of subtle things over time shape what we do. And medicine is highly skewed and highly driven towards reimbursement and towards patentable medications — medications that a big company can justify marketing expenses on. In the thyroid world, there haven’t been big advances — short of one that may come up from a company that I like — but in terms of the conventional world, there haven’t been big advances for literally over 100 years. And there is nobody handing out pens for thyroid medicines or sponsoring big events. So there’s not much focus on education for that. And the fees of most doctors that are in endocrinology practices are based upon procedures. And they’re not incentivized to spend much time talking to people with thyroid disease and trying to get their symptoms better. So it’s not something they tend to go very deeply into. And by their level of training, they’re not really given a lot of distinct treatment options whether or not they have antibodies or whether or not they have particular symptoms or whether they have abnormalities in their ultrasounds. And so it’s just not taken very thoroughly except for with the most extreme types of abnormalities.