Megan Spears:

Hi, welcome everybody to our bi-weekly webinars here at Thrivelab. My name is Megan Spears. I'm one of the nurse practitioners here at Thrive Lab. I've been with Thrive Lab for about two, over two years now, and I'm joined with Dr. Patel.

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Dr. Nayan Patel:

Hi, this is Dr. Nayan Patel. I am the Chief Scientific Officer with Thrivelab. I'm very fortunate to be working with a team of successful nurse practitioners and physicians that know more about hormones than all of us combined. So I'm very happy to be here today, and discussing today would be a topic on something that is very near and dear to me, which is thyroid health. So let me start off with it. I mean, when we talk about thyroid, I mean, it's all over the place. So can we, Megan, can you just tell me just briefly what are the thyroid hormones that we're talking about today?

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Megan Spears:

Well, we have quite a few. At times when a patient or client goes to their primary care doctor, their regular doctor, they'll typically only check one thyroid hormone. And here at Thrivelab, we check a bunch of different hormones in regards to the thyroid. We look at TSH, T3-free, T4-free, TPO. A lot of them, when we're looking at all of them, we need to see a whole picture of what the thyroid's doing and not just one small portion of it.

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Dr. Nayan Patel:

Absolutely, so the most common thing most of the doctors will prescribe is TSH because what they're looking for is that the pituitary is the brain function correctly and if that's working okay, then you should be fine. But it's further away from the truth and I'm so glad that you do check all the thyroids because it really makes it very unique to Identify if we were- the unit of the pituitary is functioning. Okay, is the body responding to the thyroids or not? So having checked all the different parameters can really help us hone down on exactly what medications we have, what the patient's needs are gonna be. So I'm glad you're doing that.

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Megan Spears:

Yeah. So as I was previously a primary care provider for 12 to 13 years, and that's what I was taught. I was taught just to check the TSH. But like you said, that's only a small portion of the full function of our thyroid. So we have other levels like the T4 and T3 we want to look at. And oftentimes I tell clients there's a communication that occurs. between these different hormones. We have an inactive hormone T4 and an active one of T3. And I explain to my clients more that it's like a traffic cop directing traffic. So that's our T4 and our T3 is gas. And so it's the gas of our engine. It makes us go. It helps with metabolism and energy. And then sometimes we can ride our brakes. And those breaks are things like environmental toxins, chemicals, prescription medications sometimes can cause us to have breaks on our thyroid. Stress, stress can cause our thyroid not to sometimes function appropriately. Hormone imbalance, progesterone helps support our thyroid function. And then other things like exercise and diet can also affect our thyroid function. So those things, if we don't have those in check, we can be putting the brakes on our thyroid and then we'll need more gas.

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Dr. Nayan Patel:

Of course. So can you tell us, I'm sure you see patients every single day with these issues, what are some of the common range of issues that these patients are coming with complaints of?

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Megan Spears:

So a lot of times symptoms of low thyroid or thyroid imbalance, so sometimes we have this wide range that we look at when we're looking at our lab values, right? And a lot of times clients will come to us with their labs already done or we'll check labs and they're like, well, for instance, I was just on with a client, she's a nurse, so she knows how to read lab values kind of, and she's like, well, they're all normal. And I said, yeah, but you're having all these symptoms that tell us that you're having a thyroid imbalance of some sort. So thyroid imbalance symptoms can include things like weight gain, constipation, hair loss, dry skin and nails, fatigue. A lot of different joint pain can be one of them. And so sometimes it seems that our, I don't know about if you've noticed Dr. Patel, but our lab ranges keep getting wider to fit people in, right?

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Dr. Nayan Patel:

Over the years. Yep.

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Megan Spears:

Over the years. And so there's an optimal value for everybody within that range, right?

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Dr. Nayan Patel:

That's true.

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Megan Spears:

And typically usually on the higher part of the range. And so I tell clients, you know what? You're having all these symptoms and yes, you're within range, but you may not be optimal for you.

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Dr. Nayan Patel:

And you bring up such a good point. Today, patients are so much into their own body, they just don't want to survive. They want to live their life, right? And to live a life, you need to optimize your body functions. And I'm glad you bring this up because the reason Thrivelab thrives is because patients are requesting us to optimize their overall health. And if we just stay within the range, it is never going to be optimized. We need to push them up towards the higher end of the ranges where the patients are actually feeling alive and lively and less fatigue and more energy and just overall functioning better. So you bring a big point about weight loss because that's another issue we have today in the whole of America. And yes, as much as we want to see if thyroid can solve this issue for us. It's not just one issue, right? Thought could be just one of the components in the whole grand scheme, but we gotta start making sure that everything that we touch can be optimized for those things. I'm glad that you brought this point because you're right. The ranges are getting wider and wider to catch all, but the reality is that what we're looking for is a narrow range where people feel the optimum, and that's what we're gonna look for.

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Megan Spears:

Exactly.

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Dr. Nayan Patel:

So that's great. So what are some of the conditions that people should look out for if you think they have, if you suspect they have thyroid conditions? Do you know?

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Megan Spears:

Symptoms?

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Dr. Nayan Patel:

Yeah, symptoms are some of the conditions that they- why they have thyroid problems. Oh, how do they get thyroid problems?

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Megan Spears:

Like we mentioned before, we could have a poor diet. It’s a genetic component. Right? So mom had it, sister had it, have thyroid imbalance. There's a small portion of people that can have a genetic component in their family that can contribute. And there can be lack of maybe iodine in the diet or selenium. So there's nutrients that also feed the thyroid to help it function better.

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Dr. Nayan Patel:

You know, you bring up the point about iodine. So I remember growing up back in the 80s, guess what? Iodine was part of your normal diet, right? We have all the salt, iodized salts available, and now to get iodized salt is a special thing. Before there was always iodized salts. The other thing that, as a pharmacist and a chemist, I'm very much particular about my chemistry, and if you look at iodine, bromides and fluorides are the same sequence on the periodic table. What that means is that if either one of them is out of range it throws your balance off track. Today we have fluoride toothpaste. Everybody use toothpaste, fluoride toothpaste. If you overuse fluorides, guess what? It displaces iodine from your body and now too much fluoride, even though it's great for preventing cavities and good for your health, but it's also affecting your thyroid health, right? And back in the 80s, guess what they did? They removed the iodine from the bread and replaced it with bromides, which is the worst thing they could have done in the history of changing. And I still do not know why they changed it because I could not read the history that far back to understand why someone would make a change like that. But it was changed. And so since then, we have deficiency of iodine in our diet because we're not getting them from our regular meals. I'm glad you've made the point because again, how many patients do you see are having thyroid deficiency or imbalances?

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Megan Spears:

It's a good amount of clients. It's mostly women. I have had some men with thyroid imbalances. And it's really- it's an epidemic in the US. And what exactly and why that is? We don't know, but we can guess. You know, one is environmental toxins and all the plastics and chemicals and all the additives in our foods. It's also like what you said, nutrient imbalance in our food. We're not getting the proper nutrients and that's not just iodine it's things like selenium and zinc and B12.  All of those help contribute and help that conversion of the T4 to T3 work better.

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Dr. Nayan Patel:

That's true. I mean, the conversion for T4, as you said earlier, T4 is an inactive form of thyroid, and to make it activate, it has to, your body has to be low, you should be having low on stress and high on magnesium, zinc, iodine, and selenium. If anything is off, right, how many of your patients are stress-free today? Ha ha. None?

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Megan Spears:

I have- actually I had one other day and she was actually pretty zen and I was like, okay, that's a new one.

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Dr. Nayan Patel:

I mean, you probably see at least 20 patients a day and to see one in a one week, it's not normal, right?

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Megan Spears:

Fair, for sure. Yeah.

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Dr. Nayan Patel:

Yeah, so yeah, stress is a cause of low thyroid deficiency or things like that. So we talk about T4 all the time. What is T4 and what is T3?

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Megan Spears:

So as you mentioned, T4 is our inactive form. And as it loses an iodine molecule, it becomes T3, which is the active form. And like I said, you want that active thyroid. So oftentimes, when we see a provider, and I'm guilty of this, I didn't know this until I really started learning thyroid much more in depth, was I was only prescribing T4. And that is great in some cases, but sometimes we need that active form of T3. And so there is prescriptions of T3, T4 combos, like an Armour thyroid. We make one at Thrive called Bio thyroid. NP thyroid's another one. So T4 and T3 combos, we typically will provide that because we need that, what I call the gas, to help the engine run.

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Dr. Nayan Patel:

Absolutely.

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Megan Spears:

And you just don't need the T4, because the T4, what it does, like I said, it's a traffic cop, so it kind of just is communicating, which is that conversion that occurs, and directing traffic here and there. But the T3 is the gas at the thyroid, so we need a little bit of both. And I'm sure you can go further on, you know, the pharmaceutical portion of it.

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Dr. Nayan Patel:

Yeah, so T4 is, the common name is Levothyroxine. It's the common generic name for it. The trade names are Synthroid is a trade name for something that makes T4. And it's been there for decades in the pharmaceutical industry is making that for us. The T3 component, which is Leothyronine, there's a trade name called Cytomel that makes a T3. And you're right, at Thrive we combine them together to optimize patients' output so that way we're not married to a trade name products. We want to make sure it's right for the patients. And sometimes having a combination of both of them is the right choice. And sometimes giving them one or the others is a better choice. Either way, we do have options available that we can help our patients all the time. So I'm glad that we have multiple options than just one. How often do you use a Porcine thyroid or the Armour thyroid?

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Megan Spears:

It really depends on the patient, right? I like the Porcine thyroid as an option for the combination of T3, T4, because it tends to be more what we call natural mimicking of what our own thyroid does. And so that's when I'll choose that.

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Dr. Nayan Patel:

But it's a set ratio. It's a set ratio between the T4 and T3 that is already present in the nature. So it's much easier to prescribe what's already in the nature and just give to them, then try to recreate the wheel again, so to speak.

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Megan Spears:

Correct. Yes.

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Dr. Nayan Patel:

So you just said earlier that you, so we have the biothyroid. So is that- is that the option that is most likely chosen for the patient because of we are only dealing with suboptimal thyroid diseases or is it all over the place?

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Megan Spears:

Can you ask again? I'm confused by what you're asking.

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Dr. Nayan Patel:

You know, when we do thyroid replacement therapy, we use thyroid, we use liver thyroxine, Leothyronine, we have all these choices available to you. Since we are only dealing with suboptimal patients, means they're not out of range most of the time, they are just not fully optimized. For them, what's the best choice of thyroid replacement for those patients?

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Megan Spears:

Typically, I like, personally I like to use Armour or a Porcine thyroid. However, for instance, I have patients that are already maybe on Levothyroxine and they need that additional T3. So I might use any and they've done well on Levothyroxine, their T4 looks great, but they need that a little additional boost of T3. I'll say well Biothyroid might be a good option because your body's already used to the Levothyroxine and we're just going to tweak it and add that little bit of Leothyronine to it.

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Dr. Nayan Patel:

Oh, we can just add the T3 by itself also. So we don't have to do a combination either. So either way, the good thing is we have all the choices available for our patients. And so that's very, very critical. And thyroid is, just as a pharmacist I understand, thyroid is measured in micrograms. You can not even literally see the powder in your hands and that's a full dose. And so making sure to correctly dose this patient is very, very critical. And it requires a special training for the providers. And I'm glad that you're very comfortable with that one, because it's not easy to just prescribe medication and it's gonna work for you like that, right? It has to be precisely measured. It has to be compounded correctly, made by the pharmaceutical company correctly. And then due to the patients in the med, they can take it and use it without having any side effects. That's so. All those things plays into a proper role in making sure thyroid replacement is done correctly. So besides medication, what else can the patients do to make sure the thyroids are optimized in the body, from the diet or exercise, whatever.

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Megan Spears:

Yeah, so a lot of things we like to focus on at Thrive is also diet and nutrient support, right? I mean, a lot of our providers are very well versed in looking at this in the whole picture, right? Because when we want to look at our health, it's not just one avenue. We have to look at the whole, the stress, the diet, all of that, and exercise, right? So we talk about things like processed foods and how they can affect, full of fillers and really no nutrients in them. Fast food. Things like energy drinks and stuff. I find a lot of clients on energy drinks and caffeine or cups of coffee all day because they're so fatigued, which is a side effect of the thyroid not functioning correctly and other hormone imbalance, that we discuss those things in regards to diet. So we're looking like, as we mentioned, selenium, iodine, a good thyroid support that have those nutrients in it can help, but then we don't wanna just give you a supplement. We wanna talk to you about, are you eating and what does that look like? Sometimes I have clients that eat a lot of stuff that isn't so healthy for them, but then I have other clients that just don't eat at all during the day. They're like, oh, I have my one meal. That's a problem as well, right? We wanna make sure that you're eating proper nutrients throughout the day and getting protein and veggies and all of that.

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Dr. Nayan Patel:

Absolutely. Thank you for bringing that point up because as we know about the nutrition, how important that is for thyroid but nutrition is there for overall health and that brings a very good point because this is why I know this you because I know you know this part because The whole endocrine system if we can put them in a pyramid guess what? The bottom of the pyramid is the bulk of the problem that can be solved by any treatment, is a stress management. Right? How do you manage stress? And so having a proper diet, it helps reduce the stress down. Having a better job, having a better life, having better spouses, it all adds up to stress management. Right above that, which is another 20, 30% of the problem can be solved by just diet, right? Insulin or nutrition, things like that. So 60 to 70% of the problems, guess what, are solved by two things, stress management and proper diet. Next comes thyroid, right? So even though we can provide the thyroid medication, guess what, at the end of the day, the patients have something they can do on their own to make sure they can help us with having a proper diet, having managed their stress better, because if they can do those two things, thyroid becomes much more effective for them.

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Megan Spears:

Yes. So things like green leafy vegetables, fish can have iodine. Brazil nuts give us some selenium. We don't have too many Brazil nuts, but they're really good and they give us some selenium. Pumpkin seeds are for your testosterone but also for supporting your thyroid as well with some zinc in there. Any other foods you can think of that help support thyroid function?

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Dr. Nayan Patel:

Kelp, anything, seaweeds, things like that, will help increase iodine content in your diet. Zinc is a big thing. It's easier to stop the loss of zinc than to take more zinc supplement. And so for me, to reduce the zinc usage, you've got to reduce your stress down. Because when you're highly stressed, your body consumes a lot of zinc. That's why when you are highly stressed and you get a cold and fever, guess what? There's a zinc loss in the cell of the pharmacy that you can pop it in and that can get off your cold. It's not because it helps with the cold, but it helps alleviate the stress that's causing this cold in the first place. So absolutely those things. What about alcohol? How do you think alcohol affects your thyroid?

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Megan Spears:

Oh, alcohol. I love a good cocktail. But I tell ya, overdoing alcohol can severely affect not only our thyroid, but can affect our hormones and our sleep patterns, which sleep in itself can affect our thyroid balance. Oftentimes that's one of the questions I ask when I'm initially seeing a patient and I'm like, how do you sleep? What time do you go to sleep? What time do you wake up? Like that is definitely a part of the balancing of our hormones and our thyroid, but also something that really affects. And then I asked, you know, especially men, but women too, do you snore? And they'll say, oh, my wife says I snore, or oh, my husband says I snore. Well, then there might be a sleep disorder that's affecting our sleep as well. So we're looking at the whole picture of things, diet, sleep, alcohol. You said, how many cocktails are you having? Are you having them daily? Is it just once a week? That's going to affect our weight. it's going to affect our sleep patterns, like I said, and our thyroid function. So oftentimes, just, you know, I'd have patients say, oh, my husband and I have a cocktail every night, one or two cocktails. Well, that's gonna affect your sleep, which then affects your weight, which then affects your thyroid. It's this cascade effect. So as much as I love a good cocktail now and then, it does affect our health greatly.

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Dr. Nayan Patel:

Well thanks for bringing the point up. Alcohol is, I'm guilty of having this once in a while because who doesn't like a good cocktail once in a while? But every time you drink alcohol, it affects your heart rate variability, right, HRV. And one of the common side effects of any thyroid medication is the changes in your heart rhythm or the heart beats. And so somebody gets tachycardia, which is racing of the heart too much, it gets too much of thyroid. And alcohol can actually change that HRV or the heart rate variability which will affect the sleep pattern. And so as much as I would love to have a cup of alcohol or a glass of it, anything all the time, I don't think there's any safe limit of drinking any alcohol at all. Even one drink a week is probably too much. But again, I'm going to piss off a lot of our patients, but you know what? That's okay. I'm guilty of having a glass of wine once in a while, but as much as I know, I should not be drinking any whatsoever because it does affect overall health, especially thyroid. And so it's not good for us, but we still do it.

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Megan Spears:

Yeah, exactly. Well, and then a lot of cocktails have sugar in them, and sugar, we know, affects our bodies in a lot of ways. And I've had a couple clients, I said, you know what, cut the nightly cocktail out, maybe just wait till the weekend, have a cocktail. And just by doing that, we see changes in how they feel, and their weight, and their sleep, and they just feel better. And they come back to me and say, I can't believe that worked. Like, I knew it, but I had to hear it from you. Yeah, and they just feel better.

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Dr. Nayan Patel:

True, true. You know what the newest trend right now is that adults drink alcohol, but the kids are on the TikTok, they are on their Facebooks and Instagrams and all this social media platforms. Guess for what? They are all looking for the quick fix, the dopamine hits. But what more than that, they are what we call them, they are adrenaline junkies. They have a lot of adrenaline pumping in. And so what we are facing is these kids are not able to sleep at night because they have too much adrenaline, they're tired but wired. Guess what? We have adults in the same situation because I personally, I have clients, I have CEOs and patients that are actually all over the world all the time. And they’re so much into the business that they forget to sleep and you think that they have all the money in the world, they should be able to sleep, right? But they don’t because they’re always, this constant dopamine hit they need to feel important. And what they’re doing is they’re pumping up the adrenals in the body. Did you know, by the way, what we do for those patients is that we give them thyroid bedtime to reduce their load down so they can sleep better.

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Megan Spears:

Yeah, you do that. I hadn't heard that before and then I was like, oh, and then I started utilizing that with clients and it really helped them with their cortisol and their sleep.

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Dr. Nayan Patel:

So it's not for everybody, but you'll find there's one or two patients here and there that we use thyroid for above and beyond just replacing thyroid to help them get an overall health and well-being. So at the end of the day, what we are doing, we are using medication to the fullest extent to address the common concerns, but not treating just the symptoms.

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Megan Spears:

Lots to address when it comes to balancing the body. Thyroid, hormones play a huge part. You know, if we have for women, if our progesterone is imbalanced, which I see so often, that can cause thyroid imbalance as well, and vice versa. So it's, everything kind of interplays with each other to, you know, balance. And I tell my clients a lot of times, it's think of Lady Justice and the scales, right? You don't want too much on one side and too little on the other. It's this fine balance to get the scales balanced, right? And the same goes for your body.

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Dr. Nayan Patel:

That is so true. Thanks for bringing it up because what you're saying all this time is basically is that, it's not just one hormone. It's your whole body. You cannot just take the medication and do whatever you want to do or you cannot have a perfect healthy diet and not assume that everything is going to be okay. Everything has to fall in places. And I'm glad that you... This is not a... I'm assuming this is... This is very fulfilling for you seeing patients' life turn in front of your eyes when-

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Megan Spears:

Oh yeah.

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Dr. Nayan Patel:

you give them the option that, hey, this thing is working for you now.

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Megan Spears:

Yeah, that's why I was so burnt out in doing primary care because I felt like all I was doing was writing a pill for an ill, right? Now I feel so much more fulfilled because I'm looking at the whole picture and saying, hmm, um, there's different things that can affect the body. Um, and so a lot of times we get a question, you know, can I take hormones at the same time as thyroid medications? Um, how does that work? Yeah, absolutely. You can take, do both at the same time. We use bioidentical hormones at Thrivelab. Um, and sometimes, you know, It may not be that you have both things going on. You may have one thing. I just met with a client and we got her thyroid- or we got her hormone labs back. And I said, guess what? Your hormones look great. You have some nutrients that are imbalanced and there was some other environmental factors we talked about. So we're really here at Thrivelab. It's not just we want to do one thing and we're tunnel focused, you know tunnel vision, we're looking at the whole and trying to figure out, why are you having these symptoms and could it be this or that and kind of being investigators of health.

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Dr. Nayan Patel:

Well, I'm glad you are on that side of investigating and we've got a lot of patients, a lot of great knowledge, and I'm glad that you are passing your knowledge to the rest of our audience. So that's really, really good. So thank you for doing that. So anything else we haven't discussed today that you want to talk about for thyroid health?

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Megan Spears:

I don't think so. How about yourself?

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Dr. Nayan Patel:

Well, I feel good that I think we have covered a lot of information. We talked about different types of thyroid. We talked about what are the symptoms that cause because of thyroid imbalances. We talked about how do you prescribe them? Is it the only solution? Probably not. For sure not. It's a whole, it touches every single thing. We give them options of what they can do to improve their own thyroid health by eating the right types of fruits and vegetables and how they can manage stress because stress affects thyroid all day long. it's easier said, right? Stress affects everything, but you know, it's always good to let them know because it's never enough to let everybody know that stress is the ultimate killer for all human beings. It just shows up in one shape or form of another. So thank you for doing that. Appreciate that.

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Megan Spears:

Yeah, absolutely.

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Dr. Nayan Patel:

All right, thank you very much. This is again, this is Dr. Nayan Patel, Chief Scientific Officer at Thrive Lab, and I'm glad you're here today with us.

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Megan Spears:

Thank you. I hope you have a great day and thank you for joining us.

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Dr. Nayan Patel:

Thank you.