Ep. 97: How To Properly Test For Thyroid Function (Hypothyroidism Part 3)

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In this episode we discuss:

  • What causes Hashimoto’s hypothyroidism
  • How to properly interpret your thyroid bloodwork (and what your doctor likely doesn’t know about thyroid testing)
  • How your cholesterol values can be used as markers of thyroid status
  • How symptoms like metabolic rate, body temperature, and pulse rate can be more helpful than blood tests when identifying thyroid status 
  • Ideal blood test values for optimal thyroid function

1:17 – what causes Hashimoto's hypothyroidism and autoimmunity in general

13:30 – how to interpret thyroid blood tests (TSH, T3, T4, rT3)

31:34 – what reverse T3 means on a blood test and how to interpret rT3 values

34:44 – looking at all thyroid markers together to determine thyroid status

40:38 – cholesterol levels as a marker of thyroid status, and the problems with cholesterol levels that are too high or too low 

52:34 – the relationship between cholesterol, heart disease, and thyroid status

56:04 – other blood markers that can be indicative of thyroid status (SHBG, ferritin) 

57:02 – how we can use symptoms like metabolic rate, body temperature, and pulse rate to determine thyroid status 

1:12:14 – other symptoms that can be used as indicators of thyroid status (low energy, fatigue, low immune function, dry or cracking skin, hair loss brittle nails, slow motility, weight gain, low mood) 

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Jay Feldman 0:05
Your doctor is most likely missing some vital information when it comes to testing for thyroid function, we're going to be going over exactly what that is and more in today's episode of the energy balance podcast, a podcast where we dig into the physiology behind the bioenergetic view of health and teach you everything you need to know to maximize your cellular energy. Today's episode is part three of our hypothyroidism series, where we'll be going over what causes Hashimotos hypothyroidism, how to properly interpret your thyroid blood work and what your doctor likely doesn't know about thyroid testing. We'll also be going over how your cholesterol values can be used as markers of thyroid status, how symptoms like metabolic rate, body temperature and pulse rate can be more helpful than blood tests when identifying thyroid status and also ideal blood test values for optimal thyroid function. To check out the show notes, as always, head over to Jay Feldman wellness.com/podcast, where you can take a look at the studies, articles and anything else that we referenced throughout this episode, and with that, let's get started.

So moving on from factors that affect the thyroid hormone production and conversion, we have alluded to wanting to talk about the autoimmunity side of hypothyroidism, and so Hashimotos is the hypothyroid autoimmune condition, and most people who are diagnosed with hypothyroidism, especially women, have Hashimotos, or are diagnosed with Hashimotos sometimes based on the presence of antibodies, or sometimes it's just assumed. And so when it comes to autoimmunity, there's a very similar perspective from the mainstream to most conditions, which is that there's something has triggered the state. There's nothing you can do about it, and you're stuck in the state where your body is fighting against itself, and in this case, it is specifically attacking and destroying the thyroid tissue, and so that's going to cause a hypothyroid state and so you are going to have to take these thyroid hormones forever, and you're never going to be able to do anything other than that, until you don't have you basically, you know, your thyroid is so damaged it's not producing any hormone, you'll just have to do t4 forever. And luckily, that's not the case in the I should touch on as well. In the more alternative sphere of autoimmunity, there's some very parallel reductionist thinking of this being a an ON or OFF state driven by some sort of kind of random external factor. One of the main thing has pointed to is molecular mimicry, where we've been exposed to some protein that is very similar to our own tissue, but it's foreign, and so our bodies have decided to attack that foreign tissue and then confuses our own tissue for that tissue. So it, you know, there's some protein that made it through our leaky gut, your intestinal permeability, that was attacked by the immune system, and then the immune system starts to think that our thyroid is the same as that protein, and attacks it. We've discussed why we, you know, the evidence behind and why it doesn't seem to make a lot of sense from either of those perspectives in a previous series discussing autoimmunity and instead, what makes much more sense is the bioenergetic view. The bioenergetic view of autoimmunity is essentially that there is damage going on in certain tissue, and that is what leads to the antibody response from the immune system to help to clean up the damage that's already there, not to cause the damage, but to clean it up. And that this is generally driven by a stress, degenerative state that causes damage. And if we alleviate that state and alleviate the driving of that stress, inflammation and damage, then we can reverse that state, essentially. So again, I'll refer back to that series that I would recommend taking a look at. But in essence, it comes down to a lot of what we've already discussed, where impairments in energy production or an energy failure is what drives an autoimmune state, and it's not anything particularly more unique than that. Of course, there can be some there's some other factors involved. The gut is pretty heavily involved, due to the influence of gut infections on energy failure. But for the most part, that is kind of the basis here. And we see this base is supported when it looks, when we look at the kind of Hashimoto state. So there's a paper that describes this, and they the title of the paper is the influence of oxidative stress on thyroid diseases. And they state that an imbalance between oxidants and antioxidants is observed at different stages and a different types of thyroid diseases, the organ, which is part of the endocrine system, uses free radicals, reactive oxygen species or ROS to produce hormones and excess of free radicals causes structural damage under Naiman, undermining genomic stability. So we talked about this before, how there is there like there are free radicals involved? Right, right. There are three free radicals involved in the production of thyroid hormone due to the need from thyroid peroxidase, that primary enzyme. And as they note here, in excess of these free radicals, if we get this imbalance, it'll cause structural cellular damage. And they then go on to state that decreased glutathione levels appear to be a distinctive parameter related to the activation and development of oxidative stress in Hashimoto thyroiditis. As oxidative stress is associated with thyroid hormone deficiency, inflammation and autoimmune parameters, patients also present with elevated age levels as advanced glycation and products in addition, which are markers of oxidative stress, in addition, increased total accident status and oxidative stress index parameters were shown to precede findings of hypothyroidism in autoimmune thyroiditis, and could therefore be treated as predictors of thyroid cell damage. So in other words, what he's saying is that there is this driver of cell damage in the thyroid prior to the autoimmune state that's driven by the excess oxidative stress, and that is, in this case, associated and shown to proceed Hashimotos or autoimmune hypothyroidism. And this is exactly what we've described, and corroborates what we've described in terms of bioenergetic bioenergetic view of autoimmunity, that is basically suggesting that an energy failure leading to structural damage is what causes the autoimmune state. And again, the most important here, or thing here, being that that means that this is a reversible state, if we just reverse that state of oxidative stress, inflammation, stress and energy failure.

Mike 6:34
Yeah. And so something to keep in mind. Well, I guess a couple things, the molecular memory mimicry idea I just want to touch on specifically. It's it when they're the proteins that they're talking about mimic that the body is like responding to that are similar to our own tissues are usually like some type of bacterial protein. So they're saying that this bacterial or microbial protein is similar, and then our immune system picks it up. So I just wanted to touch on that one specifically, I think that that's less likely. And I think what, what, and what we kind of discuss, and what you see that's more likely is the body is responding to the damaged tissue. So damaged tissues also stimulate an immune response. As an example, just like a basic example, it's parallel, but like not directly, specifically related to the thyroid, when you have cholesterol, particularly LDL particles. If the LDL particles are oxidized, they will trigger an immune response and essentially, the oxidized LDL particles are damaged LDL so what's happening is the immune system is recognizing, hey, this isn't right, and then it's basically tagging it and cleaning, cleaning up what's going on. And this falls in line with, I think it's poly Matt singers and other gentleman's name, Jamie Cunliffe, yeah, Jamie Cunliffe work, which is kind of seeing things as the body, recognizing this damage, and then, like having a response to this, instead of and not being like a random process, it being like a concerted process. So what in the in the thyroid situation, like that's parallel to the LDL situation, is in the thyroid as we talked about, thyroid peroxidase produces hydrogen peroxide, which is that creates that oxidative stress, those reactive oxygen species. Jay was talking about it initially, the hydroxyl radicals that can be produced from the hydrogen peroxide, if the if the thyroid gland doesn't have the resources to deal with that oxidative stress, to mop up those hydroxyl radicals, in this case, they discuss having adequate glutathione levels, then what winds up happening is those hydroxyl rattles are able to actually go and destroy the actual thyroid structure, and Then the immune system starts to recognize, hey, things aren't right here. This this thyroid, these thyroid cells, this thyroid gland, things aren't functioning right here and then there's an immune response to the thyroid gland and it's interesting too, is that what wounds up getting tagged is thyroid peroxidase, the thyroid pro the immune system basically goes to the enzyme that's creating the oxidative stress and blocks its functions. Like, it's like, bruh, you need to chill out here. You need to calm down. You need to stop producing all this oxidative stress. You can't smoke inside the house, essentially. And so it, it's telling, it tells the enzyme to calm down, and then you get it creates a state of hypothyroidism, because, again, thyroid peroxide. So we talked about is one of the rate limiting enzymes, or one of the major enzymes involved in thyroid hormone production, and then it will elevate the TSH, because t3 and t4 are low, so and then that kind of, it's kind of like this, this weird effect, because the hypothalamus pituitary is saying to thyroid gland, hey, we need hormone. And the thyroid, the immune system saying to the thyroid gland, you need to chill out, because you're you're creating a lot of damage and then this body's like, what happened to our t4 and our t3 so, yeah, it's a the way you could address this is, and again, this is, like, on a theoretical basis, is not like a diagnostic recommendation for anybody, or like a clinical recommendation, but you gonna you can make sure that the antioxidant status is replete, glutathione production is going well. You have the resources for those things. You don't have to necessarily take glutathione, but you can have the necessary amino acids and components, and you can kind of limit the actual TSH stimulation on the thyroid to help relax it a little bit. That's where something like maybe thyroid supplementation can be quite helpful, as well as providing the body with adequate thyroid hormone. And then you can support the body in a whole host of other ways. Maybe adjust what's going on, the microbiome, et cetera, to kind of take the stress off the immune system and allow the body to kind of clean house on the issues that are going on. That's interesting is that the over time, if the situation isn't addressed appropriately, right? That's when you start to see increases in thyroid cancer. And essentially, the cancer is like this final metabolic state where it's like you have a lot of damage to the thyroid gland, and this altered energy metabolism inside the cells, the the oxidative stress, can start to damage, the DNA can start to damage, the mitochondria can start to damage, the meta, the the membranes, and then the cells start to go into that cancer state, and then, so it's like this final step, right? It's like that final pathway where you have all this dysfunction, and then the cells kind of throw their hands up in the air, and they're like, All right, let's just divide. We're just, let's just, we're just gonna have a party now because, like, things aren't, aren't functioning appropriately for us. So it's, yeah, it's interesting. Like to look at these, these underlying pathways, what's going on with the immune system and whatnot, and look at it through this, this lens, this context, and then try to adjust it through this context. Instead of saying, Oh, it's genetic, well, we're just going to throw our hands up, or, Oh, it's molecular mimicry. I don't even know what you do with molecular mimicry and more gut protocols, probably. So, yeah,

Jay Feldman 11:46
Yep. And we've talked, I mean, we talked in that autoimmune series as well about approaches we would take and things we would do there, and the issues with those current or conventional or alternative approaches, the popular ones. I did want to mention also you were saying that molecular mimicry can be in response to bacteria, which it can or microbes, it can also be food. You know, sometimes they'll point to the food, like protein sequences as well and everything. So, yeah, they're all great points. And all of the recommendations that we'll have in the end of the series will, of course, apply to somebody who's in the autoimmune hashimatos hypothyroidism state or hypothyroid state. So it'll all directly address these underlying drivers of that autoimmune state.

Mike 12:31
Or move on, Jay, is that some of the things that they recommend in the alternative sphere, and even in like the traditional or like the mainstream sphere, do have a beneficial effect. It's just not necessarily, like, I know I kind of May joke about a little bit, but it's not necessarily through that mechanism or through that lens. So it's having a beneficial effect for maybe other specific reasons. So like in for in a hot for example, from like a mainstream perspective, you have somebody who's hypothyroid and Hashimotos, and they put them on a T for a therapy. Maybe they, maybe they're not in a state where they're converting that to t3 but they are suppressing TSH. And by suppressing TSH, they're taking that stress off the gland from TSH, basically saying, hey, TPO, we need you to, like, produce more thyroid hormone and you drive more oxidative stress. So it could be, like, helpful from that perspective, but it's not necessarily like this, just like incurable genetic situation that you have no control over,

Jay Feldman 13:27
Right. All right. So when it comes to the blood markers that are used to identify thyroid status, we've alluded to them a lot because it's the, you know, the hormones that we've been talking about, t3 t4 reverse t3 and also TSH. We've also talked about cholesterol, which is another marker that should be used it often isn't. But we'll talk about that as well, and we'll also talk about various symptoms that can be used in place of, or really in addition to, blood markers to evaluate thyroid status, if you're looking to reverse your hypothyroidism, with clear action steps and strategies, along with personalized guidance from me, head over to Jay Feldman wellness.com/solution where you can find all of the information for the energy balance Solution Program. This program includes customized health coaching, a video library that includes a video that talks specifically about how to evaluate your thyroid status using blood work and symptoms, as well as when you should supplement with thyroid hormones, how to properly dose them and how to pick the right product. It also includes resources like a sample meal plan and a supplement guide, as well as a private community so head over to Jay Feldman wellness.com/solution, to check out all the details. So when it comes to these thyroid markers, there's a graphic here that I think is helpful. I don't think it is, I don't think it's perfect. I don't think it it exemplifies or illustrates all, uh, conditions of hypothyroidism, but it's. At least a common presentation that can happen in many typical cases. And so what you see here is basically the standard normal range of TSH, free t3, t4 and reverse t3 and initially, when everything is, quote, healthy there, you know everything is right in the center of the range, or at least normal. And we'll talk about like, what values are ideal for these different markers. But as we shift into stress and dysfunction and hypothyroidism, initially we have increases in TSH. But because of the stress inhibiting the conversion from t4 to t3 the t3 doesn't effectively come up, and the reverse t3 increases. So in this presentation here, we're seeing increases in TSH, along with increases in t4 increases in reverse t3 and reductions in T in free t3 and then as that state increases, eventually you have the suppression of TSH, at which point the production of t4 goes down. You already have continually reduced t3 production due to the reverse conversion or prevent the inhibited conversion. And over all this time, you just see higher and higher levels of reverse t3 as the t4 gets converted to reverse t3 instead of t3 this is, I think, a helpful concept to have in mind, and and can be a reason why the like looking at these markers in the way that we're taught to where a low TSH always means high thyroid status or high thyroid activity. You know, not considering t3 and t4 and reverse t3 can really miss out on a lot of the picture. I think it's really helpful. I do think that there's something's missing here. I mean, maybe a first step I would show would be TSH increasing, and then t3 and t4 increasing, because in an initial state of stress, somebody might not have highly suppressed or highly inhibited t4 to t3 conversion, you know, if you're having the very initial TSH response. But I think this is talking over a much longer time scale, so you're not necessarily going to see it like that. But so I think this is helpful. Is there anything you want to add in here, as far as description? The script? Only thing

Mike 17:03
I just wanted to mention, specifically for suppression of TSH, is you have both what we talked about with the d2 enzyme, where at the pituitary, the d2 enzyme is still showing that there's adequate t3 so TSH is still can be dropping despite the low serum levels, because the pituitary may still be hypothalamus. Pituitary maybe still be getting like, an adequate signal of t3 and again, that that speaks to some of the different concentrations of active thyroid hormone and different tissues that there's some studies looking at this and basically showing that some tissues will maintain higher levels than other tissues, and even on repletion, those tissues may, like, some tissues, can still be hypothyroid, despite serum values being okay after, like, significant stressful experiences. And then the second piece is TSH in this situation can also be getting suppressed by, like, elevated cortisol or some or inflammatory components, etc. So as from my perspective, I see a lot of clients who are like, they they'll come to me and their TSH suppressed t4 and t3 is suppressed. And they've, they've had the lab work, and they've talked to the doctor like, oh, everything looks good. My thyroid is good. And I'm just like, how can your thyroid be good if your t4 is in the bottom of the reference range, your t3 is in the bottom of the reference range, and your hypothalamic intuitary system is not saying, not screaming to your body, hey, we need more thyroid hormone. It's basically like this is you're kind of seeing, like, I see that as kind of like the bottom level of suppression, because it's the brain is not even telling the tissues, hey, we need more, we need more thyroid hormone, despite being clearly on the depleted side. So that's that's just i, and this is what we were talking about before. Like, interpretation can be a bit tricky, and especially if you don't have all the factors in mind, because you'll, I'll have people whose TSH will be suppressed and cholesterol will be in the high two hundreds, three hundreds, and then they're saying, Oh, I'm my thyroid function is good, but it's like, they're cold, cholesterol is elevated, like, all the symptom profile is there. And then when you say, Okay, let's do a free let's do it t3, total t4, total free t3, free t4, reverse t3, etc. Let's look at those values. And you see reverse t3 is on the upper end of the range, and everything else is is bottomed out. And it's like, yeah, I don't know if thyroid like, I can't diagnose you per se, but just because the TSH is suppressed here doesn't mean that thyroid function is going well. So you have, like, a symptom profile that's giving you the minute by minute experience of the hypothyroid state. And then you look at, then you can look, you start to broaden your labs, your lab markers, and you start to say, Okay, well, this ts the again, the TSH isn't helping us at all really, because the only thing that TSH is going to show us is, if it's high, you probably are in a hypothyroid state and under some degree of stress. But besides that, without the other markers, it's kind of like it's not that helpful. It doesn't really say. Anything else. So I think that's important to to keep in mind a lot of people, they'll they'll tell you, like, you'll have people like, oh, but my, my TSH is fine, and I'm on my thyroid therapy, but I feel terrible, and it's just like, well, that doesn't, that doesn't mean anything. It's not, doesn't mean that anything has been solved with that solution, which is kind of upsetting, right? For a lot of people who like, that's what you go to the doctor, and this is what they tell you, this is what you get. T4 monotherapy, and TSH is suppressed, and then they're dosing to TSH, which is even worse.

Jay Feldman 20:37
And the ranges for TSH are highly off, which is what I want to talk about next. But another point I wanted to highlight here, in that case with this client, that just in general, is the lack of concern over other symptoms. So again, it's it's always a matter of treating the blood work, not treating the human in front of you, or the human from which that blood work came, where, oftentimes, if someone is dealing with hypothyroidism, and their TSH is perfectly fine. From their t4 therapy, they're still going to be dealing with low body temperature, all the other signs of low metabolic rate, potentially skin issues, potentially hormonal issues, like reproductive hormonal issues, low mood, low energy. I mean, all sorts of symptoms that should improve if someone's thyroid status is approved, but those symptoms have been so far removed from, like, what is considered to be normal thyroid status, because everything has been based on TSH, which was already based on, like, the lab values, and everything were already based on incorrect interpretations of previous labs that were not actually even measuring thyroid activity. So it's a little there's it's multifactorial. It requires interpretation, and it also requires flipping a lot of what is conventionally done on its head, because it's really ineffective for a lot of cases.

Mike 21:58
You go to the doctor. TSH is elevated, you get your t4 therapy, but you still have anxiety, you still have depression, you still have high cholesterol, you still have hypertension, so you get a benzodiazepine, you get an antidepressant, you get a statin, and you get blood pressure medications, but your thyroid is working well. The thyroid is good because TSH is

Jay Feldman 22:19
Right. It's nothing to do with your thyroid.

Mike 22:21
We already did thyroid, yeah,

Jay Feldman 22:24
yep, right. If right. And I will say like, and I know you mentioned this too, getting thyroid status up has I've seen that lead to dramatic drops of cholesterol. I've seen that rebalance blood sugar or blood pressure to where blood pressure medication isn't needed. I mean, these, it has dramatic effects in all these areas. So yeah, and again, just because it's supposedly normal from lab work, and as you were saying, I don't know how many times I've had somebody tell me that when you interpreted with the other factors, it's certainly far from ideal, yeah. So

Mike 23:00
well, I just an example. I've I, I've said this before, but I've had people that I've worked with in the hospital who are, like, in overt heart failure, and they'll test them for their their thyroid function, and they'll see TSH is fine. And then it's like, no, you don't have a thyroid problem. Or, like, there'll be, like, diabetics who have a history of cancer and chemotherapy, and the TSH is fine. Nope. Thyroid is all good. It's like, there's no way thyroid function is good. As a severe type two diabetic who has a history of cancer, like there's no way energy metabolism is functioning. Well, in those states, is it? And I don't like, I don't care what the TSH values is at that point. Now, again, in this situation. It's not my scope to say anything in the hospital, so I never will say anything. But like, from a theoretical standpoint, as we discuss it, it's like it's just mind blowing to me, like I'm looking at the patient. They're obese, they're type two diabetic, they've had cancer before, and they have tons of heart problems, and they're there for a heart attack. It's like, there's, I don't see how thyroid function is going well. I just can't see that like considering the patient profile. But again, it we're looking only at lab values. That's the thing. So just interesting to to keep in mind,

Jay Feldman 24:16
yeah, yeah. Seriously. And then when, even when somebody is looking at the lab values, those ranges are often off, as we've talked about. And so to just touch on that a little bit here, in general, the ranges for TSH typically, currently will say that anything up until four is okay. Anything above four begins to indicate hypothyroidism. But the research suggests that really anything above a two, a TSH of two indicates some level of hypothyroidism that could be treatable or might benefit from treatment. And in our case, there's a lot of things we've tried before treatment, as you said, but this is how they phrase in the research. And there's also suggestion that ideal would be at least under 1.5 maybe. Closer to one or below. And so there's a couple papers here. I'm just going to read some quotes describing the relationship between TSH and and health in these different circumstances. So the first paper is titled, elevated thyroid stimulating hormone is associated with elevated cortisol and healthy young men and women, and they state that results suggest a positive relationship between TSH and cortisol and apparently healthy young individuals, and as much as this relationship may herald a pathologic disorder, these preliminary results suggest that TSH levels above two may be abnormal. So this is in healthy individuals, showing that TSH levels above two are correlated with increased levels of cholesterol, again, suggesting that this is some level of hypothyroidism.

Mike 25:44
Oh before you go, before you go on to the next one, Jay, I've, I've gone through this paper as well. I have it indexed. And essentially, something else they talk about in there is that with a TSH level greater than two, you see increases of cortisol, pretty within the reference range for people. So you see much higher cortisol levels right now. Again, we're not and I guess this is something to talk about as well, maybe slightly tangential, but the like the reference range, again, of cortisol, like you can have somebody at 10, you can have somebody at 20, they're in the reference range, but that's twice as much cortisol. So what they're looking at in the study seeing that people with higher TSH values, even within the reference range, are having higher cortisol values in the reference range, which isn't like, it's not a good relationship to to optimize for.

Jay Feldman 26:35
Yeah, yeah, exactly, exactly we want to optimize For low cortisol. So the next paper is titled thyrotropin levels and risk of fatal coronary heart disease the hunt study, there's a couple quotes here. They state thyrotropin levels. Thyrotropin is TSH. By the way, thyrotropin levels within the reference range were positively and linearly associated with cardio or with coronary heart disease mortality in women compared with women in the lower part of the reference range, which is a TSH level of 0.5 to 1.4 the hazard ratios for coronary death were 1.41 and 1.69 for women in the intermediate TSH level of 1.5 to 2.4 and higher in the TSH level of 2.5 to 3.5 categories, respectively. So what they're saying is that if you have a TSH, or if these women had a TSH of 0.5 to 1.4 they had significantly lower risk of coronary death compared to those who had a TSH level of 1.5 to 2.4 and in that middle range of 1.5 to 2.4 they were better off than the highest range of 2.5 to 3.5 and then in this study, The same trend was seen in men. It just wasn't statistically significant. So if they had had a higher population, or something like that, I probably would have shown a similar thing. But basically, what we're seeing is that, in this case, under 1.5 was associated with the lowest risk in terms of coronary heart disease

Mike 27:56
The one one's greater than 1.4 to what is the bottom level, to the 2.4 or 1.5 to 2.4 they had a 40% increase over the 0.5 to 1.4 and then there was a, what is it, 69% increase in the group that was 2.5 to 3.5 which is, again, that's still all less than four. Now we're not even going to talk about the people who were at eight or nine.

Jay Feldman 28:30
Right? Oh, exactly. It's, I mean, it's a great point and this is also still considering that like this is including data that involves people who have really suppressed TSH levels as well. So this is, I mean, if we were able to rule that out, I bet you would see a much even clearer trajectory here, or correlation. So yeah, and then the last couple of quotes I'll mention is from the paper that we cited earlier titled thyroid hormone transport into cellular tissue. And he states that while a normal TSH cannot be used as a reliable indicator of global tissue thyroid effect. Even a minimally elevated TSH above two demonstrates that there is a diminished intra pituitary t3 level as a clear indication, except in unique situations, such as a TSH secreting tumor, that the rest of the body is suffering from an inadequate thyroid activity, because the pituitary t3 level is always significantly higher than the rest of the body. Additionally, the most rigorously screened individuals for absence of thyroid disease have a TSH below two to 2.5 thus treatment should be considered in any symptomatic person with a TSH greater than two.

Mike 29:35
So they're going to have the reference range again. So they're going to cut it from eight to four now, from for them too..

Jay Feldman 29:42
Yeah. And he was describing here specifically that because the pituitary is so much less sensitive to the rest of the body, that even a minimally elevated TSH is going to signify that there is systemic issues with t3 production. So that would indicate a

Mike 29:58
Yeah. And so that's. What t3 that's what TSH should really be used for. Is if it is elevated, it indicates hypothyroidism. But if it's suppressed, it doesn't. You have to know the other markers, or else you can't make any determination on what's going on, right?

Jay Feldman 30:13
And he states that this next quote, he says, in fact, the positive predictive value of TSH, ie, the likelihood that a suppressed TSH indicates over replacement or hyperthyroidism has been determined to be 16% in other words, a suppressed TSH is not associated with hyperthyroidism or over replacement 84% of the time, making it an inaccurate marker for determining an appropriate thyroid hormone replacement dose. So that is an extension of what you were just saying, Where, if we're not interpreting it by also looking at t3 t4, reverse t3, symptoms, pulse, temperature, which we'll talk about all those things in a moment, it really isn't helpful. And all TSH really tells us is that if it's above two, then there is likely hypothyroidism present, especially if it's way above two, and if it's below two, then you might be in a good thyroid state, or, really, if you're, you know, around 1.5 or below, you could be in a good thyroid state. Or you could have TSH suppression due to stress hormones among, you know, inflammatory cytokines, all the things we described earlier, which would be a state of still, potentially even worse or more severe,

Mike 31:16
I pretty much need to generally get all the markers, if you to really get a full thyroid panel, and that would include the things you've mentioned in US blah. Mentioned in us well as cholesterol, which we'll get into in a second. So it should never just be a TSH Test, because even if it's high, you're still going to want to see the other things to know where you're at. right?

Jay Feldman 31:34
Right, Yeah, exactly. All right. So we've talked through the TSH value side of things, and what we want to consider there. And then we want to also consider other thyroid values, thyroid markers on the blood test. And one of the most indicative of what can be going on is reverse t3 of course, based on everything we've discussed, reverse t3 is a pretty good marker of how well we're converting the t4 to t3 and so when we see reverse t3 being elevated, that tends to be a sign of reduced conversion between t4 and t3 and increased conversion from t4 to reverse t3 and this should be in all those circumstances, the stress induced circumstances that we discussed, where you have an inhibition of The deiodinase, one enzyme and increased activity of the diode and Ace three enzyme. And as we just kind of had gone through on that graph, this is something that tends to happen as our hypothyroidism gets worse, as stress gets worse, as our general environment gets worse, as our disease state or degenerative state gets worse. So reverse c3 can be a pretty helpful marker there. Of course, it's not one that's often tested, unless you really go out of your way to get it tested or prompt your doctor. And even then, it can be pretty tough, because from the conventional medical view, issues between t4 and t3 conversion are really only an issue in very, very severe cases, even though it could be influenced by the most mild of an increase in stress hormones, as we know. So with that in mind when it comes to reverse t3 if we're on that high end of the range, that can often indicate that we're having an issue with t4 to t3 conversion, like the TSA TSH range, the reverse t3 range is probably a little bit higher than it should so normally the range is up to 25 and I would normally say that if you're looking at values at 18 or above, that's typically going to indicate some issues with t4 to t3 conversion. But another aspect that we can use is we can look at the amount of reverse t3 relative to the amount of free t3 the reason for that is because, if we're in a situation where we have very low amounts of t4 and low amounts of t3 then even if we have relatively low amounts of reverse t3 it can still indicate a conversion issue, because we're just dealing with lower amounts of total hormones. Whereas if our reverse t3 is maybe a little higher, maybe we are in the 18 ish range, but we have pretty high amounts of t4 and t3 that might not indicate a problem. So that's why we can use a ratio here. So that's one thing to consider, and I'll I'll share a quote talking about that ratio in a moment. But I did want to mention one other thing. So we've talked about some of these ideas, concepts put forth by the researcher Holtorf, and he talked a lot about the uptake of thyroid hormones. And one thing that he has mentioned is that reverse t3 that hormone its uptake, is also inhibited by low energy levels. Anything that's going to impair mitochondrial respiration is going to lead to elevated reverse t3 in the blood, because it's not going to be taken up by the cells. So this is just another factor by which we can use reverse t3 as an indicator of our systemic energetic state, or systemic hypothyroid state. So we're going to show you this quote as far as the free t3 to reverse t3 ratio, and then Mike, I'll let you jump in. So the this quote is from the same Holtorf paper titled thyroid hormone transport into cellular tissue. And he. States among patients with this type of thyroid hormone transport dysfunction resulting in intracellular hypothyroidism, assessing the free t3 slash reverse t3 ratio can aid in a proper diagnosis with a free t3 to reverse t3 ratio of less than 0.2 being a marker for tissue hypothyroidism. And he states that this is when the free t3 is expressed in picograms per milliliter, and the reverse t3 is expressed in nanograms per deciliter. So this is a, again, a helpful barometer that we can use as in this case, he's talking about the thyroid hormone uptake dysfunction. But also, just in general, if we're looking, trying to get an idea of how well we're converting t4 to t3 this can be a helpful mark. We can look at the reverse t3 to free t3 ratio. And the last thing I'll say here is that looking at all of the thyroid hormones in addition to TSH, t3, t4, and reverse t3 gives us a lot more insight into what's going on, of course, compared to the TSH, which, as we've discussed, really tells us very little on its own about what's going on with our thyroid status.

Mike 36:02
Yeah, I think, I think the most important piece about the reverse t3 test is looking at what's going on at the tissue level. Because you can have adequate thyroid hormones, you can have a tshs suppressed, but if your if your cells or your liver are not appropriately converting t4 to t3 then you can still be experiencing a hypothyroid state. And I think there's kind of a spectrum where this happens depending on, like, level of stress and carbohydrate availability in the diet, and things along those lines, where you'll find that you can get these alterations in thyroid hormone levels, and they'll adjust over time depending on what's going so maybe you can receive, like, a tissue hypothyroid type of situation and conversion process happen probably midway in that spectrum, whereas maybe initially you'll see the TSH rise. So looking at all of the factors together gives you a true idea of what's going on at the multiple levels, so from the brain to the thyroid to the actual tissue. Whereas if you're just looking at TSH to discuss, you're only looking at what the brain signaling is, and it doesn't. Again, it's unless it's elevated, it doesn't really give you much quality information. Now, specifically for reverse t3 when you consider so there's some papers in PubMed that basically say, like reverse t3 is inactive in the sense that it doesn't have an effect at the cell, like a an anti t3 effect, which, even if that's true, it doesn't necessarily matter, because there's still three other mechanisms by which reverse t3 is basically impairing active thyroid hormone function. So the first piece is, it's showing an upregulation in the d3 enzyme, right? Because you're seeing the t4 converted to reverse t3 second thing is, it's actually using up that t4 that t4 that could be converted to t3 is moving to reverse t3 and then the third piece is, even if it doesn't have an effect at the cell, which we still don't 100% know what you can what you're still seeing is that competition for t3 at the cell for uptake and things along those lines. So it's still indicating an issue with the cellular utilization or peripheral conversion of thyroid hormones. And that's extremely important, because even if your thyroid hormones and serum are fine, as far as t4 and t3 to some to a large extent, if your cells aren't using them, or you're seeing that conversion switched in the other way, you can still present with hypothyroid symptoms. And so that's another, we'll talk about this in a second, but your actual real time symptoms are going to be extremely important to take into consideration with any of these labs. So the other Yeah, that that's what I would I see the biggest thing for reverse t3 and the populations I see that elevator reverse t3 in are people who are running low carb. That's like pretty much standard extended periods of low carb, and then also people who have been exercising heavy amounts for long periods of time on like low calorie diets and or the fasting crowd. So a lot of my clients that come from those different areas, I will see reverse t3 in that upper end of the range. And again, it's not, it's I'm not. I think for both of us, we're not looking to see these values over range. We're looking to see the where the values are within that range. So if you're if reverse c3 is towards the lower end of the range, usually that's that's pretty good. It means that there's not necessarily a massive conversion issue. But again, if you're in that top half of the range, then that's where I you and it does it can adjust with something as simple as bringing carbohydrate back into the back into the diet if you're in that top half of the range. And I would say that's something to address and something to look at. And in conjunction with understanding, again, is your thyroid making adequate hormone, and then is your Ts? Is your brain needing to signal your thyroid to make that adequate hormone? Does it have to elevate that TSH? So the ideal profile from these values overall would be a low a reverse t3 that's in the bottom end of the range, a t4 and t3 in the top ends of the range, and in a TSH, that's less than two, ideally less than, I think it was 1.5 in the in that paper that we were discussing. So that's and then we'll get into some of these other marker. And symptoms and whatnot. So Jay, I'll let you take the floor again here.

Jay Feldman 40:03
Sure, yeah, that was a great explanation. And of course, we've mentioned this, but it's really worth mentioning that we've seen so many times, especially people coming from either kind of undiagnosed hypothyroidism or especially low carb diets fasting, that whole world, and we'll dig into that a bit more, but we've talked about the impacts of those things on those things on thyroid activity, having a low TSH, but then low t4 low t3 high reverse t3 is pretty common, and that is a situation where you're seeing very clear hypothyroidism despite, quote, normal or low TSH due to its suppression. So that's when that's why these other markers are so important. And that does bring us to another very important marker. There's a couple, there's a handful of markers that are going to, of course, be influenced by our thyroid status, but one of the most clear is cholesterol. And so there's a few reasons for this, but essentially, we've discussed the impacts of a relationship between thyroid and cholesterol, where a thyroid increases the conversion from cholesterol to the steroid hormones and B, it increases the drop off of cholesterol and also fats from the lipoproteins to the peripheral tissues, and therefore helps to lower those things in the blood. And as a result, if our thyroid activity is low, we will tend to see higher levels of cholesterol, especially higher levels of of LDL. This is a relationship that's been known for about 100 years, actually, I think, a little bit more than 100 years, and yet has been completely forgotten or ignored by the conventional view, where now, if we're trying to lower cholesterol, or we're seeing high cholesterol, this is something that's totally independent of thyroid activity, whereas, in reality, if we can correct our thyroid activity, we can really lower our cholesterol values. So with all that being said, high cholesterol tends to be a very clear sign, or can be a very clear sign of low thyroid activity. And the part of the tricky aspect with cholesterol is that the kind of normal or ideal range changes with age, whereas we're getting older, higher cholesterol values are normal and associated with lower mortality and all of that, whereas when we're younger, we want to have slightly lower cholesterol values relative to when we're older. We discuss this all in more detail in a couple of episodes talking about cholesterol, so I'll link back to those. But the important piece here is we can use these values as indicators of hypothyroidism. So that would be the first thing here. And then the other aspect of that is we can see shifts in these or we want to see shifts in our cholesterol. If it is high, we wanted to see it come down. If we're working on addressing our thyroid activity, whether through diet or supplementation or anything like that, we'd want to see that shift downward. And there is a kind of low end of the range that can also be problematic, that we'll touch on in a second, but that would be kind of the high ends that would be looking at in terms of thyroid activity. So go ahead, Mike, if you have anything you want to chime in with. Yeah.

Mike 42:53
So a couple pieces. So I would take the cholesterol element with like the other factors in conjunction, right? So looking at your TSH, t4, t3, your reverse t3, etc, and then also your symptom profile, because there are other things that can elevate cholesterol. It's just hypothyroidism is one of the, one of the major pieces. Now, something else that can elevate it is some type of low grade inflammatory stimulus. It could be like a low grade gut derived endotoxemia, or like the general metabolic profile, metabolic syndrome profile, and so that can elevate cholesterol. But part of that mechanism can be through altering thyroid hormone signaling as well, because, as we kind of discuss, cytokines, which are the inflammatory mediators of of the immune system, can be released by endotoxin or other inflammatory stimuli, and then those can have a direct effect on the thyroid glands production of thyroid hormone as well as the regulation of TSH, and then peripheral conversion of those thyroid hormones as well. So there could be a multifactor profile underlying that hypothyroid state. It's not just pure hypothyroidism, but ideally, I would rather see somebody address like a high cholesterol level through dietary changes and through thyroid hormone use than using something like a statin or even like a red yeast rice, or something which I think has lovastatin in it at like naturally occurring From the microbes that are fermenting the rice so, and the reason why is, as we talked about, like, from a mechanistic point of view, thyroid hormone is taking the cholesterol, bringing it into the cell, and then bringing it into the mitochondria. And so it's basically increasing that that disposal of cholesterol towards the production of steroid hormones and for other cellular purposes, whereas something like a statin, or some of these other or like a polyunsaturated fats are just lowering cholesterol exportation in the form, in terms of polyunsaturated fats, by causing oxidative stress at APO B, or it's basically decreasing cholesterol production at the liver by inhibiting the enzyme, hm, what's it? HMG. Reductasia. I always forget the last part of it, but essentially, and there's problems with inhibiting inhibiting those pathways. And I, I talked about this on the study, but essentially, you can see, like all the different compounds within the cholesterol synthetic pathway are involved in producing different components for different enzymes and energy metabolism and oxidative stress, directly involved in the deiodinase enzymes, and then also involved in vascular function and heart function and mitochondrial function, things along those lines. So it's better to take that cholesterol and convert it to something useful than it is to just block the whole pathway and not and basically have this whole list of negative downstream effects. So yeah, that pipe the just to summarize, hypothyroidism is a major cause of elevated cholesterol. There can be other factors like low grade inflammation or chronic inflammation, or gut derived endotoxin and things along those lines, or even dietary factors that can drive cholesterol up as well. So it's important to take those factors into consideration. You don't want to just look at cholesterol and determine hypothyroidism based on high cholesterol or not. You want to see the other values for thyroid and take a symptom profile. The other thing I just want to briefly mention is the correcting the hypothyroidism to lower cholesterol doesn't always look like taking the thyroid supplement. Both you and ij have worked with quite a few clients who've had sky high cholesterols coming off low carb or carnivore, and then you bring carbs back into the diet, the hormonal profile starts to improve, and then cholesterol can drop from ridiculous levels. So people in the three hundreds, four hundreds can come down into the low two hundreds and have their cholesterol situated pretty nicely, and that's just from adding in the carbohydrate. And that's how powerful doing that is. And it's not that wasn't even naturalisticated thyroid or synthetics required. And I guess a last tangential, or not tangential, but direct point is a lot of people are supplementing or being prescribed Synthroid for their hypothyroidism, and they may find that their cholesterol levels aren't dropping with the Synthroid and that their symptom profiles aren't improving. And again, this, it's important to understand this in the context of active thyroid hormone, Synthroid, or levothyroxine, is just t4 so if you're just taking t4 and you're not converting, well, you're moving to reverse t3 or the deiodinase enzymes are shifted towards that d3 the d3 deiodinase enzyme, then you're not going to get active thyroid hormone in the form of t3 and then you're not going to experience any of the effects that you really want. The only thing you're really going to see is a suppressed TSH, which isn't a bad thing, but it's just not going to give you that active effect at the cells, because, again, what you really want to see is this effect at the cell. It doesn't necessarily matter what TSH is doing, because that's not providing t3 to the cells. It's what you really want to see is that t3 going to the cell,

Jay Feldman 47:56
right? Yeah, those are some great points. And just to echo some of these things and kind of direct people to where it might be helpful. There are major issues to the statins. It is generally not a an ideal route to go for lowering cholesterol, and we talked about the details. There all the problems that go with that, in that those cholesterol episodes. So I'll link to those. If somebody was just looking for a pill to lower cholesterol, at Wade, prefer them to use a desiccated thyroid like armor that's available as a prescription versus a statin. But as you're getting at and as we'll talk about, you can improve thyroid function massively without going just to a thyroid supplement, whether it's t3 t4 or a desiccated product, and there are some negatives to just doing that without addressing the other side of things. So we will talk about that in some detail, but yeah, restoring thyroid function is an important piece here that is often overlooked when it comes to cholesterol levels, and that's why we can use cholesterol levels as an indicator for our thyroid status. There is another side of the cholesterol range that's important to touch on briefly, which is that if we are too low in cholesterol, that has its own negative effects. Again, we did talk about how important cholesterol is as a protective component. That's why it's increased in response to inflammation and infection and hypothyroidism and and all of that. So we talked about that in those cholesterol episodes. But if we do have cholesterol that's too low, that comes with its own problems because of the importance of cholesterol in many functions, both in terms of steroid production, in terms of that anti inflammatory and immune function, and also in terms of its importance in our brain, among other things. And so if our cholesterol is too low, not only does it come with its own problems, but also that can often or sometimes be indicative of a lack of cholesterol production at that point, and that can come with its own issues, and is often under, uh, often associated with an underfed state. The reason why this is relevant here is that if your cholesterol levels are too far on the low end, and again, we're making generalities here, it's going to depend on the individual, but it's important to consider if your cholesterol is. Typically below 160 your total cholesterol levels, that is going to tend to be too far on the low end, and will often correlate with an underfed state that can also involve issues with thyroid tolerance. So that might be a situation where you actually don't tolerate thyroid supplementation very well, which we'll talk about a little bit later. And so, and that's because you might not be producing enough cholesterol, you might be too low in terms of your fat intake or your carb intake as well. And so those that's just another side of things to consider, where lower is not always better. There are costs there, and also it can be indicative of a state where we're not going to tolerate thyroid as well. And I did want to mention, again, there is this dichotomous effect where we can have high cholesterol from a low carb diet. And we talked about this, you know, previously, but you were kind of alluding to it. For me, I saw my cholesterol drop over 100 points from bringing carbs in. It was in the high, high two hundreds, around 280 and was, you know, able to see it drop pretty precipitously, pretty quickly, without using any thyroid supplementation or anything. But there have also been points where my cholesterol dropped too far, and that tends to be situations where I'm a little bit prone to stress and don't tolerate things that might be a little stimulating, like thyroid hormone. So that's just something to consider. I know you have some parallel experiences as well. Mike, so yeah, just kind of the last piece here as far as cholesterol goes, yeah,

Mike 51:17
yeah. And But, Jay, my cardiologist says that my cholesterol total needs to be less than 100 and

Jay Feldman 51:24
it has so, oh, it's just purely evil. I mean, there's no function for it.

Mike 51:28
Zero. It just causes heart disease. That's its only purpose, right,

Jay Feldman 51:33
right? Yes, our bodies are just trying to kill us and don't have any understanding of science, so that's why they just raised the cholesterol levels willy nilly, yeah,

Mike 51:41
yeah, so on just a few points, if you're young, if you're relatively young, and your thyroid your symptoms are going well, and thyroid function is going well, you may find that your cholesterol level isn't maybe less than 160 in your own and you're fine. But if you're really on the low side, so as like, parallel experience, when I was using thyroid hormone myself, and I went too high in the dose, I had my total cholesterol under 100 and I absolutely felt terrible, like one of the worst experiences from a health perspective, in terms of, like mood and energy and things along those lines. So that's something to keep in mind, that it could possibly be low if things are going well, or lower than 160 if, particularly if you're younger. But if you're going to ever implement thyroid, you're probably going to want it a bit higher. And we can talk about some ways to help to increase cholesterol if you're struggling from that point of view. The next thing I just want to point out directly is the the concern, and just briefly, about cholesterol and heart disease and the we've we have discussed this in couple episodes, so Jay can link link to those episodes in the description and whatnot. But essentially, it's not that cholesterol is driving the heart disease process. It's directly involved in that heart disease process, and so it's more of a function of what's going on with damage to the vasculature, and then the cholesterol having a function of kind of plastering over those damaged areas, and it also being elevated in states of that damage as well, or in or in states where the inflammatory response is leading to that damage, or in deficiency states, things like that. So it's the cholesterol is not necessarily the direct causative factor. There's other processes underlying that. And the other thing I wanted to point out is I just did a post on Instagram about this. But if you look at so dr Broda Barnes has a a graph in his book, The Hypothyroidism, the unsuspected illness, and essentially what the graph shows is that the when people are on natural desiccated thyroid supplements, the amount of heart attacks or coronary events that were expected based on the research in some of the high risk groups or even the normal groups, was drastically decreased. And so I think there's multiple underpinnings here. So the first piece is the thyroid hormone does help to lower the cholesterol, to some extent, into like a more normal range. But I think the more important piece here is that the thyroid hormone is elevating energy production, and that elevated energy production and state can help to lower some of the other stress hormone states and help to protect some of the vasculature and the cellular function from that damage and help to reverse some of those inflammatory, damaging states and things along those lines, because it's not just the cholesterol reduction that drives this benefit, and you see that in the statin studies, right in the statin studies, they're not seeing except for a very specific subset of people, they're not seeing this massive benefit towards heart disease, mortality and things along those lines, maybe some less atherosclerosis. And I think again, it's it's not in what they're talking about now, even with statins, is it's not necessarily the cholesterol lowering effect, it's the other pleiotropic effects. So they discuss that are like separate from the actual statins effect on cholesterol they're talking about. In terms of being an antioxidant or having effects in on the gut or different areas. So I think it's the even with thyroid, it's not just the cholesterol lowering effect. I think it's the other effects that are going on that are helping to improve the heart disease process overall. And again, Rhoda Barnes lays this out over I think a couple 1000 of his patients that he's worked with who are on natural desiccated thyroid, showing that their level of coronary events like heart attacks was drastically reduced when they were on the thyroid supplement compared to

Jay Feldman 55:29
the normal population, right? Yep. And we had recently discussed, you know, just discussed in terms of TSH, the correlation there where any TSH level above 1.5 was highly associated or associated with there was actually above 1.4 was associated with increased coronary deaths. And there is a pretty strong correlation between heart disease and hypothyroidism, so definitely important to mention there. And yeah, we talked about that relationship, or lack of relationship, between cholesterol and cardiovascular disease in in in those cholesterol episodes. So I'll certainly link back to those. Yep, when it comes to evaluating thyroid status on the blood lip, like on the blood test side, there are some other markers that can be indicative of our thyroid status, because hypothyroidism can impair the production of various components. A couple of those, just that might be worth mentioning, would be things like hormone binding globulin or SHBG, also ferritin. Both of those are associated low levels of those are associated with hypothyroidism, and increasing thyroid status can increase the production of both of those. There's quite a few others as well, because it's such a comprehensive, systemic of such importance, you know, it's of such systemic and comprehensive importance that pretty much anything can be impacted by it. And so there's a lot of other markers, but the looking at those, the different thyroid ones that we mentioned, those like t3 t4 reverse t3, TSH. And looking at cholesterol can give us a pretty clear indication there and then beyond that, there are other symptoms that we can use that are often even better indicators of our thyroid status relative to these blood tests, and can be super helpful, both in conjunction and even instead of thyroid hormone testing, depending on what your circumstances are. And so this might be a better route to go, is looking at these various symptoms and using changes in those symptoms as indicators of your thyroid state. So I'm going to share another quote from Holtorf and his paper titled thyroid hormone transport into cellular tissue, discussing some of these symptoms. And so he's referring to another researcher, zulusky, and says that zulusky at all found TSH to be an unsuitable measure of optimal or proper thyroid replacement. As they observed no correlation between TSH and tissue thyroid levels. However, serum t4 and t3 levels had some correlation with t3 being a better indicator than t4 based on their data, the authors concluded the ultimate test of whether a patient is experiencing the effects of too much or too little thyroid hormone is not the measurement of thyroid hormone concentration in the blood, but the effect of thyroid hormones on the peripheral tissues, ie, symptoms. And a quote later on, he says, a relatively low hormone body globulin, a slow reflex relaxation time, a low resting metabolic rate or metabolism, and a low basal body temperature can also be useful indicators of low tissue thyroid levels and can aid in the diagnosis of tissue hypothyroidism. So there's some important things that are mentioned here, and these are markers, like the non blood markers, but these symptoms have been used to diagnose thyroid status for quite a long time, way before we were testing any of these things. And low basal body temperature, low pulse rate, low metabolic rate, slow reflex time. Are all things that you can measure relatively easily and can give you an indication of where your thyroid status is. And all of those are going to be lower when our overall metabolism is lower, meaning Reno hypothyroid state. This is something that's been discussed by Rhoda Barnes, as you mentioned, also by Ray Pete. Quite a bit is using things like the body temperature as indicators of thyroid status, as well as pulse rate and metabolic rate. So just to kind of lay out a little bit of how you could use these things when it comes to metabolic rate, you can identify how much, how many calories you consume on a daily basis to, you know, estimate it using a calorie tracker, and then look at the, you know, and this is while you're maintaining your weight. Ideally, that's you would want to do that to get idea of your general kind of metabolic rate, of how many of those, quote, calories are burning. And we've discussed some of the details with issues with using these as kind of absolute measurements, but it can still be helpful for kind of a general idea. And then you can compare that to a typical, you know, metabolic rate equation based on your height, weight, activity level, age, those kinds of things. And if you're the amount that you're eating and maintaining your weight at or gaining weight at is lower than what it's quote supposed to be, that can be an indication of a suppressed metabolic rate. So that's one way that you can kind of measure and use the metabolic. Rate test, assuming that you're not going to like go do a test with a metabolic card and all of that, but you could do that too to get a much better measure. But then some other easy measures that you could use at home to indicate your thyroid status. One would be body temperature, and so you can look at, basically, there's three points that are most important when it comes to measuring body temperature. The first is your waking temperature. The next would be about 30 minutes after eating your first meal, and then the other one would be later in the day, ideally in the afternoon. And each of these gives us different indicators of where we're at. So we want our weight and temperature to be about 98.0 degrees Fahrenheit. That's typically about ideal. Anything lower of that. Lower than that tends to suggest hypothyroidism. And in Celsius, this is 36.7 degrees. Now the reason why we need to make sure we test about 30 minutes after eating as well is because that initial waking temperature can also be impacted by stress hormones. And so if that waking temperature is artificially elevated due to stress hormones, what we'll see is that when we eat our first meal, it'll decrease our body temperature. So if that happens, then we have to take that first reading as one that was influenced by stress hormones, and is not really a good basal test of our kind of metabolic status. Whereas if our body temperature stays the same or increases after that meal, that tends to be a sign that that first reading was not influenced by stress hormones. So we can take that as kind of a good measure, better objective measure, of our thyroid status, and then that last test in the afternoon is really to try to get our peak body temperature. We want that to be at least 98.6 degrees Fahrenheit, or 37 degrees Celsius, again, as an indicator of our general metabolic state. So if that is, if we're not getting that high later in the day, that can also be indicative of hypothyroidism. And I will see that, or I will say that with clients, it is, this is something that, in terms of getting a baseline of your status can be really helpful. I've seen so many clients where they're checking their waking temperatures, and it's instead of that 98.0 it's low, 9796 is even 90 fives. And those are pretty clear indicators that we're in a hypothyroid state. And this is something we'd want to see change over time as well. I will say that sometimes shifts in body temperature take a bit longer than other indicators of our metabolic stage and other symptoms. So we want to keep that in mind, but it can be helpful in the long term. And then the last one that I'll mention here, and then I'll let you go ahead, Mike, is the pulse rate, and so we can check our pulse at the same time that we check our temperature. This is checking our heart rate, and this can also give us an indication of our thyroid status, because if our pulse is generally higher, what it indicates is higher circulation higher nutrient need and higher metabolic need as a result. Now there is a confounding variable here as well, which is stress. So stress will raise that heart rate. And so that's why we want to always do the same measurements, where, if we're seeing our pulse drop after a meal, that's going to indicate that we're influenced by stress hormones. So we want to keep that in mind. And then the other thing to keep in mind with pulse, and I'll give the ranges in a second, but the other thing we want to keep in mind with pulse is that if we're particularly aerobically fit, if we do any endurance training, or if we're just generally, you know, doing a decent amount of activity, one confounding variable can be what's called our stroke volume. So over time we're doing work cardiovascularly intensive activity, our heart will beat more blood with each beat, which is called the stroke volume. So when we're looking so that'll naturally lower our pulse, because to get the same amount of blood circulating, we don't need to have as many heartbeats. And so that is a situation where a lower pulse would not necessarily be indicative of a lower metabolic rate, because we're pumping more blood with each beat. So it could be the equivalent of a higher pulse than somebody else. So we just want to consider our aerobic fitness as a possible confounding variable here. But in general, you know, throughout the day, in the morning, we want to see our resting pulse in the 70 to 85 range. Typically, it's, you know, going to most correlate with ideal direct status. Yeah, so

Mike 1:03:56
with the pulse situation specifically, and then I guess I'll touch on the temperature the way I usually interpret pulse, and particularly i i like to see the waking or, like the waking pulse with the waking temp, is if you have waking temps that are high, a lot of times the stress hormones, as you kind of mentioned, Jay, can elevate that core body temperature. But if you're seeing that elevated with you're seeing that core body temperature elevated with like, a drastically elevated pulse, then it's a good chance that that's a function of the catecholamines, like adrenaline, noradrenaline, and not necessarily thyroid hormone. So I've had quite a few clients who would wake up and they're like, Oh, my temps are 98.6 my temps are 98.8 which is also, if you're running that high in the morning, it's unlikely to be a thyroid deal. It's more likely to be a stress hormone situation. And essentially, I have them check their pulse, and I've had quite a few people who are over 100 and so if you're sitting over 100 with your pulse in the morning and your temp elevated, it's very likely that that is more of a catechol. Menergic situation and less of a my thyroid function is ideal. And then that's why, looking at those subsequent temperatures, like post meal, and then later on in the day, you'll tend to see those people have those lower those lower temperatures and pulse will usually come down from that perspective, after eating. And so what we kind of discussed previously and and in this these podcast series, is when your thyroid function is not ideal, your sympathetic nervous function can increase. And so that increase in Sympathetic Nervous function can drive core temperature up, but it will also tend to drive up your your pulse to like levels that are probably higher than you want it to be. And then it also can. You may be you may have a core warm or warm core temperature, but you can have things like cold hands, cold feet, or you could be sweating, particularly from like, like your armpits or your head or your groin areas like that, not just like a general overall, like I'm sweating because I'm warm, but more of, like a stress type of deal. And you can find you find you may have to, like anxiety or other symptoms like that, and those are all indicators pointing towards more of a Catecholaminergic drive and less of a thyroid drive. So that's why it's really important to get a sense of what your resting temp is and what your resting pulse is. Once you find that your pulse isn't like super high, and it's also not super low. What I tend to do with clients is then I just start to look at what's going on in terms of temperature, particularly waking on a consistent basis, and then possibly pulse meal. Because once you realize that you're not really running in either of those directions with pulse you may not necessarily have to always track it. It's just helpful to get your baseline in the beginning, because even, for example, in my case with exercise, as you were discussing, Jay, my pulse never really gets super high, because I exercise like on a regular basis, not even cardiovascular like weight training. So I've always had trended towards a lower pulse. Now, something to keep in mind is, when I was in a more hypothyroid state, my pulse was even lower than what it is currently. So I'll sit maybe around 60 beats per minute, maybe up to 70 beats remains at rest. I'll be like hovering around maybe 50 to 60. But when I was hypothyroid, I've seen pulse go down to 40s and even and even below that at at times. And so it's important to keep in mind, like, what is your act? Where are you? Where is your level sit? Where does your pulse sit? And then where is it moving as things start to improve? Or like, How much is it decreasing or increasing on either side? So very specific to your individual context, the temperature, though, is more standard where you really want to be waking I use you average it out to 98 Jay, I usually say between 97.8 and 98.2 and then after after a meal. I really want to see after breakfast. Specifically, I really want to see somebody coming up greater than 98.2 and essentially, the reason you're seeing that increase after breakfast is ideally, you're throwing substrate into the system, and then it's starting to oxidize that substrate, and you're starting to increase some of these, the conversion of t4 to t3 etc, having an effect of all these beneficial hormones, and that should drive body temperature up a bit, and then the later in the day, afternoon. It's pretty well known in the research, and particularly even in in exercise research, that body temperature in the like mid to late afternoon is at its peak. And so you really want to if you're dropping. So say you're waking up at 98.2 or 98.3 but then you're getting down to like 97.8 in the mid afternoon. That's, again, that's usually not a sign of, like, this optimal thyroid function, so it's really important to, like, the pulse and temp understanding of things can be a bit of an art, to some extent when you're first getting used to it, because there's, like, a lot of factors to keep in mind. Overall,

Jay Feldman 1:08:57
yeah, definitely, definitely, no, you're bringing up some good points there. We have a visitor here as well. So joining us on the podcast.

Mike 1:09:04
Yeah, so guests, our first guest, but

Jay Feldman 1:09:09
yeah, you brought up a few really good points that I want to come back to. One is the relative versus absolute values here. So you mentioned that your pulse natural is lower, but you did at least see a shift in your own pulse rate, and maybe it was lower due to a history of of more cardiovascular fitness, right? I mean, you played sports and everything when you were younger, and I think those things will typically stick around over time, among other things, so that could be a factor. But whether it's pulse or temperature, and I'll get to the reason why the temperature in a moment, these absolute values are important to consider, like we want to try to be hitting those but what's more important is that, if our temperature is 95 if we're seeing a shift up to 96 that's a really great science. A good improvement. If our pulse is 40 and we're seeing a shift to 50, that's a great improvement. It's a great shift again, assuming that these things are not due to a stress hormone influence. So that's part. Wanted, the reason why I would say that there's confounding variables with temperature is the thermometer we're using. So there is a lot of variation between thermometers. It's hard to identify which ones are accurate. And so because of that, what I tend to recommend is a when you get a thermometer, have a few different people test their temperature, so you have an idea of how high it will actually go, and how low it actually goes, and maybe kind of what the ranges are, because some of them are just off. And the other thing is, again, if you're as long as it gives you consistent results, you can look at changes over time. So I think that is an important consideration to have another thing that you had mentioned, you know, you're talking about just the literature and how peak body temperature is pretty clear in the afternoons. One thing that we're also starting to see that's coming about in the literature is that the overall normal, quote, unquote, body temperature is lowering, as in the human population as a whole. And there's a lot of signs that, you know, humans are degrading in many ways, and we've talked about the reasons for that all the time, but a clear indicator of it is generally decreased body temperature. And so this is something that we're starting to see, and that does, I would just want to make it clear that is not, quote, normal. It's not just happening totally independent of anything else. That's a sign of kind of global reductions in metabolic rate. And I'm sure it's worse in certain populations than others. I don't know if it's studied in all populations, but in the ones that they are seeing these reduced body temperatures, that's not normal. And if we start to see, you know, the doctor saying, oh, 98 six isn't normal anymore. It's normal for it to be 97 five or 98 oh, or whatever, that's another sign of of degrading population. It's not a sign that those things are normal. It's a sign of shifting the quote reference ranges, or the normal ranges, relative to what we're seeing, which is something that did happen in the history of thyroid testing as well. So it's an important thing to consider there. Yeah, I

Mike 1:11:50
think that goes hand in hand with the shrinking birth head size, and then also, like birth weights and things along those lines. But I think what this really comes down to Jay is that you just discriminate against people who have lower body temperatures.

Jay Feldman 1:12:06
Yes, your temperature absolutely, absolutely the there's a few other symptoms that I wanted to touch on that aren't as objective as temperature and pulse, but are still very clear. Sometimes they're pretty attractive, but they're also very clear indicators of metabolic rate, metabolic status and thyroid status as a result. And those are just the general symptoms that that a lot of people are experiencing low energy or fatigue, poor recovery or performance in terms of workouts, you know, lack of cognitive ability to focus, decreased immune function, getting sick very often. Dry skin, cracked heels is a very clear one as well. Dry hair, cracking skin, hair loss, you know, also seeing like degradation of nails, nails that are very brittle or that aren't growing very quickly. Same thing with hair. Hair is not hair that isn't growing very quickly, dry, dryness there as well. And any of those things we also have the gut type symptoms, which we've discussed. You know, low stomach acid, low bile flow, low motility, or slow motility. And then the effects of all those things, like overgrowth, small intestine, bacterial overgrowth. A lot of those things have underpinnings and a hypothyroid state. Also a very common one is weight gain. You know, it's a huge one, low mood, depression, all of those things are going to be indicators of our thyroid status. And so if we're dealing with these issues, it could likely indicate a hypothyroid state. And seeing these things improve over time could also indicate improvements in our thyroid state. So we really want to be consider considering the whole organism. When we're looking at these things, in addition to the markers, like cholesterol, we could also look at blood pressure as well as another one that's correlated here, and we have a couple of episodes talking about blood pressure as well. So I'll link back to those. So I would just mention that we can use all these things as indicators of our thyroid status. There's one last one that I want to mention that's a little bit unique, which is seeing yellow skin, especially in the calluses and in the hands and feet. And this could be a sign of carotenemia, which is basically a state where we have this excess form of vitamin A, where the vitamin A is not getting used properly. That could be a clear indication of a hypothyroid state. It can also be an indication of getting very high amounts of carotenoids. So we want to consider that as a possible confounding variable here. I know quite a few people had this issue, just as a real quick anecdote. There was a friend of mine who was we would box together, and he, when he was trying to lean out, would just eat tons of carrots, just bags of baby carrots, like, pounds of them. And his hands and feet would be incredibly yellow as a result. But that, and probably lovaza said this as well, while he was, you know, eating super low calories and everything to try to cut weight. But yeah, so that can be another indicator. And. Other thing we'd want to see shift as we improve our thyroid status.

Mike 1:15:02
Gotta cut back on the carrot salads. Yeah.

Jay Feldman 1:15:06
And of course, you're kind of saying that facetiously, and we've talked about the carrot salad before. I'll link back to that episode, but having a carrot a day is generally not going to cause this issue, especially if your thyroid status is pretty good. But if you're having carrots as meals, multiple meals, then might be something to consider. And if you're not having that much in terms of carotenoids, and you're just having the one carrot a day, or something like that, and you're having this issue, it's often an indication of hypothyroidism, and I would just say in that state, you could also try carrots that are are different colored, that aren't going to have as much of the carotenoids, things like that. Yeah, yeah.

Mike 1:15:43
The other thing i So, a couple things I want to add. I just want to jump back to temp really quick. A lot of people, I think, in brota Bard's book, he talks about using a mercury thermometer and placing it under the arm for that takes, like, a good five to 10 minutes to get a good reading. So for a lot of my clients to just, like, just use an oral thermometer, a digital one. And as you were kind of mentioning, Jay it, it's you're really trying to look for the trend. So even if you're not perfectly in range, if you're seeing thing, if you move up a whole degree in temperature on that same like showing on that thermometer on a consistent basis with reading, that's a very drastic improvement. That's great. So I think that you don't necessarily need to use the mercury ones, and I don't think you need to do the under the arm temperatures. The other reason I say that is because a lot of times what's most important is that you're actually doing the interventions, or you're actually measuring your temperature consistently and having to wake up every morning. And I know it's kind of sounds kind of lame, but waking up every morning and spending 10 minutes with a thermometer under your arm is not something like, even for me, like I got tired of doing that, and a lot of people won't maintain it on a regular basis. So I'd rather see somebody use an oral thermometer on a regular basis. It takes 30 seconds to read and just look at the trend over time and not worry about having, like, the perfect thermometer setup and all this type of stuff. So that's the first piece I wanted to bring there. As far as the symptoms, the symptoms are really important to look at because, and I think I've covered this or mentioned this a few times on our podcast, but your actual functions are real time information. As far as how things are going, the labs is like everybody, or there's this trend towards precision, evidence based medicine, or whatever the different terms are. And it's like, you want to look at all this data so steps and labs and yada yada and this and that. But at the end of the day, those are only snapshots in time. You're only getting one snapshot in time. There can be multiple factors affecting it. We don't even have all of the lab values. There's new lab values being discovered, new markers to look at constantly, but your real time, symptom profile, what you have going on in an everyday basis, mood, energy, libido, appetite, digestion, etc. Cold hands, cold feet, mental function, brain fog, things along those lines, those are going to give you strong, consistent daily indicators to see how things are progressing, because that's essentially showing you are do your tissues have enough? T3 is your body temperature at an appropriate level? Is your cognitive function at appropriate level? Is digestion functioning? Well, those are telling you in real time. Hey, things are kind of going pretty well here, or things are trending in the right direction. And so even with with a lot of clients I work with, particularly around weight loss in the initial phases, when someone's coming out of low carb, low calorie, intermittent fasting, heavy exercise, whatever, keto, whatever the deal is, you may not see weight loss happen immediately, but if you're seeing your symptom profile start to improve, you're seeing your mood get better, you're seeing your daily energy get better now you're sleeping through the night, things like that. Those are all indicators in and of themselves that are showing you that things are trending in the right direction. And then you then do tend to see the other things follow afterwards. So the the symptoms are extremely important. The other thing is, they're free. It's it doesn't take anything to jot down or have a general idea of taking, taking stock of what you have going on, having an awareness of your body on a regular basis, on a daily basis, so you don't have to get tests every week to say, Oh, my TSH was here last week, and now it's here, and my t3 was here. And so it's, it's a more feasible approach. Now, it's not that those other things aren't important, but getting to see real time function, I think, is is always going to be extremely valuable. And I wouldn't discount those things. And a lot of times in the modern like working in the modern medical sphere, symptoms are discounted. So you can go in, you can be on your levothyroxine, and the doctor will look at your TSH value and be like, No, your thyroid is fine, but you have high blood pressure, you have high cholesterol, you have two heart attacks, and your diabetic. It's like, just because your TSH is suppressed doesn't mean that thyroid function and metabolic function is going well, and usually the person has like, a litany of symptoms. I'm, Hey, Doc, I'm anxious. I can't sleep at night. I have joint pain. And it's like, All right, here's a SSRI, here's a benzodiazepine, here's something to sleep at night, and then here's a naprxin or diclofenac or some type of NSAID to manage your joint pain. And it's like those are it's that's not looking at like things are not moving in the right direction, and that band aid symptomatic approach, without simultaneously trying to adjust what's going on underneath is, is, I don't think a good thing in the long run, because you you don't want to just cover the symptom. Symptoms up. You want to kind of get to the root, and then you can also simultaneously minimize some of the symptoms as you go along as well. But you really want to be making sure that, like, if you're seeing somebody who's on Synthroid, even if their TSH is and this is just an example, even if TSH is suppressed, if they still have the full bag of hypothyroid symptoms, then you know that that therapy is not working appropriately. So this the real time data. I can't stress how important that is. And then the last piece, I know you probably want to jump in on some of this, Shea, but the last piece is for the the care the keratin EMIA, where you're basically at the yellow hands and feet. I've had a couple people have that, and they asked me about it. It's not dangerous, like you're not going to explode from the carotenoids. It just indicates that your conversion of the carotenoids to vitamin A may not be ideal, and it's dependent to some degree on on thyroid status and or it could be that you're just slamming carrots and sweet potatoes and squash and other things, or pumpkin or whatever you're doing and that maybe you want to, like, change around some of the vegetables a bit. So again, it's not you're not going to explode. It's not necessarily directly dangerous. It's not I it's like, indicative that something else is going on and that you just want to make a shift from there,

Jay Feldman 1:21:56
right? Just like most symptoms, they are indicators of what's going on underneath the symptom itself is not always a problem. You brought up a lot of really great points there. I think a lot of them were very clear. Just going to tack on two things. One is, you're talking about the value of using symptoms versus the labs, and how, not only is it, you're saying it's less expensive. You don't have to worry about going to your doctor again. Not that it's an either or. It can be both and, but using the symptoms is very important because of this. And also another point is that a, it gives you more autonomy and control, and B, you this allows you to make tweaks on a much more like on a much more shorter timeline. If you're waiting to get a thyroid test every three months or six months or 12 months, it's much more difficult to identify if what you're doing is working, whereas if you're using these sorts of symptoms as indicators throughout days and weeks and months, then you can identify much more clearly if what you're doing is going well, and use that to make smaller adjustments. So that's incredibly important. The other thing I wanted to mention, just as far as talking about body temperature and symptoms, another clear symptom that we can use is how cold we feel, how well we tolerate cold temperatures around us, and cold hands and feet. Specifically, those things are typically tied with low metabolic rate and low thyroid activity. So that's a another pretty clear measure we can use as far symptoms go, yep, yep, of course. All right, we're going to end that episode there and pick back up in part four, where we'll be discussing how fasting decreases thyroid function, why carbs are essential for thyroid function, the specific anti thyroid foods that you want to avoid, why interventions like cold thermogenesis, caloric restriction and fasting are not the answer for hypothyroidism and The impact of proper sleep on our thyroid health. If you did enjoy today's episode, please leave a like or comment. If you're watching on YouTube and if you're listening elsewhere, please leave a review or five star rating on iTunes. All of those things really do a lot to help support the podcast and are very much appreciated as always, to take a look at the show notes, where you can look at the studies articles on anything else that we referenced throughout today's episode, you can head over to Jay Feldman wellness.com/podcast, and if you're dealing with any of the common hypothyroid symptoms, things like low energy or fatigue, weight gain, joint pain, digestive symptoms, brain fog, poor sleep, hormonal imbalances or constant cravings or hunger, or if you're dealing with any other chronic health conditions. Then head over to Jay Feldman wellness.com/energy, where you can sign up for a free energy balance mini course. And in that mini course, I'll walk you through the main things that you can do from a diet and lifestyle perspective to maximize your cellular energy and resolve these symptoms and conditions. So to sign up for that free energy balance mini course, head over to Jay Feldman, wellness.com/energy, and with that, I'll see you in the next episode.

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