Host: Deanna Minich, PhD
Guest: Erik Lundquist, MD
In this discussion, Erik Lundquist, MD and Deanna Minich, PhD explore thyroid physiology, assessment, and clinical pearls for treating patients with thyroid dysfunction or disorders. The crux of the discussion is treating the individual patient, not the labs. You will learn valuable insights and effective clinical strategies that Dr. Lundquist utilizes every day in his clinic to provide personalized support to patients with thyroid disorders.
Dr. Lundquist shares that in his medical school training, he was taught what to do when systems of the body go wrong and how to treat downstream symptoms with “silver bullets,” oftentimes medication(s). But in Dr. Lundquist’s practice, he instead looks at the causes of symptoms and addresses those causes. While Dr. Lundquist does not treat the lab numbers themselves, he absolutely uses key labs to help guide the treatment. Further, Erik explains that lab results can be comforting, if not empowering, to a patient who has not been feeling well for so long, and now their symptoms are finally justified. This is particularly true when the healthcare practitioner (HCP) takes the time to explain what the labs mean to the patient.
Dr. Lundquist explains that the complex hormonal pathways and milieu that comprise the hypothalamic-pituitary-adrenal-gonadal-thyroid (HPATG) axis all utilize the same control center (the hypothalamus), therefore, it does not make sense clinically to consider the thyroid, adrenals, nor sex hormones separately, in silos. He also presents the caveat that much remains to be understood about the HPATG axis and how its functions translate clinically, from patient to patient.
Dr. Minich asks Dr. Lundquist to share the symptomatology that he looks out for across a spectrum of thyroid disorders —hypothyroidism, hyperthyroidism, and autoimmune thyroid disease like Hashimoto’s disease. Dr. Lundquist differentiates how fatigue typically manifests in patients with thyroid vs. adrenal dysfunction and then outlines some of the other, most common hypothyroid symptoms that he looks out for: constipation, weight gain, depression, hair loss, swelling or bloating, and cold intolerance. Chronic stress has a significant, deleterious impact on both adrenals and thyroid, so if stress is in the mix, Erik explains that it makes sense to assess adrenal function first or alongside thyroid treatment.
For the thyroid panel, Dr. Lundquist regularly orders the following labs: thyroid-stimulating hormone (TSH), total thyroxine (T4), free T4, total triiodothyronine (T3), free T3, and reverse T3. Erik measures thyroglobulin (Tg) if thyroid cancer is of concern. He also orders thyroid peroxidase (TPO) and Tg antibodies in initial patient visits, since a large portion of hypothyroid patients can have autoimmune etiology. Erik also measures the status of micronutrients associated with thyroid function, including selenium, zinc, iodine, and sometimes RBC magnesium.
Much less common, hyperthyroidism is usually associated with Graves’ disease or a thyroiditis infection, however, recognizing hyperthyroid symptoms (heart palpitations or tachycardia, tremors, anxiety, heat intolerance, loose bowel movements, sweating, insomnia, menstrual irregularities) is critical for clinicians to know, in case they are over treating their hypothyroid patients. Additional labs specific to Graves’ disease include thyroid stimulating immunoglobulin (TSI) and thyrotropin receptor antibody (TBII).
Drs. Minich and Lundquist discuss their observation that autoimmune conditions are on the rise and that environmental toxins are playing a role. Thankfully, HCPs in the integrative and Functional Medicine spaces are sensitive to assessing for and treating autoimmune etiology. Inflammation, oxidative stress, and immune dysregulation can contribute to autoimmunity, but they also contribute to thyroid resistance, meaning the patient needs more thyroid hormone to achieve symptom resolution. Dr. Lundquist explains a compelling patient case that demonstrates there’s more wiggle room than clinicians may think when tweaking doses for thyroid hormone replacement. The goal is always to resolve symptoms and help the patient achieve hormonal homeostasis overall.
In conventional medicine, TSH is the be-all and end-all. Dr. Lundquist explains why TSH is not the best marker to assess thyroid function. He reviews basic thyroid physiology, including the differences between T4, T3, and reverse T3, to demonstrate why TSH alone will not effectively treat the patient, nor their true symptoms.
In terms of targeted nutrient supplementation and repletion, Drs. Lundquist and Minich delve into an enlightening discussion on iodine and selenium. Once selenium levels are replete (based on RBC selenium lab response to supplementation) in the patient, Dr. Lundquist will then consider iodine supplementation, particularly in patients with Hashimoto’s and any patient who has iodine inadequacy from their diet. Iodine is a common nutrient gap in the US, and Erik has found that over 80% of his hypothyroid patients have suboptimal or deficient serum iodine levels.
The discussion wraps with some rapid-fire Q&A for Dr. Lundquist, including his expert insights on:
- The impact of caloric restriction, stress, and oral contraceptives on thyroxine-binding globulin (TBG), reverse T3 and thyroid function
- The impact of thyroid function on bone health
- Whether hair loss can be resolved with correcting thyroid levels (the answer is yes)
- The potential for goitrogenic effects of soy foods and Brassica vegetables
This Metagenics Institute LIVE broadcast took place live June 4, 2019 on the Metagenics Institute Facebook page.