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Welcome to the Healing on Purpose podcast. I’m your host, Dr. Miriam Rahav. The content of this show is meant for informational purposes only and is not intended to diagnose, treat, or cure any illness or health condition. Please discuss all information shared herein with your own personal health authority. I hope you find value in this episode. This podcast is also available on YouTube on the Healing On Purpose channel, should you want to look up any of the graphics, diagrams, or other visuals mentioned in the show. Links to the podcast and its YouTube channel will also be available on my practice website, rahavwellness.com. Please join me on my Facebook group, Healing On Purpose podcast with Dr. Miriam Rahav, to continue this conversation. Enjoy the show.
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Namaste. I salute the divine within you, and I’m so glad you’ve joined us on a path to healing on purpose. My name is Dr. Miriam Rahav, Today, I wanted to discuss with you the thyroid. Maybe you’ve heard of it. Maybe you’ve heard of it in the context of feeling tired. Maybe you’ve heard of it in the context of unexplainable weight gain or weight loss resistance or brain fog or depression. You may have heard of it, in other words, in the context of some of the symptoms that may hint at its dysfunction. In other words, that the thyroid might not be working well. What is the thyroid gland? The thyroid gland is a gland that sits right around here, right around the Adam’s apple. It looks a bit like a butterfly with a lobe on one side, a lobe on the other side, and a linking part, a bridge, so to speak, that is also known as an ischemus. It regulates our metabolism. As such, it has a huge impact on our health because it actually works on a cellular level, on a subcellular Every one of our cells and our DNA and how our cells use energy is in fact regulated by the thyroid.
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As one of my teachers in residency said, The thyroid is the thing that when it works, you don’t know that it’s there. When it doesn’t work properly, there’s literally nothing that doesn’t go wrong since it affects every cell in the body. If you’re a gut cell and you’re hypothyroid, your gut cell might not have the energy to assimilate nutrients. If you’re a liver cell, your liver cell might not have the energy to detoxify or create key proteins. It leads to a disharmony in all of our other hormone systems. It’s an incredibly important subject, and it’s a subject that affects so many of us. It’s one that I’ve meditated on quite a bit in practice because it’s so common for our thyroid to be vulnerable. There are some reasons why. Once upon a time, I was sitting in a classroom studying Chinese medicine on my pathway to become certified in acupuncture. Our professor of Chinese medicine described the thyroid as a garbage dump. I was immediately inserted on behalf of the thyroid. How could you say such a thing about our most precious endocrine gland? It’s a plant. And yet, there was an interesting concept that opened up in that statement.
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That has to do with the thyroid being both a source of hormones, but also a factory of It needs to source its supplies. One of its most important supplies, so to speak, is iodine. Iodine is a rare and precious mineral that we most commonly get from what? From sea vegetables. Interestingly, I read that actually dairy is a source of iodine. We wouldn’t really expect that, but it turns out that iodine has antiseptic qualities. Many people would have used it in their home cultures, perhaps. For wound care, it has this dark orange color. In hospital medicine, we actually have iodine packets that we use to clean an area that we need to sterilized for any procedural purposes. We actually sterilize the udders of cows before we milk them. Some of that residual iodine is in our dairy products. Isn’t that interesting? But I digress. Iodine is a precious mineral that is traditionally scarce and more scarce in areas that are landlocked and don’t have access to the sea. Historically mountainous areas, classically people of the Himalaya. In our medical textbooks, we would see these really awesome pictures of Indigenous peoples of the Himalayas with these big glands that became extra active, trying to source iodine in a place of scarcity.
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That condition of an enlarged thyroid that doesn’t have enough iodine to make its hormone is called a goiter. The thyroid, because it regulates metabolism and because it’s sourcing its iodine, it’s going to filter the blood. In fact, I have a neat picture that I tried to queue up to share, showing just how vascular the thyroid is. Let me see if I can figure out how to share I’ll share that with you. Let’s see here. Is this it? Yes. This is a picture of the thyroid gland. As you can see, as my cursor is moving around, it does a good job in this cartoon depiction depicting how vascular the gland is. The gland is going to try and filter into itself iodine for its own hormone production. The The tricky thing is that there are lots of substances that are now in our environment where iodine is precious and is a mineral that can look like minerals, they’re mineral lookalikes, and yet don’t function like minerals. Those are namely heavy metals. You may have heard of this concept. And heavy metals are what we call endocrine disruptors. They disrupt our thyroid function. The thyroid, going back to my professor of Chinese medicine describing the thyroid as a garbage dump, is not willingly or purposely trying to concentrate garbage.
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But if we have a lot of garbage in our environment that looks like iodine, the thyroid will accidentally concentrate those metals, potentially, in place of the iodine that it’s not able to find. Therefore, the thyroid concentrating can wind up concentrating into itself, disruptors of its own function. Thyroid dysfunction in my clinical practice is quite common. Now, let me see if I can show you another picture. Let me see, I’m scrolling here. Here, this Here is the picture. Here is that butterfly-shaped thyroid gland. Above it here is actually a depiction, although somewhat abstract, I realize, of a part of the brain known as the pituitary gland. It lives, I guess here is a picture of the brain, somewhere in here. If you can see that, sorry, that’s small. The pituitary is making a hormone known as TSH, or thyroid-stimulating hormone. Now, thyroid-stimulating hormone is named after precisely its job. It’s supposed to suss out what is happening, what is the state of the thyroid in the body. If there is not enough hormone around, it is like a foreman in the factory. The thyroid is making hormones like in a factory. Let’s say it’s making, I don’t know, for the purposes of our conversation, sandwiches.
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You have the foreman who’s overseeing the production of sandwiches from his window at his desk, and he’s looking out over the production scene and realizes there are not enough sandwiches. The foreman’s job is to get a little louder, maybe shout a little bit at the sandwich makers and say, Make more sandwiches. So too, thyroid-stimulating hormone gets louder if there’s not enough thyroid hormone circulating around. By louder, I mean higher. When I do bloodwork, I see an elevated thyroid-stimulating hormone, I realized that that is in response to hormone levels, thyroid hormone levels, being too low. But there’s a catch. This is the catch that I think the functional integrative medical space is profoundly equipped to capture. That catch is that there is a difference between receptors, meaning how thyroid acts on the level of the brain, on the pituitary, the specialty part of the brain, as opposed to the cell of the body. That is because the brain has a special circulation system, it has a blood-brain barrier. Therefore, there can be a significant lag, sometimes of years before the foreman of the thyroid factory starts getting loud, meaning we could have a scarcity of sandwiches or thyroid hormone for years before the foreman actually notices.
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That can a profound disconnect because we, people, us, we have a sense of where our energy should be, how we should be functioning, and then we go to our doctor and we say, I’m tired. I don’t feel right. I’m sluggish. Maybe I’m constipated. Maybe my skin is dry. Maybe my hair is falling out. Maybe I’m gaining weight or I just don’t lose weight the way I used too. Maybe I feel foggy. I have reduced exercise tolerance. The doctor, of course, appropriately immediately thinks of the thyroid and runs a TSH test. The TSH test comes back normal. Therein lies the rub. Can we have hypothyroidism with a normal TSH? The answer is yes. Yes. There is a specialty test called the TRH Stimulation Test. The TRH Stimulation Test proves what we might otherwise never discover as a subclinical hypothyroidism. We can actually give TRH. Well, first, let me tell you how this works. We check TSH, and then we give TRH immediately thereafter. 20 minutes later, we can check a TSH again. What TRH does is thyrotropin-releasing hormone. It will cause the TSH that’s stored in the pituitary to be released. I worked in a wonderful practice where this old test was commonplace and opened a window onto the pituitary, and I could see that when we stimulated the pituitary, the pituitary said, Well, actually, maybe we were shouting.
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Maybe the foreman was shouting, but I don’t know. I guess we just gave up. We stopped shouting. But you revealed that actually we were shouting for a while, meaning we do a TSH, and 20 minutes later, we repeat a TSH after we gave TRH, which stimulated that TSH. Lo and behold, the TSH was very high. That would be our reason or justification for working on the thyroid. What happened when I was exposed to this TRH test is that I realized that by the time someone’s TSH, a reference range on most laboratories lies between 0.4 nanograms per deciliter to 4.5 nanograms per deciliter. That’s a very, very wide range. What I realized is that by the time the TSH is hovering around the two, that person may, in fact, already be somewhat hypothyroid, meaning that thyroid is not functioning optimally and the plot thickens. TSH is part of that puzzle. Then it turns out that the gland makes two hormones, T4 and T3. Most of our hormone is actually in the form of T4. What works on a cellular level is T3. Now, why is that? By the way, there’s no dumbing this down. I apologize every day in clinical practice for speaking about the truth of thyroid hormone, because the truth of all of us is that we’re incredibly intricate and we’re incredibly complex.
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The more that we can approximate the truth of our inner intricacy and complexity, the more we can speak to it, look for it, understand it. With that understanding and with that clarity, we can actually do the work and get ourselves better. I really, really am so excited that you’re joining me today on the path to healing on purpose, where you acquire the information to really know what is required to look at a thyroid function from a medical perspective comprehensively. That means that we want to look at a TSH. Perhaps you find a practitioner that does a TRH stimulation test. Well, that’s really valuable, wonderful, and interesting. Also, that we want to look at both T4 and T3. What’s the deal here? In the thyroid hormone factory that is this gland shaped like a butterfly, most of hormone is made in T4, and yet what’s working on our cells is T3. Why is that? Well, with great power, the thyroid hormone is a powerful hormone. Comes great responsibility. We make a precursor hormone that then needs to travel and get to cells to be activated and converted into T3. It’s the T3 working on a cellular level on on a DNA level that’s actually regulating metabolism.
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Well, do we routinely check T3? That’s really what’s working on our cells. The answer is that the practice I inherited from my medical training says it’s not really needed because T4 gets converted into T3. There’s the rub. It turns out that there are a lot of obstacles to that T4, T3 conversion. And absolutely correct, T4 does get converted into T3 in normal situations. But when we’re feeling great and feeling like ourselves, we tend not to be running to the doctor. We’re running to the doctor because of various symptoms, and symptoms of hypothyroidism, classically, as I mentioned before, may be fatigue, weight gain, weight loss resistance, depression, constipation, brain fog, feeling sluggish, dry skin, hair loss. In other words, not like ourselves. Here, we might miss that problem with T4 to T3 conversion. Now, what might be the cause of the problem from T4 to T3 conversion? Well, one of the things that can cause a dysfunction in that conversion is stress. Whoa, there’s a big subject, right? The other is environmental toxins. The other is infection. The other is liver dysfunction. So much of that T4 to T3 conversion takes place in the liver and specifically in bile.
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Here in this diagram, I thought it was helpful because it’s naming some of the very common endocrine disrupting compounds that work at the level of the brain, the level of the circulation, at the level of the liver, and prevent normal thyroid physiology. It’s incredibly common and yet looking for T3, T4 to T3 conversion issues, looking for a subclinical hypothyroidism when the TSH starts climbing above the two, looking for the actual endocrine disrupting chemicals is not common practice. This is potentially a great challenge of our times the need to expand our practice, to look at TSH, to look at T4, to look at T3, to look at free T4, to look at free T3, to look at reverse T3, to look at liver function, to look for nutritional backbones of thyroid. Have you heard of one of the main ingredients that drives the thyroid forward? It’s iodine. We mentioned it earlier in our talk. The other is a very important amino acid known as tyrosine, which is also, by the way, a precursor to dopamine. Fascinating. With nutritional deficiencies, with endocrine disruption, with stress, with infection, we can be living with what we would call a subclinical clinical thyroid dysfunction for years.
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And sadly, the standard of practice may miss it until it’s led downstream to lots of other issues in addition. I know that this is only the beginning of a bigger conversation, but for you on your journey to healing on purpose, you have the possibility of understanding that just because your TSH comes out normal in routine bloodwork does not mean that your thyroid is working optimally. In understanding that there is a deeper potential story, you might be able to seek out more information. Ask for a T3. Ask for a free T3. Ask for, perhaps, a screen of your blood for mercury, aluminum, arsenic, lead, cadmium. Ask for an iodine level. Ask for thyroid antibodies, antithyroglobulin, TPO, TSI. Maybe you, too, along with me, can become more empowered through health information to be the change you want to see and live your healthiest, most vibrant, most dynamic life. Thank you for joining me today on our conversation on the thyroid. I’m Dr. Miriam Rahav with Healing on Purpose.
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Thanks for listening to the Healing on Purpose podcast today. I hope you found this information helpful, and I encourage you to share this episode with others who may also benefit from the information shared. Please consider rating and reviewing my podcast on Apple Podcasts so more people can find this information. I also invite you to join the Healing on Purpose podcast Facebook group to continue this conversation. I’ll see you there.