My Top 5 Clinical Pearls From This Last Year


Clinical Pearls From Working In The Trenches

Hey People!

Wow, it’s been a year since I launched my website and Facebook support group. SO MUCH HAS HAPPENED!

I am a big proponent of looking back at the data and the experiences and analyzing what we learned. And, hopefully, we can build from that and improve what we are trying to do.

And that is to help and educate people to heal their Hashimoto’s.

Over 500 Consultations with Hashimoto’s Patients

Over the course of this year, I have had over 500 consultations with people with this disease.

I’ve listened as people described their symptoms and their health histories and I’ve also taken a number of surveys and polls at our Facebook support group which has now reached 10,000 Likes.

I want to thank everyone who has joined us for their continued love and support! This is something we could not have achieved without you.


In this blog post I’m going to summarize the top 5 things that I think are really important (from a clinical and practical point of view) and I’ll share a few odds and ends that are just really interesting to me.

Top 5 Clinical Pearls

Here are my top 5 clinical pearls and a little discussion on each and why I believe it matters to you.

Pearl #1. The Majority Are Functionally Hypothyroid.

By far, the most common thing I have seen is that many, many people taking thyroid replacement hormone are functionally hypothyroid.

What does that mean?

Well, they are taking thyroid replacement hormone (and it doesn’t seem to matter whether it’s Synthroid, Armour, or Synthroid and Cytomel, or Naturethroid, etc.), their lab test results (usually this means TSH and if we’re lucky TSH and T4) are normal.

However, they have all the common hypothyroid symptoms: they are tired all the time, they are frequently depressed and/or they have anxiety, they have trouble losing weight, their hair is falling out, they have brain fog and memory issues, etc.

Since there is such a consistency of symptoms despite the thyroid replacement hormone, then you have to look at the possibility that the solution can be found in something other than thyroid replacement hormone.

Many people really focus on switching hormones or switching back or switching dosage up and down and for a few, the change works, for others it works for a little while and stops working and for the majority it doesn’t matter because it doesn’t work at all.

For some the addition of T3 can help tremendously, for others it helps for a little while and then stops working. And for others it doesn’t seem to help very much either.

So, if it’s not the thyroid replacement hormone, then what’s the problem?

The problem that I have seen repeatedly is that they are not converting and/or absorbing the replacement hormone.

One reason for this is that TSH is produced by the pituitary which absorbs thyroid hormone differently than the rest of cells in the body.

The pituitary can register thyroid hormone levels when the rest of the body is resistant or just not absorbing it.

There are lots of other reasons why this can happen, but the most important thing to understand is that it’s not always the choice of thyroid hormone, it’s a problem somewhere along the process of getting that hormone into the cells of your body.

What this means is that this becomes a systemic problem and trying to solve that kind of problem by just adding more thyroid hormone is like trying to fix global warming by driving a hybrid.

It might help a little, but there’s a whole lot more that needs to be done.

For example, I worked with one woman who as taking both Levothyroxine and Cytomel. She had the exact symptoms described above. Normal TSH and T4 and all the hypothyroid symptoms I described.

After doing a compete panel we discovered that she had high cholesterol, LDL and triglycerides (because she was functionally hypothyroid) and she wasn’t converting or absorbing well.

We focused on cleaning up her diet, giving her targeted nutrition to help her liver and we worked on improving conversion. She contacted me a month later in total disbelief because her cholesterol had dropped by a little more than 50 points and she noticed that she had a lot more energy.

No cholesterol medication, no changes in thyroid replacement hormone. We just made everything work better and this caused her liver to convert more efficiently. In addition, the changes to her diet help reduce the systemic inflammation and this allowed her cells to better absorb thyroid hormone.

Check out this post on T4 that goes into detail about what is happening here.

Pearl #2. Diet Is The Foundation and Key to Success

This is really a “no brainer”, but I am continually surprised at how many people refuse to accept this or want to negotiate a kinder, gentler half way approach that doesn’t involve them changing their diet and, of course, their lives.

Hashimoto’s is an autoimmune disease and that means that your immune system is attacking your your own tissue. Tissue attack and destruction is induced by immune system stimulation.

Where is your immune system? An estimated 70% lives in your digestive tract. So everything that passes through there interacts with your immune system.

Also, there is a lot of research evidence that shows a clear link between “leaky gut” or intestinal permeability and autoimmune disease.

The breakdown of your intestines is a breakdown in the barrier to your immune system and this clearly is a factor in the initiation of autoimmune disease, but it is also an important factor in people’s symptoms because if this is not addressed you have constant immune stimulation and constant tissue attack.

My advice is always get off of gluten, dairy and soy 100% and for many, because of the state of their intestines, this is not enough. They need to do more. For them we recommend a version of the Paleo diet designed for autoimmune disease and Hashimoto’s, in particular.

I have gotten messages on Facebook and emails from at least a dozen different women who have credited this change alone with completely transforming their lives.

If you’re on the fence about your diet, you’re just prolonging your misery needlessly. It’s such a simple part of the solution.

Pearl #3. Blood Sugar Imbalances Can Stop the Whole Train

This is another common area of dysfunction that is often overlooked. However, in my experience and in the experience of many of my colleagues (including my teacher and mentor, Dr. Datis Kharrazian,) this is one of the first steps that needs to be taken.

There are a couple of different types of blood sugar dysfunction. Hypoglycemia, which means your fasting glucose is generally too low and Insulin Resistance, which can be a whole combination of symptoms but is generally brought on by too much sugar in the diet.

And, in reality, lots of people have a mix of both.

The reason this can wreck the whole show is because of the impact of sugar fluctuations on the entire endocrine system.

Blood sugar and insulin spikes impacts cortisol and thyroid hormone levels. This creates a vicious cycle that impacts the pancreas and the pituitary and winds up driving you down.

And to add insult to injury, many people use sugar to get energy to overcome their fatigue.

This is like smoking cigarettes to help your asthma, it does way more harm than good.

For example, I worked with a woman who really had supplement fatigue. She had been put on so many different things that she had spent what amounted to a small fortune on supplements.

She sent me two full pages of things she had been prescribed. This was giving her very expensive urine, but wasn’t helping her feel a whole lot better.

The one thing that no one had told her was that she needed to balance her blood sugar. She had what amounted to a pretty serious case of insulin resistance. She had really bad fatigue, brain fog and memory issues and depression. She just felt like she had lost her life.

One of the main reasons that she had developed this was that her fatigue was so oppressive that sugar was the thing she relied on to get her through the day. Well, what she didn’t realize was that this was intensifying the fatigue and actually making her feel worse and worse.

So we focused on normalizing her blood sugar by getting her to stop the sugar habit and start using protein and good fats and by giving her targeted nutrition that helped to improve insulin receptor sensitivity.

And lo and behold, she felt like a new person. That was the one missing link for her. It restored her energy, it improved her brain fog and memory issues, it helped her to start feeling like her old self again.

Check out this post to get an in depth look at what happens with blood sugar issues.

Pearl #4. Adrenal Problems Can Trump Thyroid Issues

The next area that is really crucial to evaluate and treat, if necessary, is the adrenals.

There are various stages of adrenal issues from adrenal fatigue to exhaustion and if your adrenals are compromised it can dramatically impact the way you feel when you take thyroid replacement hormone.

In fact, the warning label for Synthroid reads:

“Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium.

Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone.”

What this means, in plain English, is that in cases of hypothyroidism, the adrenals need to be evaluated before putting patients on thyroid replacement hormone.

How many people with Hashimoto’s and hypothyroidism do you think have adrenal insufficiency?

I put this question to my Facebook support group and 100% of the 85 respondents with Hashimoto’s said they had most of the symptoms of adrenal insufficiency such as:

* Fatigue, also a thyroid symptom

* Headaches, splitting headaches especially

* Decreased immunity

* Sleep issues. Difficulty falling asleep, staying asleep and waking up feeling exhausted even after you had enough sleep.

* Mood swings

* Sugar and caffeine cravings, (have a hankering for a Red Bull? It could be your adrenals)

* Irritability or lightheadedness between meals, a blood sugar and adrenal problem

* Eating to relieve fatigue, another blood sugar problem

* Dizziness when moving from sitting or lying to standing, it affects your blood pressure

* Gastric ulcers, ulcers in the stomach can be caused by the adrenals

Granted, that’s not a scientific study, but it certainly is emblematic of this problem.

Unfortunately, many doctors dismiss adrenal insufficiency as one of those make believe disorders. It’s not make believe at all, it’s very real.

For example, I had a patient who had developed Hashimoto’s after having a baby. She was diagnosed after lab tests revealed antibodies above the normal range and elevated TSH.  Her doctor immediately put her on Synthroid.

She had a terrible reaction and felt so sick that she literally could not continue with the drug. The doctor dismissed this reaction and insisted that she get back on the drug.

She dismissed her doctor and eventually found me. We did a number of different things including getting her on the autoimmune diet, cleaning up her liver and we worked on restoring her adrenals and helping her body adapt to stress.

After three moths of following this protocol she went back to her doctor and asked him to reorder the tests. He grudgingly did saying there wouldn’t be any change he was sure of it.

The lab test all came back normal, TSH was within normal range and the antibodies were undetectable. Naturally, she felt vindicated and was overjoyed.

This doesn’t happen with everyone, but this was a perfect example of a case that illustrates this point.

Here’s a post I wrote that goes into the adrenal thyroid connection in much greater detail.

Pearl #5. Remission is Our Mission,

But It’s Impossible If You Don’t Go All In

I think my last important observation is one that I had to learn myself the hard way. I struggled for years before I was diagnosed with Hashimoto’s.

Largely because I didn’t really know what was happening, I kept making excuses for not fully committing to what I have now come to call the Hashimoto’s lifestyle.

Once I got diagnosed and got obsessed with learning about this disease and seeing the damage it can cause in people’s bodies, I started to realize what was at stake and went all in.

After that, things really started to turn around for me in a big way. And I have seen the exact same thing in many, many people I have worked with.

Those that aren’t successful in getting this under control are usually the ones who are unwilling to give up certain things in their lives in order to save their health.

These include stressful jobs and relationships that are repeatedly causing flare ups of their condition. Foods like gluten, dairy and soy that are in virtually every processed and fast food. (You can’t eat like the average American if you have Hashimoto’s, you just can’t).

In addition, you really need to understand that this becomes a systemic problem over time. It progresses into other systems of the body and these can include the liver, the stomach, the gall bladder, the intestines, the cardiovascular system, the brain and nervous system, the muscles and joints and more.

And sometimes you need to go through every system and evaluate it and fix what’s not working.

So you have to go all in. You have adopt a lifestyle that includes diet, includes eliminating triggers like stress and toxic (chemical and emotional) situations.

You know, I was the co-owner of large and lucrative medical practice which it took me 2 years to close. I was so stressed out running that place that it totally fired up my autoimmunity.

I am now a couple of years into an entirely new life and this life is richer, happier and it has far less stress in it.

Plus, I really love what I do. Honestly, I believe that my higher power has a plan for me and that is to help people with Hashimoto’s.

That’s why I’ve gone all in and have devoted both my personal and professional life to bringing hope, help and healing to people who suffer from Hashimoto’s.

Odds And Ends

These were some interesting observations I have made:

1. More than 80% of the people I worked with had Mono and were exposed to the Epstein Barr Virus.

Clearly this virus is somehow involved in Hashimoto’s. How? The research is far from definitive. Theories include activation of NF Kappa Beta, activation of rouge B cells and proteins like IL-8.

This is an area I intend to explore in much greater depth this year.

2. The most common symptom is fatigue.

Of all the many potential symptoms of Hashimoto’s fatigue is by far Public Enemy #1. And fatigue is often brain based which means it is the result of neurodegeneration caused by hypothyroidism and autoimmunity in the brain. Read more about this here.

3. The disease is progressive. My teacher and mentor, Dr. Datis Kharrazian and others have identified 3 stages. Read this post to learn more about this.

4. Many people have more than one autoimmune disease or at the very least antibodies to other tissues.

One of the most common places for these additional antibodies is to brain tissue, especially cerebellar tissue.

A lot of people don’t understand this and they just dismiss cognitive issues as “aging”. Well, with Hashimoto’s your brain is at serious risk of degenerating rapidly. This is something that really needs to be taken seriously.

Read this post to learn more.

Well, that’s all for now. I can’t wait to see what this next year will bring!

And if you’re not aware of it, I offer a free 30 minute Hashimoto’s Healing Discovery Session. In it you can share your story with me. Tell me where you are and where you want to be.

I’ll make some recommendations that I think will help right away and we can discuss how else I might be able to help.

I set aside time every week to talk with people who have Hashimoto’s and I’d love to talk to you.

You can schedule a free session by clicking here.

About the Author Marc Ryan

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