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Thyroid Dysfunction: Upskill and Identify with Tara Nelson

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Thyroid Dysfunction: Upskill and Identify with Tara Nelson

How often are you encountering patients with an undiagnosed thyroid condition?

As the probability of both male and female patients with thyroid disorders continues to rise, so too does our need to upskill in this area of practice. Today we are joined by naturopath, Tara Nelson,  who shares us with what led her into specialising in thyroid health. Now, in addition to helping patients navigate these waters, Tara also teaches health professionals how to better identify pathology and contributors to thyroid dysfunction, what the red flags are and how to craft a multi-layered patient-centric approach to restore patient health. 

Covered in this episode

[00:47] Welcoming Tara Nelson
[06:40] The downside of protocols
[09:41] Testing for thyroid abnormalities
[13:28] Increasing prevalence of thyroid conditions
[16:07] Stress and thyroid conditions
[19:52] “Coping” with thyroid dysfunction
[21:38] How partners can help
[24:13] Assessment of thyroid patients
[30:18] Red flags
[33:48] Endocrine disruptors and the connection to thyroid disorders
[38:05] Dietary considerations for thyroid patients
[42:30] Helping families support thyroid patients
[44:48] Supplementation and herbal remedies
[49:03] Closing remarks

   


Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line today is Tara Nelson, who's a West Australian-based naturopath with over 24 years of clinical experience. After many years of seeing primarily thyroid conditions in her clinic, Tara went into researching for herself and further education in order to improve her clinical outcomes in her complex thyroid patients.

Tara has developed a six-week online practitioner thyroid training program to further educate practitioners in thyroid health, including a thyroid recovery program. Tara has completed extra studies in the AIP dietary and lifestyle approach, which she utilises with many of her thyroid and other autoimmune patients.

Tara is on a mission to bring awareness and education to the public and practitioner community alike, about the importance of thyroid health on a deeper level. Welcome to FX Medicine, Tara. How are you?

Tara: I'm really well. Thank you, Andrew. Thanks for having me here.

Andrew: Now, I've got to ask, how did your thyroid niche come about?

Tara: Well, I think it actually chose me. So, after nearly sort of 24 years in practice, I was kind of looking for my next move so-to-speak. Even though I was still very passionate about my industry and absolutely love what I do, there's so many more pathways for naturopaths these days.

And I was just presented, probably around about five years ago, an alarming rate of thyroid cases in clinic. You know, like a whole day of just thyroid patients alone. Or just when I'm going through the history of these women taking out their...Taking thyroxine. And asking them about their thyroxine.

And many of them had been on it for many years. They had no idea if they had an autoimmune thyroid condition or what their original diagnosis was. They'd just sort of been told to take this medication for the rest of your life, no questions aree asked, or any routine testing, and definitely no antibodies ever tested for some of them. Or if tested once for their diagnosis, never ever tested again.

So, and a lot of them didn't realise that actually the symptoms or the presentation they were coming to see me for was actually due to their thyroid imbalance. But a lot of them think, just because they're taking thyroxine that that's dealing with their thyroid. "No, my thyroid is fine. I'm taking thyroxine, so it can't be the thyroid causing the symptoms."

So, you know, I was seeing a lot of more and more thyroid cases in clinic, and I had some really complex cases. So, children born without a thyroid. I had a young man, a 29-year-old man with a TSH of 229. And he hadn't even been offered thyroxine.

So, he came to me with his blood pathology tests, and I'm looking at a TSH of 229 thinking, "What's anyone doing for you? Have you had an ultrasound?" And then, seeing a lot of people with antibodies in the thousands, and on thyroxine and no other treatment. So, I was noticing all the different and varied presentations of thyroid dysfunction. And I felt really inadequate treating these people. I didn't see too many thyroid cases in my first five years of practice. Then I sold my practice and went on to have children. And then after that, I didn't see a lot of thyroid and then all of a sudden, I'm just whacked with just... it was just so many cases, and these tricky cases in clinic.

And I also found during this time that the protocols and treatments that I'd learned about treating the thyroid in my naturopathic training, and also in the current textbooks that I was referring to, just, it wasn't cutting it. They were pretty straightforward and linear. As in “this is hypothyroidism. This is hyperthyroidism. This is Hashimoto's, this Graves' disease, and this is how you treat it.”

But I was seeing all these different presentations in-between, that weren't classic textbook cases. I found it confusing, and the protocols just don't address the underlying causes. And I really feel that some naturopathic protocols were, and are still, just as bad as the medical approach of just take this one-size-fits-all pill. As in, many of the generic thyroid formulas around at the moment are protocols that they still offer practitioners today.

So I went back into study. I sort of started immersing myself in everything thyroid I could get my hands on. I read all the books. I started focusing all my CPE points on purely thyroid, endocrine, auto-immune, you know, anything I could get my hands on to try and help these people as best I could and learn how to treat these people.

And I realised that there was so much more to thyroid physiology than what I was taught in my original training. And I believe the same still stands today. Because after writing and running the first round of my thyroid training program for practitioners, you know I have quite a lot of experienced practitioners do my course, and the outstanding feedback was that this information is just not taught in naturopathic training.

Andrew: So often we hear this.

Tara: Yeah, that's right. You know, thyroid physiology is complex. It's multi-layered. It is a chronic illness, and once it's set in, it's extremely debilitating. You know, I see a lot of women that just feel misunderstood, misrepresented. Just because it's not, you know... it's an illness that you can still kind of function because we're women and we have to... it’s mostly women, sort of, dysfunction or disease, whatever you want to call it. And it really deserves the same approach to treatment. And I just don't think that's happening.

Andrew: I think, seriously, part of the issue, as you say, is indeed the word 'protocol.' When people get stuck in a fixed way of doing things, and like, I wish we could do away with the term protocol…

Tara: I agree.

Andrew: …but guideline, sure. Options, sure. Therapeutic considerations, absolutely. 

Tara: Yeah.

Andrew: But protocol is a non-thinking approach.

Tara: No, and I think our training has to change. I think we don't delve into treatment plans and diseases or dysfunctions in the body enough. We sort of generalise and then there's this treatment protocol at the end. And I think a lot of young practitioners come out with these protocols. And I know I did it when I first came out, all I had was my protocols. And it's not until you actually start experiencing these clients that you realise that those protocols are quite inadequate.

And I remember one thing I used to do is when a client would ring up and book in, I'd ask them what was going on and give me a little bit of a rundown. And then I go away, and I'd scram through my protocols and write everything down and feel, "Right, yep, I've got it covered." They'd sit down and open their mouth and I just throw that protocol out the door, go, "That person is a person sitting in front of me, that protocol is not going to work."

Andrew: This is the thing that I love learning from all of the experts that we have on FX Medicine, is they treat the person. 

Tara: Yes.

Andrew: And the person is never a textbook, not ever. 

Tara: Never.

Andrew: But one thing worried me, what you said. And that was that, for instance, you had a guy with this massive TSH level that wasn't even medically offered a drug therapy.

Tara: That's surprising. I'll never forget him. That was my highest TSH, and I was just flabbergasted that, who is your GP and why have they not offered any treatment? I mean, that's not a sub-clinical hyperthyroid that you kind of watch and wait for three months.

Andrew: No. No way is that sub-clinical.

Tara: No antibodies tested. So we went and got him some, you know, we got full thyroid function, full thyroid panel, we had an ultrasound. And yeah, he was in full-blown Hashimoto's. And amazing though, I think that's the thing with thyroid, that sometimes they're all different. Sometimes there isn't... some people are very, very debilitated and have, you know, hundreds of symptoms and others actually don't have too much at all. And yet on pathology, you think they shouldn't be able to get off the ground.

So it comes in so many types of different presentations. And that's what I originally found so confusing. When I started to see not just the standard run-of-the-mill textbook case, I started seeing so many different presentations on paper, in a clinical picture that I felt it needed more study.

And I really believe too that, I think we as naturopaths need to specialise and become really good at what we love treating because then we can really help deal with these people and these conditions a lot more effectively, than seeing this wide range of conditions where we are expected to know so much about everything.

Andrew: There was another point that I was just wondering about, and that was, you mentioned this guy with a massive TSH. So it was obviously a clinical situation. 

Tara: Yes.

Andrew: But conversely, with disorders like Hashimoto's, the patient can present with euthyroid and you don't really get a picture of what's going on until you look at the antibodies, until you look at what's being destroyed.

Tara: Absolutely. Exactly. And we're going to get to that. But, yes, I see that all the time, Andrew. People coming in, mostly women again, when I ask about their thyroid, "Oh my thyroid's fine. It's been tested, it's fine. I'm told it's fine." And then we actually look at it. And I've seen so many very normal, naturopathically normal, you know, 1.5 or 1.7 TSH with high antibodies. 

Andrew: Yeah.

Tara: But yet that will never get picked up because of the medical protocol of "we wait till that TSH gets really high, above the reference range or below and we sit on that for about three months to see if that goes back to normal before we actually go that next step."

And all my patients, I've worked with some wonderful GPs, I'm very lucky, but that's taken 20 years to get to that point. But I've worked with some wonderful integrated GP that we share patient care with, and she will test every time. I just send it straight to her. She gets a full thyroid panel among other testing and an ultrasound and we get, you know, find out exactly what's going on to these people, which is what needs to happen.

Andrew: So this is one of the conundrums that we face, and that is how do we test? There are many instances where a GP has to have clinical suspicion. And if they're not aware of this, you know, what can go on with, for instance, Hashimoto's and what can be the relevance of the antibodies. Indeed, I've seen the denial of the antibodies. So it really requires the upskilling of GPs to become aware of disease processes.

Tara: Yeah, absolutely. I totally agree with you. And I would love it to be my mission to somehow educate GPs, endocrinologists are exactly the same. And I've recently had a conversation my integrative GP that I work with, is wonderful, is actually very, very busy and is not taking on new patients anymore.

So I've actually aligned with another one, and I was talking to her the other day, and asking if she'd do all this testing for me, and she said, "Oh, well, but antibodies aren't clinically relevant." And I just said, "Well, you know, I'll send you some studies to show you that yes, they are clinically relevant. And if you do not treat the autoimmune component of a thyroid condition, that person is not going to get better and they're going to need more and more reliance on thyroxine and high dose.” So she was really great. She's prepared to work with me with that, which is really lucky but it's just very frustrating.

Andrew: If you don't treat the autoimmune component you're just waiting basically for something to become pathological for which you then have to either oblate the thyroid or you're beholden to supplementation for the rest of your life because you have a poorly functioning thyroid.

Tara: Yes. That’s right. And one really big point here, Andrew, is that autoimmunity is the number one cause of thyroid conditions in the body.

Andrew: Yeah.

Tara: The number one leading cause. So I mean, we're all about addressing the root causes. You have to address the root causes in any thyroid condition. And if autoimmunity, that's where it starts for many people. It's the immune system that starts attacking the thyroid tissue that starts affecting the pathology and the thyroid function. So unless you treat that underlying cause, again, you're not going to get anywhere.

Andrew: So why? Why are we seeing such an explosion of thyroid conditions?

Tara: Yeah, that's what I was asking myself when I just started seeing all these conditions in clinic, it was crazy.

Well, I think the three main reasons we'll get to, but thyroid hormone production, you know, really is a very complex system. So there's actually five steps to thyroid hormone production. It's a very complex interplay. There's things like toxins, deficiencies, a lack of ATP, all affect that complex interplay.

You know, we've got the sodium iodide supporter suppression that happens, which is very nutrient-dependent. You know, we need glutathione, we need selenium, toxins blocks thyroid hormone production. The whole endocrine system affects each other. So we've got to look to the other endocrine organs to find out the cause. You know, the adrenals, if there's stress going on, and it can be many different stressors. If there's insulin or hormonal gonadal problems, they're going to affect thyroid function. 

So they're just some of the sort of reasons. Thyroid function actually decreases after the age 30. The receptor sites decrease the thyroid hormones. And so the prevalence increases with age. We're all ageing. So we're going to get that higher prevalence with age. And they're just so many ways that thyroid function can be affected. But I think the three main reasons are; You know, number one has to be environmental toxicity. 

Andrew: Right.

Tara: That there's so many toxins in our environment these days we're exposed to. The thyroid is extremely sensitive to any chemical, it's a very vascular gland as all endocrine glands. It's an environmental-sensing gland. So in times of toxic stress, the thyroids will slow down, or speed up depending on what's going on.

So, you know, the water, the chlorine and the fluoride which are in most water systems are halogens that are on the same level of the periodic table as iodine. So these, because of their larger size or molecular weight actually block iodine uptake. And especially if the thyroid gland is depleting iodine. So, we need to really make sure that we have iodine repletion rather than depletion. It's a really important one to test. Because we basically need iodine to make thyroid hormone.

But we're just exposed to a plethora of toxicants and these toxicants are all endocrine disruptors, thyroid is a part of the endocrine system. And those toxicants directly interfere with thyroid hormone production. But that's definitely number one.

Andrew: We live in the 21st century and stress is the scourge of modern day life. Is this one of the major reasons why we're seeing such an increase in thyroid issues?

Tara: Yes, absolutely. So, number one was, I think, we're not even putting these in order. But when I look at the three main reasons why we're seeing more and more thyroid conditions, environmental toxicity is one and I think the next one is that HPA dysfunction. We do, as you said, live in a world these days of constant sympathetic nervous system dominance.

The adrenals are part of that whole endocrine system, including the thyroid, and they're involved in hormone production, including the stress hormones. You know, those little adrenals are like the batteries of the body. They help us to recover from disease and illnesses, and we really need good adrenal function to help heal the thyroid.

So when the thyroid's in a really dysfunctional exhausted state and it can't produce its hormones, the adrenals do...We do need to have good adrenal function to support them. But if we are constantly experiencing ongoing stress, dizziness, being on all the time 24/7 and your adrenals are just fatigued, then that's going to affect the thyroid.

And let's also talk about, we're not only talking about physiological stress, or psyche sorry, we're not only talking about psychological stress here, we're talking about other types of stress on the body that will stress the adrenal side as well like nutritional deficiencies, leaky gut, food intolerances, toxins again, infections, over-exercising, poor sleep.

So it's not only psychological, all those other things going on in the body will affect the adrenals, and then the adrenals are not there to support the thyroid. You know, we can't digest food under stress. We need our digestion for the absorbed nutrients to supply the immune system and the thyroid with those optimal nutrients it needs.

Andrew: And of course, this is when we're talking about sympathetic nervous activation, right?

Tara: Yes, yes. And it's just switched on all the time. So, I actually find that this is a-typical thyroid woman. She is that, you know, I'm her, I've got Hashimoto's as well. But we are this, it’s the busy woman scenario. And I just see so many women who are constantly busy, don't stop, don't rest or take time out for themselves. And I can almost pick them in clinic. They're very characteristic and they just become burnt out. And then the thyroid just can't keep up. It ends up slowing down as a physiological process to actually try to bring homeostasis to the body.

And then we take medication. So we're given thyroxine to actually keep us going, to give us energy, to keep our metabolism going. Rather than actually listening to the body when we're fatigued and to slow down and rest.

Over-exercising is another one which I think I've mentioned. And you know, that high cortisol blocks that conversion of T4 to T3. So it's shunted off to reverse T3 which is inactive, and then that reverse T3 competes with T3 at cellular levels, and you're just not getting that good active T3 into the cell.

You know, throw in some COMT or MAO genes where you can’t... so you've got that ongoing sympathetic dominance. You've got adrenaline, noradrenaline, cortisol. And that stress response just lasts 24/7 for these people and they can't sleep because they just can't break down those stress hormones.

You know, high stress creates hypoxia in the body and we know that we need good oxygen and ATP for thyroid hormone production. So it's just a very complex interplay, that whole HPA dysfunction affecting thyroid function.

Andrew: Do you know of anybody that's looked at why some women are able to cope? Their resilience is such that they flow on through these extremely stressful periods in their life, childbirth, early childhood rearing, looking after a family, looking after a husband. 

Tara: Yeah.

Andrew: All of these sacrifices that women make and plod on through, particularly when they're under the weather you know, and they just soldier on. But some women are able to cope, and some women aren't. Some women get a clinical picture developing.

Tara: Are they really able to cope, Andrew? I'm not so sure. 

Andrew: Ah, okay.

Tara: So, I'm seeing them ending up after years of that. We cope as women because we have to. We cope as women because there's no one else to look after the children. That's our role. It's inbred in us that we just have to get up, get on with it. No matter how bad we're feeling, how poorly, how exhausted, we have to get on. There's no one else.

But I tell you, I see the women in clinic after years of this, and even the women, it's interesting you say that, you know, I have seen women when I was a young mum, you know, I had three kids in four years, and that's a whole other reason I think why my thyroid condition developed. But I remember looking at some women thinking, "How can you run two businesses and have three kids, and I'm absolutely exhausted?" But in the end, I've seen their dysfunction come in over maybe 10 years later.

Andrew: Right. 

Tara: They end up in my clinic or in someone else's clinic. They're overweight, because the high cortisol, the inflammation, the stress, or they've got a thyroid condition.

So it will be catch up with them eventually. Maybe there's some... for some it doesn't happen, but I think that's a very small percentage. And I can't tell you why. What they've got that we don't have?

Andrew: What can partners do to alleviate some of this chronic stressor to their system? Obviously, there's things like, you know, lift your game and cook, and do some of the housework. Males are notorious for leaving this to women and it's not fair.

Tara: No. I think it's just the stereotypical, you know what I see a lot in my area is FIFO workers. A lot of young moms and moving down to this beautiful area that I live in because it's a lifestyle change from, say, the city. They don't have parents or in-laws around. They're on their own. And then the partner gets a job FIFO, so working on the mines. So they're alone with small babies and you know, babies get, and young children get sick a lot. And they just, they do it all on their own. So in that case, it's really hard. We're actually setting up a network for these young mums in this area to sort of get a network of people.

So they go home with a bit of a pack, with some numbers that they can call if they need help with some... setting up some women in menopause, women who retired that want to do that sort of thing and help these younger women. 

Andrew: Oh, that’s great.

Tara: Because... yeah. So I think we need to develop more. And I think men are doing as much as they can. Sure, they need to lift the game, but I think it's also a lack of community for these women, a lack of communal support.

Andrew: Yes. Yep.

Tara: And that's where I think we need to draw on more support groups, especially in that case of FIFO. And when they don't have family or other support, we need to be able to draw on community. Because when I ask these women in clinic, “When do you get a break? When are you able to it?” They say, “well, there's no one here and all my friends have babies.” So, it's hard.

Andrew: FIFO, fly-in fly-out.

Tara: Fly-in fly-out. So they're away for three weeks sometimes at a time. Yeah.

Andrew: Yep.

Tara: So it's really big where I live. And it's a three-hour drive to a major airport. So it's a lot of travel for these people as well. But I see a lot of young mums struggling in that area. So I think we need to really support them on a community level and have platforms where they can reach out to when they need that support.

Andrew: I think that's absolutely awesome. Because so often we forget about the basis, forgive me, the basics. And that is, it starts with community. It starts with lifestyle and diet and interconnection and things like that. These supplements that so many practitioners rely on is the last thing that we should be thinking about.

Tara: Yes, I agree.

Andrew: I love what you're doing. That's awesome,

Tara: I totally agree. Oh, that's cool. Thank you.

Andrew: So when you're considering these issues, what do you see as the most important issues to consider when assessing their thyroid needs?

Tara: Yeah. There are so many and this is what I really teach to my praccies in my training course. That, there's all these little things that are often not taught, but they're really important.

So I think number one is that we do have different reference ranges for babies, children and teens for TSH, T4, and T3. And you really need to be aware of those to assess these subsets in clinic.

So, when a baby's first born, they have actually quite a high TSH, and T4 and T3. And that begins to decline after about the first month after birth. So there will be different reference ranges for TSH, T4, and T3, up to around 15 to 18 years of age, sometimes around 15, it stabilises but for some others it takes about till they're 18 to come on to adult reference ranges. 

Andrew: Okay.

Tara: But that's something really, really important to know.

Andrew: And so, with the babies, is that because they're still being influenced by their maternal thyroid, do I say the word, habituation?

Tara: Yes. It's actually...

Andrew: What about breast milk? What about things like that?

Tara: Yeah, it's actually a pituitary... so, as the brain develops so it's that pituitary, frontal cortex development that actually influences the thyroid. So it's still that development that goes on, especially in the early or younger years that's influencing the thyroid hormone.

Andrew: And what about reference ranges for thyroid antibodies?

Tara: Yeah. They're pretty much atypical for the same for across the board. It's mainly just the TSH, T4, and T3, but antibodies are pretty much the same. I sort of really considered antibodies, anything above sort of 20, you know, some sort of thoughts are there should be some antibodies there. Others say no there shouldn't be antibodies, I haven't quite worked that one out yet. But anything above 20, definitely above 50 I'm looking at what's going on.

Andrew: Okay, and what other sorts of things do you look at assessing with thyroid patients?

Tara: Something else to consider is, and I see this a lot in clinic, is something like cellular hypothyroidism. So, when we see, you have the patient sitting in front of you that you're thinking, "Oh, you know, they have all these thyroid symptoms." You're pretty sure that they have got hyper or hypothyroidism.

And then you have them tested. You do the full thyroid panel and their tests come back absolutely perfect, in range, in, let's call it 'naturopathic ranges.' And this sometimes... but they still have all these symptoms and we need to consider that this could be cellular hypothyroidism.

And what happens here is that we do have a normal thyroid and pituitary functioning, but the thyroid hormone can't get into cells. So, we see this normal TSH, normal T4, T3 but we're seeing hypothyroid symptoms. A big cause of this is that chronic stress and high cortisol, where that increased cortisol affects the conversion of our T4 to T3. And that T3 gets, sorry that T4 gets shunted again to reverse T3 and competes with T3 at the receptor site. So the T3 is not getting into the cell, and we start to see thyroid symptoms, but it's not yet reflecting on our pathology. And this can be the start of a thyroid condition in some cases.

So we just really need to find the cause. Is it psychological stress? Is it nutritional deficiencies? Is it infection? And rather than sort of going in and treating the thyroid, we treat all these underlying causes and usually, it can resolve, the symptoms will resolve.

I think it's also important to be on alert for not so common symptoms. So, paraesthesias, carpal tunnel, fibromyalgia, there's so many symptoms because thyroid hormone is needed by every cell and tissue in the body, so we really need to look at the clinical picture plus pathology. I really try to stress getting an ultrasound as well because even autoimmunity can be diagnosed through ultrasound, even if there's no antibodies present on pathology.

Andrew: Right. Is that normally a later stage or…?

Tara: Yeah. Well, it can be...I haven't really worked out what's going on there but I've read a lot of research actually about this tissue damages in the thyroid that would normally look like the immune system has been attacking the thyroid tissue.

Andrew: Got you.

Tara: So they often diagnose that as a Hashimoto's. But sometimes the antibodies aren't reflected in the pathology, which is really interesting.

Andrew: Right. Do you ever find, when you've got normal levels of T4, T3, indeed, even lower antibodies that your rT3 is shunted up. Because it's sort of a pigeon if you like...sorry, a canary in the coal mine?

Tara: Yeah, definitely. 

Andrew: Okay.

Tara: I do like to definitely test for reverse T3 especially if your treatment's not working sometimes, test reverse T3 because everything could just be going off. You can increase that T4 all you like, they can take all the thyroxine in the world, and that's sort of a bit of a red flag we'll get to. But if someone's taking really quite adequate levels of thyroxine yet they're still having a lot of symptoms you need to find that underlying cause because say stress or whatever it is, can be causing that T4, that thyroxine to go straight to reverse T3. 

Andrew: Right.

Tara: So they're not getting that T3 into the cell.

Andrew: Now, we've mentioned stress as one of the causes of high reverse T3, but there's some heavy metals. Is that mercury?

Tara: Yes. Heavy metals can do that, yes, all toxins and sometimes infections, nutritional deficiencies, particularly selenium and zinc. So, yeah it just requires a really thorough investigation.

Andrew: Okay. You mentioned red flags before. Let's go into some of these.

Tara: So I think one really interesting one I find a red flag is low iron. So women that have had low iron all their life, perhaps they've needed two to four transfusions but when they say, "I just can't keep my iron levels up," that's a red flag.

So iron is needed for the TPO enzyme, and it’s a rate limiting step for thyroid hormone production. You can't make thyroid hormone without adequate iron. It's a really, really important nutrient for the thyroid. And how many patients do we see in clinic with low iron? I see them all the time. 

Andrew: Yeah.

Tara: With ferritin below...Well, I would say inadequate ferritin is anything from probably 35 down. So I'm really aiming to get that ferritin level up to around between 50 and 80.

Andrew: Okay. What else? What other things do we need to be aware of?

Tara: Your family history of thyroid conditions. So always check the family history, it does have a strong genetic line there. So if you've got mum, aunties, cousins, grandmothers with thyroid condition, you'll always hear that grandma had something. Or thyroidectomy is very common in that sort of age group, so always check your family history.

Women who, you know, you constantly get those women in clinic who say, have all the symptoms but they've been told over and over... I've had so many women and this is what really spurred me on to help these women more and more. Is that, you know, they're sure it's their thyroid. They've been to that many doctors over, and over, and over, and every doctor says, "Your thyroid’s fine."

And I'll tell you what, when you make that diagnosis that they've known all their life because you've done this full thyroid panel, and their antibodies, and even an ultrasound, they come and hug you because they've known all their life that they have a thyroid condition, and yet they're told over and over and over that it's not their thyroid.

So never discount these women, always really support them, and think about cellular hypothyroidism as well, because that could be the thing to them.

Andrew: Yeah.

Tara: And the other one is just women in all their hormonal stages of life. And I think too, to these women, it's often overlooked and taken for something else.

So, I'm seeing more and more pubescent girls and boys. Now, while puberty won't affect actual the levels... I've done a bit of research with, when I was looking at different reference ranges for kids, puberty doesn't actually affect overall their reference ranges, but it can trigger a thyroid condition.

And you know, often I think a lot of our teens, they're thrown out as, they're tired, they're withdrawn, they can be anxious, they can put on weight. Well, they're a teen, that's 'normal.' Always, again, get your teens tested because I'm seeing more and more teens these days with a thyroid condition. 

Women who postpartum who have postnatal depression or have had consecutive pregnancies, that's another red flag. And also, menopausal women who, again, will go to their doctor and say, "I'm putting on all this weight, I can't...you know, I'm eating nothing. I'm exercising, I'm depressed." "Oh, well, you’re going through menopause." Again, get their thyroid tested because there's all those subsets of women going through their hormonal stages of life that can actually trigger a thyroid condition. So, yeah, be on the lookout for that.

Andrew: You know, it's really interesting, I've seen pathology reports very commonly look at, even in men, and they'll say thyroid test, but they never ever look at antibodies. 

Tara: No.

Andrew: And we're missing this whole subset of patients. But including men and this is something that really interests me.

Tara: Yes, yes.

Andrew: Women I see, is it because we're concentrating on them? I don't know. But I see that women are by far the highest sufferers of thyroid disorders. 

Tara: Yes.

Andrew: What’s going on with the men that suffer with thyroid disorders?

Tara: I'll just answer about the women. So we've got those hormonal stages. I think we are...number two, we are the more stressed. You know, we're busier. So, I say this in my thyroid webinars and things. That, you know, if you look at men and women, and this, okay, I'm being a little bit stereotypical here, but men get up, they go to the toilet, sit on the toilet for about 20 minutes, half an hour while the woman is up making breakfast, putting a load of washing on, putting a load of washing on the line, getting the kids ready, da da da.... The man grabs his lunch and walks out the door. He really sort of thinks about one sort of, I know I'm being very typical here, sorry, guys. And the woman will do 20 million things.

So we are I think the busier sex. Plus, we have all those hormonal fluctuations. The other thing is that, look at what a woman puts on her body. Again, the male jumps in the shower, barely use soap or maybe a bit of soap, washes his hair. A woman puts so many different chemicals on her body every single day from the top of her...

Andrew: Yep. And afterwards.

Tara: And afterwards. So they are the three reasons why women are more prone to thyroid conditions and autoimmune conditions.

Men…look, I don’t, I actually see more hyperthyroidism and Graves' disease in men. I think genetics, there's a strong genetic line for men. But again, I think all those things apply just as all those root causes, are stress, adrenals, infections, toxicity, genes, we have to take everything into consideration. And if that man has leaky gut, and if he's really A type driven personality, he's got a high profile job, if he works in a city and it's polluted, you know there’s all those different triggers, which I think apply for men. 

Andrew: Yeah.

Tara: And it's just it's usually two or three or four that will tip his thyroid over the edge.

Andrew: You make a really good point about what women put on their bodies to make themselves you know, appealing and attractive, and all that sort of thing. I mean, that stuff that's in makeup is atrocious.

Tara: Atrocious. It's from their shampoos, to their makeup, to their moisturiser, to their deodorant, to their nail varnish, I mean, it's, oh, just incredible what we do. And when you actually point, and perfume, they spray the perfume every day over their neck, which is where their thyroid is. And it's just soaked up by that little vascular tissue.

Andrew: You were mentioning endocrine disruptors earlier on. 

Tara: Sure.

Andrew: And even with things like tampons, where they're soaked in chemicals and things like that, so you can now get organic tampons. 

Tara: Yeah.

Andrew: I just think there really needs to be this big shift towards better quality makeup with less toxicants, I don't know about no toxicants. And even...

Tara: And there are. There are so many amazing, beautiful products around these days, and it's just changing one thing at a time.

So that's the reason I did develop the thyroid recovery program for my patients. Because we get the patient in, we're getting them testing, they come back. We're sort of micromanaging symptoms, we're working out what's going on. But I wasn't getting to those root causes, like really educating them about how they can minimise their toxic exposure, one product at a time.

So that's why I wrote that program so they could learn how to do that. How they can manage their stress and all the different ways. Because, yeah, it's such a complex system, and there are so many drivers that you really need to address to really get through that dysfunction and really heal and support that thyroid. You really need to address all those things. You have to get all the ducks in the row. It can't just be one thing, like you said, just giving the thyroid supplement. It's so not about that.

Andrew: Okay, so, what else can we do to support our thyroid patients? What about diet?

Tara: Yeah, so I think number one is that we really need to look at it, is it a thyroid gland problem? Are we looking at true hypo or hyperthyroidism, or one of the autoimmune conditions, or is it just a thyroid responding to other metabolic processes?

So if there is quite a bit of stress, infection, low iron, poor gut health, just sometimes treating that or those things can actually, and rather than going and treating the thyroid, can actually give that thyroid a bit of a rest. 

Andrew: Yep.

Tara: It doesn't have to work so hard to bring balance, so, that's all. I've created many thyroid condition just by supporting the adrenals and putting some lifestyle practices in. Getting them to stop, rest, reset and support their adrenals, their thyroid settles right down. So really need to work out, is it a true hyperthyroid problem or is it the thyroid reacting something else? 

But yeah, different treatments and procedures will definitely depend on where the thyroid's at, and we do need to find root causes and start there. But I'd definitely start with diet.

So, generally, I'm looking at gluten-free, dairy-free food intolerances. If we're sort of generally looking at getting that person back into balance ,we’re looking at hyper or hypo, I do utilise the AIP diet quite a lot, particularly if those antibodies are really high or they have leaky gut pretty badly.

So, I did do some study with the Wellness Institute in America with Mickey Trescott and Sarah Ballantyne and became an autoimmune certified coach practitioner. And I found that diet invaluable in really supporting these patients.

Andrew: What is the AIP?

Tara: So the Auto-Immune Paleo diet is a whole system and protocol that aims to switch the immune system off.

So when the immune system, for whatever reason, begins to start attacking its own body tissue, the AIP, and it's not just all about the diet. The AIP protocol helps to settle all the inflammation and bring balance to the body so the immune system can go back into regulating properly.

And when I…you know, I had a lot of clients coming in either on the AIP or had heard about and read about it, and I did know about the diet a bit. But I really wanted to understand the science behind the diet. And the science sort of uses...There is all these little compounds in food that manipulate normal pathways in the gut to... and they enter through different pathways ,they’re very tricky, that stimulate the immune system.

So things like glutenins, prolamins, saponins, and that these little compounds in food can damage epithelial cells, they can open the tight junctions of the gut, they feed dysbiosis and may be digestive inhibitors. So, on the AIP diet, we eliminate all these foods that could possibly contain these compounds, and it is all about healing leaky gut and settling down the inflammation and the immune reactivity. Because every person with an autoimmune condition will have leaky gut whether they've got overt symptoms or not. 

And it's not only about the diet, it's a lifestyle. So, just as much as we're healing leaky gut, stopping that immune reactivity, we are working on things such as sleep, stress, and movement. And if the diet is all about, because if you think about the immune system, it's a really, really nutrient-dense system. It needs a lot of high-quality nutrients. And while removing foods that contain these compounds where the AIP diet focus on very nutrient-dense foods such as offal, fungi, really good quality organic or grass-fed meat, high-fat seafood, seaweeds, and a lot of vegetables as well.

Andrew: Now, seaweeds was very interesting. We've got to think about the quality of the seaweed there, obviously, because there's been some...

Tara: I think we need to think about…yeah, we have to think about the quality of everything we put in our mouth. It's not just the seaweed, but I do agree. Yes, some of the seaweeds can be quite contaminated, so you've got to really source some clean seaweed for sure.

Andrew: You mentioned community support earlier on. What about family support when you've got the woman really struggling. I shouldn't be stereotypical myself, mainly the woman, but I've known, been speaking with Cindy Kennedy about her husband who's got Hashimoto's. So, family support for the partner who has the thyroid issue. So do you engage in helping the families become aware about the issues with the patient?

Tara: Yeah. I do find that a lot of these, you know, male or female in clinic because, like I said they still... they can feel really, really tired and exhausted, fatigued, they still get up and walk around and can go to their jobs and do what they can do, most of them. And because there's no sort of, they don't look ill, we look the same, a lot of people sort of think, "Well, how can you...you shouldn't be complaining because you look fine. 

Andrew: Yeah, you look fine.

Tara: You’re doing all the things." But these people often, it's a really debilitating, especially Hashimoto's and Graves' disease, it's very, very debilitating. So, family awareness, sometimes getting the whole family into the clinic and talking about supporting each other and where everyone can help. Or just talking to that person.

But I mainly see women I have to say that I'm normally getting those women to, "Okay, how old are the kids? What can they do to help you? Can they fold some clothes or getting a food roster up, or bulk cooking when you're actually feeling good, do a great big batch cooking so you've got lots of meals in the freezer…

Andrew: Great idea.

Tara: …or getting a cleaner.” Or whatever they can to support themselves because these people need rest. They've got to rest. Yes, they still need to work, they still need to carry on. But it is all my programs really encourage rest and restoration. I'm getting people off overexercising. I'm getting them into more restorative movement. I'm getting them sleeping. I'm getting them to meditate if I can, or just lie flat on the floor for 10, 20 minutes a day. Whatever they can do, the thyroid is this little, it just wants to bring homeostasis to the body, and it’s this tiny little gland that works so hard, but when it goes into dysfunction, it needs rest and restoration to come back into balance.

Andrew: When we're talking about the last things that we really should be considering, and that is supplementation. There's been some issues presented with extraordinarily high doses of iodine previously. And conversely, there's various herbs that can be very useful in helping Graves' disease or indeed in helping Hashimoto's or hypothyroid patients.

What tend to be your, I'm not going to use favourite, but 'go-to' sort of things? And are there any caveats there that we need to be aware of with regards to dosing or testing like with iodine?

Tara: Well, I test for everything. I'm a really big believer in testing first. So, I will test for things like iron, vitamin D, zinc, B12. You know, I really want to make sure, and really looking at my dosages, so I'm going to get them up to the optimal levels of those reference ranges. So in nutrients, we want optimal ranges, sorry, optimal levels. And then I'll sort of retest in about three months to make sure we're on track, and we're getting somewhere. 

Andrew: Got you.

Tara: With the iodine, you know, I think we, because we're still sort of, there's two different views. There's the more cautious view that I tend to take or there's the high dose kind of view.

I definitely sort of stick to the more cautious path, because I just really think, even though I've done a lot of research on this, I do think that we're still not 100% there. Iodine deficiency as much as iodine excess can cause hyperthyroid problems. 

Andrew: Yes.

Tara: It’s a very fine balance that we need to find. So I recommend the fasting, first morning void urinary iodine. So they're not taking the loading and taking a big 50 milligrams of that. I find that adequate especially if they do it fasting with creatinine corrected, I’m getting a really good baseline. Especially for pregnant women, I think iodine is hugely important for managing any pregnant women, let alone your hyperthyroid or thyroid pregnant woman, they need a lot of extra support.

So, yeah, we test and then we aim to get them up to around about 150-200 micrograms on pathology as well. 

Andrew: Yeah.

Tara: So I'm testing, getting them up because we know that the adequacy for the iodine. So things like vitamin D, iron is really important, selenium, zinc, tyrosine, B12 are kind of like my 'go-to's' for treatment.

And just depending on...and then treating underlying causes. So, definitely nutritional deficiencies, making sure that thyroid, that immune system if you're treating autoimmunity has optimal levels to support everything going on. And then, depending on what's going on, treating the underlying causes.

Andrew: And what about things like bugleweed for instance, Lycopus virginicus, which is used with hyperthyroidism to bring it down safely. And herbs like say, Hemidesmus for autoimmune issues and Iris versicolor for an iodine type or a thyroid nourishing. Do you tend to favour these or you're very cautious about the use of herbs?

Tara: Oh, no. I love my herbs. I'm a herbalist at heart. So, I'm definitely making... all my thyroid patients, so pretty much every thyroid patient will get some sort of herbal. And again, it'll just be employing those thyroid herbs, my beautiful Hemidesmus, Rehmannia.

Andrew: Ahh, Rehmannia, of course.

Tara: Rehmannia, sort of autoimmune, Vitamin D is very important, vitamin D adequacy and selenium for antibodies as well are really important. And then we've got our beautiful immune modulation. So depending on, yeah, so it could be the lemon balm or the motherwort in hyper and then we've got things like, yeah, like you said, the Bladder wrack, Bacopa, I really like Nigella, it's a really nice.

Andrew: Ah, nice.

Tara: So just it really depends what's going on. In fact, yes. I'm looking up all of my beautiful herbs on my shelf right now. Yes, I do definitely make up the herbal formula and yeah, bring that in.

Andrew: I do love and I really acknowledge what you're doing about supporting your patients from the ground up. And that is right from community, I think that's something we really need to listen to. And I got to thank you for taking us through this today, Tara, because you've really opened my eyes to some deficiencies in what I have been thinking of as adequate support, you've really taken it to the next level. Well done to you.

Tara: Well, thanks, Andrew. It's something that I'm very passionate about, definitely treating thyroid conditions. And I think, yes, as I said, it's a complex system and there's so many different presentations and it really requires an integrated complex approach.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.


 


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FX Medicine Podcast
FX Medicine is at the forefront of ensuring functional and integrative medicine gains the recognition it deserves and ultimately establishes itself as an integral part of standard medical practice. Hosted by Andrew Whitfield-Cook, our podcasts are designed to promote research and evidence-based therapeutic practises, acting as a progressive force for change and improvement in patient health and wellbeing.