Vibrant Thyroid Vibrant Health

Vibrant Thyroid Vibrant Health
The Questions and Answers You and Your Doctor Need to Know to Finally Detect and
Properly Treat Your Thyroid Problem
Table of Contents
Vibrant Thyroid Vibrant Health

The Questions and Answers Youand Your Doctor Need to Know to Finally
Detect and Properly Treat Your Thyroid Problem
Whos writing this book?
Why this book?
Do I have a thyroid problemand why should

I care?
Am I suffering from thyroid issues?
Why should I be concerned about a thyroid disorder?
If my thyroid tests are normal, does that mean Im okay?
How do your patients feel when they first come in?
Can I rely on conventional medical treatment to diagnose and treat my
thyroid issues?
Can I rely on alternative practitioners or other functional M.D.s to
diagnose and treat my thyroid issues?
What is the most accurate way to diagnose and monitor thyroid
disorders?
What will this book do for me?
How will I feel when my thyroid has improved?
Part I. My Doctor Says I Should Be FineBut

Im Not. Whats Going On?
What is the thyroid?
What exactly does my thyroid do?
How do I feel when my thyroid is working well?
What are the different types of thyroid disease?
I dont think Im getting the right treatment. Whats going wrong?
Why might conventional tests miss my thyroid problem?
How do most conventional M.D.s diagnose thyroid issues?
2 Vibrant
Table of Thyroid
ContentsVibrant Health
Whats wrong with relying so heavily upon the TSH and T4 tests?
Why is my condition harder to diagnose the longer it goes on?
What are some common scenarios of thyroid imbalance?
What if my thyroid disorder is an autoimmune condition?
How do functional and holistic practitioners test for thyroid disorders?
Part II. H
ow Do You Test for Thyroid
Disordersand Why Do You Think
Your Way Is Better?
How do you test for thyroid disorders?
Why do you think the TRH Stimulation Test gives you the best
diagnoses?
Why doesnt everybody use the TRH test?
How did you come to start using this unusual test?
Part III. What Do My Test Results Mean?

If I was given the TSH test, what do the numbers mean?
What about my T4? What do those numbers mean?
What else could I have tested, and what numbers should I be looking
for?
If I cant trust the TSH and I dont have access to the TRH, how do I
know whether I have a thyroid problem?
Part IV. Whats the Best Way to Treat Thyroid

Disorder?
Why is it so hard to treat thyroid issues correctly?
What are some of the other challenges in treating thyroid
dysfunction?
What types of thyroid hormone might be prescribedand what is
your opinion of each?
My current doctor has prescribed me thyroid hormone, but I still dont
feel at my best. Whats going wrong?
kellmancenter.com 3
Part V. What Kind of Results Can I Expect from
You?
What can I expect in the short term?
What can I expect in the mid-term?
What can I expect in the long term?
What are your goals for all of your thyroid patients?
What are some examples of patients how have benefited from your
treatment?
Part VI. How can I find out more?
How Can I Make an Appointment?

How Can I buy Supplements?
My Final Message to You.
4 Part VI.
Table of Contents
How can I find out more?
Whos Writing This Book?
My name is Raphael Kellman, M.D., an internist in private practice in
Manhattan, where each year I treat thousands of patients with a wide range of
health conditionsincluding thyroid issues.
I understand your frustration with not feeling well and not getting better.
I share your desire to get to the root cause of the problem. My greatest
pleasure comes from helping others reclaim their health and vibrance to lead
happier more fulfilled lives.
As one of the early pioneers in functional medicine, my approach has
evolved to incorporate cutting-edge technology, the latest advances in natural
medicine, and the science of how nature heals.
Like any good stew, my training in the philosophy of science and my years
of experience as an M.D. have blended together over time. Each and every
person I have had the privilege to work with- patients like you- have been
the key ingredients fueling my work and enabling me to take holistic and
functional medicine in new directions with personalized care in mind.
As a result, I can offer you unique and powerful treatments for both thyroid
issues and other disorderstreatments that can transform your healthand
your life.
Thyroid: A New Epidemic

20 million Americans have some degree of thyroid disorder-
the majority of whom are women.
More than 12 percent of U.S. residents will suffer from a
thyroid problem at some point during their lifetime.
With the new diagnostic criteria some experts recommend,
the percentage of U.S. residents with a thyroid disorder
could be as a high as 20 percent or more.
Up to 60 percent of people with thyroid dysfunction do not
even realize they have a thyroid problem.
kellmancenter.com 5
The sad fact is that conventional approaches to
thyroid treatment simply do not work for many
patients.
Why This Book?

For the past twenty years, thyroid treatment has been one of my passions
and specialties. I have watched with dismay as poorly treated thyroid
conditions have created a veritable U.S. epidemic, especially among women
over forty.
The sad fact is that conventional approaches to thyroid treatment simply
do not work for a staggering number of patients. Conventional testing turns
up only a fraction of those whose thyroid is malfunctioning. And conventional
treatment helps only some of those who test positive for thyroid issues.
You might think Im exaggerating, but I assure you, Im not. Far too many
people are falling through the cracks of modern medicine leaving them
without a diagnosis or without adequate management of their condition.
The result is that millions of Americans are suffering from a host of painful
symptomsand theyre being told that the problem is all in their head! This
does not serve the patient and is unacceptable, especially when more effective
testing and treatments are available.
There is good news however. My own type of treatmenta functional,
holistic, innovative, and personalized approachsucceeds to not only treat
thyroid disorders correctly but also diagnose them when standard testing and
care has failed.
My approach relies upon restoring optimal function to the thyroid and
the gut so as to achieve optimal hormonal balance and digestive function. I
work with diet, supplements, probiotics, and bioidentical hormonesa type
of lab-created hormone that is as close as possible to the form in which the
hormone occurs in our own bodies. If the thyroid dysfunction is created by
an autoimmune condition, as many are, I address the autoimmune issue as
well. This natural approach is also highly scientific, based in the deepest
understanding of the human body and the latest discoveries in cutting-edge
research.
With this treatment, thousands of my patients have regained their
energy, their vitality, and their glow. They have gotten their metabolisms
back on track. They have reversed the typical thyroid symptoms of thinning
hair, lifeless skin, fatigue, and weight gain. They have resolved seemingly
unrelated symptoms, including insomnia, anxiety, depression, decreased
libido, and loss of sexual function.
6 Why This Book?

Most important, they feel as though they have finally reclaimed their lives.
The whole time that I was struggling with thyroid, it was as though Id turned
into someone else, more than one patient has told me. Finally, I feel like
myself again.
I want you to enjoy this state of vibrant, glowing healthand I know that
you can. If you suspect that your thyroid is out of whackif you wonder why
you just cant lose weightif youre tired of always feeling tiredread on.
In this e-book you will find your questions, your answers, and, I hope, your
solutions.
Most people who suffer from thyroid disorders

arent properly diagnosed. Most people who are
diagnosed arent properly treated.
kellmancenter.com 7
Do I Have a Thyroid Problemand Why
Should I Care?
You might very well be suffering from a thyroid

imbalanceeven if your physician tells you that
your thyroid is normal.
Am I Suffering from Thyroid Issues?

Of course, to know for sure, you need to be tested. But lets start with a list
of typical thyroid symptoms. Note that sometimes the symptoms contradict
each otherthat is, weight loss and weight gain can both be symptoms of
thyroid dysfunction.
So, does any of this sound like you?
You keep gaining weight that you just cant lose.
You retain water.
You feel tired way too much of the time.
Your hair is getting thinner or maybe even falling out.
Your libidoyour sex driveis low.
Youre struggling with PMS and/or severe menstrual cramps.
You are having trouble getting or staying pregnant.
Youre having a difficult perimenopause or menopause: hot
flashes, insomnia, brain fog, menstrual issues.
Youre often constipatedthat is, you move your bowels less than
once a day. (I know most people dont consider that constipation
but it is, and it could be a sign of an underlying thyroid problem.)
Your muscles and/or joints ache.
Your skin is dry.
Your nails are brittle.
You get cold easily or have trouble warming up. (Intolerance to
cold is the technical term.)
You cant fall asleep, or perhaps you cant stay asleep, or perhaps
your sleep simply isnt restful.
8 Do I Have a Thyroid Problemand Why Should I Care?

You suffer from brain fog: difficulty with concentration or
focus.
Youre having memory issues: senior moments, forgetfulness,
memory gaps.
You struggle with depression.
You suffer from anxiety.
You get heart palpitations.
You frequently get infections.
You feel a tingling or numbness in your hands or feet.
You feel like youre getting old before your time.
You are losing too much weight. (Yes, I know I said weight gain
earlier, but sometimes thyroid imbalance works the opposite way
also.)
You feel dizzy.
You have a ringing in the ears.
Thyroid dysfunction also creates a number of serious disorders. Do you
suffering from any of the following?:
gastrointestinal reflux disorder (GERD)a form of heartburn or
indigestion
stress-induced ulcers
insulin resistance and diabetes
high cholesterol
hypertension
heart disease
autoimmune issues
chronic fatigue syndrome
fibroids
tinnitus (ringing in the ears)
ADD/ADHD
gall bladder disease
If you are suffering from any of these symptoms or disordersand especially
if you are struggling with more than oneyou might very well be suffering
from a thyroid imbalance. This is a strong possibility even if your physician
tells you that your thyroid is normal.
kellmancenter.com 9
Thyroid conditions are one of the most severely under diagnosed problems
in the United States. If you are familiar with the symptoms and disorders I just
listed, I urge you to keep reading. The problem could very well be with your
thyroid.
Thyroid conditions are one of the most severely

under diagnosed problems in the United States.
Why Should I Be Concerned About a Thyroid Disorder?

Over the past twenty years, U.S. rates of thyroid disease have reached
epidemic proportions. Whether hypothyroidism (insufficient thyroid production)
or hyperthyroidism (excessive thyroid production), disorders of the thyroid
affect millions of Americansand the numbers keep on growing.
Now, you might be wondering, why should that concern you?
The answer is simpleand disturbing. Because the thyroid can affect so
many organs and systems in your body, thyroid disorders can have a profound
effect on your overall health. When your thyroid is functioning poorly, the rest
of your body suffers. You struggle with a wide variety of symptoms, you set
yourself up for many disorders, and you generally feel off.
Poorly functioning thyroid can also lead to heart diseasea little-known
fact, but true. It can increase your risk of developing cancer, especially breast
cancer. It can set you up for dementia and lead to cognitive decline as well as
other types of neurological dysfunction.
Even before such disorders develop, however, an imbalanced thyroid can
make your life miserable. You feel wired, or exhausted, or foggy, or hyper,
or just not yourself. You cant seem to lose weight. You dont know where
your energy went. You cant understand why your brain isnt working right.
Ive seen it in patient after patient: A poorly functioning thyroid can virtually
destroy your quality of life.
When your thyroid is functioning poorly, the rest of

your body suffers.

Hidden Dangers: Is Your Thyroid Imbalance
Producing These Conditions?
Weight gain
Premature aging
Insomnia
Fatigue
Indigestion and/or reflux
Stress-induced ulcers
Challenging PMS, menstrual, or menopause symptoms
Lower sex drive or sexual function
Memory loss
Brain fog
Depression
Anxiety
Ive seen it in patient after patient: A poorly

functioning thyroid can destroy your quality of life.
If My Thyroid Tests Are Normal, Does That Mean Im Okay?

Sadly, no.
Even though were in the midst of an epidemic, the thyroid test that
virtually all conventional doctors usea test for the hormones TSH and T4
frequently fails to detect a problem.
Later on, Ill explain what that test is, why it works so poorly, and why I
use a different test that works much, better. Now, I just want to assure you:
Your conventional M.D. might tell you that your thyroid tests are normal
and yet you still may have a thyroid problem.
Youre not going crazy.
Theyre just using an ineffective test.
You might test normal and yet still have a thyroid

problem.
kellmancenter.com 11
How Do Your Patients Feel When They First Come In?
I feel like Im going crazy.
My doctor says Im just getting older.
My doctor says Im just going through menopause.
My doctor says Im just depressed.
My doctor says Im gaining weight because Im eating more than
I realize.
I feel like Im aging right before my very eyes.
My metabolism has just gone completely out of whack.
I feel like my mind just doesnt work right any more.
Am I getting early-onset Alzheimers? Because thats what it
feels like.
I just cant concentrate.
I just cant think straight.
Im tired all the time.
Somethings wrongbut I dont know what it is.
Everything keeps changing, and I dont know what to expect
next.
Its like some alien is taking over my body.
I know something is wrongbut nobody can tell me what.
Its bad enough going through this. Its even worse not knowing
what it is.
Can I Rely on Conventional Medical Treatment to Diagnose and Treat

My Thyroid Issues?
In my opinion, no, you cant.
When it comes to thyroid issues, there are many reasons that conventional
medical treatment falls short. Here are the most important:
Not enough people get tested for thyroid issues.
Even when you are tested, the tests dont pick up a significant
portion of the disorders.
Even with conventional medical treatment, your symptoms might
persist.

Instead of treating the underlying causes so as to support the
thyroid and help it to function better, conventional doctors often
just medicate the symptoms.
If you have an autoimmune condition, again, conventional
doctors are likely to medicate the symptoms without treating the
underlying disorder.
Most conventional doctors dont look at patients individually.
Instead, they compare them to a standard range: where are your
thyroid numbers supposed to be? Your numbers might fall within
the normal range yet still be too low or too high for you. Thats
why your doctor believes that youre finewhile you know that
you are really suffering.
Even when you are tested, the tests dont pick up a

significant portion of the disorders.
Can I Rely on Alternative Practitioners or Other Functional M.D.s to

Diagnose and Treat My Thyroid Issues?
Well, thats a harder question to answer. I am more optimistic but not all of
them may be adequately equipped for the job.
Many alternative practitioners-naturopaths, acupuncturists, and
nutritionists do have some success treating thyroid disorders. So have other
functional M.D.s. Very often they rely, as I do on nutrition, supplementation,
probiotics and bioidentical hormones as the cornerstone of their approach.
These methods add up to much more comprehensive care and better outcomes
for the patient than conventional medical treatments.
Unfortunately however, even many of these practitioners rely on the
limited ability of standardized testing to both diagnose and monitor treatment
progress. There may be other problems as well and depending on your
particular condition, they might not be able to give you all the help you need.
Non-medical alternative practitioners cannot do medical testing,
so they dont have the most accurate numbers to diagnose you and
guide your treatment.
Functional medicine doctors do medical testingbut very few
are familiar with the most accurate testing method.
Most practitioners tend to treat the thyroid without fully
understanding the many mechanisms of how thyroid disorders
develop.
Specifically, most providers dont fully understand how
environmental toxins disrupt the thyroid signaling system. (Dont
worry, youll learn all about those concepts later onwhich
means that you will know more than many medical doctors!)
Most practitioners dont understand the many

mechanisms of how thyroid disorders develop.
SoWhat is the Most Accurate Way to Diagnose and Monitor Thyroid

Conditions and why is it better?
I know its hard to believe that conventional medicine is so likely to
be ineffective when it comes to diagnosing and treating thyroid issues.
Unfortunately, its trueand, as weve seen, some holistic and alternative
practitioners arent much better.
Why not? Because they arent using the right test. And without the right
test, its nearly impossible to make a correct, complete diagnosis.
The best available test for understanding thyroid issues is known as the
TRH test, which is short for the thyrotropin-releasing test. Again, youll learn
more about this in Part II. For now, let me just say that this test provides the
most complex, fine-tuned, and accurate portrait of your thyroid status that is
currently available. Consequently, Im able to develop a truly personalized
treatment geared precisely to your own body.
Every one of us is different, and we each have our own optimal level of
thyroid hormone. My goal is to determine the thyroid hormone level that
is best for you, and then to make sure you have all the support you need to
maintain that level.
Over the years, Ive learned that to truly practice personalized medicine,
I have to become a kind of detective. Ive learned the footprints left by
different types of damagewhats caused by poor nutrition, by stress, by
toxic exposure. Ive learned how to listen to each patient, how to analyze
each constellation of symptoms, how to connect the dots to come up with an
accurate diagnosis and treatment.
Most practitioners consider only the thyroid, but I cast a wider net: I also
look at hypothalamus and pituitary. Most practitioners look only at thyroid
hormone levels in the blood, but I also look at thyroid levels in the bodys
tissues. For example, a person can have completely normal levels of thyroid
hormone in the blood, but have a deficiency in the brain, possibly resulting in
brain fog, memory problems, or even dementia.

Because thyroid issues are so complex, you need extensive testingand
you need a practitioner who knows how to put the clues together and to read
between the lines. Although I believe deeply in the science of medicine,
sometimes healing is more of an art: a matter of intuition as well as evidence.
If you have a thyroid issue, the problem is not just

in your head. The problem is real. Luckily, so are
the solutions.
What Will This Book Do for Me?

Aha, the most important question of all!
First, let me tell you what this book wont do. It wont tell you that youre
making it all up, that nothing is really wrong, that everything is fine and the
problem is all in your head. Whatever else you read in these pages, youre not
going to hear that from me!
So what will you get? Youll get the answer to these six questions:
I. My Doctor Says I Should Be FineBut Im Not. Whats
Going On?
II. How Do You Test for Thyroid DisordersAnd Why Do
You Think Your Way Is better?
III. What Do My Test Results Mean?
IV. Whats the Best Way to Treat Thyroid Disorder
V. What Kind of Results Can I Expect from You?
VI. How Can I Find Out More?
Youll also meet some of my patients whose lives have been transformed
by this new approach to thyroidand youll see how your life, too, can be
transformed.
This book will help you understand what is

happening to you, and why.
How will I feel when my thyroid has improved?

I wish I could bring you into my office and introduce you to some of the
patients I have treated. Ive seen patients who have been suffering for five, ten,
even twenty years, going from doctor to doctor, only to be told, Youre fine!
Everything is normal. They go home, discouraged, confused, and knowing
that something is still not right.
So the first thing they feel when they come to me is relief. Because I believe
themand I offer the tests that actually discover what the problem really is. I
dont just treat themI treat them accurately, with the right dose and the right
combination of medications.
At the same time, Im searching for what caused the problem in the first
place. Are they eating foods that trigger inflammationan immune-system
response that can often have problematic effects for digestion, the thyroid,
and many other systems? Are they struggling with a toxic burden caused by
the industrial chemicals and heavy metals lurking in our food, our water, and
our environment? Are they overwhelmed with stress? Are they not getting
enough sleep? Do they need support for their digestion? Do they need support
for their grief, their anger, or their hunger for something more meaningful?
Whatever the root causes of their distress, Im looking at those as well as
at their thyroid. Together, we work on both the root cause and the immediate
symptoms, creating both short- and long-term relief.
With proper treatment patients lives turn around and they get their health
back. Many feel better than they ever felt. Often they have been struggling
with thyroid and related disorders since childhood. Now, finally, their brains
function the way brains are supposed to. Their weight problems disappear. At
long last, they dont have to stay on a constant diet or obsess about the scale.
Typically, they feel really wellfull of energy and vibrant, glowing health.
I cant say for sure what will happen for you. But if your problem is caused by
an imbalanced thyroid, I can help you. And you can look forward to a whole
new world of health and energy.
Sound good? Then lets get started! I cant wait for you to enjoy the many
benefits of a healthy thyroid.

What Is Inflammation?
Inflammation is an immune-system response that plays an
important role in thyroid dysfunction and in the autoimmune
conditions that often produce thyroid dysfunction. Inflammation
both causes and results from thyroid and autoimmune disorders,
creating a vicious cycle that can make you feel sicker and sicker.
Luckily, when inflammation subsides, your health vastly
improves. Your symptoms disappear and your risk for chronic
disease falls significantly. Your thyroid and autoimmune
conditions also improve. Instead of being locked into a vicious
downward spiral, your health takes a healthy upward leap.
So how exactly does inflammation work? When your body
encounters an infection or injury, your immune system responds
with chemicals intended to destroy the invader and heal the
affected area. Unfortunately, this healing response can also have
some negative effects. The key signs of inflammation are heat,
swelling, redness, and pain, each of which is a side effect of the
healing biochemicals.
When you face a short-term disorder, inflammation is
generally acute. It arises in response to a specific problem and
subsides when that problem is gone.
A long-term disorder, however, creates chronic
inflammationand thats where the real problems start. Low-
grade chronic inflammation creates several symptoms, including
weight gain, acne and other skin problems, headache, indigestion,
fatigue, brain fog, anxiety, and depression. It can also provoke
more serious disorders, such as obesity, diabetes, heart disease,
cancer, autoimmune conditionsand thyroid dysfunction.
Significantly, inflammation can both create and result
from thyroid dysfunction. Studies have shown that low levels
of thyroid hormone are associated with various markers for
inflammation. Autoimmune conditions, which are responsible for
a large percentage of thyroid problems, are also associated with
inflammation. (For more on autoimmunity, see page 42, 59.)
Because inflammation underlies both thyroid dysfunction
and autoimmune disorders, a key component of my treatment is
to bring down inflammation. I do this through diet, supplements,
and lifestyle changes, including support for healthy sleep,
recommendations for exercise, help with detoxification, and
support for stress relief.
When your thyroid is finally balanced, you can look
forward to a whole new world of health and energy.

Part I: My Doctor Says I Should Be FineBut
Im Not. Whats Going On?
Just about every patient who comes to me for thyroid issues has been
through the mill. They know theres something wrong with their bodies
even if they dont specifically know they have a thyroid problem. They
feel exhausted. Theyre gaining weight. They cant think clearly. Theyre
frequently depressed. They just feel off.
And yet, time and time again, theyre either tested and found normal, or
theyre told that their current dose of thyroid hormone should do the trick.
Whats going on? Why are conventional physiciansand even some
holistic practitionersfailing so badly to treat thyroid problems?
Simple question, complex answers. So lets start at the beginning, with a
quick understanding of the thyroid itself.
What Is the Thyroid?

Your thyroid is a gland shaped something like a butterfly. It sits at the front
of your neckright below your Adams apple, if you have one, and right in
front of your windpipe.
Like all glands, the thyroid secretes hormones: biochemicals that help
to regulate the activity of your cells and/or organs. Your thyroid hormones
are governed by the thyroid signaling system, a network so complex that it
makes a computer motherboard look like a childs toy telephone. This system
organizes communication between your hypothalamus, pituitary, thyroid,
liver, blood, and cells, all with one overriding goal: to get the right amount of
thyroid hormone into every single one of your cells.
So heres the first challenge faced by you and your physician: this isnt a
simple problem. You show up with symptoms, and you need reliefbut the
source of your problem could be in any one of several components of this
system, or in the relationships between one or more components, or in various
outside influences on the system, such as stress, problematic foods, exposure
to environmental toxins, and many other possible factors.
Its not easy to diagnose whats going wrong and to come up with the exact
right fine-tuned treatment that will truly solve the problem. Unfortunately,
many physicians never even come closebecause theyre not working with
the right tools.
Most physicians never even come close to an
effective diagnosis and treatmentbecause theyre
not working with the right tools.
What exactly does my thyroid do?

Thyroid hormones regulate the energy production and metabolism of
every cell in your body. Having the right amount is critical to good health.
As a result, imbalances in your thyroid gland can manifest in many different
ways depending on which tissues are affected. Thats why a malfunctioning
thyroid can create such big problems.
Which Organs and Systems Does My Thyroid

Affect?
Your brain: depression, memory issues, brain fog
Your gastrointestinal (GI) system: constipation, leaky gut
(see page 22)
Your heart: risk of cardiovascular disease
Your immune system: more susceptible to illness and
autoimmune conditions
Your liver: prevents efficient detox
Your metabolism: creates unhealthy weight gain or weight
loss
Your muscles: aches, pains, weakness
Your sexuality: lower libido (sex drive), imbalanced sex
hormones (estrogen, progesterone, testosterone)
EVERY SYSTEM IS AFFECTED!
20 Part I: My Doctor Says I Should Be FineBut Im Not. Whats Going On?

Every activity you take throughout the day is fueled
by your thyroid.
Every activity you take throughout the day is fueled by your thyroid:
getting out of bed, walking into the bathroom, focusing on an assignment
at work, making dinner in the evening. Thyroid gives you the ability to
concentrate on a task. It fuels your sense of energy, your get up and go. It
also powers your libidoyour sex driveso if you havent felt in the mood
lately, poor thyroid might very well be to blame. If youve been feeling listless,
apathetic, bored, or detachedas though you were watching your life rather
than living itpoor thyroid might be the culprit.
The thyroid is also crucial to the function of your immune system. If youve
been getting a lot of colds, if you keep coming down with the flu, if you
generally feel weak and fragile, again, that might be thyroid.
Last but not least, low thyroid can also be at the root of leaky gut, a
condition in which the lining of your gut wall isnt strong and secure. As a
result, tiny particles of partially digested food leak through your gut wall into
your bloodstream, where it provokes a low-gradeand very destructive
immune system response.
What Is Leaky Gut?
Leaky gut is a gastrointestinal condition that creates a whole
host of problems. It can be caused by poor thyroid functionand
it can disrupt thyroid function. By the time most of my patients
come to see me, they have both poor thyroid function and leaky
gut, in a vicious circle that leads to weight gain, fatigue, frequent
colds and flu, skin problems, anxiety and depression, brain fog,
and a whole host of other symptoms. As a result, I usually treat
poor thyroid function and leaky gut at the same time.
Leaky gut occurs when the tight junctions that hold together
the cells of your gut wall begin to loosen. This loosening can
happen as the result of stress, microbial imbalances, poor diet,
immune activation and exposure to toxins in air, food, water, and
common household products. Additionally, it can also occur as
the result of low levels of thyroid hormone. Your body needs
thyroid hormone to maintain the integrity of those tight junctions.
When the tight junctions loosen, your cell walls become
permeable. Partially digested particles of food leak through
your gut to encounter your immune system, most of which is
located just on the other side of your gut wall. Your immune
system fails to recognize this undigested food and begins to
create inflammation, an immune system response designed to
kill toxic invaders (for more on inflammation, see page 17). As a
result, your immune system treats many common foods as toxic
invaders and overreacts every time you eat them.
Dairy products, gluten (a protein found in many grains and
baked goods), soy, and eggs are some of the most common foods
to trigger these reactions, which is why diet is an important part
of my treatment for both thyroid problems and leaky gut. For
both types of disorders, it helps to avoid reactive foods, take
gut-healing supplements, and replenish the microbiome, the
community of friendly bacteria that lives in your gut. Healing
leaky gut is a top priority in my treatment because doing so goes
a long way toward restoring proper thyroid function.

How do I feel when my thyroid is working well?
You find it easier to maintain a healthy weight.
Your energy is strong: you feel balanced and energetic, neither
tired nor wired.
Your memory is good.
Your mental focus is sharp.
You glow with health.
When your thyroid is working well, you feel

energized and sharp, with a good memory and a
healthy weight.
What are the different types of thyroid disease?

Hypothyroidism occurs when your thyroid fails to produce enough
thyroid hormone. As a result, all of the bodys processes slow
down. Hypothyroidism is the most common form of thyroid
dysfunction, affecting an estimated 3 million people each year.
Hashimotos thyroiditis is an autoimmune
disease in which the immune system produces
autoantibodies that attack and destroy healthy
thyroid tissue. As the thyroid gland is damaged, it
looses its ability to produce enough hormone.
Hashimotos the most common cause of low thyroid today.
Common Symptoms of Hypothyroidism
Constipation
Cold sensitivity
Depression
Dry skin
Fatigue
Heart rate slowing
Menstrual issues
Swelling of the thyroid gland, known as goiter
Weight gain or difficulty losing weight
Remember, there might be others. These are just the most common.
Hyperthyroidism occurs when the thyroid produces too much

hormone. As a result, all of the bodys processes speed up.
Graves disease is the most common cause of
hyperthyroidism and like Hashimotos, it is also an
autoimmune condition. Here, the immune system
creates antibodies called TSI that attach to thyroid
cells stimulating them to overproduce hormone.
This overstimulation can cause the thyroid to swell
resulting in a goiter.

What are the most common symptoms of
hyperthyroidism?
Anxiety or nervousness
Excessive sweating
Fatigue
Frequent bowel movements
Goiter
Hand tremors
Heart palpitations or rapid heartbeat
Menstrual periods lighter than usual or missed altogether
Mood swings
Muscle weakness
Skin dryness
Sleep problems
Extremely rapid weight loss, including overnight
Remember, there might be others. These are just the most common.
Can I have both hypo and hyperthyroidism at the same time?

Some people do have a mixed picture appearing to suffer from
both conditions as the thyroid fluctuates wildly from under- to
overperforming. They may have symptoms from both conditions.
People who suffer from Hashimotos Thyroiditis often experience
symptoms of both hypothyroidism and hyperthyroidism. As
damage occurs to the thyroid, large amounts of hormone leak into
the body causing symptoms of too much thyroid hormone. As the
hormone depletes, patients then begin suffering with symptoms of
low thyroid. Over time the thyroid often deteriorates until patients
are finally diagnosed-usually in a low thyroid state.
In some cases of Graves disease, antibodies can actually block
thyroid hormone production creating a state of low thyroid. In
others Graves may trigger Hashimotos. Patients will experience a
fluctuation in symptoms creating a confusing clinical picture.
Thyroid problems can be hard to diagnose because
many of the symptoms resemble other disorders,
or just feeling stressed or under par. Thats
why the proper testing is so important.
I dont think Im getting the right treatment. Whats going wrong?

If youve been tested for thyroid problems and you are still having
symptoms, there are four possibilities:
1. You really dont have a thyroid condition, and your symptoms

are being caused by something else.
If your doctor has tested you for thyroid and found no dysfunction,
its possible that you really dont have thyroid dysfunction. You might
be reacting to a problematic food, an environmental toxin, a digestive
issue, lack of sleep, excessive stress, or some other disorder entirely.
However, since the thyroid interacts so profoundly with so many of your
bodys systems, you might also have some thyroid dysfunction, whether
as the cause or as the result of your other symptoms. Whenever you
arent functioning at your healthiest level, your body experiences that
as a stress, and responds with stress hormones. Over time, the wrong
level of stress hormonesespecially the hormone known as cortisol
can disrupt normal thyroid function, over and above whatever other
problems you might be having. And if you do have suboptimal thyroid
function, conventional tests wont necessarily pick it up.
2. You do have a thyroid condition, but your doctor doesnt

believe it, because the tests he or she is using read normal.
Now, how is this possible? Why, after testing you, would a conventional
physician say you were fine when you werent?
This is a very complex question, which Ill answer in a lot more detail
below. For now, Ill just say that the test that most doctors usewhich
focuses on just a single reading of the hormones known as TSH and
T4is simply not fine-tuned enough to pick up many thyroid problems.
To make matters worse, what is considered normal range for the
conventional test may not be normal for you. A test result thats just fine
for somebody else might indicate a huge problem for youbut because
your doctor is going by the numbers and not by you, the patient, he or
she may decide that youre fine when you really arent.

3. Your doctor has diagnosed a thyroid issue and prescribed
thyroid supplementbut its not the right dose.
The standard treatment for thyroid issues is to supplement with thyroid
hormone. You may be one of the millions of U.S. residents who have
been diagnosed and treated in this way.
However, because of the inadequate testing I just told you about, your
test results might not lead your doctor to prescribe you the correct dose.
As a result, you are being under-treated, and your symptoms dont
completely disappearor, perhaps, they dont get better at all. Even
though youre taking thyroid medication, youre still tired, rundown,
overweight, foggyonly now your doctor insists that the problem must
be depression, stress, or the aging process, because all the numbers
indicate that it cant be thyroid.
It can, though, and it often is. When I correct my patients dosages to
what they truly need, they start getting better almost immediately, and
within a few weeks, they feel terrific. Im happy for their recovery
and sad for the months, years, or decades they wasted on the wrong
treatment.
Another problem is that there are many different types of thyroid
supplements, and not all of them work the same way. Getting the right
dose isnt just a matter of how much thyroid supplement you takeits
also a matter of which kind. Youll learn more about that in Part IV.
4. Your doctor has given you the correct diagnosis and

prescriptionbut your body is unable to use it properly.
Remember when I told you how complicated the thyroid signaling
system was? There are many ways that the signals can get messed up
along the way, preventing your body from getting the thyroid hormone
you need:
Your cells or your liver arent properly converting
T4the less active form of thyroid hormoneinto
T3, the more active kind.
Your body may be converting too much T4 into
another type of thyroid hormone, Reverse T3,
which is inactive.
Maybe your cells have become resistantthat is,
maybe they have difficulty responding to thyroid
hormone.
There could also be what I call a local problem
one specific type of tissue that has trouble
responding to the thyroid hormone. For example,
there is some evidence that autism, Alzheimers,
and other types of dementia are at least partly due
to the brains difficulties in responding to thyroid
hormone. Youll learn more about all that below,
too.
There are ways to treat all of these problems but again and unfortunately,
most conventional doctors arent even aware of the problems, let alone
their solutions. Even most specialists focus on medicating symptoms,
not on healing the underlying cause.
Misdiagnosis and mistreatment of thyroid problems

is very common. Often, you are misdiagnosed as
normal or you are prescribed the wrong dose
or the wrong type of thyroid supplement.
Why might conventional tests miss my thyroid problem?

There are many reasons, and well run through them all. But for the answers
to make sense, you first need to understand some of the key components of the
thyroid signaling system. These arent even all the componentsbut they are
the ones that will help you understand most quickly why conventional thyroid
testing is so inadequate.
Parts of the Thyroid Signaling System
T3 (triiodothyronine). This is the more active form of thyroid
hormonethe form that actually works in cells to regulate their
metabolism. Some of it is made by your thyroid. Most of it is
converted from another thyroid hormone known as T4.
T4 (thyroxine). This is the less active form of thyroid hormone and
the majority of what is produced. It must be converted in cells to
T3 by enzymes called deiodinases. Their job is to remove one of
the 4 iodine molecules leaving 3 which is where we get the names
T4 and T3. T4 was once thought to be completely inactive but we
now know it is involved with brain function and works in cell
membranes. Once it is converted to T3, all cells can use it.
It is crucial to have exactly the right amounts of T3 at all times. Too little,
and you become sluggish, exhausted, overweight, and depressed. Too much,
and you become anxious, wired, underweight, and shaky. To ensure the exact

right amounts of T3, your body has all sorts of backup mechanisms and
intricate feedback loops.
Thats the good news. The bad news is that in a complex system, there are
lots of places where something can go wrong. This complexity is what makes
thyroid problems so difficult to diagnose and treat.
T4 is the less active form of thyroid hormone. Your

body must convert it into the more active form, T3.
Thyroid Binding Globulin (TBG). This is a protein that binds to

the thyroid hormone and transports it through your bloodstream,
so that it can reach every single cell in the body. Bound thyroid
hormone cannot have any effect. Only free thyroid hormone has
an impact on your body.
This is another one of your bodys elegant precautions. It wants to be sure
that there is a lot of thyroid hormone ready and waiting in your bloodstream
so that you have a steady, uninterrupted supply of energy. But it doesnt want
to overload the system with too much active thyroid, which might make you
burn too hot and too fast, speeding up your heart and causing you to drop a lot
of weight all at once. You want bound inactive hormone ready so that when
you need it, you can convert it into free and active hormone.
The system works beautifullyunless the ratio between bound and free
hormone becomes imbalanced. Then you get problems. So, because some
hormone is bound and some free, we have some new measurements to test:
Total T3 is the total amount of T3 hormone in your
system, both bound (inactive) and free (active).
Free T3 is the amount of free T3. Thats the
hormone that actually affects your body, so if these
levels are either too low or too high, you are likely
to have problems, regardless of what your other
numbers say.
Total T4 likewise is the total amount of T4
hormone in your body, both bound and free.
Free T4 is the amount of free T4 that can either do
work or enter cells to be converted to T3.
TSH (thyroid stimulating hormone). This is technically not a
thyroid hormone at all because its made by the pituitary, a pea-
sized gland at the base of your brain. The pituitary monitors blood
levels of thyroid hormone. When it perceives that levels are too
low, it releases TSH to stimulate your thyroids production of
more hormone. In this way high levels of TSH correspond to low
thyroid output. This is yet another system that works amazingly
wellunless something goes wrong.
Reverse T3. Your pituitary doesnt have to do all the work
of regulating thyroid levels. The liver helps, too. Remember
how your liver converts some of the T4, the less active thyroid
hormone, into the more active form of T3? Well, if youve already
got too much T3or if your signaling system thinks you have
too much T3your liver will convert T4 into another inactive
hormone known as reverse T3. Your liver also switches to Reverse
T3 production when it believes your body needs to conserve
energysay, if there is a food shortage or unusually stressful
demands upon the body. Well take a closer look at Reverse T3
later on.
What are the Key Components of the Thyroid

Signaling System?
T3the active form
T4the less active form, must be converted to T3
TBG--thyroid binding globulin, which binds T3, making it
inactive, and carries it through your bloodstream.
Total T3 includes both bound (inactive) and free (active)
T3.
Free T3 is the only the active T3.
TSHthyroid stimulating hormone, which tells your
thyroid gland to make more hormone
Reverse T3an inactive hormone that is sometimes made
from T4

In a complex system, there are lots of places where
something can go wrong. This complexity is what
makes thyroid problems so difficult to diagnose
and treat.
Now that youve got the basics, Im going to talk you through some of the
ways that conventional medicine typically gets your diagnosis and treatment
wrong. As you read through these various possibilities, keep this one thing in
mind:
The thyroid signaling system is very complex. If you dont measure the
right component, or notice how one component affects another, youre likely
to miss something important and your diagnosis and treatment will misfire.
Its not enough to measure overall thyroid levels.

You also have to know how much free and active
thyroid is operating in your system and whether
your cells are responding to it properly.
How do most conventional M.D.s diagnose thyroid issues?

They measure two items: TSH levels and T4 levels.
TSH, you will recall, is thyroid stimulating hormone. Its what your
pituitary uses to instruct your thyroid gland to make more thyroid hormone.
High amounts mean your thyroid is working at a slower pace.
T4 is the less active form of thyroid, and also the most common. About 85
percent of the hormone that your thyroid gland churns out is T4.
So the test creators reasoned like this:
If you have a normal amount of TSH and a normal amount of T4,
youre fine.
If you have a high amount of TSH and a normal (or low) amount
of T4, you are hypothyroid. Presumably, even though your TSH
keeps telling your thyroid to make more T4, your thyroid isnt
complying so your pituitary keeps releasing more and more
TSH, like a frustrated pet owner making his voice louder and
louder, hoping that his dog will finally obey. Usually, patients with
this profile are prescribed supplementary thyroid hormone.
If you have a low amount of TSH and a normal (or high) amount
of T4, you are hyperthyroid. Same thing in reversewhy does
it take so little TSH to stimulate the thyroids production of
T4? Presumably, the thyroid is overactive, like a puppy that
rushes madly around the room, trying desperately to fetch you
whatever you might want, before you even had a chance to point
at anything. Usually, patients with this profile are prescribed the
usual treatments for hyperthyroidism.*
Ive shared with you the reasoning behind the TSH/T4 test, because I
want you to understand the way your conventional M.D. has diagnosed your
condition. In my opinion, howeverand in the opinion of many functional
and holistic practitionersthe current test is a very flawed and incomplete
way to determine thyroid function.
The medical profession actually used to use a different testone that I
strongly believe is better, and that I use myself. Youll learn about that test in
Part II.
That old test was more expensive, more difficult to use, and for some
patients, more challenging. So, when these new tests came along, virtually the
whole medical profession jumped on board. I think it was a terrible mistake
because the TSH/T4 measurement is seriously inadequate. In this section,
youll find out why.
The TSH and T4 tests are too simple to accurately

measure such a complex problem. No wonder so
many people are misdiagnosed!
*There is a third conditiona low TSH and a low free T3 reading, along with hypothyroid
symptomswhich is usually diagnosed as hypopituitary, or an underperforming pituitary.
This is usually the result of a disorder in the pituitary or its neighboring gland, the
hypothalamus. Although this condition obviously affects the thyroid, it is not a thyroid
disorder per se.]

Whats wrong with relying so heavily upon the TSH and T4 tests?
Basically, these two tests alone are blunt instruments that cant really
measure the complex workings of the thyroid signaling system:
Most conventional M.D.s rely on upon a normal range. You
get your TSH and T4 tested, and if you fall within the normal
range, youre considered to be healthy. But everybodys normal
is different. A number that might correlate to perfectly good
health for one person might produce agonizing weight gain, brain
fog, and depression for another.
Normal range is not the same as optimal range. Most
conventional M.D.s tend of view disease in very black and white
terms: either you have it or you dont. But what if you sort of have
a problema suboptimal condition that doesnt quite qualify as
sick but is still very far from being fully well. Reference ranges
are not the best tools for determining the numbers that represent
optimal, top-of-the-line health for you.
Even a slight deviation can translate into significant
symptoms. Suppose your current TSH and T4 readings are just a
little off from what might be optimal for you. It doesnt show up as
a problem, because its still in the conventional reference range for
normal. Yet the slight deviationbetween whats generally okay
for most people and what is necessary for youcan show up in the
form of weight loss, depression, fatigue, brain fog, and numerous
other problems. A conventional M.D. cant explain them, because
youre numbers are normal. The focus must be shifted away
from looking at the average to taking into consideration your own
personal experience and how you feel.
Your hormone levels can fluctuate from day to day or even
from hour to hour. A test given at any one time might come
out normal, hiding the problems that might have shown up at
another day and time. This is why I do a challenge testa test that
shows me in real time how the thyroid functions. Its also why I
test repeatedly, every few weeks, to keep tracking whats really
going on.
Smoking can lower TSH. So if you smoke, the TSH/T4 ratio is an
even less reliable way to measure your thyroid function.
T4 levels are not a true picture of your thyroid function. In
theory, if youve got enough T4, youve got enough T3. After all,
your body converts T4 into T3. So just measuring T4 should be
enough, right?
In practice, its not so simple. As we will see in a moment, there are
many reasons why your body might not be properly converting T4 to
T3, and why your body might have trouble responding properly to T3.
Even if your T4 levels are normal, you might not be getting enough free
T3 into your cells and you might suffer terribly from symptoms as a
result.
All of this is bad enough. But heres something even worse: the longer your
thyroid dysfunction continues, the harder it becomes to diagnose with the
conventional test.
The normal range that most conventional M.D.s

rely upon may not be the most optimal range for
you. And even a slight deviation from your optimal
range can result in significant symptoms.
The longer youve had thyroid problems, the more normal your TSH and
T4 levels are likely to be. However, you can have normal TSH and T4 levels
even while your levels of free T3 are dropping. And its the levels of free T3
that really make the difference as to how you feel.
In my own clinical experience, the longer you have had hypothyroidism,
the less likely you are to see a high TSH reading. Its as though your pituitary
gets fatigued and cant keep producing TSH, which drives those numbers
down. Now the relationship between your TSH and T4 might look normal. But
youre still not getting enough free T3.
In the worst-case scenario, you get a condition known as nonthyroidal
illness syndrome (NTIS). When the body is under stresswhether from
illness, inflammation, or emotional challenges, such as unemployment, or a
divorcethe thyroid still appears to be functioning normally, but the levels
of thyroid hormone are completely imbalanced. The most common pattern
occurs as normal levels of T4 and bound (inactive) T3, but extremely low
levels of free T3. Its as though the body is desperately trying to conserve
energy by radically restricting the availability of free T3.
NTIS is observed among people who have undergone severe illness or
starvationcertainly conditions in which the body would want to conserve
energy as far as possible. However, less extreme versions of NTIS can also
disrupt thyroid activityeven while conventional testing for TSH and T4
levels shows thyroid activity to be normal.

Another reason that thyroid tests can be thrown off over the years is that
low thyroid levels compromise your ability to rid the body of toxins. As a
result, the toxins start building up, which affects the integrity of the thyroid
signaling system. For example, excess toxins might prevent your body from
converting T4 to T3, so that your thyroid symptoms begin to increase. Your
doctor might be telling you that your T4 levels are better than everbut
meanwhile your body is starving for T3.
To make matters even worse, your bodys tissues might be absorbing T3
at different levels. Perhaps your brain is able to absorb T3 while your muscles
are notor vice versa. Measuring your thyroid blood levels wont reveal the
extent to which every part of your body is getting all of the thyroid hormone it
needs. And of course, if even one part of your body is failing to get sufficient
thyroid hormone, that part of your body will suffer from symptomsand
your whole system is at risk for a more serious disorder.
Do These Scenes Sound Familiar?
My patients tell me heartbreaking stories of going to doctor
after doctor, looking for answers and finding none:
Mrs. Jones, your thyroid is perfect.
Then, Doctor, why am I so tired?
What do you expect, youre already over fifty. Just try to get
more sleep.
Ms. Rodriguez, your thyroid is perfect!

Then, Doctor, why am I so depressed?
Well, youre 55these things happen as you get older. Let me
prescribe you an antidepressant.
Mr. Patel, your thyroid is perfect!

Then, Doctor, why am I gaining so much weight?
Youre really eating a lot more than you think youre eating.
Why dont you make an appointment with our nutritionist?
Mrs. Chao, your thyroid is perfect!

Then, Doctor, why am I so anxious and edgy and unable to
sleep?
Oh, youre just stressedyou need a vacation.

What are some common scenarios of thyroid imbalance?
As youve seen, there are many ways in which your thyroid can become
imbalanced. Here are a few of the most common scenarios.
1. Your T4 isnt properly converting to T3

Youll have symptoms, but your TSH and T4 will be normal. If you
test your free T3, it will be low.
Elevated cortisol and stress: Earlier we discussed deiodinase enzymes

responsible for removing 1 molecule of iodine from T4 to convert it to the
more active T3. Unfortunately, elevated stress hormones-namely cortisol, can
impact the ability of this enzyme to do its job. This suppression will lead to
lower than normal amounts of T3 and often higher levels of RT3.
You can see why stress would reduce your available supply of T3. When
humans first evolved, stress meant starvation or life-threatening exertion,
such as a trek across the tundra or a fight to the death against an enemy.
Conserving the bodys energyburning fuel as slowly as possible while
holding onto body fatwould be crucial in such circumstances.
Now, however, stress might mean a troubled child, an aging parent, or a
difficult deadline at work. If that type of stress disrupts your thyroid function,
you might find yourself gaining weight, slowing down, and growing forgetful
and foggy. You need help in reducing or relieving stress while you also
reduce inflammation and restore healthy thyroid function.
Mineral deficiencies: Another reason you might have trouble converting
T4 to T3 is due to deficiencies in selenium, iron, or other key minerals.
Toxic exposure: Yet another possibility: too many toxins might interfere
with conversion. Toxins lurk in your food, air, and water, as well as in many
personal-care products, home cleaning products, and office products, as well
as in furniture and rugs.
Liver dysfunction: Finally, because so much T4-T3 conversion happens
in the liver, an unhealthy liver can also disrupt conversion and keep you from
getting the active thyroid hormone that you need.
What Might Prevent T4-T3 Conversion?
Stress-induced reduction of enzyme activity
Insufficient selenium, iron, or other minerals
Too much toxic exposure
An unhealthy liver, as the result of
Drinking
Fatty foods
Insulin resistance: trouble metabolizing blood sugar
Microbiome issues: trouble with the microbiome, gut
bacteria
Medications
Smoking
Too much toxic exposure
2. Hypothyroidism caused by elevated TBG (Thyroid Binding

Globulin)
test your free T3, it will be low. Although its rare to test for TBG, that
would test high as well.
As youve seen, TBG carries thyroid hormone through your blood. And
any thyroid hormone that is bound is by definition unavailable. So if you have
a lot of TBG, youre likely to have less available thyroid.
Note that if you are facing this scenario, your TSH and T4 levels will be
normaland most conventional M.D.s will tell you that as far as your thyroid
is concerned, you are just fine. Yet if your free T3 levels are low, youll likely
be suffering from symptoms, even though you dont have a diagnosis. Always
check levels of free T3.

Why Is Free T3 Important?
As you can see, the key to avoiding thyroid symptoms is
the level of free T3. Several studies have confirmed this point.
A study of 832 hypothyroid patients who were given urine tests
for free T3 showed that the higher the free T3 levels, the fewer
the symptoms, including fatigue, depression, cold intolerance,
headache, muscle cramps, constipation, and joint pain.
Another study of patients in an intensive care unit for
cardiovascular or pulmonary disease found that the only thyroid
hormone that was an independent predictor of patient mortality
was free T3. The other hormones did not have any predictive
power.
Despite the importance of free T3, so many practitioners
underrate its significance. Frequently, Free T3 is not even drawn
as part of routine blood tests. And yet its the key to thyroid and
overall health.
3. Hypothyroidism caused by decreased TBG (Thyroid Binding

Globulin)
test your free T3, it will be high. Although its rare to test for TBG,
that would test low.
This scenario is sort of the opposite of the last one. Because your levels of
thyroid binding globulin are low, that leaves a lot of free T3.
Now you might be wondering how its possible to have high levels of free T3
and still show up with symptoms of low thyroid. Thats because you have so
much excess thyroid hormone in your blood that your cells become resistant
to absorbing it, a condition known as thyroid resistance. This is yet another
condition that most conventional M.D.s frequently fail to diagnose.
4. Hypothyroidism caused by excess Reverse T3
test your free T3, it will be low. Although its rare to test for Reverse
T3, that would test high.
A number of factors might cue your body to produce too much Reverse T3:
Stress: If youre facing physical or emotional stress, your body might slow
down on its conversion of T4 to T3 and start converting more T4 to reverse T3.
What Does My Body Consider Stress?

Physical Stress
Diabetes
Exposure to cold
Over training
Illness
Injury
Medications, especially beta blockers and amiodarone
Emotional Stress
Care of an aging parent
Childrens illness or trouble at school
Deadlines
Death of a loved one
Divorce
Unemployment of self or partner or financial burdens
Low Free T3: If your free T3 levels are too low, your adrenal glands
produce extra amounts of a stress hormone known as cortisol to compensate.
The excess cortisol in turn inhibits the conversion of T4 to T3 while
stimulating the conversion of T4 to Reverse T3. Cortisol can also damage
other parts of your body, interfering with the optimal function of your gut,
brain, heart, and immune system.
As the downward spiral continues, your adrenals become exhausted, your
T3 levels remain low or even decline, and your symptoms worsen. Eventually,
your adrenals stop overproducing cortisol and begin under producing it. Your
free T3 levels do increasebut then in response, your T4 levels convert to
Reverse T3.

Iron deficiency: Another factor that can set off Reverse T3 conversion
is iron deficiency. Now, heres another vicious cyclethe iron deficiency
can itself be the indirect result of low thyroid, because if your thyroid is low,
your stomach acid tends to be low as well. Without enough stomach acid,
youll have a hard time digesting meat and other sources of iron. You end
up with fewer red blood cells or cells that are less red. Your depleted blood
cant transport your thyroid hormone as well, and as a result, your blood levels
of T4 become too high. In response, your body triggers more conversion to
Reverse T3.
Inflammation: Inflammation can also trigger excess conversion to
Reverse T3.
What Causes Excess Conversion to Reverse T3?

Stress
Low T3
Iron deficiency
Inflammation
5. Hypothyroidism caused by Thyroid Resistance

Youll have symptoms, but all your lab markers might be normal,
because your body is producing enough thyroid hormonebut your
cells cant absorb it.
This is one of the best examples of what is wrong with the conventional
approach to thyroid testing. If you have thyroid resistance, your pituitary is
producing TSH and your thyroid is producing T4 and T3but your body isnt
benefiting from it. An increasing body of evidence indicates that blood tests
fail to reveal the full spectrum of thyroid problems.
When I think of how insistent conventional medicine is on diagnosing
thyroid issues through blood tests, Im reminded of that old joke about the
man who loses his keys trying to get into his house late at nightbut looks
for them on the corner, under the streetlight. A passerby asks him why hes
looking for his keys so far from where he lost them. The man shrugs and
replies, Theres more light over here. Yes, its easier to look for keys under
a streetlight, and its also easier to test blood for TSH and T4 than to do other
types of more accurate tests. But neither search is likely to produce the most
useful results.
To give just one example, postmortem exams done on people with
Alzheimers suggests that they tend to have low levels of T3 in their brain
tissue, suggesting a strong correlation between low thyroid levels and
dementia. Significantly, these people had normal levels of thyroid hormone in
bloodthe deficiency was in their tissue. Routine blood test cant catch this.
6. Hypothyroidism caused by pituitary dysfunction

Youll have symptoms, and your TSH and T4 will be low
though perhaps still considered within the normal range
by conventional medical standards.
As we have seen, TSH is a hormone released by the pituitary gland. If your
pituitary is overworked, it might not be able to release enough TSH to signal
your thyroid to produce thyroid hormone. In this case, your thyroid would be
in good shapebut your pituitary isnt able to send it the right messages.
What Might Disrupt My Pituitary?

Disrupted blood sugar, insulin resistance, and/or
hypoglycemia
Pregnancy
Stress, which results in elevated cortisol levels
What if my thyroid disorder is an autoimmune condition?

As we have seen, some of the most common forms of thyroid disorders are
indeed autoimmune condition: Hashimotos thyroiditis for hypothyroidism,
and Graves disease for hyperthyroidism (see page 23, 24 for more).
In these cases, its important to treat the autoimmune condition as well
as the thyroid problem. Sadly, most conventional physicians fail to do this.
They simply prescribe the conventional remedies for each condition: thyroid
hormone medication for Hashimotos, and radioactive iodine therapy, anti-
thyroid medications, beta blockers, or surgery for Graves.
The underlying problem in both conditions, however, is an overactive
immune system that is attacking the cells of its own body. In both
autoimmune conditions and chronic thyroid problems, the major culprit is
chronic inflammation, an ongoing immune response to problematic foods and
medications, environmental toxins, physical stress (illness, injury, poor sleep,
over-exertion), and emotional stress (life challenges of all types).

A functional and holistic approach to autoimmune conditions relies upon
diet, supplements, detoxification, sleep support, and stress relief to calm and
rebalance the immune system. I use these tools to treat thyroid disorders as
well.
To determine whether your thyroid disorder has an autoimmune
component, I test for a wide variety of thyroid-related antibodies. This is
similar to what most conventional physicians do. However, most conventional
physicians do not believe that autoimmune diseases can be treated other than
through immune suppressant medication that can come with side effects. In
most cases there is a better way however. The consequences of autoimmune
diseases can absolutely be prevented through diet, supplements, and lifestyle,
and that most or all of normal immune function can be restored.
So, whether your thyroid disorder is autoimmune or results from some
other cause, much of my treatment will be the same. Our goal is to use
diet, supplements, lifestyle, and other treatments to reduce inflammation,
rebalance your hormones, and restore optimal function in both your thyroid
and your immune system.
How do functional and holistic practitioners test for thyroid disorders?

Many functional medicine practitionersM.D.s, naturopaths, and
othersshare my skepticism about the TSH and T4 tests. They are well aware
of the shortcomings of these approaches, and they understand that in many
cases, the conventional test simply doesnt provide a clear, useful picture of
whats going on.
So, whats the alternative? Many of them simply rely on symptoms. Unlike
many conventional M.D.s, functional medicine physicians are far more likely
to look at an individual patients symptoms and be motivated to find the
underlying cause. They too see health as a spectrum, where the goal is not
simply to fall within the normal reference range but to help each patient
feel completely well, enjoying not normal but optimal health and function.
As a result, they continue to address thyroid issues until their patients are
symptom-free.
Some functional and holistic practitioners also use underarm body
temperature as a means to determine thyroid function. This method
sometimes provides useful information but it is not always reliable.
I prefer to use a more scientific approacha thyroid function test that
is far more accurate and specific than the TSH/T4 test. Its called the TRH
stimulation test, and in my opinion, its the gold standard for thyroid
diagnosis. In the next section, well take a closer look.
Part II. How Do You Test for Thyroid
Disordersand Why Do You Think Your Way
Is Better?
How do you test for thyroid disorders?

I use a test known as the TRH stimulation test. In my experience, it is the
gold standard for thyroid diagnosis, and I wish it were used more widely.
TRH is short for thyrotropin-releasing hormone. This hormone is
secreted by the hypothalamus, a master gland that secretes a number of
different hormones to regulate many functions in your body, including body
temperature, thirst, hunger, sleep, mood, sex drive, and overall hormonal
balance. Many of your bodys responses begin in the hypothalamus, frequently
moving through the pituitary and on to another gland.
Thats how your thyroid works, too. Your hypothalamus secretes TRH.
This in turn signals your pituitary to secrete TSHthyroid stimulating
hormone. TSH, in turn, stimulates your thyroid to make T4 and T3:
Hypothalamus secretes TRH

Pituitary secretes TSH

Thyroid secretes T4 and some T3

Liver and cells convert T4 to T3

T3 enters your cells driving energy production
Youve already seen that most conventional practitioners simply take a

single measurement of TSH and of T4. The TRH test is more dynamic. First,
I take a baseline reading of TSH along with levels of free and total T4, free
and total T3, RT3 and antibody levels . Then I inject the patient with TRH,
which stimulates the pituitary to release TSH. Thirty minutes later, I retest
the level of TSH. That way, I can see in real time exactly how the pituitary
is responding. I can also see how the thyroid responds to the pituitarys
stimulation.
44 Part
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How DoYou
How doTest
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Thyroid
forDisordersandWhyDoYouThinkYourWayIsBetter?
Thyroid Disorders
In other words, instead of looking at hormones that are already in the
blood, I can stimulate the pituitary and the thyroid to take actionand then
test you to find out exactly what happens when they do. By challenging both
pituitary and thyroid, the TRH stimulation test gives us a picture of hormonal
action in real time.
Patients who test normal on the TSH test often

show up with serious thyroid problems when
tested with TRH.
Why do you think the TRH Stimulation Test gives you the best diagnoses?
Think of the difference between a cardiogram and a cardiac stress test.
The cardiogram gives a snapshot of your heart at one particular moment. The
cardiac stress test shows how your heart behaves when it is actually called
upon to perform.
Likewise, the conventional TSH test gives us a snapshot of your hormone
levels at that one particular moment when we happen to do the test. The TRH
Stimulation Test, by contrast, forces your pituitary and thyroid into action, so
we can observe their function in real time.
Remember when I told you that after years of dysfunction, it was hard
to detect problems simply by measuring TSH and T4? Thats because your
body always tends towards homeostasistrying to keep an equilibrium.
Sometimes your pituitary and your thyroid conspire to keep your blood levels
of TSH and thyroid hormone stableeven while your tissues are not getting
enough thyroid hormone. You can test normal for TSH and T4but your
tissues are not getting enough free, active T3. It isnt optimal but the body
does tend to create a kind of equilibrium.
But when you do the TRH Stimulation test, you disrupt that equilibrium.
You dont give the pituitary, thyroid, and all the other players a chance to
coordinate their biochemical actions, to balance hormonal levels over time,
which can fool you into thinking that everything is normal. You see what
happens right at the moment that the thyroid is asked to produce hormone.
In cases of low thyroid function, even if TSH is normal in the blood on a
routine test, the pituitary will store up large quantities. Upon stimulation, the
pituitary will release this stored hormone where it is easily measured in the
moment.
Think of your thyroid as a sick employee that cant get its work done, and
the pituitary as a sympathetic coworker who is trying to cover. Come into the
office at any one point, and you might not be able to tell how much the pituitary
is covering for the thyroid. Give the pituitary a surprise assignmenta huge,
sudden, unexpected taskand you force it to reveal how much extra work its
doing to compensate for the thyroids poor performance. The extra challenge
means that your system can no longer keep up its deceptive equilibrium. You
have forced it to reveal the truth.
In fact, with the TRH test, I have detected thyroid problems in numerous
patients who had been suffering from thyroid symptoms for yearsbut
whose conventional M.D.s insisted that they had no thyroid problems.
When I prescribed thyroid hormone, their symptoms began to disappear.
They experienced immediate short-term improvement and satisfying long-
term relief. Clearly, they did have a thyroid problem which the TSH test had
concealedbut which the TRH test revealed. After years of being told they
were normal, finally, they got the correct diagnosis, as well as the help they
so desperately needed.
The TRH Stimulation Test shows us how your

thyroid actually functions in real life.
Why doesnt everybody use the TRH test?

When I think of how much more accurate the TRH test is, I honestly cant
believe that any practitioner chooses not to use it.
However, when I consider non-medical factors, I can see why the TSH/T4
tests have become more popular.
First, the TRH test is harder to administer. The TSH test requires only one
conventional blood draw that can be conducted by just about anyone certified
to do so working in a doctors office. The TRH test requires two separate blood
draws half an hour apart, as well as the administration of the TRH itself. You
have to obtain the TRH, you have to train someone to administer it, you have
to keep patients around for an extra 30 minutes, and you have to apply more
skill to interpreting the results.
Second, the TRH test requires a more dynamic view of medicine. Instead
of seeing the body as a static entity, whose reality can easily be captured with
two simple numbers, the TRH test portrays the body as an ever-changing
organism in which different glands and biochemical work together, constantly
changing and affecting one another. Each patients response is unique
and you have to bring years of skill and experience to understanding those
responses. I think all practitioners should view the body this waybut sadly,
they dont.
The TRH Stimulation Test offers a more dynamic

view of your thyroid.
46 Part
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How doTest
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Thyroid
forDisordersandWhyDoYouThinkYourWayIsBetter?
Thyroid Disorders
How did you come to start using this unusual test?
When I first began practicing in 1996, conventional medicine had long
since abandoned the TRH stimulation test. At first I accepted the prevailing
belief that the TSH test was superior, and I treated my patients based on its
results.
But patient after patient came to me with the same heartbreaking
symptoms: fatigue, weight gain, always feeling cold, muscle pain, joint
pain, depression, hair loss, brain fog, depression. Many of them had been
from doctor to doctor, always seeking relief and never finding it. They all
felt intuitively that something was wrong with their metabolism and their
hormonesthat something was simply off. Many of them even insisted that
they had low thyroid.
And yet, their doctors dismissed them as ridiculous, crazy, hysterical.
Every doctor told them that their labs were normal. And when I did their labs,
I found them to be normal too.
Eventually I realized that all these people couldnt be crazy. They couldnt
all be making it up. They couldnt all be stressed and depressed, with no
underlying real reason for their problems.
As a holistic and functional medicine physician, I was always looking for
challenge tests and provocation teststests that would show me how a system
was truly functioning. I didnt want a test that dropped my patients into an
average or normal range. I wanted to see how close they were to optimal
function.
If my patients werent all crazy, then the problem couldnt be with them
it had to be with the test. So I did some research and found out about the
TRH test- the one doctors had done before the discovery of the TSH. Very few
doctors were still doing the TRH, but I found one old-timer who still used it,
and he trained me.
Meanwhile the TRH went completely out of vogue. Companies even
stopped producing the material used to stimulate the pituitary. I didnt let that
stop me thoughI got compounding pharmacies to make it up for me. For
many years, I was one of a very few U.S. doctors who still used this test.
I have since taught a few other physicians how to use the TRH test. I can
only hope that functional, conventional, and holistic practitioners return to
this approach to understanding the thyroid.
With so many patients having unexplained

symptoms-the problem had to be the test.
Part III. What Do My Test Results Mean?
I was given the TSH test, what do the numbers mean?

Conventional physicians diagnose your results based on what they call the
normal reference range. If your numbers fall within that range, they consider
that you have a healthy thyroid but its not always the case. Additionally there
are problems with the reference ranges themselves adding to the difficulty of
making a correct diagnoses.
The American Association of Clinical Endocrinologists recently decided
to change the reference range from 8.5 to 4.12. In other words, anyone whose
TSH tests higher than 4.12 should be considered to have a thyroid problem.
AND they have discussed lowering it to 3.
Sadly, most physicians have not heeded that recommendation. Many are
still using the old reference ranges, even though prevailing medical opinion
has said that they are much too high. That means that even those thyroid
sufferers whom the TSH has successfully identified will still be missed by
many conventional physicians.
Of course, even the figure of 4.12 has been disputed. The American
Association for Clinical Chemistry (AACC) has recommended a ceiling of
2.5. And many holistic practitioners say that even a TSH reading as high as 2
indicates problems.
I personally have had clinical experience with patients whose TSH in a
standard test was as low as 1.8 or even 1.6, which by conventional medical
standards would indicate no thyroid issues. Yet when I gave them the TRH
test, the results showed that they were absolutely hypothyroid. And when I
gave them the proper dose of thyroid hormone, their symptoms immediately
began to clear up. So again, the TRH is my gold standard, because it has
allowed me to help many patients who otherwise would remain misdiagnosed.
Your TSH level doesnt tell you how much thyroid

hormone is actually in your cells. And until thyroid
hormone enters your cells, it has no effect.
What else could I have tested?

As we touched on earlier, when running a test to determine thyroid
function I check much more than simply TSH and T4. The only way to truly
measure the complexities of this intricate system is to study several different
48 Part III. What Do My Test Results Mean?

blood markers including free and total T3, free and total T4, Reverse T3,
thyroid antibodies and of course TSH and TSH as stimulated by the TRH test.
Even if you dont have access to the TRH, including these other markers is
much more beneficial than relying solely on the TSH and T4.
If I cant trust the TSH and I dont have access to the TRH, how do I
know whether I have a thyroid problem?
If you cant get a reliable test, here are the two steps I would suggest you
take, ideally with the support of your health-care practitioner:
1. Start with your symptoms.

Symptoms are primary in the identification of thyroid problems, so look
at the list on page 8. Does that describe you? Do you have even a few of
those symptoms? Have they been hanging on for a long time with no other
explanation?
The most significant symptoms for thyroid problems are fatigue, weight
gain, constipation, and depression. Remember, constipation means moving
your bowels less frequently than once a day.
Your symptoms are more important than your

conventional test results. If your physician ignores
your symptoms, you are not getting appropriate
care.
2. Get a comprehensive blood test that covers as many thyroid

markers as possible.
3. Whenever possible, seek out a physician who can administer

the TRH.
4. Rule out other possible conditions.

You need to rule out other possibilities, primarily the following:
Chronic fatigue syndrome.
This disease usually presents with a lot of post-
exertional fatiguefatigue that comes after
making a physical effort.
It usually includes lymph nodes and complaints of
a swollen, sore throat
*undiagnosed hypothyroidism can sometimes be
confused for CFS
Lyme disease
This disorder usually presents with headaches.
A lot of neurological issues are also part of most
presentations of Lyme disease.
Symptoms in this condition tend to come and go.
Low adrenal function.
Stress can lead to a variety of health conditions
especially adrenal exhaustion. The adrenal
glands respond to stress by producing cortisol
and adrenaline to keep us going. Sustained stress
and the need for long term production of these
hormones however lead to adrenal impairment.
Symptoms can look very much like low thyroid.
*Very often low adrenal output and low thyroid go
hand in hand.
Anemia
This can usually be ruled out with a blood test for
red blood count.
Viral infection
This can usually be ruled out with a blood test for
white blood count.
Sometimes other conditions closely resemble

thyroid dysfunction.
Make sure other conditions have been ruled out

before your physician settles on a diagnosis.
50 Part III. What Do My Test Results Mean?

Part IV. Whats the Best Way to Treat a Thyroid
Disorder?
Why is it so hard to treat thyroid issues correctly?

Ive had a lot of success treating thyroid issues over the years, and when
a new thyroid patient comes to me, Im confident that I can help. Yet every
time I begin a new case, Im struck all over again at the complexity of thyroid
issues and by how hard it is to treat them correctly.
As youve already seen, the thyroid signaling system is vast and intricate.
There are numerous points at which effective communication can break
down:
between hypothalamus and pituitary
between pituitary and thyroid
within the feedback loop that informs the pituitary of how much
thyroid hormone is in the blood
in the gap between how much thyroid hormone is bound and how
much is free
in the gap between how much thyroid hormone is in your blood
and how much is in your cells
as the result of liver dysfunction, disrupting the conversion of T4
to T3
as the result of high cortisol levels disrupting the conversion of T4
to T3
as the result of a longstanding problem, producing homeostasis,
in which some numbers within the thyroid signaling system look
normalmasking the underlying problems
as the confusion between thyroid conditions and similar
conditions
And thats just a partial list!
The level of thyroid hormone in your blood is not a

reliable indicator of how much thyroid hormone is
in your cells.
And until thyroid hormone enters your cells, it has
no effect.
I have normal levels of T4, but I still feel lousy. Whats going on?
The only thyroid hormone that ultimately affects you is the free, active T3
that is able to enter your cells and drive metabolism.
In a healthy body, T4 is converted into free, active T3 that enters your cells.
But as the following chart shows, there are many points at which this process
can be disrupted:
T4 T4 is not always efficiently converted into T3.

Reverse T3 T3
If your body converts
T4 into excess Reverse
T3, your cells arent
getting enough thyroid
hormone, and youll
have symptoms.
Some T3 is bound
to proteins in your
bloodstream. Bound T3
Free T3
is not active. If too much
of your T3 is bound, you
might have symptoms

Sometimes your cells
do not actively receive
this hormone. If
not, you might have
symptoms.
Because its so difficult to pinpoint a precise thyroid dysfunction, it can

be challenging to develop a precise treatment. Thats why there is such an
advantage in being treated by a physician who has years of experience
successfully treating thyroid dysfunction. After more than two decades of
working with thyroid patients, Ive learned to smell the diagnosis and feel
out the possible treatment.
Dont misunderstand me: everything I do is based in science, and I rely
heavily on laboratory tests of a wide variety of factors: thyroid hormone, thyroid
binding globulin, TSH, antibodies, and many others. But in a system so complex
and ever-changing, you need a diagnostician who can detect subtle trends and
patterns, and a clinician who has experience fine-tuning treatment options.
52 Part IV. Whats the Best Way to Treat a Thyroid Disorder?

This is why I say that if you dont practice personalized medicine, you
shouldnt be treating thyroid disease. Every patient is different, so you need
to look closely at each patients specific test results, mood, energy levels, and
other symptoms. You need to really listen to your patient, treating the person,
not the lab results. That can be difficult to do in our current medical system,
where insurance companies often allow a maximum of 15 minutes to spend
with a patient. As a result, thyroid dysfunction is often poorly treated, and
many patients suffer.
Because thyroid dysfunction is so hard to diagnose,

you need a highly experienced physician with a
deep commitment to personalized medicine.
What are some of the other challenges in treating thyroid dysfunction?

Our toxic environment. With every generation, our exposure
to industrial chemicals increases exponentially: in our air, food,
water, furniture, household products, shampoo, face cream,
shaving cream, cosmetics, and many other places. These industrial
chemicals are endocrine disrupters: they disrupt the orderly
functioning of the endocrine system (our system of hormones).
Depending upon your genetic makeup, diet, stress level, and
many other factors, an endocrine disrupter might affect your sex
hormones, stress hormones, thyroid hormonesor all three. Since
I cant tell you to go live in a bubble, treatment options become
more challenging.
Our food culture. The modern Western diet is unhealthy for
many reasons, including its disastrous effect upon our thyroid.
For many people, glutena form of protein found in wheat,
rye, barley, and many other grainstriggers the formation of
antibodies that attack not only gluten molecules but also the tissue
of the thyroid. Caffeinea staple for many of usimbalances
stress hormones, which in turn disrupts the thyroid. White sugar
and refined flour disrupt stress hormones and impair gut function,
both of which negatively affect the thyroid. A lack of fermented
foods depletes our microbiome, the community of friendly
bacteria that are essential to healthy gut function, and, therefore,
to a healthy thyroid function. At the same time, our diets are sadly
lacking in the fresh, organic fruits and vegetables containing
vitamins and minerals needed to support the thyroid. The good
news here is that improving your diet can make a tremendous
difference in your thyroid health, as youll see in a moment.
Our toxic environment and unhealthy food culture
put a huge strain on your thyroid.
What is the conventional medical treatment for thyroid dysfunction?

Most conventional physicians will prescribe a form of thyroid hormone
that you take to supplement the hormone produced by your own thyroid.
Typically, physicians proceed with caution, beginning with the lowest possible
dose of thyroid hormone. Depending on your response, they might gradually
increase the dose.
What types of thyroid hormone might be prescribed?

Levothyroxine. This is a synthetic form of T4, the less active form
of the thyroid hormone.
T3. Synthetic T3 hormone is also available.
Natural dessicated thyroid (NDT). This is composed of the dried
thyroid from pigs. It works in the human body because our thyroid
and the pigs closely resemble each other.
There are 3 types of prescription thyroid hormone,

each with its own pros and cons.
What are the pros and cons of each type of thyroid hormone?
Levothyroxine
PROS:
It is inexpensive.
Levothyroxine is T4, the less active form of thyroid, so your body
must convert it to T3. Taking T4 allows your body to manage the
amount of T4 that is converted to T3. Many physicians worry that
if they prescribe T3, they risk over-stimulating your body with too
high a dose of active thyroid hormone. They consider T4 to be a
slower, safer option.
CONS:
Many factors might prevent T4-T3 conversion. Many other factors
might prevent free, active T3 from actually being received by
your cells. Even if levothyroxine is the right treatment option,
it might need to be supplemented with a prescription for T3 as
well. It certainly should always be complemented with diet,
supplements, and lifestyle to correct the underlying problems that
caused the thyroid dysfunction to begin with. I personally often

prescribe T4but supplemented with other types of treatment.
Unfortunately, just about every conventional M.D. simply
prescribes levothyroxine, with no other health supports.
T3
PROS
T3 is the active form of the thyroid hormone, so you can often get
better relief of symptoms by using T3.
If your body has trouble converting T4 to T3, or if your body
is making too much Reverse T3, the right dose of T3 can often
mirror the effects of a healthy thyroid system.
CONS
It can be difficult to get the right balance between doses of T4 and
T3.
You run the risk of accelerating your heart rate too fast,
thus creating another set of symptoms and risks. This risk is
especially significant for the elderly. However, a low dose of T3,
administered with caution and in slow-release form can actually
reverse irregular rhythms and palpitations.
Natural Dessicated Thyroid
PROS
This product is all-natural.
I often get comparable results with NDT as opposed to directly
prescribing T3.
CONS
Some patients respond badly to the binding chemicals used to
prepare the NDT pills.
Some people have ethical objections to this use of animals.
Most importantly, in my opinion, NDT offers less ability to
fine-tune the thyroid balance. Some of my patients need more
T4, others need more T3and almost every patients need for
both T4 and T3 fluctuates over time. NDT doesnt offer the same
opportunities for precision and for personalized medicine as does
an individually compounded dose of T4 and T3 prepared by a
compounding pharmacy. However, I have sometimes prescribed
NDT and gotten good results.
Once again, every patient is different, and personalized medicine is the key.
Many conventional M.D.s have a very simplistic
view of thyroid hormone.
My current doctor has prescribed me thyroid hormone, but I still dont

feel at my best. Whats going wrong?
There are a few possibilities:
Youve been misdiagnosed and dont really have a thyroid
problem. This is not so likelythyroid dysfunction tends to be
under-diagnosedbut its possible. (See page 11-14, 33 for more.)
If you dont have a thyroid condition, taking medication wont help
relieve your symptoms and might even make things worse.
You are not being prescribed the correct dose of thyroid
hormone. In Part II, we extensively discussed the shortcomings
of the test most commonly used in conventional medicine. Use
of this test leads to thyroid ailments being under-diagnosed and
under-treated.
Your diet and lifestyle are undermining your efforts. Common
problems including eating the wrong kinds of food; getting too
little, too much, or the wrong kind of exercise; not getting enough
sleep; and being overexposed to environmental toxins. All of these
factors create inflammation (see page 17)and inflammation has
been known to prevent cells from receiving thyroid hormone. If
youd like to explore this possibility further, ask your doctor to do
a blood test to measure your levels of these common inflammatory
markers: CRP (c-reactive protein), IL6 (interleukin-6), and TNF
(tumor necrosis factor). (I measure these factors routinely, and
track them throughout your treatment.) By the way, high CRP
levels are also a risk factor for heart disease.
Some factordiet, lifestyle, or another disorderis sapping
your body of the energy that it needs to bring thyroid hormone
into your cells. Its a vicious cycle. Without energy, your
cells cant receive thyroid hormone. Without sufficient thyroid
hormone, your cells lack energy.
You have other disorders that are either keeping thyroid
hormone from reaching your cells, or that are making you
worse even while the thyroid hormone is making you better.
Because thyroid issues affect so many systems in your body, any
type of thyroid problem is likely to set off other health crises.

Why might T4/Levothyroxine be insufficient?
You cant convert T4 to T3.
Youre making too much Reverse T3.
Too much of your T3 is bound.
Your cells arent receiving T3 even though its free and
bioavailable in your bloodstream.
You have other conditionseither caused by your thyroid
dysfunction or independent of itthat are complicating
your situation.
What happens when my cells dont get enough thyroid hormone?

Suppose your doctor tells you that your blood levels of thyroid hormone
are healthy. Suppose he or she even tests you for T3 and reverse T3, and finds
that they are normal. By all conventional tests, your thyroid function is fine,
and you cannot have a thyroid problem. Right?
Not so fast. If your cells arent able to receive the thyroid hormone,
it doesnt matter how much is in your blood. This means you could test
absolutely normal for thyroid hormoneand still have a thyroid problem.
To make matters even more confusing, you might be able to receive T3 in
some cells and not in others. This really distorts the picture! And meanwhile,
you are suffering from various types of thyroid-related disorders as seen in
these examples:
Low levels of T3 in the esophagus can lead to gastritis (stomach
disorders) and acid reflux.
Low levels of T3 in the brain might lead to autism and/or to
dementia.
If your cells cant efficiently receive thyroid

hormone, you might develop such disorders as
reflux, gastritis, autism, or dementia.
Are there any other reasons why my thyroid medication might fail to
resolve my symptoms?
Yes: the activity of three enzymes, known as D1, D2, and D3 deiodinases.
These enzymes each operate in different ways. D1 and D2 increase thyroid
activity by stimulating the conversion of T4 to T3. D3 balances the action of
the other two by triggering the conversion of T4 to reverse T3.
In certain conditions, the activity of D1 And D2 may become down-
regulated: that is, they wont work as efficiently or powerfully as they
normally would. As a result, they wont be as effective in triggering your T4-
to-T3 conversion. You can have normal blood levels of T4but you wont get
enough conversion to T3. Your conventional M.D. will tell you that your T4
levels are normalbut youll be running low on the active T3 that you need.
Down-regulation of certain enzymes can prevent

your body from converting T4 to T3leaving you
vulnerable to a wide range of symptoms.
What can depress the activity of crucial enzymes?

D1 and D2 can be down-regulated by any of the following factors:
Inflammation
Stress
Depression
Eating fewer calories
Changing your eating habits/yo-yo dieting
Long-term problems with the gut or the microbiome
Insulin resistance
Diabetes
Autoimmune conditions
Environmental toxins
Hypothyroidismwhich obviously creates another vicious circle
Remember, your active thyroid hormone, T3, is like fuel for your entire
body. T3 revs up your metabolism, cues you to burn fat, and makes you active
and energetic.
But if youre stressed or seem to be at risk of a food shortage, your body
goes into alarm modeStarvation imminent! Starvation imminent! A
body that fears starvation looks for ways to conserve calories and reduce

the expenditure of energy. So it manipulates the amount of available thyroid
hormone, causing you to retain weight, feel sluggish, and move less.
Low thyroid function can depress enzyme

activitypreventing the conversion of T4 to T3
leading to even lower thyroid function.
What can restore the activity of crucial enzymes?

We spoke earlier of the keys to treating thyroid disorders like eating a
healthy and balanced diet, supportive supplements and probiotics, healing the
gut, stress relieving techniques, detoxifying and restorative sleep. Treating
the adrenal glands to balance cortisol levels is another important factor.
Luckily these strategies are also the needed ingredients that can help restore
deiodinase enzyme activity. Other things that can be of benefit: Saunas can
sometimes be helpful in reactivating D1 and D2. Working with a doctor to
balance insulin levels and correct insulin resistance is also a key strategy.
Selenium is a crucial element in enzyme activity to convert T4 to T3 so
supplementation may be needed.
What does this situation mean for thyroid testing?
The bottom line is that if you have symptoms, you sometimes have to
consider them more than the blood tests, especially the TSH/T4 tests. Its as
though the TSH/T4 tests were the federal level, but the enzymes are operating
at a local level. You can look at what the federal government doesbut that
doesnt necessarily tell you whats happening down the block.
However, the TRH Stimulation test often will tell us whats going on
locally because it stimulates the pituitary, which in turn stimulates the
thyroid in real time. As a result, we can observe how the thyroid performs.
That plus the patients symptoms help us figure out whats going on.
The TRH Stimulation test often detects thyroid

dysfunction that the TSH test misses.
Where do autoimmune conditions fit into all this?

If your thyroid problems are caused by an autoimmune condition, you
need to treat the autoimmune disorder while also addressing the thyroid.
Autoimmune conditions cannot be cured: Once you have developed one,
your immune system will always contain the possibility of attacking the cells
of your own body.
You can reverse it however: you can bring down the inflammation that
keeps the autoimmunity active. (For more on inflammation, see page 17.)
Its as though the immune system is a panicked SWAT team member
holding a gun. If your body is full of inflammation, your SWAT guy will open
fire on just about anything, hoping to protect you but actually harming you in
the process. If your inflammation levels are low, your SWAT guy calms down,
puts down the gun, and allows business to proceed as usual.
Once you have an autoimmune condition, that SWAT guy never goes away
and his gun is always within reach. But if you keep your inflammation levels
low, your immune system will stop attacking your body and your symptoms
will subside.
Another key way to support the immune is by healing the gut. Most of the
immune system lies just on the other side of the gut wall. As we saw when we
looked at leaky gut (see page 22), gut problems can quickly become immune-
system problems. When your gut functions properly, that takes a huge burden
off your immune system and can make an enormous difference in reversing
autoimmunity.
Unfortunately, the approach Ive just described is alien to most
conventional physicians. They tend to ignore diet, lifestyle, and supplements,
or at least to downplay them, focusing on medications that will reduce the
symptoms of autoimmunity: aching joints, flaking skin, imbalanced thyroid,
and so on. If you have Hashimotos or Graves (see pages 23 and 24), a
conventional doctor will likely focus just on treating those disorders rather
than looking at the autoimmunity that gave rise to them.
Addressing both the thyroid disorder and your autoimmunity is key:
For Hashimotos: an appropriate dose of thyroid hormone, either specially
compounded from T4 and T3, or taken from NDT.
For Hashimotos and Graves:
For the autoimmune conditionand for overall support of thyroid
function:
Anti-inflammatory diet: no sugar, refined carbs, artificial
ingredients or preservatives
Pro-microbiome diet: fermented foods, high-fiber fruits and
vegetables
Immune and digestive support: lots of healthy fats, no gluten
(wheat, rye, barley, spelt, and some other grains)
Supportive herbs and supplements (see below)

Two Types of Immune System Responses
INNATE IMMUNITY
* Present from birth
* Immediate short-term defense
* Protects the body against a general variety of pathogens in
several ways
1. Physical barriers such as skin and epithelium linings in
lung and intestine
2. Phagocytic leukocytes
3. Dendritic cells
4. White blood cells-macrophages and neutrophils
5. Chemicals in the body that kill pathogens
6. Alerts the adaptive immune system to be on the look out
ADAPTIVE IMMUNITY
* Antigen specific immune response
* Highly specialized defense system that learns about,
catalogs and remembers foreign matter.
* Provides defense against specific pathogens for the long
term but takes a little while to adapt or lean about them.
1. Cell-mediated consists of T-lymphocytes made in the
thymus
2. Humoral-antibodies are made by B lymphocytes in bone
marrow to defend against bacteria and viruses.
Most conventional M.D.s treat only the symptoms of

autoimmune conditions. To be successful, we must treat
the underlying problems that created the autoimmune
disorder in the first place.
Can supplements help treat thyroid dysfunction?
Yes, absolutely, and they are a key aspect of my treatment. I use
supplements both to treat the thyroid itself and to counteract the effects that
imbalanced thyroid can have on the gut, the immune system, and the brain.
For the Thyroid
Selenium can help to support the conversion of T4 to T3. It also
plays a key role in protecting the thyroid from inflammation and
conditions that trigger auto-immunity to thyroid tissue. I check my
patients selenium levels and supplement as needed.
Iron deficiency can also contribute to thyroid problems, so I test
for iron levels as well.
Iodine is a needed ingredient in making thyroid hormone and
deficiency can impact thyroid function. I sometimes test for iodine
deficiencies with an iodine challenge test, in which you take a high
dose of iodine and then, 24 hours later, I test your urine to see how
well your absorbing this crucial mineral.
Thyroid glandulars, the dessicated version of thyroid taken from
animals, can sometimes be a helpful treatment.
Pituitary glandulars might help if your pituitary is under-
functioning.
For the Gut
Vitamin B12 can help compensate for the nutrient deficiencies
that you frequently find in someone with poor thyroid function.
Glutamine and prebiotics (such as inulin and arabinogalactans)
can help improve gut function, which in turn improves thyroid
function. Prebiotics are fibers that your gut bacteriayour
microbiomedepend upon for nourishment.
Probiotics, zinc carnosine, MSM, and glucosamine all help
to heal the gut and improve gut function. This is very important
for all patients especially autoimmune patients whose immune
systems will be supported by a healthier gut. Prebiotics are
important for these patients as well.
For the Immune System
Vitamin D is crucial for balancing immune issues.
The probiotic Sacchromyces Boulardii is a natural immune-
system modulator.

Colostrum, a key element in mothers milk, supports the immune
system, so I sometimes prescribe animal versions of colostrum.
Plant sterols (fats) can also support the immune system.
Quercetin helps reduce inflammation and reduces the immune
systems burden.
For the Brain
5-HTP is the precursor to serotonin, a key biochemical that helps
produce a feeling of calm, well-being, and optimism. Serotonin
is also crucial to combat depression, promote healthy sleep, and
for many other functions. Since most of our serotonin is made
in the gut, a distressed gut leads to low serotonin levels, helping
to create the depression often associated with thyroid issues. I
have found that treating patients with both thyroid hormone and
serotonin creates a remarkable synergy that improves patients
mood and energy enormously.
GABA (gamma-aminobutyric acid) acts to calm, soothe, and
slow down your brain. If you are low in GABA, youll often find it
difficult to sleep and to relax. If youre suffering from insomnia or
anxiety, I might suggest that you take GABA supplements.
SAMe (S-Adenosyl Methionine) is a natural brain chemical that
can also be taken as a supplement. It helps modulate depression
and anxiety as well as many other disorders. I sometimes
prescribe it to combat the effects of low thyroid on our ability to
produce dopamine, a natural feel-good chemical associated with
energy and excitement. Patients who feel unfocused, listless,
foggy, and depressed often benefit from SAMe supplements while
their thyroid function is being restored.
Serotonin and dopamine deficiencies can also affect the pituitary, which, as we
have seen, produces the TSH that kicks your thyroid into gear. Supplements
can also help restore healthy pituitary function.
A number of natural herbs and supplements can

help restore thyroid function and bring relief from
symptoms.
Can herbs help treat thyroid dysfunction?
Yes, absolutely, and I use them frequently as well:
Guggulu increase T4 production.
Ashwaganda helps your body convert T4 to T3
Various herbs help your liver to rid your body of toxins more
efficientlytoxins that might be disrupting thyroid function and
the function of other hormones.
Can diet help treat thyroid dysfunction?
Diet is a huge part of all my treatments, and thyroid treatment is no
exception. There is a lot of overlap between thyroid, gut, immune, and adrenal
issues, and in all of these, diet is crucial.
Throughout my practice, I have focused on gut healing as central to all
other types of healing. If you are suffering from leaky gut (see page 22), both
your gut and your immune system are challenged. In addition, the stress from
leaky gut creates a burden on your adrenal glands, which as a result produce
excess stress hormones. Potentially, this adrenal burden leads to adrenal
dysfunction, in which your adrenals become unable to produce enough stress
hormones. Or you might be producing too many stress hormones at some
times and not enough at others. A third possibility is that your adrenals become
unable to produce some types of stress hormones, but try to compensate by
producing too many of another type of stress hormone.
As a result of adrenal imbalance, you might frequently feel wired: anxious,
irritable, and unable to sleep. You might also feel tired: exhausted, depressed,
and unable to focus. Or you might feel both tired and wired: wide awake when
its time to sleep, exhausted in the middle of the day, and struggling in various
ways with both mood and brain function.
As you might imagine, each type of dysfunction can make the other worse.
When your adrenals are producing the wrong balance of stress hormones,
your thyroid suffers, your immune system overreacts, and your gut gets
worse. When your immune system overreacts, your stress hormones go on
high alert and your gut becomes worse still. And all of these interrelated
problems disrupt your thyroid.
The good news is that as you heal through diet, herbs, and supplements,
you can improve all of these areas and get astounding leaps in health and
well-being. This is why a holistic, integrated approach to the thyroid is so
important. You cant just medicate with thyroid hormone. You have to treat
the whole patient.

Dietary Supports
Eliminate soy, which depresses thyroid function.
Eliminate gluten, which, as we have seen, can provoke
molecular mimicry, stimulating antibodies that attack both
gluten and the thyroid itself (see page 53).
Eliminate processed foods and preservatives, which stress the
gut and deplete the microbiome.
Eat as clean and organic as possible, since toxins in our air,
water, and food are often endocrine disrupters, interfering with
the activity of such glands as the thyroids and the adrenals.
Eat fermented foods. These natural probiotics are full of healthy
bacteria that replenish the microbiome and support the gut.
Kimchi, raw sauerkraut, and fermented vegetables are beneficial
for most patients. Those who can tolerate dairy also do well with
kefir (fermented milk) and unflavored yogurt. Sheeps or goats
milk products are usually healthier and better digested than cows
milk.
Eat high-fiber foods. These natural prebiotics are the foods
needed to support healthy bacteria. Top choices include asparagus,
carrots, garlic, Jerusalem artichokes, jicama, leeks, onions,
radishes, and tomatoes.
If a patient is not taking thyroid hormone, I might also suggest reducing or
eliminating raw cruciferous vegetables, such as broccoli, Brussels sprouts,
cauliflower, and kale, which can depress thyroid function. When these
vegetables are cooked, they pose less of a problem.
To support the thyroid, you have to support the

immune system, gut, and adrenalsotherwise,
problems in those other systems can make the
thyroid worse.
Can lifestyle help treat thyroid dysfunction?

Yes, and I make sure to work with every patient on these issues:
Stress reduction is crucial, because stress provokes the adrenals
to release stress hormones, including cortisol. Excess cortisol
creates inflammation, disrupts thyroid function, distresses the gut,
and generally plays havoc with your entire system. Excess cortisol
can also disrupt the pituitary, which in turn disrupts the thyroid.
Moderate exercise is important because of its role in stress relief
and in reducing inflammation. Exercise also helps achieve better
sleep, which is key to the healing process.
Reduced exposure to toxins helps to minimize the problem of
endocrine disruption. Toxins lurk in our food, air, and water, but
they are also present in many personal-care products, cosmetics,
home cleaning products, dry-cleaned clothes, rugs, and furniture,
as well as in many office supplies and office buildings. Different
patients have different levels of sensitivity to various toxins, so I
work with each person to identify and solve problems.
All of these issues are key to thyroid support and even more important if
you have an autoimmune condition.
Each patient is differentso I work with everyone

individually to make sure that diet and lifestyle
support healing.
What other treatments do you offer for thyroid support?

At the Kellman Center for Functional and Integrative Medicine, we focus
on natural treatmentsand on cutting-edge technology. One of the most
exciting new developments in medical technology is the irradiation of blood
with ultraviolet light, a treatment that holds lots of promise for autoimmune
conditions, including Hashimotos thyroiditis.
This treatment involves a process somewhat like dialysis, in which the
patients blood is run through a special machine. There it is irradiated with
ultraviolet light, a low-dose radiation that can reduce the burden of unhealthy
bacteria in the blood. Removing this bacteria lightens the burden on the
immune system, so that it stops overreacting and therefore stops attacking
the thyroid. (For more on autoimmune conditions and thyroiditis, see page 42,
59.) I am excited to offer this treatment to complement the diet, supplements,
herbs, and lifestyle that are the cornerstone of improved health.
At the Kellman Center, we offer cutting-edge

technology along with natural treatments.

How do you treat Non-Thyroidal Illness Syndrome (NTIS)?
As you saw on page 34, nonthryroidal illnesses are disorders with thyroid-
like symptoms in which the thyroid itself seems to be functioning normally.
They are caused by the pituitary down-regulating so that it doesnt produce
enough TSH, or by problems in the cells that create problems converting T4 to
T3. Although your thyroid itself is healthy, your cells dont get enough T3, so
your symptoms will be identical to those of someone suffering from thyroid
dysfunction.
For more about what causes NTIS, see page 34. Here are some of the ways
I treat NTIS:
Treat inflammation, which is a cornerstone of all my work at
the Kellman Center. Inflammation is the key underlying cause
of every chronic disease, and reducing inflammation is crucial
for improving your health and preventing other disorders. I treat
inflammation primarily through diet, herbs, supplements, and
lifestyle changes.
Treat the underlying problem. NTIS is a response to extreme
stressinflammation, a chronic illness, or some other long-term
dysfunction. Identifying and treating that underlying cause takes
the burden off your system and allows the NTI to resolve.
Improve brain function. Inflammation of the brain is a frequent
cause of NTIS, so I prescribe supplements to reduce it:
luteolin
quercitin
curcumin
longvida
stefania
Many people are unaware that they have brain inflammation
because this is a silent problemit doesnt manifest in headaches,
blurred vision, or any of the symptoms you might expect. But if
youve suffered from long-term stress, persistent depression, or
ongoing dysfunction in your endocrine, digestive, or immune
systems, youre likely to also have subtle, subclinical brain
inflammation. Symptoms might include poor sleep, memory
problems, and brain fog, all of which can easily look like just
getting older. Fortunately, the right herbs and supplements can
help reboot your inner computer. So can healing the gut.
Heal the gut. Herbs, supplements, probiotics, and prebiotics
can help to restore the integrity of the gut lining, replenish your
microbiome, and improve digestive function. This makes a huge
difference in reducing overall inflammation and specifically, brain
inflammation, and can help to heal your NTIS.
Improve the stress response with herbs. The stress response
begins in the hypothalamus, travels to the pituitary, and
moves on to the adrenals, creating the so-called HPA axis
(hypothalamus-pituitary-adrenals). Sometimes the hypothalamus
becomes desensitized and fails to respond properly to stress.
Phosphatidylserine can sometimes improve HPA function.

Part V. What Kind of Results Can I Expect
from You?
What can I expect in the short term?
In the first three or four weeks after we start treatment, you might feel
anywhere on the spectrum from just a little bit better to completely well. In
rare cases, patients even feel worse and perhaps experience an abnormal heart
rate because we changed their bodys equilibrium too quickly with too high
a dose, or because their adrenal function wasnt strong enough to tolerate the
new infusion of thyroid hormone.
Usually what I find is that people begin to feel better. If your thyroid
has been out of balance for a long time, it can take a while to see significant
improvements. But generally, within a few weeks, most patients sense that we
are moving in the right direction, and some do improve significantly.
By the same token, some people begin losing excess weight quickly but
most see only the beginnings of weight loss and a decrease in fluid retention.
At least they have stopped gaining weight! And better results are on the
horizon.
Meanwhile, I want to re-test most patients after 3 or 4 weeks to see whether
their thyroid levels have improved. As before, I rely upon the TRH stimulation
test to see how the thyroid behaves once it has been stimulated. I want to see
what the second blood test showsthe one after the TRH stimulation, and I
look closely at the levels of free T3, since, as we have seen, that is the active
form of the hormone. Id like to see that at the high end of normal, firmly in
the top 50 percent of the normal range. I also look at total T4 and total T3, and
again, I want those numbers above the median of the normal range. I test for
Reverse T3, which tells me a lot about how the whole thyroid signaling system
is functioning. And I monitor your antibodies, to see whether a possible
autoimmune condition is improving.
Some holistic and functional practitioners will tell you that they like to see
thyroid hormone levels as high as 75-90 percent of the normal reference range,
but thats because theyre not doing the TRH test. That gives me a much better
understanding of what is going on than just looking at T4 and T3. As a result, I
can fine-tune your dose of thyroid hormone as needed.
There are many things Im looking for on this second visit. I want to
know how youre feeling. I want to hear if you notice any improvement in
brain function and mood. Are you feeling sharper, more focused? Are you
less anxious, less depressed? Whats your energy level? This tells me a lot
about your brain chemistry and helps me adjust your prescription of herbs and
supplements.
Within the first month of treatment, youll start to
lose weight and feel energized.
What can I expect in the mid-term?

About three months after your first visit, you should be feeling at least 80
percent of the way to optimal health. Some people will even feel completely
well by that point. Again, I will continue to monitor the full range of thyroid
indicators, and to follow up with you on diet, lifestyle, stress levels, and any
other factors that might affect your thyroid function and your overall health.
If you have adrenal, immune, or digestive issues, well continue to work on
them as well.
About three months in, youll see more results:

weight loss, improved mood, more energy, clearer
thinking.
What can I expect in the long term?

Within 6 months, you should see significant improvement in all the
biochemical markers associated with thyroid issues:
Cholesterol. Thyroid function and cholesterol have an inverse
relationship: when thyroid functions poorly, cholesterol levels tend
to be high, and vice versa. If you had high cholesterol, you should
see significant improvement within six months of beginning
treatment.
C-reactive protein (CRP). This type of protein is closely
associated with inflammation and is a strong indicator of potential
cardiovascular problems. Within six months of treatment, you
should see significant drop in your CRP levels.
Neurotransmitters. Neurotransmitters are the biochemicals that
enable your brain to function, determining mood and cognitive
function. When theyre out of balance, youre anxious, depressed,
or both, and you have trouble thinking clearly, remembering,
and focusing. I periodically test your neurotransmitters so that I
can fine-tune the herbs and supplements I prescribe. Within six
months after treatment, you should have healthy, balanced levels
of these crucial biochemicals.
70 Part V. What Kind of Results Can I Expect from You?

Adrenal function. As we have seen, adrenal function and thyroid
function are closely intertwined. Six months after treatment
begins, your adrenals should be healthy and balanced.
Microbiome. Your community of healthy bacteria is a key
component for the healthy function of your gut, brain, and
immune system, as well as a significant support for thyroid
function. I track the biomarkers associated with microbiome
function, which should be at a healthy level six months in.
Weight loss. Although you might not have reached all your
weight-loss goals in six months, you should have experienced
fairly significant weight loss.
Insulin and blood sugar. When your metabolism improves, your
insulin response and blood sugar levels should follow suit. I will
also be tracking these signs and making sure that you get the
dietary support, supplements, and other treatment that you need.
Six months after you start treatment, you should

feel completely well. You might feel better than you
ever have in your life!
What are your goals for all of your thyroid patients?

I want all of my thyroid patients to feel completely wellfull of energy,
calm and balanced, at a healthy weight, able to get the most from life! After
two decades of practice, I know that this is a realistic goal, and its what I want
for you.
Please, please, dont confuse thyroid dysfunction with aging. Dont let
anyone tell you that its normal to gain weight, slow down, feel depressed,
sleep poorly, or have any other type of debilitating symptom as you get older.
Aches and pains are not the inevitable results of agethey are symptoms of
inflammation and poor function, conditions which can be treated. Memory
loss, brain fog, and senior moments are not the inevitable fate of seniors
they are symptoms of dysfunction which can be corrected.
Does it sometimes take longer than we would like to restore you to optimal
health? Yes, of course. If youve been functioning poorly for several years,
we cant restore you to optimal function overnight. But working together, we
can do itso dont worry about how long it takes. And believe that once you
get better, you will stay better. What you have to look forward to is not the
inevitable decline of age but a remarkable improvement in your health and
quality of life.
The thing that makes me feel the best is when a patient says to me, Ive
never felt this good in my life! I hear that from patients in their forties, fifties,
sixtieseven in their seventies and beyond! The vitality you experience when
your thyroid is functioning properly is really extraordinaryits like a secret
fountain of youth. Please, never give up until you have achieved this level of
optimal health, because it is your birthright. You deserve to feel greatand
you can.

What are some examples of patients who have benefited from your
treatment?
Success story #1: Laila
Laila was 32 years old when she first came to see mea little young for
thyroid problems, but in the past few years, patients have been getting younger
and younger. I think its the result of environmental toxins, which, as we have
seen, are significant endocrine disrupters. Often this manifests as menstrual
issues in young women, and testosterone issues in young men, but thyroid
problems are on the rise as well.
Laila had been experiencing significant fatigue, irregular periods,
depression, and hair loss, as well as occasional joint and muscle pain. She was
distressed because for her entire life, she had been very healthy, although a
few years before, she had been struggling with some occasional difficulty in
the gut: bloating, gas, and constipation. Now she was having those symptoms
more intensely as well.
I was probably the fifth doctor Laila had come to see, after frustrating
encounters with the other four. Every other physician told Laila that her
thyroid was normal, but she was convinced that something was seriously
wrong with her metabolism.
I wake up more tired than when I went to sleep, she told me. For the first
time in my life, Im gaining weight. My periods are all messed up, my hair is
falling out, and I feel achy and miserable all the time. Im too young to feel
this way!
The TSH/T4 test had shown Lailas thyroid as normal. But when I gave her
the TRH stimulation test, it was clear that her thyroid was functioning poorly.
Her TSH was depressed. She had a high level of reverse T3, which, as we have
seen, indicates lots of other problems with thyroid metabolism. And her CRP
levels were higha clear sign of inflammation.
Laila had some other signs of poor immune function. That plus her digestive
symptoms led me to suspect that she was having problems in the gut. We did a
breath test, in which the patient drinks a solution containing lactulose, a type
of sugar. If she has bacterial overgrowth in the small intestinea sign of gut
dysfunction and microbiome imbalancethe lactulose will ferment, and her
breath will contain high amounts of hydrogen and methane.
Sure enough, Laila had a condition known as SIBOsmall intestine
bacterial overgrowth. Further testing revealed that she was sensitive to
many foods; that is, she had an immune response as though the food were
a foreign invader. As we saw, this is one of the results of leaky gut (see page
22) and creates a lot of inflammation (see page 17) while setting you up for
autoimmune conditions (see page 42, 59).
Laila was a good example of how one problem can lead to a myriad of
problems that seem disconnected but really are not. Her low thyroid function
helped to disrupt the tight junctions in her gut lining, leading to leaky gut,
stress on her immune system, and a host of digestive symptoms. Her leaky
gut also gave rise to the food sensitivities, which in turn generated other
symptoms: muscle and joint pain, menstrual issues, and fatigue. Her thyroid,
digestive, and immune issues were all part of the same downward spiral.
I have seen this frequently with many patients. They come in with a host of
symptoms that seem unrelated, and that their previous physicians have assured
them were random and unconnected. To have so many different symptoms, to
feel so out of control, to be unable to understand what is happening to you or
whyits the worst feeling in the world.
Yet in fact, Lailas mysterious ailments all sprang from the same initial
problem and could be understood and treated. This is the great contribution
of functional medicineof all good medicine!this ability to connect the
dots.
Laila found it so exhilarating when I presented her with an explanation
and a treatment plan. She was relieved to see that this one problemthyroid
dysfunctionwas responsible for so many seemingly unrelated symptoms.
And she was excited to see what treatment would bring.
Because of the severity of her symptoms, I treated Laila treated her with
pure T4 and pure T3, plus a little bit of natural desiccated thyroid. We healed
her gut with my 4R protocol:
Remove the unhealthy bacteria and the foods that stress the
microbiome and the gut
Replace the digestive enzymes that you need for optimal digestion
and that have been depleted by gut distress.
Reinoculate with probiotics (intestinal bacteria) and prebiotics
(foods and supplements that nourish this bacteria and keep it
healthy).
Repair the lining of your intestinal walls, which have likely
become permeable and are releasing partially digested food into
your bloodstreamwith disastrous results. (For more about leaky
gut, see page 22.)
I also gave Laila herbs to improve and modulate her immune system,
including astragalus and andrographus.
These treatments had a powerful synergistic effect, with the gut, immune
system, and thyroid all improving one another. As her gut healed, her immune

system stopped overreacting, and Lailas food sensitivities disappeared.
Healthy gut and thyroid function improved Lailas brain function and mood,
and her depression evaporated. Reduced inflammation cleared up her other
symptoms, as well as giving her healthy, glowing skin and thick, shiny hair.
Probably because she was relatively young, Laila responded to treatment
very quickly. Within four weeks, she had a smile on her face, because she
knew she was going in the right direction. And within a few months, she was
completely recovered and feeling great.
Success Story #2:Marcia

When Marcia came to me, she was, as she put it, climbing the walls. At
age 47, she was going through perimenopause, which her previous doctors
had assured her was the reason for all her problems. On some intuitive level,
though, Marcia knew that something else was wrong, and so, desperate for
help, she came to me.
Marcia was struggling with fatigue, irregular periods, and erratic body
temperature, so that sometimes she had hot flashes and at other times she felt
miserably cold. What really drove her crazy, though, was the brain fog.
I just cant think, she told me. I keep forgetting what I did 5 seconds
before. I cant concentrate, cant remember peoples namesI feel like Im
getting Alzheimers.
While her first doctor assured her that all these symptoms were normal
for a woman approaching menopause, she was also unwilling to give Marcia
hormone replace therapy because Marcias estrogen and progesterone both
tested normal. Basically, then, Marcia had a frustrating diagnosis and no
treatment at all.
I quickly explained to Marcia that menopause is frequently confused with
hypothyroid and vice versa. However, I assured her, it was highly possible
that all of her symptoms were caused by thyroid issueswhich meant that as
soon as we treated her thyroid, they would all clear up. After all, the thyroid
is intricately involved with our neurotransmitters, the brain chemicals that
regulate memory, focus, and concentration.
The thyroid is also closely involved with our adrenals, which affect our
energy levels, fatigue, and motivation. Sometimes stress disrupts our adrenal
function, which leads in turn to thyroid dysfunction but sometimes it works
the other way around, with thyroid dysfunction disrupting the adrenals.
If your production of cortisol, a key stress hormone, is not optimal, you
can sometimes get surges of epinephrine, another type of stress hormone.
This response mimics the hormonal imbalance that is common during
menopauseand that, I thought, was what had happened with Marcia.
I gave Marcia the TRH stimulation test. As you recall, this involves taking
two readings of TSH, the first with no challenge and the second after the
pituitary has been challenged with the thyrotropin-releasing hormone.
In Marcias first reading, before the challenge, her TSH was 3.2, which
by the latest standards was borderline high but for most conventional doctors
would not indicate much of a problem. Possibly they would give her a tiny
dose of thyroid hormone, but not much more.
After the challenge, however, Marcias TSH was 35, a reading that even a
conventional doctor would agree is through the roof. Clearly Marcia needed
not a low dose but a robust one. I used a combination of NDT and T4 to give
her the boost she needed.
I also gave Marcia intravenous feedings of a special adrenal support
formula I have developed that includes high doses of Vitamin C, B5, and a
number of adrenal-friendly herbs: rhodiola, ashwaganda, Siberian ginseng,
Corticeps.
Marcia was one of those patients who improved only slightly in the first
three weeks. She had a slight diminishment of symptoms, a little increase of
energy, but not the real improvement we were looking for. I tested her thyroid
again and significantly adjusted her dose. That was when she really started
feeling the difference. Eight weeks later, she no longer had menopausal
symptoms and her energy had really started to improve. However, neither of
us was completely satisfied and, based on another set of tests, I tweaked her
dose again.
Finally, about 12 weeks after she had first come to me, Marcia felt that
she had really gotten her life back. Her symptoms were gone. Her energy was
calm and balanced. Her brain worked just like its supposed to! as she told
me. In fact, Marcia said, she felt better than she had in decades. Probably her
thyroid function had been slowly dropping off, a little each year, until the
symptoms became so overwhelming that she was forced to seek help. Now,
however, her thyroid was at optimal function, and Marcia could really tell the
difference.
Marcia is a good example of how it can sometimes take a few tries before we
really get the treatment exactly right. A problem that has been developing for
several years might not respond immediately. Moreover, your body changes
in response to the initial treatment, so over time, you might need a different
dose. In any case, its dangerous to give too high a dose too quickly. As long as
things are going in the right direction, we can continue to test and tweak until
everything is working at its best.

Success Story #3: Rosario
Rosario was in her late thirties, with thinning hair, fatigue, sleep problems,
anxiety, short-term memory problems, difficulty concentratingin other
words, many of the typical signs of an under-performing thyroid.
She went to a conventional doctor, who told her that her thyroid antibodies
were high. A reading like this indicates an autoimmune disorder in which
Rosarios immune system was attacking her thyroid, suggesting that the
patient will have thyroid problems. But in fact, Rosarios thyroid test came
back normal. Despite her symptoms, Rosarios doctor refused to treat her for
thyroid problems although he did refer her to an endocrinologist, a specialist
in hormone disorders.
The endocrinologist repeated her TSH test, which registered 2.3well
within the normal range according to conventional standards. Rosarios T4
levels were also mid-range, or perhaps just a little low. So now a second doctor
refused treatment.
Youre likely to become hypothyroid, with these readings, but you dont
have a thyroid problem yet, he told her. Come back in six months and well
see if you need help then.
Rosario, however, felt that she needed help now. So she went to a third
physician, a holistic integrative practitioner, hoping for a better response, but
again, the numbers on the conventional test just didnt warrant treatment with
thyroid hormone. The holistic practitioner took Rosarios temperaturea
common indication of thyroid functionbut her temperature also indicated
normal thyroid function. There just wasnt any basis for treating her.
But Rosario still felt bad, and now she was getting worse. So she came to
me.
Instead of doing the standard TSH test, I, of course, did the TRH
Stimulation test. And instead of the low TSH reading of 2.3, our challenge
produced a TSH of 27, which is very high indeed.
In other words, when challenged, Rosarios pituitary was pumping out
way too much TSHand getting only a very slightly response from Rosarios
thyroid. That is a clear indication of an under-performing thyroid. Clearly,
Rosario needed to be treated with thyroid hormone.
Rosarios problem was typical of many who have autoimmune conditions.
Even though their conventional tests read normal, their symptoms plus their
high level of antibodies shows that there is indeed a thyroid problem. And
frequently, when given thyroid hormone, their symptoms disappearand
their antibodies decline!
Although this result runs directly counter to conventional medical
wisdom, it has been verified in at least one experiment. A significant study
focused on 33 patients diagnosed with Hashimotos because of their high level
of antibodies, even though, like Rosario, all of these patients tested normal for
thyroid issues when given the conventional test.
Half of these patients were given thyroid hormone, while the other
half were not. Researchers found that the patients who were treated had a
significant increase in free T4 and a significant decrease in TSH, indicating
healthier hormone levels. Even more interesting, these womens antibodies
also decreased, suggesting that the thyroid supplement had also helped calm
their immune system.
This is a very important point, because we are used to thinking of
autoimmune diseases as going only in one direction: that the immune system
attacks the thyroid and makes it worse. This experimentand my treatment
of Rosarioreveals movement in the opposite direction: improving the
thyroid can calm the immune system and help it to work better.
This is why its so important to treat thyroid disease immediately,
especially if antibodies are present. You dont wait for the problem to get
worse, as Rosarios previous doctors did. You nip it in the bud, especially if
there are debilitating symptoms. Otherwise, the worsening thyroid problem
can actually make the autoimmune condition worse. And if you do treat
the thyroid problem, you increase your chances of making the autoimmune
condition better.
At least Rosario knew she had a problem. Often, patients dont even realize
that they are suffering from thyroid issues. They know they have brain fog
and that they are only moving their bowels every other day but they dont
realize that these are symptoms of thyroid dysfunction. Yet when their thyroid
is treated, their brain, digestion, and immune system all improve.
Sadly, patients like Rosario rarely get the treatment they need as soon as
they need it. Their conventional or even their holistic doctors are all too likely
to say, Come back in six months and well decide then whether to treat you.
And as a result, those doctors are at least partly responsible for six agonizing
months.
I cant stand to see people suffer needlesslythats the main reason I became
a doctor! So I was glad that at least I could help Rosario. We gave her support
for her immune system by treating her gutremember, the gut and the immune
system are intimately related. Like Laila, Rosario benefited from my 4R gut-
healing protocol, which also supports the microbiome. Since Rosario had an
autoimmune condition, I also made sure to put her on a gluten-free diet, to avoid
any chance of gluten stimulating antibodies that might also attack her thyroid.

Six months later, Rosario felt like a new person. Her hair was thick and
full, her sleep was deep and restful, and she had all the energy, focus, and
clarity she could want. Her antibodies were gonea clear indication of a
healthy immune system. Rosario had a new lease on life and the confidence
that her good health would continue.
Part VI. How can I find out more?
How Can I Make an Appointment?

To make an appointment with a physician at the Kellman Center you can call
our office Mondays through Thursdays from 9:30am to 5:30pm and Fridays
9:30am until 3pm.
How Can I buy Supplements?

Call us at (212) 717-1118 or visit us on the web at
http://raphaelkellmanmd.com/
My Final Message to You
I started this ebook by telling you that we are seeing a fast-growing

epidemic of thyroid dysfunction. Unfortunately, many other chronic diseases
are becoming epidemic as well: obesity, diabetes, heart disease, cancer,
and autoimmune conditions, among others. Although medicine seems to be
capable of remarkable things, the U.S. population seems to be getting sicker
and sicker. Whats going on?
As I see it, were being inundated with a veritable tsunami of industrial
toxins: in our air, our water, our food, our homes, and our offices. As a result,
minor genetic weaknessesslight variants in our genetic makeupare being
triggered by environmental pressures, and all sorts of illnesses are coming to
the fore.
I dearly hope that well figure out a solution to this growing toxicity. But
meanwhile, as a physician, Im committed to finding ways for you and all my
patients to achieve vibrant, glowing health. Fortunately, once we identify the
level of thyroid hormone that you need, we can make a significant difference
almost immediately. If you support your health with diet, supplements,
herbs, and the lifestyle that is right for you, you can overcome even the most
debilitating chronic illness and enjoy the good health that is your birthright.

Vibrant Thyroid Vibrant Health

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Vibrant Thyroid Vibrant Health

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Vibrant Thyroid Vibrant Health

Vibrant Thyroid Vibrant Health

Do I have a thyroid problemand why should

Part I. My Doctor Says I Should Be FineBut

Part III. What Do My Test Results Mean?

Part IV. Whats the Best Way to Treat Thyroid

Part VI. How can I find out more?

How Can I Make an Appointment?

My Final Message to You.

Thyroid: A New Epidemic

Why This Book?

6 Why This Book?

Most people who suffer from thyroid disorders

You might very well be suffering from a thyroid

Am I Suffering from Thyroid Issues?

8 Do I Have a Thyroid Problemand Why Should I Care?

Thyroid conditions are one of the most severely

Why Should I Be Concerned About a Thyroid Disorder?

When your thyroid is functioning poorly, the rest of

10 Do I Have a Thyroid Problemand Why Should I Care?

Ive seen it in patient after patient: A poorly

If My Thyroid Tests Are Normal, Does That Mean Im Okay?

You might test normal and yet still have a thyroid

Can I Rely on Conventional Medical Treatment to Diagnose and Treat

12 Do I Have a Thyroid Problemand Why Should I Care?

Even when you are tested, the tests dont pick up a

Can I Rely on Alternative Practitioners or Other Functional M.D.s to

Most practitioners dont understand the many

SoWhat is the Most Accurate Way to Diagnose and Monitor Thyroid

14 Do I Have a Thyroid Problemand Why Should I Care?

If you have a thyroid issue, the problem is not just

What Will This Book Do for Me?

This book will help you understand what is

How will I feel when my thyroid has improved?

16 Do I Have a Thyroid Problemand Why Should I Care?

18 Do I Have a Thyroid Problemand Why Should I Care?

What Is the Thyroid?

What exactly does my thyroid do?

Which Organs and Systems Does My Thyroid

20 Part I: My Doctor Says I Should Be FineBut Im Not. Whats Going On?

22 Part I: My Doctor Says I Should Be FineBut Im Not. Whats Going On?

When your thyroid is working well, you feel

What are the different types of thyroid disease?

Hyperthyroidism occurs when the thyroid produces too much

24 Part I: My Doctor Says I Should Be FineBut Im Not. Whats Going On?

Can I have both hypo and hyperthyroidism at the same time?

I dont think Im getting the right treatment. Whats going wrong?

1. You really dont have a thyroid condition, and your symptoms

2. You do have a thyroid condition, but your doctor doesnt

26 Part I: My Doctor Says I Should Be FineBut Im Not. Whats Going On?

4. Your doctor has given you the correct diagnosis and

Misdiagnosis and mistreatment of thyroid problems

Why might conventional tests miss my thyroid problem?

28 Part I: My Doctor Says I Should Be FineBut Im Not. Whats Going On?

T4 is the less active form of thyroid hormone. Your

Thyroid Binding Globulin (TBG). This is a protein that binds to

What are the Key Components of the Thyroid

30 Part I: My Doctor Says I Should Be FineBut Im Not. Whats Going On?

Its not enough to measure overall thyroid levels.

How do most conventional M.D.s diagnose thyroid issues?

The TSH and T4 tests are too simple to accurately

32 Part I: My Doctor Says I Should Be FineBut Im Not. Whats Going On?

The normal range that most conventional M.D.s

34 Part I: My Doctor Says I Should Be FineBut Im Not. Whats Going On?

Part I. My Doctor Says I Should Be FineBut

Part IV. Whats the Best Way to Treat Thyroid