How is Hashimoto’s Diagnosed?

Note: The text below is a transcription from the video above. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors.

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The subject today is how Hashimoto’s disease is being diagnosed and that’s so basic to what I do every day for a living and yet when I heard this question, a million things went through my mind and here’s why. Hashimoto’s is a complex syndrome. It’s complex for so many reasons. One reason is you can have silent Hashimoto’s and not even though you have it, meaning that your immune system has started to attack your thyroid, but you’re not really getting any symptoms so nobody’s looking for it. Or maybe you’re getting some mild symptoms, but you would never put it together so nobody’s looking for it. Then you start getting symptoms and maybe they look for it and maybe they don’t.

Maybe they go like you got all these symptoms and now we have a joke in the functional medicine field, you go to the doctor for Hashimoto’s and they send you to counseling for your depression, anxiety, and they send you to the GI guy for your gut problems and they send you to the endocrinologist for your hormone problems and there’s like nine spikes on this little diagram that we use when it’s Hashimoto’s, when the problem is Hashimoto’s. So that creates a layer of difficulty for the patient to get diagnosed properly.

Once you get to that active stage, eventually today, more and more often, the doctors are figuring out that maybe a thyroid’s involved. The next difficulty is a lot of them still don’t run the antibodies for two reasons, one, some still don’t get the Hashimoto’s is the cause of at least 90% of thyroid problems and the second one is the medical profession is starting to figure out, “No, don’t start throwing things at me or anything like this.” This is just, I see this every day, the medical profession is still figuring out they don’t know what to do with Hashimoto’s, because they don’t treat it as what it is. It’s primarily an autoimmune problem first.

The next problem is the difficulty of diagnosing an autoimmune problem, because in the medical world, they’re going to wait until you have positive antibodies come up and there’s positive signs of tissue destruction somewhere, by that time, you’ve probably had the problem for 10 or 15 or 20 years, you’ve been exhibiting symptoms of it, but unlike the old days, when I learned how to diagnose, symptoms aren’t enough. And I can conjecture as to why that is, but I’m not going to get into that. So, now you’re in phase two and you have all these symptoms, you go, they either test you and find out your thyroid stimulating hormone markers are off. So classically, they’re going to do a TSH, T3 and a free… And well, they don’t even do free T3 most of the time and a T3, T4 and T3.

That’s not going to tell you very much. It might tell you if you have hypothyroidism, which is the first signs of Hashimoto. So then they give you the medication, you feel better, you feel worse, you feel better just for a little period of time. Usually we call it the hormone honeymoon. You go back in, you say, it’s not working. They start giving you new drugs. They try and they start giving you new, different thyroid medication. What they need to do at that point in time is look at your antibodies. So at that point in time, you may have the TSH, the fact that your thyroid’s getting damaged to be abnormal, but maybe your antibodies don’t show up that day. This question translated my brain to the difficulties of getting diagnosed.

But then maybe one day you finally go in six months later, your thyroid medication hasn’t worked. They run antibodies and they go, “Oh, you know what? You have positive antibodies for Hashimoto’s.” And then that’s a crapshoot because look, the range should be zero to nine for the range should be zero to nine. Why do I say that? I’m here in Reno, Nevada, one hospital at zero to nine, three other hospitals at zero to 32. Mayo Clinic uses zero to nine, I just did a person from Canada, they use zero to eight. So everybody from nine and above that, doesn’t go to one of those labs or hospitals is being told they don’t have it.

They do. If it’s over eight, nine, maybe eight, but definitely if it’s over nine, you have it. Okay, then what I’m starting to see now, and this is a present time answer to this question. Okay? What I’m starting to see now is people are coming to me and going, “Well, my doctor…” I just had one yesterday. “Oh, my doctor said my antibodies were high, but not high enough to treat.” “So what were your antibodies?” She’s like 79. For those of you who don’t know the numbers, that’s Hashimoto’s. Once you have it, you have it. You need to start finding the triggers that are screwing you up every single day. But what’s happening is that’s not the medical model. Okay. The medical model is now, okay you have Hashimoto’s, I have no freaking idea what to do with it because we’re still treating it as a thyroid problem. Here’s your thyroid medication, see in six months. But doctor, I don’t feel good. See you in six months. They have no other tools.

So I’m starting to hear all these weird things like, well, it’s the antibodies aren’t high enough or you don’t really need to treat it yet. Let’s wait for this. When the antibodies are up, you’re… Where the antibodies are up… And I have a colleague and a mentor who is a world renowned, published immunologist said, “Look, dude, if you have antibodies, your immune system is attacking you.” I mean, I don’t even think you got to wait for it to beat a nine. He’s kind of out there alone. But he’s also the guy who figured out mold, leaky gut, that it was gluten and not hush and not, and not wheat and all those type of stuff. So he’s smart, pretty smart, dude. I kind of like to go with his stuff, because he’s usually like 10 years ahead of the curve.

So these are the problems with getting diagnosed. So classically, those are the problems. So classic, how should you get diagnosed with Hashimoto’s? You should have people look at… You should have people do a complete, a complete thyroid blood panel. That’s like eight markers okay. And it’s teeth and it’s TSH and it’s T4 and it’s free T4 and it’s T3 uptake and it’s free T3, thyroid globulin and it includes the antibodies of thyroid peroxidase antibodies and antithyroid globulin and antibodies check and see if you got Hashimoto’s.

There is also data in the thyroid panel minus the antibodies, if you know what pattern look for, and there’s 21 different patterns in Hashimoto’s. 21 different patterns in your thyroid panel. And most of the doctors don’t even know that. But if you have a low TSH and you have a low T3 and a low T4, your doctor’s going to think, well, I’m giving you too much thyroid medication, but if you’re not taking thyroid medication or they’re already giving you a ton of thyroid medication, which will drive this T3 TSH to be low, that’s a pattern for autoimmune thyroid disease. So you can diagnose it that way, even if the antibodies are not run or even if the antibodies are normal, that is enough.

Now classic diagnosis do a history and an exam first and then do the labs. If you do a history on a person and they have like 18 out of 20 symptoms of automated thyroid disease, you have to know those antibodies aren’t going to come up every day. Some days they’re going to be high. Some days are going to be low. Some days are going to be absent, even in a person who has Hashimoto’s and that’s a whole nother presentation. So if the person’s got 20 out of 20 symptoms of Hashimoto’s, maybe you do an exam and you touch their thyroid and it’s tender, or they tell you they got nodules or they’ve had goiters, or they have all of that short of cancer, all of that is Hashimoto’s.

So you should know, as a clinician, while I have the 20 symptoms. I have 15 to 20 symptoms. I do have one of those things, a goiter or something like that, abnormal cells, the doctors freak out because they think it’s going to be cancer. And if they biopsy that good, you want to know if it’s cancer or not. But if it’s not cancer, it’s Hashimoto’s and rare occasions, it’d be Graves’, that’s another whole thing. So, now you run the tests and the antibody and everything looks normal. Well, the name of my mentors, first book in 2008 was Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal. Which is why he was the one who said, “Do the history, do the exam, if this comes up normal in the labs, treat them as Hashimoto’s because they have it.”

And so he’s been, in my view, he’s been correct because I’ve done that through the years and it’s… But the medical community has their… In their defense, they’re working with a set of handcuffs on with their hands behind their back. I mean, if they miss something, there’s always going to be somebody out there, maybe an attorney, who might want to get involved and what is missing something mean? Missing something might mean giving you a thyroid medication without you having positive lab tests, so that person’s going to look at it and go, “I did go to a class and it says that this person has Hashimoto’s because they have all this stuff and they have all the symptoms, but I’m not giving them thyroid medication, because if it makes them irritable, jittery, shaky or something like that, like it can sometimes, and they freak out and then it doesn’t go away. And next thing you know, I might be getting sued.”

And so I don’t mean to bang on the attorneys, but this, I think most people out there kind of realize this is the reality today. And doctors work under this reality. They have insurance in companies that are saying, “Don’t do all the labs.” The insurance companies tell them, “Don’t do all labs.” Well, I got news for you, there are malpractice insurance companies are saying, “Do all the labs.” But a lot of them are working basically for the insurance companies, because of the way that these groups are getting gobbled up by hospitals and these guys are technically, they’re working for the insurance companies.

So this is not only how you diagnose, I think more importantly, these are the roadblocks that I hear every, literally every day, every other day here, when the patient comes in here. And I mean, just yesterday, I had two, that one wasn’t even diagnosed with Hashimoto’s and she’s like screaming, Hashimoto she’s like, “Please diagnose me with Hashimoto’s, I have 20, all 20 symptoms.” And the other one had looked into it, but couldn’t get the testing done because she was using her insurance and they weren’t running the whole panels. Just so that was two for two yesterday. I did two new consults yesterday and both of them ran into these things. So that, is how you diagnose it. And as importantly, those are the roadblocks that you may run into as far as getting it diagnosed properly.

Particularly those you are watching this generally, you’re part of a crowd that Googles everything, searches on the internet and you’re going like, “Okay, I have all these symptoms, why aren’t they running the antibodies or they ran the antibodies and they’re really bad, why aren’t they treating me for it, or I have all symptoms, I ran the antibodies, they came out normal, but I still feel like crap, why are they sending me away for another six months?” That’s the answer to all of those things. And maybe you’ll need to replay this a couple times, because that was a lot of data, but every bit of those data, every bit of that data is data that I have to use every day to kind of evaluate the cases and go, “Okay.”

I’m dealing with diet, lifestyle, herbs, botanicals, I can make the call because I’m really not treating a disease, I’m really treating a physiology that is creating abnormal imbalances that are essentially creating the triggers that are attacking these diseases or creating the diabetes or creating the attacks on the thyroid. So it’s a whole different animal in my world. So I can make that call without having all these other things being… That the medical profession has to deal with. So that’s how you diagnose it. Those are the roadblocks.

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