Guest: Dr. Raphael Kellman
Presenter: Neal Howard
Guest Bio: Raphael Kellman, MD, is founder of the Kellman Center for Integrative & Functional Medicine. As a doctor trained in internal medicine at the Albert Einstein College of Medicine in New York, Dr. Kellman uses the latest drugs and technology to treat specific diseases, but his approach to medicine is patient-centered and holistic.
Segment overview: In this segment Dr. Raphael Kellman, MD, and founder of The Kellman Center for Integrative & Functional Medicine, discusses what parents should know about thyroid function in children, what women should know about low thyroid function and type 2 diabetes, and how the microbiome affects thyroid function.
Health Professional Radio – Thyroid Function in Children and Women
Neal Howard: Hello and welcome to Health Professional Radio, I’m your host Neal Howard. In studio is Dr. Raphael Kellman, Founder of the Kellman Center for Integrative and Functional Medicine and he’s here with us in studio as a returning guest to discuss what parents should know about thyroid function in children, what women should know about low thyroid function and type 2 diabetes and how the microbiome affects thyroid function. Welcome back to Health Professional Radio Dr. Kellman.
Dr. Raphael Kellman: Thank you, thanks for having me.
N: Thank you so much for returning. As the Author of a few books concerning well several different topics, Gut Reactions, The Microbiome Diet and Matrix Healing and also an expert in autoimmune. Talk a little bit about why women should know about low thyroid function.
K: Well that’s really, there’s so many endocrine disruptors, environment and they effect many systems but especially the thyroid is very vulnerable to endocrine disruptors and the endocrine disruptors can affect multiple points in what scientists call the thyroid signaling system. So I believe that thyroid disease like hyperthyroidism, hypothyroidism – the main cause I believe is due to endocrine disruptors and frequently it eludes routine blood testing. So I believe thyroid disease is an epidemic in our society today. So therefore yes it affects so many, so many people especially women more so than men but men as well and especially children and this is overlooked, this is not being picked up.
N: Well what is it that parents should know about thyroid function in children and why isn’t it being picked up, why is it being overlooked?
K: Well, look firstly a low thyroid plays a very, very big role in various points of developmental disorders. Whether it’s autism, ASD, PDD, so many, so many disorders and many unexplained delays and seemingly developmental challenges sometimes without clear diagnosis. In seizure disorders in children and of course in adults as well and low thyroid plays a very, very important role in speech delay as well and the research shows that children with…spectrum if there’s speech delay, if there’s hypotonia, if there’s gut issues they’re much more likely to have a low thyroid and that’s what routine testing. The problem with routine testing is multifold, number one the reference range is very controversial what is the… pituitary, what is really the value, the range? These researches show that TSH may be from .8 – 2.5 or 3.
N: You say the TSH and not the TRH?
K: Well I tell you about the TRH test in a second but TSH…the pituitary. The range is controversial plus research shows that the TSH can …in any given day by 40%. In addition to that there’s a researcher named Anderson which he distinguished the difference between the individual reference range and the population reference range, the population reference range maybe .8 to let’s say 4-4.5 or 2.8 whatever it is. But the individual reference range maybe much more narrow, it may be .9 to 1.4 or 1.4 to 2.6, it changes. Now here’s another reason, when you’re dealing with endocrine disruptors because they can affect different points on the signaling system meaning it can affect the pituitary, it can affect the hypothalamus, it can affect the thyroid gland itself, it can affect the deiodination enzymes which is involved in the conversion of T4 to T3 and T4 to reverse T3, it can affect the pathways of detoxification of the thyroid hormone in the liver and it can be very confusing because you can have contradictory results, so there is reason which beyond this discussion. Therefore, I’ve been using, then there’s one other reason by the way, the longer this problem goes on of low thyroid the less likely you are going to see them in routine testing for different reasons, one reason is that I believe over time the output of TSH may change that it may be sort of reserving the secretion of TSH for different more emergency times. But there’s another issue, another reason in that many people with chronic disease, chronic health challenges can have another concomitant problem or separate problem whether some down regulation of the hypothalamus itself which makes the results even more confusing. I see this with autoimmune diseases, chronic diseases and there’s research to support this. The condition, be very brief, is NTIS (non-thyroidal illness syndrome), now I am seeing this and I see this the clarity of this epidemic because I have started using all the way back in 1997 this test that the medical world kind of shelf in this called the TRH stimulation test. There has been research in 2007 that confirmed that the many people, this test should be used once again basically the testing is that you inject TRH which comes from the hypothalamus that stimulates the pituitary so even if the TSH assumes to be normal in the blood but there may be a lot of TSH in the pituitary and that is a signal that it’s faking “that the thyroid is suboptimal” so upon injection of TRH which stimulates the pituitary is gonna release a lot of TSH if the thyroid is low. Usually it will do this and then we see this high output, higher than you’ll see in so called healthy person and that will give you a better picture if this patient has an underactive thyroid that you’re missing on the routine test. Now because I’m doing this I am privileged and I’m … to see how extensive this epidemic is and frequently missed. Now endocrinologists and doctors pick up so many people because it’s such an epidemic that they don’t think this test looks great but I see the people that fall thru the crack and that’s why I know that the epidemic is more severe than anyone has ever imagined and because of this test, another thing that I’m seeing is that the pituitary in some people is not responding well. It’s not like it’s shut off like in hyperthyroidism which causes the pituitary to shut down but we’re seeing what we call a blunted response which means there’s something off in the axis and that the stimulation from the hypothalamus to the pituitary is downregulated which I’m seeing this… go ahead.
N: When it comes to the treatment of some of these situations, when do you advocate drugs and do you advocate maybe supplements or a combination of the two?
K: Yeah look, so many case, I mean so many people have been suffering for so many years with chronic health issues because one of the underlying variables has not been detected and then that leads to a cascade of other problems that the only solution to so many people because of such disruption is actual bio identical … sometimes I use … which comes from an animal source but is that really natural? It depends on how you look at it I prefer the compound purity 4 and purity 3 and I always use both T4 and T3. Now there are some people that do benefit to some different herbs and supplements, who you decide to treat one way or the other way is a whole lot of different conversation but yes you have to be open to both possibilities but what’s very important is that invariably you’re gonna see some aspect of inflammation that extends much beyond the manifestations, etc. inflammation by test like ESR and CRP especially when you’re dealing with this entity called non-thyroidal illness syndrome, NTIS but also many, many conditions. The inflammatory markers like TNF-alpha, IL-6, IL-8 that commonly gone but if you do them you’ll see chaos frequently underneath the seemingly very calm sea. So and research has shown that this condition called NTIS is associated with the patients in the ICU, it’s associated with burn patients, it’s associated with significant depression and anxiety, it’s been shown to be associated with colitis but one of the common variables is that this inflammation but not always but frequently there is inflammation and some of the markers that they see associated with NTIS is TNF-alpha and IL-6 so in order to, that’s why so many doctors they’ll say “Hey wait a minute the TSH is only .6 everything’s fine.” Wait a minute, that’s so fast maybe it’s .6 because there’s also this issue and maybe it’s that by itself, maybe it’s a combination. Look, I’m not saying that NTIS is our big problem, it’s another component, the biggest problem is thyroid disease itself mostly the course of the endocrine disruptors also due to autoimmune issues, Hashimoto’s, also due to inflammation and who knows viral infections too because of a suboptimal microbiome, a suboptimal immune system and then there we go we have the epidemic of thyroid disease.
N: It’s been great having you here with us in studio today Dr. Kellman. You’ve been listening to Health Professional Radio, I’m your host Neal Howard. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm and you can subscribe to this podcast on iTunes.